Stages of Reproductive Aging Workshop (STRAW)

Pain during menopause

Menopause is a biological process marking the end of a woman's reproductive years, typically occurring between the ages of 45 and 55. While often associated with hot flashes, mood swings, and hormonal changes, pain is a frequently overlooked and under-addressed aspect of the menopausal experience. This review article explores the multifaceted nature of pain during menopause, and sheds light on its various manifestations and the factors contributing to its prevalence and severity. Pain during menopause may include musculoskeletal discomfort, headaches or migraines, and vulvovaginal pain. The etiology of these is intricate, involving hormonal fluctuations, psychosocial factors, and genetic predispositions. Fluctuations in estrogen and progesterone levels play a pivotal role in musculoskeletal pain and joint stiffness, and increase susceptibility to conditions such as osteoarthritis. Furthermore, mood disorders, stress, and sleep disturbances may exacerbate the perception of pain. Gender norms, as well as changes in reproductive capacity and societal views on aging, may adversely the impact the self-esteem of individuals undergoing menopause. These symptoms can significantly impact a woman's quality of life, underscoring the need for early identification and appropriate management strategies. This review article highlights the factors contributing to pain during menopause, evaluates the effects of hormones on menopausal pain, and investigates management strategies for pain during menopause, including both pharmacological and non-pharmacological approaches. It also emphasizes the need for further research to better understand the interplay of factors contributing to pain during menopause, in order to allow for more tailored and effective interventions. In understanding and addressing this often-neglected aspect of menopause, healthcare providers can enhance the overall wellbeing and quality of life for women transitioning through this natural life stage.

Development and Impact of a Cognitive Reserve Enhancement Program for Climacteric Korean Women

BACKGROUND

In light of the rising incidence of mild cognitive impairment in women, an appropriate cognitive reserve enhancement program is urgently needed for women experiencing climacteric symptoms.

PURPOSE

The purpose of this study was to develop a cognitive reserve enhancement program for climacteric women based on cognitive reserve theory (CRT) and to verify its effectiveness.

METHODS

A nonequivalence control group, pre- and post-quasi-experimental design was used. The 58 climacteric women with subjective memory deterioration enrolled as participants were divided into the experimental group (28 women), which received a 24-session CRT-based cognitive reserve enhance program, and the control group (30 women), the members of which received the cognitive training via a mobile application after completion of the study. Valid data from 24 experimental and 26 control participants were available for analysis. Objective cognitive functions, including overall cognitive, memory, attention, and language, were measured pretest and posttest using the following tools: Everyday Cognition Scale (subjective cognitive function), Center for Epidemiologic Studies Depression Scale (depression), and World Health Organization Quality of Life-Brief Version (quality of life).

RESULTS

The experimental group showed a statistically significant increase in overall cognitive function (t = 3.82, p = .001), memory (t = 2.63, p = .012), attention: number of correct answers (t = 2.12, p = .040), language high-frequency response speed (Z = -2.49, p = .013), and language low-frequency response speed (Z = -2.77, p = .006) in objective cognitive function after 8 weeks in comparison to the control group.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The intervention program tested in this study to enhance cognitive reserve in climacteric women includes cognitive training, emotional and social support, and group physical activity components was found to be effective in enhancing cognitive function.

Socioecological factors influencing physical activity engagement for women across the menopausal transition: a systematic review

IMPORTANCE

Physical activity during menopause can be effective in reducing the physiological changes associated with reproductive aging that increase risks for noncommunicable diseases, yet many women do not meet the recommendations for physical activity.

OBJECTIVE

This study aimed to synthesize factors influencing physical activity for women across menopausal transition phases using a socioecological approach.

EVIDENCE REVIEW

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used to systematically search 10 databases between 2001 and 2021. A comprehensive search strategy was used to identify studies on physical activity of women in various stages of menopause. A socioecological model was used to categorize the reported barriers and enablers.

FINDINGS

Twenty studies met the inclusion criteria. The findings highlight several intrapersonal barriers such as existing health complaints versus enablers such as awareness of the health benefits of physical activity during menopause. Ensuring women's safety, preventing injury, and enhancing exercise self-efficacy were important components of programs. Social support was also an important enabler of women's engagement in activities.

CONCLUSIONS AND RELEVANCE

Several barriers and enablers were identified and can inform practitioners and future interventions to encourage physical activity among women in various stages of menopause. For instance, when encouraging physical activity during menopause, practitioners should consider other health complaints, safety, and injury prevention while discussing the benefits of physical activity related to managing menopausal symptoms. There was a lack of theoretically informed studies exploring the barriers and enablers to physical activity for women in various stages of menopause; thus, research designs may not have fully accounted for influences. Future research that combines socioecological and individual theories of behavior is needed to comprehensively understand the complexity of physical activity among women across the menopausal transition.

Yoga Nidra, a Nonpharmacological Technique in Management of Insomnia and Overall Health in Postmenopausal Women

Yoga Nidra is a promising technique through which body is consciously simulated into a profound relaxation state similar to attained during naturally occurring deep sleep. It is aimed to attain complete emotional, physical, and mental relaxation of body and mind. In postmenopausal phase of life, regular practice of Yoga Nidra at home preferably in morning, can help in reduction in anxiety and pain associated with early morning awakenings. This nonpharmacological technique has a therapeutic potential to improve sleep quality and quantity, and overall well-being.

Beliefs and strategies about urinary incontinence: a possible moderation role between symptoms and sexual function, and quality of life

Background

Urinary Incontinence (UI) has numerous repercussions in women's lives, and it is underreported/underdiagnosed.

Objective

The present study aimed to understand: (1) the differences between women with and without urine loss regarding Quality of Life (QoL) and Sexual Function (SF); (2) the possible moderation role of UI-related beliefs and strategies on the relationship between UI-symptom severity and SF and QoL, in women with UI.

Methods

Cross-sectional Design. Participants: Primary aim: Overall, 2,578 women aged 40-65 (Mage = 49.94, DPage = 6.76) were collected online. Secondary aim: 1,538 women who self-reported having urine loss occasionally/frequently (Mage = 50.19, DPage = 6.58). All data analyses were done with IBM SPSS Statistics and R statistical system 4.0 through RStudio. Statistical Path analysis was performed with the lavaan package to study the hypothetical association and moderating effects between the variables.

Results

Primary aim: women without UI had a better SF [t(2576) = 3.13, p = 0.002; 95% C.I., 0.18 to 0.80] and QoL [t(2576) = 7.71, p < 0.001; 95% C.I., 3.14 to 5.28] than their counterparts with UI. Secondary aim: UI-related coping strategies attenuated the impact of UI-symptom severity on SF(β = -0.07; p = 0.041); the more dysfunctional the UI-related beliefs were, the poorer QoL was (β = -0.06; p = 0.031); the more frequent the UI-related hiding/defensive strategies were, the poorer QoL was (β = -0.26; p < 0.001).

Discussion

Limitations: online data collection, which thwarted the clarification of participants, if needed; absence of a UI medical diagnosis (only self-reported measures were used). Strengths and practical implications: (i) the crucial role of UI-related beliefs and strategies in the QoL of women with UI; (ii) the impact that UI-concealing/defensive strategies have in attenuating the impact of UI-symptom severity on SF, which might be perceived as a short-term benefit and hence contribute to maintaining the UI condition and constitute a barrier to help-seeking, (iii) impact of UI-symptom severity on QoL and SF (including a comparison group entailing women without UI, which is scarcely used); and (iv) the use of gold-standard and psychometrically robust instruments.

Conclusion

Changing dysfunctional UI-related beliefs and strategies in clinical settings may improve the QoL; UI-concealing strategies may reinforce themselves by immediate effects on SF, but are not functional in the long term.

Postmenopausal women's cognitive function and performance of virtual reality tasks

OBJECTIVE

This study aimed to assess whether prior knowledge of computer use determines performance of virtual reality tasks by postmenopausal women and whether menopausal symptoms, sociodemographic factors, lifestyle and cognition modify or interfere with their performance.

METHOD

This cross-sectional study included 152 postmenopausal women divided into two groups: computer users and non-users. Age, ethnicity, time of menopause, menopausal symptoms, female health status, level of physical activity and cognitive function were considered. The participants played a virtual reality game and were assessed for hits, errors, omissions and game time. The Mann-Whitney, chi-square and Fisher exact tests and multivariate linear regression analysis were used.

RESULTS

Postmenopausal computer users play virtual reality games (p = 0.005) better than postmenopausal non-users of computers. Vasomotor symptoms were high in women who used computers compared to those who did not (p = 0.006). Multivariate linear regression analysis found that the best-fitting predictors for the number of hits - that is, age (p = 0.039), Mini-Mental State Examination score (p = 0.006) and the headache symptom (p = 0.021) - influence the performance of virtual reality tasks.

CONCLUSION

Computer users performed virtual reality tasks better than non-users. Headache and age but not vasomotor symptoms negatively affected the postmenopausal women's performance.

Experience and severity of menopause symptoms and effects on health-seeking behaviours: a cross-sectional online survey of community dwelling adults in the United Kingdom

BACKGROUND

Almost all women will experience menopause, and the symptoms can have a severely detrimental impact on their quality of life. However, there is limited research exploring health-seeking behaviours and alternative service design or consultation formats. Group consultations have been successfully deployed in perinatal and diabetic care, improving accessibility and outcomes. This cross-sectional online survey was conducted to explore women's personal experiences of menopause, including perspectives on group consultations.

METHODS

An online survey investigated the experiences of individuals at all stages of menopause and their receptiveness towards group consultations for menopause. Respondents were categorised by menopause stage according to the STRAW + 10 staging system. Associations between menopause stage, acceptability of group consultations and participant demographics were assessed using logistic regression.

RESULTS

Respondents experienced an average of 10.7 menopausal symptoms, but only 47% of respondents felt they had the knowledge and tools to manage their symptoms. Advice on menopause was sought from a healthcare professional (HCP) by 61% of respondents, the largest trigger for this being severity of symptoms and the main barrier for this was the perception that menopause wasn't a valid enough reason to seek help. Of the respondents seeking advice from HCPs, 32% were prescribed transdermal HRT, 29% received oral HRT, 19% were offered antidepressants, 18% received local oestrogen and 6% were prescribed testosterone. Over three quarters (77%) of respondents indicated that they would join a group consultation for menopause and would be comfortable sharing their experiences with others (75%). Logistic regression indicated premenopausal respondents were 2.84 times more likely than postmenopausal women to be interested in a group consultation where they can meet or learn from others' experiences.

CONCLUSIONS

This study highlighted a strong willingness of women aged 35-70 to participate in group consultations for menopause, with motivation being strongest amongst premenopausal women. Low awareness of self-management and lifestyle interventions to manage the symptoms of menopause highlight the need for greater outreach, research and interventions to build knowledge and confidence in the general population at scale. Future studies should focus on investigating the effectiveness and economic impact of menopause group consultations and the lived experience of individuals participating in group consultations.

Chronic mitochondria antioxidant treatment in older adults alters the circulating milieu to improve endothelial cell function and mitochondrial oxidative stress

Excessive reactive oxygen species production by mitochondria (mtROS) is a key contributor to age-related vascular endothelial dysfunction. We recently showed in a crossover design, placebo-controlled clinical trial in older adults that 6 wk of treatment with the mitochondria-targeted antioxidant (MitoQ) improved endothelial function, as measured by nitric oxide (NO)-mediated endothelium-dependent dilation (EDD), by lowering mtROS and was associated with reduced circulating levels of oxidized low-density lipoprotein (oxLDL). Here, we conducted an ancillary analysis using plasma samples from our clinical trial to determine if MitoQ treatment-mediated changes in the "circulating milieu" (plasma) contribute to improvements in endothelial function and the mechanisms involved. With the use of an ex vivo model of endothelial function, acetylcholine-stimulated NO production was quantified in human aortic endothelial cells (HAECs) exposed to plasma collected after chronic MitoQ and placebo supplementation in 19 older adults (67 ± 1 yr; 11 females). We also assessed the influence of plasma on endothelial cell (EC) mtROS bioactivity and the role of lower circulating oxLDL in plasma-mediated changes. NO production was ∼25% higher (P = 0.0002) and mtROS bioactivity was ∼25% lower (P = 0.003) in HAECs exposed to plasma collected from subjects after MitoQ treatment versus placebo. Improvements in NO production ex vivo and NO-mediated EDD in vivo with MitoQ were correlated (r = 0.4683; P = 0.0431). Increasing oxLDL in plasma collected after MitoQ to placebo levels abolished MitoQ treatment effects on NO production and mtROS bioactivity, whereas inhibition of endogenous oxLDL binding to its lectin-like oxidized low-density lipoprotein receptor 1 (LOX-1) prevented these effects. These findings provide novel insight into the mechanisms by which MitoQ treatment improves endothelial function in older adults.NEW & NOTEWORTHY Chronic supplementation with a mitochondria-targeted antioxidant (MitoQ) improves vascular endothelial function in older adults, but the mechanisms of action are incompletely understood. Here, we show that MitoQ supplementation leads to changes in the circulating milieu (plasma), including reductions in oxidized low-density lipoprotein that enhance nitric oxide production and reduce mitochondrial oxidative stress in endothelial cells. These findings provide new information regarding the mechanisms by which MitoQ improves age-related endothelial dysfunction.

Latent Profile Analysis for Classification of Psychosomatic Symptoms in Perimenopausal Women

BACKGROUND

Over 80% of perimenopausal women experience various physical and neuropsychiatric symptoms due to changes in hormones. However, accurate evaluation and treatment of menopausal symptoms are lacking due to limited evidence regarding customized treatment for each symptom type.

OBJECTIVE

This study aimed to identify and cluster psychosomatic symptoms in Korean perimenopausal women and to investigate the characteristics of each cluster type.

METHODS

This Web-based survey assessed 1060 Korean perimenopausal women recruited from nationally representative panels available from a commercial research company. Menopausal symptoms were evaluated using the Menopause Rating Scale, Patient Health Questionnaire-15, Patient Health Questionnaire-9, Insomnia Severity Index, Subjective Memory Complaints Questionnaire, and Overactive Bladder Symptom Score. Data were analyzed using latent profile analysis and multinomial logistic regression.

RESULTS

Latent profile analysis identified 4 latent classes: "all unimpaired (class 1)," "impaired sexual function, while others are unimpaired (class 2)," "unimpaired sexual function, while others are impaired (class 3)," and "all impaired (class 4)." Classes 3 and 4 were significantly more likely to have a family history of perimenopausal syndrome and a history of other mental disorders, postpartum depression, and postpartum psychosis than classes 1 and 2.

CONCLUSIONS

Psychosomatic symptoms appear during perimenopause along with depression, somatic symptoms, insomnia, impaired memory, and overactive bladder symptoms. Individuals with these symptoms are more likely to have a history of postpartum depression, psychosis, and other psychiatric disorders. Therefore, sexual dysfunction must be independently treated. Further studies are needed to develop and verify individualized treatments according to symptom class.

Perimenopausal Effects of Estradiol on Anhedonia and Psychosis Study (PEEPs): study protocol for a neural and molecular mechanistic clinical trial

BACKGROUND

The perimenopausal transition is accompanied by psychiatric symptoms in over 10% of women. Symptoms commonly include depressed mood and anhedonia and less commonly include psychosis. Psychiatric symptoms have been linked to the depletion and/or variability of circulating estradiol, and estradiol treatment reduces perimenopausal anhedonia and psychosis in some women. Estrogen fluctuations may disrupt function in the mesolimbic reward system in some women, leading to psychiatric symptoms like anhedonia or psychosis. The Perimenopausal Effects of Estradiol on Anhedonia and Psychosis Study (PEEPs) is a mechanistic clinical trial that aims to (1) identify relationships between perimenopausal-onset anhedonia and psychosis and neuromolecular markers of mesolimbic reward responses and (2) determine the extent to which estradiol treatment-induced changes in mesolimbic reward responses are associated with alleviation of perimenopausal onset anhedonia or psychosis.

METHODS

This study will recruit 100 unmedicated women ages 44-55 in the late-stage perimenopausal transition, sampling across the range of mild-to-high anhedonia and absent-to-moderate psychosis symptoms. Patients will be randomized to receive either estradiol or placebo treatment for 3 weeks. Clinical outcome measures will include symptoms of anhedonia (measured with Snaith-Hamilton Pleasure Scale; SHAPS) and psychosis (measured with Brief Psychiatric Rating Scale; BPRS psychosis subscale) as well as neural markers of mesolimbic reward system functioning, including reward-related fMRI activation and PET-derived measure of striatal dopamine binding. Pre-treatment associations between (1) SHAPS/BPRS scores and (2) reward-related striatal dopamine binding/BOLD activation will be examined. Furthermore, longitudinal mixed models will be used to estimate (1) symptom and neuromolecular trajectories as a function of estradiol vs. placebo treatment and (2) how changes in reward-related striatal dopamine binding and BOLD activation predict variability in symptom trajectories in response to estradiol treatment.

DISCUSSION

This clinical trial will be the first to characterize neural and molecular mechanisms by which estradiol treatment ameliorates anhedonia and psychosis symptoms during the perimenopausal transition, thus laying the groundwork for future biomarker research to predict susceptibility and prognosis and develop targeted treatments for perimenopausal psychiatric symptoms. Furthermore, in alignment with the National Institute for Mental Health Research Domain Criteria initiative, this trial will improve our understanding of a range of disorders characterized by anhedonia, psychosis, and reward system dysfunction.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05282277.

How preclinical models of menopause can inform clinical care: A focus on midlife and reciprocal communication between clinical and preclinical science

Midlife in women typically includes the menopausal transition, a time of hormonal transformation, adaptation, and reorganization. Coincident with this dynamic period of physiological change, there are putatively modifiable factors that influence disease, short-term and long-term health outcomes, symptom emergence, and longevity. The menopause transition could be considered a window of vulnerability; however, it is also a window of opportunity for intervention. Thus, the menopause transition is a critical sensitive window whereby there is opportunity for turning points for healthy aging trajectories. Preclinical research can aid in this pursuit of scientific discovery for modifiable factors and treatments, and their particular parameters. Rodent menopause models include surgical and transitional variations, allowing detection of precise determinants impacting menopause-related outcomes. These models permit systematic manipulation of endogenous and exogenous hormone exposures across the lifespan, with infinite outcome measurements ranging from molecular to behavioral. This research is uniquely poised to address complex, interactive hypotheses with extensive control in a relatively short timeframe, including dissociation of age and menopause effects. To understand the many dynamic changes with menopause, iterative and reciprocal communication between clinical and preclinical domains of science is key.

The impact of exercise training on endothelial function in postmenopausal women: a systematic review

NEW FINDINGS

What is the topic of this review? The aim of this systematic review was to evaluate and summarize all published literature examining the impact of various exercise training interventions on endothelial function in postmenopausal women. What advances does it highlight? There was a moderate effect of training on macrovascular and microvascular endothelial function and just under two-thirds of studies demonstrated a significant increase in at least one measure of endothelial function in postmenopausal women. Factors including exercise intensity and duration, vessel type, clinical status, hormone therapy, and menopausal status may influence the effects of training on endothelial function in postmenopausal women.

ABSTRACT

Women experience a rapid decline in endothelial function during menopause. Therefore, it is important to explore interventions, such as exercise training, that may prevent endothelial dysfunction in postmenopausal women. The aim of this systematic review was to evaluate and summarize all published literature examining the impact of various exercise training interventions on endothelial function in postmenopausal women. Three electronic databases (MEDLINE, EMBASE and Web of Science) were used to systematically select studies related to exercise training, endothelial function and postmenopausal women. The major initial and secondary update systematic searches yielded 502 unique articles that were screened for eligibility. Thirty-five studies were included in the systematic review. Two-thirds of all studies demonstrated a group-level increase in at least one measure of endothelial function with training. Most studies investigating biomarkers of endothelial function showed improvement in at least one measured biomarker post-training. There was a moderate effect of training on both macrovascular and microvascular endothelial function in observational and randomized intervention studies. Variability in study designs, training protocols and participant characteristics make it difficult to directly compare studies. Factors including exercise intensity and duration, vessel type, clinical status, hormone therapy, and menopausal status may contribute to the inconsistent effects of training on endothelial function in postmenopausal women. Future research is needed in this population to understand the mechanisms driving inter-study and inter-individual differences in training-induced changes in endothelial function.

Menopausal Voice-Related Work Limitation Scale (MenoVWL): Development and Validation

OBJECTIVES

Menopause has been reported to affect the voice of female professional voice users (FPVUs). The present study aims at the development and validation of a scale to measure self-perceived menopausal voice-related limitation to work in FPVUs, henceforth the Menopausal Voice-Related Work Limitation Scale (MenoVWL).

METHODS

Items were drawn from previous studies on impacts of sex steroid hormones on voice, available validated scales, and in-depth interviews with post-menopausal FPVUs. A preliminary version with 16 items was evaluated by a panel of 15 voice experts. The resulting revised version was filled in online, together with questions on current endocrinological reproductive status and related symptoms, history of amenorrhea, professional occupation, and demographic information. Responses concerning only professional voice users were selected and inclusive and exclusive criteria were applied for correct allocation of participants into pre- and post-menopausal stages within a restrict age range;192 responses were subject to factorial analysis for MenoVWL validation. Cronbach's alpha measured internal reliability. The scale was tested by comparing MenoVWL scores between pre- and post-menopausal FPVUs (98 and 94, respectively).

RESULTS

Thirteen items were retained from the expert panel evaluation. Items presented a high Content Validity Index (.94 out of 1) and high Item Acceptance Ratio (86.25 %). Both exploratory and confirmatory factorial analysis rendered one dimension scale with an excellent internal consistency (Cronbach's alpha = .9). The results of a Mann-Whitney test showed a higher MenoVWL score for post- as compared to pre-menopausal FPVUs (Z = - 2.818; P = .005).

CONCLUSIONS

MenoVWL is a comprehensive and validated scale with a known factor structure. It constitutes a health care and safety outcome self-perceived measure of value to the early detection of voice-related limitations to work in FPVUs during menopause.

Contraception During Perimenopause: Practical Guidance

Climacteric is by no means in itself a contraindication to safe contraception. On the contrary, there are several conditions related to the perimenopause that could benefit from the use of modern contraceptives, mainly hormonal, with the goals of avoiding unintended pregnancies and giving further possible benefits beyond contraception (menstrual cycle control, a reduction of vasomotor symptoms and menstrual migraines, a protection against bone loss, a positive oncological risk/benefit balance). This narrative review aims to provide practical guidance on their possible use in this particular life stage, both short- and long-acting reversible contraceptives, and to assist clinicians for women transitioning from contraception to their menopausal years, including the possible initiation of postmenopausal hormone therapy. Comprehensive contraceptive counselling is an essential aspect of the overall health and wellbeing of women and should be addressed with each such patient irrespective of age.

Correction of menopausal disorders: new possibilities of menopausal hormone therapy

Determining the role of menopausal hormone therapy in the era of covid infection is an urgent task. The reasons for the lower rate of severe outcomes in women against the background of covid infection compared to men are currently being discussed. This is suggestive of the idea that the female body has the protection that accounts for this advantage. that Scientific literature data were reviewed to select the best combination of estrogen and progesterone when used as menopausal hormone therapy in the present setting. During the analysis of the literature on the use of estrogens and progestins as menopausal hormone therapy published in recent years, we used the following sources: PubMed, E-libary, Scopus. The body of material, which we studied, led us to a conclusion about the preference for the gestagen component when menopausal hormone therapy was prescribed. Gestagen should have the lowest risks in the development of thrombosis, as well as level the pronounced symptoms of peri- and postmenopause. According to the sources we studied and the authors’ own clinical experience, levonorgestrel-containing menopausal hormone therapy preparations have a high safety profileImproving physicians’ literacy about the criteria for prescribing menopausal hormone therapy, including drugs containing two components, estrogen and levonorgestrel in a cyclic regimen, will allow the use of hormone therapy in a wider range of patients in the perimenopausal and postmenopausal periods.

Vitamin D and green tea extracts for the treatment of uterine fibroids in late reproductive life: a pilot, prospective, daily-diary based study

OBJECTIVE

The beneficial effects of Vitamin D (VD) and Epigallocatechin gallate (EGCG), a polyphenol of green tea, on the growth of uterine fibroids (UF) were previously described in vitro and in vivo. We have decided to investigate their simultaneous administration in women with UFs in late reproductive life.

METHODS

>40 years old n = 16 premenopausal women with intramural (IM) or subserosal (SS) UF of ≥3 cm or several UFs of different sizes, even smaller but with a total diameter ≥3 cm but <10 cm, without further concomitant organic causes of abnormal uterine bleeding, treated with EGCG 300 mg, Vitamin B6 10 mg and VD 50 µg/day for 90 days. Women completed a diary on a daily basis to obtain information about bleeding and pelvic pain.

RESULTS

We have observed a significant reduction in UF's mean size both at patient's (-17.8%, p = .03) and at single UF's level (-37.3%, p = .015). The effect was more evident in women with predominant IM (p = .016) in comparison to SS UFs. No significant changes were observed for uterine and ovarian volume and endometrial thickness during treatment. We reported a significant decrease in menstrual flow length of 0.9 day (p = .04) with no modification in cycle length, menstrual flow intensity and menstrual pain intensity. The satisfaction with treatment was in general very high, with no adverse effects reported.

CONCLUSION

The concomitant administration of VD and EGCG represents a promising treatment of UF in women of late reproductive life for which hormonal manipulation is not foreseen.

Surgical Menopause and Estrogen Therapy Modulate the Gut Microbiota, Obesity Markers, and Spatial Memory in Rats

Menopause in human females and subsequent ovarian hormone deficiency, particularly concerning 17β-estradiol (E2), increase the risk for metabolic dysfunctions associated with obesity, diabetes type 2, cardiovascular diseases, and dementia. Several studies indicate that these disorders are also strongly associated with compositional changes in the intestinal microbiota; however, how E2 deficiency and hormone therapy affect the gut microbial community is not well understood. Using a rat model, we aimed to evaluate how ovariectomy (OVX) and subsequent E2 administration drive changes in metabolic health and the gut microbial community, as well as potential associations with learning and memory. Findings indicated that OVX-induced ovarian hormone deficiency and E2 treatment had significant impacts on several health-affecting parameters, including (a) the abundance of some intestinal bacterial taxa (e.g., Bifidobacteriaceae and Porphyromonadaceae), (b) the abundance of microbial short-chain fatty acids (SCFAs) (e.g., isobutyrate), (c) weight/BMI, and (d) high-demand spatial working memory following surgical menopause. Furthermore, exploratory correlations among intestinal bacteria abundance, cognition, and BMI underscored the putative influence of surgical menopause and E2 administration on gut-brain interactions. Collectively, this study showed that surgical menopause is associated with physiological and behavioral changes, and that E2-linked compositional changes in the intestinal microbiota might contribute to some of its related negative health consequences. Overall, this study provides novel insights into interactions among endocrine and gastrointestinal systems in the post-menopausal life stage that collectively alter the risk for the development and progression of cardiovascular, metabolic, and dementia-related diseases.

Women's Health in/and Work: Menopause as an Intersectional Experience

This paper employs an intersectional lens to explore menopausal experiences of women working in the higher education and healthcare sectors in Australia. Open-text responses from surveys across three universities and three healthcare settings were subject to a multistage qualitative data analysis. The findings explore three aspects of menopause experience that required women to contend with a constellation of aged, gendered and ableist dynamics and normative parameters of labor market participation. Reflecting on the findings, the paper articulates the challenges of menopause as issues of workplace inequality that are rendered visible through an intersectional lens. The paper holds a range of implications for how to best support women going through menopause at work. It emphasizes the need for approaches to tackle embedded and more complex modes of inequality that impact working women’s menopause, and ensure that workforce policy both protects and supports menopausal women experiencing intersectional disadvantage.

Lavender essential oil on postmenopausal women with insomnia: Double-blind randomized trial

BACKGROUND

To evaluate the effect of Lavandula angustifolia essential oil inhalation on sleep and menopausal symptoms in postmenopausal women with insomnia.

PARTICIPANTS

35 postmenopausal women with a clinical diagnosis of insomnia were included, 17 in Aroma Group (AG) and 18 in Placebo Group (PG).

METHODS

In this double-blind, randomized controlled trial, PG participants inhaled sunflower oil and AG participants inhaledLavandula angustifolia essential oil, for 29 days. Both groups received sleep hygiene guidelines before the intervention and weekly follow-up during it. Evaluations were performed before and after intervention. All statistical analyses and intention-to-treat test were performed in SPSS 22. Sleep quality (Primary outcome) was measured by Pittsburgh Sleep Quality Index. Secondary outcomes were polysomnography data, severity of insomnia, anxiety and depression symptoms, and postmenopausal symptoms.

RESULTS

There were no significant differences between groups after intervention in the primary outcome (P = 0.22; effect size=0.69); however, a tendency of improvement in wake after sleep onset (WASO) was observed (P = 0.07; effect size=0.81; B = 42.2). Both groups presented better sleep quality over time (AG P < 0.001; PG P = 0.011). AG participants showed a significant decrease in sleep onset latency (P = 0.001), depression levels (P = 0.025), hot flashes (P < 0.001), postmenopausal symptoms (P < 0.001) and, in polysomnography data, increased sleep efficiency (P = 0.002) compared to baseline.

CONCLUSION

Although no significant differences were observed between groups, our data presented a tendency of improvement in WASO. Moreover, AG participants had enhanced overall sleep pattern, quality and sleep efficiency. Weekly follow-up and sleep hygiene instructions were essential for both groups to show improvement in almost all outcomes.

CLINICAL TRIAL REGISTRATION

Brazilian Registry of Clinical Trials, www.ensaiosclinicos.gov.br, RBR-5q5t5z.

Effect of menopause on cerebral artery blood flow velocity and cerebrovascular reactivity: Systematic review and meta-analysis

BACKGROUND

Menopause and its associated decline in oestrogen is linked to chronic conditions like cardiovascular disease and osteoporosis, which may be difficult to disentangle from the effects of ageing. Further, post-menopausal women are at increased risk of cerebrovascular disease, linked to declines in cerebral blood flow (CBF) and cerebrovascular reactivity (CVR), yet the direct understanding of the impact of the menopause on cerebrovascular function is unclear. The aim of this systematic review and meta-analysis was to examine the literature investigating CBF and CVR in pre- compared with post-menopausal women METHODS: Five databases were searched for studies assessing CBF or CVR in pre- and post-menopausal women. Meta-analysis examined the effect of menopausal status on middle cerebral artery velocity (MCAv), and GRADE-assessed evidence certainty RESULTS: Nine studies (n=504) included cerebrovascular outcomes. Six studies (n=239) reported negligible differences in MCAv between pre- and post-menopausal women [2.11cm/s (95% CI: -8.94 to 4.73, p=0.54)], but with a "low" certainty of evidence. MCAv was lower in post-menopausal women in two studies, when MCAv was adjusted for blood pressure. CVR was lower in post- compared with pre-menopausal women in two of three studies, but high-quality evidence is lacking. Across outcomes, study methodology and reporting criteria for menopause were inconsistent CONCLUSIONS: MCAv was similar in post- compared with pre-menopausal women. Methodological differences in characterising menopause and inconsistent reporting of cerebrovascular outcomes make comparisons difficult. Comprehensive assessments of cerebrovascular function of the intra- and extracranial arteries to determine the physiological implications of menopause on CBF with healthy ageing is warranted.

The relationship between personality traits, menopausal symptoms and marital adjustment

This study was aimed at determining the relationship between personality traits, menopausal symptoms and marital adjustment in postmenopausal women. This cross-sectional study was conducted with 599 postmenopausal women who presented to the family health centers between September 2018 and February 2019. Data were collected with the Personal Information Form, Marital Adjustment Test, Cervantes Personality Scale and Menopause Rating Scale. The mean marital adjustment score of the postmenopausal women was 44.03 ± 10.75. The correlation analysis revealed significant negative correlations between marital adjustment, and personality traits and menopausal symptoms. Education level, economic status, duration of menopause, neurotic and inconsistent personality traits, somatic, psychological and urogenital symptoms were determined to be statistically significant predictive factors of marital adjustment in postmenopausal women.

What women think about menopause: An Italian survey

INTRODUCTION

Menopause is a critical period for most women who experience associated symptoms while they are still socially and individually active.

OBJECTIVES

The objective of this study is to report how Italian women perceive and approach menopause.

MATERIALS AND METHODS

A survey of 1028 Italian women aged 45-65 years was conducted by the Italian Center for Studies of Social Investments (CENSIS) through anonymous interviews using two methods: CATI (Computer Assisted Telephone Interviewing) and CAWI (Computer Assisted Web Interviewing).

PRINCIPAL OUTCOME MEASURES

Principal outcome measures were women's perceptions and experiences of menopause and its treatments.

RESULTS

The global consciousness and understanding of menopause was common (82.8 %) among Italian women and it was usually considered a physiological condition (77 %). Overall, 74.6 % of the sample were postmenopausal. Hot flushes were reported to be the most frequent (37.9 %) and bothersome symptoms (43.1 %) while 12.9 % of the women were asymptomatic. As for menopausal therapies, 24.5 % were on treatment; herbal medications were the most common remedy (63.3 %) whereas 7.6 % of the women took hormone replacement therapy (HRT). About half of the sample (50.4 %) had not sought help from the Italian National Health System (INHS). Medical expertise in the field of menopause was thought to be moderately satisfactory by 54.5 % of the sample.

CONCLUSIONS

Italian women consider menopause a physiological condition. Most postmenopausal women had experienced symptoms but relied on non-hormonal treatments. The median women's satisfaction with the role of the INHS and medical competence suggests the need to improve current knowledge and awareness concerning menopause.

Lowered progesterone metabolite excretion and a variable LH excretion pattern are associated with vasomotor symptoms but not negative mood in the early perimenopausal transition: Study of Women's Health Across the Nation

OBJECTIVE

The menopausal transition is characterized by progressive changes in ovarian function and increasing circulating levels of gonadotropins, with some women having irregular menstrual cycles well before their final menstrual period. These observations indicate a progressive breakdown of the hypothalamic-pituitary-ovarian axis often associated with an increase in menopausal symptoms. Relationships between vasomotor symptoms (VMS) and depressed mood and sleep as well as a bidirectional association between VMS and depressed mood in mid-life women have been reported, but the endocrine foundations and hormone profiles associated with these symptoms have not been well described. Our objective was to determine the relationship between daily urinary hormone profiles and daily logs of affect and VMS during the early perimenopausal transition.

STUDY DESIGN

SWAN, the Study of Women's Health Across the Nation, is a large, mutli-ethnic, multisite cohort study of 3302 women aged 42-52 at baseline, designed to examine predictors of health and disease in women as they traversed the menopause. Inclusion criteria were: an intact uterus and at least one ovary present, at least one menstrual period in the previous three months, no use of sex steroid hormones in the previous three months, and not pregnant or lactating. A subset (n = 849) of women aged 43-53 years from all study sites in the first Daily Hormone Study collection were evaluated for this substudy.

OUTCOME MEASURES

We measured daily VMS, and urinary hormones: follicle stimulating hormone (FSH), luteinizing hormone (LH), pregnanediol glucuronide (PdG) and estradiol (estrone conjugate, E1C).

RESULTS

A variable pattern of LH and negative LH feedback were the hormone patterns most strongly associated with increased VMS. In contrast, no hormone pattern was significantly related to negative mood.

CONCLUSION

Fluctuations of LH associated with low progesterone production were associated with VMS but not negative mood, suggesting different endocrine patterns may be related to increased negative mood than to the occurrence of VMS.

Perception of menopause among women of Sarawak, Malaysia

Background

Various factors, including menopausal status, educational and social background, culture, and physical and emotional health, may influence women’s perceptions of menopause. This study documents the elements influencing attitudes towards menopause among women in Sarawak, Malaysia.

Methods

A face-to-face interview using a validated questionnaire was conducted with 324 Sarawakian women aged 40–65 to determine the mean age of menopause and perceptions and experiences of menopause among these women.

Results

The mean age ± standard deviation of the women was 51.37 ± 5.91 years. Ninety (27.8%) participants were premenopausal, 124 (38.5%) perimenopausal and 110 (33.7%) postmenopausal. The majority of these women (228; 70.4%) were local indigenous inhabitants of Sarawak. The findings show that 22.5% of the participants agreed that problems during menopause are a natural process. While 21.9% of the participants suggested that menopause should be treated medically, 32.3% argued that natural approaches for menopause symptoms are better than hormonal treatments. Seventy-five per cent of the women agreed that the absence of menses after menopause is a relief; meanwhile, 61.2% stated that menopause causes unpleasant symptoms. Notably, 51.7% were not sure whether women become less sexually attractive after menopause, and 51.1% were uncertain as to whether they feel less of a woman following menopause. Finally, 81.7% of participants were unsure if sexual activity is more enjoyable after menopause, and 71.9% were uncertain whether changes in life during menopause are more stressful. Among the different menopausal stages, the premenopausal group of women were noted to have more positive perceptions of menopause compared to the peri- and postmenopausal women. The study also observed that women with a better educational background generally had more positive perceptions of menopause.

Conclusions

The women’s perceptions of menopause in this study were found to correspond to those in other studies on Asian women. Women with higher levels of education and premenopausal women comparatively expressed more positive opinions regarding menopause. Lastly, most of the women noted that menopausal symptoms are unpleasant, but that the absence of menses after menopause is a relief.

Bone Mineral Density in Different Menopause Stages is Associated with Follicle Stimulating Hormone Levels in Healthy Women

Although estradiol (E2) has been believed to be the most critical factor in the menopause-associated decrease in bone mineral density (BMD), the role of increasing follicle stimulating hormone (FSH) during menopause is relatively unclear. We determined the extent to which hip and lumbar spine BMD differ among the stages of menopause in healthy women, and whether BMD is associated with FSH and E2 levels. A cross-sectional study of 141 healthy women classified as premenopausal (Pre; 38 ± 6 yrs; mean ± SD, n = 30), early perimenopausal (EPeri; 50 ± 3yrs, n = 31), late perimenopausal (LPeri; 50 ± 4yrs, n = 30), early postmenopausal (EPost; 55 ± 3yrs, n = 24), or late postmenopausal (LPost; 62 ± 4 yrs, n = 26), was conducted. Spine/hip BMD and sex hormones were measured using dual-energy X-ray absorptiometry and enzymatic/colorimetric methods, respectively. Compared to EPeri, spine BMD was lower (p < 0.05) in LPeri, EPost, and LPost and hip BMD was lower (p < 0.05) in EPost and LPost. BMD was inversely associated with FSH (spine: r = -0.341; hip: r = -0.271, p < 0.05) and directly associated with E2 (spine: r = 0.274; hip: r = 0.256, p < 0.05). The menopause-related loss of spine and hip BMD is associated not only with low E2 but also higher FSH. Future studies are essential to delineating the mechanisms by which FSH regulates bone health in aging women.

Decline in endothelial function across the menopause transition in healthy women is related to decreased estradiol and increased oxidative stress

Endothelial function declines progressively across stages of the menopause transition; however, the mechanisms contributing to this decline are unknown. We hypothesized that differences in endothelial function among pre-, peri, and postmenopausal women are related to differences in estradiol and oxidative stress. Brachial artery flow-mediated dilation (FMD) was measured in 87 healthy women categorized by menopause stage (24 premenopausal, 17 early and 21 late perimenopausal, and 25 postmenopausal) before and after 3 days of ovarian hormone suppression (gonadotropin releasing hormone antagonist [GnRHant]) alone, and an additional 3 days of GnRHant with concurrent transdermal estradiol or placebo add-back treatment. In 82 women, FMD during acute vitamin C (antioxidant) infusion was measured before and after GnRHant + add-back. Before GnRHant, FMD was different among groups (p < 0.005; reduced across stages of menopause). Vitamin C increased FMD in late peri- and post- (p < 0.005) but not pre- or early perimenopausal women (p > 0.54). After GnRHant alone, FMD decreased in pre- and peri- (p < 0.01), but not postmenopausal women, and was restored to premenopausal levels by estradiol add-back in the pre- and perimenopausal groups. Vitamin C improved FMD in pre-, peri-, and postmenopausal women on GnRHant + placebo. There was no effect of vitamin C on FMD in women on GnRHant + estradiol. These observations support the concept that the decline in endothelial function across the menopause transition is related to the loss of ovarian estradiol. The decline in estradiol may alter redox balance, thereby increasing oxidative stress and impairing endothelial function.

Musculoskeletal Pain during the Menopausal Transition: A Systematic Review and Meta-Analysis

Musculoskeletal pain (MSP) is one of the most severe complaints in women undergoing menopause. The prevalence of MSP varied when taking the menopausal state and age factor into consideration. This study investigated the prevalence of MSP in perimenopausal women and its association with menopausal state. The MEDLINE, Embase, Web of Science, and PubMed databases were searched from inception to July 2020, and 16 studies were retrieved for the current meta-analysis. The primary outcome measure was the MSP Odds Ratio (OR). The estimated overall prevalence of MSP among perimenopausal women was 71% (4144 out of 5836, 95% confidence interval (CI): 64%-78%). Perimenopausal women demonstrated a higher risk for MSP than premenopausal ones (OR: 1.63, 95% CI: 1.35-1.96, P = 0.008, I² = 59.7%), but similar to that in postmenopausal ones (OR: 1.07, 95% CI: 0.95–1.20, P = 0.316, I² = 13.4%). The postmenopausal women were at a higher risk of moderate/severe MSP than the premenopausal ones (OR: 1.45, 95% CI: 1.21-1.75, P = 0.302, I² = 16.5%) or the perimenopausal ones (OR: 1.40, 95% CI: 1.09–1.79, P = 0.106, I² = 55.4%). In conclusion, the perimenopause is a state during which women are particularly predisposed to develop MSP. As to moderate to severe degrees of MSP, the odds increase linearly with age, from premenopause to peri- and then to postmenopause.

N1-Methylnicotinamide: An Anti-Ovarian Aging Hormetin?

Ovarian aging occurs due to the reduction of the quality and quantity of the oocytes, and is regulated by mitochondrial survival and apoptotic signals. Reactive Oxygen Species (ROS) are one of those signals considered detrimental to cellular homeostasis. Nowadays, ROS are regarded as a regulatory factor at low levels as it induces the stress resistance which in turn increases the longevity. It is believed that the main mechanism for the life-promoting role of the ROS mediated by the 5' Adenosine Monophosphate-activated Protein Kinase (AMPK). N1-Methylnicotinamide (MNAM) is well known for its anti-diabetic, anti-thrombotic, and anti-inflammatory activity. Aldehyde oxidase 1 (AOX1) is a detoxifying enzyme, which metabolizes the MNAM and produces two metabolites including N1-methyl-2-pyridone-5- carboxamide (2py) and N1-methyl-4-pyridone-3-carboxamide (4py). The activity of AOX1 enhances the production of ROS and improves the longevity. It has been reported that the MNAM could postpone the aging through the induction of low-level stress. It has been documented that the production of MNAM is significantly higher in the cumulus cells of the patients with Polycystic Ovary Syndrome (PCOS) and its administration on the rat model of PCOS has been shown to alleviate the hyperandrogenism and successfully activate the ovarian AMPK. Therefore, it can be hypothesized that the anti-ovarian aging effects of the MNAM are possibly based on the activation of AMPK through transient elevation of the ROS.

Appendicular lean mass is lower in late compared with early perimenopausal women: potential role of FSH

Age-related declines in skeletal muscle mass (i.e., sarcopenia) contribute to physical disability in older women. Although a menopause-related increase in fat mass is well documented, whether menopause influences muscle mass and sarcopenia is unclear. We determined the extent to which skeletal muscle mass differs across the stages of the menopause transition in women and whether these differences are associated with estradiol or other sex hormones. This was a cross-sectional study of 144 healthy women (aged 30-70 yr) classified as premenopausal [n = 30, 38 ± 6 yr (means ± SD)], early (n = 31, 50 ± 3 yr) and late (n = 30, 50 ± 4 yr) perimenopausal, and early (n = 26, 55 ± 3 yr) and late (n = 27, 62 ± 4 yr) postmenopausal. Appendicular lean mass (ALM) adjusted by the square of height in meters (ALM index; ALMi) was assessed by dual-energy X-ray absorptiometry. ALMi was lower (P < 0.05) in late perimenopausal and postmenopausal compared with early perimenopausal, with no significant differences between other groups (premenopausal 6.6 ± 0.6, early perimenopausal 6.8 ± 0.8, late perimenopausal 6.1 ± 0.8, early postmenopausal 6.5 ± 1.1, and late postmenopausal 6.2 ± 0.9 kg/m²). The prevalence of sarcopenia (ALMi ≤ 5.67 kg/m²) was 7%, 3%, 30%, 27%, and 32% in premenopausal, early and late perimenopausal, and early and late postmenopausal groups, respectively. ALMi measured across menopause stages was inversely correlated to follicle-stimulating hormone (FSH; r = -0.28, P = 0.003) but not to estradiol (r = 0.088, P = 0.34). The menopause transition appears to be a vulnerable period for the loss of skeletal muscle mass that may begin during the late perimenopausal transition. Future studies are necessary to investigate the potential effect of FSH on skeletal muscle.NEW & NOTEWORTHY Our data suggest that the late perimenopausal stage may be a vulnerable period for the loss of skeletal muscle, potentially related to elevations in FSH.

Age and leptinemia association with anxiety and depression symptoms in overweight middle-aged women

OBJECTIVE

The aim of the study was to investigate the effect of menopause and of postmenopausal stages on depression and anxiety symptoms, and whether these symptoms associate with anthropometric, metabolic, and hormonal parameters in midlife women.

METHODS

Postmenopausal women (age 50-65), either at early (EPM, n=33) or late (LPM, n = 23) postmenopause, and 23 premenopausal controls (PreM, age 40-50), matched for BMI with the PM groups, were studied. Blood biochemical and hormonal determinations, bioimpedance anthropometry, and depression and anxiety symptoms (Beck's depression [BDI] and anxiety [BAI] inventories) were conducted.

RESULTS

The BAI score was higher in both PM groups than in the PreM group. In contrast, only the LPM group showed a significantly elevated BDI score. All groups presented overweight and abdominal obesity, having similar BMI and waist/hip ratio values. Both PM groups showed insulin resistance, whereas only the LPM group presented decreased skeletal muscle mass and basal metabolic rate. Correlation analysis, including all 79 middle-aged women, showed age, percentage body fat, waist/hip ratio, and leptinemia to correlate positively with the anxiety and depression scores. Multivariate regression showed leptin and age to associate positively with depressive- and anxious-like symptoms.

CONCLUSIONS

Postmenopausal women presented impaired body composition, energy expenditure, insulin sensitivity, and mental symptoms, in comparison to similarly overweight premenopausal women. Among all the overweight midlife women, these symptoms were more strongly associated with age and leptin levels than with reproductive aging itself. The data indicate that, among overweight middle-aged women with abdominal obesity, the aging process and the development of leptin resistance are associated with impairment of mental health.

Effects of resveratrol or estradiol on postexercise endothelial function in estrogen-deficient postmenopausal women

Regular exercise enhances endothelial function in older men, but not consistently in estrogen-deficient postmenopausal women. Estradiol treatment improves basal endothelial function and restores improvements in endothelial function (flow-mediated dilation, FMD) to aerobic exercise training in postmenopausal women; however, estradiol treatment is controversial. Resveratrol, an estrogen receptor ligand, enhances exercise training effects on cardiovascular function and nitric oxide (NO) release in animal models, but impairs exercise training effects in men. We conducted a randomized cross-over, double-blinded, placebo-controlled pilot study to determine whether acute (single dose) resveratrol (250-mg tablet) or estradiol (0.05 mg/day transdermal patch) treatment enhances FMD at rest and after a single bout of moderate-intensity aerobic exercise in healthy estrogen-deficient postmenopausal women (n = 15, 58.1 ± 3.2 yr). FMD was measured before and after (30, 60, and 120 min) a 40-min bout of moderate-intensity treadmill exercise (60-75% peak heart rate) under the respective conditions (separated by 1-2 wk). FMD was higher (P < 0.05) before exercise and at all post-exercise time points in the resveratrol and estradiol conditions compared to placebo. FMD was increased from baseline by 120 min postexercise in the estradiol condition (P < 0.001), but not resveratrol or PL conditions. Consistent with our previous findings, estradiol also enhances endothelial function in response to acute endurance exercise. Although resveratrol improved basal FMD, there was no apparent enhancement of FMD to acute exercise and, therefore, may not act as an estradiol mimetic.NEW & NOTEWORTHY The benefits of endurance exercise training on endothelial function are diminished in estrogen-deficient postmenopausal women, but estradiol treatment appears to restore improvements in endothelial function in this group. We show that basal endothelial function is enhanced with both acute estradiol and resveratrol treatments in estrogen-deficient postmenopausal women, but endothelial function is only enhanced following acute endurance exercise with estradiol treatment.

Impact of Health-Promoting Lifestyle Education Intervention on Health-Promoting Behaviors and Health Status of Postmenopausal Women: A Quasi-Experimental Study from Sri Lanka

Health promotion through lifestyle education is an important measure to enhance health status of postmenopausal women (PMW). This study evaluated the effectiveness of health-promoting lifestyle education intervention (HPLEI) on adhering to health-promoting behaviors (HPB) and enhancing the health status in a group of Sri Lankan PMW. A quasi-experimental study was conducted with randomly selected, sociodemographic status matched, 72 PMW from two geographically separated areas in Galle District, Sri Lanka, allocated as experimental (n = 37, 54.6 ± 4.5 years) and control (n = 35, 56.5 ± 3.4 years) groups. Education intervention focused on postmenopausal health management including lifestyle modifications was performed only for the experimental group during 8 weeks, and a health education package was provided. The control group was not given any planned education programme. Both groups were followed up for a 6-month period. HPB and menopausal symptoms severity were evaluated by validated Health Promoting Lifestyle Profile-II and Menopause Rating Scale, respectively. Anthropometric adiposity indices (AAIs) including weight, body mass index (BMI), waist (WC) and hip (HC) circumferences, and waist to hip ratio (WHR); cardiovascular disease risk indicators (CVDRI) including systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood sugar (FBS), total cholesterol and triglycerides, muscle strength; hand grip strength (HGS) and physical performance (PP); gait speed (GS) were measured. All parameters were evaluated before the intervention (baseline) and after follow-up of 6 months. All evaluated parameters were not different between experimental and control groups (p > 0.05) at the baseline. In the follow-up evaluation, HPB (p < 0.001), menopausal symptom scores (p < 0.001), AAI (p < 0.001), CVDRI (SBP, DBP, and FBS) (p < 0.05) and HGS and GS (p < 0.001) were significantly improved in the experimental group but not in the control group. Health education intervention focused on health-promoting lifestyle modifications is effective in improving the adherence to HPB and enhances the health status in PMW. This provides positive impact in lifestyle medicine.

Aging women and their endothelium: probing the relative role of estrogen on vasodilator function

Despite significant decreases in cardiovascular disease (CVD) mortality in the past three decades, it still remains the leading cause of death in women. Following menopause and the accompanying loss of estrogen, women experience a unique, accelerated rise in CVD risk factors. Dysfunction of the endothelium represents an important antecedent to CVD development, with rapid declines in endothelial vasodilator function reportedly taking place across the menopause transition. Importantly, the decline in endothelial function is independent of chronological age and is associated with estrogen deficiency. Estrogen-mediated effects, including increasing nitric oxide bioavailability and attenuating oxidative stress and inflammation, contribute to preserving endothelial health. This review will discuss studies that have probed the role of estrogen on endothelial vasodilator function in women at discrete stages of the menopause transition and the effects of estradiol supplementation in postmenopausal women. Estrogen receptor signaling is also an important aspect of endothelial function in women, and studies suggest that expression is reduced with both acute and prolonged estrogen deficiency. Changes in regulatory mechanisms of estrogen receptor-α expression as well as sensitivity to estrogen may underlie the differential effects of estrogen therapy in early (≤5 yr past final menstrual period) and late postmenopausal women (>5 yr past final menstrual period). Lastly, this review presents potential therapeutic targets that include increasing l-arginine bioavailability and estrogen receptor activation to prevent endothelial dysfunction in postmenopausal women as a strategy for decreasing CVD mortality in this high-risk population.

Elevated plasma homocysteine and cysteine are associated with endothelial dysfunction across menopausal stages in healthy women

Hyperhomocysteinemia is associated with endothelial dysfunction and increased cardiovascular disease (CVD). We determined whether elevated homocysteine (Hcy) and markers of Hcy metabolism were associated with the previously reported endothelial dysfunction across stages of the menopause transition. Brachial artery flow-mediated dilation (FMD) and plasma concentrations of Hcy, cysteine, and methionine were measured in healthy women (n = 128) 22-70 yr of age categorized as premenopausal (n = 35), perimenopausal (early: n = 16; late: n = 21), and postmenopausal (early: n = 21; late: n = 35). Dietary intake of micronutrients involved in Hcy metabolism (e.g., vitamins B6, B12, folate) was assessed in a subpopulation of women. Hcy and cysteine concentrations were progressively higher, and methionine was progressively lower across menopausal stages (all P < 0.005). The higher Hcy and cysteine concentrations correlated with lower circulating estradiol levels (r = -0.49 and -0.50, respectively, both P < 0.001). FMD was inversely correlated with Hcy (r = -0.25, P = 0.004) and cysteine (r = -0.39, P < 0.001) and positively correlated with methionine concentrations (r = 0.25, P = 0.005). Dietary intake of vitamins B6 and B12 (both P < 0.05) were lower in postmenopausal women. Vitamin B12 intake correlated with FMD (r = 0.22, P = 0.006). These data suggest that declines in estradiol across stages of the menopause transition may lead to elevations in Hcy and cysteine that may contribute to endothelial dysfunction in postmenopausal women. Future studies should examine whether targeting Hcy metabolism during the perimenopausal to early postmenopausal period with interventions, including diet, attenuates or reverses the decline in endothelial function in women. NEW & NOTEWORTHY Declines in circulating estradiol across the stages of the menopausal transition may lead to elevations in Hcy and cysteine concentrations that may contribute to endothelial dysfunction. Abnormalities in the Hcy metabolic pathways, possibly related to dietary deficiencies of vitamins B12 and B6 and folate, may contribute to elevations in Hcy and cysteine concentrations. Findings also suggest that higher cysteine levels may be more damaging to the vascular endothelium than Hcy.

Management of the Perimenopause

Perimenopause, or the menopausal transition, represents a period of time during which newly arising symptoms can present complex management decisions for providers. Many women present to care with complaints of hot flashes, vaginal and sexual changes, altered mood and sleep, and changing bleeding patterns. The effect of these symptoms on quality of life, even before a woman enters menopause, can be significant. The appropriate evaluation and evidence-based management of women in this transition is reviewed in this article. Two case vignettes are used to highlight certain evaluation and treatment challenges.

Testosterone is related to GABA+ levels in the posterior-cingulate in unmedicated depressed women during reproductive life

BACKGROUND

The role of testosterone (T) in the pathophysiology of affective disorders and anxiety is broadly supported. Evidence suggests that T has anxiolytic and antidepressant properties. One proposed route for the central effects of T is its interaction with the gamma-aminobutyric acid (GABA) system. We explored the relationship between T levels and GABA+ levels in anterior-cingulate (ACC) and the posterior-cingulate (PCC) regions in depressed women, using magnetic resonance spectroscopy (1H-MRS).

METHODS

Twenty-one depressed patients with regularly cycling who were not taking hormonal or psychotropic drugs were recruited. We assessed severity of depression using the Hamilton Depression Rating Scale (HDRS). Blood samples were taken for quantification of free (FT) and total testosterone (TT) on the day of the magnetic resonance (MR) scan. We evaluated GABA+ levels in the PCC and ACC, using the Hadamard Encoding and Reconstruction of MEGA-Edited Spectroscopy (HERMES) sequence. Pearson correlations were used to evaluate the association between FT, TT, GABA+ concentrations, and HDRS scores.

RESULTS

TT and FT levels were positively correlated with GABA+ levels in the PCC. No correlation was observed between T levels and GABA+ levels in the ACC. The HDRS total scores correlated negatively with FT levels.

LIMITATIONS

Limitations include the cross-sectional evaluation and the lack of a comparative healthy group.

CONCLUSIONS

Our findings suggest that the potential anxiolytic and antidepressant properties of T are related to increased GABA+ levels in the PCC. This observation may contribute to increased understanding of the role of T in depressive and anxiety symptoms in women.

Retrograde and oscillatory shear increase across the menopause transition

Declines in endothelial function can take place rapidly across the menopause transition, placing women at heightened risk for atherosclerosis. Disturbed patterns of conduit artery shear, characterized by greater oscillatory and retrograde shear, are associated with endothelial dysfunction but have yet to be described across menopause. Healthy women, who were not on hormone therapy or contraceptives, were classified into early perimenopausal, late perimenopausal, and early postmenopausal stage. Resting antegrade, retrograde, and oscillatory shear were calculated from blood velocity and diameter measured in the brachial and common femoral artery using Doppler ultrasound. Serum was collected for measurements of estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone. After adjusting for age, brachial artery oscillatory shear was significantly higher in early postmenopausal women (n = 15, 0.17 ± 0.08 a.u.) than both early (n = 12, 0.08 ± 0.05 a.u., P < 0.05) and late (n = 8, 0.08 ± 0.04 a.u) perimenopausal women, and retrograde shear was significantly greater in early postmenopausal versus early perimenopausal women (-19.47 ± 12.97 vs. -9.62 ± 6.11 sec-1 , both P < 0.05). Femoral artery oscillatory and retrograde shear were greater, respectively, in early postmenopausal women (n = 15, 0.19 ± 0.08 a.u.; -13.57 ± 5.82 sec-1 ) than early perimenopausal women (n = 14, 0.11 ± 0.08 a.u.; -8.13 ± 4.43 sec-1 , P < 0.05). Further, Pearson correlation analyses revealed significant associations between FSH and both retrograde and oscillatory shear, respectively, in the brachial (r = -0.40, P = 0.03; r = 0.43, P = 0.02) and common femoral artery (r = -0.45, P = 0.01; r = 0.56, P = 0.001). These results suggest menopause, and its associated changes in reproductive hormones, adversely influences conduit arterial shear rate patterns to greater oscillatory and retrograde shear rates.

Intersection between gonadal function and vascular aging in women

Vascular aging, characterized by endothelial dysfunction and large elastic arterial stiffening, is a major risk factor for age-associated cardiovascular disease (CVD). Although women have a lower prevalence of CVD until midlife, prevalence rates increase rapidly coincident with the menopausal transition to match those observed in men. The menopausal transition, or perimenopause, is a chaotic period that is associated with increased symptoms (e.g., hot flashes, depressed mood, anxiety, sleep disturbances) and CVD risk factors due to changes in the hormonal environment. Because these quality of life factors and CVD risk factors also change with aging, the arteries of women appear to endure a double insult. Our laboratory has been investigating how changes in gonadal function and hormone levels with the menopause transition impacts the vascular aging process in healthy women. Our work has shown that vascular endothelial function progressively declines, and large elastic arterial stiffness is greater across the stages of the menopausal transition. This acceleration in vascular aging may be due to the loss of vasodilatory, antioxidant, anti-inflammatory, and antiproliferative effects of estradiol on the vascular wall. This minireview discusses the impact of changes in gonadal function and hormones with the menopausal transition on vascular aging in women and areas for investigations to further our understanding of the intersection between gonadal function and vascular aging.

Vascular dysfunction across the stages of the menopausal transition is associated with menopausal symptoms and quality of life

OBJECTIVE

The menopausal transition is associated with somatic symptoms and increased rates of depression, which can impair quality of life (QOL) and increase cardiovascular disease (CVD) risk. This period is also associated with accelerated vascular aging (arterial stiffening and endothelial dysfunction), an antecedent to CVD. This secondary analysis sought to explore associations between depression, menopausal symptoms and QOL, and vascular aging across menopause stages.

METHODS

Arterial stiffness (carotid artery compliance), endothelial function (brachial artery flow-mediated dilation [FMD]), menopausal symptoms (Menopausal Symptom List [MSL]), depression (Center for Epidemiologic Studies Depression Scale [CES-D]), and QOL (Utian QOL Scale [UQOL]) were measured in 138 women (19-70 years) classified as premenopausal (n = 41, 34 ± 8 years; mean ± SD), early (n = 25, 49 ± 3 years), or late perimenopausal (n = 26, 50 ± 4 years), or early (n = 22, 55 ± 4 years) or late postmenopausal (n = 24, 61 ± 5 years). Differences across menopause stages were determined using one-way analysis of variance; associations between vascular measures and MSL, CES-D, and UQOL were tested using Pearson's correlation analyses.

RESULTS

Menopausal symptoms, depression, and QOL worsened across menopause stages, particularly in late perimenopausal women. Vasosomatic symptom frequency, and general somatic symptom frequency and severity were inversely correlated with carotid artery compliance and FMD (r = -0.27 to -0.18, all P < 0.05). Only correlations with general somatic symptoms were significant after adjusting for multiple comparisons. Total QOL was positively correlated with carotid artery compliance (r = 0.23, P = 0.01). CES-D scores were not correlated with carotid artery compliance or FMD (r = -0.08, -0.03, P = 0.35).

CONCLUSIONS

Vascular dysfunction across the stages of menopause was associated with greater frequency and severity of menopausal symptoms, and lower QOL, but not depression. Mechanisms underlying these associations (eg, inflammation, oxidative stress) should be explored.

Development and validation of a new rating scale for perimenopausal depression-the Meno-D

The menopause transition is a time when women experience an increased risk for new onset depression, as well as relapse of depression. While there are overlapping symptoms between major depression and depression during menopause, differences suggest 'perimenopausal depression' may be a unique subtype of depression associated with characteristic symptoms. There is currently no validated scale designed to measure perimenopausal depression. The aim of the current study was to develop and validate the 'Meno-D', a self-reporting or clinician rated questionnaire, designed to rate the severity of symptoms of perimenopausal depression. The development phase of the Meno-D involved literature review, clinical observation, and focus groups. A 12-item questionnaire was developed and clinically reviewed for face validity for content. The Meno-D was administered to women experiencing symptoms of perimenopausal depression as part of a larger baseline assessment battery. Validation involved confirmatory factor analysis (CFA). The development of the Meno-D resulted in 12 items. A total of 93 participants with perimenopausal depression were involved in the baseline assessments, 82 completed the Meno-D. Factor analysis identified five sub-scales of the Meno-D "somatic; cognitive; self; sleep; sexual" with high-internal consistency; discriminant validity and a good construct and convergent validity. The Meno-D provides a unique tool for clinicians and researchers to measure the presence of perimenopausal depression.

A relative L-arginine deficiency contributes to endothelial dysfunction across the stages of the menopausal transition

Vascular endothelial function declines across the menopause transition in women. We tested the hypothesis that reduced availability of the endothelial nitric oxide synthase [eNOS] substrate L‐arginine is an underlying mechanism to vascular endothelial dysfunction across menopause stages. Endothelial function (brachial artery flow‐mediated dilation [FMD]) and plasma markers of L‐arginine metabolism (citrulline, N^G‐mono‐methyl‐ւ‐arginine [L‐NMMA] asymmetric dimethylarginine [ADMA] and N^G‐N^′G‐dimethyl‐l‐arginine [SDMA]), were measured in 129 women: 36 premenopausal (33 ± 7 years), 16 early‐ (49 ± 3 years) or 21 late‐ (50 ± 4 years) perimenopausal, and 21 early‐ (55 ± 3 years) or 35 late‐ (61 ± 4 years) postmenopausal. FMD was progressively reduced across menopause stages (P < 0.001). Menopause stage was associated with L‐arginine concentrations (P = 0.012), with higher levels in early postmenopausal compared to early and late perimenopausal women (P < 0.05). The methylarginine and eNOS inhibitor L‐NMMA was higher in early and late postmenopausal women compared to premenopausal and early and late perimenopausal women (all P < 0.001), and was inversely correlated with FMD (r = −0.30, P = 0.001). The L‐arginine/L‐NMMA ratio, a potential biomarker of relative L‐arginine levels, was lower in postmenopausal compared to either premenopausal or perimenopausal women (both P < 0.001), and was positively correlated with FMD (r = 0.33, P < 0.001). There were no differences in plasma citrulline, ADMA or SDMA across groups. These data suggest that a relative L‐arginine deficiency may be a mechanism underlying the decline in endothelial function with the menopause transition in women. The relative L‐arginine deficiency may be related to elevated levels of the methylarginine L‐NMMA, which would compete with L‐arginine for eNOS and for intracellular transport, reducing NO biosynthesis.

Circulating interleukin-8 and tumor necrosis factor-α are associated with hot flashes in healthy postmenopausal women

Introduction

Hot flashes have been postulated to be linked to systemic inflammation. This study aimed to investigate the relationship between hot flashes, pro-inflammatory factors, and leukocytes in healthy, non-obese postmenopausal women.

Participants and design

In this cross-sectional study, a total of 202 women aged 45–60 years were stratified into one of four groups according to their hot-flash status: never experienced hot flashes (Group N), mild hot flashes (Group m), moderate hot flashes (Group M), and severe hot flashes (Group S). Variables measured in this study included clinical parameters, hot flash experience, leukocytes, and fasting plasma levels of nine circulating cytokines/chemokines measured by using multiplex assays. Multiple linear regression analysis was used to evaluate the associations of hot flashes with these pro-inflammatory factors.

Settings

The study was performed in a hospital medical center.

Results

The mean values of leukocyte number were not different between these four groups. The hot flash status had a positive tendency toward increased levels of circulating IL-6 (P-trend = 0.049), IL-8 (P-trend < 0.001), TNF-α (P-trend = 0.008), and MIP1β (P-trend = 0.04). Multivariate linear regression analysis revealed that hot-flash severity was significantly associated with IL-8 (P-trend < 0.001) and TNFα (P-trend = 0.007) among these nine cytokines/chemokines after adjustment for age, menopausal duration, BMI and FSH. Multivariate analysis further revealed that severe hot flashes were strongly associated with a higher IL-8 (% difference, 37.19%; 95% confidence interval, 14.98,63.69; P < 0.001) and TNFα (51.27%; 6.64,114.57; P < 0.05).

Conclusion

The present study provides evidence that hot flashes are associated with circulating IL-8 and TNF-α in healthy postmenopausal women. It suggests that hot flashes might be related to low-grade systemic inflammation.

Endocrinology of human female sexuality, mating, and reproductive behavior

Hormones orchestrate and coordinate human female sexual development, sexuality, and reproduction in relation to three types of phenotypic changes: life history transitions such as puberty and childbirth, responses to contextual factors such as caloric intake and stress, and cyclical patterns such as the ovulatory cycle. Here, we review the endocrinology underlying women's reproductive phenotypes, including sexual orientation and gender identity, mate preferences, competition for mates, sex drive, and maternal behavior. We highlight distinctive aspects of women's sexuality such as the possession of sexual ornaments, relatively cryptic fertile windows, extended sexual behavior across the ovulatory cycle, and a period of midlife reproductive senescence-and we focus on how hormonal mechanisms were shaped by selection to produce adaptive outcomes. We conclude with suggestions for future research to elucidate how hormonal mechanisms subserve women's reproductive phenotypes.