1
|
Hershko Klement A, Asali A, Shalev Ram H, Haikin-Herzberger E, Shlezinger R, Wiser A, Miller N. Cancer-Related Morbidity Among Patients Conceiving Through Oocyte Donation: A Healthcare Registry Cohort Study. J Womens Health (Larchmt) 2024. [PMID: 39177947 DOI: 10.1089/jwh.2024.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
Background: Ovarian aging, often leads to increased use of a donor oocyte, which is associated with greater risk for age-related diseases. Objective: To evaluate the association between women conceiving through oocyte donation (OD) and future cancer-related morbidity, as compared with women conceiving through IVF (in vitro fertilization) with autologous oocytes (AO), spontaneous conceptions (SC), and nulliparas. Methods: This retrospective, cohort study was based on the electronic health records of a very large health maintenance organization. The cohort included mothers who delivered before age 45, during 2000-2019. The index date for surveillance was the delivery date of the relevant pregnancy. Each woman from the OD group was matched to a woman the same age at delivery and with the same number of children. Cancer diagnosis was the main outcome. Results: Matching: 664 OD cases to 664 AO, 700 OD cases to 700 SC, and 700 OD cases to 700 nulliparas. Mean follow-up times were 8.9 ± 3.8 OD, 10 ± 4.1 AO, and 6.4 ± 4.1 years SC. Cancer-related morbidity rates were comparable between OD and the other groups, but compared with nulliparas, a trend was noted (1.6% and 3.1%, respectively, p = 0.07). Survival analysis curves were not significantly different, although a trend was shown in the curve comparing to nulliparity (p = 0.07). In a Cox regression model corrected for BMI, smoking and hormone replacement therapy exposure, cancer in the OD group did not differ compared to the other groups. Conclusion: Women conceiving through OD do not have increased risk for cancer-related morbidity in the decade following delivery.
Collapse
Affiliation(s)
- Anat Hershko Klement
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aula Asali
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Hila Shalev Ram
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Einat Haikin-Herzberger
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Roi Shlezinger
- Department of Statistics and Data Science, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amir Wiser
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Netanella Miller
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Mayanei Hayeshua Medical Center, IVF unit, Bnei Brak, Israel
| |
Collapse
|
2
|
Xing Z, Kirby RS. Sex differences in all-cause mortality and life span between women with premature menopause and men: propensity score matching analysis. Menopause 2024:00042192-990000000-00367. [PMID: 39137103 DOI: 10.1097/gme.0000000000002412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
OBJECTIVE This study investigated sex differences in all-cause mortality and life span between women undergoing premature menopause and men using propensity score matching analysis. METHODS Data were from the National Health and Nutrition Examination Survey (1999-2018) and the National Health and Nutrition Examination Survey III (1988-1994). We included 3,214 women experiencing premature menopause and 23,067 men. The participants were all older than 40 years. Propensity score matching analysis created matched cohorts of women and men using a 1:1 ratio. We employed Cox proportional hazard models to estimate unadjusted and adjusted hazard ratios (HR) (95% confidence interval [CI]) for the association between sex and both all-cause mortality and survival up to the 75th percentile of life span. A subgroup analysis examined the effects of hormone therapy on mortality and life span. RESULTS Compared with men in the matched cohorts, the adjusted HR values (95% CI) for all-cause mortality in women with age at menopause at <35, 35 to 39, and <40 years were 0.65 (0.54-0.78), 0.72 (0.59-0.87), and 0.67 (0.60-0.76), respectively. However, the adjusted HR values (95% CI) for women and men to survive to the 75th percentile of life span were not statistically significant. Besides, there was no significant difference in the mean life span between deceased women and men in the matched cohorts. In the subgroup analysis, the mean life span did not differ significantly between deceased women taking hormone therapy and men. However, the average life span of women never using hormone therapy was significantly longer than that of men (78.3 ± 11.6 vs 76.6 ± 11.9 years, P = 0.0154). CONCLUSIONS Women experiencing premature menopause had lower risks of all-cause mortality than men, but the advantage that women had in terms of life span was insignificant.
Collapse
Affiliation(s)
- Zailing Xing
- From the Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL
| |
Collapse
|
3
|
Theodorou A, Karagiannakis DS, Stefanaki K, Kassi E, Peppa M, Vryonidou A, Paschou SA. Female-specific risk factors for cardiovascular disease: an update. Hormones (Athens) 2024:10.1007/s42000-024-00576-5. [PMID: 38922384 DOI: 10.1007/s42000-024-00576-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024]
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. While it was previously believed that men have greater susceptibility to CVD, recent research suggests that women face an increased risk of CVD after the onset of menopause, primarily due to the loss of the protective effects of estrogens. Premature ovarian insufficiency (POI), polycystic ovarian syndrome (PCOS), and gestational factors, such as gestational diabetes mellitus (GDM), recurrent pregnancy loss, preterm delivery, and preeclampsia, are specific reproductive disorders that may contribute to an elevated risk of CVD at earlier ages, i.e., before the onset of menopause. This suggests that women with these conditions should be closely monitored for CVD risk factors even before reaching menopause. Such early intervention may help reduce the incidence of CVD and improve overall cardiovascular health in this population. The precise pathophysiological mechanism underlying the development of CVD in women with menopause, premature POI, PCOS, and gestational factors remains elusive. This review article seeks to elucidate the latest research on the relationship between these conditions and CVD in women, aiming to explore the underlying pathogenic mechanisms contributing to this association.
Collapse
Affiliation(s)
- Angeliki Theodorou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilisis Sophias Avenue, Athens, PC, 11528, Greece
| | - Dimitrios S Karagiannakis
- Academic Department of Gastroenterology, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Stefanaki
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilisis Sophias Avenue, Athens, PC, 11528, Greece
| | - Evanthia Kassi
- Endocrine Unit, First Department of Propaedeutic and Internal Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Melpomeni Peppa
- Endocrine Unit and Diabetes Center, Second Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andromachi Vryonidou
- Department of Endocrinology and Diabetes Center, Hellenic Red Cross Hospital, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilisis Sophias Avenue, Athens, PC, 11528, Greece.
| |
Collapse
|
4
|
Gai X, Feng Y, Flores TM, Kang H, Yu H, Leslie KK, Zhu Y, Doherty JA, Guo Y, Belinsky SA, Cook LS, Leng S. Early menopause and hormone therapy as determinants for lung health outcomes: a secondary analysis using the PLCO trial. Thorax 2024:thorax-2023-220956. [PMID: 38871464 DOI: 10.1136/thorax-2023-220956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/02/2024] [Indexed: 06/15/2024]
Abstract
RATIONALE Early natural menopause (early-M; <45 years of age) increases the risk of lung morbidities and mortalities in smokers. However, it is largely unknown whether early-M due to surgery demonstrates similar effects and whether menopausal hormone therapy (MHT) is protective against lung diseases. OBJECTIVES To assess the associations of early-M and MHT with lung morbidities and mortalities using the prospective Prostate, Lung, Colorectal and Ovarian (PLCO) trial. METHODS We estimated the risk among 69 706 postmenopausal women in the PLCO trial, stratified by menopausal types and smoking status. RESULTS Early-M was associated with an increased risk of most lung disease and mortality outcomes in ever smokers with the highest risk seen for respiratory mortality (HR 1.98, 95% CI 1.34 to 2.92) in those with bilateral oophorectomy (BO). Early-M was positively associated with chronic bronchitis, and all-cause, non-cancer and respiratory mortality in never smokers with natural menopause or BO, with the highest risk seen for BO- respiratory mortality (HR 1.91, 95% CI 1.16 to 3.12). Ever MHT was associated with reduced all-cause, non-cancer and cardiovascular mortality across menopause types regardless of smoking status and was additionally associated with reduced risk of non-ovarian cancer, lung cancer (LC) and respiratory mortality in ever smokers. Among smokers, ever MHT use was associated with a reduction in HR for all-cause, non-cancer and cardiovascular mortality in a duration-dependent manner. CONCLUSIONS Smokers with early-M should be targeted for smoking cessation and LC screening regardless of menopause types. MHT users had a lower likelihood of dying from LC and respiratory diseases in ever smokers.
Collapse
Affiliation(s)
- Xiaochun Gai
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Yue Feng
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Tessa M Flores
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Huining Kang
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Cancer Control and Population Sciences, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Hui Yu
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Kimberly K Leslie
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Cancer Control and Population Sciences, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Yiliang Zhu
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Jennifer A Doherty
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
| | - Yan Guo
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Steven A Belinsky
- Cancer Control and Population Sciences, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
- Lung Cancer Program, Lovelace Biomedical Research Institute, Albuquerque, New Mexico, USA
| | - Linda S Cook
- Department of Epidemiology, Colorado School of Public Health, University of Colorado-Anschutz, Aurora, Colorado, USA
| | - Shuguang Leng
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Cancer Control and Population Sciences, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
- Lung Cancer Program, Lovelace Biomedical Research Institute, Albuquerque, New Mexico, USA
| |
Collapse
|
5
|
Xing Z, Kirby RS. Age at natural or surgical menopause, all-cause mortality, and lifespan among postmenopausal women in the United States. Menopause 2024; 31:176-185. [PMID: 38385730 DOI: 10.1097/gme.0000000000002314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVE This study investigated the association of age at natural menopause with or without undergoing hysterectomy and/or bilateral oophorectomy after menopause and age at surgical menopause with all-cause mortality and lifespan in postmenopausal women. METHODS The data stemmed from the National Health and Nutrition Examination Survey (NHANES) (1999-2018) and NHANES III (1988-1994), including 14,161 postmenopausal women over 40. Cox proportional hazard models were used to estimate unadjusted and adjusted hazard ratios (HRs) (95% confidence intervals [CIs]). We also used Cox proportional hazard models with penalized splines to depict the association between continuous age at menopause and all-cause mortality and nonparametric regression with smoothing splines to illustrate the association between age at menopause and lifespan in deceased participants. RESULTS The adjusted HRs (95% CIs) for age at natural menopause of <40, 40 to 44, and 55+ years in women without undergoing hysterectomy or bilateral oophorectomy after menopause were 1.48 (1.15-1.91), 1.16 (1.00-1.35), and 0.91 (0.77-1.07) compared with age at natural menopause of 45 to 54, respectively. The respective HRs (95% CIs) for age at surgical menopause were 1.39 (1.11-1.75), 1.09 (0.86-1.38), and 0.83 (0.53-1.32). However, no significant association was found between age at natural menopause and all-cause mortality among women undergoing hysterectomy and/or bilateral oophorectomy after menopause. When treated as continuous variables, age at natural menopause without undergoing hysterectomy or bilateral oophorectomy after menopause presented inverse and nonlinear associations with all-cause mortality, whereas age at surgical menopause was linearly inversely associated with all-cause mortality. The association between age at menopause and lifespan was linearly positive regardless of menopausal type. CONCLUSION Young age at menopause was associated with increased risks of all-cause mortality. The later menopause age was related to a longer lifespan.
Collapse
Affiliation(s)
- Zailing Xing
- From the Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL
| |
Collapse
|
6
|
Xing Z, Alman AC, Kirby RS. Premature Menopause and All-Cause Mortality and Life Span Among Women Older Than 40 Years in the NHANES I Epidemiologic Follow-Up Study: Propensity Score Matching Analysis. J Womens Health (Larchmt) 2023; 32:950-959. [PMID: 37439866 DOI: 10.1089/jwh.2023.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Objective: Findings from studies of the long-term effect of premature menopause on risks of all-cause mortality in women are equivocal. We used the approach of propensity score matching to examine the causal association of premature menopause with all-cause mortality and life span among women older than 40 years. Methods: The data were from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. We calculated the propensity score of premature menopause using a logistic regression model, then matched premature menopause with nonpremature menopause according to the score and the ratio of 1:1. We estimated mortality hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazard models. We also analyzed and plotted the relationship between age at menopause and reproductive life span with all-cause mortality and life span. Results: The mean age of 1,210 women was 55.4 ± 10.8 years at baseline. The unadjusted and adjusted HRs of all-cause mortality for women with premature menopause were 1.46 (95% CI: 1.08-1.96) and 1.53 (95% CI: 1.13-2.08), respectively, compared to nonpremature menopause. Nonlinear associations were found between age at menopause, reproductive life span, all-cause mortality, and life span. Menopausal age <37.5 years of age or reproductive life span <24 years increased the risk of all-cause mortality. Women with menopausal age <39 years of age or reproductive life span <24 years had a lower mean life span than the overall average of 76 years. Conclusions: Premature menopause significantly increased all-cause mortality risk and shortened life span in women. As women's age at menopause or reproductive life span increases, their overall life span also tends to increase.
Collapse
Affiliation(s)
- Zailing Xing
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Amy C Alman
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
| |
Collapse
|
7
|
Behboudi-Gandevani S, Arntzen EC, Normann B, Haugan T, Bidhendi-Yarandi R. Cardiovascular Events Among Women with Premature Ovarian Insufficiency: A Systematic Review and Meta-Analysis. Rev Cardiovasc Med 2023; 24:193. [PMID: 39077000 PMCID: PMC11266470 DOI: 10.31083/j.rcm2407193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/15/2023] [Accepted: 05/05/2023] [Indexed: 07/31/2024] Open
Abstract
Background It is well documented that menopause is linked to an increased risk of cardiovascular (CV) events; however, the results of studies focusing on the association between premature ovarian insufficiency (POI) and the risk of CV events are controversial. The aim of this systematic review and meta-analysis was to assess the risk of CV events among women with POI compared to women with menopausal aged 50-54 years. Methods A systematic literature search of PubMed (including Medline), Scopus, and Web of Science was conducted from 1990 to 2022 to retrieve observational studies published in English-language. The studies' quality was assessed using structured standard tools. Primary-outcome was the pooled risk of the composite outcome of CV events. Results We included 16 studies involving 40,549 women who suffered from POI and 1,016,633 women as controls. After adjustment for hormone therapy, the pooled risk of composite outcome of CV events and coronary heart disease, among women with the POI was significantly 1.3 (Pooled-adjusted hazard ratio (HR) = 1.35, 95% CI: 1.06-1.63, I 2 : 0%) and 1.4 (Pooled adjusted HR = 1.42, 95% CI: 1.17-1.66, I 2 : 0%) fold higher than women with menopausal age 50-54 years. There was no difference between the groups regarding the risk of stroke and death due to CV events between two groups. There was not sufficient data for pooled analysis of other specific CV events. Conclusions In conclusion, POI is associated with an increased risk of CV events, particularly coronary heart disease. Our findings extend prior work with data supporting POI as a risk-enhancing factor for CV events. However, more studies are needed to confirmed these findings.
Collapse
Affiliation(s)
| | | | - Britt Normann
- Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway
| | - Tommy Haugan
- Faculty of Nursing and Health Sciences, Nord University, 7629 Levanger, Norway
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, 1985713871 Tehran, Iran
| |
Collapse
|
8
|
Liu J, Jin X, Liu W, Chen W, Wang L, Feng Z, Huang J. The risk of long-term cardiometabolic disease in women with premature or early menopause: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1131251. [PMID: 37025693 PMCID: PMC10072266 DOI: 10.3389/fcvm.2023.1131251] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Background Transition into menopause is associated with an increased risk of cardiovascular disease (CVD). However, it is unclear whether the association exists between premature menopause (defined as age at menopause 40 years) or early menopause (defined as age at menopause 40-45 years) and CVD or cardiovascular risk factors. The aim of this review was to comprehensively evaluate and meta-analyze the most reliable evidence about the relationship between menopausal age and the risk of long-term cardiometabolic disease. Methods A comprehensive literature search of the PubMed, Web of Science, and Embase databases from inception to October 1, 2022, for titles and abstracts with a restriction to English language papers led to the discovery of the studies. Data are expressed as the Hazard Ratio (HR) with 95% confidence intervals (CI). The degree of heterogeneity was measured using the I-square (I 2) index. Results 921,517 participants from 20 cohort studies published between 1998 and 2022 were considered. Compared to women with menopause at age >45 years, women with premature menopause (PM) or early menopause (EM) had a higher risks of type 2 diabetes (RR: 1.32, 95% CI: 1.08-1.62; RR: 1.11, 95% CI: 0.91-1.36, respectively), hyperlipidemia (RR: 1.21, 95% CI: 1.05-1.39; RR: 1.17, 95% CI: 1.02-1.33, respectively), coronary heart disease (RR: 1.52, 95% CI: 1.22-1.91; RR: 1.19, 95% CI: 1.07-1.32, respectively), stroke (RR: 1.27, 95% CI: 1.02-1.58; RR: 1.13, 95% CI: 0.97-1.32, respectively) and total cardiovascular event (RR: 1.36, 95% CI: 1.16-1.60; RR: 1.14, 95% CI: 0.97-1.35, respectively). No difference was found for hypertension in PM or EM women (RR: 0.98, 95% CI: 0.89-1.07; RR: 0.97, 95% CI: 0.91-1.04, respectively). Additionally, we also found that PM women, but not EM women, were linked with an increased risk of ischemic and hemorrhagic stroke. However, this is not in line with the conclusion that both PM and EM had a higher risk of total stroke. Conclusion Women with PM or EM have a higher risk of developing long-term CVD, compared to women with menopause at age >45 years. Therefore, we recommend early lifestyle interventions (e.g., maintaining a healthy lifestyle) and medical treatments (e.g., timely initiation of menopausal hormone therapy) to decrease the risk of cardiometabolic disease in early or premature menopausal women. Systematic Review Registration PROSPERO, identifier CRD42022378750.
Collapse
Affiliation(s)
- Jiajun Liu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xueshan Jin
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Wenbin Liu
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wanying Chen
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lan Wang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ziyi Feng
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jieming Huang
- Department of Gynecology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
- Correspondence: Jieming Huang
| |
Collapse
|
9
|
Zhai T, Diergaarde B, Wilson DO, Kang H, Sood A, Bayliss SH, Yuan JM, Picchi MA, Lan Q, Belinsky SA, Siegfried JM, Cook LS, Leng S. Early natural menopause is associated with poor lung health and increased mortality among female smokers. Am J Obstet Gynecol 2022; 227:885.e1-885.e12. [PMID: 35934119 PMCID: PMC9729368 DOI: 10.1016/j.ajog.2022.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/06/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Early natural menopause has been regarded as a biomarker of reproductive and somatic aging. Cigarette smoking is the most harmful factor for lung health and also an established risk factor for early menopause. Understanding the effect of early menopause on health outcomes in middle-aged and older female smokers is important to develop preventive strategies. OBJECTIVE This study aimed to examine the associations of early menopause with multiple lung health and aging biomarkers, lung cancer risk, and all-cause and cause-specific mortality in postmenopausal women who were moderate or heavy smokers. STUDY DESIGN This study was conducted on postmenopausal women with natural (n=1038) or surgical (n=628) menopause from the Pittsburgh Lung Screening Study. The Pittsburgh Lung Screening Study is a community-based research cohort of current and former smokers, screened with low-dose computed tomography and followed up for lung cancer. Early menopause was defined as occurring before 45 years of age. The analyses were stratified by menopause types because of the different biological and medical causes of natural and surgical menopause. Statistical methods included linear model, generalized linear model, linear mixed-effects model, and time-to-event analysis. RESULTS The average age of the 1666 female smokers was 59.4±6.7 years, with 1519 (91.2%) of the population as non-Hispanic Whites and 1064 (63.9%) of the population as current smokers at baseline. Overall, 646 (39%) women reported early menopause, including 198 (19.1%) women with natural menopause and 448 (71.3%) women with surgical menopause (P<.001). Demographic variables did not differ between early and nonearly menopause groups, regardless of menopause type. Significant associations were identified between early natural menopause and higher risk of wheezing (odds ratio, 1.65; P<.01), chronic bronchitis (odds ratio, 1.73; P<.01), and radiographic emphysema (odds ratio, 1.70; P<.001) and lower baseline lung spirometry in an obstructive pattern (-104.8 mL/s for forced expiratory volume in the first second with P<.01, -78.6 mL for forced vital capacity with P=.04, and -2.1% for forced expiratory volume in the first second-to-forced vital capacity ratio with P=.01). In addition, early natural menopause was associated with a more rapid decline of forced expiratory volume in the first second-to-forced vital capacity ratio (-0.16% per year; P=.01) and incident airway obstruction (odds ratio, 2.02; P=.04). Furthermore, women early natural menopause had a 40% increased risk of death (P=.023), which was mainly driven by respiratory diseases (hazard ratio, 2.32; P<.001). Mediation analyses further identified that more than 33.3% of the magnitude of the associations between early natural menopause and all-cause and respiratory mortality were explained by baseline forced expiratory volume in the first second. Additional analyses in women with natural menopause identified that the associations between continuous smoking and subsequent lung cancer risk and cancer mortality were moderated by early menopause status, and females with early natural menopause who continued smoking had the worst outcomes (hazard ratio, >4.6; P<.001). This study did not find associations reported above in female smokers with surgical menopause. CONCLUSION Early natural menopause was found to be a risk factor for malignant and nonmalignant lung diseases and mortality in middle-aged and older female smokers. These findings have strong public health relevance as preventive strategies, including smoking cessation and chest computed tomography screening, should target this population (ie, female smokers with early natural menopause) to improve their postmenopausal health and well-being.
Collapse
Affiliation(s)
- Ting Zhai
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Brenda Diergaarde
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA
| | - David O Wilson
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Huining Kang
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM; Cancer Control and Population Sciences, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Akshay Sood
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM
| | - Samuel H Bayliss
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM
| | - Jian-Min Yuan
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Maria A Picchi
- Lung Cancer Program, Lovelace Biomedical Research Institute, Albuquerque, NM
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Steven A Belinsky
- Cancer Control and Population Sciences, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM; Lung Cancer Program, Lovelace Biomedical Research Institute, Albuquerque, NM
| | - Jill M Siegfried
- Department of Pharmacology, University of Minnesota, Minneapolis, MN; Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA
| | - Linda S Cook
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz, Arora, CO
| | - Shuguang Leng
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM; Cancer Control and Population Sciences, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM; Lung Cancer Program, Lovelace Biomedical Research Institute, Albuquerque, NM.
| |
Collapse
|
10
|
Xu Z, Chung HF, Dobson AJ, Wilson LF, Hickey M, Mishra GD. Menopause, hysterectomy, menopausal hormone therapy and cause-specific mortality: cohort study of UK Biobank participants. Hum Reprod 2022; 37:2175-2185. [PMID: 35690930 PMCID: PMC9433845 DOI: 10.1093/humrep/deac137] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
STUDY QUESTION What is the association between menopausal hormone therapy (MHT) and cause-specific mortality? SUMMARY ANSWER Self-reported MHT use following early natural menopause, surgical menopause or premenopausal hysterectomy is associated with a lower risk of breast cancer mortality and is not consistently associated with the risk of mortality from cardiovascular disease or other causes. WHAT IS KNOWN ALREADY Evidence from the Women's Health Initiative randomized controlled trials showed that the use of estrogen alone is not associated with the risk of cardiovascular mortality and is associated with a lower risk of breast cancer mortality, but evidence from the Million Women Study showed that use of estrogen alone is associated with a higher risk of breast cancer mortality. STUDY DESIGN, SIZE, DURATION Cohort study (the UK Biobank), 178 379 women, recruited in 2006-2010. PARTICIPANTS/MATERIALS, SETTING, METHODS Postmenopausal women who had reported age at menopause (natural or surgical) or hysterectomy, and information on MHT and cause-specific mortality. Age at natural menopause, age at surgical menopause, age at hysterectomy and MHT were exposures of interest. Natural menopause was defined as spontaneous cessation of menstruation for 12 months with no previous hysterectomy or oophorectomy. Surgical menopause was defined as the removal of both ovaries prior to natural menopause. Hysterectomy was defined as removal of the uterus before natural menopause without bilateral oophorectomy. The study outcome was cause-specific mortality. MAIN RESULTS AND THE ROLE OF CHANCE Among the 178 379 women included, 136 790 had natural menopause, 17 569 had surgical menopause and 24 020 had hysterectomy alone. Compared with women with natural menopause at the age of 50-52 years, women with natural menopause before 40 years (hazard ratio (HR): 2.38, 95% CI: 1.64, 3.45) or hysterectomy before 40 years (HR: 1.60, 95% CI: 1.23, 2.07) had a higher risk of cardiovascular mortality but not cancer mortality. MHT use was associated with a lower risk of breast cancer mortality following surgical menopause before 45 years (HR: 0.17, 95% CI: 0.08, 0.36), at 45-49 years (HR: 0.15, 95% CI: 0.07, 0.35) or at ≥50 years (HR: 0.28, 95% CI: 0.13, 0.63), and the association between MHT use and the risk of breast cancer mortality did not differ by MHT use duration (<6 or 6-20 years). MHT use was also associated with a lower risk of breast cancer mortality following natural menopause before 45 years (HR: 0.59, 95% CI: 0.36, 0.95) or hysterectomy before 45 years (HR: 0.49, 95% CI: 0.32, 0.74). LIMITATIONS, REASONS FOR CAUTION Self-reported data on age at natural menopause, age at surgical menopause, age at hysterectomy and MHT. WIDER IMPLICATIONS OF THE FINDINGS The current international guidelines recommend women with early menopause to use MHT until the average age at menopause. Our findings support this recommendation. STUDY FUNDING/COMPETING INTEREST(S) This project is funded by the Australian National Health and Medical Research Council (NHMRC) (grant numbers APP1027196 and APP1153420). G.D.M. is supported by NHMRC Principal Research Fellowship (APP1121844), and M.H. is supported by an NHMRC Investigator Grant (APP1193838). There are no competing interests. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Zhiwei Xu
- The University of Queensland, School of Public Health, NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CRE WaND), Brisbane, Australia
| | - Hsin-Fang Chung
- The University of Queensland, School of Public Health, Brisbane, Australia
| | - Annette J Dobson
- The University of Queensland, School of Public Health, Brisbane, Australia
| | - Louise F Wilson
- The University of Queensland, School of Public Health, NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CRE WaND), Brisbane, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, Australia
| | - Gita D Mishra
- The University of Queensland, School of Public Health, NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CRE WaND), Brisbane, Australia
| |
Collapse
|
11
|
Christensen MW, Kesmodel US, Christensen K, Kirkegaard K, Ingerslev HJ. Early ovarian ageing: is a low number of oocytes harvested in young women associated with an earlier and increased risk of age-related diseases? Hum Reprod 2021; 35:2375-2390. [PMID: 32949236 DOI: 10.1093/humrep/deaa188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/26/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Do young women with early ovarian ageing (EOA), defined as unexplained, and repeatedly few oocytes harvested in ART have an increased risk of age-related events? SUMMARY ANSWER At follow-up, women with idiopathic EOA had an increased risk of age-related events compared to women with normal ovarian ageing (NOA). WHAT IS KNOWN ALREADY Early and premature menopause is associated with an increased risk of cardiovascular diseases (CVDs), osteoporosis and death. In young women, repeated harvest of few oocytes in well-stimulated ART cycles is a likely predictor of advanced menopausal age and may thus serve as an early marker of accelerated general ageing. STUDY DESIGN, SIZE, DURATION A register-based national, historical cohort study. Young women (≤37 years) having their first ART treatment in a public or private fertility clinic during the period 1995-2014 were divided into two groups depending on ovarian reserve status: EOA (n = 1222) and NOA (n = 16 385). Several national registers were applied to assess morbidity and mortality. PARTICIPANTS/MATERIALS, SETTING, METHODS EOA was defined as ≤5 oocytes harvested in a minimum of two FSH-stimulated cycles and NOA as ≥8 oocytes in at least one cycle. Cases with known causes influencing the ovarian reserve (endometriosis, ovarian surgery, polycystic ovary syndrome, chemotherapy etc.) were excluded. To investigate for early signs of ageing, primary outcome was an overall risk of ageing-related events, defined as a diagnosis of either CVD, osteoporosis, type 2 diabetes, cancer, cataract, Alzheimer's or Parkinson's disease, by death of any-cause as well as a Charlson comorbidity index score of ≥1 or by registration of early retirement benefit. Cox regression models were used to assess the risk of these events. Exposure status was defined 1 year after the first ART cycle to assure reliable classification, and time-to-event was measured from that time point. MAIN RESULTS AND THE ROLE OF CHANCE Median follow-up time from baseline to first event was 4.9 years (10/90 percentile 0.7/11.8) and 6.4 years (1.1/13.3) in the EOA and NOA group, respectively. Women with EOA had an increased risk of ageing-related events when compared to women with a normal oocyte yield (adjusted hazard ratio 1.24, 95% CI 1.08 to 1.43). Stratifying on categories, the EOA group had a significantly increased risk for CVD (1.44, 1.19 to 1.75) and osteoporosis (2.45, 1.59 to 3.90). Charlson comorbidity index (1.15, 0.93 to 1.41) and early retirement benefit (1.21, 0.80 to 1.83) was also increased, although not reaching statistical significance. LIMITATIONS, REASONS FOR CAUTION Cycles never reaching oocyte aspiration were left out of account in the inclusion process and we may therefore have missed women with the most severe forms of EOA. We had no information on the total doses of gonadotrophin administered in each cycle. WIDER IMPLICATIONS OF THE FINDINGS These findings indicate that oocyte yield may serve as marker of later accelerated ageing when, unexpectedly, repeatedly few oocytes are harvested in young women. Counselling on life-style factors as a prophylactic effort against cardiovascular and other age-related diseases may be essential for this group of women. STUDY FUNDING/COMPETING INTEREST(S) No external funding was received for this study. All authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- M W Christensen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - U S Kesmodel
- Fertility Unit, Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - K Christensen
- Department of Public Health, The Danish Aging Research Center, University of Southern Denmark, Odense C, Denmark
| | - K Kirkegaard
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
| | - H J Ingerslev
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Fertility Unit, Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
12
|
Meta-analysis: Early Age at Natural Menopause and Risk for All-Cause and Cardiovascular Mortality. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6636856. [PMID: 33816624 PMCID: PMC7987413 DOI: 10.1155/2021/6636856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/10/2021] [Accepted: 03/01/2021] [Indexed: 11/18/2022]
Abstract
Aims The aim of this meta-analysis was to comprehensively evaluate the association of early age at natural menopause with the risk for all-cause and cardiovascular mortality. Methods Literature retrieval was done on August 4, 2020. Article selection and data extraction were completed independently and in duplicate. Early age at natural menopause was grouped into premature menopause (<40 years), early menopause (40-44 years), and relatively early menopause (45-49 years). Effect-size estimates are summarized as hazard ratio (HR) or relative risk (RR) with 95% confidence interval (CI). Results Sixteen articles involving 321,233 women were meta-analyzed. Overall analyses revealed a statistically significant association of early age at natural menopause with all-cause mortality risk (HRadjusted = 1.08, 95% CI: 1.03 to 1.14, P = 0.002; RRadjusted = 1.05, 95% CI 1.01 to 1.08, P = 0.005), but not with cardiovascular mortality risk. In dose-response analyses, the association with all-cause mortality was significant for premature menopause with (HRadjusted = 1.10; 95% CI: 1.01 to 1.21; P = 0.034) and without (RRadjusted = 1.34; 95% CI: 1.08 to 1.66; P = 0.007) considering follow-up intervals. As for cardiovascular mortality, marginal significance was noted for premature menopause after considering follow-up intervals (HR = 1.09; 95% CI: 1.00-1.19; P = 0.045). Subgroup analyses indicated that gender, country, and follow-up periods were possible causes of heterogeneity. There was an overall low probability of publication bias. Conclusions Our findings indicate that premature menopause is a promising independent risk factor for both all-cause and cardiovascular mortality.
Collapse
|
13
|
Rostami Dovom M, Bidhendi-Yarandi R, Mohammad K, Farahmand M, Azizi F, Ramezani Tehrani F. Prevalence of premature ovarian insufficiency and its determinants in Iranian populations: Tehran lipid and glucose study. BMC Womens Health 2021; 21:79. [PMID: 33622308 PMCID: PMC7903639 DOI: 10.1186/s12905-021-01228-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Premature ovarian insufficiency (POI) considered as a concerning health issue for women of reproductive age. In this study we aim to estimate the prevalence of POI and assessing the influential factors. METHODS Data was obtained from Tehran lipid and glucose study (TLGS). All eligible post-menarcheal female participants of the TLGS, ages 20-65, were recruited (n = 6521). Participants were followed for the event of menopause, and age at menopause was recorded. Kaplan Meier analysis was applied to estimate mean and median for age at menopause. Weibull accelerated failure time survival regression model (AFT), was applied to assess influential determinants of POI. Conditional probability approach was used to provide estimation for prevalence of POI. RESULTS In this population-based study, the prevalence of POI (menopause age < 40 years) and early menopause (menopause age < 45 years) were estimated 3.5% and 24.6%, respectively. AFT model showed that in comparison to normal weight women, time to menopause was decreased by - 0.09 year (95% CI - 0.27, - 0.01, p = 0.023) and - 0.03 year (95% CI - 0.05, - 0.02, p = 0.000) in underweight and overweight women, respectively. Moreover, time to natural menopause was increased by 0.12 year (95% CI 0.07 to 0.17, p = 0.000) in women used oral contraceptives for > 6 months. CONCLUSION About one quartile of Iranian women experienced menopause at an age less than 45, especially the non-normal weight ones; this high prevalence is a critical public health concerns that needs to be addressed by health policy makers.
Collapse
Affiliation(s)
- Marzieh Rostami Dovom
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Shahid Arabi St., Yaman Ave, Velenjak, P.O.Box, 19395-4763, Tehran, Iran
| | - Razieh Bidhendi-Yarandi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Shahid Arabi St., Yaman Ave, Velenjak, P.O.Box, 19395-4763, Tehran, Iran.
| | - Kazem Mohammad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Farahmand
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Shahid Arabi St., Yaman Ave, Velenjak, P.O.Box, 19395-4763, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Shahid Arabi St., Yaman Ave, Velenjak, P.O.Box, 19395-4763, Tehran, Iran
| |
Collapse
|
14
|
The Impact of Premature Menopause on Future Risk of Cardiovascular Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00854-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
15
|
Mishra SR, Chung HF, Waller M, Mishra GD. Duration of estrogen exposure during reproductive years, age at menarche and age at menopause, and risk of cardiovascular disease events, all-cause and cardiovascular mortality: a systematic review and meta-analysis. BJOG 2020; 128:809-821. [PMID: 32965759 DOI: 10.1111/1471-0528.16524] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little is known about the estrogen exposure measurement and mutual effect of age at menarche and age at menopause in the risk of cardiovascular disease (CVD) events. OBJECTIVES To evaluate estrogen exposure measurement and describe mutual effect of age at menarche and age at menopause in the risk of CVD events. SEARCH STRATEGY Systematic review of literature in PubMed, Embase and Web of Science for studies published up to 28 June 2020. SELECTION CRITERIA Observational studies related to estrogen exposure measurement, including mutual effect of age at menarche and age at menopause and risk of CVD events. DATA COLLECTION AND ANALYSIS Synthesis of evidence was conducted by reviewing individual estimates, followed by meta-analysis. The study received no external funding. MAIN RESULTS A total of 75 studies were included in synthesis of evidence, of which 17 studies were included in meta-analysis. Reproductive lifespan (age at menopause - age at menarche), endogenous estrogen exposure and total estrogen exposure were used for estrogen exposure measurement. Reproductive lifespan was by far the most commonly used method for estrogen exposure measurement. A shorter reproductive lifespan was associated with a higher risk of CVD events; the pooled relative risk (95% CI) was 1.31 (1.25-1.36) for stroke events. Robust epidemiological studies with measurement of estrogen exposure and associated health risk would strengthen the evidence. CONCLUSIONS Reproductive lifespan was the most commonly used method for estrogen exposure measurement in epidemiological studies. A shorter reproductive lifespan was associated with a higher risk of CVD events, particularly stroke. TWEETABLE ABSTRACT A systematic review and meta-analysis found that women with a shorter reproductive lifespan have a higher risk of stroke events.
Collapse
Affiliation(s)
- S R Mishra
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - H-F Chung
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - M Waller
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - G D Mishra
- School of Public Health, The University of Queensland, Brisbane, Australia
| |
Collapse
|
16
|
The cardiovascular risk profile of middle age women previously diagnosed with premature ovarian insufficiency: A case-control study. PLoS One 2020; 15:e0229576. [PMID: 32134933 PMCID: PMC7058320 DOI: 10.1371/journal.pone.0229576] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 02/10/2020] [Indexed: 11/19/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death in women worldwide. The cardiovascular risk profile deteriorates after women enter menopause. By definition, women diagnosed with premature ovarian insufficiency (POI) experience menopause before 40 years of age, which may render these women even more susceptible to develop CVD later in life. However, prospective long-term follow up data of well phenotyped women with POI are scarce. In the current study we compare the CVD profile and risk of middle aged women previously diagnosed with POI, to a population based reference group matched for age and BMI. Methods and findings We compared 123 women (age 49.0 (± 4.3) years) and diagnosed with POI 8.1 (IQR: 6.8–9.6) years earlier, with 123 population controls (age 49.4 (± 3.9) years). All women underwent an extensive standardized cardiovascular screening. We assessed CVD risk factors including waist circumference, BMI, blood pressure, lipid profile, pulse wave velocity (PWV), and the prevalence of diabetes mellitus, metabolic syndrome (MetS) and carotid intima media thickness (cIMT), in both women with POI and controls. We calculated the 10-year CVD Framingham Risk Score (FRS) and the American Heart Association’s suggested cardiovascular health score (CHS). Waist circumference (90.0 (IQR: 83.0–98.0) versus 80.7 (IQR: 75.1–86.8), p < 0.01), waist-to-hip ratio (0.90 (IQR: 0.85–0.93) versus 0.79 (IQR: 0.75–0.83), p < 0.01), systolic blood pressure (124 (IQR 112–135) versus 120 (IQR109-131), p < 0.04) and diastolic blood pressure (81 (IQR: 76–89) versus 78 (IQR: 71–86), p < 0.01), prevalence of hypertension (45 (37%) versus 21 (17%), p < 0.01) and MetS (19 (16%) versus 4 (3%), p < 0.01) were all significantly increased in women with POI compared to healthy controls. Other risk factors, however, such as lipids, glucose levels and prevalence of diabetes were similar comparing women with POI versus controls. The arterial stiffness assessed by PWV was also similar in both populations (8.1 (IQR: 7.1–9.4) versus 7.9 (IQR: 7.1–8.4), p = 0.21). In addition, cIMT was lower in women with POI compared to controls (550 μm (500–615) versus 684 μm (618–737), p < 0.01). The calculated 10-year CVD risk was 5.9% (IQR: 3.7–10.6) versus 6.0% (IQR: 3.9–9.0) (p = 0.31) and current CHS was 6.1 (1.9) versus 6.5 (1.6) (p = 0.07), respectively in POI versus controls. Conclusions Middle age women with POI presented with more unfavorable cardiovascular risk factors (increased waist circumference and a higher prevalence of hypertension and MetS) compared to age and BMI matched population controls. In contrast, the current study reveals a lower cIMT and similar 10-year cardiovascular disease risk and cardiovascular health score. In summary, neither signs of premature atherosclerosis nor a worse cardiovascular disease risk or health score were observed among middle age women with POI compared to population controls. Longer-term follow-up studies of women of more advanced age are warranted to establish whether women with POI are truly at increased risk of developing CVD events later in life. Trial registration ClinicalTrials.gov Identifier: NCT02616510.
Collapse
|
17
|
Saeaib N, Peeyananjarassri K, Liabsuetrakul T, Buhachat R, Myriokefalitaki E. Hormone replacement therapy after surgery for epithelial ovarian cancer. Cochrane Database Syst Rev 2020; 1:CD012559. [PMID: 31989588 PMCID: PMC7027384 DOI: 10.1002/14651858.cd012559.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Women who have undergone surgical treatment for epithelial ovarian cancer (EOC) may develop menopausal symptoms due to immediate loss of ovarian function following surgery and chemotherapy. Women may experience vasomotor symptoms, sleep disturbance, difficulty concentrating, sexual dysfunction, vaginal symptoms and accelerated osteoporosis. Although hormone replacement therapy (HRT) is the most effective treatment to relieve these symptoms, its safety has been questioned for women with EOC. OBJECTIVES To assess the safety and efficacy of HRT for menopausal symptoms in women surgically treated for EOC. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 6), MEDLINE via Ovid (1946 to 12 June 2019) and Embase via Ovid (1980 to 2019, week 23). We also handsearched conference reports and trial registries. There was no language restriction. SELECTION CRITERIA We included randomized controlled trials (RCTs) with participants of any age and menopausal status who had undergone surgery for EOC and, after diagnosis and treatment, used any regimen and duration of HRT compared with placebo or no hormone therapy. We also included trials comparing different regimens or duration of administration of HRT. DATA COLLECTION AND ANALYSIS Two review authors independently identified studies that met the inclusion criteria. They used Covidence to extract study characteristics, outcome data and to assess methodological quality of the included studies. MAIN RESULTS Our search strategy identified 2617 titles, of which 2614 titles were excluded. Three studies, involving 350 women, met our inclusion criteria. Two of the studies included pre and postmenopausal women, and the third only included premenopausal women. The overall age range of those women included in the studies was 20 to 89.6 years old, with a median follow-up ranging from 31.4 months to 19.1 years. The geographical distribution of participants included Europe, South Africa and China. All stages and histological subtypes were included in two of the studies, but stage IV disease had been excluded in the third. The three included studies used a variety of HRT regimens (conjugated oestrogen with or without medroxyprogesterone and with or without nylestriol) and HRT administrations (oral, patch and implant), In all studies, the comparisons were made versus women who had not received HRT. The studies were at low or unclear risk of selection and reporting bias, and at high risk of performance, detection and attrition bias. The certainty of the evidence was low for overall survival and progression-free survival, and very low for quality-of-life assessment, incidence of breast cancer, transient ischaemic attack (TIA), cerebrovascular accident (CVA) and myocardial infarction (MI). Meta-analysis of these studies showed that HRT may improve overall survival (hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.54 to 0.93; 350 participants, 3 studies; low-certainty evidence). Quality-of-life assessment by use of the EORTC-C30 questionnaire was performed only in one study. We are uncertain whether HRT improves or reduces quality of life as the certainty of the evidence was assessed as very low (mean difference (MD) 13.67 points higher, 95% CI 9.26 higher to 18.08 higher; 1 study; 75 participants; very low-certainty evidence). Likewise, HRT may make little or no difference to progression-free survival (HR 0.76, 95% CI 0.57 to 1.01; 275 participants, 2 studies; low-certainty evidence). We are uncertain whether HRT improves or reduces the incidence of breast cancer (risk ratio (RR) 2.00, 95% CI 0.19 to 21.59; 225 participants, 2 studies; very low-certainty evidence); TIA (RR 5.00, 95% CI 0.24 to 102.42; 150 participants, 1 study; very low-certainty evidence); CVA (RR 0.67, 95% CI 0.11 to 3.88; 150 participants, 1 study; very low-certainty evidence); and MI (RR 0.20, 95% CI 0.01 to 4.10; 150 participants, 1 study; very low-certainty evidence). The incidence of gallstones was not reported in the included studies. AUTHORS' CONCLUSIONS Hormone replacement therapy may slightly improve overall survival in women who have undergone surgical treatment for EOC, but the certainty of the evidence is low. HRT may make little or no difference to quality of life, incidence of breast cancer, TIA, CVA and MI as the certainty of the evidence has been assessed as very low. There may be little or no effect of HRT use on progression-free survival. The evidence in this review is limited by imprecision and incompleteness of reported relevant outcomes and therefore the results should be interpreted with caution. Future well-designed RCTs are required as this is an important area to women experiencing menopausal symptoms following surgical treatment for ovarian cancer, especially as doctors are often reluctant to prescribe HRT in this scenario. The evidence in this review is too limited to support or refute that HRT is very harmful in this population.
Collapse
Affiliation(s)
- Nungrutai Saeaib
- Prince of Songkla UniversityDepartment of Obstetrics and Gynecology, Faculty of MedicineHat YaiSongkhlaThailand90112
| | - Krantarat Peeyananjarassri
- Prince of Songkla UniversityDepartment of Obstetrics and Gynecology, Faculty of MedicineHat YaiSongkhlaThailand90112
| | - Tippawan Liabsuetrakul
- Prince of Songkla UniversityEpidemiology Unit, Faculty of MedicineHat YaiSongkhlaThailand90110
| | - Rakchai Buhachat
- Prince of Songkla UniversityDepartment of Obstetrics and Gynecology, Faculty of MedicineHat YaiSongkhlaThailand90112
| | | | | |
Collapse
|
18
|
Park SH, Park YE, Lee J, Choi JH, Heo NY, Park J, Kim TO, Moon YS, Kim HK, Jang HJ, Park HY, Jeong CH, Suk KT, Kim DJ. Lack of association between early menopause and non-alcoholic fatty liver disease in postmenopausal women. Climacteric 2019; 23:173-177. [DOI: 10.1080/13697137.2019.1650018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- S. H. Park
- Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, South Korea
| | - Y. E. Park
- Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, South Korea
| | - J. Lee
- Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, South Korea
| | - J. H. Choi
- Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, South Korea
| | - N. Y. Heo
- Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, South Korea
| | - J. Park
- Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, South Korea
| | - T. O. Kim
- Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, South Korea
| | - Y. S. Moon
- Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, South Korea
| | - H. K. Kim
- Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, South Korea
| | - H. J. Jang
- Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, South Korea
| | - H. Y. Park
- Department of Emergency Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, South Korea
| | - C.-H. Jeong
- Department of Obstetrics & Gynecology, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, South Korea
| | - K. T. Suk
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - D. J. Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea
| |
Collapse
|
19
|
Malek AM, Vladutiu CJ, Meyer ML, Cushman M, Newman R, Lisabeth LD, Kleindorfer D, Lakkur S, Howard VJ. The association of age at menopause and all-cause and cause-specific mortality by race, postmenopausal hormone use, and smoking status. Prev Med Rep 2019; 15:100955. [PMID: 31367516 PMCID: PMC6651856 DOI: 10.1016/j.pmedr.2019.100955] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 11/29/2022] Open
Abstract
While a mean age at menopause of 51 years has been reported in the United States (U.S.), some U.S. women experience menopause before age 45, possibly increasing risk of cardiovascular mortality; however, the role in all-cause and cerebrovascular-related mortality is unclear. The purpose of this study was to investigate the association between age at menopause and all-cause and cause-specific mortality by race, hormone replacement therapy (HRT) use, and smoking status. REasons for Geographic and Racial Differences in Stroke (REGARDS) is a population-based study of 30,239 participants aged ≥45 years enrolled between 2003 and 2007 of whom 14,361 were postmenopausal women. Age at menopause was defined as <45 (early) or ≥45. All-cause and cause-specific mortality were ascertained through 2013. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association between age at menopause and mortality, adjusting for baseline measures. Of 11,287 eligible women (6403 white; 4884 black), mean menopause age was 45.2 (SD 7.9) with 1524 deaths over 7.1 years. Significant interactions were detected between early age at menopause (39%) and HRT use in association with all-cause mortality (p < 0.01), mortality from coronary heart disease (p = 0.06), and mortality from all other causes (p = 0.04). An association between early age at menopause and all-cause mortality was observed among ever-HRT users (HR = 1.31, 95% CI: 1.10–1.56), but not never-HRT users (HR = 1.01, 95% CI: 0.85–1.20). There were no differences in associations examined by race or smoking status. Increased all-cause mortality risk was observed for ever-HRT users with menopause before age 45. Increased all-cause mortality risk in ever-HRT users with menopause before age 45 HRT use modified the association of menopause before age 45 and CHD mortality. There were no differences in associations examined by race or smoking status.
Collapse
Key Words
- Age
- BMI, body mass index
- BWHS, Black Women's Health Study
- CHD, coronary heart disease
- CI, confidence interval
- CVD, cardiovascular disease
- Coronary heart disease
- ECG, electrocardiogram
- FDA, Food and Drug Administration
- HR, hazard ratio
- HRT, hormone replacement therapy
- MI, myocardial infarction
- MRR, mortality rate ratio
- Menopause
- Mortality
- NAMS, North American Menopause Society
- NDI, National Death Index
- REGARDS
- REGARDS, REasons for Geographic and Racial Differences in Stroke
- RR, relative risk
- Race
- SD, standard deviation
- Smoking
- U.S., United States
- Women
Collapse
Affiliation(s)
- Angela M Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Catherine J Vladutiu
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary Cushman
- Department of Med-Hematology Oncology, University of Vermont, Burlington, VT, USA.,Department of Pathology & Laboratory Medicine, University of Vermont, Burlington, VT, USA
| | - Roger Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Lynda D Lisabeth
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Dawn Kleindorfer
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Sindhu Lakkur
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
20
|
Golezar S, Ramezani Tehrani F, Khazaei S, Ebadi A, Keshavarz Z. The global prevalence of primary ovarian insufficiency and early menopause: a meta-analysis. Climacteric 2019; 22:403-411. [PMID: 30829083 DOI: 10.1080/13697137.2019.1574738] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective: The aim of this study was to estimate the global prevalence of primary ovarian insufficiency (POI) and early menopause (EM). Methods: A comprehensive literature search was performed in several databases to retrieve relevant English articles published between 1980 and 2017. To assess the methodological quality of the studies, the Newcastle-Ottawa Scale was used. The heterogeneity of results across the studies was assessed using Cochran's Q test and quantified by the I2 statistic. Prevalence estimates of all studies were pooled using a random-effects meta-analysis model at a confidence level of 95%. Results: A total of 8937 potentially relevant articles were identified from the initial searches. Thirty-one studies met the inclusion criteria and were included in this meta-analysis. The pooled prevalence of POI and EM was calculated as 3.7% (95% confidence interval: 3.1, 4.3) and 12.2% (95% confidence interval: 10.5, 14), respectively. The prevalence of POI was higher in medium and low Human Development Index countries. The prevalence trend did not change over time. Conclusion: The prevalence of POI and EM in women is considerable. The results of this study could contribute to consciousness-raising of health policy-makers toward the necessity of prioritizing, planning, and allocating health resources as preventive and treatment interventions for these women.
Collapse
Affiliation(s)
- S Golezar
- a Student Research Committee, School of Nursing and Midwifery , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - F Ramezani Tehrani
- b Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - S Khazaei
- c Department of Epidemiology, School of Public Health , Hamadan University of Medical Sciences , Hamadan , Iran
| | - A Ebadi
- d Behavioral Sciences Research Center, Life Style Institute , Nursing Faculty of Baqiyatallah University of Medical Sciences , Tehran , Iran
| | - Z Keshavarz
- e Midwifery and Reproductive Health Research Center and Department of Midwifery and Reproductive Health, School of Nursing and Midwifery , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| |
Collapse
|
21
|
Otsuki S, Saito E, Sawada N, Abe SK, Hidaka A, Yamaji T, Shimazu T, Goto A, Iwasaki M, Iso H, Mizoue T, Shibuya K, Inoue M, Tsugane S. Female reproductive factors and risk of all-cause and cause-specific mortality among women: The Japan Public Health Center–based Prospective Study (JPHC study). Ann Epidemiol 2018; 28:597-604.e6. [DOI: 10.1016/j.annepidem.2018.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 05/15/2018] [Accepted: 06/03/2018] [Indexed: 10/28/2022]
|
22
|
Roman Lay AA, do Nascimento CF, de Oliveira Duarte YA, Porto Chiavegatto Filho AD. Age at natural menopause and mortality: A survival analysis of elderly residents of São Paulo, Brazil. Maturitas 2018; 117:29-33. [PMID: 30314558 DOI: 10.1016/j.maturitas.2018.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/25/2018] [Accepted: 08/30/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To conduct a survival analysis according to age at natural menopause (NM) in a representative sample of elderly women from the municipality of São Paulo, Brazil. STUDY DESIGN We analyzed data from the Health, Well-Being and Aging study (SABE), a cohort that started in 2000. Mortality data up to September 2016 were obtained by linkage from the Program for Mortality Information of São Paulo (PRO-AIM). MAIN OUTCOME MEASURES We used Cox regression to analyze all-cause and cause-specific mortality rates for cardiovascular diseases, respiratory diseases and cancer, according to age at menopause, categorized as <40, 41-44, 45-49, 50-54 (reference) and ≥55. RESULTS After 16 years of follow-up, there were 444 deaths, of which 199 were from cardiovascular diseases, 73 from respiratory diseases and 65 from cancer. After adjustment for socioeconomic, reproductive and lifestyle factors, having an early menopause (at age 41-44) was associated with an increased risk of all-cause mortality (HR = 1.48, 95% IC: 1.03, 2.14) relative to NM at 50-54 years. Women aged 41-44 and 45-49 at NM had twice the risk of cancer mortality of the reference group. We did not find significant associations between age at NM and cause-specific mortality for respiratory and cardiovascular diseases. CONCLUSIONS Our findings suggest that early menopause is associated with all-cause mortality in the largest city of Latin America. In addition, earlier age at NM was associated with cancer mortality. These results suggest that age at NM may be a biomarker for mortality, irrespective of country of residence.
Collapse
Affiliation(s)
- Alejandra Andrea Roman Lay
- Department of Epidemiology, School of Public Health, University of São Paulo, Brazil; Faculty of Health Sciences, University of Tarapacá, Chile.
| | | | | | | |
Collapse
|
23
|
Dunneram Y, Greenwood DC, Burley VJ, Cade JE. Dietary intake and age at natural menopause: results from the UK Women's Cohort Study. J Epidemiol Community Health 2018; 72:733-740. [PMID: 29712719 PMCID: PMC6204950 DOI: 10.1136/jech-2017-209887] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/06/2018] [Accepted: 03/22/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Age at natural menopause is a matter of concern for women of reproductive age as both an early or late menopause may have implications for health outcomes. METHODS Study participants were women aged 40-65 years who had experienced a natural menopause from the UK Women's Cohort Study between baseline and first follow-up. Natural menopause was defined as the permanent cessation of menstrual periods for at least 12 consecutive months. A food frequency questionnaire was used to estimate diet at baseline. Reproductive history of participants was also recorded. Regression modelling, adjusting for confounders, was used to assess associations between diet and age at natural menopause. RESULTS During the 4-year follow-up period, 914 women experienced a natural menopause. A high intake of oily fish and fresh legumes were associated with delayed onset of natural menopause by 3.3 years per portion/day (99% CI 0.8 to 5.8) and 0.9 years per portion/day (99% CI 0.0 to 1.8), respectively. Refined pasta and rice was associated with earlier menopause (per portion/day: -1.5 years, 99% CI -2.8 to -0.2). A higher intake of vitamin B6 (per mg/day: 0.6 years, 99% CI 0.1 to 1.2) and zinc (per mg/day: 0.3 years, 99% CI -0.0 to 0.6) was also associated with later age at menopause. Stratification by age at baseline led to attenuated results. CONCLUSION Our results suggest that some food groups (oily fish, fresh legumes, refined pasta and rice) and specific nutrients are individually predictive of age at natural menopause.
Collapse
Affiliation(s)
- Yashvee Dunneram
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | | | - Victoria J Burley
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| |
Collapse
|
24
|
Wang Q, Ferreira DLS, Nelson SM, Sattar N, Ala-Korpela M, Lawlor DA. Metabolic characterization of menopause: cross-sectional and longitudinal evidence. BMC Med 2018; 16:17. [PMID: 29402284 PMCID: PMC5800033 DOI: 10.1186/s12916-018-1008-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/17/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Women who experience menopause are at higher cardiometabolic risk and often display adverse changes in metabolic biomarkers compared with pre-menopausal women. It remains elusive whether the changes in cardiometabolic biomarkers during the menopausal transition are due to ovarian aging or chronological aging. Well-conducted longitudinal studies are required to determine this. The aim of this study was to explore the cross-sectional and longitudinal associations of reproductive status, defined according to the 2012 Stages of Reproductive Aging Workshop criteria, with 74 metabolic biomarkers, and establish whether any associations are independent of age-related changes. METHODS We determined cross-sectional associations of reproductive status with metabolic profiling in 3,312 UK midlife women. In a subgroup of 1,492 women who had repeat assessments after 2.5 years, we assessed how the change in reproductive status was associated with the changes in metabolic biomarkers. Metabolic profiles were measured by high-throughput quantitative nuclear magnetic resonance metabolomics. In longitudinal analyses, we compared the change in metabolic biomarkers for each reproductive-status category change to that of the reference of being pre-menopausal at both time points. As all women aged by a similar amount during follow-up, these analyses contribute to distinguishing age-related changes from those related to change in reproductive status. RESULTS Consistent cross-sectional and longitudinal associations of menopause with a wide range of metabolic biomarkers were observed, suggesting the transition to menopause induces multiple metabolic changes independent of chronological aging. The metabolic changes included increased concentrations of very small very low-density lipoproteins, intermediate-density lipoproteins, low-density lipoproteins (LDLs), remnant, and LDL cholesterol, and reduced LDL particle size, all toward an atherogenic lipoprotein profile. Increased inflammation was suggested via an inflammatory biomarker, glycoprotein acetyls, but not via C-reactive protein. Also, levels of glutamine and albumin increased during the transition. Most of these metabolic changes seen at the time of becoming post-menopausal remained or became slightly stronger during the post-menopausal years. CONCLUSIONS The transition to post-menopause has effects on multiple circulating metabolic biomarkers, over and above the underlying age trajectory. The adverse changes in multiple apolipoprotein-B-containing lipoprotein subclasses and increased inflammation may underlie women's increased cardiometabolic risk in their post-menopausal years.
Collapse
Affiliation(s)
- Qin Wang
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
| | - Diana L. Santos Ferreira
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Mika Ala-Korpela
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Systems Epidemiology, Baker Heart and Diabetes Institute, Melbourne, VIC Australia
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, School of Public Health and Preventive Medicine, The Alfred Hospital, Monash University, Melbourne, VIC Australia
| | - Debbie A. Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
25
|
1-Year Clinical Outcomes in Women After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:1-12. [DOI: 10.1016/j.jcin.2017.09.034] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/26/2017] [Accepted: 09/28/2017] [Indexed: 11/18/2022]
|
26
|
Agaba P, Meloni S, Sule H, Ocheke A, Agaba E, Idoko J, Kanki P. Factors associated with early menopause among women in Nigeria. J Virus Erad 2017; 3:145-151. [PMID: 28758022 PMCID: PMC5518243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Effective antiretroviral therapy has prolonged the survival of patients with HIV. Accordingly, studies of the consequences of ageing are increasingly important. We determined the prevalence of early menopause (EM) and its associated factors in a cohort of HIV-infected and HIV-negative controls in Jos, Nigeria. METHODS HIV-infected women accessing care in an ambulatory setting and their negative counterparts from the general population were included. Menopause was defined as having gone one year since the last menstrual period. EM was defined as the onset of menopause at ≤45 years of age. Baseline characteristics were compared and logistic regression analyses were used to determine factors independently associated with EM. RESULTS Out of a total of 253 women included, 58 attained menopause early, giving an EM prevalence of 22.9% (95% confidence interval [CI] 17.9-28.6%). Women with EM were younger (P<0.001) and had been infected with HIV for a shorter period (P=0.007). Baseline CD4+ cell count (P=0.66) and viral load (P=0.15) were similar among those with and without EM. For all subjects, HIV infection (adjusted odds ratio [AOR}=10.95, 95% CI 1.39-86.33) and sexual activity (AOR=2.37, 95% CI 1.24-4.52) were associated with EM while early menarche (AOR=14.88, 95% CI 1.37-161.10) and sexual activity (AOR=2.02, 95% CI 1.03-3.96) were independently associated with EM. CONCLUSION Over a quarter of our postmenopausal women attained menopause early. No HIV-related factor predicted EM in this study. A better understanding of ageing in these women is important to determine a more appropriate disease-management approach during this period of life.
Collapse
Affiliation(s)
- Patricia Agaba
- Department of Family Medicine,
University of Jos/Jos University Teaching Hospital,
Nigeria,APIN Centre, Jos University Teaching Hospital,
Jos,
Nigeria,Corresponding author: Patricia A Agaba,
Department of Family Medicine,
University of Jos/Jos University Teaching Hospital,
2 Murtela Mohammed Way,
PMB 2076,
Jos,
Plateau State,
Nigeria
,
| | - Seema Meloni
- Department of Immunology and Infectious Diseases,
Harvard TH Chan School of Public Health,
Boston,
MA,
USA
| | - Halima Sule
- Department of Family Medicine,
University of Jos/Jos University Teaching Hospital,
Nigeria,APIN Centre, Jos University Teaching Hospital,
Jos,
Nigeria
| | - Amaka Ocheke
- Department of Obstetrics & Gynaecology,
University of Jos/Jos University Teaching Hospital,
Nigeria
| | - Emmanuel Agaba
- Department of Medicine,
University of Jos/Jos University Teaching Hospital,
Nigeria
| | - John Idoko
- Department of Medicine,
University of Jos/Jos University Teaching Hospital,
Nigeria
| | - Phyllis Kanki
- Department of Immunology and Infectious Diseases,
Harvard TH Chan School of Public Health,
Boston,
MA,
USA
| |
Collapse
|
27
|
Agaba P, Meloni S, Sule H, Ocheke A, Agaba E, Idoko J, Kanki P. Factors associated with early menopause among women in Nigeria. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30333-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
28
|
Shadyab AH, Macera CA, Shaffer RA, Jain S, Gallo LC, Gass MLS, Waring ME, Stefanick ML, LaCroix AZ. Ages at menarche and menopause and reproductive lifespan as predictors of exceptional longevity in women: the Women's Health Initiative. Menopause 2017; 24:35-44. [PMID: 27465713 PMCID: PMC5177476 DOI: 10.1097/gme.0000000000000710] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate associations between reproductive factors and survival to age 90 years. METHODS This was a prospective study of postmenopausal women from the Women's Health Initiative recruited from 1993 to 1998 and followed until the last outcomes evaluation on August 29, 2014. Participants included 16,251 women born on or before August 29, 1924 for whom survival to age 90 during follow-up was ascertained. Women were classified as having survived to age 90 (exceptional longevity) or died before age 90. Multivariable logistic regression models were used to evaluate associations of ages at menarche and menopause (natural or surgical) and reproductive lifespan with longevity, adjusting for demographic, lifestyle, and reproductive characteristics. RESULTS Participants were on average aged 74.7 years (range, 69-81 y) at baseline. Of 16,251 women, 8,892 (55%) survived to age 90. Women aged at least 12 years at menarche had modestly increased odds of longevity (odds ratio [OR], 1.09; 95% CI, 1.00-1.19). There was a significant trend toward increased longevity for later age at menopause (natural or surgical; Ptrend = 0.01), with ORs (95% CIs) of 1.19 (1.04-1.36) and 1.18 (1.02-1.36) for 50 to 54 and at least 55 compared with less than 40 years, respectively. Later age at natural menopause as a separate exposure was also significantly associated with increased longevity (Ptrend = 0.02). Longer reproductive lifespan was significantly associated with increased longevity (Ptrend = 0.008). The odds of longevity were 13% (OR 1.13; 95% CI, 1.03-1.25) higher in women with more than 40 compared with less than 33 reproductive years. CONCLUSIONS Reproductive characteristics were associated with late-age survival in older women.
Collapse
Affiliation(s)
- Aladdin H Shadyab
- 1San Diego State University/University of California San Diego Joint-Doctoral Program in Public Health (Epidemiology), San Diego, CA 2Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA 3Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA 4Department of Psychology, San Diego State University, San Diego, CA 5The North American Menopause Society, Emeritus, Cleveland, OH 6Departments of Quantitative Health Sciences and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA 7Department of Medicine, Stanford Center for Prevention Research, Stanford University School of Medicine, Stanford, CA 8Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Dhingra R, Darrow LA, Klein M, Winquist A, Steenland K. Perfluorooctanoic acid exposure and natural menopause: A longitudinal study in a community cohort. ENVIRONMENTAL RESEARCH 2016; 146:323-330. [PMID: 26802619 DOI: 10.1016/j.envres.2015.12.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/27/2015] [Accepted: 12/31/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Perfluorooctanoic acid (PFOA), a suspected endocrine disruptor, is a bio-persistent chemical found at low levels in the serum of nearly all U.S. residents. Early menopause has been positively associated with serum PFOA in prior cross-sectional studies. METHODS We conducted a longitudinal analysis of age at menopause among women, aged ≥40 years, (N=8759) in a Mid-Ohio Valley community cohort, exposed to high PFOA levels via contaminated drinking water. Using estimated retrospective year-specific serum PFOA concentrations (1951-2011), we examined the associations between PFOA, as cumulative exposure or year-specific serum estimates, and natural menopause using a Cox proportional hazards models. As participants were initially recruited in 2005-2006, we also analyzed the cohort prospectively (i.e., from the time of enrollment), using both modeled cumulative PFOA, and PFOA serum levels measured in 2005-2006. Women with hysterectomy (a competing risk) were either censored or excluded from the analysis. RESULTS Neither in the retrospective nor the prospective cohort did we find a significant (at α=0.05) trend between PFOA exposure and natural menopause. The non-significant, hazard ratios by quintile of increasing cumulative serum PFOA were 1.00 (referent), 1.00, 1.09, 1.05 and 1.06 (trend test for log cumulative exposure: p=0.37) with hysterectomies censored, and 1.00 (referent), 1.06, 1.13, 1.09 and 1.11 (trend test for log cumulative exposure: p=0.85) with hysterectomies excluded. Year-specific serum estimates were also not associated with early menopause. CONCLUSION Our data suggest that earlier age at menopause is not associated with PFOA exposure.
Collapse
Affiliation(s)
- Radhika Dhingra
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Lyndsey A Darrow
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Mitch Klein
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Andrea Winquist
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| |
Collapse
|
30
|
Association of menopause age and N-terminal pro brain natriuretic peptide: the Multi-Ethnic Study of Atherosclerosis. Menopause 2016; 22:527-33. [PMID: 25290536 DOI: 10.1097/gme.0000000000000342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Menopause age can affect the risk of developing cardiovascular disease (CVD). The purpose of this study was to investigate the associations of early menopause (menopause occurring before age 45 y) and menopause age with N-terminal pro brain natriuretic peptide (NT-proBNP), a potential risk marker of CVD and heart failure. METHODS Our cross-sectional study included 2,275 postmenopausal women, aged 45 to 85 years and without clinical CVD (2000-2002), from the Multi-Ethnic Study of Atherosclerosis. Participants were classified as having or not having early menopause. NT-proBNP was log-transformed. Multivariable linear regression was used for analysis. RESULTS Five hundred sixty-one women had early menopause. The median (25th-75th percentiles) NT-proBNP value was 79.0 (41.1-151.6) pg/mL for all participants, 83.4 (41.4-164.9) pg/mL for women with early menopause, and 78.0 (40.8-148.3) pg/mL for women without early menopause. The mean (SD) age was 65 (10.1) and 65 (8.9) years for women with and without early menopause, respectively. No significant interactions between menopause age and ethnicity were observed. In multivariable analysis, early menopause was associated with a 10.7% increase in NT-proBNP levels, whereas each 1-year increase in menopause age was associated with a 0.7% decrease in NT-proBNP levels. CONCLUSIONS Early menopause is associated with greater NT-proBNP levels, whereas each 1-year increase in menopause age is associated with lower NT-proBNP levels, in postmenopausal women.
Collapse
|
31
|
|
32
|
Tao XY, Zuo AZ, Wang JQ, Tao FB. Effect of primary ovarian insufficiency and early natural menopause on mortality: a meta-analysis. Climacteric 2015; 19:27-36. [DOI: 10.3109/13697137.2015.1094784] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
33
|
Gong D, Sun J, Zhou Y, Zou C, Fan Y. Early age at natural menopause and risk of cardiovascular and all-cause mortality: A meta-analysis of prospective observational studies. Int J Cardiol 2015; 203:115-9. [PMID: 26512821 DOI: 10.1016/j.ijcard.2015.10.092] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/06/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Dandan Gong
- Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu 212002, PR China
| | - Jun Sun
- Department of Gynaecology and Obstetrics, Tieling Central Hospital, Tieling 112000, PR China
| | - Yongjing Zhou
- Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu 212002, PR China
| | - Chen Zou
- Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu 212002, PR China
| | - Yu Fan
- Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu 212002, PR China.
| |
Collapse
|
34
|
Shenassa ED, Rossen LM. Telomere length and age-at-menopause in the US. Maturitas 2015; 82:215-21. [PMID: 26297686 PMCID: PMC4669569 DOI: 10.1016/j.maturitas.2015.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/02/2015] [Accepted: 07/09/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Age-at-menopause and leukocyte telomere length (LTL) are both associated with biologic aging. Therefore, it would be reasonable to hypothesize that LTL may also serve as a marker for reproductive aging as shorter LTL may be associated with earlier age-at-menopause. METHODS We analyzed data from 799 post-menopausal (ages 41-85) participants in the National Health and Nutrition Examination Survey (1999-2002), a nationally representative sample of U.S. women. RESULTS Controlling for behavioral, socio-demographic, and health-related determinants of menopause, we found that among non-Hispanic white women, an increase of one standard deviation in LTL was associated with a 0.43 year higher reported age-at-menopause. Among Mexican-Americans, an increase of one standard deviation in LTL was associated with a 1.56 year earlier menopause. There was no significant association between LTL and age-at-menopause among non-Hispanic black women. CONCLUSIONS Our main finding is evidence of a strong interaction by race/ethnicity in the association between LTL and age-at-menopause. This evidence does not support the hypothesis that shorter LTL is a predictor of earlier age-at-menopause, as the magnitude and direction of the associations between LTL and age-at-menopause varied across racial/ethnic groups.
Collapse
Affiliation(s)
- Edmond D Shenassa
- Maternal & Child Health Program, School of Public Health, University of Maryland, College Park, United States; Department of Epidemiology & Biostatistics, School of Public Health, University of Maryland, College Park, United States; Department of Epidemiology, School of Public Health, Brown University, United States; Department of Epidemiology, University of Maryland, Baltimore,United States.
| | - Lauren M Rossen
- Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention,United States
| |
Collapse
|
35
|
Yang HJ, Suh PS, Kim SJ, Lee SY. Effects of Smoking on Menopausal Age: Results From the Korea National Health and Nutrition Examination Survey, 2007 to 2012. J Prev Med Public Health 2015; 48:216-24. [PMID: 26265667 PMCID: PMC4542296 DOI: 10.3961/jpmph.15.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/23/2015] [Indexed: 11/25/2022] Open
Abstract
Objectives: Decreased fertility and impaired health owing to early menopause are significant health issues. Smoking is a modifiable health-related behavior that influences menopausal age. We investigated the effects of smoking-associated characteristics on menopausal age in Korean women. Methods: This study used data from the Korea National Health and Nutrition Examination Survey from 2007 to 2012. Menopausal age in relation to smoking was analyzed as a Kaplan-Meier survival curve for 11 510 women (aged 30 to 65 years). The risk of entering menopause and experiencing early menopause (before age 48) related to smoking were assessed using a Cox proportional hazards model. Results: The menopausal age among smokers was 0.75 years lower than that among non-smokers (p<0.001). The results of the Cox proportional hazards model showed pre-correction and post-correction risk ratios for entering menopause related to smoking of 1.26 (95% confidence interval [CI], 1.09 to 1.46) and 1.27 (95% CI, 1.10 to 1.47), respectively, and pre-correction and post-correction risk ratios for experiencing early menopause related to smoking of 1.36 (95% CI, 1.03 to 1.80) and 1.40 (95% CI, 1.05 to 1.85), respectively. Conclusions: Smokers reached menopause earlier than non-smokers, and their risk for experiencing early menopause was higher.
Collapse
Affiliation(s)
- Hee Jung Yang
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
| | - Pae Sun Suh
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
| | - Soo Jeong Kim
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
| | - Soon Young Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
36
|
Tarín JJ, García-Pérez MA, Hamatani T, Cano A. Infertility etiologies are genetically and clinically linked with other diseases in single meta-diseases. Reprod Biol Endocrinol 2015; 13:31. [PMID: 25880215 PMCID: PMC4404574 DOI: 10.1186/s12958-015-0029-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/09/2015] [Indexed: 02/07/2023] Open
Abstract
The present review aims to ascertain whether different infertility etiologies share particular genes and/or molecular pathways with other pathologies and are associated with distinct and particular risks of later-life morbidity and mortality. In order to reach this aim, we use two different sources of information: (1) a public web server named DiseaseConnect ( http://disease-connect.org ) focused on the analysis of common genes and molecular mechanisms shared by diseases by integrating comprehensive omics and literature data; and (2) a literature search directed to find clinical comorbid relationships of infertility etiologies with only those diseases appearing after infertility is manifested. This literature search is performed because DiseaseConnect web server does not discriminate between pathologies emerging before, concomitantly or after infertility is manifested. Data show that different infertility etiologies not only share particular genes and/or molecular pathways with other pathologies but they have distinct clinical relationships with other diseases appearing after infertility is manifested. In particular, (1) testicular and high-grade prostate cancer in male infertility; (2) non-fatal stroke and endometrial cancer, and likely non-fatal coronary heart disease and ovarian cancer in polycystic ovary syndrome; (3) osteoporosis, psychosexual dysfunction, mood disorders and dementia in premature ovarian failure; (4) breast and ovarian cancer in carriers of BRCA1/2 mutations in diminished ovarian reserve; (5) clear cell and endometrioid histologic subtypes of invasive ovarian cancer, and likely low-grade serous invasive ovarian cancer, melanoma and non-Hodgkin lymphoma in endometriosis; and (6) endometrial and ovarian cancer in idiopathic infertility. The present data endorse the principle that the occurrence of a disease (in our case infertility) is non-random in the population and suggest that different infertility etiologies are genetically and clinically linked with other diseases in single meta-diseases. This finding opens new insights for clinicians and reproductive biologists to treat infertility problems using a phenomic approach instead of considering infertility as an isolated and exclusive disease of the reproductive system/hypothalamic-pituitary-gonadal axis. In agreement with a previous validation analysis of the utility of DiseaseConnect web server, the present study does not show a univocal correspondence between common gene expression and clinical comorbid relationship. Further work is needed to untangle the potential genetic, epigenetic and phenotypic relationships that may be present among different infertility etiologies, morbid conditions and physical/cognitive traits.
Collapse
Affiliation(s)
- Juan J Tarín
- Department of Functional Biology and Physical Anthropology, Faculty of Biological Sciences, University of Valencia, Burjassot, Valencia, 46100, Spain.
| | - Miguel A García-Pérez
- Department of Genetics, Faculty of Biological Sciences, University of Valencia, Burjassot, Valencia, 46100, Spain.
- Research Unit-INCLIVA, Hospital Clínico de Valencia, Valencia, 46010, Spain.
| | - Toshio Hamatani
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan.
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, University of Valencia, Valencia, 46010, Spain.
- Service of Obstetrics and Gynecology, University Clinic Hospital, Valencia, 46010, Spain.
| |
Collapse
|
37
|
Duan P, Wang ZM, Liu J, Wang LN, Yang Z, Tu P. Gene polymorphisms in RANKL/RANK/OPG pathway are associated with ages at menarche and natural menopause in Chinese women. BMC WOMENS HEALTH 2015; 15:32. [PMID: 25884698 PMCID: PMC4397679 DOI: 10.1186/s12905-015-0192-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/01/2015] [Indexed: 11/29/2022]
Abstract
Background Age at menarche (AAM) and age at natural menopause (AANM) have been shown intimately associated with woman’s health later in life. Previous studies have indicated that AAM and AANM are highly heritable. RANKL/RANK/OPG signaling pathway is essential for mammary gland development, which is also found associated with post-menopausal and hormone-related diseases. The aim of this study was to evaluate associations between the polymorphisms in the TNFSF11, TNFRSF11A and TNFRSF11B genes in the RANKL/RANK/OPG pathway with AAM and AANM in Chinese women. Methods Post-menopausal Chinese women (n = 845) aged from 42 to 89 years were recruited in the study. Information about AAM and AANM were obtained through questionnaires and the genomic DNA was isolated from peripheral blood from the participants. Total 21 tagging single nucleotide polymorphisms (SNPs) of TNFSF11, TNFRSF11A and TNFRSF11B were genotyped. Results Three SNPs of TNFRSF11A (rs4500848, rs6567270 and rs1805034) showed significant association with AAM (P < 0.01, P = 0.02 and P = 0.01, respectively), and one SNP (rs9962159) was significantly associated with AANM (P = 0.03). Haplotypes TC and AT (rs6567270-rs1805034) of TNFRSF11A were found to be significantly associated with AAM (P = 0.01 and P = 0.02, respectively), and haplotypes GC and AC (rs9962159-rs4603673) of TNFRSF11A showed significant association with AANM (P = 0.03 and P < 0.01, respectively). No significant association between TNFSF11 or TNFRSF11B gene with AAM or AANM was found. Conclusions The present study suggests that TNFRSF11A but not TNFSF11 and TNFRSF11B genetic polymorphisms are associated with AAM and AANM in Chinese women. The findings provide evidence that genetic variations in RANKL/RANK/OPG pathway may be associated with the onset and cessation of the menstruation cycle.
Collapse
Affiliation(s)
- Peng Duan
- Department of Endocrinology and Metabolism, Nanchang Key Laboratory of Diabetes, The Third Hospital of Nanchang/The Affiliated Nanchang Hospital of Southern Medical University, NO.2, South Xiangshan road, Nanchang city, Xihu District, Jiangxi province, 330009, People's Republic of China.
| | - Zhi-Ming Wang
- Department of Endocrinology and Metabolism, Nanchang Key Laboratory of Diabetes, The Third Hospital of Nanchang/The Affiliated Nanchang Hospital of Southern Medical University, NO.2, South Xiangshan road, Nanchang city, Xihu District, Jiangxi province, 330009, People's Republic of China.
| | - Jiang Liu
- Department of Endocrinology and Metabolism, Nanchang Key Laboratory of Diabetes, The Third Hospital of Nanchang/The Affiliated Nanchang Hospital of Southern Medical University, NO.2, South Xiangshan road, Nanchang city, Xihu District, Jiangxi province, 330009, People's Republic of China.
| | - Li-Na Wang
- Department of Endocrinology and Metabolism, Nanchang Key Laboratory of Diabetes, The Third Hospital of Nanchang/The Affiliated Nanchang Hospital of Southern Medical University, NO.2, South Xiangshan road, Nanchang city, Xihu District, Jiangxi province, 330009, People's Republic of China.
| | - Zhi Yang
- Department of Endocrinology and Metabolism, Nanchang Key Laboratory of Diabetes, The Third Hospital of Nanchang/The Affiliated Nanchang Hospital of Southern Medical University, NO.2, South Xiangshan road, Nanchang city, Xihu District, Jiangxi province, 330009, People's Republic of China.
| | - Ping Tu
- Department of Endocrinology and Metabolism, Nanchang Key Laboratory of Diabetes, The Third Hospital of Nanchang/The Affiliated Nanchang Hospital of Southern Medical University, NO.2, South Xiangshan road, Nanchang city, Xihu District, Jiangxi province, 330009, People's Republic of China.
| |
Collapse
|
38
|
Hoyt LT, Falconi AM. Puberty and perimenopause: reproductive transitions and their implications for women's health. Soc Sci Med 2015; 132:103-12. [PMID: 25797100 DOI: 10.1016/j.socscimed.2015.03.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This scoping review synthesizes existing research on two major transitions in females' lives: puberty and perimenopause. These two periods of vast physiological change demarcate the beginning and the end of the reproductive life cycle and are associated with major neuroendocrine reorganization across two key systems, the hypothalamic-pituitary-gonadal (HPG) axis the hypothalamus-pituitary-adrenal (HPA) axis. Despite growing evidence suggesting that the timing and experience of puberty and perimenopause are related to various physical and mental health outcomes (e.g., mood disorders, metabolism, cardiovascular health, autoimmune conditions, and cancer), these two processes are rarely examined together. In this paper, we bridge these disparate literatures to highlight similarities, isolate inconsistencies, and identify important areas for future research in women's health.
Collapse
Affiliation(s)
- Lindsay Till Hoyt
- Robert Wood Johnson Foundation Health & Society Scholar at the University of California, San Francisco and Berkeley, 3333 California St., Suite 465, San Francisco, CA 94143, USA.
| | - April M Falconi
- School of Public Health, University of California, Berkeley, 13A University Hall, Berkeley, CA 94720, USA.
| |
Collapse
|
39
|
Piérard GE, Hermanns-Lê T, Gaspard U, Piérard-Franchimont C. Asymmetric facial skin viscoelasticity during climacteric aging. Clin Cosmet Investig Dermatol 2014; 7:111-8. [PMID: 24748810 PMCID: PMC3990288 DOI: 10.2147/ccid.s60313] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Climacteric skin aging affects certain biophysical characteristics of facial skin. The purpose of the present study was to assess the symmetric involvement of the cheeks in this stage of the aging process. Methods Skin viscoelasticity was compared on both cheeks in premenopausal and post-menopausal women with indoor occupational activities somewhat limiting the influence of chronic sun exposure. Eighty-four healthy women comprising 36 premenopausal women and 48 early post-menopausal women off hormone replacement therapy were enrolled in two groups. The tensile characteristics of both cheeks were tested and compared in each group. A computerized suction device equipped with a 2 mm diameter hollow probe was used to derive viscoelasticity parameters during a five-cycle procedure of 2 seconds each. Skin unfolding, intrinsic distensibility, biological elasticity, and creep extension were measured. Results Both biological elasticity and creep extension were asymmetric on the cheeks of the post-menopausal women. In contrast, these differences were more discrete in the premenopausal women. Conclusion Facial skin viscoelasticity appeared to be asymmetric following menopause. The possibility of asymmetry should be taken into account in future studies of the effects of hormone replacement therapy and any antiaging procedure on the face in menopausal women.
Collapse
Affiliation(s)
- Gérald E Piérard
- Laboratory of Skin Bioengineering and Imaging, Department of Clinical Sciences, University of Liège, Belgium
| | - Trinh Hermanns-Lê
- Laboratory of Skin Bioengineering and Imaging, Department of Clinical Sciences, University of Liège, Belgium
| | - Ulysse Gaspard
- Department of Gynecology and Obstetrics, University Hospital of Liège, Liège, Belgium
| | | |
Collapse
|
40
|
Bjelland EK, Wilkosz P, Tanbo TG, Eskild A. Is unilateral oophorectomy associated with age at menopause? A population study (the HUNT2 Survey). Hum Reprod 2014; 29:835-41. [PMID: 24549218 DOI: 10.1093/humrep/deu026] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
STUDY QUESTION Is unilateral oophorectomy associated with age at menopause? SUMMARY ANSWER Women who had undergone unilateral oophorectomy entered menopause 1 year earlier than women with two ovaries intact. WHAT IS ALREADY KNOWN There is substantial variation in age at natural menopause. Unilateral oophorectomy implies a significant reduction of the ovarian follicular reserve. Thus, one might expect that the time to menopause is shortened by several years in women who have undergone unilateral oophorectomy. STUDY DESIGN, SIZE AND DURATION A retrospective cohort study of 23 580 Norwegian women who were included in the population-based HUNT2 Survey during the years 1995-1997. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were obtained by two self-administered questionnaires at study inclusion. Cox proportional hazard models were used to estimate relative risks of menopause according to unilateral oophorectomy status with and without adjustment for birth cohort, parity, smoking, body mass index (BMI) and age at menarche. MAIN RESULTS AND THE ROLE OF CHANCE Women who had undergone unilateral oophorectomy were younger at menopause [mean 49.6 years; 95% confidence interval (CI): 49.2-50.0] than women without unilateral oophorectomy (mean 50.7 years; 95% CI: 50.6-50.8) (P < 0.001). The crude relative risk of menopause was 1.28 (95% CI: 1.15-1.42) and remained similar after adjustment for the study factors above (adjusted relative risk 1.27; 95% CI: 1.14-1.41). In addition, recent birth cohort and high BMI were associated with higher age at menopause. LIMITATIONS, REASONS FOR CAUTION Information on unilateral oophorectomy was based on self-reports. Some women may therefore have been misclassified. WIDER IMPLICATIONS OF THE FINDINGS Although the effect of unilateral oophorectomy on the age at menopause is similar to that of smoking, it is weaker than anticipated from the loss of ovarian follicular reserve. Thus, compensatory mechanisms may occur in the remaining ovary.
Collapse
Affiliation(s)
- E K Bjelland
- Health Services Research Centre, Akershus University Hospital, N-1478 Lørenskog, Norway
| | | | | | | |
Collapse
|
41
|
Abstract
Aging is the strongest risk factor for cognitive decline. The perimenopausal period puts women in a more vulnerable state in regard to certain functions such as memory. Also, the Women's Health Initiative Memory Study (WHIMS) pointed at some cognitive adverse effects of postmenopausal hormone therapy, but these results were not relevant for the peri- and early menopause since WHIMS recruited women above the age of 65 years. The 'window of opportunity' theory, pointing at potential protective effects of postmenopausal hormone therapy in the early menopause, mainly applies to coronary artery disease, but clinical data on neuroprotection by estrogen are not consistent. In view of a recent publication, the following article discusses the issue of menopause and cognitive decline, with a focus on possible associations with surgical menopause.
Collapse
Affiliation(s)
- A Pines
- Sackler School of Medicine, Tel-Aviv University , Tel-Aviv , Israel
| |
Collapse
|
42
|
Suba Z. Triple-negative breast cancer risk in women is defined by the defect of estrogen signaling: preventive and therapeutic implications. Onco Targets Ther 2014; 7:147-64. [PMID: 24482576 PMCID: PMC3905095 DOI: 10.2147/ott.s52600] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Epidemiologic studies strongly support that triple-negative breast cancers (TNBCs) may be distinct entities as compared with estrogen receptor (ER)+ tumors, suggesting that the etiologic factors, clinical characteristics, and therapeutic possibilities may vary by molecular subtypes. Many investigations propose that reproductive factors and exogenous hormone use differently or even quite inversely affect the risk of TNBCs and ER+ cancers. Controversies concerning the exact role of even the same risk factor in TNBC development justify that the biological mechanisms behind the initiation of both TNBCs and non-TNBCs are completely obscure. To arrive at a comprehensive understanding of the etiology of different breast cancer subtypes, we should also reconsider our traditional concepts and beliefs regarding cancer risk factors. Malignancies are multicausal, but the disturbance of proper estrogen signaling seems to be a crucial risk factor for the development of mammary cancers. The grade of defect in metabolic and hormonal equilibrium is directly associated with TNBC risk for women during their whole life. Inverse impact of menopausal status or parity on the development of ER+ and ER− breast cancers may not be possible; these controversial results derive from the misinterpretation of percentage-based statistical evaluations. Exogenous or parity-associated excessive estrogen supply is suppressive against breast cancer, though the lower the ER expression of tumors, the weaker the anticancer capacity. In women, the most important preventive strategy against breast cancers – included TNBCs – is the strict control and maintenance of hormonal equilibrium from early adolescence through the whole lifetime, particularly during the periods of great hormonal changes.
Collapse
Affiliation(s)
- Zsuzsanna Suba
- National Institute of Oncology, Surgical and Molecular Tumor Pathology Centre, Budapest, Hungary
| |
Collapse
|
43
|
Pérez-Alcalá I, Sievert LL, Obermeyer CM, Reher DS. Cross cultural analysis of factors associated with age at natural menopause among latin-american immigrants to madrid and their spanish neighbors. Am J Hum Biol 2013; 25:780-8. [DOI: 10.1002/ajhb.22447] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/01/2013] [Accepted: 08/06/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Irene Pérez-Alcalá
- Department of Sociology II (Human Ecology and Population Studies); Universidad Complutense de Madrid; Madrid Spain
| | | | | | - David Sven Reher
- Department of Sociology II (Human Ecology and Population Studies); Universidad Complutense de Madrid; Madrid Spain
| |
Collapse
|