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Gibson CJ, Ajmera M, O'Sullivan F, Shiozawa A, Lozano-Ortega G, Badillo E, Venkataraman M, Mancuso S. Epidemiology and clinical outcomes of vasomotor symptoms among perimenopausal women and women aged 65 years or older in the US: a systematic review. Women Health 2024:1-17. [PMID: 39353876 DOI: 10.1080/03630242.2024.2392136] [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: 05/10/2024] [Revised: 07/12/2024] [Accepted: 08/07/2024] [Indexed: 10/04/2024]
Abstract
Vasomotor symptoms (VMS) are the hallmark of menopause and negatively affect a large proportion of women over many years. However, studies evaluating the overall impact of VMS are limited. This systematic review (SR) aimed to examine epidemiological, clinical, humanistic, and economic outcomes of VMS among perimenopausal women and among women aged ≥65 years in the US. A systematic search of the MEDLINE and Embase databases was conducted to identify observational studies (2010-2022) reporting on these populations. Data reporting outcomes of interest were extracted and analyzed descriptively. Of 7,613 studies identified, 34 met inclusion criteria, of which 30 reported on perimenopausal women and 4 reported on VMS in women aged ≥ 65 years. VMS and severe/moderate-to-severe VMS were reported by 48.4-70.6 percent and 13.0-63.1 percent, respectively, of perimenopausal women. Mean VMS duration was 2.6 years, and median duration ranged from 7.4 to 10.1 years among women with onset in early perimenopause and from 3.8 to 6.1 years among those with onset in late perimenopause. Among women aged ≥65 years, 20.9-45.1 percent reported VMS; 2.0 percent reported severe symptoms, and 17.6 percent reported moderate symptoms. No studies reported VMS frequency and duration or the economic or humanistic burden among women aged ≥65 years. In conclusion, high VMS frequency and severity were observed among perimenopausal women and women aged ≥65 years in the US in this SR, highlighting the need for (1) better management of VMS to reduce frequency and severity and (2) further research to clarify the impact of VMS on disease burden, quality of life, and economic impact.
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Affiliation(s)
- Carolyn J Gibson
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
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Pertynska-Marczewska M, Pertynski T. Non-hormonal pharmacological interventions for managing vasomotor symptoms-how can we help: 2024 landscape. Eur J Obstet Gynecol Reprod Biol 2024; 302:141-148. [PMID: 39270577 DOI: 10.1016/j.ejogrb.2024.09.013] [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: 08/12/2024] [Revised: 09/06/2024] [Accepted: 09/09/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Vasomotor symptoms (VMS) affect 70% of menopausal women and are considered as hallmark symptoms of the menopausal transition experienced by over three quarters of women and severely by 25% of women. Estrogen withdrawal alone is not fully responsible for the onset of the menopausal vasomotor symptoms and the mechanism of altered thermoregulation appears to be centrally mediated with alterations in hypothalamic neurotransmitters playing a key part. The loss of thermoregulatory control coexists with the altered Kisspeptin- Neurokinin B-Dynorphin-expressing (KNDy) neurons of the arcuate nucleus signaling triggered by menopause. OBJECTIVE Aim of the review was to explore evidence-based non-hormonal pharmacological interventions for treating vasomotor symptoms. METHODS Comprehensive overview of relevant literature. CONCLUSIONS In the population where, hormonal options are contraindicated or not preferred by the patient, it is essential to explore evidence-based non-hormonal pharmacological interventions for treating vasomotor symptoms. The 2024 landscape of available treatments has expanded yet again, arming the providers with an even wider range of possibilities to help their patients. Fezolinetant, is the first NK3R antagonist developed for the purpose of treating hot flashes in menopausal women. NK3R antagonists provide a safe and effective treatment option for managing menopausal women with VMS.
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Shrivastava R, Bhattacharya S, Verma N, Mehdi AA, Pandey A, Ansari JA. Effects of Flaxseed on Perimenopausal Symptoms: Findings From a Single-Blind, Randomized, Placebo-Controlled Study. Cureus 2024; 16:e68534. [PMID: 39364521 PMCID: PMC11448742 DOI: 10.7759/cureus.68534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 10/05/2024] Open
Abstract
Background Flaxseed contains many phytoestrogens that share structural similarities with endogenous estrogens. It has beneficial properties that improve hormonal effects that may influence chronic disorders. Objective This study aims to evaluate the impact of flaxseed supplementation on perimenopausal syndrome symptoms and serum polyphenol metabolites enterodiol (ED) and enterolactone (EL). Methods Recruitment of 145 perimenopausal women from Queen Mary's Hospital OPD in K.G.M.U. Lucknow, India, was done for this single-blind randomized placebo-controlled experiment, considering inclusion and exclusion criteria. We randomly divided subjects into two groups using a computer-generated random number table. The intervention group A received 10 grams of flaxseed powder, while the placebo group B received 10 grams of roasted wheat flour for a continuous three months. We measured their demographic characteristics, menopausal symptoms score using the modified Kupperman's index (KI), the menopause rating scale (MRS), and the menopause-specific quality of life (MENQOL) intervention questionnaire. Moreover, using high-performance liquid chromatography (HPLC), biochemical parameters (ED, EL) were assessed both at baseline and after three months. For the statistical analysis, Statistical Product and Service Solutions (SPSS, version 24; IBM SPSS Statistics for Windows, Armonk, NY) was employed. Result The study involved 123 individuals, with 22 subjects losing out during follow-up. From baseline to follow-up comparison, the intervention group demonstrated an average percentage decline in the final score of the KI, MRS, and MENQOL intervention questionnaire of -47.25%, -54.05%, and -50.39%, respectively, while the placebo group demonstrated an average percentage decline of -3.83%, -4.91%, and -7.92%, respectively. From baseline to follow-up, ED and EL levels increased by 2.81-fold and 8.55-fold in the intervention group and decreased by 0.25-fold and 0.27-fold in the placebo group. Conclusion Following three months of supplementation, the intervention group showed substantially lower menopausal symptoms (p < 0.001), and ED and EL levels were considerably higher (p < 0.001). Therefore, flaxseed might ameliorate the symptoms associated with perimenopause.
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Affiliation(s)
| | | | - Narsingh Verma
- Physiology, Hindi Institute of Medical Sciences, Lucknow, IND
| | - Abbas A Mehdi
- Biochemistry, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Amita Pandey
- Obstetrics and Gynaecology, King Georges Medical University, Lucknow, IND
| | - Jamal A Ansari
- Clinical Biochemistry, Integral University Lucknow, Lucknow, IND
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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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Villar-López M, Soto-Becerra P, Chedraui P, Osorio-Manyari JD, Al-Kassab-Córdova A, Osorio-Manyari AA, Fernandez-Sosaya JL, Moya-Silvestre E, Rojas PA, Lugo-Martínez G, Mezones-Holguín E. Short-term effects and safety of a natural oral supplement containing glucosinolates, phytosterols, and citrus flavonoids compared with hormone treatment for the management of postmenopausal symptomatic women: a pilot single-center randomized phase 2 clinical trial. Menopause 2023; 30:1230-1240. [PMID: 37874969 DOI: 10.1097/gme.0000000000002268] [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: 10/26/2023]
Abstract
OBJECTIVE This study aimed to evaluate the short-term efficacy and safety of an oral herbal supplement containing glucosinolates, phytosterols, and citrus flavonoids for menopausal symptoms in comparison with estrogen plus progestogen therapy (EPT) among postmenopausal women. METHODS This was a pilot single-blinded, three-armed phase II randomized clinical trial, controlled with EPT. Sixty participants were randomly assigned to receive treatment for 3 months: (1) an oral herbal supplement of 1,500 mg/d (G1, n = 20), (2) an oral herbal supplement of 3,000 mg/d (G2, n = 20), or (3) conjugated equine estrogens 0.625 mg/d plus medroxyprogesterone acetate of 5 mg/d (EPT group, n = 20). The primary endpoint was the intensity of menopausal symptoms as measured using the Menopause-Specific Quality of Life Questionnaire (global and domain scores). The Menopause-Specific Quality of Life Questionnaire uses a 7-point scale to rate the symptom intensity, with higher scores indicating severity. The secondary endpoints were hormonal, lipid, and safety profiles. RESULTS Fifty-four participants (n = 54) completed the study. The mean, model-estimated, and global menopausal symptom scores at 3 months were 85.8 in the EPT group, 61.3 in G1, and 62.5 in G2. Participants treated with the herbal compound had lower global (13.7 [6.9-20.4], P < 0.001) and physical symptom scores (6.6 [1.6-11.5], P = 0.002) on the second month and lower psychosocial symptom scores (3.8 [1.3 to 6.3], P < 0.001) on the third month of follow-up, compared with EPT. Conversely, participants receiving EPT showed better outcomes on vasomotor symptoms since the first month of treatment (-6.1 [-8.3 to -4.0], P < 0.001). The EPT group exhibited higher values of estradiol and lower follicle-stimulating hormone and luteinizing hormone since the first month of follow-up. Also, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were significantly higher in this group than in G2. CONCLUSIONS In this small single-blind exploratory trial, the oral herbal supplement was more efficacious in reducing global, physical, and psychosocial menopausal symptoms in the short term than EPT. However, further studies are needed to adequately assess the efficacy and safety of this herbal supplement in the treatment of menopausal symptoms.
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Affiliation(s)
| | | | - Peter Chedraui
- Escuela de Posgrado en Salud, Universidad Espíritu Santo, Samborondón, Ecuador
| | | | - Ali Al-Kassab-Córdova
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Perú
| | | | | | | | - Percy A Rojas
- Universidad Peruana Cayetano Heredia, Laboratorios de Investigación y Desarrollo, Unidad de Biotecnología Molecular, Lima, Perú
| | - Gabriela Lugo-Martínez
- Instituto Politécnico Nacional, Escuela Superior de Medicina, Sección de Estudios de Posgrado e Investigación, Ciudad de México, México
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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: 17] [Impact Index Per Article: 17.0] [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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Kazama M, Terauchi M, Odai T, Kato K, Miyasaka N. The Inverse Correlation of Isoflavone Dietary Intake and Headache in Peri- and Post-Menopausal Women. Nutrients 2022; 14:nu14061226. [PMID: 35334883 PMCID: PMC8954352 DOI: 10.3390/nu14061226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
This study investigated the relationship between headache and dietary consumption of a variety of nutrients in middle-aged women. This cross-sectional analysis used first-visit records of 405 women aged 40–59 years. The frequency of headaches was assessed using the Menopausal Health-Related Quality of Life Questionnaire. Of the 43 major nutrient intakes surveyed using the brief-type self-administered diet history questionnaire, those that were not shared between women with and without frequent headaches were selected. Multiple logistic regression analysis was used to identify nutrients independently associated with frequent headaches. After adjusting for background factors related to frequent headache (vasomotor, insomnia, anxiety, and depression symptoms), the estimated dietary intake of isoflavones (daidzein + genistein) (mg/1000 kcal/day) was negatively associated with frequent headaches (adjusted odds, 0.974; 95% confidence interval, 0.950–0.999). Moreover, the estimated isoflavone intake was not significantly associated with headache frequency in the premenopausal group, whereas it significantly correlated with that in the peri- and post-menopausal groups. Headache in peri- and post-menopausal women was inversely correlated with the dietary intake of isoflavones. Diets rich in isoflavones may improve headaches in middle-aged women.
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Affiliation(s)
- Mayuko Kazama
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (M.K.); (N.M.)
| | - Masakazu Terauchi
- Department of Women’s Health, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.O.); (K.K.)
- Correspondence:
| | - Tamami Odai
- Department of Women’s Health, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.O.); (K.K.)
| | - Kiyoko Kato
- Department of Women’s Health, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.O.); (K.K.)
| | - Naoyuki Miyasaka
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (M.K.); (N.M.)
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Chan CWH, Law BMH, Ng MSN, Wong CCY, Wong CWY, Quinley M, Orgusyan JM, Chow KM, Waye MMY. Association of single nucleotide polymorphisms of cytochrome P450 enzymes with experience of vasomotor, vaginal and musculoskeletal symptoms among breast cancer patients: a systematic review. BMC Cancer 2021; 21:570. [PMID: 34006247 PMCID: PMC8130378 DOI: 10.1186/s12885-021-08268-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 04/28/2021] [Indexed: 02/20/2023] Open
Abstract
Background Adjuvant endocrine therapies are known to induce undesirable adverse effects such as vasomotor, vaginal and musculoskeletal symptoms among breast cancer patients. Drugs used in these therapies are often metabolised by cytochrome P450 (CYP) enzymes, in which their metabolising activities can be modified by single nucleotide polymorphisms (SNP) in CYP genes and CYP genotypes. This review aims to explore whether SNPs or genotypes of CYP are associated with the occurrence, frequency and severity of vasomotor, vaginal and musculoskeletal symptoms in breast cancer patients on adjuvant endocrine therapies. Methods A literature review was conducted using five electronic databases, resulting in the inclusion of 14 eligible studies, and their findings were presented narratively. Selected items from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist were used for critical appraisal of the reporting quality of the included studies. Results Most of the included studies showed that SNPs or genotypes of CYP that modify its metabolising activity have no effect on the occurrence, frequency or severity of vasomotor symptoms, including hot flashes. One study showed no correlation of these genetic variations in CYP with musculoskeletal symptoms, and no data were available on the association between such genetic variations and vaginal symptoms. Conclusions Overall, genetic variations in CYP have no effect on the experience of hot flashes among breast cancer patients. We recommend exploration of the link between the active metabolites of chemotherapeutic drugs and the molecules shown to affect the occurrence or severity of hot flashes, and the establishment of the relationship between such genetic variations and patients’ experience of musculoskeletal and vaginal symptoms. Subgroup analyses based on patients’ duration of adjuvant endocrine therapies in such studies are recommended.
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Affiliation(s)
- Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, the New Territories, Hong Kong SAR, China.,The Croucher Laboratory for Human Genomics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Bernard M H Law
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, the New Territories, Hong Kong SAR, China
| | - Marques S N Ng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, the New Territories, Hong Kong SAR, China
| | | | - Carissa W Y Wong
- University College London Cancer Institution, University College London, London, UK
| | - Morgan Quinley
- Molecular, Cell & Development Biology, University of California, Santa Cruz, USA
| | | | - Ka Ming Chow
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, the New Territories, Hong Kong SAR, China. .,Asia-Pacific Genomic and Genetic Nursing Centre, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Mary M Y Waye
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, the New Territories, Hong Kong SAR, China.,The Croucher Laboratory for Human Genomics, The Chinese University of Hong Kong, Hong Kong SAR, China.,Asia-Pacific Genomic and Genetic Nursing Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
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Frigo M, de Barros E, Dos Santos PCB, Peres GL, Weber J, Zanelatto C, Koehnlein EA. Effects of a Cereal Bar with a Combination of Phytoestrogens on the Climacteric Symptoms: A Placebo-Controlled, Randomized Trial. J Am Coll Nutr 2021; 41:325-332. [PMID: 33734035 DOI: 10.1080/07315724.2021.1884143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study evaluated whether the consumption of a cereal bar combining different phytoestrogens could contribute to the reduction of climacteric symptoms in women. METHODS This is a clinical, prospective, randomized, simple-blind trial. Forty-eight women, aged 40-65 years, with climacteric symptoms, from a city in southwestern Paraná, Brazil. Participants were randomly assigned into two groups; Phytoestrogens group (PHY = 24), which received for 90-day period a cereal bar containing 80.73 milligrams of soybean and flaxseed phytoestrogens, and the placebo group (PLA = 24), which consumed rice flakes biscuit. Clinical, sociodemographic and anthropometric data were collected and climacteric symptoms were assessed using the Kupperman Index (KI). RESULTS Forty-three women were analyzed (PHY = 21 and PLA = 22). There were significant reductions in the overall KI score in both groups at the end of the intervention period (p < 0.05). However, the comparison between the groups using linear regression models presented expressively better symptom improvement in the PHY group -6.43 over time (95% CI: -11.6; -1.26; p < 0.05) KI points, with perimenopausal -15.15 (95% CI: -28.95; -1.35) and postmenopausal women -19.34 (95% CI: -33.68; -4.99) showed considerably greater reductions in symptoms at the end of the intervention period compared to premenopausal women. There was also significant reduction in symptoms of hot flushes, paresthesia, sexual complaints, insomnia and melancholy. CONCLUSION The consumption of a cereal bar containing phytoestrogens was able to improve the symptoms of climacteric syndrome.
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Affiliation(s)
- M Frigo
- Post Graduate Program in Food Science and Technology, Federal University of Fronteira Sul, Laranjeiras do Sul, Brazil
| | - E de Barros
- Course of Nutrition, Federal University of Fronteira Sul, Realeza, Brazil
| | - P C B Dos Santos
- Course of Nutrition, Federal University of Fronteira Sul, Realeza, Brazil
| | - G L Peres
- Course of Chemistry, Federal University of Fronteira Sul, Realeza, Brazil
| | - J Weber
- Course of Nutrition, Federal University of Fronteira Sul, Realeza, Brazil
| | - C Zanelatto
- Course of Nutrition, Federal University of Fronteira Sul, Realeza, Brazil
| | - E A Koehnlein
- Post Graduate Program in Food Science and Technology, Federal University of Fronteira Sul, Laranjeiras do Sul, Brazil.,Course of Nutrition, Federal University of Fronteira Sul, Realeza, Brazil
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10
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Tulmac OB, Simsek G. Assessment of the effects of menopause on semicircular canal using the video head impulse test. J OBSTET GYNAECOL 2020; 41:939-945. [PMID: 33228415 DOI: 10.1080/01443615.2020.1819213] [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: 10/22/2022]
Abstract
This cross-sectional study included early menopausal and late menopausal women aged between 40 and 60 years to evaluate the effects of menopause on semicircular canal function. A video head impulse test (vHIT) was performed for all subjects. Vestibulo-ocular reflex (VOR) mean gains of each semicircular canal and gain asymmetry were compared between groups. Of the 87 subjects, 37(42.5%) were reproductive age 28(32.5%) were early menopausal and 22(25.3%) were late menopausal patients. VOR gain of semicircular canals or gain asymmetry values did not differ between groups. In postmenopausal women, presence of vasomotor symptoms was associated with higher gain asymmetry of the left anterior-right posterior (LARP) plane (p = .01), and presence of balance problems was associated with lower right anterior (RA) VOR gain (p = .01). In conclusion semicircular canal function in postmenopausal women was similar to that in women of reproductive age.IMPACT STATEMENTWhat is already known on this subject? During menopause, women face potential risks such as dizziness, balance problems, falls and fractures. Postmenopausal patients were tested with dynamic posturography to measure balance before and after oestrogen treatment, and it was shown that balance problems significantly improved with oestrogen treatment. Healthy vestibular system is one of the components for sustaining normal balance.What do the results of this study add? In postmenopausal women the function of the semicircular canals is normal and the balance deficit in postmenopausal women may not be caused by the vestibular system. In this study changes within normal limits were observed in vestibular system of postmenopausal women.What are the implications of these findings for clinical practice and/or further research? Reported balance deficits might have been due to central origin. Further research to differentiate origin of balance deficits are needed. Specific research on symptomatic postmenopausal patients would reveal more information.
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Affiliation(s)
- Ozlem Banu Tulmac
- Department of Obsterics and Gynecology, Kırıkkale University, Kirikkale, Turkey
| | - Gokce Simsek
- Department of Otolaryngology, Kirikkale University, Kirikkale, Turkey
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Jokar M, Delam H, Bakhtiari S, Paki S, Askari A, Bazrafshan MR, Shokrpour N. The Effects of Inhalation Lavender Aromatherapy on Postmenopausal Women’s Depression and Anxiety: A Randomized Clinical Trial. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Radzinsky VE, Uspenskaya Y, Shulman LP, Kuznetsova IV. Succinate-Based Dietary Supplement for Menopausal Symptoms: A Pooled Analysis of Two Identical Randomized, Double-Blind, Placebo-Controlled Clinical Trials. Obstet Gynecol Int 2019; 2019:1572196. [PMID: 31781230 PMCID: PMC6875258 DOI: 10.1155/2019/1572196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 10/05/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To evaluate the efficacy of a succinate-based dietary supplement (SBDS; Amberen) in symptomatic menopausal women using a larger sample size derived by pooling data from two identical trials. METHODS Raw data were pooled from two identical randomized, multicenter, double-blinded, placebo-controlled, 90-day clinical trials. Women aged 42-60 years with mild to moderate vasomotor and psychosomatic menopausal symptoms were included (114 in the treatment group and 113 in the placebo group). Symptoms were assessed by the Greene Climacteric Scale and State-Trait Anxiety Inventory. Changes in body mass index, body weight, waist and hip circumferences, and plasma levels of follicle stimulating hormone, luteinizing hormone, estradiol, leptin, and apolipoproteins A1 and B were also evaluated. RESULTS SBDS use resulted in significant improvements in several endpoints including alleviation of 16 of 21 menopausal symptoms (p ≤ 0.05, Greene Scale) and a decrease in anxiety (p < 0.0001, State-Trait Anxiety Inventory) when compared to placebo. Significant reductions were observed in weight, body mass index, and waist and hip circumferences in the supplement cohort. Evaluation of physiological parameters showed a significant increase in serum estradiol levels compared to baseline (p < 0.0001) among users of the SBDS. Levels of follicle stimulating hormone and luteinizing hormone decreased slightly in both groups, without significant differences between the groups. Leptin levels decreased with statistical significance in the SBDS cohort compared to placebo (p=0.027). For those with initial leptin concentrations above the reference range, leptin decreased significantly in the SBDS group compared to the baseline (p < 0.0001) and to placebo (p=0.027). CONCLUSIONS The pooled analysis reaffirms the outcomes from the individual trials. A nonhormonal, succinate-based dietary supplement is shown to relieve menopausal symptoms when compared to a placebo regimen in a randomized, double-blinded clinical trial.
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Affiliation(s)
- Viktor E. Radzinsky
- Department of Obstetrics and Gynecology with a Course of Perinatology, The Peoples' Friendship University of Russia Medical Institute, Mikluho-Maklaya St. 8, 117198 Moscow, Russia
| | - Yulia Uspenskaya
- Department of Obstetrics and Gynecology, The I.M. Sechenov First Moscow State Medical University, Elanskogo Str. 2, bld. 1, Moscow, Russia
| | - Lee P. Shulman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine of Northwestern University, 250 East Superior Street, Room 05-2174, Chicago, USA
| | - Irina V. Kuznetsova
- Department of Obstetrics and Gynecology, The I.M. Sechenov First Moscow State Medical University, Elanskogo Str. 2, bld. 1, Moscow, Russia
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What's in a name: are menopausal "hot flashes" a symptom of menopause or a manifestation of neurovascular dysregulation? Menopause 2019; 25:700-703. [PMID: 29381665 DOI: 10.1097/gme.0000000000001065] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hot flashes have typically been classified as "symptoms of menopause" that should be tolerated or treated until they resolve. However, mounting evidence points to hot flashes as a manifestation of one or several underlying pathophysiological processes. Associations exist between the presence, timing of onset, severity, and duration of hot flashes, and the risk of several neurological (affecting sleep, mood, and cognition) and cardiovascular conditions. In addition, four consistent patterns of vasomotor disturbances have been identified across different countries, making it unlikely that these patterns are solely explained by socioeconomic or cultural factors. The changing hormonal environment of menopause may unmask differences in the autonomic neurovascular control mechanisms that put an individual woman at risk for chronic conditions of aging. These differences may have a genetic basis or may be acquired across the life span and are consistent with the variability of the clinical manifestations of aging observed in women after bilateral oophorectomy. It is time to investigate the pathophysiological mechanisms underlying the four patterns of vasomotor symptoms more closely, and to shift from describing hot flashes as symptoms to be tolerated to manifestations of an underlying autonomic neurovascular dysregulation that need to be addressed.
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Leysen L, Lahousse A, Nijs J, Adriaenssens N, Mairesse O, Ivakhnov S, Bilterys T, Van Looveren E, Pas R, Beckwée D. Prevalence and risk factors of sleep disturbances in breast cancersurvivors: systematic review and meta-analyses. Support Care Cancer 2019; 27:4401-4433. [DOI: 10.1007/s00520-019-04936-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 06/11/2019] [Indexed: 01/31/2023]
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Effects of oral versus transdermal menopausal hormone treatments on self-reported sleep domains and their association with vasomotor symptoms in recently menopausal women enrolled in the Kronos Early Estrogen Prevention Study (KEEPS). Menopause 2019; 25:145-153. [PMID: 28832429 PMCID: PMC5771895 DOI: 10.1097/gme.0000000000000971] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study determined whether two different formulations of hormone therapy (HT): oral conjugated equine estrogens (o-CEE; 0.45 mg/d, n = 209), transdermal 17β-estradiol (t-E2; 50 μg/d, n = 201) plus cyclic progesterone (Prometrium, 200 mg) or placebo (PBO, n = 243) affected sleep domains in participants of the Kronos Early Estrogen Prevention Study. METHODS Participants completed the Pittsburgh Sleep Quality Index at baseline and during the intervention at 6, 18, 36, and 48 months. Global sleep quality and individual sleep domain scores were compared between treatments using analysis of covariance, and correlated with vasomotor symptom (VMS) scores using Spearman correlation coefficients. RESULTS Global Pittsburgh Sleep Quality Index scores (mean 6.3; 24% with score >8) were similar across groups at baseline and were reduced (improved sleep quality) by both HT (average change -1.27 [o-CEE] and -1.32 [t-E2]) when compared with PBO (-0.60; P = 0.001 [o-CEE vs PBO] and P = 0.002 [t-E2 vs PBO]). Domain scores for sleep satisfaction and latency improved with both HT. The domain score for sleep disturbances improved more with t-E2 than o-CEE or PBO. Global sleep scores significantly correlated with VMS severity (rs = 0.170, P < 0.001 for hot flashes; rs = 0.177, P < 0.001 for night sweats). Change in scores for all domains except sleep latency and sleep efficiency correlated with change in severity of VMS. CONCLUSIONS Poor sleep quality is common in recently menopausal women. Sleep quality improved with both HT formulations. The relationship of VMS with domains of sleep suggests that assessing severity of symptoms and domains of sleep may help direct therapy to improve sleep for postmenopausal women.
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No Author. Chapitre 4 : Symptômes vasomoteurs. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S68-S72. [DOI: 10.1016/j.jogc.2019.02.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Soy intake and vasomotor menopausal symptoms among midlife women: a pooled analysis of five studies from the InterLACE consortium. Eur J Clin Nutr 2019; 73:1501-1511. [DOI: 10.1038/s41430-019-0398-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/03/2019] [Accepted: 01/16/2019] [Indexed: 01/13/2023]
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Rouhbakhsh M, Kermansaravi F, Shakiba M, Navidian A. The effect of couples education on marital satisfaction in menopausal women. J Women Aging 2018; 31:432-445. [DOI: 10.1080/08952841.2018.1510244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mahdieh Rouhbakhsh
- Department of Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Fatihe Kermansaravi
- Department of Nursing, Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mansour Shakiba
- Department of Psychiatry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ali Navidian
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Stincic TL, Rønnekleiv OK, Kelly MJ. Diverse actions of estradiol on anorexigenic and orexigenic hypothalamic arcuate neurons. Horm Behav 2018; 104:146-155. [PMID: 29626486 PMCID: PMC6196116 DOI: 10.1016/j.yhbeh.2018.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 12/13/2022]
Abstract
Contribution to Special Issue on Fast effects of steroids. There is now compelling evidence for membrane-associated estrogen receptors in hypothalamic neurons that are critical for the hypothalamic control of homeostatic functions. It has been known for some time that estradiol (E2) can rapidly alter hypothalamic neuronal activity within seconds, indicating that some cellular effects can occur via membrane initiated events. However, our understanding of how E2 signals via membrane-associated receptors and how these signals impact physiological functions is only just emerging. Thus, E2 can affect second messenger systems including calcium mobilization and a plethora of kinases to alter cell excitability and even gene transcription in hypothalamic neurons. One population of hypothalamic neurons, the anorexigenic proopiomelanocortin (POMC) neurons, has long been considered to be a target of E2's actions based on gene (Pomc) expression studies. However, we now know that E2 can rapidly alter POMC neuronal activity within seconds and activate several intracellular signaling cascades that ultimately affect gene expression, actions which are critical for maintaining sensitivity to insulin in metabolically stressed states. E2 also affects the orexigenic Neuropeptide Y/Agouti-related Peptide (NPY/AgRP) neurons in similarly rapid but antagonistic manner. Therefore, this review will summarize our current state of knowledge of how E2 signals via rapid membrane-initiated and intracellular signaling cascades in POMC and NPY/AgRP neurons to regulate energy homeostasis.
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Affiliation(s)
- Todd L Stincic
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Oline K Rønnekleiv
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR 97239, USA; Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR 97239, USA; Division of Neuroscience, Oregon Regional Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA
| | - Martin J Kelly
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR 97239, USA; Division of Neuroscience, Oregon Regional Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA.
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Hakimi S, Haggi HB, Shojai SK, Farahbakhsh M, Farhan F. Comparing the Pattern of Menopausal Symptoms, Concern and Attitudes in Urban and Rural Postmenopausal Iranian Women. J Menopausal Med 2018; 24:50-55. [PMID: 29765927 PMCID: PMC5949308 DOI: 10.6118/jmm.2018.24.1.50] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/27/2018] [Accepted: 02/22/2018] [Indexed: 11/05/2022] Open
Abstract
Objectives Although hormonal changes during menopause are inevitable in this period, the severity of the menopausal symptoms can be controlled. Accepting menopause and having a positive attitude toward it can also help. Given the results of previous studies, and since environmental factors affect the pattern of menopausal symptoms the present study was conducted to compare the pattern of menopausal symptoms, concern and attitudes in urban and rural postmenopausal women. Methods This cross-sectional study was conducted on urban and rural postmenopausal women residing in and around Tabriz, Iran. Cluster sampling was used to select the subjects. The data collection tools used included a demographic questionnaire to assess women's experiences during menopause. Results This study examined 544 urban and rural postmenopausal women between March and September 2015. The women had a mean age of 51.8 ± 3.1. After adjusting the basic variables, the mean scores of menopausal symptoms and their subscales showed significantly higher scores in the physical and psychological subscales in the urban women, while the rural women had significantly higher scores in the concern subscale. Conclusions Rural women were significantly different from urban women in terms of menopausal symptoms, concern and attitudes. Hot flushes, a common menopausal symptom, and decreased sexual desire were more common in the urban women; in contrast, the rural women experienced more concern about menopause and its consequences.
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Affiliation(s)
- Sevil Hakimi
- School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| | - Hurieh Badali Haggi
- School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| | | | - Mostafa Farahbakhsh
- School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| | - Faranak Farhan
- School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
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Monteiro NE, Queirós LD, Lopes DB, Pedro AO, Macedo GA. Impact of microbiota on the use and effects of isoflavones in the relief of climacteric symptoms in menopausal women – A review. J Funct Foods 2018. [DOI: 10.1016/j.jff.2017.12.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Abstract
The thermoregulatory functions may vary with age. Thermosensitivity is active in neonates and children; both heat production and heat loss effector mechanisms are functional but easily exhaustable. Proportional and lasting defense against thermal challenges is difficult, and both hypothermia and hyperthermia may easily develop. Febrile or hypothermic responses to infections or endotoxin can also develop, together with confusion. In small children febrile convulsions may be dangerous. In old age the resting body temperature may be lower than in young adults. Further, thermosensitivity decreases, the thresholds for activating skin vasomotor and evaporative responses or metabolism are shifted, and responses to thermal challenges are delayed or insufficient: both hypothermia and hyperthermia may develop easily. Infection-induced fevers are often limited or absent, or replaced by hypothermia. Various types of brain damage may induce special forms of hypothermia, hyperthermia, or severe fever. Impaired mental state often accompanies hypothermia and hyperthermia, and may occasionally be a dominant feature of infection (instead of the most commonly observed fever). Aging brings about a turning point in women's life: the menopause. The well-known influence of regular hormonal cycles on the thermoregulation of a woman of fertile age gives way to menopausal hot flushes caused by estrogen withdrawal. Not all details of this thermoregulatory anomaly are fully understood yet.
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Sharifi N, Khazaeian S, Khazaeian S, Masjoudi M, Kazemi AF, Nia ASN. Examining Psychometric Characteristics of a Menopausal Health Questionnaire: Translation and Psychometric Evaluation of the Persian Version. Electron Physician 2017; 9:3616-3622. [PMID: 28243415 PMCID: PMC5308503 DOI: 10.19082/3616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/16/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction Menopause is a natural event in a woman’s life which affects her general health and quality of life. However, currently there is no Persian instrument for measuring health status during this period. Therefore, the present study was performed to assess the validity and reliability of the Persian version of the Menopausal Health Questionnaire in Iran. Methods The questionnaire was translated to Persian with the approach of Jones et al and its validity was assessed by a panel of experts. The Persian version was tested among 300 patients who had referred to the gynecological clinic at the Ali ibn Abi Talib Hospital in Zahedan. Convenience method was used for sampling. Exploratory factor analysis was used to assess construct validity of collected data. Test-retest method was used to determine reliability in two-week intervals and Cronbach’s alpha coefficient was used to check the internal consistency. Results According to research findings, the exploratory factor analysis showed an acceptable fitness. Varimax rotation indicated 6 factors with Eagan values more than 1, which explained 49.27% of the variance. Cronbach’s alpha coefficient for the entire tool was 0.84 and it was from 0.50 to 0.82 for the subcategories. All factors had a significant case-total correlation. Results of test-retest showed the stability of the questionnaire and its subcategories, and the intraclass correlation coefficient (ICC) was assessed to be 0.93. Conclusions The 14-item Menopausal Health Questionnaire is a valid and reliable instrument to assess postmenopausal women’s health.
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Affiliation(s)
- Nasibeh Sharifi
- M.Sc. of Midwifery, Ph.D. Candidate of Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayyeh Khazaeian
- M.Sc. of Midwifery, Pregnancy Health Research Center, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Safoura Khazaeian
- Gynecologist, Department of Obstetrics and Gynecology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Marzieh Masjoudi
- M.Sc. of Midwifery, Faculty Member, Department of Midwifery, School of Nursing and Midwifery, Islamic Azad University of Rasht, Rasht, Iran
| | - Azita Fathnejad Kazemi
- M.Sc. of Midwifery, Faculty Member, Department of Midwifery, School of Nursing and Midwifery, Islamic Azad University of Tabriz, Tabriz, Iran
| | - Anvar-Sadat Nayebi Nia
- M.Sc. of Midwifery, Faculty Member, Department of Midwifery, School of Nursing and Midwifery, Islamic Azad University of Karaj, Karaj, Iran
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Direkvand-Moghadam A, Delpisheh A, Montazeri A, Sayehmiri K. Quality of Life among Iranian Infertile Women in Postmenopausal Period: A Cross-sectional Study. J Menopausal Med 2016; 22:108-13. [PMID: 27617245 PMCID: PMC5016498 DOI: 10.6118/jmm.2016.22.2.108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/11/2016] [Accepted: 07/19/2016] [Indexed: 11/24/2022] Open
Abstract
Objectives Infertility has a significant impact on a women's quality of life (QOL). Infertile women face with physical and mental challenges during their postmenopausal period. Therefore, the present study aimed to evaluate the QOL among Iranian infertile women in the postmenopausal period using a valid and reliable instrument. Methods In this cross-sectional study both snowball and social networking methods were used for sampling. Two demographic and QOL questionnaire were used for data collection. The QOL questionnaire includes 41 items which measure the QOL in five dimensions: socioeconomic, mental health, religiousness, physical health and future imagining. Data analyzed was carried out in IBM SPSS ver. 20.0 using descriptive statistic, χ2 test, and Fisher test. A P value of 0.01 or less was considered significant. Results Overall 211 eligible participants were studied. Some participants obtained full score on socioeconomic, religiousness, physical health and future imagining dimensions of QOL but none on the mental health dimension of the QOL. Only, 6.6% of study participants have a good QOL. There was a significant relationship between age and financial provider whit status of QOL. Conclusion Most Iranian infertile women in the postmenopausal period have poor or moderate QOL. Therefore, improving the QOL among these women should be considered.
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Affiliation(s)
- Ashraf Direkvand-Moghadam
- Department of Nursing and Midwifery, Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Delpisheh
- Department of Clinical Epidemiology, Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Montazeri
- Mental Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Kourosh Sayehmiri
- Department of Community Medicine, Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
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Kelly MJ, Rønnekleiv OK. Minireview: neural signaling of estradiol in the hypothalamus. Mol Endocrinol 2015; 29:645-57. [PMID: 25751314 PMCID: PMC4415204 DOI: 10.1210/me.2014-1397] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/02/2015] [Indexed: 12/22/2022] Open
Affiliation(s)
- Martin J Kelly
- Departments of Physiology and Pharmacology (M.J.K., O.K.R.) and Anesthesiology and Perioperative Medicine (O.K.R.), Oregon Health and Science University, Portland, Oregon 97239; and Division of Neuroscience (M.J.K., O.K.R.), Oregon National Primate Research Center; Oregon Health and Science University, Beaverton, Oregon 97006
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Macías-Cortés EDC, Llanes-González L, Aguilar-Faisal L, Asbun-Bojalil J. Individualized homeopathic treatment and fluoxetine for moderate to severe depression in peri- and postmenopausal women (HOMDEP-MENOP study): a randomized, double-dummy, double-blind, placebo-controlled trial. PLoS One 2015; 10:e0118440. [PMID: 25768800 PMCID: PMC4359147 DOI: 10.1371/journal.pone.0118440] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/13/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Perimenopausal period refers to the interval when women's menstrual cycles become irregular and is characterized by an increased risk of depression. Use of homeopathy to treat depression is widespread but there is a lack of clinical trials about its efficacy in depression in peri- and postmenopausal women. The aim of this study was to assess efficacy and safety of individualized homeopathic treatment versus placebo and fluoxetine versus placebo in peri- and postmenopausal women with moderate to severe depression. METHODS/DESIGN A randomized, placebo-controlled, double-blind, double-dummy, superiority, three-arm trial with a 6 week follow-up study was conducted. The study was performed in a public research hospital in Mexico City in the outpatient service of homeopathy. One hundred thirty-three peri- and postmenopausal women diagnosed with major depression according to DSM-IV (moderate to severe intensity) were included. The outcomes were: change in the mean total score among groups on the 17-item Hamilton Rating Scale for Depression, Beck Depression Inventory and Greene Scale, after 6 weeks of treatment, response and remission rates, and safety. Efficacy data were analyzed in the intention-to-treat population (ANOVA with Bonferroni post-hoc test). RESULTS After a 6-week treatment, homeopathic group was more effective than placebo by 5 points in Hamilton Scale. Response rate was 54.5% and remission rate, 15.9%. There was a significant difference among groups in response rate definition only, but not in remission rate. Fluoxetine-placebo difference was 3.2 points. No differences were observed among groups in the Beck Depression Inventory. Homeopathic group was superior to placebo in Greene Climacteric Scale (8.6 points). Fluoxetine was not different from placebo in Greene Climacteric Scale. CONCLUSION Homeopathy and fluoxetine are effective and safe antidepressants for climacteric women. Homeopathy and fluoxetine were significantly different from placebo in response definition only. Homeopathy, but not fluoxetine, improves menopausal symptoms scored by Greene Climacteric Scale. TRIAL REGISTRATION ClinicalTrials.gov NCT01635218. PROTOCOL PUBLICATION https://clinicaltrials.gov/ct2/show/NCT01635218 [corrected].
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Affiliation(s)
- Emma del Carmen Macías-Cortés
- División de Estudios de Posgrado, Escuela Superior de Medicina, Instituto Politécnico Nacional, Distrito Federal, México
- Consulta Externa de Homeopatía, Hospital Juárez de México, Secretaría de Salud, Distrito Federal, México
| | - Lidia Llanes-González
- Unidad de Salud Mental, Hospital Juárez de México, Secretaría de Salud, Distrito Federal, México
| | - Leopoldo Aguilar-Faisal
- División de Estudios de Posgrado, Escuela Superior de Medicina, Instituto Politécnico Nacional, Distrito Federal, México
| | - Juan Asbun-Bojalil
- División de Estudios de Posgrado, Escuela Superior de Medicina, Instituto Politécnico Nacional, Distrito Federal, México
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Tal JZ, Suh SA, Dowdle CL, Nowakowski S. Treatment of Insomnia, Insomnia Symptoms, and Obstructive Sleep Apnea During and After Menopause: Therapeutic Approaches. ACTA ACUST UNITED AC 2015; 11:63-83. [PMID: 26478725 DOI: 10.2174/1573400510666140929194848] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Understanding sleep complaints among menopausal women is an emerging area of clinical and research interest. Several recent reviews have focused on mechanisms of menopausal insomnia and symptoms. In this review, we present a discussion on the most relevant and recent publications on the treatment of sleep disorders for menopausal women, with a focus on menopause-related insomnia, insomnia symptoms, and obstructive sleep apnea. We discuss both nonpharmacological and pharmacological treatments, including cognitive-behavioral therapy for insomnia (CBT-I), complementary and alternative medicine, hormone replacement therapy, sedative hypnotics, antidepressants, and continuous positive airway pressure. In addition, we briefly discuss methods and considerations of assessment of sleep disorders in menopausal women.
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Affiliation(s)
- Joshua Z Tal
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, CA 94305 ; Palo Alto University, Palo Alto, CA 94304
| | - Sooyeon A Suh
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, CA 94305 ; Korea University Ansan Medical Center, Institute of Human Genomic Study, Ansan, Republic of Korea
| | - Claire L Dowdle
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, CA 94305 ; PGSP -Stanford Psy. D. Consortium, Palo Alto, CA 94304
| | - Sara Nowakowski
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, CA 94305 ; University of Texas Medical Branch, Department of Obstetrics and Gynecology, Galveston, TX 77555
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Sexual function in women on estradiol or venlafaxine for hot flushes: a randomized controlled trial. Obstet Gynecol 2014; 124:233-241. [PMID: 25004335 DOI: 10.1097/aog.0000000000000386] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate sexual function in midlife women taking low-dose oral estradiol or venlafaxine for hot flushes. METHODS In an 8-week randomized controlled trial among women aged 40-62 years, sexual function was compared between 0.5 mg oral estradiol per day or 75 mg venlafaxine per day (both compared with a placebo). Measures included composite and six domain scores from the Female Sexual Function Index and sexually related personal distress. RESULTS Participants were aged 54.6 years (standard deviation [SD] 3.8) years, 59% white, with 8.1 (SD 5.3) daily hot flushes. Median composite baseline Female Sexual Function Index score was 16.3 (SD 11.9, n=256) for all women and 21.7 (SD 9.3, n=198) among sexually active women. Composite mean Female Sexual Function Index change from baseline to week 8 was 1.4 (95% confidence interval [CI] -0.4 to 3.2) for estradiol, 1.1 (95% CI -0.5 to 2.7) for venlafaxine, and -0.3 (95% CI -1.6 to 1.0) for placebo. Composite Female Sexual Function Index and sexually related distress change from baseline did not differ between estradiol and placebo (P=.38, P=.30) or venlafaxine and placebo (P=.79, P=.48). Among sexually active women, Female Sexual Function Index domain score change from baseline differences (active compared with placebo) in desire was 0.3 (95% CI 0.0-0.6) for estradiol, -0.6 (95% CI -1.2 to 0.0) in orgasm for venlafaxine, and 0.9 (95% CI 0.2-1.6) in penetration pain for venlafaxine. No women reported adverse events related to sexual dysfunction. CONCLUSION Overall sexual function among nondepressed midlife women experiencing hot flushes did not change over 8 weeks with low-dose oral estradiol or venlafaxine (compared with placebo), although a subtle increase in desire (estradiol) and decreases in orgasm and pain (venlafaxine) may exist. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT01418209. LEVEL OF EVIDENCE I.
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RETIRED: Managing Menopause Chapter 4 Vasomotor Symptoms. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014. [DOI: 10.1016/s1701-2163(15)30460-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Two populations of cells within the hypothalamus exert opposite actions on food intake: proopiomelanocortin (POMC) neurons decrease it, while neuropeptide Y (NPY)/agouti-related peptide (AgRP) neurons increase it. 17β-Estradiol (E2) is a potent anorexigenic hormone that exerts both genomic and non-genomic, rapid actions on these metabolic neurons. This review focuses on the rapid membrane effects of E2 in both POMC and NPY/AgRP neurons and how these combined effects mediate the anorexigenic effects of this steroid.
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Affiliation(s)
- A W Smith
- Department of Physiology and Pharmacology, Oregon Health and Science University, Portland, OR 97239, USA
| | - O K Rønnekleiv
- Department of Physiology and Pharmacology, Oregon Health and Science University, Portland, OR 97239, USA; Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR 97006, USA
| | - M J Kelly
- Department of Physiology and Pharmacology, Oregon Health and Science University, Portland, OR 97239, USA; Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR 97006, USA.
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Kelly MJ, Rønnekleiv OK. A selective membrane estrogen receptor agonist maintains autonomic functions in hypoestrogenic states. Brain Res 2013; 1514:75-82. [PMID: 23535448 PMCID: PMC5432040 DOI: 10.1016/j.brainres.2013.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 03/09/2013] [Accepted: 03/19/2013] [Indexed: 12/14/2022]
Abstract
It is well known that many of the actions of estrogens in the central nervous system are mediated via intracellular receptor/transcription factors that interact with steroid response elements on target genes. But there is also a compelling evidence for the involvement of membrane estrogen receptors in hypothalamic and other CNS functions. However, it is not well understood how estrogens signal via membrane receptors, and how these signals impact not only membrane excitability but also gene transcription in neurons. Indeed, it has been known for sometime that estrogens can rapidly alter neuronal activity within seconds, indicating that some cellular effects can occur via membrane delimited events. In addition, estrogens can affect second messenger systems including calcium mobilization and a plethora of kinases within neurons to alter cellular functions. Therefore, this brief review will summarize our current understanding of rapid membrane-initiated and intracellular signaling by estrogens in the hypothalamus, the nature of receptors involved and how these receptors contribute to maintenance of homeostatic functions, many of which go awry in menopausal states. This article is part of a Special Issue entitled Hormone Therapy.
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Affiliation(s)
- Martin J Kelly
- Department of Physiology and Pharmacology, L334, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098, USA.
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Macías-Cortés EDC, Aguilar-Faisal L, Asbun-Bojalil J. Efficacy of individualized homeopathic treatment and fluoxetine for moderate to severe depression in peri- and postmenopausal women (HOMDEP-MENOP): study protocol for a randomized, double-dummy, double-blind, placebo-controlled trial. Trials 2013; 14:105. [PMID: 23782520 PMCID: PMC3748824 DOI: 10.1186/1745-6215-14-105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 04/09/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The perimenopausal period refers to the interval when women's menstrual cycles become irregular and is characterized by an increased risk of depressive symptoms. Use of homeopathy to treat depression is widespread but there is a lack of clinical trials about its efficacy in depression in peri- and postmenopausal women. Previous trials suggest that individualized homeopathic treatments improve depression. In classical homeopathy, an individually selected homeopathic remedy is prescribed after a complete case history of the patient. The aim of this study is to assess the efficacy and safety of the homeopathic individualized treatment versus placebo or fluoxetine in peri- and postmenopausal women with moderate to severe depression. METHODS/DESIGN A randomized, placebo-controlled, double-blind, double-dummy, three-arm trial with a six-week follow-up study was designed. The study will be conducted in a public research hospital in Mexico City (Juárez de México Hospital) in the outpatient service of homeopathy. One hundred eighty nine peri- and postmenopausal women diagnosed with major depression according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (moderate to severe intensity) will be included. The primary outcome is change in the mean total score among groups on the 17-item Hamilton Rating Scale for Depression after the fourth and sixth week of treatment. Secondary outcomes are: Beck Depression Inventory change in mean score, Greene's Scale change in mean score, response and remission rates and safety. Efficacy data will be analyzed in the intention-to-treat population. To determine differences in the primary and secondary outcomes among groups at baseline and weeks four and six, data will be analyzed by analysis of variance for independent measures with the Bonferroni post-hoc test. DISCUSSION This study is the first trial of classical homeopathy that will evaluate the efficacy of homeopathic individualized treatment using C-potencies versus placebo or fluoxetine in peri- and postmenopausal women with moderate to severe depression. It is an attempt to deal with the obstacles of homeopathic research due to the need for individual prescriptions in one of the most common psychiatric diseases. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01635218.
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Affiliation(s)
- Emma del Carmen Macías-Cortés
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Ave. Plan de San Luis y Salvador Díaz Mirón, Casco de Santo Tomás, Distrito Federal, CP 11340, Mexico
- Hospital Juárez de México, Secretaría de Salud, Ave. Instituto Politécnico Nacional 5160, Col. Magdalena de las Salinas, Distrito Federal, CP 7760, Mexico
| | - Leopoldo Aguilar-Faisal
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Ave. Plan de San Luis y Salvador Díaz Mirón, Casco de Santo Tomás, Distrito Federal, CP 11340, Mexico
| | - Juan Asbun-Bojalil
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Ave. Plan de San Luis y Salvador Díaz Mirón, Casco de Santo Tomás, Distrito Federal, CP 11340, Mexico
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Morton TL, Gattermeir DJ, Petersen CA, Day WW, Schumacher RJ. Steady-State Pharmacokinetics Following Application of a Novel Transdermal Estradiol Spray in Healthy Postmenopausal Women. J Clin Pharmacol 2013; 49:1037-46. [DOI: 10.1177/0091270009339187] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Conley AJ, Stanczyk FZ, Morrison JH, Borowicz P, Benirschke K, Gee NA, Lasley BL. Modulation of higher-primate adrenal androgen secretion with estrogen-alone or estrogen-plus-progesterone intervention. Menopause 2013; 20:322-8. [PMID: 23435030 PMCID: PMC3610787 DOI: 10.1097/gme.0b013e318273a070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Circulating adrenal steroids rise during the menopausal transition in most middle-aged women and may contribute to differences in between-women symptoms and ultimate health outcomes. However, the mechanisms for this shift in adrenal steroid production in middle-aged women are not known. This study aims to determine whether hormone therapy (HT) for 1 year can modulate adrenal androgen production. METHODS Younger (9.8 [0.4] years, n = 20) and older (22.7 [0.4] years, n = 37) female laboratory macaques were ovariectomized, and each group was treated with different regimens of HT for up to 1 year. Changes in adrenal histology and circulating adrenal androgens were monitored after estrogen-alone (E) or estrogen plus progesterone (E + P) treatment, and these changes were compared with the same measures in similarly aged animals given vehicle. RESULTS Zona reticularis area, serum dehydroepiandrosterone (DHEA), and serum dehydroepiandrosterone sulfate (DHEAS) were higher in younger vehicle-treated animals compared with older vehicle-treated animals (P < 0.02). Both E and E + P treatments decreased circulating DHEAS in the younger group (P < 0.05). Although E treatment also decreased DHEAS in the older group, this was not statistically significant. In contrast, E + P treatment in the older group resulted in a rise in DHEAS over vehicle, which was significantly higher than the results of E treatment (P < 0.01). Circulating concentrations of DHEA exhibited similar trends, but these changes did not reach statistical significance. CONCLUSIONS These data demonstrate that intervention with ovarian steroids can modulate adrenal androgen production in female higher primates and that both animal age and type of HT regimen determine adrenal response.
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Affiliation(s)
- Alan J Conley
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California at Davis, Davis, CA, USA
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Kelly MJ, Rønnekleiv OK. Membrane-initiated actions of estradiol that regulate reproduction, energy balance and body temperature. Front Neuroendocrinol 2012; 33:376-87. [PMID: 22871514 PMCID: PMC3618441 DOI: 10.1016/j.yfrne.2012.07.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 07/07/2012] [Accepted: 07/11/2012] [Indexed: 12/21/2022]
Abstract
It is well known that many of the actions of estrogens in the central nervous system are mediated via intracellular receptor/transcription factors that interact with steroid response elements on target genes. However, there now exists compelling evidence for membrane estrogen receptors in hypothalamic and other brain neurons. But, it is not well understood how estrogens signal via membrane receptors, and how these signals impact not only membrane excitability but also gene transcription in neurons. Indeed, it has been known for sometime that estrogens can rapidly alter neuronal activity within seconds, indicating that some cellular effects can occur via membrane delimited events. In addition, estrogens can affect second messenger systems including calcium mobilization and a plethora of kinases to alter cell signaling. Therefore, this review will consider our current knowledge of rapid membrane-initiated and intracellular signaling by estrogens in the hypothalamus, the nature of receptors involved and how they contribute to homeostatic functions.
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Affiliation(s)
- Martin J. Kelly
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR 97239
- Division of Neuroscience, Oregon Regional Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006
| | - Oline K. Rønnekleiv
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR 97239
- Division of Neuroscience, Oregon Regional Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR 97239
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Pomegranate seed oil in women with menopausal symptoms: a prospective randomized, placebo-controlled, double-blinded trial. Menopause 2012; 19:426-32. [PMID: 22240636 DOI: 10.1097/gme.0b013e3182345b2f] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the potential effects of pomegranate seed oil (PGS) on menopausal symptoms. METHODS The prospective randomized, placebo-controlled, double-blinded trial was completed by 81 postmenopausal women, who received two daily doses of either 30 mg PGS containing 127 μg of steroidal phytoestrogens per dose or a placebo for 12 weeks. The participants reported their number of hot flashes and completed the Menopause Rating Scale II at baseline and at weeks 4, 8, 12, and 24. At baseline and after 12 weeks, hormonal status was determined. RESULTS After 12 weeks of treatment, PGS reduced the number of hot flashes per day by 4.3 (38.7%), whereas placebo reduced it by 2.5 (25.6%). Both groups were significant compared with baseline, but the treated group was not significant compared with the placebo group (P = 0.17). After 24 weeks, the treated group showed a mean of 7.1 (interquartile range, 4.0) hot flashes per day compared with the placebo group with a mean of 8.8 (interquartile range, 5.0; P = 0.02). Although the overall sum score of the Menopause Rating Scale II parameters at week 12 decreased in the treated group from 16.0 to 9.0 at week 12 and in the placebo group from 18.0 to 14.5 (P = 0.08), the sum score of the vegetative somatic symptoms subgroup decreased strongly versus placebo (P < 0.03), attributable mainly to an improvement in sleeping disorders. PGS did not affect the hormone status, and no adverse effects were reported. CONCLUSIONS In postmenopausal women, PGS does not significantly reduce hot flashes within a 12-week observation period, but further studies are needed to investigate the long-term effect.
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Sexual function in nondepressed women using escitalopram for vasomotor symptoms: a randomized controlled trial. Obstet Gynecol 2012; 119:527-38. [PMID: 22353950 DOI: 10.1097/aog.0b013e3182475fa4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate sexual function in midlife women using selective serotonin reuptake inhibitors for vasomotor symptoms. Selective serotonin reuptake inhibitors effectively treat vasomotor symptoms but adversely affect sexual function in depressed populations. Information on sexual function in nondepressed midlife women using selective serotonin reuptake inhibitors for vasomotor symptoms is lacking; any treatments that might impair function are of concern. METHODS This was a randomized controlled trial comparing 8 weeks of escitalopram with placebo in women ages 40-62 years with 28 or more bothersome vasomotor symptoms per week. Change in Female Sexual Function Index composite score (ranges from 2 [not sexually active, no desire] to 36) and six sexual domains (desire, arousal, lubrication, orgasm, satisfaction, pain) and the Female Sexual Distress Scale, and a single-question of sexually-related personal distress from the Female Sexual Distress Scale, were compared between groups. RESULTS Among all women, median composite baseline Female Sexual Function Index score was 18.1 (interquartile range 2.4-26.5, n=200) and among sexually active women was 22.8 (interquartile range 17.4-27.0, n=75) in the escitalopram group and 23.6 (interquartile range 14.9-31.0, n=70) in the placebo group. Treatment with escitalopram did not affect composite Female Sexual Function Index score at follow-up compared with placebo (P=.18 all women; P=.47 sexually active at baseline). Composite mean Female Sexual Function Index change from baseline to week 8 was 0.1 (95% confidence interval [CI] -1.5 to 1.7) for escitalopram and 2.0 (95% CI 0.2-3.8) for placebo. The Female Sexual Distress Scale results did not differ between groups (P=.73) nor did adverse reports of sexual function. At week 8, among those women sexually active at baseline, there was a small difference between groups in Female Sexual Function Index domain mean score change in lubrication (P=.02) and a marginal nonsignificant difference in orgasm (P=.07). CONCLUSION Escitalopram, when used in the treatment of vasomotor symptoms, did not worsen overall sexual function among nondepressed midlife women.
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Abstract
Hot flushes are complained of by approximately 75% of all postmenopausal women, and hormone therapy (HT) is the most effective way to alleviate them. Hot flushes are characterized by altered vascular function and sympathetic nervous system activity. Hot flushes occurred more often in women attending large, non-randomized observational studies (e.g. Nurses' Health Study), where HT use protected against cardiovascular disease (CVD). However, they were absent (or mild) in randomized HT trials where HT use was accompanied with an elevated risk for CVD. Hot flushes, if a factor for cardiovascular health, could partly explain the conflict between observational and randomized trials. Several cross-sectional studies imply that hot flushes are detrimental to the cardiovascular system. However, the data are not uniform, and hot flushes were recalled retrospectively or during HT use. In our prospective study hot flushes were accompanied with a vasodilatory effect during endothelial testing, and this was related to the severity of hot flushes. Night-time hot flushes were followed with transient rises in ambulatory blood pressure (BP). However, no effect of hot flushes on diurnal BP was detected. The use of estradiol showed no harmful effects on endothelial function in women with hot flushes, but in non-flushing women oral, but not transdermal, estradiol led to vasoconstrictive changes. Estradiol complemented with medroxyprogesterone acetate eliminated the vasoconstrictive effect of sole oral estradiol. Thus, both oral and transdermal estradiol are applicable in flushing women, whereas a transdermal route should be favored in non-flushing women if used e.g. for bone protection.
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Affiliation(s)
- Pauliina Tuomikoski
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Finland
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40
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Polo-Kantola P. Sleep problems in midlife and beyond. Maturitas 2011; 68:224-32. [DOI: 10.1016/j.maturitas.2010.12.009] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 12/16/2010] [Indexed: 12/20/2022]
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Waalen J, Buxbaum JN. Is older colder or colder older? The association of age with body temperature in 18,630 individuals. J Gerontol A Biol Sci Med Sci 2011; 66:487-92. [PMID: 21324956 DOI: 10.1093/gerona/glr001] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In animal studies, caloric restriction resulting in increased longevity is associated with a reduction in body temperature, which is strain specific and likely under genetic control. Small studies in humans have suggested that temperatures may be lower among elderly populations, usually attributed to loss of thermoregulation. We analyzed cross-sectional data from 18,630 white adults aged 20-98 years (mean 58.3 years) who underwent oral temperature measurement as part of a standardized health appraisal at a large U.S. health maintenance organization. Overall, women had higher mean temperatures (97.5 ± 1.2°F) than men (97.2 ± 1.1°F; p < .0001). Mean temperature decreased with age, with a difference of 0.3°F between oldest and youngest groups after controlling for sex, body mass index, and white blood cell count. The results are consistent with low body temperature as a biomarker for longevity. Prospective studies are needed to confirm whether this represents a survival advantage associated with lifetime low steady state temperature.
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Affiliation(s)
- Jill Waalen
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA.
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Roepke TA, Bosch MA, Rick EA, Lee B, Wagner EJ, Seidlova-Wuttke D, Wuttke W, Scanlan TS, Rønnekleiv OK, Kelly MJ. Contribution of a membrane estrogen receptor to the estrogenic regulation of body temperature and energy homeostasis. Endocrinology 2010; 151:4926-37. [PMID: 20685867 PMCID: PMC2946146 DOI: 10.1210/en.2010-0573] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The hypothalamus is a key region of the central nervous system involved in the control of homeostasis, including energy and core body temperature (Tc). 17β-Estradiol (E2) regulates Tc, in part, via actions in the basal hypothalamus and preoptic area. E2 primarily controls hypothalamic functions via the nuclear steroid receptors, estrogen receptor α/β. However, we have previously described an E2-responsive, Gq-coupled membrane receptor that reduces the postsynaptic inhibitory γ-aminobutyric acid-ergic tone and attenuates postovariectomy body weight gain in female guinea pigs through the administration of a selective Gq-mER ligand, STX. To determine the role of Gq-mER in regulating Tc, energy and bone homeostasis, ovariectomized female guinea pigs, implanted ip with temperature probes, were treated with STX or E2 for 7-8 wk. Tc was recorded for 4 wk, whereas food intake and body weight were monitored daily. Bone density and fat accumulation were determined postmortem. Both E2 and STX significantly reduced Tc in the females compared with controls. STX, similar to E2, reduced food intake and fat accumulation and increased tibial bone density. Therefore, a Gq-mER-coupled signaling pathway appears to be involved in maintaining homeostatic functions and may constitute a novel therapeutic target for treatment of hypoestrogenic symptoms.
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Affiliation(s)
- Troy A Roepke
- Department of Physiology and Pharmacology, Mail Code L334, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, USA
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Abstract
During the climacteric period, several symptoms exist that motivate women to seek medical advice; one of the most common is the hot flush, which presents in 75%–85% of these during a variable time span. For the treatment of hot flush, several non-hormonal treatments exist; among them, veralipride has shown to be a useful treatment of vasomotor symptoms during the climacteric period. In recent times, several medical societies have discredited its use. The purpose of this review, therefore, is to define a measured position in relation to the use of this drug. On completion of this review, it was possible to conclude that this drug has an antidopaminergic mechanism of action. The recommended schedule is: 100 mg/day for 20 days, with 10 days drug free. Since the risk of undesirable secondary effects such as galactorrhea, mastodynia, and extrapyramidal can increase with use, no more than 3 treatment cycles are recommended. This drug has a residual effect that can allow drug-free intervals, which permit a longer time between schedules.
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Affiliation(s)
- Sebastián Carranza-Lira
- Reproductive Medicine Service. Hospital de Ginecología y Obstetricia Luis Castelazo Ayala Instituto Mexicano del Seguro Social, México DF.
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Buster JE. Transdermal menopausal hormone therapy: delivery through skin changes the rules. Expert Opin Pharmacother 2010; 11:1489-99. [PMID: 20426703 DOI: 10.1517/14656561003774098] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
IMPORTANCE TO THE FIELD Transdermal hormone therapy is replacing oral estrogens and androgens as safe enhancements of life quality for postmenopausal women. Estradiol and testosterone are dosed into the microvascular circulation directly through skin so there is no first-pass hepatic transformation or deactivation of the dosed estradiol or testosterone. AREAS COVERED IN THIS REVIEW This review critically examines recent clinical trials describing experience with transdermal estradiol and testosterone in postmenopausal women. Transdermal estradiol is effective in the treatment of vasomotor symptoms (VMS) and can provide its benefits at higher levels of safety than have been heretofore possible with oral estrogens. Transdermal testosterone is effective in the treatment of hypoactive sexual desire disorder (HSDD) documented in multiple, well-powered randomized clinical trials with demonstrated high levels of safety. WHAT THE READER WILL GAIN The reader will learn that transdermal estradiol and testosterone, in properly selected postmenopausal women, significantly and safely enhance life quality, are likely to become increasingly popular, and will probably replace oral hormone therapy. TAKE HOME MESSAGE Transdermal delivery of native estradiol for VMS and testosterone for HSDD has significant advantages in safety and efficacy over traditional oral preparations which are now available for clinical use.
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Affiliation(s)
- John E Buster
- Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Warren Alpert Medical School of Brown University, Women and Infants Hospital, 101 Dudley, Providence, Rhode Island 02905, USA.
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Abstract
OBJECTIVE No guidelines or randomized trials address best practices for hormone therapy (HT) discontinuation. METHODS We conducted a survey study to explore HT discontinuation practices at Group Health and Harvard Vanguard, large integrated health systems in the Northwest and Northeast United States, focusing on differences between specialties and study site. RESULTS The response rate to the written questionnaire (mailed between December 2005 and May 2006) was 78.5% (736/928); this article reports the results for 483 eligible physicians. To discontinue oral HT, most physicians (91%) advised tapering, not immediate cessation (8%), and most (60%) suggested decreasing both dose and days per week. Almost 60% of physicians reported no experience with tapering patches. Harvard Vanguard physicians were more likely than Group Health physicians to encourage discontinuing HT and less likely to recommend resuming HT when a woman's symptoms returned after discontinuing HT. Physicians were most strongly influenced by their own experience (48%), advice from colleagues (25%), and the woman's preference (19%) when choosing a discontinuation strategy; only 2% relied on research evidence. Physicians endorsed various approaches to manage symptoms after HT discontinuation, most often behavioral changes (44%) and increased exercise (37%), and these approaches were more often endorsed by Harvard Vanguard physicians and obstetrician/gynecologists than Group Health physicians or family practitioners or internists. CONCLUSIONS Two health plans in the Northwestern and Northeastern United States have no standard protocol for HT discontinuation. Physicians customized approaches, influenced by their location, colleagues, and specialty. Research is needed to guide approaches to HT discontinuation.
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Abstract
BACKGROUND Vasomotor symptoms are the most common complaints for which menopausal women seek medical care. Eighty per cent of all menopausal women will have hot flushes and night sweats, and of these 9% will have severe symptoms impacting their quality of life. Ideally, treatment should target the group most severely afflicted, and options for treatment should be tailored to each woman, since, for most women, vasomotor symptoms spontaneously resolve in 3 - 5 years. Recommendation at this time is for the shortest duration of therapy, which means that episodic review of therapy is indicated. OBJECTIVE To review the latest literature investigating therapies for vasomotor symptoms and to discuss their effectiveness with emphasis on placebo-controlled, randomized clinical trials. METHODS A literature search in PubMed for 'vasomotor symptoms', 'menopause symptoms', 'hot flushes', 'hot flashes' and 'night sweats' from 2003 to the present was performed. CONCLUSIONS Estrogen remains the gold standard for treating vasomotor symptoms. As investigations into the physiology of hot flushes continue, centrally active drugs (selective serotonin or norepinephrine-serotonin reuptake inhibitors and gabapentin) have increased in use. The benefit from dietary herbal supplements is still inconclusive; however, recent studies have shown some mild response to soy and black cohosh.
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Affiliation(s)
- Wen Shen
- Johns Hopkins University School of Medicine, Division of Gynecology, 600 North Wolfe Street, Phipps 249, Baltimore, MD 21287, USA .
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Skurnick JH, Weiss G, Goldsmith LT, Santoro N, Crawford S. Longitudinal changes in hypothalamic and ovarian function in perimenopausal women with anovulatory cycles: relationship with vasomotor symptoms. Fertil Steril 2009; 91:1127-34. [DOI: 10.1016/j.fertnstert.2008.01.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 01/07/2008] [Accepted: 01/07/2008] [Indexed: 11/15/2022]
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Palacio C, Masri G, Mooradian AD. Black cohosh for the management of menopausal symptoms : a systematic review of clinical trials. Drugs Aging 2009; 26:23-36. [PMID: 19102512 DOI: 10.2165/0002512-200926010-00002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Alternative medicine preparations represent a significant industry worldwide. Black cohosh (Cimicifuga racemosa), a buttercup plant grown in North America, is one such popular preparation for the treatment of menopausal symptoms. Because the proportion of women experiencing climacteric symptoms is high, black cohosh merits further study as to its efficacy and safety. Convincing evidence for its efficacy in this setting remains to be demonstrated. The purpose of this systematic review was to assess the current literature on the benefits of black cohosh for women experiencing climacteric symptoms. To this end, a PubMed search was conducted on 1 November 2007 using the search terms 'black cohosh' AND 'menopause'. The search was limited to randomized controlled trials in the English language involving adults. Several additional reviews dealing with alternative therapies for menopause were included to capture additional older and non-English language literature. Ultimately, 16 studies eligible for review were identified. Many of the studies had conflicting results. Methodological flaws included lack of uniformity of the drug preparation used, variable outcome measures and lack of a placebo group. The benefits of black cohosh in the management of climacteric symptoms remain to be proven. Case studies suggest an additional unexplored area of adverse events that also needs to be addressed.
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Affiliation(s)
- Carlos Palacio
- Department of Medicine, University of Florida, College of Medicine, Jacksonville, Florida, USA.
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Kopper NW, Gudeman J, Thompson DJ. Transdermal hormone therapy in postmenopausal women: a review of metabolic effects and drug delivery technologies. DRUG DESIGN DEVELOPMENT AND THERAPY 2009; 2:193-202. [PMID: 19920906 PMCID: PMC2761184 DOI: 10.2147/dddt.s4146] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Vasomotor symptoms (VMS) associated with menopause can cause significant discomfort and decrease the quality of life for women in the peri-menopausal and post-menopausal stages of life. Hormone therapy (HT) is the mainstay of treatment for menopausal symptoms and is currently the only therapy proven effective for VMS. Numerous HT options are available to treat VMS, including estrogen-only and estrogen-progestogen combination products to meet the needs of both hysterectomized and nonhysterectomized women. In addition to selecting an appropriate estrogen or estrogen-progestogen combination, consideration should be given to the route of administration to best suit the needs of the patient. Delivery systems for hormone therapy include oral tablets, transdermal patches, transdermal topical (nonpatch) products, and intravaginal preparations. Oral is currently the most commonly utilized route of administration in the United States. However, evidence suggests that oral delivery may lead to some undesirable physiologic effects caused by significant gut and hepatic metabolism. Transdermal drug delivery may mitigate some of these effects by avoiding gut and hepatic first-pass metabolism. Advantages of transdermal delivery include the ability to administer unmetabolized estradiol directly to the blood stream, administration of lower doses compared to oral products, and minimal stimulation of hepatic protein production. Several estradiol transdermal delivery technologies are available, including various types of patches, topical gels, and a transdermal spray.
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Affiliation(s)
- Nathan W Kopper
- KV Pharmaceutical, 2503 South Hanley Road, St. Louis, MO 63144, USA.
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Bosch MA, Hou J, Fang Y, Kelly MJ, Rønnekleiv OK. 17Beta-estradiol regulation of the mRNA expression of T-type calcium channel subunits: role of estrogen receptor alpha and estrogen receptor beta. J Comp Neurol 2009; 512:347-58. [PMID: 19003958 PMCID: PMC2821194 DOI: 10.1002/cne.21901] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Low-voltage-activated (T-type) calcium channels are responsible for burst firing and transmitter release in neurons and are important for exocytosis and hormone secretion in pituitary cells. T-type channels contain an alpha1 subunit, of which there are three subtypes, Cav3.1, -3.2, and -3.3, and each subtype has distinct kinetic characteristics. Although 17beta-estradiol (E2) modulates T-type calcium channel expression and function, little is known about the molecular mechanisms involved. We used real-time PCR quantification of RNA extracted from hypothalamic nuclei and pituitary in vehicle and E2-treated C57BL/6 mice to elucidate E2-mediated regulation of Cav3.1, -3.2, and -3.3 subunits. The three subunits were expressed in both the hypothalamus and the pituitary. E2 treatment increased the mRNA expression of Cav3.1 and -3.2, but not Cav3.3, in the medial preoptic area and the arcuate nucleus. In the pituitary, Cav3.1 was increased with E2 treatment, and Cav3.2 and -3.3 were decreased. To examine whether the classical estrogen receptors (ERs) were involved in the regulation, we used ERalpha- and ERbeta-deficient C57BL/6 mice and explored the effects of E2 on T-type channel subtypes. Indeed, we found that the E2-induced increase in Cav3.1 in the hypothalamus was dependent on ERalpha, whereas the E2 effect on Cav3.2 was dependent on both ERalpha and ERbeta. However, the E2-induced effects in the pituitary were dependent on only the expression of ERalpha. The robust E2 regulation of T-type calcium channels could be an important mechanism by which E2 increases the excitability of hypothalamic neurons and modulates pituitary secretion.
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Affiliation(s)
- Martha A Bosch
- Department of Physiology and Pharmacology, Oregon Health and Science University, Portland, Oregon 97239, USA
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