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Paschou SA, Athanasiadou KI, Hafford-Letchfield T, Hinchliff S, Mauskar M, Rees M, Simon JA, Armeni E, Erel CT, Fistonic I, Hillard T, Hirschberg AL, Meczekalski B, Mendoza N, Mueck AO, Simoncini T, Stute P, van Dijken D, Lambrinoudaki I. Sexual health and wellbeing and the menopause: An EMAS clinical guide. Maturitas 2024; 189:108055. [PMID: 39226624 DOI: 10.1016/j.maturitas.2024.108055] [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: 09/05/2024]
Abstract
INTRODUCTION Sexual health and wellbeing are significant aspects of quality of life. However, taking a sexual history is often avoided in medical practice, leaving a void in management and awareness. As the menopause can have a major impact on sexual health, it is imperative that healthcare providers are appropriately trained in sexual health and wellbeing and the aligned disciplines in order to achieve optimal care. AIM To provide an evidence-based clinical guide for the assessment and management of sexual problems at the menopause and beyond. MATERIALS AND METHODS Review of the literature and consensus of expert opinion. RESULTS AND CONCLUSION The assessment of sexual problems includes history taking, examination and laboratory investigation (if indicated), and occasionally the use of specific validated questionnaires. Management of sexual problems requires a multidimensional approach using biopsychosocial measures. Medical management and psychosexual counselling include pharmacological and non-pharmacological interventions, and sex therapy and psychoeducation. Furthermore, perimenopausal women should be advised about the need for contraception if they wish to avoid pregnancy. Also, sexually transmitted diseases can be acquired at any age. To conclude, taking a sexual history should be incorporated into medical practice and healthcare providers should be appropriately trained to assess and manage sexual problems at the menopause and beyond.
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Affiliation(s)
- Stavroula A Paschou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece.
| | - Kleoniki I Athanasiadou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | | | - Sharron Hinchliff
- School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, UK
| | - Melissa Mauskar
- Department of Dermatology and Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Margaret Rees
- Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - James A Simon
- Department of Obstetrics & Gynecology, George Washington University, IntimMedicine Specialists, Washington, DC, USA
| | - Eleni Armeni
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece; Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - C Tamer Erel
- Istanbul-Cerrahpaşa University, Cerrahpaşa School of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ivan Fistonic
- Faculty for Health Studies, University of Rijeka, Rijeka, Croatia
| | - Timothy Hillard
- Department of Obstetrics and Gynaecology, University Hospitals Dorset, Poole, UK
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Nicolás Mendoza
- Department of Obstetrics and Gynecology, University of Granada, Spain
| | - Alfred O Mueck
- Department of Women's Health, University Hospital Tuebingen, Germany
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Clinic Inselspital, Bern, Switzerland
| | - Dorenda van Dijken
- Department of Obstetrics and Gynecology, OLVG Hospital, Amsterdam, the Netherlands
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
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Andrews R, Lacey A, Bache K, Kidd EJ. The role of menopausal symptoms on future health and longevity: A systematic scoping review of longitudinal evidence. Maturitas 2024; 190:108130. [PMID: 39366170 DOI: 10.1016/j.maturitas.2024.108130] [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: 04/24/2024] [Revised: 08/20/2024] [Accepted: 09/25/2024] [Indexed: 10/06/2024]
Abstract
Women live longer than men but spend more years in poor health. Menopausal symptoms are not generally associated with adverse health outcomes. However, increasingly, evidence suggests they can significantly impact future health and longevity. Understanding the long-term effects of menopausal symptoms will enable clinicians to identify risk factors and intervene with modifications to support healthy aging. This review examined the scope of research investigating the association between menopausal symptoms and future health outcomes. We searched for longitudinal cohort studies. Date and geographical restrictions were not applied. Articles were screened and data extracted using standardised methods. Included studies examined the role of menopausal symptoms on future health developments using a sample who had experienced menopause and were deemed healthy at baseline, with clear reporting of their menopausal status at symptom assessment. We identified 53 eligible studies with data from over 450,000 women enrolled in 28 longitudinal cohorts. Cardiovascular disease, psychiatric disorders, diabetes, and reduced bone mineral density were positively associated with menopausal symptoms. Breast cancer was associated with an asymptomatic menopause. Psychological menopausal symptoms and cognitive decline improved after menopause, except among women from low socioeconomic backgrounds. These findings demonstrate that menopausal symptoms are important indicators for future health risks. Future work should investigate the impact of underexplored menopausal symptoms on future health, such as sleeping problems and urogenital issues, and evaluate whether treating menopausal symptoms could lead to improvements in future health outcomes. Should future research continue to support these findings, clinical guidelines should be updated to support clinical decision-making in menopause care.
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Affiliation(s)
- Robin Andrews
- Cardiff University Welsh School of Pharmacy and Pharmaceutical Sciences, Redwood Building, King Edward VII Ave, Cardiff, Wales CF10 3NB, United Kingdom.
| | - Arron Lacey
- Swansea University Institute of Life Science, Swansea University Medical School, Institute of Life Science 2, Sketty, Swansea, Wales SA2 8QA, United Kingdom.
| | - Kate Bache
- Health & Her Unit D, Tramshed Tech, Pendyris St, Cardiff, Wales CF11 6BH, United Kingdom.
| | - Emma J Kidd
- Cardiff University Welsh School of Pharmacy and Pharmaceutical Sciences, Redwood Building, King Edward VII Ave, Cardiff, Wales CF10 3NB, United Kingdom.
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Westwood S. 'GP services are still heteronormative': Sexual minority cisgender women's experiences of UK menopause healthcare - Health equity implications. Post Reprod Health 2024:20533691241279887. [PMID: 39251395 DOI: 10.1177/20533691241279887] [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: 09/11/2024]
Abstract
OBJECTIVE This article reports on UK sexual minority cisgender women's experiences of menopause health and healthcare, based on a data subset from a study exploring lesbian, gay, bisexual, and queer (LGBTQ+) menopause. METHODS An online survey was conducted with UK LGBTQ + individuals who went through/are going through the menopause. Quantitative data were analysed using simple descriptive statistics. Qualitative data were analysed using thematic analysis. RESULTS Cisgender respondents comprised 51 lesbian, gay, bisexual, pansexual, queer, and 'other' women, aged between 17 and 89 years. They reported similar types and levels of menopause symptoms as heterosexual cisgender women in other studies, apart from higher levels of anxiety and depression, especially bisexual women. Dissatisfaction regarding menopause healthcare services related to access, information, and heteronormative/heterosexist provision. CONCLUSIONS Healthcare providers must ensure they provide inclusive menopause services to sexual minority cisgender women.
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Stuenkel CA, Kinney CC, Schiff I. Menopause Step-by-Step, a new monthly menopause education feature. Menopause 2024; 31:737-739. [PMID: 39186449 DOI: 10.1097/gme.0000000000002417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Affiliation(s)
- Cynthia A Stuenkel
- From the Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Diego, School of Medicine, La Jolla, California
| | | | - Isaac Schiff
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
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Han B, Duan Y, Zhang P, Zeng L, Pi P, Chen J, Du G. Effects of exercise on depression and anxiety in postmenopausal women: a pairwise and network meta-analysis of randomized controlled trials. BMC Public Health 2024; 24:1816. [PMID: 38977980 PMCID: PMC11229230 DOI: 10.1186/s12889-024-19348-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/03/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Exercise has been identified as a promising non-pharmacological therapy for the management of depression, but there is still controversy over which type is most effective. We aimed to compare and rank the types of exercise that improve depression in postmenopausal women by quantifying information from randomized controlled trials (RCTs). METHODS The PubMed, Web of Science, SPORTDiscus, CNKI, The Cochrane Library, PsycINFO, EMBASE, and CINAHL Plus databases were searched to identify articles published from inception to 1 March 2024 reporting RCTs that examined the effectiveness of exercise on depression in postmenopausal women. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for RCTs. The quality of the evidence for each comparison was graded using the online confidence in network meta-analysis tool (CINeMA). Standardized mean differences (SMDs) were calculated using the mean and standard deviation of pre-to-post intervention changes and then pooled using a random effects model in a pairwise meta-analysis using Review Manager 5.4. Then, a frequentist network meta-analysis was conducted using a random effects model was conducted to evaluate the efficacy of different exercise types using the network package of Stata 15. RESULTS This study included 26 studies involving 2,170 participants. The pairwise meta-analysis revealed that exercise had a significant positive effect on depression in postmenopausal women (SMD = -0.71, 95% confidence interval [CI] = -0.94 to -0.48; I2 = 78%). The network meta-analysis revealed that mind-body exercise (SMD = -0.97, 95% CI = -1.28 to -0.67), aerobic exercise (SMD = -0.58, 95% CI = -0.88 to -0.27) and multicomponent exercise (SMD = -0.57, 95% CI = -1.15 to -0.002) significantly reduced depression compared to the control intervention. Mind-body exercise had the highest probability of being the most effective intervention. Exercise interventions also showed positive effects on anxiety. Most studies were judged to have some concerns regarding their risk of bias, and the confidence in evidence was often very low according to CINeMA. CONCLUSION For postmenopausal women, there is very low to moderate quality evidence that exercise interventions are an effective antidepressant therapy, with mind-body exercise most likely being the optimal type. TRIAL REGISTRATION This meta-analysis was prospectively registered with PROSPERO (registration number: CRD42024505425).
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Affiliation(s)
- Bing Han
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, 100084, China
| | - Yaya Duan
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, 100084, China
| | - Peizhen Zhang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, 100084, China.
- Key Laboratory for Performance Training & Recovery of General Administration of Sport, Beijing Sport University, Beijing, 100084, China.
| | - Liqing Zeng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, 100084, China
| | - Peng Pi
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, 100084, China
| | - Jiping Chen
- School of Physical Education, Shandong University, Jinan, Shandong, 250061, China
| | - Guoli Du
- School of Physical Education, Shandong University, Jinan, Shandong, 250061, China
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Simpson EEA, Doherty J, Timlin D. Menopause as a window of opportunity: the benefits of designing more effective theory-driven behaviour change interventions to promote healthier lifestyle choices at midlife. Proc Nutr Soc 2024; 83:120-129. [PMID: 37955168 DOI: 10.1017/s0029665123004810] [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: 11/14/2023]
Abstract
Menopause is a natural developmental phase that all women go through from their early forties to mid-fifties, marking the transition from the reproductive to the non-reproductive years. This is characterised as the permanent cessation of menses due to progressive ovarian failure. Each woman's experience of the menopause is unique. Biopsychosocial changes occur during this time with some symptoms affecting up to 80 % of women and lasting for 4-5 years from the peri- to post-menopause. Reduced oestrogen may predispose some women to health issues following menopause, such as heart disease, diabetes, stroke and cognitive decline. It is vital to understand how to promote health and well-being to reduce the risk of developing chronic conditions in later life. Increased symptoms and concerns about health during the menopausal transition can be cues to action for some women to actively maintain their health. Menopause represents a window of opportunity to promote health, and to support women to make healthier lifestyle choices, part of the National Institute for Clinical Excellence guidelines for menopause management. Identifying appropriate strategies to change behaviour is less clear. Theories of behaviour change can provide frameworks to gain more insight into the facilitators and barriers to behaviour and can inform the researcher on what needs to change. This information can be used to inform the design, content, implementation and evaluation of a lifestyle intervention. This review paper will explore the impact of menopause on health and well-being generally, and the benefits of designing more effective theory-driven behaviour change interventions for menopause.
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Affiliation(s)
- Ellen Elizabeth Anne Simpson
- Psychology Research Institute, Ulster University, Cromore Road, Coleraine, County Londonderry, Northern Ireland, UK
| | - Julie Doherty
- School of Nursing & Midwifery, Queens University Belfast, Belfast, Northern Ireland, UK
| | - Deirdre Timlin
- Department of Psychology, Rockhampton Hospital, Queensland Health, Rockhampton, Australia
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Ruan X, Bai W, Ren M, Kim T, Lee JY, Chuang FC, Wang PH, He W, Ma X, Miyazaki K, Song N, Wang X, Yu Q. Efficacy and safety of fezolinetant for moderate to severe vasomotor symptoms associated with menopause among women in East Asia: a phase 3 randomized study (MOONLIGHT I). J Int Med Res 2024; 52:3000605241247684. [PMID: 38818888 PMCID: PMC11143828 DOI: 10.1177/03000605241247684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/27/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of fezolinetant for moderate to severe vasomotor symptoms (VMS) associated with menopause in East Asian women. METHODS In this phase 3, randomized, double-blind study, postmenopausal women with moderate to severe VMS (minimum average frequency in the 10 days before randomization, ≥7/day or 50/week) received fezolinetant 30 mg/day or placebo (weeks 1-12), followed by an open-label extension phase with fezolinetant 30 mg/day (weeks 13-24). The co-primary endpoints were the mean changes in the daily frequency and severity of VMS at weeks 4 and 12. RESULTS Among 301 participants, the difference in the least squares mean change (95% confidence interval) from baseline in the daily frequency of moderate to severe VMS versus placebo was -0.65 (-1.41 to 0.12) at week 4 and -0.55 (-1.35 to 0.26) at week 12. The differences in the least squares mean change from baseline in the VMS severity score versus placebo were -0.06 (-0.14 to 0.03) and -0.13 (-0.27 to 0.01) at weeks 4 and 12, respectively. Serious adverse events occurred in 0.7% of participants receiving fezolinetant in weeks 1 to 12, compared with 1.3% of those receiving placebo. CONCLUSIONS Fezolinetant was generally safe but did not reduce the frequency or severity of VMS versus placebo in postmenopausal women in this study.ClinicalTrials.Gov Identifier: NCT04234204.
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Affiliation(s)
- Xiangyan Ruan
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing
| | - Wenpei Bai
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing
| | - Mulan Ren
- Department of Obstetrics and Gynecology, Zhongda Hospital Southeast University, Jiangsu
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul
| | - Ji Young Lee
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Konkuk University Hospital, Seoul
| | - Fei-Chi Chuang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Weizhong He
- Astellas Pharma Global Development, Inc., Northbrook, IL
| | - Xiao Ma
- Astellas (China) Investment Co, Ltd, Beijing
| | | | - Nan Song
- Astellas (China) Investment Co, Ltd, Beijing
| | - Xuegong Wang
- Astellas Pharma Global Development, Inc., Northbrook, IL
| | - Qi Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing
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Demirhan Kayacik A, İlcioglu K. Effects of melatonin intake on depression and anxiety in postmenopausal women: a systematic review and meta-analysis of randomised controlled trials. Arch Womens Ment Health 2024; 27:265-273. [PMID: 37945913 DOI: 10.1007/s00737-023-01395-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) evaluating the effects of melatonin intake on depression and anxiety in postmenopausal women. To identify RCTs examining the effect of melatonin supplementation on depression and anxiety scores in postmenopausal women, a comprehensive electronic search was conducted via the Cochrane Central Register of Controlled Trials, Science direct, Google Scholar, PubMed, Medline, Scopus and Web of Science databases using the keywords ("melatonin" OR "N-acetyl serotonin") AND ("menopause" OR "climacteric") AND ("depression" OR "anxiety"). The search strategy was applied to articles published between January 2000 and April 2023. The Cochrane tool was used to evaluate the bias risk in RCTs. For the meta-analysis, fixed effect models and random effect models were employed based on heterogeneity. Preferred Reporting Items for Systematic Reviews and Meta-Analysis in Our Study guidelines were followed. Five RCTs were included in the study, with a total sample size of 441 (experimental: 227 and control: 214). When the effect of melatonin use on depression in menopausal women was analysed, it was found that melatonin significantly reduced menopausal depression (SMD - 0.166, CI = - 0.288/ - 0.045, p < 0.05). When the effect of melatonin use on anxiety in postmenopausal women was analysed, it was found that melatonin significantly improved menopausal anxiety (SMD - 0.806, CI = 1.491/ - 0.120, p < 0.05). Melatonin is promising as a potential treatment to help depression and anxiety in the postmenopausal period. More high-quality studies are needed to determine their safety.
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Affiliation(s)
| | - Kevser İlcioglu
- Department of Nursing, Faculty of Health Sciences, Sakarya University, Sakarya, Turkey
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9
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Paschou SA, Athanasiadou KI, Papanas N. Menopausal Hormone Therapy in Women with Type 2 Diabetes Mellitus: An Updated Review. Diabetes Ther 2024; 15:741-748. [PMID: 38363540 PMCID: PMC10951155 DOI: 10.1007/s13300-024-01546-1] [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: 01/07/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024] Open
Abstract
Menopause is accompanied by several metabolic adaptations, which are related to insulin resistance, increased total body fat mass, and central abdominal fat accumulation, predisposing women to type 2 diabetes mellitus (T2DM) development. Metabolic syndrome has a high prevalence in postmenopausal women, indicating the loss of estrogen protection on metabolic and cardiovascular health. Moreover, earlier age at menopause has been related to increased risk of T2DM. Menopausal hormone therapy (MHT) has favorable results in glucose metabolism. Indeed, it reduces the risk of T2DM in women without this condition and improves glycemic control in women with T2DM. Before MHT initiation in women with clinical indications, it is imperative to assess their cardiovascular disease (CVD) risk, using official electronic algorithms for score calculation. The latter will determine regimen, dose, and administration route of MHT. Oral estrogens are preferable in women with low CVD risk, while transdermal administration is indicated in those with moderate and high CVD risk, as the risk of stroke and venous thromboembolism (VTE) is increased with oral administration. Oral 17β-estradiol is usually preferred in women with T2DM, as this route has more beneficial effects on glucose metabolism. Oral estrogens are also suggested in perimenopausal or recently postmenopausal women with low CVD risk. Although oral estrogens have favorable effects when indicated, the risk of VTE or stroke should always be considered. Micronized progesterone, dydrogesterone, and transdermal norethisterone are the progestogens used in postmenopausal women with T2DM and intact uterus. MHT should not be initiated in women > 60 years or > 10 years in menopause, as there is an increased thromboembolic risk in women with established atherosclerosis and no additional cardiovascular benefit in women without atherosclerosis. In conclusion, MHT administration in postmenopausal women with T2DM can be safe and effective as long as the therapeutic regimen has been properly selected according to their cardiovascular, metabolic, and fracture risk.
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Affiliation(s)
- Stavroula A Paschou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kleoniki I Athanasiadou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Medical School, University Hospital of Alexandroupolis, Democritus University of Thrace, G. Kondyli 22, 68132, Alexandroupolis, Greece.
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Saarinen T, Savukoski SM, Pesonen P, Vaaramo E, Laitinen J, Varanka-Ruuska T, Ala-Mursula L, Niinimäki M. Climacteric status at age 46 is associated with poorer work ability, lower 2-year participation in working life, and a higher 7-year disability retirement rate: a Northern Finland Birth Cohort 1966 study. Menopause 2024; 31:275-281. [PMID: 38412401 DOI: 10.1097/gme.0000000000002327] [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: 02/29/2024]
Abstract
OBJECTIVE To study the association between an advanced climacteric status at 46 years of age and current perceived work ability, the consequent 2-year accumulation of disability and unemployment days, and the 7-year incidence of disability pensions. METHODS Study participants (n = 2,661) were recruited from the Northern Finland Birth Cohort 1966 study's 46-year follow-up in 2012. The participants' perceived work ability was investigated using the Work Ability Score (0-7 = poor vs 8-10 = good), along with potential covariates. Data concerning their consequent disability days, unemployment days, and disability pensions were collected from national registers. The association between their climacteric status at age 46 years, work ability, and working life participation was assessed using regression models. RESULTS The climacteric women were more often smokers and more often had a lower level of education. The odds ratio for poor perceived work ability was 1.41 (95% CI, 1.06-1.87), and the incidence rate ratios for disability and unemployment days during the 2-year follow-up were 1.09 (95% CI, 1.07-1.11) and 1.16 (95% CI, 1.14-1.18), respectively, for the climacteric women compared with the preclimacteric women in models adjusted for smoking and education. The 7-year hazard ratio for disability pensions was 1.72 (95% CI, 1.02-2.91) for the climacteric women. CONCLUSIONS An earlier menopausal transition is associated with poorer perceived work ability, and it predicts lower recorded work participation and a higher disability pension rate in subsequent years.
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Affiliation(s)
| | | | - Paula Pesonen
- Northern Finland Birth Cohorts, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Eeva Vaaramo
- Northern Finland Birth Cohorts, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jaana Laitinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Leena Ala-Mursula
- Research Unit of Population Health, University of Oulu, Oulu, Finland
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11
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McNulty K, Olenick A, Moore S, Cowley E. Invisibility of female participants in midlife and beyond in sport and exercise science research: a call to action. Br J Sports Med 2024; 58:180-181. [PMID: 38320852 DOI: 10.1136/bjsports-2023-107165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Kelly McNulty
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Alyssa Olenick
- Department of Endocrinology and Metabolism, University of Colorado Anschutz Medical School, Aurora, Colorado, USA
| | - Sam Moore
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emma Cowley
- Doctoral Training Alliance, University Alliance, London, UK
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12
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Karaflou M, Goulis DG. Body composition analysis: A snapshot across the perimenopause. Maturitas 2024; 180:107898. [PMID: 38086169 DOI: 10.1016/j.maturitas.2023.107898] [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] [Received: 09/01/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
During the perimenopause, estrogen concentrations gradually decrease, and this is associated with changes to women's energy expenditure and intake. These changes result in weight gain and altered body fat distribution, with increased abdominal fat deposition and cardiometabolic risk via insulin resistance. Body composition analysis is a useful clinical tool in outpatient settings, as it is simple, not expensive and provides information on body mass index, skeletal mass, fat mass, fat percentage and basal metabolic rate. This review discusses body composition analysis as part of a health assessment for healthy women during the perimenopause and investigates the associations between body composition and cardiometabolic profile.
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Affiliation(s)
- Maria Karaflou
- Endocrinology, Diabetes and Metabolism private practice, Faros, Neo Psychiko, GR-15451 Athens, Greece.
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki GR-56429, Greece
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13
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Lambrinoudaki I, Armeni E. Understanding of and clinical approach to cardiometabolic transition at the menopause. Climacteric 2024; 27:68-74. [PMID: 37224871 DOI: 10.1080/13697137.2023.2202809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 05/26/2023]
Abstract
Cardiovascular disease (CVD) represents the leading cause of death and accounts for almost 50% of all deaths in women worldwide. The menopausal transition is associated with central body fat accumulation, a decrease in energy expenditure, weight gain, insulin resistance and a pro-atherogenic lipid profile. Moreover, menopause is independently associated with an adverse effect on functional and structural indices of subclinical atherosclerosis. Women with premature ovarian insufficiency have heightened CVD risk compared to women of natural age at menopause. Furthermore, women with severe menopausal symptoms may have a more adverse cardiometabolic profile than those without symptoms. We reviewed the latest evidence on the cardiovascular management of perimenopausal or postmenopausal women. Clinicians should aim for cardiovascular risk stratification, followed by dietary and lifestyle advice as required based on individual needs. The medical management of cardiometabolic risk factors at midlife should always be individualized, focusing on hypertension, diabetes and dyslipidemia. Menopausal hormone therapy, when prescribed for the management of bothersome menopausal symptoms or for the prevention of osteoporosis, has also a beneficial effect on cardiometabolic risk factors. This narrative review aims to summarize the cardiometabolic alternations occurring during the menopausal transition and to outline the appropriate prevention strategies to prevent future cardiovascular adverse outcomes.
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Affiliation(s)
- I Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - E Armeni
- 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
- Royal Free Hospital NHS Foundation Trust, UCL Medical School, London, UK
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Mansour D, Barber K, Chalk G, Noble N, Digpal AAS, Talaulikar V, Gray S. The evolving perspective of menopause management in the United Kingdom. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241288641. [PMID: 39378060 PMCID: PMC11467997 DOI: 10.1177/17455057241288641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 09/05/2024] [Accepted: 09/13/2024] [Indexed: 10/13/2024]
Abstract
BACKGROUND The use of menopausal hormone therapy (MHT) was significantly reduced following the publication of the Women's Health Initiative study results and has remained low ever since. However, from 2015 onwards, the UK has seen a substantial increase in MHT prescribing compared to other European countries. OBJECTIVES To evaluate the factors contributing to the shift in women's and healthcare professionals' (HCPs) perception of MHT in the United Kingdom and to provide learning points for other European countries. DESIGN An exploratory, descriptive and qualitative study. METHODS An interactive virtual panel discussion in which seven UK-based HCPs with a special interest in the menopause discussed the evolution of its management in the United Kingdom. RESULTS In the last 8 years, there has been a substantial increase in MHT prescriptions in the United Kingdom due to improved menopause awareness and acceptance of MHT. Accessibility to accurate, scientific, information and guidance from respected institutions is one of the main drivers of this change. Social media has increased that reach with 'influencers' empowering women to seek help. Women are demanding access to menopause health care so that they can receive holistic and individualized treatment based on their clinical conditions and needs. Standardized education of HCPs is an essential pillar to provide appropriate and equitable care to menopausal women and to guarantee safe prescribing of MHT. Furthermore, up to date and factually correct menopausal education would benefit all the population. CONCLUSIONS Publication of new scientific data reporting a more favourable benefit/risk ratio with MHT, production of national guidance and an increased awareness via social media have led to the significant rise in MHT prescribing and improvement of menopause care in the United Kingdom. The lessons learned may benefit other European countries.
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Affiliation(s)
- Diana Mansour
- Department of Obstetrics and Gynaecology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katie Barber
- Community Gynaecology Oxfordshire (NHS), Oxfordshire, UK
- Oxford Menopause Ltd., Wantage, UK
| | | | - Nikki Noble
- Aneurin Bevan University Health Board, Newport, UK
| | | | - Vikram Talaulikar
- Reproductive Medicine Unit, University College London Hospital, London, UK
- Women’s Health, University College London, London, UK
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Cronin C, Abbott J, Asiamah N, Smyth S. Menopause at work-An organisation-based case study. Nurs Open 2024; 11:e2058. [PMID: 38268277 PMCID: PMC10721947 DOI: 10.1002/nop2.2058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 11/07/2023] [Accepted: 11/19/2023] [Indexed: 01/26/2024] Open
Abstract
AIM The aim of the study was to explore and understand the organizational culture of a workplace in terms of support and well-being for staff experiencing perimenopausal and menopausal symptoms at work. DESIGN It is widely acknowledged that perimenopause and menopause symptoms are experienced by a large percentage of the female workforce. There is a lack of research into how nurses are supported through menopause (Cronin et al. Issues in Mental Health Nursing, 42, 2021, 541-548). The perimenopause and menopause transition can be a challenging time where many may require symptom management and support (RCN, The Menopause and Work: Guidance for RCN Representatives, 2020). This paper presents a case study research (CSR) approach to examine one healthcare organization. METHODS CSR design was used: A survey distributed to all staff employed, a review of the available documentation on menopause and interviews with managers from different levels of the organization. The COREQ consolidated criteria was used for reporting the qualitative research reported this study. RESULTS The case study generated both quantitative and qualitative data using surveys, interviews and documentation. Data from the organization (n = 6905) showed a majority female workforce of 81.9% with 40.6% aged between 41 and 55 years old, meaning a third of the organization working through perimenopause and menopause. Survey responses (n = 167) collected biographical and psychometric data on the prevalence of perimenopausal and menopausal symptoms. Seven managers were interviewed highlighting two themes: Access to support and culture of menopause and 13 documents from the organization on menopause were analysed for content. The study design permitted an iterative approach to data collection and providing an in-depth understanding of the needs and support for those experiencing perimenopause and menopause. The findings help healthcare organizations to understand their workforce and take in to account the larger numbers of female employees particularly nurses with the need to provide person-centred support mechanisms and an organizational approach for all employees.
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Affiliation(s)
- Camille Cronin
- School of Health & Social CareUniversity of EssexColchesterUK
| | - Joanne Abbott
- School of Health & Social CareUniversity of EssexColchesterUK
| | - Nestor Asiamah
- School of Health & Social CareUniversity of EssexColchesterUK
| | - Susan Smyth
- North East London NHS Foundation TrustRainham, EssexUK
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Erdélyi A, Pálfi E, Tűű L, Nas K, Szűcs Z, Török M, Jakab A, Várbíró S. The Importance of Nutrition in Menopause and Perimenopause-A Review. Nutrients 2023; 16:27. [PMID: 38201856 PMCID: PMC10780928 DOI: 10.3390/nu16010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Menopause is associated with an increased prevalence of obesity, metabolic syndrome, cardiovascular diseases, and osteoporosis. These diseases and unfavorable laboratory values, which are characteristic of this period in women, can be significantly improved by eliminating and reducing dietary risk factors. Changing dietary habits during perimenopause is most effectively achieved through nutrition counseling and intervention. To reduce the risk factors of all these diseases, and in the case of an already existing disease, dietary therapy led by a dietitian should be an integral part of the treatment. The following review summarizes the recommendations for a balanced diet and fluid intake, the dietary prevention of cardiovascular diseases, the role of sleep, and the key preventive nutrients in menopause, such as vitamin D, calcium, vitamin C, B vitamins, and protein intake. In summary, during the period of perimenopause and menopause, many lifestyle factors can reduce the risk of developing all the diseases (cardiovascular disease, insulin resistance, type 2 diabetes mellitus, osteoporosis, and tumors) and symptoms characteristic of this period.
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Affiliation(s)
- Aliz Erdélyi
- Hungarian Dietetic Association, 1034 Budapest, Hungary; (A.E.); (Z.S.)
- EndoCare Institute, Endocrinology Center, 1037 Budapest, Hungary; (L.T.); (K.N.)
| | - Erzsébet Pálfi
- Faculty of Health Sciences, Department of Dietetics and Nutritional Sciences, Semmelweis University, 1088 Budapest, Hungary
| | - László Tűű
- EndoCare Institute, Endocrinology Center, 1037 Budapest, Hungary; (L.T.); (K.N.)
- School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
| | - Katalin Nas
- EndoCare Institute, Endocrinology Center, 1037 Budapest, Hungary; (L.T.); (K.N.)
- School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
| | - Zsuzsanna Szűcs
- Hungarian Dietetic Association, 1034 Budapest, Hungary; (A.E.); (Z.S.)
- School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
| | - Marianna Török
- EndoCare Institute, Endocrinology Center, 1037 Budapest, Hungary; (L.T.); (K.N.)
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary;
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - Szabolcs Várbíró
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary;
- Department of Obstetrics and Gynecology, University of Szeged, 6725 Szeged, Hungary
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Cronin C, Bidwell G, Carey J, Donevant S, Hughes KA, Kaunonen M, Marcussen J, Wilson R. Exploring digital interventions to facilitate coping and discomfort for nurses experiencing the menopause in the workplace: An international qualitative study. J Adv Nurs 2023; 79:3760-3775. [PMID: 37700454 DOI: 10.1111/jan.15679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/26/2023] [Accepted: 04/09/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION The global nursing workforce is predominantly female, with a large proportion working in the 45-55 age group. Menopause is a transition for all women, and; therefore needs recognition as it can impact work performance and consequently staff turnover. BACKGROUND Women will go through the menopause, but not all women are affected. The menopause transition presents a range of signs and symptoms both physical and psychological which can impact the quality of life and individuals' work/life balance. The nursing workforce is predominantly women that will work through the menopause transition. OBJECTIVES The study explored perspectives on digital health interventions as strategies to support menopausal women and to understand the requirements for designing health interventions for support in the workplace. DESIGN A qualitative explorative design. SETTINGS Nurses working in a range of clinical settings in England, Finland, Denmark, New Zealand, Australia and USA. METHODS Nurses (n = 48) participated in focus groups from six different countries from February 2020-June 2022 during the pandemic from a range of acute, primary care and education settings. Nurses were invited to participate to share their experiences. Thematic analysis was used. RESULTS All participants were able to describe the physical symptoms of menopause, with some cultural and possible hemisphere differences; more noticeable was the psychological burden of menopause and fatigue that is not always recognized. Four themes were identified: Managing symptoms in the workplace; Recognition in the workplace; Menopause interventions; and Expectation versus the invisible reality. These themes revealed information that can be translated for implementation into digital health interventions. CONCLUSIONS Managers of nursing female staff in the menopausal age range need greater awareness, and menopause education should involve everyone. Finally, our results demonstrate design attributes suitable for inclusion in digital health strategies that are aligned with likely alleviation of some of the discomforts of menopause. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Camille Cronin
- School of Health and Social Care, University of Essex, Essex, UK
| | - Gemma Bidwell
- School of Health & Social Care, University of Essex, Essex, UK
| | - Janene Carey
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sara Donevant
- University of South Carolina, Columbia, South Carolina, USA
| | | | - Marja Kaunonen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Jette Marcussen
- The Department of Applied Health Sciences, UCL University College, Svendborg, Denmark
| | - Rhonda Wilson
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
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Oude Hengel KM, Soeter M, In der Maur M, van Oostrom SH, Loef B, Hooftman WE. Perimenopause: Symptoms, work ability and health among 4010 Dutch workers. Maturitas 2023; 176:107793. [PMID: 37393659 DOI: 10.1016/j.maturitas.2023.107793] [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] [Received: 02/03/2023] [Revised: 05/31/2023] [Accepted: 06/17/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE In this study we examined the associations between menopausal symptoms and work ability and health among a general population of Dutch female workers. STUDY DESIGN This nationwide cross-sectional study was a follow-up of the Netherlands Working Conditions Survey 2020. In 2021, 4010 Dutch female employees aged 40-67 years completed an online survey on a variety of topics, including menopausal symptoms, work ability and health. METHODS Linear and logistic regression analyses were performed to investigate the association between the degree of menopausal symptoms with work ability, self-rated health and emotional exhaustion, after adjustment for potential confounders. RESULTS Almost one-fifth of participants were in the perimenopause (n = 743). Of these women, 80 % experienced menopausal symptoms: 27.5 % 'often' and 52.5 % 'sometimes'. Experiencing menopausal symptoms was associated with lower work ability, poorer self-rated health, and more emotional exhaustion. These associations were most pronounced among perimenopausal women 'often' experiencing symptoms. CONCLUSIONS Menopausal symptoms threaten the sustainable employability of female workers. Interventions and guidelines are needed to support women, employers and (occupational) health professionals.
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Affiliation(s)
- Karen M Oude Hengel
- Netherlands Organization for Applied Scientific Research TNO, Sylviusweg 71, 2333 BE Leiden, the Netherlands.
| | - Marieke Soeter
- Netherlands Organization for Applied Scientific Research TNO, Sylviusweg 71, 2333 BE Leiden, the Netherlands
| | - Merel In der Maur
- Netherlands Organization for Applied Scientific Research TNO, Sylviusweg 71, 2333 BE Leiden, the Netherlands
| | - Sandra H van Oostrom
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, P.O Box 1, 3720 BA Bilthoven, the Netherlands
| | - Bette Loef
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, P.O Box 1, 3720 BA Bilthoven, the Netherlands
| | - Wendela E Hooftman
- Netherlands Organization for Applied Scientific Research TNO, Sylviusweg 71, 2333 BE Leiden, the Netherlands
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Estrugo CP, Rodríguez MT, de Guevara NML, Gómez JG, Ridocci F, Moro-Martín MT, Guinot M, Saz-Leal P, Nieto Magro C. Combination of Soy Isoflavones, 8-Prenylnaringenin and Melatonin Improves Hot Flashes and Health-Related Quality of Life Outcomes in Postmenopausal Women: Flavie Study. J Menopausal Med 2023; 29:73-83. [PMID: 37691315 PMCID: PMC10505517 DOI: 10.6118/jmm.22034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 05/26/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVES This study aims to investigate the effects of a combination of soy isoflavones, 8-prenylnaringenin (8-PN), and melatonin in postmenopausal women suffering from moderate-to-severe hot flashes (HFs). METHODS A multicenter, prospective, open-label study enrolled 44 postmenopausal women suffering from moderate-to-severe HFs (≥ 5 daily or ≥ 35 weekly) to receive 54.4 mg standardized soy isoflavones (including 24.5 mg genistein and 16.3 mg daidzein), 100 µg 8-PN, and 1 mg melatonin once daily for 12 weeks. The primary clinical outcomes included changes in health-related quality of life (HRQoL) scores (Menopause-Specific QoL questionnaire [MENQoL] and Cervantes Scale) and HFs following 4 and 12 weeks of treatment. Other analyses included treatment adherence, acceptability, tolerability, and safety. RESULTS All of the four domains of MENQoL questionnaire significantly improved at 4 weeks (P < 0.05) and 12 weeks (P < 0.001), affecting significantly the vasomotor, psychosocial, and physical spheres (41.2%, 26.3%, and 25.0%; 12 weeks improvements, respectively). Similarly, in the menopause (39.3%) and psychic (51.7%) domains (both P < 0.05 at 12 weeks), the global score of the Cervantes Scale significantly increased at 4 weeks (18.6%) and 12 weeks (35.4%). Accordingly, moderate-to-severe HFs significantly decreased at 4 weeks compared to baseline (41.7% reduction) and further reduced at 12 weeks (76.5%), including the total number of episodes. CONCLUSIONS Food supplements containing soy isoflavones, 8-PN, and melatonin showed an early and progressive benefit for reducing clinically significant HFs and for improving HRQoL across all domains, favorably affecting postmenopausal women's overall well-being.
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Affiliation(s)
| | | | | | | | | | | | - Misericordia Guinot
- Department of Obstetrics and Gynecology, Dra. Guinot's Surgery, Barcelona, Spain
| | - Paula Saz-Leal
- Medical Affairs, Italfarmaco (ITF) Research Pharma Sociedad de Responsabilidad Limitada Unipersonal (SLU), Madrid, Spain.
| | - Concepción Nieto Magro
- Medical Affairs, Italfarmaco (ITF) Research Pharma Sociedad de Responsabilidad Limitada Unipersonal (SLU), Madrid, Spain
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Panay N, Nappi RE, Stute P, Palacios S, Paszkowski T, Kagan R, Archer DF, Héroux J, Boolell M. Oral estradiol/micronized progesterone may be associated with lower risk of venous thromboembolism compared with conjugated equine estrogens/medroxyprogesterone acetate in real-world practice. Maturitas 2023; 172:23-31. [PMID: 37084589 DOI: 10.1016/j.maturitas.2023.04.004] [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: 11/29/2022] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVES The Women's Health Initiative study reported an increased risk of venous thromboembolism among menopausal women treated with conjugated equine estrogens/medroxyprogesterone acetate (CEE/MPA) versus placebo. Newer hormone therapies may have a lower venous thromboembolism risk. The study compared the risk of venous thromboembolism between women treated with the combined oral product 17β-estradiol/micronized progesterone (E2/P4) and those treated with oral CEE/MPA regimens. STUDY DESIGN In a retrospective longitudinal study using real-world claims data from April 2019 to June 2021, women aged 40 years or more treated with oral E2/P4 or oral CEE/MPA who did not have a venous thromboembolism diagnosis before first dispensing claim of CEE/MPA or E2/P4 identified on or after May 1st 2019 (index date) were observed for 6 months or more after the index date. Oral E2/P4 and oral CEE/MPA had been prescribed by the treating physician in real-world practice and were observed through pharmacy dispensing records. MAIN OUTCOME MEASURES Venous thromboembolism risk was compared between women receiving oral E2/P4 versus oral CEE/MPA. RESULTS The study included 36,061 women treated with oral E2/P4 or oral CEE/MPA. In the analyses weighted by the inverse probability of treatment for control of potential confounding factors, the incidence of venous thromboembolism was significantly lower for oral E2/P4 compared with oral CEE/MPA (37/10,000 women-years for oral E2/P4 vs 53/10,000 women-years for oral CEE/MPA; incidence rate ratio 0.70, 95 % confidence interval: 0.53-0.92). CONCLUSIONS Real-world evidence suggests that the risk of venous thromboembolism is significantly lower among women treated with oral E2/P4 compared with oral CEE/MPA.
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Affiliation(s)
- Nick Panay
- Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, London W2 1NY, United Kingdom; Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, 116, London SW10 9NH, United Kingdom; Queen Charlotte's & Chelsea Hospital, Du Cane Rd, London W12 0HS, United Kingdom
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Piazzale Golgi 2, 27100 Pavia, Italy
| | - Petra Stute
- Department of Obstetrics and Gynecology, Inselspital, University Clinic Bern, Friedbühlstr. 19, 3010 Bern, Switzerland
| | - Santiago Palacios
- Palacios Institute of Women's Health and Medicine, Calle Antonio Acuña, 9, Madrid 28009, Spain
| | - Tomasz Paszkowski
- III Chair and Department of Gynecology, Medical University of Lublin, 8 Jaczewskiego St., 20-954 Lublin, Poland
| | - Risa Kagan
- Sutter East Bay Medical Group, Affiliated with Sutter East Bay Medical Foundation, Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF, 2500 Milvia Street, Berkeley, CA, USA
| | - David F Archer
- Clinical Research Center, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, 601 Colley Avenue, Suite 241, Norfolk, VA 23507, USA
| | - Julie Héroux
- Heroux Consulting, Vrouwe Meilendislaan 14, Den Haag 2553EX, Netherlands
| | - Mitra Boolell
- Theramex HQ UK Ltd., Sloane Square House, 1 Holbein Place, London SW1W 8NS, United Kingdom.
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21
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Shah N, Ariel D. The role of menopausal hormone therapy in the prevention and treatment of low bone density in perimenopausal and postmenopausal women. Curr Opin Obstet Gynecol 2023; 35:141-149. [PMID: 36912327 DOI: 10.1097/gco.0000000000000858] [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: 03/14/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the evidence on the benefits of menopausal hormone therapy (MHT) for the maintenance of skeletal health, prevention of osteoporosis and related fractures in peri and postmenopausal women. RECENT FINDINGS We will review the impact of estrogen on skeletal health as well as the physiology of bone loss during the perimenopause and postmenopause. We will then elucidate the data that include estrogen alone and combination of MHT to demonstrate that in the absence of contraindication, MHT should be considered as an option for the maintenance of skeletal health both when concomitant menopausal symptoms are present and when not. SUMMARY It has been well established that estrogens maintain bone mineral density (BMD) and reduce fracture risk at all sites. However, the most extensively studied form of estrogen with established fracture prevention is oral doses of synthetic estrogens. Due to the reduced risk profile, lower doses of bioidentical oral or transdermal estrogens are often preferred in clinical practice. We will highlight the current data on improvement in BMD and fracture risk reduction, including differences in formulation, dose, and route of delivery, to support a provider in the clinical decision-making process.
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Affiliation(s)
- Nandi Shah
- Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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Li Y, He H, Wang J, Chen Y, Wang C, Li X, Dai A, Liu Y, Xi X, Huang J, Zou M, Fan Y, Zhou M, Yi P, Yu L, Lei X. Effect of multidisciplinary health education based on lifestyle medicine on menopausal syndrome and lifestyle behaviors of menopausal women: A clinical controlled study. Front Public Health 2023; 11:1119352. [PMID: 37006585 PMCID: PMC10060660 DOI: 10.3389/fpubh.2023.1119352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/23/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundMenopausal women may experience menopausal syndrome and long-term effects caused by low estrogen levels, such as senile dementia and osteoporosis in the elderly. Most menopausal women may have misconceptions about menopause and low use of pharmacological interventions. These misconceptions may damage the quality of life and miss the critical period for preventing senile diseases. Thus, enhancing the awareness of menopausal women regarding psychosocial and physical changes through health education programs was a way to improve positive attitudes toward menopause and make further treatment options.ObjectivesThis study aimed to evaluate the effect of multidisciplinary health education based on lifestyle medicine on menopausal syndrome and lifestyle behaviors of menopausal women.MethodsThe study was conducted in several hospitals in Chongqing, China. The two groups were from different hospitals with similar medical levels in order to reduce information contamination. It was designed as a clinical controlled trial in which the intervention group (n = 100) and control group (n = 87) were matched for age, age at menarche, menopausal symptoms and drug use status at enrollment. Women in the intervention group received multidisciplinary health education based on lifestyle medicine for 2 months while those in the control group received routine outpatient health guidance. Menopausal syndrome, physical activity and dietary status of participants were assessed before and after the intervention. Paired t-tests and Independent-sample t-tests were adopted for comparison within and between groups, respectively, in the normal variables. Wilcoxon signed-rank tests and Mann-Whitney U tests were adopted for comparison within and between group, respectively, in the abnormal variables. Categorical variables were tested using Pearson's χ2. P-value < 0.05 was statistically significant in statistical tests.ResultsPost intervention testing indicated that menopausal syndrome of participants was significantly improved in the intervention group compared to the control group (P < 0.001). Between-group comparison showed a significant improvement of weekly energy expenditure of total physical activity (P = 0.001) and participation in exercise (P < 0.001) in the intervention group compared to the control group after the intervention. The dietary status of participants was significantly improved in the intervention group compared to the control group (P < 0.001). In the intervention group, the menopausal syndrome of participants improved more in the hormone drug group than in the non-hormone group (P = 0.007), as did the control group (P = 0.02). In the hormone drug group, the physical activity (P = 0.003) and dietary status (P = 0.001) mproved more in the intervention group than in the control group.ConclusionsThe multidisciplinary health education based on lifestyle medicine was effective in improving the menopausal syndrome and healthy lifestyle behaviors of menopausal women. Studies with extended observation period and larger sample size are in need to evaluate the long-term scale-up effects of the multidisciplinary health education.
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Affiliation(s)
- Yangmei Li
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Haiyang He
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Jiaxi Wang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Yifan Chen
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Chunyuan Wang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Xinyue Li
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Anqi Dai
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Yue Liu
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
| | - Xin Xi
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Huang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mi Zou
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yao Fan
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
| | - Mingfang Zhou
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Yi
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lili Yu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Lili Yu
| | - Xun Lei
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
- *Correspondence: Xun Lei
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Macpherson BE, Quinton ND. Menopause and healthcare professional education: A scoping review. Maturitas 2022; 166:89-95. [PMID: 36095904 DOI: 10.1016/j.maturitas.2022.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There has been a growing discourse regarding menopause, but despite this growth there is little education on this important topic across health professions. This scoping review provides a comprehensive synthesis of how menopause is represented in health professions' education literature, to inform future pedagogy and practice. DESIGN A scoping review using the framework developed by Arksey and O'Malley (2005). METHODS In the scoping review, only empirical studies were considered and only those published in the English language were included. Four databases were interrogated using a variety of search terms, including menopause, healthcare, medical and education. RESULTS Twelve studies were included and mapped independently by the authors onto the internally developed data-extraction tool. Insights into how menopause is understood in educational terms and how it is taught within health professions' education were gained, specifically in relation to knowledge, language used, and learning and educational gaps. CONCLUSION The review establishes how menopause is understood in educational terms and how it is taught within health professions' education, and develops an understanding of the pedagogy of menopause. There is an urgent need for menopause to be included in mainstream curricula and for an appropriate pedagogy that acknowledges the complexity of the topic, to achieve excellence in education across health professions' education. There is a broader perspective in addressing the challenges for health professions' education in terms of the prioritisation and pedagogy of women's health.
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Affiliation(s)
- Barbara E Macpherson
- Leeds Institute of Medical Education, School of Medicine, University of Leeds, Leeds LS2 9NL, UK.
| | - Naomi D Quinton
- Leeds Institute of Medical Education, School of Medicine, University of Leeds, Leeds LS2 9NL, UK. https://twitter.com/drna
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Menopause, wellbeing and health: A care pathway from the European Menopause and Andropause Society. Maturitas 2022; 163:1-14. [DOI: 10.1016/j.maturitas.2022.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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