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Stute P, Henneicke-von Zepelin HH, Nicken P. Transfer of preclinical study data on the influence of cimicifuga racemosaon functional changes in the hippocampus during menopause. Gynecol Endocrinol 2024; 40:2360066. [PMID: 38833172 DOI: 10.1080/09513590.2024.2360066] [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: 12/04/2023] [Accepted: 05/22/2024] [Indexed: 06/06/2024] Open
Abstract
Menopausal transition in women involves complex neurobiochemical changes linked to ovarian dysfunction, resulting in symptoms like vasomotor symptoms (VMS), sleep disturbances, anxiety, and cognitive impairments. Hormone replacement therapy is the first-line treatment. However, many women are reluctant to use HRT or have contraindications toward HRT and seek for alternatives. Non-hormonal therapies with extracts of Cimicifuga racemosa rhizomes like the isopropanolic extract (iCR, black cohosh) offer a promising alternative. A preclinical pilot study exploring iCR's effects on gene expression in the hippocampus and hypothalamus of ovarectomized (OVX) rats mimicking menopausal conditions identified important signaling pathways and CNS-based contributions to the multitargeted modes of action of iCR. Especially in the hippocampus, iCR compensated effects of OVX on gene expression profiles. These changes are reflected by the genes AVPR1A, GAL, CALCA, HCRT, PNOC, ESR1, ESR2 and TAC3 contributing to the formation of hot flushes or thermoregulation as well as to secondary effects such as blood pressure, metabolism, hormonal regulation, homeostasis, mood regulation, neuroendocrine modulation, regulation of sleep and arousal, and in learning, memory and cognition. To understand the mechanisms in the brain of estrogen-depressed animals (OVX) and subsequent iCR treatment we combined the results of the pilot study with those of up-to-date literature and tried to transfer the current knowledge to humans during menopausal transition and adaptation. Focus was laid on changes in the hippocampal function, that is disturbed by hormonal fluctuations, but can also be brought back into balance by iCR.
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Affiliation(s)
- Petra Stute
- Department of Obstetrics and Gynecology, University Women's Hospital, Inselspital, Berne, Switzerland
| | | | - Petra Nicken
- Regulatory Affairs Department, Schaper and Brümmer GmbH and Co. KG, Salzgitter, Germany
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2
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Safwan N, Saadedine M, Shufelt CL, Kapoor E, Kling JM, Chaudhry R, Faubion SS. Menopause in the workplace: Challenges, impact, and next steps. Maturitas 2024; 185:107983. [PMID: 38581822 DOI: 10.1016/j.maturitas.2024.107983] [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: 11/17/2023] [Revised: 02/23/2024] [Accepted: 03/27/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Menopause is a natural part of a woman's life that coincides with a time when many women play significant roles in the workforce. Menopause symptoms, such as hot flashes, fatigue, and difficulty with concentration and memory, can have a negative effect on work productivity and efficiency. OBJECTIVES This paper summarizes the impact of menopause in the workplace, with an emphasis on the impact of symptoms on employed women and how the workplace influences their experiences. It highlights economic implications, promotes awareness, and suggests potential next steps. METHODS A search for papers was conducted between August and November 2023 in the PubMed and Medline databases. Papers were selected based on personal experience and interpretation of the findings. Recommendations for managing menopause symptoms in the workplace and guidance on an optimal workplace intervention strategy were provided. RESULTS Women experiencing severe menopause symptoms are more likely to report adverse work outcomes, including absenteeism and job-related decisions such as quitting, retiring early, or declining promotions than women experiencing few symptoms. Factors such as a lack of awareness about menopause, inflexible work conditions, and high-stress jobs can exacerbate the severity of these symptoms. Additionally, unaddressed menopause symptoms contribute to both direct and indirect economic costs, including medical resource utilization and lost work productivity, resulting in a substantial economic burden. CONCLUSION Menopause symptoms impair women's work experiences and productivity. In addition to dismantling the stigma associated with menopause, it is critical to create and implement menopause workplace policies and interventions aimed at supporting women in this universal life stage.
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Affiliation(s)
- Nancy Safwan
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States of America; Mayo Clinic Center for Women's Health, Rochester, MN, United States of America
| | - Mariam Saadedine
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States of America; Mayo Clinic Center for Women's Health, Rochester, MN, United States of America
| | - Chrisandra L Shufelt
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States of America; Mayo Clinic Center for Women's Health, Rochester, MN, United States of America; Women's Health Research Center, Mayo Clinic, Rochester, MN, United States of America
| | - Ekta Kapoor
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States of America; Mayo Clinic Center for Women's Health, Rochester, MN, United States of America; Women's Health Research Center, Mayo Clinic, Rochester, MN, United States of America; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, United States of America
| | - Juliana M Kling
- Mayo Clinic Center for Women's Health, Rochester, MN, United States of America; Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, United States of America
| | - Rajeev Chaudhry
- Mayo Clinic Center for Women's Health, Rochester, MN, United States of America; Division of Community Internal Medicine, Mayo Clinic, Eau Claire, WI, United States of America
| | - Stephanie S Faubion
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States of America; Mayo Clinic Center for Women's Health, Rochester, MN, United States of America.
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3
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Mosconi L, Nerattini M, Matthews DC, Jett S, Andy C, Williams S, Yepez CB, Zarate C, Carlton C, Fauci F, Ajila T, Pahlajani S, Andrews R, Pupi A, Ballon D, Kelly J, Osborne JR, Nehmeh S, Fink M, Berti V, Dyke JP, Brinton RD. In vivo brain estrogen receptor density by neuroendocrine aging and relationships with cognition and symptomatology. Sci Rep 2024; 14:12680. [PMID: 38902275 PMCID: PMC11190148 DOI: 10.1038/s41598-024-62820-7] [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: 04/04/2024] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
17β-estradiol, the most biologically active estrogen, exerts wide-ranging effects in brain through its action on estrogen receptors (ERs), influencing higher-order cognitive function and neurobiological aging. However, our knowledge of ER expression and regulation by neuroendocrine aging in the living human brain is limited. This in vivo brain 18F-fluoroestradiol (18F-FES) Positron Emission Tomography (PET) study of healthy midlife women reveals progressively higher ER density over the menopause transition in estrogen-regulated networks. Effects were independent of age, plasma estradiol and sex hormone binding globulin, and were highly consistent, correctly classifying all women as being postmenopausal or premenopausal. Higher ER density in target regions was associated with poorer memory performance for both postmenopausal and perimenopausal groups, and predicted presence of self-reported mood and cognitive symptoms after menopause. These findings provide novel insights on brain ER density modulation by female neuroendocrine aging, with clinical implications for women's health.
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Affiliation(s)
- Lisa Mosconi
- Department of Neurology, Weill Cornell Medicine, 402 East 70th Street, LH-404, New York, NY, 10021, USA.
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
| | - Matilde Nerattini
- Department of Neurology, Weill Cornell Medicine, 402 East 70th Street, LH-404, New York, NY, 10021, USA
- Nuclear Medicine Unit, Department of Biomedical Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | - Steven Jett
- Department of Neurology, Weill Cornell Medicine, 402 East 70th Street, LH-404, New York, NY, 10021, USA
| | - Caroline Andy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Schantel Williams
- Department of Neurology, Weill Cornell Medicine, 402 East 70th Street, LH-404, New York, NY, 10021, USA
| | - Camila Boneu Yepez
- Department of Neurology, Weill Cornell Medicine, 402 East 70th Street, LH-404, New York, NY, 10021, USA
| | - Camila Zarate
- Department of Neurology, Weill Cornell Medicine, 402 East 70th Street, LH-404, New York, NY, 10021, USA
| | - Caroline Carlton
- Department of Neurology, Weill Cornell Medicine, 402 East 70th Street, LH-404, New York, NY, 10021, USA
| | - Francesca Fauci
- Department of Neurology, Weill Cornell Medicine, 402 East 70th Street, LH-404, New York, NY, 10021, USA
| | - Trisha Ajila
- Department of Neurology, Weill Cornell Medicine, 402 East 70th Street, LH-404, New York, NY, 10021, USA
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medicine, 402 East 70th Street, LH-404, New York, NY, 10021, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Alberto Pupi
- Nuclear Medicine Unit, Department of Biomedical Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Douglas Ballon
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - James Kelly
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Joseph R Osborne
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Sadek Nehmeh
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Matthew Fink
- Department of Neurology, Weill Cornell Medicine, 402 East 70th Street, LH-404, New York, NY, 10021, USA
| | - Valentina Berti
- Nuclear Medicine Unit, Department of Biomedical Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | - Roberta Diaz Brinton
- Department of Pharmacology and Neurology, University of Arizona, Tucson, AZ, USA
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Nguyen TTB, Hsu YY. Features, measurements, determinants, treatments, and outcomes of musculoskeletal symptoms in postmenopausal women: A scoping review. Geriatr Nurs 2024; 58:416-429. [PMID: 38901307 DOI: 10.1016/j.gerinurse.2024.05.038] [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: 01/30/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND The literature lacks a consistent review of musculoskeletal symptoms in postmenopausal women. AIM To identify features, measurements, determinants, treatments, and outcomes of musculoskeletal symptoms in postmenopausal women. METHOD A scoping review was completed using six databases: Embase, Medline, Cochrane, CINAHL, Web of Science, and Scopus up to December 2022. Sixty-three articles were identified. RESULTS Musculoskeletal symptoms in postmenopausal women include somatic symptoms of non-specific origin, upper and lower limb symptoms, spinal pain, and decline in physical performance. Measurements were categorized into four groups: musculoskeletal symptoms for menopause, general musculoskeletal symptoms, menopause-specific quality of life, and general quality of life questionnaires. The determinants were grouped into four themes: demographics, physical determinants, psychosocial determinants, and lifestyle. Pharmacological interventions, supplementation options, and exercise regimens exist for postmenopausal women with musculoskeletal symptoms. CONCLUSION A comprehensive policy is needed to address musculoskeletal symptoms in postmenopausal women, promoting diverse treatments for improved quality of life.
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Affiliation(s)
- Tram Thi Bich Nguyen
- National Cheng Kung University, No.1, University Road, Tainan City 701, Taiwan; Duy Tan University, 120 Hoang Minh Thao, Da Nang, 550000, Viet Nam
| | - Yu-Yun Hsu
- National Cheng Kung University, No.1, University Road, Tainan City 701, Taiwan.
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Honda S, Tominaga Y, Espadaler-Mazo J, Huedo P, Aguiló M, Perez M, Ueda T, Sawashita J. Supplementation with a Probiotic Formula Having β-Glucuronidase Activity Modulates Serum Estrogen Levels in Healthy Peri- and Postmenopausal Women. J Med Food 2024. [PMID: 38742994 DOI: 10.1089/jmf.2023.k.0320] [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: 05/16/2024] Open
Abstract
Declines in estrogen levels occur in women transitioning to menopause. Estrogen hormones play important roles in multiple systems of the body, and estrogen loss is associated with a variety of symptoms that can decrease quality of life. The gut microbiota is involved in regulating endogenous estrogen levels. A portion of estrogen glucuronides can be reactivated in the gut by the microbial enzyme β-glucuronidase, and the resulting free estrogens can return to the bloodstream. Here, we carried out in vitro screening of β-glucuronidase activities for 84 strains belonging to 16 different species of lactic acid bacteria and bifidobacteria and found that one and three strains of Levilactobacillus brevis and Lacticasebacillus rhamnosus, respectively, can deconjugate estrogens. Among these strains, L. brevis KABP052 had the highest β-glucuronidase activity. Moreover, in an exploratory, randomized, double-blind, placebo-controlled trial, we demonstrated that serum estrogen levels in healthy peri- and postmenopausal women given a probiotic formula containing KABP052 were maintained over time, whereas levels significantly decreased in the group given a placebo. Significantly higher levels of estradiol (31.62 ± 7.97 pg/mL vs. 25.12 ± 8.17 pg/mL) and estrone (21.38 ± 8.57 pg/mL vs. 13.18 ± 8.77 pg/mL) were observed in the probiotic versus placebo group after 12 weeks of intervention. This clinical study demonstrated for the first time the estrogen modulation capacity of a probiotic formula containing a bacterial strain having β-glucuronidase activity in women during the menopausal transition and formed the basis for future investigations using probiotics in the menopausal population.
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Affiliation(s)
- Shinichi Honda
- Agri-Bio & Supplement Research Laboratories, Kaneka Corporation, Takasago-cho, Takasago Hyogo, Japan
| | - Yuji Tominaga
- Agri-Bio & Supplement Research Laboratories, Kaneka Corporation, Takasago-cho, Takasago Hyogo, Japan
| | - Jordi Espadaler-Mazo
- R&D Department, AB-Biotics SA, ESADE Creapolis Av. De la Torre Blanca, Sant Cugat del Vallès, Barcelona, Spain
| | - Pol Huedo
- R&D Department, AB-Biotics SA, ESADE Creapolis Av. De la Torre Blanca, Sant Cugat del Vallès, Barcelona, Spain
- Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Meritxell Aguiló
- R&D Department, AB-Biotics SA, ESADE Creapolis Av. De la Torre Blanca, Sant Cugat del Vallès, Barcelona, Spain
| | - Marta Perez
- R&D Department, AB-Biotics SA, ESADE Creapolis Av. De la Torre Blanca, Sant Cugat del Vallès, Barcelona, Spain
| | - Takahiro Ueda
- Pharma & Supplemental Nutrition Solutions Vehicle, Kaneka Corporation, Tokyo, Japan
| | - Jinko Sawashita
- Pharma & Supplemental Nutrition Solutions Vehicle, Kaneka Corporation, Osaka, Japan
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6
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Quintana DS, Glaser BD, Kang H, Kildal ESM, Audunsdottir K, Sartorius AM, Barth C. The interplay of oxytocin and sex hormones. Neurosci Biobehav Rev 2024; 163:105765. [PMID: 38885888 DOI: 10.1016/j.neubiorev.2024.105765] [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: 01/23/2024] [Revised: 05/31/2024] [Accepted: 06/08/2024] [Indexed: 06/20/2024]
Abstract
The neuropeptide oxytocin has historically been associated with reproduction and maternal behavior. However, more recent research has uncovered that oxytocin has a much wider range of roles in physiology and behavior. Despite the excitement surrounding potential therapeutical applications of intranasally administered oxytocin, the results of these intervention studies have been inconsistent. Various reasons for these mixed results have been proposed, which tend to focus on methodological issues, such as study design. While methodological issues are certainly important, emerging evidence suggests that the interaction between oxytocin and sex hormones may also account for these varied findings. To better understand the purpose and function of the interaction of oxytocin with sex hormones, with a focus on estrogens, progesterone, and testosterone, we conducted a comprehensive thematic review via four perspectives: evolutionary, developmental, mechanistic, and survival. Altogether, this synergistic approach highlights the critical function of sex hormone activity for accomplishing the diverse roles of oxytocin via the modulation of oxytocin release and oxytocin receptor activity, which is also likely to contribute to the heterogeneity of outcomes after oxytocin administration.
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Affiliation(s)
- Daniel S Quintana
- Department of Psychology, University of Oslo, Oslo, Norway; KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway; NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway.
| | - Bernt D Glaser
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Heemin Kang
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Emilie S M Kildal
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Psychiatry, Lovisenberg Diakonale Sykehus, Oslo, Norway
| | - Kristin Audunsdottir
- Department of Psychology, University of Oslo, Oslo, Norway; KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | | | - Claudia Barth
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
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Bayraktar E, Erel CT, Akturk H, Ozcivit Erkan IB, Hamid R, Alper E, Adaletli I, Urfalioglu M. A novel objective evaluation method, shear wave elastography, in the treatment of atrophic vaginitis by nonablative intravaginal Er:YAG laser, a randomized-sham controlled pilot study. Menopause 2024:00042192-990000000-00337. [PMID: 38860935 DOI: 10.1097/gme.0000000000002380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVE The aim of the study was to investigate the effectiveness of intravaginal Er:YAG laser for treating atrophic vaginitis in postmenopausal women utilizing shear wave elastography. METHODS In this prospective randomized sham-controlled double-blind pilot study, 20 participants were included (laser group [n = 12] / sham-control group [n = 8]). A nonablative (Smooth mode) Er:YAG laser with a wavelength of 2,940 nm was used. Objective evaluation of laser treatment efficacy was conducted using a special ultrasonic technique: shear wave elastography. Ultrasonic velocity measurements were taken from the anterior and posterior vaginal walls. Mean elasticity (E mean ) was expressed in kilopascals (kPa). Additional outcome parameters were vaginal pH, Vaginal Health Index (VHI), Female Sexual Function Index (FSFI), and visual analog scale (VAS) scores for dyspareunia. RESULTS Baseline clinical characteristics, vaginal pH, VHI, VAS and FSFI scores, and E mean values were comparable between the laser and sham-control groups. Statistically significant differences were observed in the final E mean values of the anterior vaginal wall (13.1 ± 6.3 vs 20.0 ± 3.3 kPA, P = 0.01) and posterior vaginal wall (12.7 ± 10.3 vs 19.4 ± 6.9 kPA, P = 0.04) between the laser and sham-control group. Despite comparable baseline E mean values, significant differences in vaginal wall stiffness posttreatment indicated a notable increase in tissue elasticity following laser treatment. Statistically significant differences were also observed in final vaginal pH values, VHI, VAS scores, and FSFI score improvement in favor of laser treatment. CONCLUSIONS Shear wave elastography may be considered as a reliable and objective technique for evaluating the efficacy of Er:YAG laser treatment in women with atrophic vaginitis. However, additional studies with larger sample sizes are necessary to establish conclusive evidence.
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Affiliation(s)
- Elif Bayraktar
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - C Tamer Erel
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Hayedeh Akturk
- Department of Radiology, American Hospital, Istanbul, Turkey
| | - Ipek Betul Ozcivit Erkan
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Rauf Hamid
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ebru Alper
- Department of Obstetrics and Gynecology, American Hospital, Istanbul, Turkey
| | - Ibrahim Adaletli
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Mert Urfalioglu
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Li J, Liu F, Liu Z, Li M, Wang Y, Shang Y, Li Y. Prevalence and associated factors of depression in postmenopausal women: a systematic review and meta-analysis. BMC Psychiatry 2024; 24:431. [PMID: 38858633 PMCID: PMC11165857 DOI: 10.1186/s12888-024-05875-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/29/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Depression is a prevalent mental health problem in postmenopausal women. Given its significant impact on the quality of life and overall well-being of postmenopausal women, there is need for a comprehensive review and meta-analysis of the existing research globally. This systematic review and meta-analysis evaluated the global prevalence of depression and potential associated factors in postmenopausal women. METHODS The Cochrane Library, PubMed, EMBASE, Web of Science, MEDLINE, and PsycINFO databases were systematically searched from inception to March 22, 2023. The meta-analysis used the random-effects model to calculate the prevalence of depression rates and associated factors. In addition, subgroup analysis and sensitivity analysis were performed. Publication bias was assessed using funnel plots, Egger's test, and nonparametric trim-and-fill tests. RESULTS The meta-analysis included 50 studies that involved 385,092 postmenopausal women. The prevalence of depression in postmenopausal women was 28.00% (95% CI, 25.80-30.10). Among the factors relevant to depression among postmenopausal women, marital status (OR: 2.03, 95%CI: 1.33-3.11), history of mental illness (OR: 2.31, 95%CI: 1.50-3.57), chronic disease (OR: 3.13, 95%CI: 2.20-4.44), menstrual cycle (OR: 1.42, 95%CI: 1.17-1.72), abortion numbers (OR: 1.59, 95%CI: 1.40-1.80), menopausal symptoms (OR: 2.10, 95%CI: 1.52-2.90), and hormone replacement therapy (OR: 1.76, 95%CI: 1.31-2.35) were risk factors, while physical activity (OR: 0.56, 95%CI: 0.53-0.59), number of breastfed infants (OR: 0.43, 95%CI: 0.19-0.97), menopause age (OR: 0.44, 95%CI: 0.37-0.51) were preventive factors. CONCLUSIONS This study demonstrated that the prevalence of postmenopausal depression is high, and some risk factors and protective factors associated with it have been identified. It is necessary to improve screening and management and optimize prevention and intervention strategies to reduce the harmful effects of postmenopausal depression.
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Affiliation(s)
- Jiaxin Li
- School of Nursing and Health, Henan University, Kaifeng, Henan, P. R. China
| | - Fangli Liu
- School of Nursing and Health, Henan University, Kaifeng, Henan, P. R. China.
- Institution of Nursing and Health, Henan University, Kaifeng, Henan, P. R. China.
- Xinyang Vocational and Technical College, Xinyang, Henan, P. R. China.
| | - Ziwei Liu
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, P. R. China
| | - Mengjie Li
- School of Nursing and Health, Henan University, Kaifeng, Henan, P. R. China
| | - Yingying Wang
- School of Nursing and Health, Henan University, Kaifeng, Henan, P. R. China
| | - Yameng Shang
- School of Nursing and Health, Henan University, Kaifeng, Henan, P. R. China
| | - Yuege Li
- School of Nursing and Health, Henan University, Kaifeng, Henan, P. R. China
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9
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Chen LL, Zhu G, Xie JP. Mechanism of network pharmacology of Erzhi Pill and Erxian Decoction in treating climacteric syndrome with "treating the same disease with different methods": A review. Medicine (Baltimore) 2024; 103:e38440. [PMID: 38847696 PMCID: PMC11155544 DOI: 10.1097/md.0000000000038440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/10/2024] [Indexed: 06/10/2024] Open
Abstract
Network pharmacology and molecular docking methods were used in the present study to clarify the molecular mechanism of two traditional Chinese medicine prescriptions of climacteric syndrome. Based on oral availability and drug similarity, the main active components of Erzhi Pill and Erxian Decoction were screened through the platform of traditional Chinese medicine system pharmacology. The target database of climacteric syndrome was established by using GENECARD, OMIM, PharmGKB, Targets and Drugbank. The "component - target" network diagram was constructed using Cytoscape software (version 3.8.2). Topology analysis, module analysis, and GO and KEGG enrichment analyses were used to explore the core target and action pathway of Erzhi Pill-Erxian Decoction for treating climacteric syndrome of same disease with different treatments. There were 16 active components and 103 corresponding targets found in Erzhi Pill; 69 active components and 121 corresponding targets were found in Erxian Decoction; and 100 potential targets were found in Erzhi Pill and Erxian Decoction. Through network analysis, topology and module analysis, TP53, AKT1, Jun, ESR1, IL1B, CASP3, MMP9, PTGS2, HIF1A, MYC and EGFR could be considered as potential targets of the 2 prescriptions for alleviating climacteric syndrome. The effects of Erzhi pill and Erxian Decoction on climacteric syndrome are mainly in the pathway of lipid and atherosclerosis, AGE-RAGE signaling pathway and PI3K-Akt signaling pathway in diabetic complications. The active components in Erzhi Pill - Erxian Decoction, such as quercetin, show considerable potential as a candidate drug for the treatment of climacteric syndrome.
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Affiliation(s)
- Lin-Lin Chen
- Department of Gynaecology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Guang Zhu
- Department of Gynaecology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Ji-Ping Xie
- Department of Gynaecology, Tongde Hospital of Zhejiang Province, Hangzhou, China
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10
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Cignarella A, Bolego C, Barton M. Sex and sex steroids as determinants of cardiovascular risk. Steroids 2024; 206:109423. [PMID: 38631602 DOI: 10.1016/j.steroids.2024.109423] [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: 12/21/2023] [Revised: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 04/19/2024]
Abstract
There are considerable sex differences regarding the risk of cardiovascular disease (CVD), including arterial hypertension, coronary artery disease (CAD) and stroke, as well as chronic renal disease. Women are largely protected from these conditions prior to menopause, and the risk increases following cessation of endogenous estrogen production or after surgical menopause. Cardiovascular diseases in women generally begin to occur at a later age than in men (on average with a delay of 10 years). Cessation of estrogen production also impacts metabolism, increasing the risk of developing obesity and diabetes. In middle-aged individuals, hypertension develops earlier and faster in women than in men, and smoking increases cardiovascular risk to a greater degree in women than it does in men. It is not only estrogen that affects female cardiovascular health and plays a protective role until menopause: other sex hormones such as progesterone and androgen hormones generate a complex balance that differentiates heart and blood vessel function in women compared to men. Estrogens improve vasodilation of epicardial coronary arteries and the coronary microvasculature by augmenting the release of vasodilating factors such as nitric oxide and prostacyclin, which are mechanisms of coronary vasodilatation that are more pronounced in women compared to men. Estrogens are also powerful inhibitors of inflammation, which in part explains their protective effects on CVD and chronic renal disease. Emerging evidence suggests that sex chromosomes also play a significant role in shaping cardiovascular risk. The cardiovascular protection conferred by endogenous estrogens may be extended by hormone therapy, especially using bioidentical hormones and starting treatment early after menopause.
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Affiliation(s)
| | - Chiara Bolego
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Matthias Barton
- Molecular Internal Medicine, University of Zürich, Zürich, Switzerland; Andreas Grüntzig Foundation, Zürich, Switzerland.
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Lambrinoudaki I, Mili N, Augoulea A, Armeni E, Vlahos N, Mikos T, Grimbizis G, Rodolakis A, Athanasiou S. The LADY study: epidemiological characteristics of prevalent and new genitourinary syndrome of menopause cases in Greece. Climacteric 2024; 27:289-295. [PMID: 38415685 DOI: 10.1080/13697137.2024.2314504] [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: 06/15/2023] [Accepted: 01/28/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE The genitourinary syndrome of menopause (GSM) is often underdiagnosed and undertreated despite its significant impact on postmenopausal quality of life. We assessed the prevalence of GSM and associated symptoms in Greek perimenopausal/postmenopausal women attending gynecology clinics. METHODS Four hundred and fifty women, aged 40-70 years (93.1% postmenopausal), attending three gynecology clinics at university hospitals completed a validated questionnaire and underwent pelvic examination. RESULTS GSM was diagnosed in 87.6% of the women at the study visit, whereas only 16% of the overall sample had been previously diagnosed with the condition. Vaginal dryness (72.7%), vulvar burning sensation or itching (58.0%) and dyspareunia (52.7%) were the most prevalent symptoms. Pelvic signs consisted of vaginal dryness (89.1%), loss of vaginal rugae (80.6%) and vulvovaginal pallor (86.9%). However, only 31.3% of the participants had discussed genitourinary symptoms with their health-care professionals (HCPs). Regarding management, only 11.1% of women had prior experience with any form of therapy, and currently only 8.7% were receiving treatment. CONCLUSION GSM is highly prevalent in this Greek perimenopausal/postmenopausal population. Nevertheless, the majority of women remain undiagnosed and untreated. Education for both women and HCPs regarding GSM will lead to improved diagnosis and better management of this syndrome.
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Affiliation(s)
- I Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - N Mili
- 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - A Augoulea
- 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - E Armeni
- 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - N Vlahos
- 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - T Mikos
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - G Grimbizis
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - A Rodolakis
- 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - S Athanasiou
- 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
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12
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Huang F, Fan Y, Tang R, Xie Z, Yang L, Ma X, Liang J, Chen R. Musculoskeletal pain among Chinese women during the menopausal transition: findings from a longitudinal cohort study. Pain 2024:00006396-990000000-00608. [PMID: 38787639 DOI: 10.1097/j.pain.0000000000003283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/28/2024] [Indexed: 05/26/2024]
Abstract
ABSTRACT The profiles of muscle and joint pain throughout the menopausal transition and the factors associated with these symptoms have not been determined. A total of 609 participants from a longitudinal cohort study conducted in an urban Chinese community were enrolled in this study. We assessed the prevalence of musculoskeletal symptoms at different menopausal stages and explored the factors associated with these symptoms. The prevalence and severity of muscle and joint pain increase as menopausal stages progress, and late menopausal transition may be a crucial timepoint that triggers the onset of musculoskeletal pain. The results of the multivariate analysis revealed that poor health status (OR = 2.245, 95% CI = 1.714-2.94, P < 0.001), body mass index (BMI) (OR = 1.046, 95% CI = 1.01-1.084, P = 0.011), the presence of anxiety (OR = 1.601, 95% CI = 1.211-2.117, P < 0.001), and depression (OR = 1.368, 95% CI = 1.143-1.639, P < 0.001) were independently associated with muscle and joint pain. In addition, the severity of musculoskeletal pain was related to poor health status (OR = 2.738, 95% CI = 1.91-3.924, P < 0.001) and depression (OR = 1.371, 95% CI = 1.095-1.718, P = 0.006). Musculoskeletal symptoms are frequent somatic symptoms experienced by Chinese middle-aged women. Women with poor health status, high BMI, anxiety, and depression were at heightened risk of experiencing musculoskeletal pain. The severity of pain increased over time.
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Affiliation(s)
- Feiling Huang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
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13
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Sumit K, Vikram K, Rajlaxmi M, Ranjitkumar P, Anastasios G, Abhishek K. Evaluation of oral health, taste perception, nutritional status and emotional well-being in post-menopausal women. J Oral Rehabil 2024. [PMID: 38778703 DOI: 10.1111/joor.13734] [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: 12/11/2023] [Revised: 03/23/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND In postmenopausal women (PMW), vasomotor symptoms, emotional oscillations and sleep disturbances can affect physiological and psychological functioning. However, the effect of menopause on oral health-related parameters is not been thoroughly studied. OBJECTIVE To evaluate oral health, taste perception, eating habits, nutritional status and emotional well-being in PMW compared with a group of young and healthy pre-menopausal women (PrMW). MATERIALS AND METHODS Two groups (Group I: PMW and Group II: PrMW) with 30 participants each, participated in the cross-sectional study. The study proforma contained measures of oral health, taste perception, nutritional status and anxiety levels of the women in both groups using validated and previously used tools were designed and implemented. The data were analysed with student t, Mann-Whitney U, and chi-squared tests to evaluate the differences between the two groups. RESULTS The cross-sectional study indicates no major differences in oral health, taste perception, nutritional and emotional status between PMW and PrMW. Nonetheless, there was a significant difference in perception of 'front teeth lengthening in size' and change in hot and cold sensations between the groups. Furthermore, the study group with PMW tends to have fewer natural teeth than the reference group. CONCLUSION Overall, menopause does not appear to affect oral health, taste perception, nutrition or emotional health. It is suggested that oral health and taste perception, as well as nutritional and emotional status, are associated with gradual aging processes that may or may not be affected by menopause.
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Affiliation(s)
- Kumar Sumit
- Department of Health Research-Multidisciplinary Unit, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Khanna Vikram
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Mitra Rajlaxmi
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Patil Ranjitkumar
- Department of Oral Medicine & Radiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Grigoriadis Anastasios
- Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kumar Abhishek
- Unit of Oral Rehabiliation, Division of Oral Diagnostics & Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Academic Center for Geriatric Dentistry, Stockholm, Sweden
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14
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Støer NC, Vangen S, Singh D, Fortner RT, Hofvind S, Ursin G, Botteri E. Menopausal hormone therapy and breast cancer risk: a population-based cohort study of 1.3 million women in Norway. Br J Cancer 2024:10.1038/s41416-024-02590-1. [PMID: 38740969 DOI: 10.1038/s41416-024-02590-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND It is important to monitor the association between menopausal hormone therapy (HT) use and breast cancer (BC) risk with contemporary estimates, and specifically focus on HT types and new drugs. METHODS We estimated hazard ratios (HR) of BC risk according to HT type, administration route and individual drugs, overall and stratified by body mass index (BMI), molecular subtype and detection mode, with non-HT use as reference. RESULTS We included 1,275,783 women, 45+ years, followed from 2004, for a median of 12.7 years. Oral oestrogen combined with daily progestin was associated with the highest risk of BC (HR 2.42, 95% confidence interval (CI) 2.31-2.54), with drug-specific HRs ranging from Cliovelle®: 1.63 (95% CI 1.35-1.96) to Kliogest®: 2.67 (2.37-3.00). Vaginal oestradiol was not associated with BC risk. HT use was more strongly associated with luminal A cancer (HR 1.97, 95% CI 1.86-2.09) than other molecular subtypes, and more strongly with interval (HR 2.00, 95% CI: 1.83-2.30) than screen-detected (HR 1.33, 95% CI 1.26-1.41) BC in women 50-71 years. HRs for HT use decreased with increasing BMI. CONCLUSIONS The use of oral and transdermal HT was associated with an increased risk of BC. The associations varied according to HT type, individual drugs, molecular subtype, detection mode and BMI.
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Affiliation(s)
- Nathalie C Støer
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway.
- Norwegian Research Centre for Women's Health, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.
| | - Siri Vangen
- Norwegian Research Centre for Women's Health, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Deependra Singh
- Norwegian Research Centre for Women's Health, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Renée T Fortner
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Solveig Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Giske Ursin
- Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Edoardo Botteri
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
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Santos JDM, Silva JFT, Alves EDS, Cruz AG, Santos ARM, Camargo FN, Talarico CHZ, Silva CAA, Camporez JP. Strength Training Protects High-Fat-Fed Ovariectomized Mice against Insulin Resistance and Hepatic Steatosis. Int J Mol Sci 2024; 25:5066. [PMID: 38791103 PMCID: PMC11120807 DOI: 10.3390/ijms25105066] [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: 04/12/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
Menopause is characterized by a reduction in sex hormones in women and is associated with metabolic changes, including fatty liver and insulin resistance. Lifestyle changes, including a balanced diet and physical exercise, are necessary to prevent these undesirable changes. Strength training (ST) has been widely used because of the muscle and metabolic benefits it provides. Our study aims to evaluate the effects of ST on hepatic steatosis and insulin resistance in ovariectomized mice fed a high-fat diet (HFD) divided into four groups as follows: simulated sedentary surgery (SHAM-SED), trained simulated surgery (SHAM-EXE), sedentary ovariectomy (OVX-SED), and trained ovariectomy (OVX-EXE). They were fed an HFD for 9 weeks. ST was performed thrice a week. ST efficiently reduced body weight and fat percentage and increased lean mass in OVX mice. Furthermore, ST reduced the accumulation of ectopic hepatic lipids, increased AMPK phosphorylation, and inhibited the de novo lipogenesis pathway. OVX-EXE mice also showed a better glycemic profile, associated with greater insulin sensitivity identified by the euglycemic-hyperinsulinemic clamp, and reduced markers of hepatic oxidative stress compared with sedentary animals. Our data support the idea that ST can be indicated as a non-pharmacological treatment approach to mitigate metabolic changes resulting from menopause.
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Affiliation(s)
| | | | | | | | | | | | | | | | - João Paulo Camporez
- Department of Physiology, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto 14049-900, Brazil (J.F.T.S.); (E.d.S.A.); (A.G.C.); (A.R.M.S.); (F.N.C.); (C.H.Z.T.); (C.A.A.S.)
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16
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Wang Q, Peng F, Yang J, Chen X, Peng Z, Zhang M, Tang D, Liu J, Zhao H. MicroRNAs regulate the vicious cycle of vascular calcification-osteoporosis in postmenopausal women. Mol Biol Rep 2024; 51:622. [PMID: 38709309 DOI: 10.1007/s11033-024-09550-1] [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: 12/29/2023] [Accepted: 04/12/2024] [Indexed: 05/07/2024]
Abstract
Menopause is a normal physiological process accompanied by changes in various physiological states. The incidence of vascular calcification (VC) increases each year after menopause and is closely related to osteoporosis (OP). Although many studies have investigated the links between VC and OP, the interaction mechanism of the two under conditions of estrogen loss remains unclear. MicroRNAs (miRNAs), which are involved in epigenetic modification, play a critical role in estrogen-mediated mineralization. In the past several decades, miRNAs have been identified as biomarkers or therapeutic targets in diseases. Thus, we hypothesize that these small molecules can provide new diagnostic and therapeutic approaches. In this review, we summarize the close interactions between VC and OP and the role of miRNAs in their interplay.
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Affiliation(s)
- Qian Wang
- Department of Radiology, The First Affiliated Hospital of The University of South China, Hengyang, Hunan, China
| | - Fei Peng
- Department of Radiology, The First Affiliated Hospital of The University of South China, Hengyang, Hunan, China
| | - Jing Yang
- Changsha Central Hospital Affiliated to University of South China, Changsha, Hunan, China
| | - Xiaolong Chen
- Department of Radiology, The First Affiliated Hospital of The University of South China, Hengyang, Hunan, China
| | - Zhaojie Peng
- Department of Radiology, The First Affiliated Hospital of The University of South China, Hengyang, Hunan, China
| | - Minyi Zhang
- The University of South China, Hengyang, Hunan, China
| | - Deqiu Tang
- Department of Radiology, The First Affiliated Hospital of The University of South China, Hengyang, Hunan, China
| | - Jianghua Liu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of The University of South China, Hengyang, Hunan, China.
| | - Heng Zhao
- Department of Radiology, The First Affiliated Hospital of The University of South China, Hengyang, Hunan, China.
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17
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Grub J, Willi J, Süss H, Ehlert U. The role of estrogen receptor gene polymorphisms in menopausal symptoms and estradiol levels in perimenopausal women - Findings from the Swiss Perimenopause Study. Maturitas 2024; 183:107942. [PMID: 38412592 DOI: 10.1016/j.maturitas.2024.107942] [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: 11/17/2023] [Revised: 01/15/2024] [Accepted: 02/10/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES Fluctuating estradiol (E2) levels seem to be associated with menopausal symptoms, though not all women suffer from these symptoms to the same extent despite experiencing these hormonal changes. This suggests underlying, interindividual mechanisms, such as single-nucleotide polymorphisms (SNPs) influencing estrogen receptors α and β, and the g-protein-coupled estrogen receptor (GPER). As research is scarce, we aimed to address this research gap by assessing genetic traits, E2 levels, and menopausal symptoms longitudinally. STUDY DESIGN 129 perimenopausal women (aged 40-56 years) participated in the 13-month longitudinal Swiss Perimenopause Study. MAIN OUTCOME MEASURES Menopausal symptoms were assessed fortnightly using the Menopause Rating Scale (MRS II). Salivary E2 levels were assessed 14 times over two non-consecutive months. Blood samples were collected using the dried blood spot (DBS) technique to analyze ESR1 rs2234693, ESR1 rs9340799, ESR2 rs1256049, ESR2 rs4906938, and GPER rs3808350. Group-based trajectory modeling was performed to identify interindividual trajectories of menopausal symptoms. Multinomial logistic regression models were employed to identify factors associated with these trajectories. RESULTS Four distinct trajectory groups of menopausal symptoms were identified (increase, moderate, rebound, decrease). ER gene polymorphisms and E2 fluctuation were significantly associated with group membership. Furthermore, ER gene polymorphisms modulated the effect of E2 fluctuations on menopausal symptom trajectory. CONCLUSIONS This study illuminates the multifaceted factors contributing to the individuality of the perimenopausal experience. ER gene polymorphisms emerged as integral factors by modulating the effect of E2 fluctuations on menopausal symptom trajectory. This underscores the intricate interplay of genetic factors, E2 fluctuations, and menopausal symptoms during perimenopause.
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Affiliation(s)
- Jessica Grub
- Clinical Psychology and Psychotherapy, University of Zurich, Switzerland; University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Jasmine Willi
- Clinical Psychology and Psychotherapy, University of Zurich, Switzerland; University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Hannah Süss
- Clinical Psychology and Psychotherapy, University of Zurich, Switzerland; University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, University of Zurich, Switzerland; University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland.
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18
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Wood Alexander M, Wu CY, Coughlan GT, Puri T, Buckley RF, Palta P, Swardfager W, Masellis M, Galea LAM, Einstein G, Black SE, Rabin JS. Associations Between Age at Menopause, Vascular Risk, and 3-Year Cognitive Change in the Canadian Longitudinal Study on Aging. Neurology 2024; 102:e209298. [PMID: 38569140 DOI: 10.1212/wnl.0000000000209298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/13/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Mounting evidence supports sex differences in Alzheimer disease (AD) risk. Vascular and hormonal factors may together contribute to AD risk in female adults. We investigated whether age at menopause, vascular risk, and history of hormone therapy (HT) containing estrogens together influence cognition over a 3-year follow-up period. We hypothesized that earlier menopause and elevated vascular risk would have a synergistic association with lower cognitive scores at follow-up and that HT containing estrogens would attenuate this synergistic association to preserve cognition. METHODS We used data from postmenopausal female participants and age-matched male participants in the Canadian Longitudinal Study on Aging. Vascular risk was calculated using a summary score of elevated blood pressure, antihypertensive medications, elevated low-density lipoprotein cholesterol, diabetes, smoking, and obesity. Cognition was measured with a global cognitive composite at baseline and 3-year follow-up. Linear models tested independent and interactive associations of age at menopause, vascular risk, and HT history with cognition at 3-year follow-up, adjusting for baseline cognition, baseline age, years of education, and test language (English/French). RESULTS We included 8,360 postmenopausal female participants (mean age at baseline = 65.0 ± 8.53 years, mean age at menopause = 50.1 ± 4.62 years) and 8,360 age-matched male participants for comparison. There was an interaction between age at menopause and vascular risk, such that earlier menopause and higher vascular risk were synergistically associated with lower cognitive scores at follow-up (β = 0.013, 95% CI 0.001-0.025, p = 0.03). In stratified analyses, vascular risk was associated with lower cognitive scores in female participants with earlier menopause (menopausal ages 35-48 years; β = -0.044, 95% CI -0.066 to -0.022, p < 0.001), but not average (ages 49-52 years; β = -0.007, 95% CI -0.027 to 0.012, p = 0.46) or later menopause (ages 53-65 years; β = 0.003, 95% CI -0.020 to 0.025, p = 0.82). The negative association of vascular risk with cognition in female participants with earlier menopause was stronger than the equivalent association in age-matched male participants. HT history did not further modify the synergistic association of age at menopause and vascular risk with follow-up cognition (β = -0.005, 95% CI -0.032 to 0.021, p = 0.69). DISCUSSION Endocrine and vascular processes may synergistically contribute to increased risk of cognitive decline in female adults. These findings have implications for the development of sex-specific dementia prevention strategies.
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Affiliation(s)
- Madeline Wood Alexander
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Che-Yuan Wu
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Gillian T Coughlan
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Tanvi Puri
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Rachel F Buckley
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Priya Palta
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Walter Swardfager
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Mario Masellis
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Liisa A M Galea
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Gillian Einstein
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Sandra E Black
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Jennifer S Rabin
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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19
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Xu H, Liu J, Li P, Liang Y. Effects of mind-body exercise on perimenopausal and postmenopausal women: a systematic review and meta-analysis. Menopause 2024; 31:457-467. [PMID: 38669625 DOI: 10.1097/gme.0000000000002336] [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: 04/28/2024]
Abstract
IMPORTANCE The increasing attention to the management of perimenopausal and postmenopausal women parallels the growth of the aging population. Although hormone therapy is commonly used to alleviate menopausal symptoms, it carries a potential risk of cancer. Recently, mind-body exercises have emerged as innovative approaches for improving menopausal symptoms and bone health. However, research findings have needed to be more consistent, highlighting the significance of this study's systematic review of mind-body exercise effects on perimenopausal and postmenopausal women. OBJECTIVE This study aims to evaluate the impact of mind-body exercises, including tai chi, yoga, Pilates, qigong, baduanjin, and mindfulness-based stress reduction, on bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women. EVIDENCE REVIEW Four electronic databases-PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science-were systematically searched from inception until July 2023. The search focused exclusively on randomized controlled trials to examine the impact of mind-body exercise interventions on perimenopausal and postmenopausal women. The methodological quality of the included studies was evaluated using the Cochrane Bias Risk Assessment tool. FINDINGS A total of 11 randomized controlled trials, comprising 1,005 participants, were included in the analysis. Traditional meta-analysis indicated that mind-body exercise significantly enhanced bone mineral density in perimenopausal and postmenopausal women compared with control groups, with a standardized mean difference (SMD) of 0.41 (95% CI, 0.17 to 0.66; P = 0.001, I2 = 7%). In addition, significant improvements were observed in sleep quality (SMD, -0.48; 95% CI, -0.78 to -0.17; P = 0.002, I2 = 76%), anxiety reduction (SMD, -0.80; 95% CI, -1.23 to -0.38; P = 0.0002, I2 = 84%), depressive mood (SMD, -0.80; 95% CI, -1.17 to -0.44; P < 0.0001, I2 = 79%), and fatigue (SMD, -0.67; 95% CI, -0.97 to -0.37; P < 0.0001, I2 = 0%). CONCLUSIONS AND RELEVANCE The findings of this meta-analysis demonstrate that mind-body exercise positively influences bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women.
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Affiliation(s)
- Hong Xu
- From the Department of Obstetrics and Gynecology, Chengdu Shuangliu District Maternal and Child Health Hospital, Chengdu, China
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20
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Abiç A, Yilmaz Vefikuluçay D. The Effect of Yoga on Menopause Symptoms: A Randomized Controlled Trial. Holist Nurs Pract 2024; 38:138-147. [PMID: 38709129 DOI: 10.1097/hnp.0000000000000646] [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: 05/07/2024]
Abstract
The research was conducted as a randomized controlled study with the aim of determining the effect of yoga on menopause symptoms. Menopausal women between the ages of 40 and 60 years were included in the research. There were 31 menopausal women in each of 2 groups, making a total of 62. A Descriptive Characteristics Form and the Menopause Rating Scale (MRS) were used to collect data. In the research, the yoga group practiced yoga for 60 minutes twice a week for 10 weeks. In the final lesson of the 10 weeks of yoga training, the women were again given the MRS. No intervention was performed on the control group. The median score on the MRS of the women in the yoga group was 16 (11-21) in the pretest, and 5 (3-9) in the posttest (P < .05). The median score on the subscale of psychological complaints of the women in the yoga group was 6 (3-8) in the pretest, and 1 (1-2) in the posttest (P < .05). The median score on the subscale of urogenital complaints of the women in the yoga group was 3 (3-5) in the pretest, and 1 (0-2) in the posttest (P < .05). The median score on the subscale of somatic complaints of the women in the yoga group was 7 (4-10) in the pretest, and 1 (1-3) in the posttest (P < .05). It was concluded from the research that 60 minutes of yoga 2 days a week for 10 weeks may reduce the psychological, somatic, and urogenital symptoms experienced in menopause.
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Affiliation(s)
- Arzu Abiç
- Author Affiliations: Department of Obstetrics and Gynecology Nursing, Eastern Mediterranean University Department of Nursing, Famagusta, Turkish Republic of Northern Cyprus (Dr Abiç); and Department of Obstetrics and Gynecology Nursing, Mersin University Faculty of Nursing, Mersin, Turkey (Dr Yilmaz Vefikuluçay)
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21
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Nakamura K, Hoshi H, Kobayashi M, Fukasawa K, Ichikawa S, Shigihara Y. Dorsal brain activity reflects the severity of menopausal symptoms. Menopause 2024; 31:399-407. [PMID: 38626372 DOI: 10.1097/gme.0000000000002347] [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: 04/18/2024]
Abstract
OBJECTIVE The severity of menopausal symptoms, despite being triggered by hormonal imbalance, does not directly correspond to hormone levels in the blood; thus, the level of unpleasantness is assessed using subjective questionnaires in clinical practice. To provide better treatments, alternative objective assessments have been anticipated to support medical interviews and subjective assessments. This study aimed to develop a new objective measurement for assessing unpleasantness. METHODS Fourteen participants with menopausal symptoms and two age-matched participants who visited our outpatient section were enrolled. Resting-state brain activity was measured using magnetoencephalography. The level of unpleasantness of menopausal symptoms was measured using the Kupperman Kohnenki Shogai Index. The blood level of follicle-stimulating hormone and luteinizing hormone were also measured. Correlation analyses were performed between the oscillatory power of brain activity, index score, and hormone levels. RESULTS The level of unpleasantness of menopausal symptoms was positively correlated with high-frequency oscillatory powers in the parietal and bordering cortices (alpha; P = 0.016, beta; P = 0.015, low gamma; P = 0.010). The follicle-stimulating hormone blood level was correlated with high-frequency oscillatory powers in the dorsal part of the cortex (beta; P = 0.008, beta; P = 0.005, low gamma; P = 0.017), whereas luteinizing hormone blood level was not correlated. CONCLUSION Resting-state brain activity can serve as an objective measurement of unpleasantness associated with menopausal symptoms, which aids the selection of appropriate treatment and monitors its outcome.
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Affiliation(s)
| | - Hideyuki Hoshi
- Precision Medicine Centre, Hokuto Hospital, Kisen-7-5 Inadacho, Obihiro, Hokkaido, 080-0833, Japan
| | - Momoko Kobayashi
- Precision Medicine Centre, Kumagaya General Hospital, 4 Chome-5-1 Nakanishi, Kumagaya, Saitama, 360-8567, Japan
| | - Keisuke Fukasawa
- Clinical Laboratory, Kumagaya General Hospital, 4 Chome-5-1 Nakanishi, Kumagaya, Saitama, 360-8567, Japan
| | - Sayuri Ichikawa
- Clinical Laboratory, Kumagaya General Hospital, 4 Chome-5-1 Nakanishi, Kumagaya, Saitama, 360-8567, Japan
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22
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Hemachandra C, Taylor S, Islam RM, Fooladi E, Davis SR. A systematic review and critical appraisal of menopause guidelines. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024; 50:122-138. [PMID: 38336466 DOI: 10.1136/bmjsrh-2023-202099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE AND RATIONALE To identify and appraise current national and international clinical menopause guidance documents, and to extract and compare the recommendations of the most robust examples. DESIGN Systematic review. DATA SOURCES Ovid MEDLINE, EMBASE, PsycINFO and Web of Science ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Practice guidance documents for menopause published from 2015 until 20 July 2023. Quality was assessed by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. RESULTS Twenty-six guidance papers were identified. Of these, five clinical practice guidelines (CPGs) and one non-hormonal therapy position statement met AGREE II criteria of being at least of moderate quality. The five CPGs listed symptoms associated with the perimenopause and menopause to be vasomotor symptoms (VMS), disturbed sleep, musculoskeletal pain, decreased sexual function or desire, and mood disturbance (low mood, mood changes or depressive symptoms). Acknowledged potential long-term menopause consequences were urogenital atrophy, and increased risks of cardiovascular disease and osteoporosis. VMS and menopause-associated mood disturbance were the only consistent indications for systemic menopausal hormone therapy (MHT). Some CPGs supported MHT to prevent or treat osteoporosis, but specific guidance was lacking. None recommended MHT for cognitive symptoms or prevention of other chronic disease. Perimenopause-specific recommendations were scant. A neurokinin 3B antagonist, selective serotonin/norepinephrine (noradrenaline) reuptake inhibitors and gabapentin were recommended non-hormonal medications for VMS, and cognitive behavioural therapy and hypnosis were consistently considered as being of potential benefit. DISCUSSION The highest quality CPGs consistently recommended MHT for VMS and menopause-associated mood disturbance, whereas clinical depression or cognitive symptoms, and cardiometabolic disease and dementia prevention were not treatment indications. Further research is needed to inform clinical recommendations for symptomatic perimenopausal women.
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Affiliation(s)
- Chandima Hemachandra
- Women's Health Research Program, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Sasha Taylor
- Women's Health Research Program, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Rakibul M Islam
- Women's Health Research Program, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Ensieh Fooladi
- Monash School of Nursing and Midwifery, Clayton, Victoria, Australia
| | - Susan R Davis
- Women's Health Research Program, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
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23
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Long T, Cheng B, Zhang K. Abdominal obesity as assessed by anthropometric measures associates with urinary incontinence in females: findings from the National Health and Nutrition Examination Survey 2005-2018. BMC Womens Health 2024; 24:212. [PMID: 38566030 PMCID: PMC10986057 DOI: 10.1186/s12905-024-03059-2] [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: 09/07/2023] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Urinary incontinence (UI) is significantly link to abdominal obesity. This study aimed to assess the association between anthropometric indices of abdominal obesity, including body roundness index (BRI), conicity index (CI), and waist-to-height ratio (WHtR), and UI risk in adult females. METHODS We analyzed data from 10, 317 adult females in the National Health and Nutrition Examination Survey (NHANES) database (2005-2018). Weighted multivariable-adjusted regression analysis was conducted to determine the odds ratio (OR) and 95% confidence intervals (CI) for the association between BRI, CI, WHtR, and UI. Stratified analyses revealed the association based on the population type. Receiver operating characteristic curve (ROC) analyses were used to assess the predictive value of UI. RESULTS All indices of abdominal obesity investigated were positively and independently associated with the prevalence and severity of three types of UI. After adjusting for all relevant confounding variables, a significantly positive association between BRI and the prevalence of UI were observed (OR quartile 4 vs. quartile 1: urge UI (UUI): 1.93, 95% CI 1.61-2.30; stress UI (SUI): 2.29, 95% CI 1.94-2.70; mixed UI (MUI): 2.26, 95% CI 1.82-2.82; all P < 0.0001, P for trend < 0.0001, respectively), as well as WHtR and CI, which particularly prominent for female in premenopausal. Moreover, a one-unit increment of BRI was significantly associated with an increased severity index of UUI (β: 0.06, 95% CI 0.04-0.09, P < 0.0001), SUI (β: 0.10, 95% CI 0.07-0.13, P < 0.0001) and MUI (β: 0.07, 95% CI 0.04-0.10, P < 0.0001), which this trend was also observed in each subtype of UI for WHtR and CI. Furthermore, the ROC analysis demonstrated a higher diagnostic efficacy of BRI and WHtR compared with BMI in discriminating UI with an AUC of 0.600 for SUI, 0.617 for UUI, and 0.622 for MUI (all P < 0.05). CONCLUSIONS An increased BRI, CI, and WHtR are significantly associated with higher prevalence and severity of UI in females.
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Affiliation(s)
- Ting Long
- Department of Pelvic Floor, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410007, China
| | - Bohuai Cheng
- Department of Otorhinolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Ke Zhang
- Department of Pelvic Floor, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410007, China.
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24
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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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25
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Moore SR, Cabre HE, Smith-Ryan AE. Body composition, physical activity, and menopause symptoms: how do they relate? Menopause 2024; 31:336-341. [PMID: 38442308 DOI: 10.1097/gme.0000000000002334] [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: 03/07/2024]
Abstract
OBJECTIVE This study characterized the impact of physical activity (light, moderate, and vigorous [VIG] active minutes per day) and body composition (percent body fat [%BF] and fat-free mass index) on total menopausal symptoms (TMSs) in 72 premenopausal, perimenopausal (PERI), or postmenopausal women. METHODS Activity minutes were collected from wearable fitness trackers. Body composition was evaluated using a whole-body dual-energy x-ray absorptiometry scan. TMSs were quantified using The North American Menopause Society Questionnaire. RESULTS Significant associations were observed between TMSs and %BF ( r = 0.464, P < 0.001) and VIG ( r = -0.245, P = 0.038). %BF and VIG were significant predictors for TMSs across groups ( R2 = 0.146 and R2 = 0.092, respectively), but only %BF maintained for PERI ( R2 = 0.421, P < 0.001). CONCLUSIONS %BF predicted nearly half of the variance in PERI TMSs, whereas VIG predicted 9% of the sample variance, demonstrating an important influence of body fat accumulation and intense physical activity in the menopause transition. High-intensity exercise interventions to alleviate body composition changes may also reduce menopausal-related symptoms for PERI women.
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26
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Castillo-Bustamante M, Çelebisoy N, Echavarria LG, Franco I, Valencia S, Gonzalez S, García A. Balance in Transition: Unraveling the Link Between Menopause and Vertigo. Cureus 2024; 16:e59277. [PMID: 38813338 PMCID: PMC11135238 DOI: 10.7759/cureus.59277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
The onset of menopause, marked by hormonal fluctuations and a decline in estrogen levels, is suggested to be linked to increased susceptibility to vestibular disturbances. Estrogen, beyond its established association with reproductive physiology, plays modulatory roles in various physiological systems, including neurosensory function. The vestibular system, crucial for balance and spatial orientation, is influenced by hormonal changes during menopause, potentially contributing to the emergence of vertigo symptoms. This interplay between hormones and the vestibular system is a burgeoning area of research with clinical implications, offering insights into novel diagnostic and therapeutic approaches for managing postmenopausal women with vestibular disorders. The article reviews current scientific literature, delves into the hormonal intricacies of menopause, and investigates potential mechanisms underlying the connection between hormonal fluctuations and vertigo symptoms.
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Affiliation(s)
- Melissa Castillo-Bustamante
- Otoneurology, Centro de Vértigo y Mareo, Mexico City, MEX
- Medicine, Universidad Pontificia Bolivariana, Medellín, COL
| | | | - Luis G Echavarria
- Obstetrics and Gynecology, Clinica Universitaria Bolivariana, Medellín, COL
| | - Isabela Franco
- Otolaryngology, Universidad Pontificia Bolivariana, Medellín, COL
| | | | - Sara Gonzalez
- Otolaryngology, Universidad Pontificia Bolivariana, Medellin, COL
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Zong Y, Mao T, Yao P, Liang J, Lai Y, Chen Z, Chen S, Huang L, Guo Y, Zhu M, Zhao J, Liu Y, Li Y, Guo K, Tang H, Ke X, Zhou Y. Effects of Guizhi and Erxian Decoction on menopausal hot flashes: insights from the gut microbiome and metabolic profiles. J Appl Microbiol 2024; 135:lxae016. [PMID: 38253409 DOI: 10.1093/jambio/lxae016] [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: 09/29/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 01/24/2024]
Abstract
AIMS To examine the influence of GED on the gut microbiota and metabolites using a bilateral ovariectomized (OVX) rat model. We tried to elucidate the underlying mechanisms of GED in the treatment of menopausal hot flashes. METHODS AND RESULTS 16S rRNA sequencing, metabonomics, molecular biological analysis, and fecal microbiota transplantation (FMT) were conducted to elucidate the mechanisms by which GED regulates the gut microbiota. GED significantly reduced OVX-induced hot flashes and improved disturbances in the gut microbiota metabolites. Moreover, FMT validated that the gut microbiota can trigger hot flashes, while GED can alleviate hot flash symptoms by modulating the composition of the gut microbiota. Specifically, GED upregulated the abundance of Blautia, thereby increasing l(+)-ornithine levels for the treatment of menopausal hot flashes. Additionally, GED affected endothelial nitric oxide synthase and heat shock protein 70 (HSP70) levels in the hypothalamic preoptic area by changing the gut microbiota composition. CONCLUSIONS Our study illuminated the underlying mechanisms by which GED attenuated the hot flashes through modulation of the gut microbiota and explored the regulatory role of the gut microbiota on HSP70 expression in the preoptic anterior hypothalamus, thereby establishing a foundation for further exploration of the role of the gut-brain axis in hot flashes.
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Affiliation(s)
- Yun Zong
- The First Clinical College of Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou 510403, China
| | - Ting Mao
- The First Clinical College of Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou 510403, China
| | - Peixun Yao
- The First Clinical College of Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou 510403, China
| | - Jingtao Liang
- The First Clinical College of Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou 510403, China
| | - Yawei Lai
- The First Clinical College of Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou 510403, China
| | - Zhenyue Chen
- The First Clinical College of Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou 510403, China
| | - Siyang Chen
- The First Clinical College of Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou 510403, China
| | - Lei Huang
- The First Clinical College of Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou 510403, China
| | - Yong Guo
- The First Clinical College of Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou 510403, China
| | - Min Zhu
- The First Clinical College of Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou 510403, China
| | - Jingbing Zhao
- The First Clinical College of Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou 510403, China
| | - Yaqian Liu
- Gynecology, Dongguan Maternal and Child Health Hospital, Dongguan 523057, China
| | - Yanfang Li
- The First Clinical College of Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou 510403, China
| | - Kaixin Guo
- The First Clinical College of Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou 510403, China
| | - Hui Tang
- The First Clinical College of Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou 510403, China
| | - Xuehong Ke
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou 510405, China
| | - Ying Zhou
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou 510405, China
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Alzueta E, Menghini L, Volpe L, Baker FC, Garnier A, Sarrel PM, de Zambotti M. Navigating menopause at work: a preliminary study about challenges and support systems. Menopause 2024; 31:258-265. [PMID: 38442310 DOI: 10.1097/gme.0000000000002333] [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: 03/07/2024]
Abstract
OBJECTIVE Women's increasing workforce participation necessitates understanding unique life phases like menopause for enhanced workplace inclusivity. This research investigates the challenges and needs of peri-menopausal women in work settings, using the Job Demands-Resources model as a foundation. METHODS A cross-sectional survey was administered to 351 working women aged 40 to 65 years in the United States. Hierarchical multiple regression models were employed to assess the relationship between the severity of menopausal symptoms, emotional exhaustion, work engagement, and turnover intentions. RESULTS Most of the respondents reported moderate (38.46%) to severe (35.9%) menopausal symptoms. Notably, 54% of the women were caregivers for children or adults. About 77.7% of participants reported work-related challenges due to menopause, with a perceived reduction in productivity (56.8%) being the most common issue. The severity of menopausal symptoms was found to significantly predict more emotional exhaustion ( P < 0.001), less work engagement ( P < 0.001), and greater turnover intentions ( P = 0.03). Concerns about being perceived as less capable in the workplace due to menopausal symptoms were reported by 51.2% of respondents. A striking gap exists between the workplace measures desired by women, such as formal menopause policies and managerial training (65.4%-68%), and their actual implementation (2%-6.3%). CONCLUSIONS This study reveals an exigent need for increased awareness and structural changes to support working women going through menopause. The findings have far-reaching implications for not just promoting gender equity and well-being but are also pivotal for maintaining a diversified, engaged, and effective workforce.
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Affiliation(s)
- Elisabet Alzueta
- From the Center for Health Sciences, SRI International, Menlo Park, CA
| | - Luca Menghini
- Department of General Psychology, University of Padova, Italy
| | - Laila Volpe
- From the Center for Health Sciences, SRI International, Menlo Park, CA
| | - Fiona C Baker
- From the Center for Health Sciences, SRI International, Menlo Park, CA
| | | | - Philip M Sarrel
- Obstetrics, Gynecology, and Reproductive Sciences and Psychiatry, Yale University, CT
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Manoharan A, Harris MM, Chin BH, Ming KW, Asmuee Z, Salamon N, Pefer J, Radhiyah H, Hamimmah MN, Goldstein S, Ramasamy S, Sreeramareddy CT. Translation and validation of menopause quick 6 (MQ6) into the Malay language. BMC PRIMARY CARE 2024; 25:95. [PMID: 38519908 PMCID: PMC10958974 DOI: 10.1186/s12875-024-02342-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Inquiring conservative Asian women about their menopausal symptoms is often challenging in crowded primary healthcare clinics. Furthermore, the subject matter is culturally sensitive to most Malaysian women. Hence, the translation of MQ6 into Malay is crucial to enable self-administration, eliminating the necessity for interviewers and mitigating potential respondent shyness. METHODS The Menopause Quick 6 (MQ6) questionnaire was translated into the Malay language with an addition of an item, henceforth termed MQ6 (M). Forward and backward translation was performed. Face and content validity were conducted. MQ6 (M) was self-administered to 400 women aged between 40 and 60 attending six primary healthcare clinics in Malaysia. To ascertain the reliability for MQ6 (M), corrected Item-Total Correlation, Squared Multiple Correlation, Cronbach's Alpha if the Item is Deleted, and Kuder-Richardson Reliability Coefficients (KR20). Exploratory factor analysis was done to determine its' construct validity. RESULTS The outcome of the validation was satisfactory. By the Lawshe method, the content validity ratios ranged from 0.6 to 1.0 and the content validity index was 0.914. The Internal consistency for MQ6(M) Cronbach's alpha was 0.711 while Kuder-Richardson Reliability Coefficients KR20 was 0.676. Factor loading of all four items is above 0.70, indicating a well-defined structure. Whereas factor loading for three items fell within the range of 0.50-0.69 indicating a practically significant threshold for a new questionnaire. CONCLUSION MQ6 (M) has acceptable reliability and construct validity to be considered as a self-administered screening tool in primary care clinics in Malaysia.
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Affiliation(s)
- Anusha Manoharan
- Klinik Kesihatan Bandar Botanic, Bandar Botanic, Selangor, Malaysia
| | | | - Beh Hooi Chin
- The Department of Primary Care, University Malaya, Kuala Lumpur, Malaysia
| | | | | | | | | | - H Radhiyah
- Klinik Kesihatan Tanglin, Kuala Lumpur, Malaysia
| | | | - Susan Goldstein
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Shamala Ramasamy
- Department of Psychology, International Medical University (IMU), Kuala Lumpur, Malaysia
| | - Chandrashekhar T Sreeramareddy
- Department of Community Medicine and Public Health, International Medical University (IMU), Kuala Lumpur, Malaysia.
- Centre for Translational Research, Institute for Research Development and Innovation, International Medical University, Kuala Lumpur, Malaysia.
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Giraldi A, Nappi RE, Palacios S, Reisman Y, Jannini EA. From couplepause to doublepause: the impact of midlife physical, psychological, and social changes on the sexual life of aging couples. Sex Med Rev 2024:qeae016. [PMID: 38515320 DOI: 10.1093/sxmrev/qeae016] [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: 10/18/2023] [Revised: 02/12/2024] [Accepted: 03/07/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Midlife men and women are facing frequent sexual problems that affect not only individuals' sexual health but also the sexual health of aging couples. OBJECTIVES To review the main sexual life challenges faced by midlife couples, to present the concepts of couplepause and doublepause as 2 new paradigms to address the sexual health needs of aging couples, and to discuss key aspects in couple-focused care. METHODS An online meeting attended by 5 European experts in sexual health was carried out in June 2023 to discuss the topic. The conversation centered on their clinical experience and expert opinion. Additionally, the indexed literature was reviewed to endorse and complement the expert opinions obtained in the aforementioned meeting. RESULTS Midlife men and women face physical, psychological, and sociocultural changes that affect their sexual activity. These changes may be experienced differently between genders. Both members of a couple may experience age-related changes concurrently or in an unsynchronized manner affecting their sexual health. Communication, sharing expectations, defining sexual dynamics, and couple goals are determinant for the sexual health of a midlife couple. Couplepause and doublepause are 2 new complementary paradigms that effectively address the sexual health needs of aging couples as a unit, considering physical, psychological, cultural, social, and dyadic-related factors. Couple-centered strategies should promote open communication about couple intimacy issues, understanding the diverse expectations according to gender and orientation, communication styles, and goals. The following are identified as crucial aspects to promote couple-focused care: education and training of health care professionals, the provision of information to aging couples, physician involvement in addressing sexual problems, the need for collaboration across medical specialties, and the development of effective tools and strategies. CONCLUSIONS The sexual problems of aging couples should be managed following couple-centered strategies that effectively address their sexual health needs as a couple.
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Affiliation(s)
- Annamaria Giraldi
- Sexological Clinic, Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, 2200, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, 27100, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, 27100, Italy
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Brown L, Hunter MS, Chen R, Crandall CJ, Gordon JL, Mishra GD, Rother V, Joffe H, Hickey M. Promoting good mental health over the menopause transition. Lancet 2024; 403:969-983. [PMID: 38458216 DOI: 10.1016/s0140-6736(23)02801-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/01/2023] [Accepted: 12/11/2023] [Indexed: 03/10/2024]
Abstract
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.
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Affiliation(s)
- Lydia Brown
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; Academic Research Collaborative in Health, La Trobe University, Bundoora, VIC, Australia; Healthscope Hospitals, Melbourne, VIC, Australia.
| | - Myra S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rong Chen
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Carolyn J Crandall
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | | | - Gita D Mishra
- NHMRC Centre for Research Excellence in Women and NCDs, School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Viktoria Rother
- Inner West Area Mental Health Service, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology and Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha Hickey
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC, Australia
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Andy C, Nerattini M, Jett S, Carlton C, Zarate C, Boneu C, Fauci F, Ajila T, Battista M, Pahlajani S, Christos P, Fink ME, Williams S, Brinton RD, Mosconi L. Systematic review and meta-analysis of the effects of menopause hormone therapy on cognition. Front Endocrinol (Lausanne) 2024; 15:1350318. [PMID: 38501109 PMCID: PMC10944893 DOI: 10.3389/fendo.2024.1350318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Despite evidence from preclinical studies suggesting estrogen's neuroprotective effects, the use of menopausal hormone therapy (MHT) to support cognitive function remains controversial. Methods We used random-effect meta-analysis and multi-level meta-regression to derive pooled standardized mean difference (SMD) and 95% confidence intervals (C.I.) from 34 randomized controlled trials, including 14,914 treated and 12,679 placebo participants. Results Associations between MHT and cognitive function in some domains and tests of interest varied by formulation and treatment timing. While MHT had no overall effects on cognitive domain scores, treatment for surgical menopause, mostly estrogen-only therapy, improved global cognition (SMD=1.575, 95% CI 0.228, 2.921; P=0.043) compared to placebo. When initiated specifically in midlife or close to menopause onset, estrogen therapy was associated with improved verbal memory (SMD=0.394, 95% CI 0.014, 0.774; P=0.046), while late-life initiation had no effects. Overall, estrogen-progestogen therapy for spontaneous menopause was associated with a decline in Mini Mental State Exam (MMSE) scores as compared to placebo, with most studies administering treatment in a late-life population (SMD=-1.853, 95% CI -2.974, -0.733; P = 0.030). In analysis of timing of initiation, estrogen-progestogen therapy had no significant effects in midlife but was associated with improved verbal memory in late-life (P = 0.049). Duration of treatment >1 year was associated with worsening in visual memory as compared to shorter duration. Analysis of individual cognitive tests yielded more variable results of positive and negative effects associated with MHT. Discussion These findings suggest time-dependent effects of MHT on certain aspects of cognition, with variations based on formulation and timing of initiation, underscoring the need for further research with larger samples and more homogeneous study designs.
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Affiliation(s)
- Caroline Andy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Matilde Nerattini
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Steven Jett
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Caroline Carlton
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Camila Zarate
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Camila Boneu
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Francesca Fauci
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Trisha Ajila
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Michael Battista
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Paul Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Matthew E Fink
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Schantel Williams
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Roberta Diaz Brinton
- Department of Neurology and Pharmacology, University of Arizona, Tucson, AZ, United States
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
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Najafi S, Mohammadkhah F, Ebrahimi MM, Harsini PA, Khani Jeihooni A. Effect of educational intervention on preventing osteoporosis in postmenopausal women. Osteoporos Int 2024; 35:505-513. [PMID: 37938406 DOI: 10.1007/s00198-023-06962-w] [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: 03/20/2023] [Accepted: 10/27/2023] [Indexed: 11/09/2023]
Abstract
In the experimental group, the average scores of knowledge, constructs of theory of planned behavior, nutrition, and walking had a significant enhancement compared to the control group after the educational intervention. After the intervention, the value of the lumbar spine bone mineral density T-score in the experimental group increased, while in the control group, it decreased. INTRODUCTION Osteoporosis is a global public health problem currently affecting millions of people worldwide and in Iran. This study was conducted to assess the effect of an educational intervention based on the theory of planned behavior on the prevention of osteoporosis in postmenopausal women. METHODS This quasi-experimental study was performed on 160 women aging over 50 who were referred to health centers in Fasa City, Iran, in 2019. A simple random sampling method was applied to assign the participants into control and intervention groups (80 participants for each group). Data were gathered by questionnaires arranged based on the constructs of the theory of planned behavior, nutrition performance, and walking performance. The educational intervention included seven 50-minute educational sessions. The obtained data were analyzed using SPSS 22 software and Chi-square test, independent T-test, and paired T-test, and the significance level was considered 0.05. RESULTS The mean ages of the studied participants in the experimental and control groups were 59.18 ± 6.56 and 57.92 ± 5.70, respectively. In the experimental group, the average scores of knowledge, constructs of the theory of planned behavior, nutrition performance, and walking performance had a significant enhancement compared to the control group one year after the intervention (p < 0.001). At 12 months after the intervention, the value of the lumbar spine bone mineral density T-score in the experimental group increased, while in the control group, it reduced (p < 0.001). CONCLUSIONS The theory of planned behavior affected nutrition and walking performance in osteoporosis prevention of subjects. This theory can be used as a framework for designing and performing educational interventions for preventing osteoporosis and promoting women's health.
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Affiliation(s)
- S Najafi
- Department of Internal Medicine, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - F Mohammadkhah
- Department of Community Health, Child Nursing and Aging, Ramsar School of Nursing, Babol University of Medical Sciences, Babol, Iran
| | - M M Ebrahimi
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran
| | - P A Harsini
- Department of Public Health, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - A Khani Jeihooni
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
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Pound M, Massey H, Roseneil S, Williamson R, Harper CM, Tipton M, Shawe J, Felton M, Harper JC. How do women feel cold water swimming affects their menstrual and perimenopausal symptoms? Post Reprod Health 2024; 30:11-27. [PMID: 38271095 DOI: 10.1177/20533691241227100] [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: 01/27/2024]
Abstract
OBJECTIVE This study aimed to determine how women felt cold water swimming affected their menstrual and perimenopausal symptoms. STUDY DESIGN An online survey that asked women who regularly swim in cold water about their experiences. The survey was advertised for 2 months on social media. Questions related to cold water swimming habits and menstrual and perimenopausal symptoms were analysed. MAIN OUTCOME MEASURES Quantitative and qualitative data including; frequency of menstrual and menopause symptoms, the effect of cold water swimming on these symptoms. RESULTS 1114 women completed the survey. Women reported that cold water swimming reduced their menstrual symptoms, notably psychological symptoms such as anxiety (46.7%), mood swings (37.7%) and irritability (37.6%). Perimenopausal women reported a significant improvement in anxiety (46.9%), mood swings (34.5%), low mood (31.1%) and hot flushes (30.3%). The majority of women with symptoms swam specifically to reduce these symptoms (56.4% for period and 63.3% for perimenopause symptoms). Women said they felt it was the physical and mental effects of the cold water that helped their symptoms. For the free text question, five themes were identified: the calming and mood-boosting effect of the water, companionship and community, period improvements, an improvement in hot flushes and an overall health improvement. CONCLUSION Women felt that cold water swimming had a positive overall effect on menstrual and perimenopause symptoms. Studies on other forms of exercise to relieve menstrual and perimenopause symptoms may show similar findings.
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Affiliation(s)
- Megan Pound
- EGA Institute for Women's Health, University College London, London, UK
| | - Heather Massey
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | | | | | - C Mark Harper
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
- Sørlandet Sykehus, Kristiansand, Norway
| | - Mike Tipton
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Jill Shawe
- University of Plymouth and Royal Cornwall Hospitals NHS Trust, Cornwall, UK
| | - Malika Felton
- Department of Rehabilitation and Sport Sciences, Bournemouth University, Poole, UK
| | - Joyce C Harper
- EGA Institute for Women's Health, University College London, London, UK
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Testo AA, Makarewicz J, McGee E, Dumas JA. Estradiol associations with brain functional connectivity in postmenopausal women. Menopause 2024; 31:218-224. [PMID: 38385731 PMCID: PMC10885742 DOI: 10.1097/gme.0000000000002321] [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] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Previous studies have found that estrogens play a role in functional connectivity in the brain; however, little research has been done regarding how estradiol is associated with functional connectivity in postmenopausal women. The purpose of this study was to examine the relationship between estradiol and functional connectivity in postmenopausal women. METHODS Structural and blood oxygenation level-dependent resting-state magnetic resonance imaging scans of 88 cognitively healthy postmenopausal individuals were obtained along with blood samples collected the same day as the magnetic resonance imaging to assess hormone levels. We generated connectivity values in CONN toolbox version 20.b, an SPM-based software. RESULTS A regression analysis was run using estradiol level and regions of interest (ROI), including the hippocampus, parahippocampus, dorsolateral prefrontal cortex, and precuneus. Estradiol level was found to enhance parahippocampal gyrus anterior division left functional connectivity during ROI-to-ROI regression analysis. Estradiol enhanced functional connectivity between the parahippocampal gyrus anterior division left and the precuneus as well as the parahippocampal gyrus anterior division left and parahippocampal gyrus posterior division right. An exploratory analysis showed that years since the final menstrual period was related to enhanced connectivity between regions within the frontoparietal network. CONCLUSIONS These results illustrated the relationship between estradiol level and functional connectivity in postmenopausal women. They have implications for understanding how the functioning of the brain changes for individuals after menopause that may eventually lead to changes in cognition and behavior in older ages.
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Affiliation(s)
| | | | - Elizabeth McGee
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, VT
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Gui Q, Ding N, Yao Z, Wu M, Fu R, Wang Y, Zhao Y, Zhu L. Extracellular vesicles derived from mesenchymal stem cells: the wine in Hebe's hands to treat skin aging. PRECISION CLINICAL MEDICINE 2024; 7:pbae004. [PMID: 38516531 PMCID: PMC10955876 DOI: 10.1093/pcmedi/pbae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
Owing to its constant exposure to the external environment and various stimuli, skin ranks among the organs most vulnerable to manifestations of aging. Preventing and delaying skin aging has become one of the prominent research subjects in recent years. Mesenchymal stem cells (MSCs) are multipotent stem cells derived from mesoderm with high self-renewal ability and multilineage differentiation potential. MSC-derived extracellular vesicles (MSC-EVs) are nanoscale biological vesicles that facilitate intercellular communication and regulate biological behavior. Recent studies have shown that MSC-EVs have potential applications in anti-aging therapy due to their anti-inflammatory, anti-oxidative stress, and wound healing promoting abilities. This review presents the latest progress of MSC-EVs in delaying skin aging. It mainly includes the MSC-EVs promoting the proliferation and migration of keratinocytes and fibroblasts, reducing the expression of matrix metalloproteinases, resisting oxidative stress, and regulating inflammation. We then briefly discuss the recently discovered treatment methods of MSC-EVs in the field of skin anti-aging. Moreover, the advantages and limitations of EV-based treatments are also presented.
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Affiliation(s)
- Qixiang Gui
- Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai 200001, China
| | - Neng Ding
- Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai 200001, China
| | - Zuochao Yao
- Department of Plastic and Reconstructive Surgery of Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Minjuan Wu
- Department of Histology and Embryology, Naval Medical University, Shanghai 200433, China
| | - Ruifeng Fu
- Shanghai Key Laboratory of Cell Engineering, Translational Medical Research Center, Naval Medical University, Shanghai 200433, China
| | - Yue Wang
- Department of Histology and Embryology, Naval Medical University, Shanghai 200433, China
- Shanghai Key Laboratory of Cell Engineering, Translational Medical Research Center, Naval Medical University, Shanghai 200433, China
- Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai 200092, China
| | - Yunpeng Zhao
- Shanghai Key Laboratory of Cell Engineering, Translational Medical Research Center, Naval Medical University, Shanghai 200433, China
| | - Lie Zhu
- Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai 200001, China
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Chow H, Righton O, Berry H, Bell Z, Flynn AC. A systematic review of community pharmacy interventions to improve peri- and post-menopausal health. Post Reprod Health 2024; 30:55-63. [PMID: 38185857 DOI: 10.1177/20533691231223681] [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: 01/09/2024]
Abstract
Menopause is defined as the permanent cessation of menstruation due to loss of ovarian follicular function. Symptoms include mood disorders, vaginal atrophy, hot flashes and night sweats and can emerge during a gradual transition period called perimenopause. Community pharmacies are well placed to deliver a wide range of healthcare services, including supporting and educating menopausal women; however, to date, no systematic review has assessed the effectiveness of community pharmacy-led interventions in improving peri- and post-menopausal health. In accordance with PRISMA guidelines we evaluated community pharmacy-led interventions that targeted women in peri- or post-menopause. Electronic searches in EMBASE, MEDLINE, CINAHL and Cochrane Library were conducted on 13th February 2023. Additionally, we examined the included studies references and citation lists using Google Scholar. A total of 915 articles were identified and screened against the inclusion criteria. Two studies were included; one identified post-menopausal women at risk of developing osteoporosis (OP), and one evaluated the outcomes of a community pharmacy-based menopause education programme. Study one found 11 (11%) post-menopausal women were at risk of developing OP based on quantitative ultrasound screening offered by community pharmacists and referred to their physician. Study two reported that women had access to adequate personalised menopause counselling and increased knowledge of menopause topics because of the educational programme within community pharmacies. Both studies were of low quality. The lack of included studies reflects the need for high-quality research to determine whether community pharmacy-led interventions are feasible, effective and acceptable, to improve health outcomes of peri- or post-menopausal women.
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Affiliation(s)
- H Chow
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, UK
| | - O Righton
- Department of Nutritional Sciences, School of Life Course & Population Sciences, King's College London, London, UK
| | - H Berry
- Centre for Pharmacy Postgraduate Education (CPPE), University of Manchester, Manchester, UK
| | - Z Bell
- Department of Nutritional Sciences, School of Life Course & Population Sciences, King's College London, London, UK
| | - A C Flynn
- Department of Nutritional Sciences, School of Life Course & Population Sciences, King's College London, London, UK
- School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
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Kuck MJ, Hogervorst E. Stress, depression, and anxiety: psychological complaints across menopausal stages. Front Psychiatry 2024; 15:1323743. [PMID: 38455517 PMCID: PMC10917984 DOI: 10.3389/fpsyt.2024.1323743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024] Open
Abstract
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.
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Affiliation(s)
- Ming Jun Kuck
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
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39
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Hou SY, Chiu CJ, Shea JL, Wang CL, Tang HH, Kuo PC, Yang YC, Hsu HP. Sleep and rest-activity rhythms for women at different menopausal statuses: the role of mental health. Menopause 2024; 31:138-144. [PMID: 38113433 DOI: 10.1097/gme.0000000000002297] [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: 12/21/2023]
Abstract
OBJECTIVE To examine how mental health interplays with menopausal status in relation to sleep patterns and rest-activity rhythms (RARs) among middle-aged women. METHODS This cross-sectional study recruited 87 women aged 45 to 60 years from community and a gynecology clinic in Taiwan. Participants wore actigraphy devices for 7 days and were also assessed with self-reported questionnaires. Hierarchical regression was used to examine the effects of menopausal status and mental health on sleep and RARs. RESULTS Perimenopausal and postmenopausal women had higher relative amplitude and interdaily stability of RARs than premenopausal women. There were no differences in actigraphy-based sleep parameters across menopausal statuses. There was no difference in depressive symptoms or loneliness across menopausal statuses. Higher levels of depressive symptoms were significantly associated with longer sleep latency ( β = 0.26, P = 0.022) and wake after sleep onset ( β = 0.28, P = 0.012), and lower sleep efficiency ( β = -0.30, P = 0.008) after adjusting for menopausal status and age. In addition, there was marginal significance of the positive association between loneliness and interdaily stability ( β = 0.18, P = 0.079). A moderating effect ( βmenopausal status*loneliness = -0.40, P = 0.025) showed that lonelier premenopausal women exhibited greater relative amplitude (RA) of rest-activity rhythms, but lonelier menopausal women had lower RA of RAR. CONCLUSION Mental health plays an important role for middle-aged women with different menopausal statuses in relation to sleep patterns and RARs.
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Affiliation(s)
- Szu-Yu Hou
- From the Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Ju Chiu
- From the Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Chih-Liang Wang
- From the Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Han Tang
- From the Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Ching Kuo
- From the Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Chieh Yang
- Yang's Clinic of Obstetrics and Gynecology, Tainan, Taiwan
| | - Hsin-Ping Hsu
- Department of Psychology, National Cheng Kung University, Tainan, Taiwan
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Franzoi MA, Aupomerol M, Havas J, Soldato D, Lambertini M, Massarotti C, Hang H, Pistilli B, Fasse L, Tredan O, Gillanders E, Joly F, Cottu P, Mouret-Reynier MA, Tarpin C, Arnaud A, Everhard S, Martin AL, Di Meglio A, Vaz-Luis I. Investigating sexual health after breast cancer by longitudinal assessment of patient-reported outcomes. ESMO Open 2024; 9:102236. [PMID: 38350335 PMCID: PMC10937197 DOI: 10.1016/j.esmoop.2024.102236] [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: 08/07/2023] [Revised: 11/28/2023] [Accepted: 01/05/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Sexual concerns are a major unaddressed need among survivors of breast cancer (BC) with significant negative effects on quality of life. We longitudinally analyzed sexual health over time, using patient-reported outcomes. METHODS Patients with stage I-III BC prospectively included from the CANcer TOxicity cohort (CANTO) provided data at diagnosis, then 1, 2, and 4 years afterward. Sexual concerns outcomes included poor body image (score ≤91/100), poor sexual functioning (≤16/100), poor sexual enjoyment (≤66/100), and sexual inactivity (EORTC QLQ-B23). Multivariate generalized estimating equation models assessed associations with sexual concerns after diagnosis, adjusting for age, sociodemographic, tumor, treatment, and clinical characteristics. RESULTS Nearly 78.1% among 7895 patients reported at least one sexual concern between diagnosis and 4 years' follow-up. Over time, the proportion of patients reporting sexual concerns either increased or remained constant with diagnosis. Less than half (46%, range 11.4-57) of the patients with sexual concerns reported the use of supportive care strategies, including gynecological or psychological consultations (range 11.4-57.4). Factors consistently associated with sexual concerns up to 4 years after diagnosis included already reporting the same concern at diagnosis [odds ratio (OR)poor body image 3.48 [95% confidence interval (CI) 3.11-3.89]; ORsexual inactivity 9.94 (95% CI 8.84-11.18), ORpoor sexual function 9.75 (95% CI 8.67-10.95), ORpoorsexual enjoyment 3.96 (95% CI 3.34-4.69)], endocrine therapy use [ORpoor body image 1.15 (95% CI 1.01-1.31); ORsexual inactivity 1.19 (95% CI 1.02-1.39), ORpoor sexual function 1.17 (95% CI 1.01-1.37), ORpoor sexual enjoyment 1.23 (95% CI 1.00-1.53)], and depression [ORpoor body image 2.00 (95% CI 1.72-2.34); ORsexual inactivity 1.66 (95% CI 1.40-1.97), ORpoor sexual function 1.69 (95% CI 1.43-2.00), ORpoor sexual enjoyment 1.94 (95% CI 1.50-2.51)]. Outcome-specific associations were also identified. CONCLUSIONS Sexual concerns seem frequent, persistent, and insufficiently addressed. Pretreatment concerns, endocrine therapy, and emotional distress are commonly associated factors. A proactive evaluation of sexual health across the care continuum is needed, to promptly identify patients suitable for multidisciplinary counseling, referral, and supportive interventions.
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Affiliation(s)
- M A Franzoi
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif.
| | - M Aupomerol
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - J Havas
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - D Soldato
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Gynecology Department, Policlinico San Martino, University of Genova, Genova; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | - C Massarotti
- Physiopatology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Health (DiNOGMI department), School of Medicine, University of Genova, Genova, Italy
| | - H Hang
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - B Pistilli
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - L Fasse
- Interdisciplinary and Patient Pathway Department, Institut Gustave Roussy, Villejuif
| | | | - E Gillanders
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - F Joly
- Centre François Baclesse, Caen
| | | | | | - C Tarpin
- Institut Paoli Calmettes, Marseille
| | | | | | | | - A Di Meglio
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - I Vaz-Luis
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
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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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42
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Acquarulo EL, Hernandez EC, Kodzodziku F, Nemec EC. The efficacy of purified pollen extract for reducing vasomotor symptoms in women: a systematic review and meta-analysis. Menopause 2024; 31:154-159. [PMID: 38194609 DOI: 10.1097/gme.0000000000002301] [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: 01/11/2024]
Abstract
IMPORTANCE Menopause impacts the quality of life for women, with symptoms varying from hot flashes to night disturbances. When menopausal hormonal therapy is contraindicated or women refuse menopausal hormonal therapy, many consider alternatives such as pollen extract for treating vasomotor symptoms. OBJECTIVE This meta-analysis focuses on the impact of using purified pollen extract as a treatment option to reduce vasomotor symptoms in women, specifically focusing on symptoms such as hot flashes, night disturbances, myalgias, and depression. EVIDENCE REVIEW A comprehensive literature search was conducted using the following Boolean search string "women OR females" AND "purified pollen OR pollen extract OR cytoplasmic pollen OR Bonafide OR Femal OR Estroven OR Serelys" AND "menopausal symptoms OR vasomotor symptoms OR hot flashes OR night sweats OR sleep disturbance." Publications in English from 2003 to the present were included. To assess the risk of bias, authors used the Cochrane Risk-of-Bias 2 for a randomized controlled trial and Risk-of-Bias in Non-Randomized Studies of Interventions (ROBINS-I) for observational studies. Using ReviewManager, a Der Simonian-Laird random-effects model meta-analysis was conducted to determine the standardized mean differences (SMDs) in the outcomes for each study. FINDINGS Five articles were retained: one randomized controlled trial and four observational studies ( N = 420). An overall decrease in scores from the baseline of studies compared with a 3-month follow-up after purified cytoplasm of pollen (PCP) treatment was recognized when compiling the data. Overall, there was significant improvement across all outcomes at 3 months: hot flashes demonstrated an overall improvement in SMD of -1.66 ( P < 0.00001), night disturbance scores were improved with an SMD of -1.10 ( P < 0.0001), depression scores were improved with an SMD of -1.31 ( P < 0.0001), and myalgia had an improvement in SMD of -0.40 ( P < 0.00001). When controlled studies were pooled for meta-analysis, outcomes, however, were no longer statistically significant. CONCLUSIONS AND RELEVANCE Evaluating the risk-to-benefit ratio of alternative therapies, such as PCP extract, is important to care for women who cannot take traditional vasomotor symptom therapies. Pooled data from controlled studies evaluating PCP extract suggest that vasomotor symptom improvements seen in noncontrolled studies may have been due to the placebo effect; however, its use was not associated with significant adverse effects.
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Affiliation(s)
- Erica L Acquarulo
- From the Sacred Heart University College of Health Professions, Fairfield, CT
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Genazzani AR, Divakar H, Khadilkar SS, Monteleone P, Evangelisti B, Galal AF, Priego PIR, Simoncini T, Giannini A, Goba G, Benedetto C. Counseling in menopausal women: How to address the benefits and risks of menopause hormone therapy. A FIGO position paper. Int J Gynaecol Obstet 2024; 164:516-530. [PMID: 38178609 DOI: 10.1002/ijgo.15278] [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: 01/06/2024]
Abstract
Menopause marks the end of menstrual cyclicity and, depending on individual vulnerability, has several consequences related to gonadal steroid deprivation, especially if it is premature. Menopause may be more burdensome for some women than for others. Individual factors, such as personal history, socioeconomic status, ethnicity, and current health conditions, affect symptomatology and, thereby, the menopausal experience. In addition, some menopausal symptoms, such as severe hot flashes, sleep disorders, and depression, are markers of future health risks. Counseling is a fundamental part of health care in the peri- and postmenopause periods. It must include an assessment of the patient's symptoms, needs, desires, and risk profile to address the benefits and risks of menopausal hormone therapy (MHT) on an individual basis and promote a healthy lifestyle. Indeed, healthcare practitioners can and must protect the health and lives of mid-life women by increasing awareness of menopausal symptoms and ensuring healthcare options, especially MHT. The type and duration of MHT should be tailored based on the patient's history, menopausal age, physical characteristics, and current health status so that the benefits always outweigh the risks. This FIGO position paper focuses on the benefits and risks of MHT on health domains, target organs, and systems, and on systemic and vaginal MHT regimens, to provide indications that can be used in the clinical practice for menopausal counseling. Moreover, it offers insights into what FIGO considers the mainstay for the healthcare management of women in peri- and postmenopause, worldwide.
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Affiliation(s)
- Andrea R Genazzani
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, The University of Pisa, Pisa, Italy
| | - Hema Divakar
- Obstetrics and Gynaecology, Divakars Speciality Hospital, Bengaluru, India
- FIGO Committee on Well Woman Health Care, London, UK
| | - Suvarna S Khadilkar
- FIGO Committee on Well Woman Health Care, London, UK
- Department of Obstetrics and Gynecology, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Patrizia Monteleone
- Division of Obstetrics and Gynecology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | | | - Ahmed F Galal
- FIGO Committee on Well Woman Health Care, London, UK
- Department of Obstetrics and Gynecology, Elshatby Maternity University Hospital, Alexandria, Egypt
| | - Paola I R Priego
- FIGO Committee on Well Woman Health Care, London, UK
- Hospital Ángeles del Pedregal, Mexico City, Mexico
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, The University of Pisa, Pisa, Italy
| | - Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, The University of Pisa, Pisa, Italy
| | - Gelila Goba
- FIGO Committee on Well Woman Health Care, London, UK
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA
| | - Chiara Benedetto
- FIGO Committee on Well Woman Health Care, London, UK
- Department of Obstetrics and Gynecology, Sant'Anna University Hospital, Torino, Italy
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Carter E, Bruinvels G, Timmins K, Pedlar C, Martin D. Menopausal symptoms, exercise practices, and advice received in active women: a multi-country survey of strava app users. Women Health 2024; 64:23-31. [PMID: 37996389 DOI: 10.1080/03630242.2023.2284730] [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: 04/28/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
The study aimed to identify the prevalence of symptoms, changes in exercise levels, and exercise advice received during the menopausal transition in a large multi-country sample. Using total population sampling, 2.5 percent of female Strava app users (n = 970) from 7 countries completed an online survey between 14 February 2019 and 11 March 2019. The survey discussed menopause status (perimenopausal or postmenopausal), menopausal symptoms, changes to exercise behaviors, and advice received concerning exercise during menopause. Frequencies, chi-square statistics, and linear regressions were used to analyze data. The most commonly reported menopausal symptoms were sexual (18-83 percent) and cognitive/psychological (77-78 percent). 41 percent of women reported no change in exercise behavior since menopause began (46 percent increased and 11 percent decreased behaviors). The majority (88 percent) of women did not receive advice regarding exercise during menopause. Women who received advice were more likely to report an increase in their exercise than those not receiving advice (60 percent vs 46 percent; X2 (df 2, n = 927) = 7.1, p = .03). Exercise behaviors increased the longer it had been since the menopausal onset (X2 (df 8, n = 937) = 77.42, p < .001). The results suggested high menopausal symptom prevalence in active women and a general lack of exercise advice. More women reported higher symptom prevalence and an increase in exercise participation, the longer it had been since menopause onset. Future research should determine whether these increased exercise behaviors are being used as a coping mechanism.
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Affiliation(s)
- Esther Carter
- School of Sport, Exercise and Rehabilitation Sciences, University of Hull, Hull, UK
| | - Georgie Bruinvels
- Orreco Ltd, Business Innovation Unit, NUI Galway, Galway, Ireland
- Institute of Sport, Exercise and Health, University College London, London, UK
- Faculty of Sport, Allied Health and Performance Science, St Mary's University, Twickenham, UK
| | - Kate Timmins
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Charles Pedlar
- Orreco Ltd, Business Innovation Unit, NUI Galway, Galway, Ireland
- Institute of Sport, Exercise and Health, University College London, London, UK
- Faculty of Sport, Allied Health and Performance Science, St Mary's University, Twickenham, UK
| | - Daniel Martin
- School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
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Hou SY, Chiu CJ, Shea JL, Wang CL, Tang HH, Kuo PC, Yang YC, Wu CH. Role of age, menopausal status, and symptoms in midlife women: Examination of sleep patterns and rest-activity circadian rhythms. Sleep Med 2024; 113:172-179. [PMID: 38039943 DOI: 10.1016/j.sleep.2023.11.015] [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: 06/19/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Midlife women experience menopausal transition at different ages with a variety of symptoms. This study aimed to identify the effects of age, menopausal status, and symptoms in women on their actigraphy-based sleep patterns and circadian rhythms. METHODS A total of 87 women aged 45-60 from the community and a gynecology clinic in Taiwan who had their sleep and circadian rhythms recorded with a 7-day actigraphy were analyzed. Multiple linear regression was used to estimate the association of age, menopausal status, and symptoms with sleep parameters and circadian rhythms. RESULTS A sleep efficiency below 85 % was observed in 46.0 % of women, and those with severe somatic-vegetative or psychological symptoms tended to have problems with sleep latency (β = 0.22 and β = 0.42, respectively) and efficiency (β = -0.26 and β = -0.36, respectively). Women with more severe urogenital symptoms only experienced significantly longer sleep latency (β = 0.33). There was a weak correlation between circadian rhythms and symptoms. Additionally, perimenopausal (β = 0.30 and β = 0.35, respectively) and late postmenopausal (β = 0.67 and β = 0.59, respectively) women had higher relative amplitude and stability in circadian rhythms than premenopausal women. Age had no significant effect on sleep parameters or circadian rhythms. CONCLUSIONS Premenopausal women had the most unstable day-to-day rhythms compared to their peri- and postmenopausal counterparts. Women with higher somatic-vegetative, psychological, and urogenital symptoms showed greater sleep problems. Psychological symptoms (e.g., depression, irritability, anxiety, exhaustion) were the strongest predictors for all sleep parameters. The mechanisms underlying these associations warrant investigation.
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Affiliation(s)
- Szu-Yu Hou
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Jeanne Laraine Shea
- Department of Anthropology, University of Vermont, Burlington, VT, 05405, USA
| | - Chih-Liang Wang
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Han Tang
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Ching Kuo
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Chieh Yang
- Yang's Clinic of Obstetrics and Gynecology, Tainan, Taiwan
| | - Chih-Hsing Wu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Fernández‐Pena A, Navas‐Sánchez FJ, de Blas DM, Marcos‐Vidal L, Desco M, Carmona S. Previous pregnancies might mitigate cortical brain differences associated with surgical menopause. Hum Brain Mapp 2024; 45:e26538. [PMID: 38063284 PMCID: PMC10789212 DOI: 10.1002/hbm.26538] [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: 01/20/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 01/16/2024] Open
Abstract
Surgical menopause causes a sharp drop in estrogen levels in middle-aged women, thus preventing the gradual physiological adaptation that is characteristic of the perimenopause. Previous studies suggest that surgical menopause might increase the risk of dementia later in life. In addition, the transition to motherhood entails long-lasting endocrine and neuronal adaptations. We compared differences in whole-brain cortical volume between women who reached menopause by surgery and a group of women who reached spontaneous non-surgical menopause and determined whether these cortical differences were influenced by previous childbearing. Using surface-based neuroimaging techniques, we investigated cortical volume differences in 201 middle-aged women (134 women who experienced non-surgical menopause, 78 of whom were parous women; and 67 women who experienced surgical menopause, 39 of whom were parous women). We found significant atrophy in the frontal and temporal regions in women who experienced surgical menopause. Nulliparous women with surgical menopause showed significant lower cortical volume in the left temporal gyrus extending to the medial temporal lobe cortex, as well as in the precuneus bilaterally compared to parous women with surgical menopause; whereas our results revealed no significant differences between parous women with surgical menopause and both parous and nulliparous women who reached a non-surgical menopause. Furthermore, in the surgical menopause group, we found a negative correlation between cortical volume and age at first pregnancy in the temporal lobe. Our study suggests that the long-term brain remodeling of parity may mitigate the neural impact of the sudden drop in estrogen levels that characterizes surgical menopause.
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Affiliation(s)
- Alberto Fernández‐Pena
- Departamento de BioingenieríaUniversidad Carlos III de MadridMadridSpain
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
- CIBER de Salud MentalInstituto de Salud Carlos IIIMadridSpain
| | | | - Daniel Martín de Blas
- Departamento de BioingenieríaUniversidad Carlos III de MadridMadridSpain
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
- CIBER de Salud MentalInstituto de Salud Carlos IIIMadridSpain
| | - Luis Marcos‐Vidal
- Departamento de BioingenieríaUniversidad Carlos III de MadridMadridSpain
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
- CIBER de Salud MentalInstituto de Salud Carlos IIIMadridSpain
| | - Manuel Desco
- Departamento de BioingenieríaUniversidad Carlos III de MadridMadridSpain
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
- CIBER de Salud MentalInstituto de Salud Carlos IIIMadridSpain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC)MadridSpain
| | - Susanna Carmona
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
- CIBER de Salud MentalInstituto de Salud Carlos IIIMadridSpain
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Schwarz KG, Vicencio SC, Inestrosa NC, Villaseca P, Del Rio R. Autonomic nervous system dysfunction throughout menopausal transition: A potential mechanism underpinning cardiovascular and cognitive alterations during female ageing. J Physiol 2024; 602:263-280. [PMID: 38064358 DOI: 10.1113/jp285126] [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: 08/02/2023] [Accepted: 11/24/2023] [Indexed: 01/16/2024] Open
Abstract
Cardiovascular diseases (CVD) and neurodegenerative disorders, such as Alzheimer's disease (AD), are highly prevalent conditions in middle-aged women that severely impair quality of life. Recent evidence suggests the existence of an intimate cross-talk between the heart and the brain, resulting from a complex network of neurohumoral circuits. From a pathophysiological perspective, the higher prevalence of AD in women may be explained, at least in part, by sex-related differences in the incidence/prevalence of CVD. Notably, the autonomic nervous system, the main heart-brain axis physiological orchestrator, has been suggested to play a role in the incidence of adverse cardiovascular events in middle-aged women because of decreases in oestrogen-related signalling during transition into menopause. Despite its overt relevance for public health, this hypothesis has not been thoroughly tested. Accordingly, in this review, we aim to provide up to date evidence supporting how changes in circulating oestrogen levels during transition to menopause may trigger autonomic dysfunction, thus promoting cardiovascular and cognitive decline in women. A main focus on the effects of oestrogen-mediated signalling at CNS structures related to autonomic regulation is provided, particularly on the role of oestrogens in sympathoexcitation. Improving the understanding of the contribution of the autonomic nervous system on the development, maintenance and/or progression of both cardiovascular and cognitive dysfunction during the transition to menopause should help improve the clinical management of elderly women, with the outcome being an improved life quality during the natural ageing process.
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Affiliation(s)
- Karla G Schwarz
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sinay C Vicencio
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nibaldo C Inestrosa
- Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
| | - Paulina Villaseca
- Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
| | - Rodrigo Del Rio
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
- Department of Cell Biology and Physiology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Kim B, Park H. The Effects of Auricular Acupressure on Menopausal Symptoms, Stress, and Sleep in Postmenopausal Middle-Aged Women: A Randomized Single-Blind Sham-Controlled Trial. J Midwifery Womens Health 2024; 69:41-51. [PMID: 37549976 DOI: 10.1111/jmwh.13554] [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] [Revised: 05/16/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Middle-aged women in the postmenopausal period experience menopause symptoms, stress, and poor sleep quality due to hormonal changes. Nonetheless, most of them recognize such symptoms as an aging process without receiving proper treatment, and there are few nonpharmacologic interventions available. METHODS This was a randomized single-masked, sham-controlled trial. For the intervention group, a vaccaria seed was applied to the auricular points of Shenmen, anterior lobe, adrenal glands, central rim, and endocrine that are related to the menopause symptoms, stress, and sleep while applying a seed to the auricular points not related to the forementioned symptoms to the control group. The Menopause Rating Scale (MRS), Perceived Stress Scale (PSS), heart rate variability, and electroencephalogram (EEG) were measured before the intervention, 4 weeks after the intervention, and 8 weeks after the intervention. Actigraphy was measured with a Fitbit, and the Pittsburgh Sleep Quality Index (PSQI) was measured before and after the intervention. The study was registered with the World Health Organization International Clinical Trials Registry Platform (KCT0007364). RESULTS The MRS showed significant differences over time in the intervention group (F, 22.057; P < .001). There was a significant difference over time in the PSS (F, 22.576; P < .001), stress index measured by heart rate variability (F, 14.027; P = .001), and antistress quotient of the right brain measured by EEG (F, 4.865; P = .033). Sleep quality, measured by the PSQI (t = -4.050, P < .001), and sleep efficiency measured by actigraphy (t = 5.996, P < .001) were found to be significantly different over time in the intervention group. DISCUSSION This study demonstrated that auricular acupressure is effective in improving menopause symptoms, stress, and sleep in postmenopausal middle-aged women. Therefore, auricular acupressure may be a useful nonpharmacologic intervention for alleviating these symptoms in this population.
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Affiliation(s)
- Bomi Kim
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | - Hyojung Park
- College of Nursing, Ewha Womans University, Seoul, South Korea
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Nomura K, Shimizu K, Taka F, Griffith-Quintyne M, Iida M. Scale development and validation of perimenopausal women disability index in the workplace. Environ Health Prev Med 2024; 29:4. [PMID: 38311393 PMCID: PMC10853391 DOI: 10.1265/ehpm.23-00239] [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] [Accepted: 12/30/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Menopausal disorders include obscure symptomatology that greatly reduce work productivity among female workers. Quantifying the impact of menopause-related symptoms on work productivity is very difficult because no such guidelines exist to date. We aimed to develop a scale of overall health status for working women in the perimenopausal period. METHODS In September, 2021, we conducted an Internet web survey which included 3,645 female workers aged 45-56 years in perimenopausal period. We asked the participants to answer 76 items relevant to menopausal symptomatology, that were created for this study and performed exploratory and confirmatory factor analyses for the scale development. Cronbach's alpha, receiver operating characteristic analysis, and logistic regression analysis were used to verify the developed scale. RESULTS Approximately 85% participants did not have menstruation or disrupted cycles. Explanatory factor analysis using the maximum likelihood method and Promax rotation identified 21 items with a four-factor structure: psychological symptoms (8 items, α = 0.96); physiological symptoms (6 items, alpha = 0.87); sleep difficulty (4 items, alpha = 0.92); human relationship (3 items, alpha = 0.92). Confirmatory factor analyses found excellent model fit for the four-factor model (RMSR = 0.079; TLI = 0.929; CFI = 0.938). Criterion and concurrent validity were confirmed with high correlation coefficients between each of the four factors, previously validated menopausal symptom questionnaire, and Copenhagen Burnout Inventory scales, respectively (all ps < 0.0001). The developed scale was able to predict absenteeism with 78% sensitivity, 58% specificity, and an AUC of 0.727 (95%CI: 0.696-0.757). Higher scores of each factor as well as total score of the scale were more likely to be associated with work absence experience due to menopause-related symptoms even after adjusting for Copenhagen Burnout Inventory subscales (all ps < 0.0001). CONCLUSION We found that the developed scale has high validity and reliability and could be a significant indicator of absenteeism for working women in perimenopausal period.
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Affiliation(s)
- Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Kisho Shimizu
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Fumiaki Taka
- Faculty of Sociology, Toyo University, Tokyo, Japan
| | - Melanie Griffith-Quintyne
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Miho Iida
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
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Sassarini J, Anderson RA. Elinzanetant: a phase III therapy for postmenopausal patients with vasomotor symptoms. Expert Opin Investig Drugs 2024; 33:19-26. [PMID: 38224099 DOI: 10.1080/13543784.2024.2305122] [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: 10/19/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Menopausal vasomotor symptoms (VMS) are experienced by most women and are often debilitating and can last for years. While hormone replacement therapy is effective, it carries risks that have impacted its wider use, and it can be contraindicated. There is a large unmet need for a safe, effective non-hormonal therapy. AREAS COVERED The importance of the neurokinin (NK) system in the hypothalamic regulation of the vasomotor center has become clear. NK antagonists, previously developed for other indications, have therefore been investigated for the treatment of VMS. Elinzanetant is a potent antagonist at both NK1 (endogenous ligand Substance P) and NK3 (neurokinin B) receptors, whereas other related drugs in development are selective NK3 antagonists. Elinzanetant has been investigated in 2 Phase II trials for menopausal VMS, demonstrating rapid onset and dose-dependant efficacy for the relief of VMS and improvement in quality of life for up to 12 weeks. Phase III trials are underway in women both with physiological menopause and after treatment for breast cancer. EXPERT OPINION Elinzanetant is a very promising non-hormonal approach to a highly prevalent symptom constellation, with rapid onset and high efficacy. Wider indications are being explored in current Phase III trials.
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Affiliation(s)
- Jenifer Sassarini
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Richard A Anderson
- Centre for Reproductive Health, Institute for Repair and Regeneration, University of Edinburgh, Edinburgh, UK
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