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Park J, Chang Y, Kim JH, Choi HR, Kwon R, Lim GY, Ahn J, Kim KH, Kim H, Hong YS, Zhao D, Cho J, Guallar E, Park HY, Ryu S. Menopausal stages and overactive bladder symptoms in middle-aged women: A cross-sectional study. BJOG 2024. [PMID: 38992913 DOI: 10.1111/1471-0528.17912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/25/2024] [Accepted: 06/30/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To examine the prevalence of overactive bladder (OAB) according to menopausal stages in middle-aged women. DESIGN Cross-sectional study. SETTING Total Healthcare Center in South Korea. POPULATION Middle-aged Korean women (n=3469, mean age, 49.5 ± 2.9 years). METHODS Menopausal stages were defined according to the Stages of Reproductive Aging Workshop +10 criteria, and menopausal symptoms were assessed using the Korean version of Menopause-Specific Quality of Life (MENQOL). Logistic regression models were used to estimate prevalence ratios with 95% confidence intervals for OAB according to menopausal stage and to assess the associations with menopausal symptoms. MAIN OUTCOME MEASURES OAB symptoms were evaluated using the Overactive Bladder Symptom Score (OABSS). RESULTS The prevalence of OAB increased with menopausal stage; however, the multivariable-adjusted prevalence ratios for women in menopausal transition and postmenopausal stage were insignificant (ptrend = 0.160) compared to those for premenopausal women. Among individual OAB symptoms, the multivariable-adjusted prevalence ratios for nocturia increased with menopausal stage in a dose-response manner (ptrend = 0.005 for 1 time/day; ptrend < 0.001 for ≥2 times/day). The association between menopausal stages and nocturia occurring ≥2 times/day was evident in women without OAB and with relatively high MENQOL scores, vasomotor symptoms and difficulty sleeping. CONCLUSIONS The prevalence of OAB, particularly nocturia, increased with menopausal stage, and the association was obvious in women with other menopausal symptoms. This finding underscores the importance of addressing nocturia as a potential menopausal symptom in middle-aged women. Further studies are required to understand the mechanisms linking OAB with menopausal symptoms in middle-aged women.
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Affiliation(s)
- Jungeun Park
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Science and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hye Rin Choi
- Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Korea
- Healthcare Data Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ria Kwon
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Ga-Young Lim
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Jiin Ahn
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kye-Hyun Kim
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Soo Hong
- Department of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Di Zhao
- Department of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea
| | - Eliseo Guallar
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
| | | | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Science and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
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Kachko VA, Shulman LP, Kuznetsova IV, Uspenskaya YB, Burchakov DI. Clinical Evaluation of Effectiveness and Safety of Combined Use of Dietary Supplements Amberen ® and Smart B ® in Women with Climacteric Syndrome in Perimenopause. Adv Ther 2024:10.1007/s12325-024-02910-0. [PMID: 38904899 DOI: 10.1007/s12325-024-02910-0] [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: 02/14/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Perimenopause is a time of transition in a woman's life that links her reproductive years to the cessation of ovulation, or menopause. For many women, this time is characterized by a variety of physiological and lifestyle changes, including increasing irregularity in menstrual bleeding, frequency and severity of vasomotor symptoms, etc. Therapies evaluated specifically for the perimenopausal women are very limited. This study aimed to evaluate the effectiveness and safety of Amberen® (a succinate-based non-hormonal supplement) combined with a Smart B® (vitamin B) complex in women with typical (without complications) mild to moderate climacteric syndrome during perimenopause. METHODS Women up to 50 years of age, in perimenopause, with vasomotor and psychosomatic symptoms of the climacteric syndrome were enrolled for the study. The trial was randomized, double-blinded, placebo-controlled, comparative, and prospective. RESULTS A total of 106 participants were enrolled in the trial and, per protocol, 105 completed the trial. We observed statistically significant improvements in most of the Greene Climacteric Scale symptoms, State-Trait Anxiety Inventory (STAI), Hospital Anxiety and Depression Scale (HADS), and Well-being, Activity, and Mood (WAM) scores. The intervention was well tolerated with few adverse effects reported to be mild and transient. CONCLUSION The use of this dietary supplement is safe and eliminates or improves vasomotor and psychosomatic symptoms of climacteric symptoms in perimenopausal women: it improves sleep and cognitive abilities, lowers depression and anxiety, improves mood and well-being, and positively affects quality of life. CLINICALTRIALS GOV IDENTIFIER NCT03897738.
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Affiliation(s)
- Vera A Kachko
- Alliance Pharma plc and Alliance Pharmaceuticals Ltd. Avonbridge House, Bath Road, Chippenham, Wiltshire, SN15 2BB, England.
| | - Lee P Shulman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 250 East Superior Street, Room 05-2174, Chicago, USA
| | - Irina V Kuznetsova
- Vitbiomed Medical Center, 11 bld 2 Donskaya Street, Moscow, 119049, Russia
- International Association of Gynecologists, Endocrinologists and Therapists, 2 bld. 6 Marshal Rybalko Str., Room 14-15, Moscow, 123060, Russia
| | - Yulia B Uspenskaya
- Medsanchast No 14 LLC, 3 bld. 2 Stolyarny Pereulok, Moscow, 123022, Russia
| | - Denis I Burchakov
- NOCHU DPO "Higher School of Medicine", 3A bld. 2 Malaya Semenovskaya Street, Moscow, 107023, Russia
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Pauwaert K, Goessaert AS, Robinson D, Cardozo L, Bower W, Calders P, Mariman A, Abrams P, Tubaro A, Dmochowski R, Weiss JP, Hervé F, Depypere H, Everaert K. Nocturia in Menopausal Women: The Link Between Two Common Problems of the Middle Age. Int Urogynecol J 2024; 35:935-946. [PMID: 38436669 DOI: 10.1007/s00192-024-05743-1] [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: 05/06/2023] [Accepted: 12/29/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this review is to discuss the link between menopause and nocturia and to give an overview of the increasing prevalence, risk factors, causative factors, treatment needs and options for nocturia in peri-menopausal women. METHODS This opinion article is a narrative review based on the expertise and consensus of a variety of key opinion leaders, in combination with an extensive literature review. This literature search included a thorough analysis of potential publications on both the PubMed Database and the Web of Science and was conducted between November 2022 and December 2022. The following key words were used "nocturia" and "menopause" or "nocturnal frequency and menopause." Moreover, key words including "incidence," "prevalence," "insomnia," "estrogen therapy," "metabolic syndrome," and "hot flushes" were used in combination with the aforementioned key words. Last, the reference lists of articles obtained were screened for other relevant literature. RESULTS The perimenopause can be a trigger for inducing nocturia. Typically, obesity, body mass index (BMI), and waist circumference are risk factors for developing peri-menopausal nocturia. Presumably the development of peri-menopausal nocturia is multifactorial, with interplay among bladder, sleep, and kidney problems due to estrogen depletion after the menopause. First, impaired stimulation of estrogen receptors in the urogenital region leads to vaginal atrophy and reduced bladder capacity. Moreover, menopause is associated with an increased incidence of overactive bladder syndrome. Second, estrogen deficiency can induce salt and water diuresis through blunted circadian rhythms for the secretion of antidiuretic hormone and the activation of the renin-angiotensin-aldosterone system. Additionally, an increased incidence of sleep disorders, including vasomotor symptoms and obstructive sleep apnea signs, is observed. Oral dryness and a consequent higher fluid intake are common peri-menopausal symptoms. Higher insulin resistance and a higher risk of cardiovascular diseases may provoke nocturia. Given the impact of nocturia on general health and quality of life, bothersome nocturia should be treated. Initially, behavioral therapy should be advised. If these modifications are inadequate, specific treatment should be proposed. Systemic hormone replacement is found to have a beneficial effect on nocturia, without influencing sodium and water clearance in patients with nocturnal polyuria. It is presumed that the improvement in nocturia from hormonal treatment is due to an improvement in sleep disorders.
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Affiliation(s)
- Kim Pauwaert
- Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - An-Sofie Goessaert
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Dudley Robinson
- Department of Urogynecology, King's College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynecology, King's College Hospital, London, UK
| | - Wendy Bower
- Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Aged Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Patrick Calders
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - An Mariman
- Department of Physical Therapy, Ghent University Hospital, Ghent, Belgium
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, School of Health Sciences, Sapienza University of Rome, Rome, Italy
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University, Nashville, TN, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Health Science University, Brooklyn, NY, USA
| | - Francois Hervé
- Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Herman Depypere
- Department of Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Vicariotto F, Malfa P, Viciani E, Dell’Atti F, Squarzanti DF, Marcante A, Castagnetti A, Ponchia R, Governini L, De Leo V. Efficacy of Lactiplantibacillus plantarum PBS067, Bifidobacterium animalis subsp. lactis BL050, and Lacticaseibacillus rhamnosus LRH020 in the Amelioration of Vaginal Microbiota in Post-Menopausal Women: A Prospective Observational Clinical Trial. Nutrients 2024; 16:402. [PMID: 38337685 PMCID: PMC10857347 DOI: 10.3390/nu16030402] [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: 01/09/2024] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
The menopausal transition marks a significant physiological shift in women. Menopause-related symptoms can significantly affect a woman's quality of life and probiotics have emerged as a promising avenue. This study aims to investigate the benefits of probiotics in improving vaginal well-being and microbiota composition in post-menopausal women. A prospective observational clinical trial was carried out enrolling 50 post-menopausal healthy women, aged between 45 and 65 years old, taking a supplement containing Lactiplantibacillus plantarum PBS067, Bifidobacterium animalis subsp. lactis BL050, and Lacticaseibacillus rhamnosus LRH020 (3B CFU/day) for 28 days. Vaginal swabs were collected to evaluate microbiota fluctuation and the inflammatory pattern was recorded. A Vaginal Health Index was provided to evaluate vaginal well-being throughout the trial. Clinical outcomes revealed a decrease in menopausal symptoms. Significant improvements were observed across various parameters: a 50% enhancement in the VHI score (p < 0.0001), alongside substantial reductions in inflammatory cytokine levels. An 87.8% decrease in IL-6, 57.6% in IL-1β, and 40.8% in TNF-α was observed (p < 0.05). Moreover, the probiotic intervention facilitated the restoration of vaginal microbiota, evidenced by an increase in lactobacilli abundance. In conclusion, the combination of these specific probiotic strains, previously clinically tested in childbearing-age women, showed to be effective also for post-menopausal women.
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Affiliation(s)
| | - Patrizia Malfa
- R&D Department, SynBalance Srl, 21040 Origgio, VA, Italy;
| | - Elisa Viciani
- Wellmicro Srl, 40138 Bologna, BO, Italy; (E.V.); (A.M.); (A.C.)
| | - Federica Dell’Atti
- Immunomics Laboratory, Department of Health Sciences, Center for Translational Research on Autoimmune and Allergic Diseases (CAAD), University of Eastern Piedmont, 28100 Novara, NO, Italy;
| | | | - Andrea Marcante
- Wellmicro Srl, 40138 Bologna, BO, Italy; (E.V.); (A.M.); (A.C.)
| | | | - Rosetta Ponchia
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, SI, Italy; (R.P.); (L.G.); (V.D.L.)
| | - Laura Governini
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, SI, Italy; (R.P.); (L.G.); (V.D.L.)
| | - Vincenzo De Leo
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, SI, Italy; (R.P.); (L.G.); (V.D.L.)
- Medical Policlinic Colledoro, 53100 Siena, SI, Italy
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Wyman JF, Cain CH, Epperson CN, Fitzgerald CM, Gahagan S, Newman DK, Rudser K, Smith AL, Vaughan CP, Sutcliffe S. Urination Frequency Ranges in Healthy Women. Nurs Res 2022; 71:341-352. [PMID: 35319538 PMCID: PMC9420750 DOI: 10.1097/nnr.0000000000000595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited information on the normal range of urination frequencies in women is available to guide bladder health promotion efforts. OBJECTIVES This study used data from the Boston Area Community Health (BACH) Survey to (a) estimate normative reference ranges in daytime and nighttime urination frequencies in healthy women based on two operational definitions of "healthy" and (b) compare urination frequencies by age, race/ethnicity, and fluid intake. METHODS A secondary analysis of cross-sectional interview data collected from female participants was performed using less restrictive ("healthy") and strict ("elite healthy") inclusion criteria. All analyses were weighted to account for the BACH sampling design. Normative reference values corresponding to the middle 95% of the distribution of daytime and nighttime urination frequencies were calculated overall and stratified by age, race/ethnicity, and fluid intake. Generalized linear regression with a log-link was used to estimate rate ratios of daytime and nighttime urination frequencies by age, race/ethnicity, and fluid intake. RESULTS Of the 2,534 women who completed the BACH follow-up interviews, 1,505 women met healthy eligibility criteria, and 300 met elite healthy criteria. Overall, reference ranges for urination frequencies were 2-10 times/day and 0-4 times/night in healthy women and 2-9 times/day and 0-2 times/night in elite healthy women. Women ages 45-64 years, but not 65+ years, reported a greater number of daytime urination than those aged 31-44 years, whereas women 65+ years reported a greater number of nighttime urination. Black women reported fewer daytime urination and more nighttime urinations than White women. Women who consumed less than 49 oz daily reported fewer daytime and nighttime urinations than those who drank 50-74 oz; drinking 75+ oz had only a small effect on urination frequencies. DISCUSSION Normative reference values for daytime and nighttime urination frequencies were similar in women using strict and relaxed definitions of health. These results indicate a wide range of "normal" urination frequencies, with some differences by age, race/ethnicity, and fluid intake. Future research is needed to examine urination frequencies in minority women and whether fluid intake amount and type influence the development of lower urinary tract symptoms.
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Pérez-López FR, Vieira-Baptista P, Phillips N, Cohen-Sacher B, Fialho SCAV, Stockdale CK. Clinical manifestations and evaluation of postmenopausal vulvovaginal atrophy. Gynecol Endocrinol 2021; 37:740-745. [PMID: 34036849 DOI: 10.1080/09513590.2021.1931100] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION It is estimated that 50% of women will suffer a severe form of vulvovaginal atrophy (VVA) related to menopause. Equally, young women may temporarily present this clinical problem while receiving various pharmacological or endocrine treatments or radiotherapy. AIM To determine clinical and diagnostic exams required to confirm the presence of VVA (also referred to as atrophic vaginitis, urogenital atrophy, or genitourinary syndrome of menopause) and rule out other genital or pelvic clinical conditions. MATERIALS AND METHODS Literature review searches were carried out on the main scientific article search engines (PubMed, SciELO, Cochrane) using different clinical terms, treatments or interventions and comorbidity related to VVA. RESULTS The development and severity of VVA depend mainly on the duration of hypoestrogenism. Hypoestrogenism causes changes in the urogenital tissue, generating signs and symptoms, such as dryness, burning, soreness, itching, and irritation of the genital skin. The diagnosis can be made through anamnesis (patient history), questionnaires, physical exam, and, sometimes, complementary exams. Objective vaginal assessment is essential and can be completed with the Vaginal Health Index, the Vaginal Maturation Index, or vaginal pH in the absence of infection or semen. The exclusion of other vulvovaginal organic pathology is essential to reach an accurate diagnosis and provide adequate treatment. CONCLUSIONS The specialist should be able to identify VVA, rule out other pathologies that make a differential diagnosis and conduct proper management.
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Affiliation(s)
- Faustino R Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | - Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Porto, Portugal
- LAP, Unilabs, Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Nancy Phillips
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Bina Cohen-Sacher
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
| | - Susana C A V Fialho
- Department of Obstetrics and Gynecology, Universidade Federal Fluminense Niterói, Rio de Janeiro, Brazil
| | - Colleen K Stockdale
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Coslov N, Richardson MK, Woods NF. Symptom experience during the late reproductive stage and the menopausal transition: observations from the Women Living Better survey. Menopause 2021; 28:1012-1025. [PMID: 34313615 PMCID: PMC8549458 DOI: 10.1097/gme.0000000000001805] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the occurrence of a variety of symptoms, their frequency, bother, burden, and interference in the lives of women in the late reproductive stage (LRS) and compare their experiences to that of women in the menopausal transition (MT) stage. METHODS Women ages 35 to 55 years responded to an 82-question online survey offered by Women Living Better. Participants reported current menstrual patterns, recent changes and symptom frequency, bother, and interference. Women's cycles were classified as LRS or MT using Stages of Reproductive Aging Workshop +10 criteria. RESULTS Of 2,406 respondents, 946 met criteria for LRS and 583 for MT. Participants included 30% from outside the United States, 31% from diverse racial/ethnic groups, and 18% reported having difficulty paying for basics. A similar proportion of women in the LRS and MT+ groups reported each of the symptoms: there was a less than 10% difference for 54 of the 61 symptoms. Of mean bother ratings for all symptoms, only hot flashes differed significantly between the LRS and MT groups. LRS women experienced similar levels of symptom-related interference with personal relationships and daily living to those in the MT stage but did not anticipate these symptoms occurring until they were 50 years old. CONCLUSIONS Women in the LRS experience symptoms strikingly similar to those often associated with the MT. Women do not expect these changes until the age of 50 years or later and are surprised by such symptoms before cycle irregularity. Research about the epidemiology and management of LRS symptoms, anticipatory guidance for women, and education for clinicians who care for them warrant increased attention.
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Affiliation(s)
| | | | - Nancy Fugate Woods
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA
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Aririguzo C, Spencer BS, Freysteinson W. "You're acting womanish!" A qualitative descriptive study of the experiences of African American women in menopausal transition. J Women Aging 2021; 34:258-275. [PMID: 34024266 DOI: 10.1080/08952841.2021.1915095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study explores how African American women understand and experience menopausal transition. Data were collected from 14 women in individual interviews and a focus group of seven participants. Transcripts were analyzed using content analysis. Black Feminist Thought and Womanist Thought were the frameworks used to understand the experiences of participants. Key themes emerged including silence as a form of survival, resilience amidst the chaos, socialization for self-preservation and empowerment, and reshaping and reclaiming womanhood. African American women need to be approached from a culturally sensitive care model to address their care during this phase and to optimize health outcomes.
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Affiliation(s)
- Corletta Aririguzo
- College of Nursing and Health Sciences, Texas A&M University Corpus Christi, Corpus Christi, Texas, USA
| | - Becky S Spencer
- College of Nursing and Health Sciences, Texas Woman's University, Denton, Texas, USA
| | - Wyona Freysteinson
- College of Nursing and Health Sciences, Texas Woman's University, Houston, Texas, USA
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Transitioning to the menopausal transition: a scoping review of research on the late reproductive stage in reproductive aging. ACTA ACUST UNITED AC 2021; 28:447-466. [PMID: 33470754 DOI: 10.1097/gme.0000000000001707] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE AND OBJECTIVE In 2001 Staging Reproductive Aging Workshop conferees described the late reproductive stage (LRS) of reproductive aging as preceding the onset of the menopausal transition, yet there has been little attention to this aspect of reproductive aging. The aim of this scoping review was to examine scientific publications characterizing the LRS to map what is known about this stage with particular focus on reproductive endocrine patterns, menstrual cycle changes, and symptoms. METHODS The initial search strategy included PubMed and CINAHL searches for the phrase LRS and "human." Given a low yield of research articles, a second stage used "late reproductive age" (LRA) as a search term. These strategies yielded 9 and 26 research articles, respectively. Publications meeting inclusion criteria (data-based research studies, focus on LRS or LRA and hormonal patterns, menstrual characteristics, and symptoms) published in English were reviewed by coinvestigators. Excluded studies were related to specific diseases, such as cardiovascular disease, and treatment studies. Data were summarized using qualitative methods. To ensure adequate coverage of published research we expanded our review to a third phase in which we identified longitudinal studies of the menopausal transition. DISCUSSION AND CONCLUSIONS Studies of the LRS focused on: symptoms (anxiety and mood symptoms, bladder symptoms, urinary incontinence, urinary frequency, and nocturia) and associated factors, such as endocrine levels and gene polymorphisms; symptom clusters women experienced during the LRS; cognitive function testing results; changing patterns of physiology such as cytokines and chemokines, lipids, hormone patterns/levels; and association of lifestyle factors such as smoking with hormone levels and symptoms. The LRA search yielded a preponderance of studies of reproductive hormones (such as anti-Mullerian hormone) and menstrual cycle patterns. Remaining studies focused on symptoms, gene variants, health-related behaviors and approaches to classifying menstrual cycles. Longitudinal studies revealed reports of symptoms as well as attempts to classify the progression from the reproductive years to the menopausal transition. Study of the LRS has not been systematic and the limited number and scope of completed studies have yet to contribute a clear and complete picture of the LRS. In some, LRS provided a comparison stage against which to evaluate menopausal transition hormonal and cycle patterns and symptoms. Harmonizing the results of studies of the LRS and LRA is essential to understand more completely women's experiences of the LRS and to allow clinicians to provide better support for women during this time. The LRS also represents an ideal inflection point to promote lifestyle choices that could alter the trajectories of chronic diseases that arise in the fifth, sixth, and seventh decades of women's lives.
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Corona-Quintanilla DL, López-Juárez R, Pacheco P, Romero-Ortega MI, Castelán F, Martínez-Gómez M. Bladder and urethral dysfunction in multiparous and mature rabbits correlates with abnormal activity of pubococcygeus and bulbospongiosus muscles. Neurourol Urodyn 2020; 39:116-124. [PMID: 31578766 PMCID: PMC9271261 DOI: 10.1002/nau.24176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/16/2019] [Indexed: 11/11/2023]
Abstract
AIMS To evaluate the combined effect of age and multiparity on the micturition reflex, including pelvic floor muscle activation. METHODS Young and mature nulliparous rabbits were compared to young and mature multiparas (n = 6 per group). Cystometrograms and urethral pressure (UP) were performed while simultaneously recording the electromyogram (EMG) activity of the pubococcygeus and bulbospongiosus muscles to establish their functional correlation to urological function. RESULTS Multiparity and age significantly influence the bladder and UP affecting the voiding efficiency and intercontraction interval. Such interaction also reduced the UP threshold, timing, and duration. Other bladder and urethral variables were predominantly affected only by age. Urodynamic alterations correlated with abnormal patterns or absent EMG activity of the pubococcygeus and bulbospongiosus muscles. CONCLUSIONS The present findings strongly suggest that multiparity and age affects specific pelvic floor muscle reflex activation during micturition, and may contribute to alterations in bladder and urethral function. This data broadens our understanding of the critical role of the appropriate activity of the individual pelvic floor muscles in micturition.
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Affiliation(s)
| | - Rhode López-Juárez
- Doctorado en Ciencias Biológicas, Universidad Autónoma de Tlaxcala, Tlaxcala, México
| | - Pablo Pacheco
- Instituto de Investigaciones Biomédicas, Departamento de Biología Celular y Fisiología, Universidad Nacional Autónoma de México, Ciudad de México, México
- Instituto de Neuroetología, Universidad Veracruzana, Xalapa, Veracruz, México
| | | | - Francisco Castelán
- Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, México
- Instituto de Investigaciones Biomédicas, Departamento de Biología Celular y Fisiología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Margarita Martínez-Gómez
- Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, México
- Instituto de Investigaciones Biomédicas, Departamento de Biología Celular y Fisiología, Universidad Nacional Autónoma de México, Ciudad de México, México
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Influence of Menopausal Status on the Symptom Experience of Women Before Breast Cancer Surgery. Cancer Nurs 2019; 41:265-278. [PMID: 28945634 DOI: 10.1097/ncc.0000000000000545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Breast cancer treatments can change women's hormonal milieu and alter their symptom experience. Little is known about associations between menopausal status and menopausal symptoms in women with breast cancer before surgery. OBJECTIVE The purpose of this study was to evaluate for differences in occurrence, severity, and distress of symptoms between premenopausal and postmenopausal women before breast cancer surgery. METHODS A total of 312 women with breast cancer completed the Menopausal Symptoms Scale, a self-report measure that evaluated the occurrence, severity, and distress of 46 common symptoms associated with menopause. Regression analyses were used to evaluate for between-group differences in these symptoms. RESULTS Of the 312 patients enrolled, 37.4% (n = 116) were premenopausal, and 62.6% (n = 196) were postmenopausal. In the multivariate analysis that adjusted for 7 covariates, premenopausal patients reported higher occurrence rates for urinary frequency (P = .006) and reported lower occurrence rates for joint pain/stiffness (P = .011), difficulty falling asleep (P = .025), and vaginal dryness (P = .002). A significant interaction was found between age and menopausal status for hot flashes (P = .002), wake during the night (P = .025), and headache (P = .040). CONCLUSION Regardless of menopausal status, women reported high occurrence rates for several menopausal symptoms. Associations between some symptom occurrence rates and menopausal status depended on the patients' age. IMPLICATIONS FOR PRACTICE As part of a preoperative symptom assessment, clinicians need to consider a woman's menopausal status and salient demographic and clinical characteristics. The identification of women with a higher symptom burden will assist with more effective management.
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Ribeiro AE, Monteiro NES, Moraes AVGD, Costa-Paiva LH, Pedro AO. Can the use of probiotics in association with isoflavone improve the symptoms of genitourinary syndrome of menopause? Results from a randomized controlled trial. Menopause 2018; 26:643-652. [PMID: 30531444 DOI: 10.1097/gme.0000000000001279] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the effect of isoflavone administration, either in conjunction with probiotic use or not, on the symptoms of genitourinary syndrome of menopause, and compare the effects with those of hormone therapy. METHODS A randomized clinical trial was conducted on 60 postmenopausal women aged 40 to 60 years, randomly assigned to receive oral isoflavone (150 mg dry extract of glycine max) alone or isoflavone plus probiotic (Lactobacillus acidophilus, Lactobacillus casei, Lactococcus lactis, Bifidobacterium bifidum, and Bifidobacterium lactis) or hormone therapy (1 mg estradiol and 0.5 mg norethisterone acetate). The urogenital symptom subscale of the Menopause Rating Scale and International Consultation on Incontinence Questionnaire-Short Form were used to assess genitourinary symptoms. Vaginal maturation value, pH, vaginal health score, and vaginal flora were used to evaluate vaginal atrophy. Equol, equol intermediate, O-dimethylangolensin, and aglycones were measured using gas chromatography coupled to mass spectrometry. RESULTS After 16 weeks of treatment, the urogenital symptoms, mainly vaginal dryness and sexual problem complaints, improved significantly in the hormone therapy group. There was a significant increase in the daidzein, glycitein, equol intermediate, and O-dimethylangolensin contents after 16 weeks in the isoflavone plus probiotic group. The maturation value, vaginal pH, and vaginal flora improved in the hormone therapy group. The vaginal health score increased in the isoflavone and hormone therapy groups. CONCLUSIONS Probiotics improved the metabolism of isoflavones after 16 weeks of treatment. However, the increase in the contents of isoflavones and their metabolites failed to yield an estrogenic effect on the urogenital tract and relieve the vulvovaginal symptoms.
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Affiliation(s)
- Ana Elisa Ribeiro
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP - Universidade Estadual de Campinas), Campinas, São Paulo, Brazil
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13
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Jones HJ, Zak R, Lee KA. Sleep Disturbances in Midlife Women at the Cusp of the Menopausal Transition. J Clin Sleep Med 2018; 14:1127-1133. [PMID: 29991421 DOI: 10.5664/jcsm.7208] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/14/2018] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVES To compare causes of sleep disturbance and to compare self-reported sleep duration among groups of late premenopausal women and early perimenopausal women. METHODS In a longitudinal study of a community-based sample of healthy women 40 to 50 years of age, menstrual cycle and symptom data were collected every 2 months; anthropometric measures, a urine sample for follicle stimulating hormone (FSH), and the Pittsburgh Sleep Quality Index (PSQI) measures were collected every 6 months. RESULTS At 12 to 18 months, 206 women remained premenopausal and 69 women became perimenopausal. Poor sleep quality (PSQI score > 5) was experienced by 42% of the total cohort. Awakening to use the bathroom was the most frequent reason (81%) for sleep disturbance in the entire cohort, followed by feeling too hot (26%). However, premenopausal women were significantly more likely to awaken to use the bathroom than perimenopausal women (P = .047), and perimenopausal women were more likely than premenopausal women to awaken because of feeling too hot (P = .002). Women in early perimenopause reported shorter sleep duration (P = .007) and worse sleep quality (P = .05) than premenopausal women of similar age. CONCLUSIONS Sleep disturbance is a significant issue for midlife women regardless of age or reproductive stage. Identification of salient factors that disrupt sleep, such as nocturia prior to menopausal transition or feeling too hot early in menopausal transition, will provide direction for developing tailored intervention strategies to improve sleep and quality of life. COMMENTARY A commentary on this article appears in this issue on page 1095.
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Affiliation(s)
- Holly J Jones
- College of Nursing, University of Cincinnati, Cincinnati, Ohio
| | - Rochelle Zak
- Sleep Disorders Center, University of California, San Francisco, California
| | - Kathryn A Lee
- Department of Family Health Care Nursing, University of California, San Francisco, California
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14
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Expanding Access to Sexual and Reproductive Health Services Through Nursing Education. J Obstet Gynecol Neonatal Nurs 2017; 46:e149-e156. [DOI: 10.1016/j.jogn.2017.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 11/24/2022] Open
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Abstract
PURPOSE OF REVIEW Sexuality is an essential part of a healthy life. It can contribute significantly to the physical, psychological and social wellbeing of menopausal women, therefore, to their quality of life. This study is an overview of the most recent findings in the literature retrieved from searches of computerized databases. We extracted all notable information concerning definition, epidemiology, symptoms, diagnostic evaluation and management. RECENT FINDINGS The experience of sexuality in menopause is fundamentally shaped by the biological and psychological changes that occur on a substrate of modifications linked to the ageing process. Moreover, several additional factors, including effects of illness, medications and psychosocial stressors can contribute to sexual dysfunction. Patients should be educated about the causes of sexual dysfunction and available treatment. SUMMARY In recent years, the field of research in sexual dysfunctions has made great progress in many areas of investigation, from epidemiology to pathophysiology providing a better understanding of causes and promoting better care. However, the multifactorial nature of human sexuality still makes our ability to comprehensively treat sexual dysfunction quite difficult. An integrated approach is needed to recognize different aspects involved and to identify the proper intervention strategies for early prevention and promotion of a healthy sexuality in menopause.
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Abstract
Perimenopause, or the menopause transition, is a time in a woman's life that bridges her reproductive years through to the non-surgical cessation of ovulation, or menopause. For many women this time is one of changes: changes in gynecological issues, onset of symptoms not experienced in her youth and increasing risks for adverse medical conditions. Despite the clear changes that occur for many women during this time, one critical issue is frequently ignored, namely, that, until the onset of menopause, she is exposed to pregnancy if sexually active, and pregnancy for older reproductive women is fraught with considerable increases in morbidity and mortality compared to younger women. This paper will present a review of the reproductive issues of the perimenopause and interventions geared to preventing pregnancy and relieving menopause-related symptoms. As counseling remains a critical aspect in empowering women to make informed choices about their health care, this paper will present current evidence that will help clinicians provide accurate reproductive counseling to women in the menopause transition.
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Affiliation(s)
- A Linton
- a Section of Family Planning, Department of Obstetrics and Gynecology of the Feinberg School of Medicine of Northwestern University , Chicago , Illinois , USA
| | - A Golobof
- a Section of Family Planning, Department of Obstetrics and Gynecology of the Feinberg School of Medicine of Northwestern University , Chicago , Illinois , USA
| | - L P Shulman
- a Section of Family Planning, Department of Obstetrics and Gynecology of the Feinberg School of Medicine of Northwestern University , Chicago , Illinois , USA.,b Division of Clinical Genetics, Department of Obstetrics and Gynecology of the Feinberg School of Medicine of Northwestern University , Chicago , Illinois , USA
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