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Kawakita T, Yasui T, Yoshida K, Matsui S, Iwasa T. Correlations of androstenediol with reproductive hormones and cortisol according to stages during the menopausal transition in Japanese women. J Steroid Biochem Mol Biol 2021; 214:106009. [PMID: 34571175 DOI: 10.1016/j.jsbmb.2021.106009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Abstract
Associations of androstenediol, which has both androgenic and estrogenic activities, with circulating reproductive hormones and stress hormone in women during the menopausal transition may be different depending on the menopausal stage. The aim of this study was to determine the changes in circulating androstenediol during the menopausal transition in Japanese women and the associations of androstenediol with estrogen, androgen and cortisol for each stage of the menopausal transition. We divided the 104 subjects into 6 stages by menstrual regularity and follicle-stimulating hormone level: mid reproductive stage, late reproductive stage, early menopausal transition, late menopausal transition, very early postmenopause and early postmenopause. Levels of dehydroepiandrosterone sulfate (DHEAS), estradiol, estrone, testosterone (T), free T, androstenedione and cortisol were measured. Serum androstenediol concentration was measured by using liquid chromatography mass spectrometry. There were no significant differences in androstenediol levels among the 6 stages. Levels of DHEA-S and testosterone showed significant and positive correlations with androstenediol in all stages. Estradiol levels showed negative correlations with androstenediol levels in the late menopausal transition and very early postmenopause (r=-0.452, p = 0.052 and r=-0.617, p = 0.006, respectively). Cortisol levels showed significant and positive correlations with androstenediol levels in the mid and late reproductive stages (r = 0.719, p = 0.003 and r = 0.808, p < 0.001, respectively).The associations of androstenediol with estradiol and cortisol were different depending on the stage of the menopausal transition. Androstenediol may play a compensatory role for estrogen deficiency from late menopausal transition to very early postmenopause.
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Affiliation(s)
- Takako Kawakita
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, The University of Tokushima Graduate School, Japan.
| | - Toshiyuki Yasui
- Department of Reproductive and Menopausal Medicine, Institute of Biomedical Sciences, The University of Tokushima Graduate School, Japan
| | - Kanako Yoshida
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, The University of Tokushima Graduate School, Japan
| | - Sumika Matsui
- Department of Obstetrics and Gynecology, Tokushima Red Cross Hospital, Japan
| | - Takeshi Iwasa
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, The University of Tokushima Graduate School, Japan
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Zhao W, Smith JA, Yu M, Crandall CJ, Thurston RC, Hood MM, Ruiz-Narvaez E, Peyser PA, Kardia SL, Harlow SD. Genetic variants predictive of reproductive aging are associated with vasomotor symptoms in a multiracial/ethnic cohort. Menopause 2021; 28:883-892. [PMID: 33906203 PMCID: PMC8373653 DOI: 10.1097/gme.0000000000001785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Vasomotor symptoms (VMS), hot flashes, and night sweats are cardinal symptoms of the menopausal transition. Little is known about genetic influences on VMS. This study evaluated whether previously identified genetic factors predictive of VMS, age at menarche, and age at menopause were associated with VMS in a multiracial/ethnic cohort. METHODS For 702 White, 306 Black, 126 Chinese, and 129 Japanese women from the Study of Women's Health Across the Nation (SWAN) Genomic Substudy, we created polygenic risk scores (PRSs) from genome-wide association studies of VMS and ages at menarche and menopause. PRSs and single nucleotide polymorphisms (SNPs) from a previously identified VMS locus (tachykinin receptor 3 [TACR3]) were evaluated for associations with frequent VMS (VMS ≥6 days in the past 2 weeks at any visit) and with VMS trajectories (persistently low, early onset, final menstrual period onset, persistently high). RESULTS The C-allele of rs74827081 in TACR3 was associated with reduced likelihood of frequent VMS in White women (odds ratio [OR] = 0.49 [95% CI, 0.29-0.83]). With higher menarche PRS (later menarche), Black women were less likely (OR = 0.55 [95% CI, 0.38-0.78]) to report frequent VMS. With higher PRS for age at menarche, Black women were also less likely to have a persistently high VMS trajectory (OR = 0.55 [95% CI, 0.34-0.91]), whereas White women (OR = 0.75 [95% CI, 0.58-0.98]) were less likely to have a final menstrual period onset trajectory (vs persistently low). Chinese women with higher menopause PRS were more likely to have frequent VMS (OR = 2.29 [95% CI, 1.39-3.78]). Associations were substantively similar after excluding rs74827081 C-allele carriers. CONCLUSIONS Genetic factors predictive of reproductive aging are also associated with VMS, suggesting that VMS have a polygenic architecture. Further study in this area may help to identify new targets for novel VMS therapies.
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Affiliation(s)
- Wei Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109
| | - Jennifer A. Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109
| | - Miao Yu
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109
| | - Carolyn J. Crandall
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, 90024
| | - Rebecca C. Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
| | - Michelle M. Hood
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109
| | - Edward Ruiz-Narvaez
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, 48109
| | - Patricia A. Peyser
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109
| | - Sharon L.R. Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109
| | - Sioban D. Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109
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Crandall CJ, Diamant AL, Maglione M, Thurston RC, Sinsheimer J. Genetic Variation and Hot Flashes: A Systematic Review. J Clin Endocrinol Metab 2020; 105:dgaa536. [PMID: 32797194 PMCID: PMC7538102 DOI: 10.1210/clinem/dgaa536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/10/2020] [Indexed: 12/26/2022]
Abstract
CONTEXT Approximately 70% of women report experiencing vasomotor symptoms (VMS, hot flashes and/or night sweats). The etiology of VMS is not clearly understood but may include genetic factors. EVIDENCE ACQUISITION We searched PubMed and Embase in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. We included studies on associations between genetic variation and VMS. We excluded studies focused on medication interventions or prevention or treatment of breast cancer. EVIDENCE SYNTHESIS Of 202 unique citations, 18 citations met the inclusion criteria. Study sample sizes ranged from 51 to 17 695. Eleven of the 18 studies had fewer than 500 participants; 2 studies had 1000 or more. Overall, statistically significant associations with VMS were found for variants in 14 of the 26 genes assessed in candidate gene studies. The cytochrome P450 family 1 subfamily A member 1 (CYP1B1) gene was the focus of the largest number (n = 7) of studies, but strength and statistical significance of associations of CYP1B1 variants with VMS were inconsistent. A genome-wide association study reported statistically significant associations between 14 single-nucleotide variants in the tachykinin receptor 3 gene and VMS. Heterogeneity across trials regarding VMS measurement methods and effect measures precluded quantitative meta-analysis; there were few studies of each specific genetic variant. CONCLUSIONS Genetic variants are associated with VMS. The associations are not limited to variations in sex-steroid metabolism genes. However, studies were few and future studies are needed to confirm and extend these findings.
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Affiliation(s)
- Carolyn J Crandall
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - Allison L Diamant
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | | | - Rebecca C Thurston
- University of Pittsburgh School of Medicine & Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Janet Sinsheimer
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
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Cathcart-Rake E, Novotny P, Leon-Ferre R, Le-Rademacher J, Storrick EM, Adjei AA, Terstriep S, Glaser R, Giuliano A, Mitchell WR, Page S, Austin C, Deming RL, Ferreira MA, Lafky JM, Birrell SN, Loprinzi CL. A randomized, double-blind, placebo-controlled trial of testosterone for treatment of postmenopausal women with aromatase inhibitor-induced arthralgias: Alliance study A221102. Support Care Cancer 2020; 29:387-396. [PMID: 32372176 DOI: 10.1007/s00520-020-05473-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/14/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate the efficacy of testosterone supplementation for improving aromatase inhibitor musculoskeletal symptoms (AIMSS). METHODS Postmenopausal women experiencing moderate-to-severe arthralgias while taking adjuvant aromatase inhibitors for breast cancer were enrolled in this trial. Initially, patients were randomly allocated to receive either a subcutaneous testosterone pellet versus a placebo pellet. Due to slow accrual, the protocol was modified such that additional participants were randomized to receive either a topical testosterone gel or a placebo gel. Changes in patient-reported joint pain were compared between patients receiving testosterone and those receiving placebo using a two-sample t test. Changes in hot flashes and other vasomotor symptoms were also analyzed. Further analyses were conducted to evaluate whether 27 single nucleotide polymorphisms (SNPs) in 14 genes previously associated with AIMSS were associated with testosterone supplementation benefit. RESULTS While 64% of patients reported an improvement in joint pain at 3 months, there were no significant differences in average pain or joint stiffness at 3 or 6 months between testosterone and placebo arms. Patients receiving testosterone did report improvements in strength, lack of energy, urinary frequency, and stress incontinence (p < 0.05). The subset of patients receiving subcutaneous testosterone also experienced improvements in hot flashes and mood swings. An inherited variant (rs7984870 CC genotype) in TNFSF11 was more likely to be associated with improvements in hot flashes in patients receiving testosterone. CONCLUSION The doses of testosterone supplementation used in this study did not significantly improve AIMSS. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01573442.
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Affiliation(s)
| | - Paul Novotny
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | - Rebecca Glaser
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | | | - William R Mitchell
- Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC, USA
| | - Seth Page
- Wichita NCI Community Oncology Research Program, Wichita, KS, USA
| | | | | | | | | | - Stephen N Birrell
- The Breast and Endocrine Centre, Toorak Gardens, South Australia, Australia
| | - Charles L Loprinzi
- Mayo Clinic, Rochester, MN, USA. .,Department of Medical Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, USA.
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Costanian C, Zangiabadi S, Bahous SA, Deonandan R, Tamim H. Reviewing the evidence on vasomotor symptoms: the role of traditional and non-traditional factors. Climacteric 2020; 23:213-223. [DOI: 10.1080/13697137.2019.1711051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- C. Costanian
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - S. Zangiabadi
- School of Kinesiology & Health Science, York University, Toronto, ON, Canada
| | - S. A. Bahous
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - R. Deonandan
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - H. Tamim
- School of Kinesiology & Health Science, York University, Toronto, ON, Canada
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Slopien R, Owecki M, Slopien A, Bala G, Meczekalski B. Climacteric symptoms are related to thyroid status in euthyroid menopausal women. J Endocrinol Invest 2020; 43:75-80. [PMID: 31392574 PMCID: PMC6952338 DOI: 10.1007/s40618-019-01078-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Climacteric symptoms are a variety of disturbing complaints occurring during menopausal transition, many of which may be influenced by hormonal abnormalities other than related to sex steroids. AIM OF THE STUDY In this study, we investigated the association between the intensity of climacteric symptoms measured with the Kupperman index and a thyroid status. MATERIAL AND METHODS We evaluated by measuring serum thyrotropin (TSH), and free thyroxine (fT4) 202 euthyroid women admitted to the Department of Gynecological Endocrinology, Poznan University of Medical Sciences because of climacteric symptoms. Patients were both in perimenopause (n = 74) and postmenopause (n = 128), with no history of thyroid disorders. RESULTS Results presented as the mean value and standard deviation were as follows: age 54.2 ± 4.9 years, BMI 26.8 ± 4.6 kg/m2, Kupperman index 26 ± 13.1 points, TSH 2.4 ± 2.6 mU/l, fT4 1.2 ± 0.37 ng/dl. We observed a negative correlation between fT4 and the time since the last menses (R = - 0.38; p = 0.02) as well as between serum TSH concentration and sweating (R = - 0.18; p = 0.03), general weakness (R = - 0.17; p = 0.03), and palpitation (R = - 0.18; p = 0.02) and a positive correlation between fT4 and nervousness (R = 0.34; p = 0.007) and palpitations (R = 0.25; p = 0.04). In the perimenopausal subgroup, there was a positive correlation between fT4 and general weakness (R = 0.42; p = 0.03), palpitations (R = 0.50; p = 0.009), and paresthesia (R = 0.46; p = 0.01). In the postmenopausal subgroup, there was a negative correlation between TSH and sweating (R = - 0.21; p = 0.03). CONCLUSIONS Menopausal symptoms are related to thyroid status in euthyroid menopausal women.
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Affiliation(s)
- R Slopien
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland.
| | - M Owecki
- Department of Public Health, Poznan University of Medical Sciences, Poznan, Poland
| | - A Slopien
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - G Bala
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - B Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
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Abstract
OBJECTIVE The aim of this study was to examine interactions between hot flushes, estrogen plus progestogen therapy (EPT), and coronary heart disease (CHD) events in postmenopausal women with CHD. METHODS We analyzed data from the Heart and Estrogen/Progestin Replacement Study, a randomized, placebo-controlled trial of 0.625 mg conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate in 2,763 postmenopausal women with CHD. Hot flushes were assessed at baseline using self-administered questionnaires; women reporting bothersome hot flushes "some" to "all" of the time were considered to have clinically significant flushing. Cox regression models were used to examine the effect of EPT on risk of CHD events among women with and without significant flushing at baseline. RESULTS The mean age of participants was 66.7 ± 6.8 years, and 89% (n = 2,448) were white. Sixteen percent (n = 434) of participants reported clinically significant hot flushes at baseline. Among women with baseline flushing, EPT increased risk of CHD events nine-fold in the first year compared with placebo (hazard ratio = 9.01; 95% CI, 1.15-70.35); among women without baseline flushing, treatment did not significantly affect CHD event risk in the first year (hazard ratio = 1.32; 95% CI, 0.86-2.03; P = 0.07 for interaction of hot flushes with treatment). The trend toward differential effects of EPT on risk for CHD among women with and without baseline flushing did not persist after the first year of treatment. CONCLUSIONS Among older postmenopausal women with CHD, EPT may increase risk of CHD events substantially in the first year of treatment among women with clinically significant hot flushes but not among those without hot flushes.
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El Khoudary SR, Greendale G, Crawford SL, Avis NE, Brooks MM, Thurston RC, Karvonen-Gutierrez C, Waetjen LE, Matthews K. The menopause transition and women's health at midlife: a progress report from the Study of Women's Health Across the Nation (SWAN). Menopause 2019; 26:1213-1227. [PMID: 31568098 PMCID: PMC6784846 DOI: 10.1097/gme.0000000000001424] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Our initial understanding of the menopause transition (MT) has been framed by clinical samples of women seeking treatment rather than by population-based studies. The Study of Women's Health Across the Nation (SWAN) initiated in 1996 with an overall goal to define the MT, to characterize its biological and psychosocial antecedents and sequelae in an ethnically and racially diverse sample of midlife women. METHODS This review summarizes the central findings of SWAN to date that can inform women and their healthcare providers about the impact of the MT and midlife aging on overall health and well-being. RESULTS SWAN characterized changes in reproductive axis and menstrual cycle patterns that informed the development of the reproductive aging staging system Staging of Reproductive Aging Workshop+10; MT-related symptoms and mental health (vasomotor symptoms, sleep complaints, psychological symptoms, cognitive performance, and urogenital and sexual health); and physiological systems and functions (cardiovascular and cardiometabolic health, bone health, physical function performance) that are influenced by the MT. SWAN demonstrated substantial interrelations among these changes and significant racial/ethnic differences in the rate and magnitude of change in multiple health indictors in midlife women. The findings point to midlife as a critical stage for adopting healthy behavior and preventive strategies. CONCLUSIONS Over the past 23 years, SWAN has advanced our understanding of the impact of the MT and midlife aging on health and well-being in women. SWAN will be instrumental to determine whether MT-related changes during midlife are related to unfavorable health and well-being in early old age.
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Affiliation(s)
- Samar R. El Khoudary
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA
| | - Gail Greendale
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sybil L. Crawford
- University of Massachusetts Medical School, Graduate School of Nursing, Worcester, MA
| | - Nancy E. Avis
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Maria M. Brooks
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA
| | - Rebecca C. Thurston
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | | | - L. Elaine Waetjen
- Department of Obstetrics and Gynecology, University of California Davis School of Medicine, Sacramento, CA
| | - Karen Matthews
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
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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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The association of an alpha2C adrenoreceptor gene polymorphism with vasomotor symptoms in African American women. Menopause 2018; 26:300-305. [PMID: 30277919 DOI: 10.1097/gme.0000000000001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The alpha2C adrenoreceptor deletion 322-325 (ADRA2C del 322-325) polymorphism has been associated with autonomic activity and thermoregulation, which are implicated in the vasomotor symptom (VMS) mechanism. The ADRA2C del (322-325) has higher prevalence in African American women, a group known to experience more frequent and bothersome VMS. We assessed whether the ADRA2C del (322-325) genotype is associated with increased frequency of VMS in African American women. METHODS DNA samples from African American (N = 400) women participating in the Study of Women's Health Across the Nation (SWAN) were genotyped for the ADRA2C del (322-325) polymorphism. Longitudinal data on VMS were obtained from the SWAN repository. The relation of ADRA2C del (322-325) genotypes (deletion/deletion [D/D]; insertion/deletion [I/D]; insertion/insertion [I/I]) with VMS over the menopausal transition for up to 12 years of follow-up was examined using generalized estimating equations. Primary models considered the outcome of frequent VMS (6 or more days in the prior 2 wk vs VMS <6 d in the prior 2 wk) by stage of menopause. RESULTS Four hundred DNA samples from African American women were included. Seventy-five women (18.8%) were found to carry the homozygous variant allele (D/D). There was no significant difference in the trajectory of frequent VMS over the menopausal transition between women with D/D and I/I + I/D genotypes (P = 0.39). CONCLUSIONS In this preliminary study among African American women in SWAN, ADRA2C del (322-325) was not significantly related to self-reported VMS. Further studies are warranted to help us understand the role of the adrenergic system in the physiology of VMS to tailor medical therapy to patient needs.
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Woods NF, Cray LA, Mitchell ES, Farrin F, Herting J. Polymorphisms in Estrogen Synthesis Genes and Symptom Clusters During the Menopausal Transition and Early Postmenopause: Observations From the Seattle Midlife Women's Health Study. Biol Res Nurs 2018; 20:153-160. [PMID: 29334760 PMCID: PMC5942527 DOI: 10.1177/1099800417753536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
During the menopausal transition and early postmenopause, participants in the Seattle Midlife Women's Health Study (SMWHS) experienced one of the three symptom severity clusters identified through latent class analysis: severe hot flashes with moderate sleep, mood, cognitive, and pain symptoms (high-severity hot flash); low-severity hot flashes with moderate levels of all other symptom groups (moderate severity); and low levels of all symptom groups (low severity). In an effort to determine whether gene polymorphisms were associated with these symptom severity classes, we tested associations between gene polymorphisms in the estrogen synthesis pathways (cytochrome P450 19 [CYP 19] and 17 beta hydroxysteroid dehydrogenase [ 17HSDB1]) and the three symptom severity clusters. SMWHS participants ( N = 137) recorded symptoms monthly in diaries and provided buccal smears for genotyping. Multilevel latent class analysis with multinomial regression was used to determine associations between gene polymorphisms and symptom severity clusters. Only the 17HSDB1 polymorphisms ( rs615942 and rs592389) were associated significantly with the high-severity hot flash cluster versus the low-severity symptom cluster. None of the polymorphisms was associated with the moderate-severity cluster versus the low-severity symptom cluster. Findings of associations of the 17HSDB1 polymorphisms with the high-severity hot flash symptom cluster are consistent with those of an association between 17HSDB1 polymorphisms and hot flashes in the Study of Women and Health Across the Nation population and our previous findings of associations between these polymorphisms with greater estrone levels.
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Affiliation(s)
| | - Lori A Cray
- 2 College of Nursing, Seattle University, Seattle, WA, USA
| | | | - Fred Farrin
- 3 Department of Environmental and Occupational Health Sciences, Center for Ecogenetics and Environmental Health, University of Washington, Seattle, WA, USA
| | - Jerald Herting
- 4 Department of Sociology, University of Washington, Seattle, WA, USA
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12
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The time has come for a safe, effective way to relieve menopausal symptoms. Menopause 2017; 24:1113-1115. [DOI: 10.1097/gme.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Crandall CJ, Manson JE, Hohensee C, Horvath S, Wactawski-Wende J, LeBlanc ES, Vitolins MZ, Nassir R, Sinsheimer JS. Association of genetic variation in the tachykinin receptor 3 locus with hot flashes and night sweats in the Women's Health Initiative Study. Menopause 2017; 24:252-261. [PMID: 28231077 PMCID: PMC5327841 DOI: 10.1097/gme.0000000000000763] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Vasomotor symptoms (VMS, ie, hot flashes or night sweats) are reported by many, but not all, women. The extent to which VMS are genetically determined is unknown. We evaluated the relationship of genetic variation and VMS. METHODS In this observational study, we accessed data from three genome-wide association studies (GWAS) (SNP Health Association Resource cohort [SHARe], WHI Memory Study cohort [WHIMS+], and Genome-Wide Association Studies of Treatment Response in Randomized Clinical Trials [GARNET] studies, total n = 17,695) of European American, African American, and Hispanic American postmenopausal women aged 50 to 79 years at baseline in the Women's Health Initiative Study. We examined genetic variation in relation to VMS (yes/no) in each study and using trans-ethnic inverse variance fixed-effects meta-analysis. A total of 11,078,977 single-nucleotide polymorphisms (SNPs) met the quality criteria. RESULTS After adjustment for covariates and population structure, three SNPs (on chromosomes 3 and 11) were associated with VMS at the genome-wide threshold of 5 × 10 in the African American SHARe GWAS, but were not associated in the other cohorts. In the meta-analysis, 14 SNPs, all located on chromosome 4 in the tachykinin receptor 3 (TACR3) locus, however, had P < 5 × 10. These SNPs' effect sizes were similar across studies/participants' ancestry (odds ratio ∼1.5). CONCLUSIONS Genetic variation in TACR3 may contribute to the risk of VMS. To our knowledge, this is the first GWAS to examine SNPs associated with VMS. These results support the biological hypothesis of a role for TACR3 in VMS, which was previously hypothesized from animal and human studies. Further study of these variants may lead to new insights into the biological pathways involved in VMS, which are poorly understood.
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Affiliation(s)
- Carolyn J. Crandall
- Dept. of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90024, USA
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, 02215, USA
| | - Chancellor Hohensee
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Steve Horvath
- Dept. of Human Genetics and Biostatistics, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90024, USA
| | - Jean Wactawski-Wende
- Dept. of Epidemiology and Environmental Health, University at Buffalo, the State University of NY, Buffalo, NY, 14214, USA
| | - Erin S. LeBlanc
- Center for Health Research NW, Kaiser Permanente, Portland, OR, 97239, USA
| | - Mara Z. Vitolins
- Dept of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Rami Nassir
- Department of Biochemistry and Molecular Medicine, University of California-Davis Davis, CA, 95616, USA
| | - Janet S. Sinsheimer
- Dept. of Human Genetics and Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90024, USA
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Loja-Chango R, Pérez-López FR, Simoncini T, Escobar GS, Chedraui P. Increased mood symptoms in postmenopausal women related to the polymorphism rs743572 of the CYP17 A1 gene. Gynecol Endocrinol 2016; 32:827-830. [PMID: 27117436 DOI: 10.1080/09513590.2016.1177015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Menopausal and depressive symptoms are highly prevalent after the menopause; but may vary from one population to another and genetics play a key role. OBJECTIVE To analyze the intensity of these symptoms in relation to the genetic variants of the rs743572 polymorphism of the CYP17 A1 gene in postmenopausal women. METHODS DNA was extracted from the whole blood of 168 natural postmenopausal women (40-65 years) and tested for the rs743572 polymorphism of the CYP17 A1 gene. Intensity of menopausal (Menopause Rating Scale, MRS) and depressive symptoms (Hospital Anxiety and Depressive Scale, HADS) were correlated to polymorphism genotypes. RESULTS Women with the GG genotype of the rs743572 polymorphism displayed significantly higher scores for the MRS (items 5 and 6 [irritability and anxiety] and the psychological subscale) and the HADS (total and subscales). CONCLUSION The intensity of menopausal symptoms related to mood was found higher among postmenopausal women presenting the GG genotype of the rs743572 polymorphism of the CYP17 A1 gene. There is a need for more research in this regard.
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Affiliation(s)
- Rita Loja-Chango
- a Facultad de Ciencias Médicas , Institute of Biomedicine, Research Area for Women's Health, Universidad Católica de Santiago de Guayaquil, Enrique C. Sotomayor Obstetrics and Gynecology Hospital , Guayaquil , Ecuador
| | - Faustino R Pérez-López
- b Department of Obstetrics and Gynecology , Facultad de Medicina, Universidad de Zaragoza, Lozano Blesa University Hospital , Zaragoza , Spain , and
| | - Tommaso Simoncini
- c Department of Clinical and Experimental Medicine , Division of Obstetrics and Gynecology, University of Pisa , Pisa , Italy
| | - Gustavo S Escobar
- a Facultad de Ciencias Médicas , Institute of Biomedicine, Research Area for Women's Health, Universidad Católica de Santiago de Guayaquil, Enrique C. Sotomayor Obstetrics and Gynecology Hospital , Guayaquil , Ecuador
| | - Peter Chedraui
- a Facultad de Ciencias Médicas , Institute of Biomedicine, Research Area for Women's Health, Universidad Católica de Santiago de Guayaquil, Enrique C. Sotomayor Obstetrics and Gynecology Hospital , Guayaquil , Ecuador
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Sievert LL, Begum K, Sharmeen T, Murphy L, Whitcomb BW, Chowdhury O, Muttukrishna S, Bentley GR. Hot flash report and measurement among Bangladeshi migrants, their London neighbors, and their community of origin. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 161:620-633. [DOI: 10.1002/ajpa.23062] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/26/2016] [Indexed: 12/16/2022]
Affiliation(s)
- L. L. Sievert
- Department of AnthropologyUniversity of MassachusettsAmherst Massachusetts
| | - K. Begum
- Department of AnthropologyUniversity College LondonLondon United Kingdom
| | - T. Sharmeen
- Department of AnthropologyUniversity College LondonLondon United Kingdom
| | - L. Murphy
- Department of AnthropologyUniversity of MassachusettsAmherst Massachusetts
| | - B. W. Whitcomb
- School of Public HealthUniversity of MassachusettsAmherst Massachusetts
| | | | - S. Muttukrishna
- Department of Obstetrics and GynecologyUniversity College CorkCork Ireland
| | - G. R. Bentley
- Department of AnthropologyDurham UniversityDurham United Kingdom
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Current knowledge of the multifunctional 17β-hydroxysteroid dehydrogenase type 1 (HSD17B1). Gene 2016; 588:54-61. [PMID: 27102893 DOI: 10.1016/j.gene.2016.04.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 02/10/2016] [Accepted: 04/11/2016] [Indexed: 02/06/2023]
Abstract
At the late 1940s, 17β-HSD1 was discovered as the first member of the 17β-HSD family with its gene cloned. The three-dimensional structure of human 17β-HSD1 is the first example of any human steroid converting enzyme. The human enzyme's structure and biological function have thus been studied extensively in the last two decades. In humans, the enzyme is expressed in placenta, ovary, endometrium and breast. The high activity of estrogen activation provides the basis of 17β-HSD1's implication in estrogen-dependent diseases, such as breast cancer, endometriosis and non-small cell lung carcinomas. Its dual function in estrogen activation and androgen inactivation has been revealed in molecular and breast cancer cell levels, significantly stimulating the proliferation of such cells. The enzyme's overexpression in breast cancer was demonstrated by clinical samples. Inhibition of human 17β-HSD1 led to xenograft tumor shrinkage. Unfortunately, through decades of studies, there is still no drug using the enzyme's inhibitors available. This is due to the difficulty to get rid of the estrogenic activity of its inhibitors, which are mostly estrogen analogues. New non-steroid inhibitors for the enzyme provide new hope for non-estrogenic inhibitors of the enzyme.
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Winham SJ, de Andrade M, Miller VM. Genetics of cardiovascular disease: Importance of sex and ethnicity. Atherosclerosis 2015; 241:219-28. [PMID: 25817330 DOI: 10.1016/j.atherosclerosis.2015.03.021] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/03/2015] [Accepted: 03/08/2015] [Indexed: 12/11/2022]
Abstract
Sex differences in incidence and prevalence of and morbidity and mortality from cardiovascular disease are well documented. However, many studies examining the genetic basis for cardiovascular disease fail to consider sex as a variable in the study design, in part, because there is an inherent difficulty in studying the contribution of the sex chromosomes in women due to X chromosome inactivation. This paper will provide general background on the X and Y chromosomes (including gene content, the pseudoautosomal regions, and X chromosome inactivation), discuss how sex chromosomes have been ignored in Genome-wide Association Studies (GWAS) of cardiovascular diseases, and discuss genetics influencing development of cardiovascular risk factors and atherosclerosis with particular attention to carotid intima-medial thickness, and coronary arterial calcification based on sex-specific studies. In addition, a brief discussion of how ethnicity and hormonal status act as confounding variables in sex-based analysis will be considered along with methods for statistical analysis to account for sex in cardiovascular disease.
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Affiliation(s)
- Stacey J Winham
- Health Sciences Research, Division of Biostatistics and Informatics, Mayo Clinic, Rochester, MN 55905, USA
| | - Mariza de Andrade
- Health Sciences Research, Division of Biostatistics and Informatics, Mayo Clinic, Rochester, MN 55905, USA
| | - Virginia M Miller
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA.
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Montasser ME, Ziv-Gal A, Brown JP, Flaws JA, Merchenthaler I. A potentially functional variant in the serotonin transporter gene is associated with premenopausal and perimenopausal hot flashes. Menopause 2015; 22:108-13. [PMID: 25026114 PMCID: PMC4270913 DOI: 10.1097/gme.0000000000000291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE An increase in the use of selective serotonin reuptake inhibitors (SSRIs) and/or serotonin-norepinephrine reuptake inhibitors (SNRIs) to relieve menopausal hot flashes (HFs) has been observed recently. However, response to them has been heterogeneous. We hypothesized that this heterogeneity might be partially attributed to genetic variations in genes encoding the serotonin and/or norepinephrine transporters (SLC6A4 and SLC6A2). As a first step in testing the role of genetics in response to SSRIs/SNRIs, we examined the association between HFs and genetic variants within these two genes. METHODS We tested 29 haplotype-tagging single nucleotide polymorphisms within SLC6A4 and SLC6A2 for their association with HFs separately for European-American (396 cases and 392 controls) and African-American (125 cases and 81 controls) premenopausal and perimenopausal women. RESULTS We found that the minor allele of SLC6A4_rs11080121 was associated with protection against HFs (odds ratio, 0.75; 95% CI, 0.60-0.94) only in European-American women. Bioinformatics analyses indicated that rs11080121 is fully correlated with rs1042173 in the 3' untranslated region of SLC6A4. The minor allele of rs1042173 seems to disrupt a conserved binding site for hsa-miR-590-3p microRNA. CONCLUSIONS Disruption of a microRNA binding site leads to higher expression of SLC6A4, higher expression of SLC6A4 leads to depletion of serotonin in synaptic clefts, and depletion of serotonin triggers the presynaptic autoreceptor feedback mechanism to produce more serotonin, which is protective against HFs. This is the first study to test the association between HFs in both European-American and African-American premenopausal and perimenopausal women and genetic variants in two neurotransmitter transporter genes, SLC6A2 and SLC6A4. This information can be used in tailoring the pharmaceutical use of SSRIs/SNRIs for HF relief.
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Affiliation(s)
- May E Montasser
- Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD
| | - Ayelet Ziv-Gal
- Department of Comparative Biosciences, University of Illinois, Urbana, IL
| | - Jessica P Brown
- Department of Epidemiology & Public Health, University of Maryland, School of Medicine, Baltimore, MD
| | - Jodi A Flaws
- Department of Comparative Biosciences, University of Illinois, Urbana, IL
| | - Istvan Merchenthaler
- Department of Epidemiology & Public Health, University of Maryland, School of Medicine, Baltimore, MD
- Department of Anatomy & Neurobiology, University of Maryland, School of Medicine, Baltimore, MD
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Krause MS, Nakajima ST. Hormonal and nonhormonal treatment of vasomotor symptoms. Obstet Gynecol Clin North Am 2014; 42:163-79. [PMID: 25681847 DOI: 10.1016/j.ogc.2014.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article focuses on the cause, pathophysiology, differential diagnosis of, and treatment options for vasomotor symptoms. In addition, it summarizes important points for health care providers caring for perimenopausal and postmenopausal women with regard to health maintenance, osteoporosis, cardiovascular disease, and vaginal atrophy. Treatment options for hot flashes with variable effectiveness include systemic hormone therapy (estrogen/progestogen), nonhormonal pharmacologic therapies (selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors, clonidine, gabapentin), and nonpharmacologic therapy options (behavioral changes, acupuncture). Risks and benefits as well as contraindications for hormone therapy are further discussed.
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Affiliation(s)
- Miriam S Krause
- Fertility and Endocrine Associates, 4121 Dutchman's Lane, Suite 414, Louisville, KY 40207, USA.
| | - Steven T Nakajima
- Stanford Fertility and Reproductive Medicine Center, 900 Welch Road, Suite 20, Palo Alto, CA 94304, USA
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Ojeda E, Blümel JE, Vallejo MS, Lavín P. Climacteric symptoms in Quechua and Mestizo women from the Andean region of Cusco, Peru: Effects of altitude and ethnicity. Maturitas 2014; 77:356-60. [DOI: 10.1016/j.maturitas.2014.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/24/2014] [Accepted: 01/27/2014] [Indexed: 11/15/2022]
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Al-Safi ZA, Santoro N. Menopausal hormone therapy and menopausal symptoms. Fertil Steril 2014; 101:905-15. [PMID: 24613533 DOI: 10.1016/j.fertnstert.2014.02.032] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/18/2014] [Accepted: 02/18/2014] [Indexed: 11/28/2022]
Abstract
A majority of women will experience bothersome symptoms related to declining and/or fluctuating levels of estrogen during their menopausal transition. Vasomotor symptoms, vaginal dryness, poor sleep, and depressed mood have all been found to worsen during the menopausal transition. While vasomotor symptoms gradually improve after menopause, the time course can be many years. Vaginal dryness does not improve without treatment, while the long-term course of sleep and mood deterioration is not clearly defined at this time. A small minority of women have vasomotor symptoms that persist throughout the remainder of their lives. These common menopausal symptoms all improve with estrogen treatment. Over the last 10 years, we have witnessed a dramatic reduction in enthusiasm for menopausal hormone therapy, despite its high efficacy relative to other treatments. We have also seen the emergence of sound, evidence-based clinical trials of non-hormonal alternatives that can control the common menopausal symptoms. Understanding the natural history of menopausal symptoms, and the risks and benefits of both hormonal and non-hormonal alternatives, helps the clinician individualize management plans to improve quality of life.
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Affiliation(s)
- Zain A Al-Safi
- Division of Reproductive Endocrinology and Infertility, University of Colorado, Aurora, Colorado.
| | - Nanette Santoro
- Division of Reproductive Endocrinology and Infertility, University of Colorado, Aurora, Colorado
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23
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Alexander JL, Dennerstein L, Woods NF, McEwen BS, Halbreich U, Kotz K, Richardson G. Role of stressful life events and menopausal stage in wellbeing and health. Expert Rev Neurother 2014; 7:S93-113. [DOI: 10.1586/14737175.7.11s.s93] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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24
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Reed SD, Lampe JW, Qu C, Gundersen G, Fuller S, Copeland WK, Newton KM. Self-reported menopausal symptoms in a racially diverse population and soy food consumption. Maturitas 2013; 75:152-8. [PMID: 23562010 DOI: 10.1016/j.maturitas.2013.03.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 03/01/2013] [Accepted: 03/05/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Evaluate the association of self-reported vasomotor symptom (VMS) frequency with race/ethnicity among a diverse midlife US population and explore menopause symptom differences by dietary soy isoflavone (genistein+daidzein) consumption. STUDY DESIGN Cross-sectional population-based study of peri- and postmenopausal women, ages 45-58. OUTCOMES Recent VMS frequency, VMS ever; recent symptom bother (hot flashes, night sweats, headache and joint-ache). RESULTS Of 18,500 potentially eligible women, 9325 returned questionnaires (50.4% response); 3691 were excluded (premenopausal, missing data, taking hormones). Of 5634 remaining women, 82.1% reported hot flashes ever, 73.1% reported night sweats ever; 48.8% and 38.6% reported recent hot flashes or night sweats, respectively. Compared with White women, Chinese, Japanese, Vietnamese, other Asian (each p<0.001) and Filipino (p<0.01) women less commonly reported ever having hot flashes; Asian women less commonly reported recent VMS bother (p<0.001). Black women more commonly reported hot flashes ever (p<0.05) and recent VMS bother (p<0.05). Compared with non-Hispanic White women, Hispanic women were less likely to report hot flashes (p<0.05) or night sweats (p<0.001) ever. Women were classified by isoflavone consumption: (1) none (n=1819), (2) 0.01-4.30 mg/day (n=1931), (3) 4.31-24.99 mg/day (n=1347) and (4) ≥ 25 mg/day (n=537). There were no group differences in recent VMS number/day: (1) 7.0 (95% CI 6.5, 7.5); (2) 6.4 (95% CI 6.0, 7.1); (3) 7.0 (95% CI 6.3, 8.2); and (4) 6.8 (95% CI 6.1, 7.7). CONCLUSIONS Menopausal symptoms, independent of isoflavone intake, varied considerably by race/ethnicity and were least common among Asian races.
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25
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Fisher WI, Johnson AK, Elkins GR, Otte JL, Burns DS, Yu M, Carpenter JS. Risk factors, pathophysiology, and treatment of hot flashes in cancer. CA Cancer J Clin 2013; 63:167-92. [PMID: 23355109 PMCID: PMC3640615 DOI: 10.3322/caac.21171] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hot flashes are prevalent and severe symptoms that can interfere with mood, sleep, and quality of life for women and men with cancer. The purpose of this article is to review existing literature on the risk factors, pathophysiology, and treatment of hot flashes in individuals with cancer. Electronic searches were conducted to identify relevant English-language literature published through June 15, 2012. Results indicated that risk factors for hot flashes in cancer include patient-related factors (eg, age, race/ethnicity, educational level, smoking history, cardiovascular risk including body mass index, and genetics) and disease-related factors (eg, cancer diagnosis and dose/type of treatment). In addition, although the pathophysiology of hot flashes has remained elusive, these symptoms are likely attributable to disruptions in thermoregulation and neurochemicals. Therapies that have been offered or tested fall into 4 broad categories: pharmacological, nutraceutical, surgical, and complementary/behavioral strategies. The evidence base for this broad range of therapies varies, with some treatments not yet having been fully tested or showing equivocal results. The evidence base surrounding all therapies is evaluated to enhance hot flash treatment decision-making by clinicians and patients.
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Affiliation(s)
- William I Fisher
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
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26
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Miller VM, Manson JE. Women's Health Initiative Hormone Therapy Trials: New insights on Cardiovascular Disease from Additional Years of Follow up. CURRENT CARDIOVASCULAR RISK REPORTS 2013; 7:196-202. [PMID: 23682305 DOI: 10.1007/s12170-013-0305-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Debate and controversy surrounding the benefits and risks of menopausal hormone therapy (MHT) for prevention of cardiovascular disease has continued in the decade since the cessation of the Women's Health Initiative (WHI) hormone therapy interventions. As a result, many women and their physicians have been reluctant to turn to MHT for relief of vasomotor and other menopausal symptoms. However, several follow-up studies of WHI participants provide additional insight into clinical characteristics of women who are more likely to have favorable outcomes and lower rates of adverse events associated with MHT. This report focuses on those studies that identify characteristics and biomarkers helpful in stratifying risk for an individual. Incorporation of these factors into a benefit:risk model could assist in patient-oriented decision making regarding use of MHT. Personalizing treatment offers the potential to minimize risk and improve health outcomes.
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Affiliation(s)
- Virginia M Miller
- Departments of Surgery and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
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Ziv-Gal A, Flaws JA. Factors that may influence the experience of hot flushes by healthy middle-aged women. J Womens Health (Larchmt) 2013; 19:1905-14. [PMID: 20831431 DOI: 10.1089/jwh.2009.1852] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Interest in menopausal symptoms in general and hot flushes (HFs) in particular has grown in recent years. This is mostly due to increased awareness and the vast impact these symptoms have on women's lives. Despite the high prevalence of women who experience HFs, a definitive etiology for HFs is yet to be found. Our objective was to review the current literature dealing with associated factors for experiencing HFs and to provide a synthesized overview on this common and often debilitating condition. METHODS We systematically searched the English-language literature in the PubMed database using relevant key words and included only those articles that contained information on associated factors for HFs in generally healthy midlife women. RESULTS Both conflicting scientific results between studies documenting factors that influence HFs and the lack of validated measuring tools make it difficult to truly pinpoint associated factors for HFs. Nonetheless, we identified the following clusters of associated factors: the menopausal stages, sex steroid hormones, other endocrine agents, genetic polymorphisms, race/ethnicity, body mass index (BMI) and obesity, mood disorders, smoking, soy isoflavones and phytoestrogens, alcohol consumption, and physical activity. CONCLUSIONS No single associated factor was consistently identified as having a major role in experiencing HFs. More resources should be directed to develop a unified study system along with multivariable analyses to get a better understanding of this condition, which often imposes a tremendous social and personal toll on the women who experience it.
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Affiliation(s)
- Ayelet Ziv-Gal
- Department of Veterinary Biosciences, University of Illinois, Urbana, Illinois 61802, USA
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Hunter MS, Gupta P, Chedraui P, Blümel JE, Tserotas K, Aguirre W, Palacios S, Sturdee DW. The International Menopause Study of Climate, Altitude, Temperature (IMS-CAT) and vasomotor symptoms. Climacteric 2012; 16:8-16. [DOI: 10.3109/13697137.2012.699563] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M. S. Hunter
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
| | - P. Gupta
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
| | - P. Chedraui
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
| | - J. E. Blümel
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
| | - K. Tserotas
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
| | - W. Aguirre
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
| | - S. Palacios
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
| | - D. W. Sturdee
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
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29
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Ziv-Gal A, Gallicchio L, Miller SR, Zacur HA, Flaws JA. Genetic polymorphisms in the aryl hydrocarbon receptor signaling pathway as potential risk factors of menopausal hot flashes. Am J Obstet Gynecol 2012; 207:202.e9-202.e18. [PMID: 22840970 DOI: 10.1016/j.ajog.2012.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 05/10/2012] [Accepted: 05/23/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We sought to determine if genetic polymorphisms in the aryl hydrocarbon receptor signaling pathway are associated with menopausal hot flashes via hormone levels. STUDY DESIGN Women (n = 639) aged 45-54 years completed a study survey and provided blood for genetic and hormone analyses. The associations were analyzed using multivariable logistic regression and generalized linear models. RESULTS Women carrying CYP1B1 (rs1800440) GG genotype had 3-fold greater odds of experiencing hot flashes for ≥1 year compared to the AA genotype (adjusted odds ratio [OR], 3.05; 95% confidence interval [CI], 1.12-8.25). Adding serum estradiol concentrations to the confounder-adjusted model resulted in a nonsignificant association (adjusted OR, 2.59; 95% CI, 0.91-7.18). Carriers of both CYP1B1 (rs1800440) G and CYP1B1 (rs1058636) G alleles had higher odds of experiencing hot flashes for ≥1 year compared to women homozygous for the major alleles (adjusted OR, 1.77; 95% CI, 1.06-2.96), even after adjustment for serum estradiol. CONCLUSION CYP1B1 is associated with menopausal hot flashes via pathways that may involve changes in serum estradiol concentration.
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Affiliation(s)
- Ayelet Ziv-Gal
- Department of Comparative Biosciences, University of Illinois, Urbana, IL 61802, USA
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Butts SF, Freeman EW, Sammel MD, Queen K, Lin H, Rebbeck TR. Joint effects of smoking and gene variants involved in sex steroid metabolism on hot flashes in late reproductive-age women. J Clin Endocrinol Metab 2012; 97:E1032-42. [PMID: 22466345 PMCID: PMC3387409 DOI: 10.1210/jc.2011-2216] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 03/08/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although smoking has a known association with hot flashes, the factors distinguishing smokers at greatest risk for menopausal symptoms have not been well delineated. Recent evidence supports a relationship between menopausal symptoms and variants in several genes encoding enzymes that metabolize substrates such as sex steriods, xenobiotics, and catechols. It is currently not known whether the impact of smoking on hot flashes is modified by the presence of such variants. OBJECTIVE The objective of the study was to investigate the relationship between smoking and hot flash occurrence as a function of genetic variation in sex steroid-metabolizing enzymes. METHODS A cross-sectional analysis of data from the Penn Ovarian Aging study, an ongoing population-based cohort of late reproductive-aged women, was performed. Smoking behavior was characterized. Single-nucleotide polymorphisms in five genes were investigated: COMT Val158Met (rs4680), CYP1A2*1F (rs762551), CYP1B1*4 (Asn452Ser, rs1800440), CYP1B1*3 (Leu432Val, rs1056836), and CYP3A4*1B (rs2740574). RESULTS Compared with nonsmokers, European-American COMT Val158Met double-variant carriers who smoked had increased odds of hot flashes [adjusted odds ratio (AOR) 6.15, 95% confidence interval (CI) 1.32-28.78)]; European-American COMT Val158Met double-variant carriers who smoked heavily had more frequent moderate or severe hot flashes than nonsmokers (AOR 13.7, 95% CI 1.2-154.9). European-American CYP 1B1*3 double-variant carriers who smoked described more frequent moderate or severe hot flashes than nonsmoking (AOR 20.6, 95% CI 1.64-257.93) and never-smoking (AOR 20.59, 95% CI 1.39-304.68) carriers, respectively. African-American single-variant CYP 1A2 carriers who smoked were more likely to report hot flashes than the nonsmoking carriers (AOR 6.16, 95% CI 1.11-33.91). CONCLUSION This is the first report demonstrating the effects of smoking within the strata of gene variants involved in sex steroid metabolism on hot flashes in late reproductive-age women. The identification of individuals with a genetic susceptibility to smoking-related menopausal symptoms could contribute to interventions targeted at reducing reproductive morbidity both in the menopause and across the reproductive life course.
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Affiliation(s)
- Samantha F Butts
- Division of Infertility and Reproductive Endocrinology, Perelman School of Medicine, University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, Pennsylvania 19104, USA.
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Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation. Obstet Gynecol Clin North Am 2012; 38:489-501. [PMID: 21961716 DOI: 10.1016/j.ogc.2011.05.006] [Citation(s) in RCA: 208] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Vasomotor symptoms (VMS), or hot flashes and night sweats, are often considered the cardinal symptoms of menopause. SWAN, one of the largest and most ethnically diverse longitudinal studies of the menopausal transition, has allowed unique insights into VMS. Specifically, SWAN has helped yield important information about the prevalence of, racial/ethnic differences in, risk factors for, and implications of VMS for midlife women's mental and physical health. We have reviewed the literature on VMS, emphasizing findings that have emerged from SWAN and new areas of inquiry in the area of VMS.
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Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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A large multinational study of vasomotor symptom prevalence, duration, and impact on quality of life in middle-aged women. Menopause 2011; 18:778-85. [PMID: 21407137 DOI: 10.1097/gme.0b013e318207851d] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this study was to determine vasomotor symptom (VMS) prevalence, duration, and impact on quality of life in middle-aged women using a validated menopausal tool. METHODS The Menopause Rating Scale (MRS) and an itemized questionnaire containing personal sociodemographic data were used to examine 8,373 women aged 40 to 59 years from 22 healthcare centers in 12 Latin American countries. RESULTS Less than half (48.8%) of all women studied were postmenopausal, 14.7% used hormone therapy (HT), 54.5% presented VMS of any degree, and 9.6% presented severe/bothersome symptoms. The rate of VMS (any degree) significantly increased from one menopausal stage to the next. HT users presented more VMS (any degree) than did nonusers (58.6% vs 53.8%, P = 0.001). When surgical postmenopausal women were compared, non-HT users displayed a higher prevalence of severe VMS (16.1% vs 9.0%, P = 0.0001). The presence of VMS of any degree was related to a more impaired quality of life (higher total MRS score; odds ratio, 4.7; 95% CI, 4.1-5.3). This effect was even higher among women presenting severe VMS. Logistic regression analysis determined that the presence of severe psychological/urogenital symptoms (MRS), lower educational level, natural perimenopause-postmenopause status, nulliparity, surgical menopause, and living at high altitude were significant risk factors for severe VMS. HT use was related to a lower risk. A second regression model determined that surgical menopause, intense psychological/urogenital symptoms, and a history of psychiatric consultation were factors related to severe VMS persisting into the late postmenopausal stage (5 or more years). CONCLUSIONS In this Latin American middle-aged series, VMS prevalence was high, persisting into the late postmenopausal phase in a high rate and severely impairing quality of life. HT use was related to a lower risk of severe VMS.
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Abstract
Incidence and rate of cardiovascular disease differ between men and women across the life span. Although hypertension is more prominent in men than women, there is a group of vasomotor disorders [i.e. Raynaud's disease, postural orthostatic tachycardia syndrome and vasomotor symptoms (hot flashes) of menopause and migraine] with a female predominance. Both sex and hormones interact to modulate neuroeffector mechanisms including integrated regulation of the Sry gene and direct effect of sex steroid hormones on synthesis, release and disposition of monoamine neurotransmitters, and distribution and sensitivity of their receptors in brain areas associated with autonomic control. The interaction of the sex chromosomes and steroids also modulates these effector tissues, that is, the heart, vascular smooth muscle and endothelium. Although involvement of central serotonergic centres has been studied in regard to mood disorders such as depression, their contribution to cardiovascular risk is gaining attention. Studies are needed to further evaluate how hormonal treatments and drugs used to modulate adrenergic and serotonergic activity affect progression and risk for cardiovascular disease in men and women.
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Affiliation(s)
- Emma C. Hart
- Department of Anesthesia, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nisha Charkoudian
- Department of Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Virginia M. Miller
- Department of Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
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Grover S, Talwar P, Gourie-Devi M, Gupta M, Bala K, Sharma S, Baghel R, Kaur H, Sharma A, Kukreti R. Genetic polymorphisms in sex hormone metabolizing genes and drug response in women with epilepsy. Pharmacogenomics 2011; 11:1525-34. [PMID: 21121773 DOI: 10.2217/pgs.10.120] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS It is hypothesized that functionally relevant polymorphisms in genes encoding metabolizing enzymes of sex steroids may influence drug response by directly predisposing women with epilepsy to seizure exacerbation. An alteration in estradiol:progesterone ratio is believed to play a role in seizure occurrence in women. CYP1A1 is a key enzyme involved in the metabolism of estradiol, with variants of the CYP1A1 gene having been reported to play a role in the alteration of sex hormone metabolism in women. The objective of the present study was to test for the association of genetic variants in CYP1A1 with seizure recurrence in patients diagnosed with epilepsy. MATERIALS & METHODS In the study, the association of five variants in CYP1A1 with seizure control in 228 patients with epilepsy on first-line antiepileptic drug therapy for a minimum period of 12 months was investigated. RESULTS A significant association of an intronic SNP, IVS1 +606C>A (rs2606345), with respect to seizure recurrence (genotypic: p = 3.3 × 10(-4); allelic: p = 7.2 × 10(-4); OR: 2.86; 95% CI: 1.5-5.3) in women with epilepsy from North India was observed. CONCLUSION Since CYP1A1 is not involved in the metabolism of any of the first-line antiepileptic drugs, these results imply that variants from genes encoding sex hormone metabolizing enzymes might act as markers for predicting response to antiepileptic drug therapy in women with epilepsy.
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Affiliation(s)
- Sandeep Grover
- Institute of Genomics & Integrative Biology (IGIB), Council of Scientific & Industrial Research (CSIR), Delhi, India
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Xu L, Tsai KS, Kim GS, Wu Y, Vincendon P, Chines AA, Constantine GD. Efficacy and safety of bazedoxifene in postmenopausal Asian women. Osteoporos Int 2011; 22:559-65. [PMID: 20535607 DOI: 10.1007/s00198-010-1259-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 03/30/2010] [Indexed: 11/25/2022]
Abstract
UNLABELLED This 6-month study examined the efficacy and safety of bazedoxifene 20 mg in postmenopausal Asian women. Bazedoxifene showed statistically significant improvements over placebo in bone mineral density at all skeletal sites evaluated. Bazedoxifene significantly reduced bone turnover and had favorable effects on lipid parameters. Bazedoxifene was safe and well tolerated. INTRODUCTION This 6-month, randomized, double-blind, placebo-controlled phase 3 study conducted in China, Korea, and Taiwan evaluated the efficacy and safety of bazedoxifene in postmenopausal Asian women. METHODS Generally, healthy postmenopausal Asian women (N=487; mean age, 57.2 years; mean lumbar spine bone mineral density [BMD], -1.1) were randomized to daily therapy with bazedoxifene 20 mg or placebo; all subjects received daily supplemental calcium carbonate 600 mg. The changes from baseline in BMD at the lumbar spine (primary end point) and at other skeletal sites, bone turnover markers, and lipid parameters were evaluated at 6 months. Safety assessments included adverse event (AE) reporting and physical/gynecologic examination. RESULTS At 6 months, women who received bazedoxifene 20 mg had significantly greater BMD compared with those receiving placebo at the lumbar spine (0.41% vs -0.32%, P<0.01), femoral neck (-0.08% vs -0.69%, P=0.014), trochanter (0.50% vs -0.23%, P=0.010), and total hip (-0.03% vs -0.77%, P<0.001), respectively. Bazedoxifene 20 mg was also associated with significant differences from placebo in median percent reductions from baseline in serum C-telopeptide (-21.8%, P<0.001) and osteocalcin (-12.9%, P<0.001) levels and total (-5.0%, P<0.001) and low-density lipoprotein cholesterol (-9.5%, P<0.001) levels. The incidence of AEs was not different between subjects treated with bazedoxifene and those who received placebo. CONCLUSION Bazedoxifene was generally safe and effective in preventing bone loss in this short-term study of postmenopausal Asian women.
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Affiliation(s)
- L Xu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, #1 Shuaifuyuan, Wangfujing, Beijing, 100730, People's Republic of China.
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Kronenberg F. Menopausal hot flashes: a review of physiology and biosociocultural perspective on methods of assessment. J Nutr 2010; 140:1380S-5S. [PMID: 20505017 DOI: 10.3945/jn.109.120840] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Hot flashes continue to be a troublesome problem for menopausal women the world over. After >50 y of research, we still do not understand the etiology and mechanism of hot flashes, nor do we know how estrogen, the major pharmaceutical treatment, works to reduce hot flashes. We are gaining insight into sociocultural complexities that may affect how and whether women report hot flashes. And we are becoming more sophisticated in our research tools (be it questionnaires, physiological monitors, or brain imaging techniques). New aspects of hot flash research, including neuroimaging and the study of genetic polymorphisms, when combined with increasingly nuanced ways of asking questions of culturally distinct populations, provide challenges but rich complexity from which a better understanding will emerge.
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Affiliation(s)
- Fredi Kronenberg
- Clayman Institute for Gender Research, Stanford University, Stanford, CA 94305, USA.
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Tuomikoski P, Haapalahti P, Sarna S, Ylikorkala O, Mikkola TS. Vasomotor hot flushes and 24-hour ambulatory blood pressure in normotensive women: A placebo-controlled trial on post-menopausal hormone therapy. Ann Med 2010; 42:334-43. [PMID: 20429800 DOI: 10.3109/07853891003796760] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Blood pressure (BP) is one of the most powerful determinants of cardiovascular risk in women. This risk may differ between post-menopausal women with and without vasomotor hot flushes, possibly indicating different vascular responses to hormone therapy (HT). Thus, we compared in a clinical trial the effect of HT on ambulatory BP in normotensive, recently post-menopausal women with or without severe hot flushes. METHODS A total of 147 women recorded prospectively their hot flushes for 2 weeks; 70 women were symptomatic (>or=7 moderate/severe hot flush episodes/day), whereas 77 women were defined as asymptomatic (<or=3 mild hot flush episodes/day). Women were treated for 6 months with either transdermal estradiol, oral estradiol with or without medroxyprogesterone acetate, or placebo. RESULTS In symptomatic women decreases in BPs were seen during estradiol use. In contrast, in asymptomatic women receiving oral but not transdermal estradiol, increases in 24-h and day-time systolic and diastolic BPs were encountered. CONCLUSION Hot flushes modify the HT-mediated responses in ambulatory BP. In asymptomatic women oral but not transdermal estradiol show potentially harmful cardiovascular effect by increasing BP. Our results give additional justification to prescribing HT primarily for the treatment of troublesome hot flushes and avoiding HT in women without vasomotor symptoms.
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Affiliation(s)
- Pauliina Tuomikoski
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
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Egras AM, Umland EM. The role of transdermal estrogen sprays and estradiol topical emulsion in the management of menopause-associated vasomotor symptoms. Int J Gen Med 2010; 3:147-51. [PMID: 20531974 PMCID: PMC2880349 DOI: 10.2147/ijgm.s4336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Vasomotor symptoms (VMS) are among the most bothersome complaints of postmenopausal women. To date, the most widely studied and effective treatment for VMS is hormone replacement therapy, consisting of estrogen (in women without a uterus) or estrogen plus progestin (in women with a uterus). Traditionally, oral estrogens have been used for treatment. However, over the years, additional estrogen formulations have been developed including transdermal patches; vaginal rings, creams, and tablets; and injectable preparations. Two newer formulations are transdermal estrogen spray and estradiol topical emulsion. This review evaluates the current literature assessing the use of these two newer formulations for the treatment of VMS associated with menopause.
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Affiliation(s)
- Amy M Egras
- Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA
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Im EO. A situation-specific theory of Asian immigrant women's menopausal symptom experience in the United States. ANS Adv Nurs Sci 2010; 33:143-57. [PMID: 20460960 PMCID: PMC2878203 DOI: 10.1097/ans.0b013e3181dbc5fa] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this article, a situation-specific theory that explains the menopausal symptom experiences of Asian immigrant women in the United States is presented. Using an integrative approach, the theory was developed on the basis of the transitions theory, a review of the relevant literature, and a study on Asian immigrant women's menopausal symptom experience in the United States. The proposed theory includes transition conditions, patterns of response, and nursing therapeutics as major concepts and explains the relationships among these major concepts. This theory should be further validated and developed in intervention studies and nursing practice with this specific population.
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Affiliation(s)
- Eun-Ok Im
- School of Nursing, The University of Texas at Austin, Austin, TX 78701, USA.
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Do Japanese American women really have fewer hot flashes than European Americans? The Hilo Women's Health Study. Menopause 2009; 16:870-6. [PMID: 19367185 DOI: 10.1097/gme.0b013e31819d88da] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Many studies have found a significantly lower frequency of reported hot flashes (HFs) in Japanese and Japanese American (JA) populations, leading to speculation about possible dietary, genetic, or cultural differences. These studies have relied on subjective reports of HFs. Accordingly, the purpose of this study was to compare both reported and objective HFs measured by sternal and nuchal skin conductance among JA and European American (EA) women. METHODS Two surveys of HF frequencies were carried out among women of either EA or JA ethnicity; aged 45 to 55 years; living in Hilo, Hawaii; and not using exogenous hormones. The first was a postal questionnaire (n = 325); the second was carried out during a clinical study of HFs (n = 134). Women in the second group underwent 24-hour ambulatory and 3-hour laboratory monitoring for objective HFs measured through skin conductance at sternal and nuchal sites. Subjective HFs were recorded on the monitor or in a diary. RESULTS JAs were significantly less likely to report having had HFs in the previous 2 weeks compared with EAs (postal sample: JAs, 30.9%; EAs, 43.9%; chi(2) = 6.9, P < 0.01; monitored sample: JAs, 26.1%; EAs, 46.6%; chi(2) = 5.3, P < 0.05). JAs were also significantly less likely to report experiencing other symptoms (15 of 30 in the postal sample; 6 of 30 in the monitored sample) than EAs. However, JAs did not significantly differ in likelihood of reporting subjective HFs during the 24-hour ambulatory period (JAs, 51.1%; EAs, 55.8%; chi(2) = 0.3, NS), nor in percentage of individuals displaying one or more objective HFs as measured by the skin conductance monitor (JAs, 77.8%; EAs, 72.1%; chi(2) = 0.5, NS). JAs also did not have a significantly fewer number of objective HFs (t = 0.2, NS) nor of subjective HFs (t = 0.8, NS) during the monitoring period, and these results were unchanged when analyses controlled for menopause status and body mass index. CONCLUSIONS The common finding of fewer reported HFs in people of Japanese ancestry may be a consequence of reporting bias: JAs report fewer symptoms of many conditions compared with people from other ethnic groups. This is probably due to cultural conceptions of what is appropriate to report.
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Is there an association between vasomotor symptoms and both low bone density and cardiovascular risk? Menopause 2009; 16:219-23. [PMID: 19188853 DOI: 10.1097/gme.0b013e318199404a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE The aim of this study was to examine interactions between hot flushes, estrogen plus progestogen therapy (EPT), and coronary heart disease (CHD) events in postmenopausal women with CHD. METHODS We analyzed data from the Heart and Estrogen/Progestin Replacement Study, a randomized, placebo-controlled trial of 0.625 mg conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate in 2,763 postmenopausal women with CHD. Hot flushes were assessed at baseline using self-administered questionnaires; women reporting bothersome hot flushes "some" to "all" of the time were considered to have clinically significant flushing. Cox regression models were used to examine the effect of EPT on risk of CHD events among women with and without significant flushing at baseline. RESULTS The mean age of participants was 66.7 +/- 6.8 years, and 89% (n = 2,448) were white. Sixteen percent (n = 434) of participants reported clinically significant hot flushes at baseline. Among women with baseline flushing, EPT increased risk of CHD events nine-fold in the first year compared with placebo (hazard ratio = 9.01; 95% CI, 1.15-70.35); among women without baseline flushing, treatment did not significantly affect CHD event risk in the first year (hazard ratio = 1.32; 95% CI, 0.86-2.03; P = 0.07 for interaction of hot flushes with treatment). The trend toward differential effects of EPT on risk for CHD among women with and without baseline flushing did not persist after the first year of treatment. CONCLUSIONS Among older postmenopausal women with CHD, EPT may increase risk of CHD events substantially in the first year of treatment among women with clinically significant hot flushes but not among those without hot flushes.
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Miller VM, Black DM, Brinton EA, Budoff MJ, Cedars MI, Hodis HN, Lobo RA, Manson JE, Merriam GR, Naftolin F, Santoro N, Taylor HS, Harman SM. Using basic science to design a clinical trial: baseline characteristics of women enrolled in the Kronos Early Estrogen Prevention Study (KEEPS). J Cardiovasc Transl Res 2009; 2:228-39. [PMID: 19668346 PMCID: PMC2721728 DOI: 10.1007/s12265-009-9104-y] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 04/27/2009] [Indexed: 12/24/2022]
Abstract
Observational and epidemiological studies suggest that menopausal hormone therapy (MHT) reduces cardiovascular disease (CVD) risk. However, results from prospective trials showed neutral or adverse effects most likely due to differences in participant demographics, such as age, timing of initiation of treatment, and preexisting cardiovascular disease, which reflected in part the lack of basic science information on mechanisms of action of hormones on the vasculature at the time clinical trials were designed. The Kronos Early Estrogen Replacement Study (KEEPS) is a prospective, randomized, controlled trial designed, using findings from basic science studies, to test the hypothesis that MHT when initiated early in menopause reduces progression of atherosclerosis. KEEPS participants are younger, healthier, and within 3 years of menopause thus matching more closely demographics of women in prior observational and epidemiological studies than women in the Women's Health Initiative hormone trials. KEEPS will provide information relevant to the critical timing hypothesis for MHT use in reducing risk for CVD.
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Affiliation(s)
- V M Miller
- Medical Science 4-62, College of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
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Caan BJ, Aragaki A, Thomson CA, Stefanick ML, Chlebowski R, Hubbell FA, Tinker L, Vitolins M, Rajkovic A, Bueche M, Ockene J. Vasomotor symptoms, adoption of a low-fat dietary pattern, and risk of invasive breast cancer: a secondary analysis of the Women's Health Initiative randomized controlled dietary modification trial. J Clin Oncol 2009; 27:4500-7. [PMID: 19687338 DOI: 10.1200/jco.2008.20.0493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess whether the effect of a low-fat dietary pattern on breast cancer incidence varied by report of baseline vasomotor symptoms. METHODS Postmenopausal women age 50 to 79 years enrolled onto the Women's Health Initiative (WHI) Dietary Modification trial from 1993 to 1998 were randomly assigned to a low-fat dietary intervention (n = 19,541) or comparison (n = 29,294). Presence of vasomotor symptoms at baseline was ascertained from a 34-item self-report symptom inventory. Women were queried semi-annually for a new diagnosis of breast cancer. Each case report was verified by medical record and pathology report review by centrally trained WHI physician adjudicators. RESULTS Among participants who reported hot flashes (HFs) at baseline (n = 3,375), those assigned to the low-fat diet had a breast cancer rate of 0.27 compared with their counterparts in the control group who had a rate of 0.41 (hazard ratio [HR] = 0.65; 95% CI, 0.42 to 1.01). Among women reporting no HFs (n = 45,160), the breast cancer rate was 0.42 in those assigned to the low-fat diet compared with 0.46 in the control group (HR = 0.93; 95% CI, 0.84 to 1.03; P for interaction = .12 by HF status). Furthermore, the dietary benefits observed seemed to be specific to estrogen receptor (ER) -positive/progesterone receptor (PR) -positive tumors (ER positive/PR positive v other, P for risk = .03). Although women with and without HFs differed with regard to breast cancer risk factors, the effect of the diet intervention on breast cancer incidence by HF status was consistent across risk factor strata. CONCLUSION The results of this trial, which are hypothesis generating, suggest that HFs may identify a subgroup of postmenopausal women whose risk of invasive breast cancer might be reduced with the adoption of a low-fat eating pattern.
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Affiliation(s)
- Bette J Caan
- DrPH, Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, USA.
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Pierce JP, Natarajan L, Caan BJ, Flatt SW, Kealey S, Gold EB, Hajek RA, Newman VA, Rock CL, Pu M, Saquib N, Stefanick ML, Thomson CA, Parker B. Dietary change and reduced breast cancer events among women without hot flashes after treatment of early-stage breast cancer: subgroup analysis of the Women's Healthy Eating and Living Study. Am J Clin Nutr 2009; 89:1565S-1571S. [PMID: 19339393 PMCID: PMC2677006 DOI: 10.3945/ajcn.2009.26736f] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A diet high in vegetables, fruit, and fiber and low in fat decreased additional risk of secondary breast cancer events in women without hot flashes (HF-) compared with that in women with hot flashes (HF+), possibly through lowered concentrations of circulating estrogens. OBJECTIVE The objective was to investigate the intervention effect by baseline quartiles of dietary pattern among breast cancer survivors in the HF- subgroup of the Women's Healthy Eating and Living Study. DESIGN A randomized controlled trial compared a putative cancer prevention diet with a diet of 5 servings of vegetables and fruit daily in early-stage breast cancer survivors. Participants did not experience hot flashes at baseline (n = 896). We confirmed cancer status for 96% of participants approximately 7.3 y after enrollment. RESULTS The study intervention achieved a large between-group difference in dietary pattern that, at 4 y, was not significantly different across baseline quartiles of dietary pattern. The intervention group experienced fewer breast cancer events than did the comparison group for all of the baseline quartiles. This difference was significant only in upper baseline quartiles of intake of vegetables, fruit, and fiber and in the lowest quartile of fat. A significant trend for fewer breast cancer events was observed across quartiles of vegetable-fruit and fiber consumption. CONCLUSIONS The secondary analysis showing the decreased risk in the HF- subgroup was not explained by amount of change in dietary pattern achieved. The difference was strongest in the quartile with the most putatively cancer-preventive dietary pattern at baseline.
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Affiliation(s)
- John P Pierce
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA, USA.
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Moeller G, Adamski J. Integrated view on 17beta-hydroxysteroid dehydrogenases. Mol Cell Endocrinol 2009; 301:7-19. [PMID: 19027824 DOI: 10.1016/j.mce.2008.10.040] [Citation(s) in RCA: 158] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 10/27/2008] [Accepted: 10/27/2008] [Indexed: 10/21/2022]
Abstract
17beta-Hydroxysteroid dehydrogenases (17beta-HSDs) are important enzymes in steroid metabolism. Long known members of the protein family seemed to be well characterised concerning their role in the regulation of the biological potency of steroid hormones, but today more and more evidence points to pivotal contributions of these enzymes in a variety of other metabolic pathways. Therefore, studies on 17beta-HSDs develop towards metabolomic survey. Latest research results give new insights into the complex metabolic interconnectivity of the 17beta-HSDs. In this paper metabolic activities of 17beta-HSDs will be compared, their interplay with endogenous substrates summarised, and interlacing pathways depicted. Strategies on deciphering the physiological role of 17beta-HSDs and the genetic predisposition for associated diseases will be presented.
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Affiliation(s)
- Gabriele Moeller
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Experimental Genetics, Genome Analysis Center, Neuherberg, Germany.
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Crandall CJ. Gene Testing to Predict Tamoxifen-Induced Hot Flashes: New Biological Insights. J Clin Oncol 2008; 26:5841-2. [DOI: 10.1200/jco.2008.19.5040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Carolyn J. Crandall
- David Geffen School of Medicine at University of California, Los Angeles, UCLA Medicine/General Internal Medicine, Los Angeles, CA
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Gold EB, Pierce JP, Natarajan L, Stefanick ML, Laughlin GA, Caan BJ, Flatt SW, Emond JA, Saquib N, Madlensky L, Kealey S, Wasserman L, Thomson CA, Rock CL, Parker BA, Karanja N, Jones V, Hajek RA, Pu M, Mortimer JE. Dietary pattern influences breast cancer prognosis in women without hot flashes: the women's healthy eating and living trial. J Clin Oncol 2008; 27:352-9. [PMID: 19075284 DOI: 10.1200/jco.2008.16.1067] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To determine whether a low-fat diet high in vegetables, fruit, and fiber differentially affects prognosis in breast cancer survivors with hot flashes (HF) or without HF after treatment. PATIENTS AND METHODS A secondary analysis was conducted on 2,967 breast cancer survivors, age 18 to 70 years, who were randomly assigned between 1995 and 2000 in a multicenter, controlled trial of a dietary intervention to prevent additional breast cancer events and observed through June 1, 2006. We compared the dietary intervention group with a group who received five-a-day dietary guidelines. RESULTS Independent of HF status, a substantial between-group difference among those who did and did not receive dietary guidelines was achieved and maintained at 4 years in intake of vegetable/fruit servings per day (54% higher; 10 v 6.5 servings/d, respectively), fiber (31% higher; 25.5 v 19.4 g/d, respectively), and percent energy from fat (14% lower; 26.9% v 31.3%, respectively). Adjusting for tumor characteristics and antiestrogen treatment, HF-negative women assigned to the intervention had 31% fewer events than HF-negative women assigned to the comparison group (hazard ratio [HR] = 0.69; 95% CI, 0.51 to 0.93; P = .02). The intervention did not affect prognosis in the women with baseline HFs. Furthermore, compared with HF-negative women assigned to the comparison group, HF-positive women had significantly fewer events in both the intervention (HR = 0.77; 95% CI, 0.59 to 1.00; P = .05) and comparison groups (HR = 0.65; 95% CI, 0.49 to 0.85; P = .002). CONCLUSION A diet with higher vegetable, fruit, and fiber and lower fat intakes than the five-a-day diet may reduce risk of additional events in HF-negative breast cancer survivors. This suggestive finding needs confirmation in a trial in which it is the primary hypothesis.
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Affiliation(s)
- Ellen B Gold
- Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
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Thurston RC, Everson Rose SA, Matthews KA. Finding a way through the forest: A Biopsychosocial model of hot flashes. Menopause 2008; 15:1027-1028. [PMID: 25514441 PMCID: PMC4263248 DOI: 10.1097/gme.0b013e3181846cc6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rebecca C. Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health
| | - Susan A. Everson Rose
- Department of Medicine, Program in Health Disparities Research, University of Minnesota School of Medicine
| | - Karen A. Matthews
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health
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