Ages at menarche and menopause, and mortality among postmenopausal women

Associated between cognition, brain-derived neurotrophic factor (BDNF) and macronutrients in normal and overweight postmenopausal women

BDNF is a protein associated with cognitive dysfunction. The aim of the study was to determine the relationship between BDNF and cognitive functions and the intake of macronutrients in postmenopausal women. For this purpose, 72 postmenopausal women were recruited to the study and divided into two subgroups: overweight/obese and normal weight. Using a 3-day food record, nutrition was assessed. The markers studied were the level of BDNF, which was determined from the venous blood serum collected from women, and selected cognitive functions. We observed that in the normal BMI group macronutrient intake was correlated with BDNF levels, and only total fat and carbohydrate intake were inversely correlated with BDNF levels. There were inverse correlations observed among selected parameters of cognitive functioning. In the Ov/Ob group, macronutrient intake correlated with the BDNF level for several variables, e.g. vice versa with total protein, fat and carbohydrate intake, as well as dietary cholesterol. It has also been noted that there are links between the BDNF factor and excessive body weight.

A signature of circulating miRNAs predicts the prognosis and therapeutic outcome of taxane/platinum regimen in advanced ovarian carcinoma patients

PURPOSE

Ovarian carcinoma (OC) is ranked as the eighth most lethal gynecological cancer due to late diagnosis and high recurrence. Existing biomarkers are lacking to predict the recurrence and stratify patients who are likely to benefit from chemotherapy. MicroRNAs (miRNAs/miRs) are persistently present in humans and are capable of predicting treatment outcomes. Thus, the purpose of the study was to assess the potential of circulatory miRNAs to predict the efficacy of OC.

METHODS

Newly diagnosed n = 208 OC patients were administrated neoadjuvant/adjuvant chemotherapy (taxane + platinum) after surgery. Their demographic, gynecologic, clinical parameters, response, and survival were recorded. MiR-27a, miR-182, miR-199a, miR-214, and miR-591 were taken and the expression were analyzed using real-time PCR at different treatment intervals. Further, its prognostic value (Kaplan-Meier, and Cox regression analysis) and diagnostic importance (receiver operating characteristic curve) were validated.

RESULT

The mean age of patients with poorly differentiated (45.2%) serous OC was 48.69 ± 10.38. The majority experienced menarche at ≥ 12 (62.2%) with poor menstrual hygiene (81.8%) and were post-menopausal (69.4%), some were associated with high risk of survival (HR =  > 1). MiRNA signature showed three over-expression and two under-expression (miR-27a, miR-182, and miR-214; miR-199a and miR-591) in advanced OC compared to the control (P=  < 0.05). Also, a significant difference was detected at each time interval of treatment with the response (P =  ≤ 0.001) associated with resistance and overall survival (P =  ≤ 0.001) with risk (HR =  > 1). ROC analysis showed enhanced the diagnostics accuracy (< 0.001).

CONCLUSION

Our findings indicate that circulating miRNAs might be a potential minimally invasive diagnostic marker for treatment outcome and recurrence in ovarian carcinoma.

Early menopause and hormone therapy as determinants for lung health outcomes: a secondary analysis using the PLCO trial

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.

Effects of Supplementation with Microalgae Extract from Phaeodactylum tricornutum (Mi136) to Support Benefits from a Weight Management Intervention in Overweight Women

BACKGROUND

Microalgae like Phaeodactylum tricornutum (PT) contain the carotenoid, fucoxanthin, which has been purported to promote fat loss, lower blood lipids, and improve glucose management. This study examined whether dietary supplementation with microalgae extracts from PT containing 4.4 mg/d of fucoxanthin affects changes in body composition or health markers in overweight women during an exercise and diet intervention.

MATERIALS AND METHODS

A total of 37 females (28.6 ± 7.9 years, 80.2 ± 14.9 kg, 29.6 ± 3.8 kg/m², 41.4 ± 4.2% fat) fasted for 12 h, donated a fasting blood sample, completed health and mood state inventories, and undertook body composition, health, and exercise assessments. In a counterbalanced, randomized, and double-blind manner, participants ingested a placebo (PL), or microalgae extract of Phaeodactylum tricornutum standardized to 4.4 mg of fucoxanthin (FX) for 12 weeks while participating in a supervised exercise program that included resistance-training and walking (3 days/week) with encouragement to accumulate 10,000 steps/day on remaining days of the week. The diet intervention involved reducing energy intake by about -300 kcal/d (i.e., ≈1400-1600 kcals/d, 55% carbohydrate, 30% fat, 15% protein) to promote a -500 kcal/d energy deficit with exercise. Follow-up testing was performed at 6 and 12 weeks. A general linear model (GLM) with repeated measures statistical analysis was used to analyze group responses and changes from baseline with 95% confidence intervals.

RESULTS

Dietary supplementation with microalgae extract from PT containing fucoxanthin for 12 weeks did not promote additional weight loss or fat loss in overweight but otherwise healthy females initiating an exercise and diet intervention designed to promote modest weight loss. However, fucoxanthin supplementation preserved bone mass, increased bone density, and saw greater improvements in walking steps/day, resting heart rate, aerobic capacity, blood lipid profiles, adherence to diet goals, functional activity tolerance, and measures of quality of life. Consequently, there appears to be some benefit to supplementing microalgae extract from PT containing fucoxanthin during a diet and exercise program. Registered clinical trial #NCT04761406.

The J shaped association of age at menarche and cardiovascular events: systematic review and meta-analysis

This study aimed to evaluate the association between age at menarche and cardiovascular (CV) events through a systematic review and meta-analysis of observational studies. A comprehensive literature search covering studies published from January 1, 2000, to October 31, 2023, was conducted in PubMed, MEDLINE, Embase, and Scopus. Twenty-nine observational studies involving 4,931,160 adult women aged 18 years or older were included. The meta-analysis revealed a J-shaped association between age at menarche and CV events. Individuals with menarche at 12-13 years exhibited the lowest risk, while those with younger (≤ 11 years) or older ages (14-15 years and ≥ 16 years) showed an increased risk. Notably, individuals with age at menarche of 16 years and older had the highest risk of CV events. The pooled odds of CV mortality in age at menarche categories 14-15 years and ≥ 16 years were 37% (OR: 1.37, 95% CI 1.14-1.64, I2: 76.9%) and 64% (OR: 1.64, 95% CI 1.20-2.24, I2: 87%) higher than referent age at menarche 12-13 years. No statistically significant difference was found in CV mortality risk between individuals with age at menarche ≤ 11 years and those with age at menarche 12-13 years. The ORs for coronary heart disease were significantly higher for age at menarche ≥ 16 years (35% increase), while no significant difference was found for age at menarche ≤ 11 years or 14-15 years compared to age at menarche 12-13 years. Regarding stroke, the ORs for age at menarche ≤ 11, 14-15, and ≥ 16 years were significantly higher (7%, 24%, and 94% increase, respectively) compared to age at menarche 12-13 years. Dose-response meta-analysis and one-stage random-effect cubic spline models confirmed the J-shaped risk pattern. Meta-regression indicated that age and BMI were not significant sources of heterogeneity. Sensitivity analyses and the absence of publication bias further supported the robustness of the findings. This study concludes that age at menarche is independently associated with CV events, with a J-shaped pattern. The findings underscore the significance of considering menarche age as an independent risk factor for CV events. Further research is warranted to validate these findings and explore potential underlying mechanisms.

Chronic Variable Stress and Cafeteria Diet Combination Exacerbate Microglia and c-fos Activation but Not Experimental Anxiety or Depression in a Menopause Model

The menopause transition is a vulnerable period for developing both psychiatric and metabolic disorders, and both can be enhanced by stressful events worsening their effects. The present study aimed to evaluate whether a cafeteria diet (CAF) combined with chronic variable stress (CVS) exacerbates anxious- or depressive-like behavior and neuronal activation, cell proliferation and survival, and microglia activation in middle-aged ovariectomized (OVX) rats. In addition, body weight, lipid profile, insulin resistance, and corticosterone as an index of metabolic changes or hypothalamus-pituitary-adrenal (HPA) axis activation, and the serum pro-inflammatory cytokines IL-6, IL-β, and TNFα were measured. A CAF diet increased body weight, lipid profile, and insulin resistance. CVS increased corticosterone and reduced HDL. A CAF produced anxiety-like behaviors, whereas CVS induced depressive-like behaviors. CVS increased serum TNFα independently of diet. A CAF and CVS separately enhanced the percentage of Iba-positive cells in the hippocampus; the combination of factors further increased Iba-positive cells in the ventral hippocampus. A CAF and CVS increased the c-fos-positive cells in the hippocampus; the combination of factors increased the number of positive cells expressing c-fos in the ventral hippocampus even more. The combination of a CAF and CVS generates a slight neuroinflammation process and neuronal activation in a hippocampal region-specific manner and differentially affects the behavior.

Female Reproductive Events and Subclinical Atherosclerosis of the Brain and Carotid Arteriopathy: the Ohasama Study

AIMS

Few studies have investigated the subclinical atherosclerotic changes in the brain and carotid artery, and in East Asian populations. We sought to investigate whether gravidity, delivery, the age at menarche and menopause and estrogen exposure period are associated with subclinical atherosclerosis of the brain and carotid arteriopathy.

METHODS

This cross-sectional study formed part of a cohort study of Ohasama residents initiated in 1986. Brain atherosclerosis and carotid arteriopathy were diagnosed as white matter hyperintensity (WMH) and lacunae evident on brain magnetic resonance imaging (MRI) and carotid intimal media thickness (IMT) or plaque revealed by ultrasound, respectively. The effect of the reproductive events on brain atherosclerosis and carotid arteriopathy was investigated using logistic regression and general linear regression models after adjusting for covariates.

RESULTS

Among 966 women aged ≥ 55 years in 1998, we identified 622 and 711 women (mean age: 69.2 and 69.7 years, respectively) who underwent either MRI or carotid ultrasound between 1992-2008 or 1993-2018, respectively. The highest quartile of gravidity (≥ 5 vs. 3) and delivery (≥ 4 vs. 2), and the highest and second highest (3 vs. 2) quartiles of delivery were associated with an increased risk of WMH and carotid artery plaque, respectively. Neither of age at menarche, menopause, and estrogen exposure period estimated by subtracting age at menarche from age at menopause was associated with atherosclerotic changes of brain and carotid arteries.

CONCLUSIONS

Higher gravidity and delivery are associated with subclinical atherosclerosis of the brain and carotid plaque.

Association of ESR1 gene polymorphisms with the susceptibility to Hepatitis B virus infection and the clinical outcomes

Estrogen receptor alpha (ESR1) has been implicated in the pathological process of Hepatitis B virus (HBV) infection and is probably an important determinant for gender differences. In this study, a total of 975 subjects including 368 healthy controls, 323 hepatocellular carcinoma (HCC) patients with HBsAg positive, and 284 HBV-infected subjects without HCC were included. Three single nucleotide polymorphisms of ESR1 (rs2234693, rs2077647, rs2228480) were detected to investigate the correlation between ESR1 polymorphisms and the susceptibility to HBV persistence and the clinical outcomes. The association of ESR1 polymorphisms with HCC prognosis was investigated in our cohort enrolling 376 HBV-HCC patients. The frequency of rs2234693 C allele was lower in chronic Hepatitis B (CHB) and liver cirrhosis (LC) than that in HCC patients in the males (adjusted odds ratio [AOR] = 0.63, 95% confidence interval [CI] = 0.41-0.96). rs2228480 A allele was associated with increased risk of LC (AOR = 2.20, 95% CI = 1.06-4.56) in HBV genotype C, and significantly decreased the risk of HCC recurrence (p = 0.010) and ESR1 mRNA level in tumor tissues (p = 0.032). Haplotype C-G-G was associated with significantly increased risk of HBV persistence (OR = 1.37, 95% CI = 1.08-1.73), while it was opposite for C-A-G and T-G-G (OR = 0.41, 95% CI = 0.27-0.62; OR = 0.53, 95% CI = 0.32-0.85, respectively). These results imply that combinations of these ESR1 polymorphisms may be valuable for the prediction of HBV persistence.

The association between diabetes type, age of onset, and age at natural menopause: a retrospective cohort study using the Canadian Longitudinal Study on Aging

OBJECTIVES

With growing incidence of type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes, more women are expected to spend a larger proportion of their reproductive years living with a diabetes diagnosis. It is important to understand the long-term implications of premenopausal diabetes type on women's reproductive health including their age at natural menopause (ANM).

METHODS

Baseline data from the Comprehensive Cohort of Canadian Longitudinal Study on Aging were used. Females who reported premenopausal diagnosis of diabetes were considered exposed. Kaplan-Meier cumulative survivorship estimates and multivariable Cox regression models were used to assess the association between diabetes types and ANM. Sociodemographic, lifestyle, and premenopausal clinical factors were adjusted in the final model as covariates.

RESULTS

The sample comprised 11,436 participants, weighted to represent 1,474,412Canadian females aged 45 to 85 years. The median ANM was 52 years. After adjusting for ethnicity, education, smoking, and premenopausal clinical factors, early age of diagnosis of both T1D (<30 years) and T2D (30-39 years) were associated with earlier menopause (T1D, <30: hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.05-2.28; T2D, 30-39: HR, 1.82; 95% CI, 1.12-2.94), as compared with nondiabetics. In addition, later age of diagnosis of T2D (≥40 years) was associated with later ANM (T2D: HR, 0.63; 95% CI, 0.50-0.80). No significant association between gestational diabetes and ANM was noted.

CONCLUSIONS

Our results point to early menopause among young women living with a diabetes diagnosis. These findings should allow for more focused research geared toward understanding the long-term health implications of diabetes on women's reproductive health and aging.

Association of life-course reproductive duration with mortality: a population-based twin cohort study

BACKGROUND

Although age at menopause has been linked to mortality, the association between the entire reproductive lifespan and mortality remains unclear.

OBJECTIVE

This study aimed to examine to what extent life-course reproductive duration is associated with all-cause mortality and explore the role of a healthy lifestyle and familial background in such an association.

STUDY DESIGN

A total of 11,669 women (mean age, 63.54 years) from the Swedish Twin Registry were followed for up to 19 years. Information on reproductive duration (the interval between ages at menarche and menopause) and lifestyle factors (including smoking, alcohol consumption, and physical activity; divided into unfavorable/intermediate/favorable) was collected on the basis of a structured questionnaire. Survival status was obtained from the Sweden Cause of Death Register. The data were analyzed using generalized estimating equation models, Laplace regression, and conditional logistic regression.

RESULTS

In the generalized estimating equation model, compared with those with ≤34 reproductive years, the odds ratio (95% confidence interval) of all-cause mortality was 0.79 (0.68-0.90) for those with ≥40 reproductive years, which prolonged survival time by 0.84 (0.24-1.43) years. Women with ≥40 reproductive years plus a favorable lifestyle (odds ratio, 0.28; 95% confidence interval, 0.23-0.35) were at a lower risk of all-cause mortality than those with <40 reproductive years plus an unfavorable lifestyle. An additive interaction between ≥40 reproductive years and a favorable lifestyle on all-cause mortality was observed (attributable proportion, 0.584; 95% confidence interval, 0.016-1.151). The odds ratios in conditional logistic regression and generalized estimating equation models did not differ significantly (P=.67).

CONCLUSION

A longer reproductive lifespan is associated with reduced all-cause mortality and prolongs survival by 0.84 years. A favorable lifestyle may amplify the beneficial effect of longer reproductive lifespan on mortality. Familial background does not account for the observed association.

Early B Cytokine 1 Improves the Proliferation, Invasion and Migration of Ovarian Cancer Cells by Transcriptional Inhibition of the Expression of Cripto-1

Ovarian cancer is a common malignant tumor in obstetrics and gynecology and its pathogenesis is complex. EBF1 expression is significantly decreased in ovarian cancer tissues, but its specific mechanism in ovarian cancer has not been studied. In this study, GEPIA website predicted the expression of EBF1 in ovarian cancer tissues. Expression of EBF1 in ovarian cancer cells was detected by RT-qPCR and western blot. CCK-8 and clone formation assay were used to detect the cell proliferation level. Wound healing and Transwell assays detected the levels of cell invasion and migration. Western blot was used to detect the expression of migration-related proteins. Cell transfection techniques were used to overexpress or reduce the expression levels of EBF1 and Cripto-1. Luciferase assay was used to detect the transcriptional activity of Cripto-1 promoter mutant in ovarian cancer cells. ChIP assay was used to verify the combination of EBF1 and the E1 element of the Cripto-1 promoter. The results showed that the expression of EBF1 was down-regulated in all ovarian cancer cell lines. Overexpression of EBF1 can inhibit the proliferation, invasion and migration of ovarian cancer cells, which is achieved by inhibiting the expression of Cripto-1. Overall, EBF1 improved the malignant progression of ovarian cancer cells by transcriptional inhibition of the expression of Cripto-1.

Life course reproductive dynamics associated with menopause in Ugandan women aged 40-49

BACKGROUND

Early menopausal onset can increase adverse health outcomes in later life; meanwhile, reproductive experiences before menopause may affect its timing. Framed by life course methodology, the study tested for independent and interdependent associations between reproductive history (contraception, age at first birth, parity, terminated pregnancy) and socioeconomic factors (education, wealth, rural-urban residence, cigarette use, marital status, age at first cohabitation) with the occurrence of early menopause.

METHODS

The study population was ever-married women aged 40-49 from the 2016 Demographic & Health Survey (N = 2748). Analytical methods involved probability- and age-adjusted multivariate logistic regression models and predictive margins.

RESULTS

Connections between reproductive and socioeconomic characteristics were key dynamics associated with menopause in ages 40-49. Contraception, parity, and ages at first birth and marriage were found to be independently associated with menopause in this age group. Evidence of interactions was found where no contraceptive use was associated with higher probabilities of menopause for first-time mothers aged 12-15 and for women with no education.

CONCLUSIONS

Studying Ugandan women's reproductive histories highlighted the importance of regional knowledge about menopause. Though we hypothesized that risks would correlate in a chain, the results pointed to risks clustering around contraception, suggesting that improving contraceptive use and education for women could increase menopausal age. Furthermore, the positive association between low parity and early menopause supports the biological mechanism of faster oocyte depletion; however, high-parity populations like Uganda tend to have a younger menopausal age than low-parity populations. Declining mortality in the demographic transition could explain these inverse associations.

Menopause, hysterectomy, menopausal hormone therapy and cause-specific mortality: cohort study of UK Biobank participants

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.

Primary ovarian cancer after colorectal cancer: a Dutch nationwide population-based study

BACKGROUND AND PURPOSE

Women with colorectal cancer (CRC) are at risk not only of developing ovarian metastases, but also of developing a primary ovarian malignancy. Several earlier studies have in fact shown a link between the development of primary ovarian cancer and CRC. The purpose of this study was therefore to determine the risk of developing a primary ovarian cancer in women with prior CRC compared to the general population.

METHODS

Data from the Netherlands Cancer Registry were used. All women diagnosed with invasive CRC between 1989 and 2017 were included. Standardized incidence ratios (SIRs) and absolute excess risks (AERs) per 10,000 person-years were calculated.

RESULTS

During the study period, 410 (0.3%) CRC patients were diagnosed with primary ovarian cancer. Women with CRC had a 20% increased risk of developing ovarian cancer compared to the general population (SIR = 1.2, 95% CI: 1.1-1.3). The AER of ovarian cancer was 0.9 per 10,000 person-years. The risk was especially increased within the first year of a CRC diagnosis (SIR = 3.3, 95% CI: 2.8-3.8) and in women aged ≤ 55 years (SIR = 2.0, 95% CI: 1.6-2.6).

CONCLUSION

This study found a slightly increased risk of primary ovarian cancer in women diagnosed with CRC compared to the general population. However, this may be partly attributable to surveillance or detection bias. Nevertheless, our findings could be helpful for patient counseling, as CRC patients do not currently receive information concerning the increased risk of ovarian cancer.

Nutritional Risk Factors Associated with Vasomotor Symptoms in Women Aged 40-65 Years

Vasomotor symptoms (VMS) are the most common symptoms among menopausal women; these include hot flashes and night sweats, and palpitations often occur along with hot flashes. Some studies in Mexico reported that around 50% of women presented with VMS mainly in the menopausal transition. It has been proven that VMS are not only triggered by an estrogen deficiency, but also by nutritional risk factors. Evidence of an association between nutritional risk factors and VMS is limited in Mexican women. The aim of this study is to identify nutritional risk factors associated with VMS in women aged 40−65 years. This is a comparative cross-sectional study, undertaken in a retrospective way. A sample group (n = 406 women) was divided into four stages according to STRAW+10 (Stages of Reproductive Aging Workshop): late reproductive, menopausal transition, early postmenopause, and late postmenopause. Hot flashes were present mainly in the early postmenopause stage (38.1%, p ≤ 0.001). Two or more VMS were reported in 23.2% of women in the menopausal transition stage and 29.3% in the early postmenopause stage (p < 0.001). The presence of VMS was associated with different nutritional risk factors (weight, fasting glucose levels, cardiorespiratory fitness, and tobacco use) in women living in the northeast of Mexico.

Is age of menarche directly related to vitamin D levels?

INTRODUCTION

Very few studies have examined the direct link between age of menarche and vitamin D level and controversial results have been reported. This study aimed to investigate the association between vitamin D and age of menarche in a group of adolescent girls in an area with plenty of sunshine.

METHODS

At baseline, data were collected on 722 middle schoolgirls that were randomly selected by probability proportional to size sampling method. Of this group, 598 were followed including 173 who had their menarche during the follow-up. Serum 25-hydroxyvitamin D (25OHD) was measured at baseline using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Data on potential confounders were collected at baseline from the parents using self-administered questionnaire and from schoolgirls through face-to-face interview. Multiple linear regression and time-to-event analysis were used to investigate the association between 25OHD concentration and age of menarche.

RESULTS

The mean (SD) age of the study group was 12.51 (0.91) years while the main (SD) age of menarche was 11.82 (1.04) years. The prevalence of vitamin D deficiency (<50 nmol/L) among schoolgirls was 91.69%. We found no evidence for the association between 25OHD levels and age of menarche before (β, .00, 95% confidence interval (CI) [-0.01, 0.01]; p = .808) or after (β, .00, 95% CI [-0.01, 0.01]; p = .765) adjusting for potential confounders. We also found no evidence for association between 25OHD status and age of menarche before (p = .424) or after (p = .356) adjusting for potential confounders. Time-to-event analysis showed no association between 25OHD level or status and age of menarche (p = .850).

CONCLUSION

In Middle Eastern setting, where vitamin D deficiency is common despite plenty of sunshine, vitamin D is not a major determinant of the age at menarche. Regardless of the link between vitamin D and age of menarche, there are several other health benefits of having adequate vitamin D level during childhood and adolescence.

The Influence of Female Reproductive Factors on Longevity: A Systematized Narrative Review of Epidemiological Studies

Purpose: This systematized review presents a synthesis of epidemiological studies that examine the association between female reproductive factors and longevity indicators. Methods: A comprehensive literature search was conducted using four bibliographic databases: OVID Medline, Web of Science, PubMed, and Google Scholar, including English language articles published until March 2022. Results from the search strategy yielded 306 articles, 37 of which were included for review based on eligibility criteria. Results were identified within the following nine themes: endogenous androgens and estrogens, age at first childbirth, age at last childbirth, parity, reproductive lifespan, menopause-related factors, hormone therapy use, age at menarche, and offspring gender. Results: Evidence that links reproductive factors and long lifespan is limited. Several female reproductive factors are shown to be significantly associated with longevity, yet findings remain inconclusive. The most consistent association was between parity (fertility and fecundity) and increased female lifespan. Age at first birth and parity were consistently associated with increased longevity. Associations between age at menarche and menopause, premature menopause, reproductive lifespan, offspring gender and longevity are inconclusive. Conclusion: There is not enough evidence to consider sex a longevity predictor. To understand the mechanisms that predict longevity outcomes, it is imperative to consider sex-specific within-population differences.

Ovarian metastases from colorectal cancer in young women: a systematic review of the literature

BACKGROUND AND PURPOSE

In female colorectal cancer patients, a mean proportion of synchronous and/or metachronous ovarian metastases of 3.4% was described. Previous literature showed that young or premenopausal women (≤ 55 years of age) may be more frequently affected. Once ovarian metastases are diagnosed, the prognosis of the patient is generally dismal, with 5-year survival varying from 12 to 27%. The present study is aimed at determining the proportion of young or premenopausal women diagnosed with colorectal cancer who presented with or developed ovarian metastases by reviewing the current literature on this topic.

METHODS

This review was performed by querying MEDLINE and EMBASE databases using a combination of terms: "colorectal neoplasms, colorectal cancer, ovarian neoplasms, Krukenberg tumor, young adult, young age, premenopause." Studies that indicated ovarian metastases, either synchronous or metachronous (or a combination of the two), in young women were retrieved and analyzed.

RESULTS

The review identified 14 studies encompassing 3379 young or premenopausal female colorectal cancer patients. In this selected group of patients, a mean proportion of ovarian metastases of 4.6% [95% CI: 4.0;5.4] was found.

CONCLUSIONS

This review showed that approximately one in twenty young female colorectal cancer patients will present with or develop ovarian metastases. Since outcome of this specific oncological pathology is often dismal, this finding is clinically relevant. It demonstrates the need to develop strategies to lower the incidence of ovarian metastases with adequate treatment and counseling of these patients.

Association between body mass index, waist circumference, and age at natural menopause: a population-based cohort study in Chinese women

The purpose of the study was to investigate whether premenopausal body mass index (BMI) and waist circumference (WC) influence age at menopause. A total of 2116 women aged 35-64 years from two communities of the CMCS Beijing cohort were recruited in 1992 and followed up to 2018. Of 1439 premenopausal women at baseline, 6 women data were missing. Finally, 1433 women were included for analysis. Overweight was defined as BMI 24-27.99 kg/m². Central obesity was defined as WC ≥80 cm. Age at menopause was categorized as <45 years, 45-49 years, 50-51 years (reference), and >51 years. Multinomial logistic regression models were used to estimate relative odds ratios (RORs) and 95% confidence intervals (CIs). Compared to women with normal weight and normal WC, overweight women with normal WC had higher risk of menopause at >51 years (ROR 1.64, 95% CI 1.10-2.45; P = .01); and overweight women with central obesity had higher risk of menopause at not only >51 years (ROR 1.82, 95% CI 1.13-2.93; P = .01) but also <45 years (ROR 3.13, 95% CI 1.20-8.43; P = .02) and 45-49 years (ROR 2.76, 95% CI 1.71-4.46; P < .001). When overweight women combine with central obesity, the risk of early menopause will increase in some of them.

Effects of DHA-Rich n-3 Fatty Acid Supplementation and/or Resistance Training on Body Composition and Cardiometabolic Biomarkers in Overweight and Obese Post-Menopausal Women

Resistance training (RT) and n-3 polyunsaturated fatty acids (n-3 PUFA) supplementation have emerged as strategies to improve muscle function in older adults. Overweight/obese postmenopausal women (55–70 years) were randomly allocated to one of four experimental groups, receiving placebo (olive oil) or docosahexaenoic acid (DHA)-rich n-3 PUFA supplementation alone or in combination with a supervised RT-program for 16 weeks. At baseline and at end of the trial, body composition, anthropometrical measures, blood pressure and serum glucose and lipid biomarkers were analyzed. Oral glucose tolerance tests (OGTT) and strength tests were also performed. All groups exhibit a similar moderate reduction in body weight and fat mass, but the RT-groups maintained bone mineral content, increased upper limbs lean mass, decreased lower limbs fat mass, and increased muscle strength and quality compared to untrained-groups. The RT-program also improved glucose tolerance (lowering the OGTT incremental area under the curve). The DHA-rich supplementation lowered diastolic blood pressure and circulating triglycerides and increased muscle quality in lower limbs. In conclusion, 16-week RT-program improved segmented body composition, bone mineral content, and glucose tolerance, while the DHA-rich supplement had beneficial effects on cardiovascular health markers in overweight/obese postmenopausal women. No synergistic effects were observed for DHA supplementation and RT-program combination.

Meta-analysis: Early Age at Natural Menopause and Risk for All-Cause and Cardiovascular Mortality

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 (HR_adjusted = 1.08, 95% CI: 1.03 to 1.14, P = 0.002; RR_adjusted = 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 (HR_adjusted = 1.10; 95% CI: 1.01 to 1.21; P = 0.034) and without (RR_adjusted = 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.

Factors influencing age at natural menopause

AIM

Women who experience menopause before 45 years, have an increased risk for morbidity and mortality. We aimed to identify the factors influencing the age at natural menopause and to investigate whether tubal ligation alter age at natural menopause.

METHODS

This cross-sectional study was conducted on total 1660 women with natural menopause. The participants were divided into two groups as the ones having menopause before age of 45 years and after 45 years old.

RESULTS

Positive family history, smoking and use of oral contraceptive were found to increase the risk of early menopause by 3.68, 1.34 and 1.04 times, respectively. First pregnancy at older age reduced the risk of early menopause by 0.97 and obesity reduced this risk by 0.65 (95% CI 0.47-0.90). There was no significant difference between menopausal age of patients who underwent BTL (47.46 ± 4.67 years old) and those who did not (47.68 ± 5.18 years old) (P:0.320; P > 0.05). The mean age at menopause of patients who had tubal ligation with laparoscopic cauterization and Pomeroy technique was 46.91 ± 4.07 and 47.55 ± 4.76 years old, respectively (P:0.503; P > 0.05). Besides, there was no significant difference between patients having tubal ligation at the time of cesarean section and those who did not regarding menopausal age (P:0.314; P > 0.05).

CONCLUSION

We recommend identifying modifiable factors and informing women at risk of early menopause. Tubal ligation, when performed correctly, should not compromise ovarian function. If tubal ligation interferes with vascular supply to the ovaries, it may not be substantial enough to result in an earlier onset of menopause.

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

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.

Effect of age at menarche on the mother's weight status two and four years after delivery: a cohort study

We aimed to estimate the effect of age at menarche on the risk of excess body weight in Brazilian women two and four years after delivery. This was a cohort study that used data from adult women of the Predictors of Maternal and Child Excess Body Weight (PREDI) Study obtained at baseline (2012) and at 1^st(2014) and 2^nd(2016) follow-up. A total of 435 women attending a public maternity hospital in Joinville-Brazil were initially included in the study (baseline) and 215 of them continued to participate in the 2^nd follow-up carried out in the homes of the participants. Regression analysis was used to estimate the association between age at menarche (<12; ≥12 years) and excess body weight (≥25 kg/m²) trajectory during the follow-ups. Unadjusted analysis showed that mothers with age at menarche <12 years were 1.29 times (p = .018) more likely to be overweight/obese than those with age at menarche ≥12 years. After adjustment, age at menarche continued to exert an independent effect on the mother's body mass index (RR = 1.23; p = .037) four years after delivery. Strategies designed to attenuate the rising prevalence of maternal overweight and obesity, especially after pregnancy, could help improve the mother's health status in the future.