Psychological resilience during the perimenopause

Protective and harmful social and psychological factors associated with mood and anxiety disorders in perimenopausal women: A narrative review

Perimenopause is often called a window of vulnerability for the development or exacerbation of mood and anxiety disorders. Evidence points to social and psychological factors contributing to the onset of mood and anxiety disorders or the symptoms of depression and anxiety during perimenopause. Therefore, the purpose of this narrative review was to synthesize the findings of studies examining associations between social and psychological factors and the development of mood and anxiety disorders and the symptoms of depression and anxiety during perimenopause. PsychINFO, Ovid MEDLINE, and CINAHL were searched for studies (published between January 2014 and November 2023) assessing the social and psychological factors associated with perimenopausal mood and anxiety disorders and the symptoms of depression and anxiety. These factors were categorized as either protective or harmful. Study quality was assessed using STROBE guidelines. The search yielded 17 studies. Social support was identified as a social factor protective against perimenopausal depression and anxiety. Resiliency characteristics were reported to be protective psychological factors associated with fewer depressive symptoms. Mental health history, family history of major depressive disorder, trait anxiety and neuroticism, stressful life events, adverse childhood events, and chronic stress were categorized as harmful psychological factors associated with depression during perimenopause. Limited research has been conducted to understand factors associated with perimenopausal anxiety. The identification of these social and psychological factors associated with mood and anxiety disorders during perimenopause will help lead to earlier detection of women at risk and the development of multifaceted interventions.

The impact of resistance training on memory, gait and oxidative stress during periestropause in rats

Aging, especially in female, is complex, involving various factors such as reproductive sensitivity, cognitive and functional decline, and an imbalance in the redox system. This study aims to assess the effectiveness of long-term resistance training as a non-pharmacological strategy to mitigate the impairment of recognition memory, hippocampal redox state, and ambulation in aging female Wistar rats during the periestropause period. Thirty Wistar rats aged 17 months, in periestropause, were distributed into non-trained (NT) and resistance training (RT; stair climbing 3 times per week for 4 months) groups. Before (17 months) and after (21 months) of the RT period, the rats underwent tests for ambulation, elevated plus maze (EPM), open field, and object recognition. Biochemical and histological analyses were conducted on the hippocampus of these animals. Analysis of the results revealed that at 21 months, females in the NT group (21Mo/NT) exhibited a decreased in length (p=0.0458) and an increased in past width (p<0.0479) compared to their measurements at 17 months. However, after 4 months of RT, the female rats aged 21 months (21Mo/RT group) experienced changes in gait components, showing an increase in length (p<0.0008) and a decrease in stride width. Regarding memory, the object recognition test indicated potential cognitive improvement in 21Mo/RT animals, with significant interaction between intervention and age across all three stages of the test (total exploration time, p=0.0001; Test 1, p=0.0003; Test 2, p=0.0014). This response was notable compared to animals in the 21Mo/NT group, which showed a decline in memory capacity (p<0.01). The data showed a significant difference in relation to the age of the animals (p<0.01). The hippocampal redox state markers showed reduced lipid oxidative (p=0.028), catalase (p=0.022), and superoxide dismutase (p=0.0067) in the RT group compared to the NT group. Hippocampal cells from the 21Mo/RT group showed increased citrate synthase enzyme activity (p<0.05) and Nissl body staining (p<0.05). The results of this study demonstrate that RT performed during the periestropause phase leads to significant improvements in functional abilities, cognitive performance, and neuroplasticity in aging female rats.

Illness uncertainty, resilience, and perceived social support among patients with moyamoya disease: a cross-sectional study

Objective

The present study aims to investigate the levels of illness uncertainty in patients with moyamoya disease and to determine the association of socio-demographic characteristics, perceived social support and resilience with illness uncertainty in patients with moyamoya disease.

Method

A cross-sectional survey using convenience sampling was conducted in two hospitals in China from August to December 2023. A socio-demographic characteristics questionnaire, the Chinese versions of Mishel’s Unsurety in Disease Scale (MUIS), the Chinese version of Connor-Davidson Resilience Scale (CD-RISC), and the Chinese version of Multidimensional Scale of Perceived Social Support (MSPSS) were used to perform this research. The collected data were analyzed using SPSS 24.0 statistical software. The t-test, one-way analysis of variance (ANOVA), pearson correlation analysis and hierarchical regression analysis were used to identify associated factors.

Result

A total of 263 patients with moyamoya disease were recruited in this survey. The score of illness uncertainty was at a moderate level of (100.03 ± 18.59). The present study identified a negative correlation between illness uncertainty with resilience perceived social support. Hierarchical regression analysis showed that gender, occupation, education level, resilience and perceived social support were the related factors of illness uncertainty.

Conclusion

Patients with moyamoya disease experienced moderate disease uncertainty on average, which was related to gender, occupation, education level, resilience and perceived social support. Future research is needed to better explore the complex relationships between illness uncertainty, resilience, and perceived social support with different types of moyamoya disease using longitudinal research.

Effect of Physical Exercise on Executive Functions Using the Emotional Stroop Task in Perimenopausal Women: A Pilot Study

Exercise has beneficial effects on emotional cognitive control for the majority of the population. However, the impact of exercise on cognitive processes in perimenopausal women remains unclear. Therefore, this study investigated the effect of aerobic exercise on the cognitive processes of perimenopausal women using an emotional Stroop task (EST).

METHOD

A quasi-experimental pilot study was conducted involving 14 perimenopausal women (Peri-MG) and 13 healthy young women (YG) who completed an EST before and after an aerobic cycling exercise. Mixed-effects models for repeated measures were used to analyze reaction times (RTs) and error rates (ERs) during emotional word processing (positive, negative, and neutral) for both groups.

RESULTS

Compared with the YG, the Peri-MG showed significantly shortened RTs for positive and negative emotions (p < 0.05) post-exercise, but not for neutral words. In addition, the Peri-MG exhibited significantly increased ERs for negative words at baseline compared with the YG (p < 0.05), but this difference was not observed during the post-exercise test.

CONCLUSION

The findings suggest that aerobic exercise can enhance executive control performance in perimenopausal women. The Peri-MG exhibited marked behavioral plasticity in the form of reduced bias to salient cues that were significantly more sensitive to alterations due to exercise. This new evidence enhances the understanding of emotional vulnerability and beneficial susceptibility to exercise in perimenopausal women.

Promoting good mental health over the menopause transition

The potential risk for mental health conditions over the menopause transition shapes women's expectations and informs putative physiological mechanisms regulating women's mental health. We review evidence from prospective studies reporting on associations between mental health conditions and the menopause transition. Major depressive disorder and the more prevalent subthreshold depressive symptoms are the most common conditions studied. We reviewed 12 prospective studies reporting depressive symptoms, major depressive disorder, or both over the menopause transition and found no compelling evidence for a universal increased risk for either condition. However, specific subgroups of participants, primarily defined by menopause-related risk factors (ie, vasomotor symptoms that are severe or disturb sleep, a long duration of the transition, or reproductive hormone dynamics) and psychosocial risk factors (eg, stressful life events), were vulnerable to depressive symptoms. The increased risk of major depressive disorder over the menopause transition appears predominantly in individuals with previous major depressive disorder. Greater focus on recognising risk factors in primary care is warranted. On the basis of scarce data, we found no compelling evidence that risk of anxiety, bipolar disorder, or psychosis is universally elevated over the menopause transition. Potential misattribution of psychological distress and psychiatric disorders to menopause could harm women by delaying accurate diagnosis and the initiation of effective psychotropic treatments, and by creating negative expectations for people approaching menopause. A paradigm shift is needed. We conclude with recommendations for the detection and treatment of depressive symptoms or major depressive disorder and strategies to promote good mental health over the menopause transition, while responsibly preparing and supporting those at risk.

Stress, depression, and anxiety: psychological complaints across menopausal stages

Introduction

With the number of menopausal women projected estimated to reach 1.2 billion by 2030 worldwide, it is critically important to understand how menopause may affect women's emotional well-being and how many women are affected by this. This study aimed to explore (i) the relationship between psychological complaints (depression, anxiety, poor memory) across different menopausal stages and (ii) investigate the correlation between resilience, self-efficacy, and perceived stress levels, with psychological complaints and whether this was associated with menopausal stage and/or age.

Methods

287 respondents completed the Menopausal Quality of Life (MenQoL), Perceived Stress Scale (PSS-10), Brief Resilience Scale (BRS), and General Self-efficacy (GSE) scales. Parametric and non-parametric analysis were used to analyse how bothered women were by self-reported poor memory and feelings of depression and anxiety, alongside perceived stress, resilience, and self-efficacy between women in different menopausal stages using STRAW criteria. The association between protective factors (self-efficacy and resilience) and psychological complaints was analysed with partial correlation analysis controlling for menopausal stages and/or age.

Results

A significant difference was found between the levels of perceived stress, and how bothered women were by feelings of depression and anxiety between early-perimenopausal and post-menopausal women. However, with the inclusion of age as a covariate, menopausal stage no longer predicted the level of self-reported stress and anxiety in menopausal women. There was also no difference between poor self-reported memory, or of self-efficacy or resilience between women in different menopausal stages. However, self-efficacy and resilience were associated with how bothered women were by feelings of depression and anxiety, and the experience of stress. Stress was the only variable to be associated with poor self-reported memory independent of age and/or menopausal status.

Discussion

Early perimenopausal women experienced the highest level of stress and were more severely bothered by feelings of depression and anxiety, with the poorest overall self-reported psychosocial quality of life. Post-menopausal women, however, reported to have similar experiences as premenopausal women. Age explained the associations between menopausal stage, stress and anxiety, but not between depression and different menopausal stages. Resilience and self-efficacy were associated with psychological complaints independent of menopausal stage and age, suggesting that therapies focusing on increasing resilience and self-efficacy may be beneficial to help target these psychological complaints at any time.

The effects of physical activity on depression and quality of life in Chinese perimenopausal women

BACKGROUND

Women are more likely to experience depressive symptoms and poor quality of life (QoL) during perimenopause. The effectiveness of physical activity (PA) in perimenopause on mental well-being and health outcomes has been frequently reported. This study aimed to investigate the mediating effect of PA on the relationship between depression and QoL in Chinese perimenopausal women.

METHODS

A cross-sectional study was performed, and participants were recruited through a multistage, stratified, probability proportional to size sampling method. Depression, PA, and QoL were measured by Zung Self-rating Depression Scale, Physical Activity Rating Scale-3, and World Health Organization Quality of Life Questionnaire. The direct and indirect effects of PA on QoL were analyzed by PA in a mediation framework.

RESULTS

1100 perimenopausal women participated in the study. PA mainly plays partial mediating roles in the relationship between depression and physical (ab = -0.493, 95 % CI: -0.582 to -0.407; ab = -0.449, 95 % CI: -0.553 to -0.343) and psychological (ab = -0.710, 95 % CI: -0.849 to -0.578; ab = -0.721, 95 % CI: -0.853 to -0.589; ab = -0.670, 95 % CI: -0.821 to -0.508) domains of QoL. Additionally, intensity (ab = -0.496, 95 % CI: -0.602 to -0.396; ab = -0.355, 95 % CI: -0.498 to -0.212) and duration (ab = -0.201, 95 % CI: -0.298 to -0.119; ab = -0.134, 95 % CI: -0.237 to -0.047) intermediated the relationship between moderate-to-severe depression and physical domain; frequency (ab = -0.130, 95 % CI: -0.207 to -0.066) only had a mediation influence between moderate depression and physical domain; intensity (ab = -0.583, 95 % CI: -0.712 to -0.460; ab = -0.709, 95 % CI: -0.854 to -0.561; ab = -0.520, 95 % CI: -0.719 to -0.315), duration (ab = -0.433, 95 % CI: -0.559 to -0.311; ab = -0.389, 95 % CI: -0.547 to -0.228; ab = -0.258, 95 % CI: -0.461 to -0.085), and frequency (ab = -0.365, 95 % CI: -0.493 to -0.247; ab = -0.270, 95 % CI: -0.414 to -0.144) all interceded between the psychological domain and all levels of depression, except for the frequency between severe depression and psychological domain; in terms of social relationship and environment domains, intensity (ab = -0.458, 95 % CI: -0.593 to -0.338; ab = -0.582, 95 % CI: -0.724 to -0.445), duration (ab = -0.397, 95 % CI: -0.526 to -0.282; ab = -0.412, 95 % CI: -0.548 to -0.293), and frequency (ab = -0.231, 95 % CI: -0.353 to -0.123; ab = -0.398, 95 % CI: -0.533 to -0.279) were mediators only on mild depression.

LIMITATIONS

The cross-sectional study and self-reported data are major limiting factors.

CONCLUSION

PA and its components partially mediated the association between depression and QoL. Suitable prevention methods and interventions for PA may improve the QoL for perimenopausal women.

Individual and Work-Related Psychological Characteristics Contributing to Subjective Well-Being in Air Rescue Employees

OBJECTIVE

Air rescue staff are subject to stressors, including frequent traumatic events, shift work, and unfavorable conditions during rescue missions. We investigated subjective well-being among employees of the Swiss Air-Rescue organization and the potential determining factors, such as sense of coherence, self-esteem, coping, stress, and mental health status.

METHODS

All employees (N = 142) received a questionnaire battery composed of the Trier Inventory for the Assessment of Chronic Stress, the Salutogenic Subjective Work Analysis, the Stress Coping Questionnaire, the Health and Stress Questionnaire, the Sense of Coherence Scale 13-item scale, the Inventory for the Measurement of Self-Efficacy and Externality, the Brief Symptom Inventory, the 12-item General Health Questionnaire, and the Posttraumatic Stress Diagnostic Scale. A discriminant analysis was conducted (input: subjective well-being, output: potential determining factors). A total of 48 participants provided complete data.

RESULTS

The discriminant analysis was significant (χ² = 40.80, P < .001; correct classification: 89.4%) and revealed that sense of coherence (F_1,45 = 40.46) and self-esteem (F_1,45 = 36.20) were the most important discriminating factors for subjective well-being.

CONCLUSION

Sense of coherence and self-esteem play an important role in the subjective well-being of emergency and rescue personnel. Fostering these traits should be included in preventive programs.

Strategies to cope with stress and anxiety during the menopausal transition

The menopausal transition is often accompanied by psycho-vegetative symptoms, including stress and anxiety symptoms. Identifying stress and anxiety and intervening early can have an enormous public health impact. Health care practitioners like obstetrician-gynecologists or family doctors play a critical role in the diagnosis, prevention and treatment of stress and anxiety symptoms or disorders, as they often represent women's primary medical contact during the menopausal transition. However, they frequently do not feel confident in identifying and treating mental health problems. The aim of this review was to summarize current (since 2010) knowledge from randomized controlled trials, systematic reviews, and meta-analyses on diagnostics and treatment options, and to provide clinical decision-making algorithms. The recent literature suggests pharmacological, (cognitive) behavioral, and complementary treatments. The choice about which one to use should be discussed with the patient.

Association between resting-state EEG oscillation and psychometric properties in perimenopausal women

Background

The perimenopausal period is associated with a higher risk of various mood disorders. Similarly, although resting-state electroencephalogram (rsEEG) brain oscillatory activity has been associated with various neuropsychological disorders and behaviours, these issues have not been assessed in perimenopausal women. This study aimed to evaluate quantitative relationships between psychometric properties and rsEEG rhythms (delta, theta, alpha, beta and gamma powers) in perimenopausal women.

Methods

A cross-sectional correlational descriptive study was conducted to quantitatively analyze the correlations between rsEEG low-to-high band activities (delta, theta, alpha, beta, and gamma powers) and psychometric properties in 14 perimenopausal women. Participants completed a psychological inventory comprising the State Anxiety Inventory (SAI), Depression Inventory (DI), Behavioural Inhibition Scale (BIS) and short-form UPPS Impulsive Behaviour Scale (IS) before EEG recording.

Results

Results showed that impulsivity was positively related to the beta power, symmetrical at most channels (frontal, temporal, central, parietal and occipital regions; p < .05); but did not related to the delta, theta, alpha and gamma powers. The brainwave low-to-high bands, delta, theta, alpha, beta and gamma power were not associated with DI, SAI or BIS scores.

Conclusions

This study’s findings propose that significantly enhanced resting-state beta activity is a trait of impulsivity in perimenopausal women. Therefore, results have potential implications for the preclinical or clinical evaluation of these issues in perimenopausal women.

Psychological well-being of midlife women: a structural equation modeling approach

OBJECTIVE

Women experience menopause at approximately 50 to 52 years of age, when reproductive aging causes various somatic, psychological, and urogenital symptoms. Women's changing lifestyles and increasing lifespan make it difficult to pinpoint the factors affecting their well-being during menopause, warranting continuous research in this field. Therefore, this study developed a structural equation model, based on the transactional model of stress and coping, to test the significance of positive and negative factors associated with psychological health during menopause.

METHODS

This study validated a structural equation model based on the empirical data collected using a crosssectional study. We analyzed 300 questionnaire responses completed between May 15 and July 10, 2020, by South Korean middle-aged women (aged 45-60 y) who agreed to participate. The study's structural equation model used self-efficacy as an exogenous variable and perceived stress, menopausal management, self-compassion, menopausal symptoms, and psychological well-being as endogenous variables. Educational and economic levels were set as control variables.

RESULTS

We observed statistical support for 9 out of 10 hypotheses; the predictor variables had an explanatory power of 79.5% for psychological well-being. Self-efficacy was positively associated with the psychological wellbeing of middle-aged menopausal women and appeared to be mediated by perceived stress, menopausal management, menopausal symptoms, and self-compassion.

CONCLUSIONS

To improve the psychological well-being of middle-aged women, it is important to increase their self-efficacy and minimize stress. Moreover, managing menopausal symptoms and increasing self-compassion through effective coping may maximize psychological well-being.

VIDEO SUMMARY

http://links.lww.com/MENO/A933.

How perimenopause shaped perspectives on life during the pandemic: A study on india's working and non-working women

The menopausal transition is a challenging phase in a woman's life and has been compounded by the COVID-19 pandemic. This study aimed to examine the association between meaning in life, quality of life, and satisfaction with life among perimenopausal women during the pandemic, as well as to determine if there was a difference in attitudes towards life between working and non-working perimenopausal women. The study sample consisted of 114 perimenopausal women, with 64 being employed and 50 being non-employed. A quantitative cross-sectional design was employed, and the results showed that satisfaction with life was positively correlated with both meaning in life and quality of life. Working perimenopausal women had a higher level of satisfaction with life (mean score of 63.24) as compared to non-working perimenopausal women (mean score of 50.14), but there was no significant difference in quality of life or meaning in life between the two groups. The study highlights the impact of various social and personal factors on how women perceive their lives during the pandemic and underscores the need for increased support and resources for perimenopausal women in the workplace. Additionally, promoting menopause awareness in general and in the workplace could help to reduce social barriers and improve women's perspectives on life, leading to an improvement in their overall quality of life and satisfaction with life. This study insisted on the need for giving importance to this stage in women's life-rather passing it just like that. Policy makers in the HR field should make a note to the finding and incorporate necessary amendment in terms of the female workforce.

Estradiol and progesterone as resilience markers? - Findings from the Swiss Perimenopause Study

While resilience seems to be associated with a variety of biological markers, studies assessing such correlates in women during the perimenopause are lacking. The perimenopause constitutes a phase of major biopsychosocial changes, during which the sex hormones estradiol (E2) and progesterone (P4) eventually decrease significantly. The aim of this study was to examine the extent to which the declining levels of E2 and P4 serve as resilience markers in perimenopausal women. In 129 healthy perimenopausal women aged 40-56 years, saliva samples were collected on every fourth day over a period of four weeks in order to investigate E2 and P4 levels. All participants completed psychosocial questionnaires including variables related to resilience, well-being, and mental health. Perimenopausal status was determined using the Stages of Reproductive Aging Workshop (STRAW) criteria. The results indicate that P4 is linked to psychosocial resilience. More precisely, women with higher P4 levels seem to be more resilient than women with lower P4 levels, irrespective of the perimenopausal status. No such relation was found for E2 levels. Further analyses revealed that women with higher P4 levels experience significantly higher life satisfaction, lower perceived stress, and lower depressive symptoms than women with lower P4 levels. Accordingly, P4 can be considered as a biological marker of resilience in perimenopause.

Cortisol and estriol responses to awakening in the first pregnancy trimester: Associations with maternal stress and resilience factors

BACKGROUND

Little is known about the maternal cortisol awakening response (CAR) in the first pregnancy trimester. Similarly unknown is how the CAR in early gestation relates to other steroid hormones, such as estriol. Maternal estriol in blood and urine is used to monitor fetal well-being since it is produced by the fetoplacental unit from fetal precursors. Low levels have been associated with maternal-fetal complications. We were recently able to show that estriol is measurable in maternal saliva from 6 weeks' gestation onwards. However, its pattern following morning awakening and potential links with salivary cortisol in early gestation is relatively unknown. In this prospective study, we explored the cortisol and estriol responses to morning awakening in first-trimester pregnant women, the potential association of these endocrine variables with maternal stress and resilience factors, and their predictive value for the further pregnancy course.

METHODS

Fifty-one women with an uncomplicated, singleton pregnancy responded to questionnaires measuring chronic and pregnancy-specific stress, emotional support, and daily uplifts at 6 weeks' gestation. At 8 and 10 weeks, the women collected saliva samples immediately, 30, and 60 min after morning awakening. After 12 weeks, 40 women reported on the further pregnancy course, of whom 6 had developed complications.

RESULTS

In response to morning awakening, cortisol levels increased significantly at 10 weeks (p = .04), while estriol levels decreased significantly at both 8 and 10 weeks (p < .001). A stronger cortisol increase was linked to a stronger estriol decrease at 8 (p = .03), but not at 10 weeks. Then, perceived emotional support at 6 weeks was negatively associated with cortisol baseline at 8 (p = .01) and positively with estriol baseline at 10 weeks (p = .03). Moreover, higher pregnancy-specific stress was related to a lower estriol baseline at 8 weeks (p = .047). Furthermore, compared to healthy women, those with complications at follow-up had already reported less emotional support (p = .03) and fewer daily uplifts (p = .03) at 6 weeks. These women also seemed to lack a significant estriol response to morning awakening at 8 weeks (p > .10).

DISCUSSION

These findings advance our knowledge of cortisol and estriol secretion following morning awakening and encourage the investigation of E3 in addition to cortisol when researching prenatal stress and its consequences for maternal and fetal health.

Psychosocial factors promoting resilience during the menopausal transition

Despite significant biological, psychological, and social challenges in the perimenopause, most women report an overall positive well-being and appear to be resilient to potentially negative effects of this life phase. The objective of this study was to detect psychosocial variables which contribute to resilience in a sample of perimenopausal women. A total of 135 healthy perimenopausal women aged 40-56 years completed a battery of validated psychosocial questionnaires including variables related to resilience, well-being, and mental health. First, using exploratory factor analysis, we examined which of the assessed variables related to resilience can be assigned to a common factor. Second, linear regression analyses were performed to investigate whether a common resilience factor predicts well-being and mental health in the examined sample of women. Optimism (LOT-R-O), emotional stability (BFI-K-N), emotion regulation (ERQ), self-compassion (SCS-D), and self-esteem (RSES) in perimenopausal women can be allocated to a single resilience-associated factor. Regression analyses revealed that this factor is related to higher life satisfaction (SWLS; β = .39, p < .001, adj. R² = .20), lower perceived stress (PSS-10; β = - .55, p < .001, adj. R² = .30), lower psychological distress (BSI-18; β = - .49, p < .001, adj. R² = .22), better general psychological health (GHQ-12; β = - .49, p < .001, adj. R² = .22), milder menopausal complaints (MRS II; β = - .41, p < .001, adj. R² = .18), and lower depressive symptoms (ADS-L; β = - .32, p < .001, adj. R² = .26). The α levels were adjusted for multiple testing. Our findings confirm that several psychosocial variables (optimism, emotional stability, emotion regulation, self-compassion, and self-esteem) can be allocated to one common resilience-associated factor. This resilience factor is strongly related to women's well-being as well as mental health in perimenopause.

Acupuncture as an Independent or Adjuvant Management to Standard Care for Perimenopausal Depression: A Systematic Review and Meta-Analysis

Background: Many women with perimenopausal depression (PMD) have sought alternative therapies such as acupuncture because of concerns about risks associated with antidepressant and hormone replacement therapy (HRT). This systematic review aimed to clarify if acupuncture is effective for PMD compared with waitlist control or placebo/sham acupuncture, and if acupuncture alone or combined with standard care (antidepressant and/or HRT) is more effective in ameliorating PMD in comparison with standard care alone. Methods: Randomized controlled trials (RCTs) of PMD treatment via acupuncture vs. waitlist control or placebo/sham acupuncture, and RCTs of PMD treatment via acupuncture alone or combined with Western pharmacotherapy vs. Western pharmacotherapy were searched for from seven databases from inception to December 2020. Cochrane criteria were followed. Results: Twenty-five studies involving 2,213 women were analyzed. Meta-analyses indicated that acupuncture significantly reduced the global scores of Hamilton Depression Scale (HAMD) [standardized mean difference (SMD) = -0.54, 95% CI (-0.91, -0.16), p < 0.01], compared with standard care. The therapeutic effect of acupuncture maintained at 2-, 4-, and 12-week follow-ups. Acupuncture combined with standard care was more effective than standard care alone in decreasing HAMD scores [SMD = -0.82, 95% CI (-1.07, -0.58), p < 0.01]. Too few RCTs were available to assess the clinical efficacy differences between acupuncture and placebo/sham acupuncture or HRT alone. Acupuncture also showed better effects in decreasing Kupperman index (KI) scores, whether compared with antidepressant alone [MD = -4.55, 95% CI (-8.46, -0.65), p = 0.02] or antidepressant combined with HRT [MD = -0.89, 95% CI (-1.34, -0.43), p < 0.01]. Conclusions: In comparison with standard care, acupuncture alone or combined with standard care was associated with significant improvements in PMD and reductions of other menopausal symptoms. This finding suggests that acupuncture may be a useful addition to treatment for PMD.

Prior depression affects the experience of the perimenopause - findings from the Swiss Perimenopause Study

BACKGROUND

There is a prevalence peak of depression in the perimenopause, with this reproductive phase being considered a window of vulnerability due to major biopsychosocial changes. Depression has been associated with physical and psychosocial impairment. Prior depression has been shown to be a risk factor for the development of several somatic and mental diseases. We assume that women with prior depression will exhibit increased burdensome symptoms in the perimenopause compared to women without prior depression.

METHODS

A total of 135 perimenopausal women aged 40-56 years participated in the longitudinal Swiss Perimenopause Study. For the purpose of this investigation, a cross-sectional design was chosen. A wide range of validated psychosocial questionnaires were used to compare women with and without prior depression regarding their experience of the perimenopause. Findings were statistically adjusted for multiple testing.

RESULTS

Women with prior depression showed significantly more depressive symptoms (U = 1215.5, p < .01), more menopausal symptoms (U = 1395.0, p < .01), and more sleep disturbances (U = 1583.5, p < .05) than women without prior depression. Moreover, women with a history of depression reported lower subjective mental health (U = 1573.0, p <  05) and felt more isolated (U = 1524.0, p < .05) than those without prior depression.

LIMITATIONS

Self-report data may affect the results. Furthermore, due to the cross-sectional design, causality cannot be inferred.

CONCLUSIONS

Prior depression affects women's experience of the perimenopause. Women with prior depression exhibit significantly more negative health outcomes in the perimenopause than those without prior depression.

Sleeve gastrectomy-induced endocrine changes in the remnant stomachs of premenopausal and postmenopausal rats: role of the estrogen receptors

BACKGROUND

Although alterations in the plasma levels of leptin, glucagon-like peptide-1, and gastrin were linked with bariatric surgery outcomes, gastric production of these peptides was not elucidated before.

OBJECTIVE

The aim was to evaluate the impact of estrogen depletion and estrogen receptors (ERs) on sleeve gastrectomy (SG)-induced alterations in gastric hormone production, gastric mucosal integrity, and bone mass.

SETTING

Physiology Research Lab at the University.

METHODS

Female Sprague-Dawley rats underwent ovariectomy or sham operation (control), and 2 months later SG or sham SG was performed. Rats received either nonselective agonist 17 β, ER-α agonist, ER-β agonist, or vehicle for 3 weeks. Trunk blood and gastric tissues were collected for biochemical measurements, while histopathologic examination was performed in gastric and femur samples.

RESULTS

In the presence of intact ovaries, SG-induced weight loss was accompanied by reductions in the gastric synthesis of leptin and gastrin, while gastric glucagon-like peptide-1 was additionally decreased when SG was performed at the postmenopausal state. SG elevated the depleted serum estradiol levels of menopause, implicating a beneficial effect, but the occurrence of severe gastric mucosal injury was triggered. On the other hand, using ER agonists upregulated gastrin-expressing cells, ameliorated gastric injury, and improved bone loss.

CONCLUSIONS

SG, either at premenopausal or postmenopausal state, resulted in considerable loss in bone mass, along with reductions in the gastric levels of gastrin and leptin. Functional status of the ovaries needs to be taken into consideration when monitoring the outcomes of SG, and ER agonists could be of value in controlling SG-induced complications.

The Swiss Perimenopause Study - study protocol of a longitudinal prospective study in perimenopausal women

BACKGROUND

The perimenopause is associated with considerable biopsychosocial changes. The majority of women manage to adjust to these changes and cope well with the shift from reproductive to non-reproductive life. However, some women develop burdensome physical and psychological symptoms during the perimenopause. A strong link between menopausal complaints and depressed mood has been shown in this regard. To date, the decisive factors determining whether a woman will successfully achieve a healthy transition remain unclear. Thus, the purpose of this study is to investigate a range of theory-based markers related to health in perimenopausal women.

METHODS

The Swiss Perimenopause Study comprises a sample of 135 healthy perimenopausal women aged 40-56. A variety of health-related genetic, epigenetic, endocrinological, physiological, and psychosocial markers associated with the menopausal transition are investigated over a period of 13 months.

DISCUSSION

The Swiss Perimenopause Study will contribute to a better understanding of the biopsychosocial processes associated with the perimenopause, which should help to improve the clinical care of women undergoing the menopausal transition.