1
|
Jukic AMZ, Sandler DP, Weinberg CR, O'Brien KM. Vitamin D status and supplementation, calcium supplementation, and timing of natural menopause. Maturitas 2024; 182:107916. [PMID: 38266360 PMCID: PMC11000149 DOI: 10.1016/j.maturitas.2024.107916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/23/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
Vitamin D status has been inconsistently associated with ovarian reserve and menopause. We used data from the Sister Study cohort to examine the associations of vitamin D supplement use, total 25-hydroxyvitamin D (25OHD) level, and calcium supplement use with the timing of natural menopause. Vitamin D and calcium supplement use were assessed on a questionnaire at baseline (mean age: 46) and two follow-up time points, and characterized in multiple ways based on type, dose, and duration of use. Serum samples from a random subset of participants were analyzed for total 25OHD (25OHD3 + 25OHD2 + epi-25OHD3) using liquid chromatography-mass spectrometry. Menopause was assessed at each yearly follow-up with the question "Have you had a menstrual period in the past 12 months?"; if the response was "no", age at last menstrual period was recorded. We censored women at time of hysterectomy or medically induced menopause, death, loss to follow-up or October 2020. We used multivariable Cox proportional hazard models with age as the time scale to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs), adjusting for race/ethnicity, education, body mass index, alcohol use, smoking status, and physical activity. Among the 13,102 eligible premenopausal participants, 8897 experienced natural menopause during follow-up. Concomitant use of a multivitamin and a vitamin D supplement was associated with slightly earlier menopause (HR(CI): 1.10 (0.98, 1.24)). None of the remaining vitamin D or calcium supplement variables (alone or in combination) were meaningfully associated with timing of natural menopause. In a subsample with 25OHD measurements (n = 906), neither total 25OHD nor 25OHD3 was associated with timing of menopause. Our study includes, on average, 6 years of follow-up from an average age of 46 years and did not find associations between vitamin D or calcium supplement use and timing of menopause. Future studies should focus on a life course approach to this question and include 25OHD measures from early mid-life when examining menopause timing.
Collapse
Affiliation(s)
- Anne Marie Z Jukic
- PO BOX 12233, MD A3-05, Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC 27709, USA.
| | - Dale P Sandler
- PO BOX 12233, MD A3-05, Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC 27709, USA.
| | - Clarice R Weinberg
- PO Box 12233, MD A3-03, Biostatistics Branch, National Institute of Environmental Health Sciences, Durham, NC 27709, USA.
| | - Katie M O'Brien
- PO BOX 12233, MD A3-05, Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC 27709, USA.
| |
Collapse
|
2
|
Santos MP, Li Y, Bazzano LA, He J, Rexrode KM, Ley SH. Age at menarche, type 2 diabetes and cardiovascular disease complications in US women aged under 65 years: NHANES 1999-2018. BMJ Nutr Prev Health 2023; 6:293-300. [PMID: 38264363 PMCID: PMC10800266 DOI: 10.1136/bmjnph-2023-000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/01/2023] [Indexed: 01/25/2024] Open
Abstract
Background Diabetes and diabetes complications are on the rise in US adults aged <65 years, while onset of menarche at a younger age is also increasing. We examined the associations of age at menarche with type 2 diabetes among women aged <65 years and with cardiovascular disease (CVD) complications among women with diabetes. Methods Using the nationally representative cross-sectional National Health and Nutrition Examination Survey 1999-2018, women aged 20-65 years free of cancer were included in the current analysis. Diabetes was defined as a self-reported diabetes diagnosis. CVD was defined as coronary heart disease or stroke. Age at menarche was self-reported age of first menstruation and categorised into ≤10, 11, 12, 13, 14 and ≥15 years. Results Of 17 377 women included in the analysis, 1773 (10.2%) reported having type 2 diabetes. Earlier age at menarche was associated with type 2 diabetes compared with median age at menarche of 13 years, after adjustment for age, race/ethnicity, education, parity, menopause status and family history of diabetes, smoking status, physical activity, alcohol consumption and body mass index (p for trend=0.02). Among women with diabetes, earlier age at menarche was associated with stroke with similar adjustment (p for trend=0.03), but not with total CVD. Extremely early age at menarche (≤10 years) was significantly associated with stroke (adjusted OR 2.66 (95% CI 1.07 to 6.64)) among women aged <65 years with diabetes with similar adjustment. Conclusions Earlier age at menarche was associated with type 2 diabetes among young and middle-aged women in the USA and with stroke complications among these women living with diabetes.
Collapse
Affiliation(s)
- Maria P Santos
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Yaling Li
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Kathryn M Rexrode
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sylvia H Ley
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| |
Collapse
|
3
|
Long G, Liu C, Liang T, Zhang Z, Qin Z, Zhan X. Predictors of osteoporotic fracture in postmenopausal women: a meta-analysis. J Orthop Surg Res 2023; 18:574. [PMID: 37543616 PMCID: PMC10404374 DOI: 10.1186/s13018-023-04051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023] Open
Abstract
Osteoporosis affects more than 200 million women worldwide, with postmenopausal women being particularly susceptible to this condition and its severe sequelae disproportionately, such as osteoporotic fractures. To date, the current focus has been more on symptomatic treatment, rather than preventive measures. To address this, we performed a meta-analysis aiming to identify potential predictors of osteoporotic fractures in postmenopausal women, with the ultimate goal of identifying high-risk patients and exploring potential therapeutic approaches. We searched Embase, MEDLINE and Cochrane with search terms (postmenopausal AND fracture) AND ("risk factor" OR "predictive factor") in May 2022 for cohort and case-control studies on the predictors of osteoporotic fracture in postmenopausal women. Ten studies with 1,287,021 postmenopausal women were found eligible for analyses, in which the sample size ranged from 311 to 1,272,115. The surveyed date spanned from 1993 to 2021. Our results suggested that age, BMI, senior high school and above, parity ≥ 3, history of hypertension, history of diabetes mellitus, history of alcohol intake, age at menarche ≥ 15, age at menopause < 40, age at menopause > 50, estrogen use and vitamin D supplements were significantly associated with osteoporotic fracture in postmenopausal women. Our findings facilitate the early prediction of osteoporotic fracture in postmenopausal women and may contribute to potential therapeutic approaches. By focusing on preventive strategies and identifying high-risk individuals, we can work toward reducing the burden of osteoporosis-related fractures in this vulnerable population.
Collapse
Affiliation(s)
- Guanghua Long
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021 Guangxi China
| | - Chong Liu
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021 Guangxi China
| | - Tuo Liang
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021 Guangxi China
| | - Zide Zhang
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021 Guangxi China
| | - Zhaojie Qin
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021 Guangxi China
| | - Xinli Zhan
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021 Guangxi China
| |
Collapse
|
4
|
Yue X, Yue Z, Wang Y, Dong Z, Yang H, Yue S. Value of the Copenhagen index in the diagnosis of malignant adnexal tumors: A meta-analysis. Int J Gynaecol Obstet 2023; 160:506-515. [PMID: 35696160 DOI: 10.1002/ijgo.14310] [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: 03/15/2022] [Accepted: 06/09/2022] [Indexed: 01/20/2023]
Abstract
Ovarian cancer is a common gynecological malignant tumor. Early diagnosis is important for the prognosis of patients with ovarian cancer. To evaluate the accuracy of the Copenhagen Index (CPH-I) in detecting malignant adnexal tumors and to compare the diagnostic accuracy of CPH-I and the Risk of Ovarian Malignancy Algorithm (ROMA). PubMed, Web of Science, and Cochrane Library databases were used to retrieve eligible studies. The overall sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the (summary receiver operating characteristic) curve (AUC) were 0.81, 0.88, 6.61, 0.22, 30.43, and 0.91, respectively, in diagnosing malignant adnexal tumors. In addition, using ROMA, the sensitivity, specificity, and AUC were 0.83, 0.85, and 0.90, respectively. CPH-I showed high accuracy in diagnosing malignant adnexal tumors, which could be an alternative method with similar efficacy to ROMA. CPH-I was more advantageous in diagnosing adnexal tumors in postmenopausal women.
Collapse
Affiliation(s)
- Xiang Yue
- Second Bethune Clinical Medical College of Jilin University, Changchun, China
| | - Zhenni Yue
- Department of Gynecology, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Ying Wang
- Department of Gynecology, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Zhenjin Dong
- School of Clinical Medicine, Henan University, Kaifeng, China
| | - Hua Yang
- Department of Gynecology, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Sifeng Yue
- Department of Neonatal Pediatrics, Affiliated Hospital of Guilin Medical College, Guilin, China
| |
Collapse
|
5
|
Tang R, Luo M, Fan Y, Peng Y, Wang Y, Liu G, Wang Y, Lin S, Chen R. Menopause-specific quality of life during ovarian aging among Chinese women: A prospective cohort study. Maturitas 2022; 157:7-15. [DOI: 10.1016/j.maturitas.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
|
6
|
Metcalf CA, Johnson RL, Novick AM, Freeman EW, Sammel MD, Anthony LG, Epperson CN. Adverse childhood experiences interact with inflammation and menopause transition stage to predict verbal memory in women. Brain Behav Immun Health 2022; 20:100411. [PMID: 35079709 PMCID: PMC8777090 DOI: 10.1016/j.bbih.2022.100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Women with more adverse childhood experiences (ACEs) may face a triple threat of risk factors for cognitive concerns during the menopause transition: reduced estradiol, increased inflammation, and early life stress sequelae. Our objective was to determine the extent to which ACEs and peripheral basal inflammatory markers associate with verbal memory across the menopause transition. METHODS Penn Ovarian Aging cohort participants (n = 167) were assessed for ACEs (low (0-1) or high (≥2)) and had remaining stored blood samples at study end assayed for interleukin (IL)-6, IL-1-beta (IL-1β), C-reactive protein (CRP), and tumor necrosis factor alpha (TNF-α). Annual assessment included a verbal memory test (the Buschke Selective Reminding Test) and menopause stage determination. To estimate the effects of menopause stage, ACEs, and cytokines on verbal memory, repeated cognitive outcome measures were modeled in generalized estimating equations. Covariates included body mass index, smoking, race, education, age at baseline, and baseline verbal memory performance. Cytokine levels were log-transformed. RESULTS Advancing menopause stage was associated with worse performance on immediate verbal recall and delayed verbal recall (ps < 0.001). During perimenopause, higher ACE exposure was associated with worse immediate verbal recall at higher levels of TNF-α (slope difference p = 0.041). CONCLUSIONS Inflammation may mechanistically link ACEs and verbal memory for high ACE women during perimenopause. Reducing inflammation for these individuals may have positive impact on verbal memory across the menopause transition.
Collapse
Affiliation(s)
- Christina A. Metcalf
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Rachel L. Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Andrew M. Novick
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Ellen W. Freeman
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Mary D. Sammel
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, 80045, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Laura G. Anthony
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - C. Neill Epperson
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, 80045, USA
- Department of Family Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, 80045, USA
| |
Collapse
|
7
|
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.
Collapse
Affiliation(s)
| | | | - Nancy Fugate Woods
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA
| |
Collapse
|
8
|
Swain D, Nanda P, Das H. Impact of yoga intervention on menopausal symptoms-specific quality of life and changes in hormonal level among menopausal women. J Obstet Gynaecol Res 2021; 47:3669-3676. [PMID: 34254406 DOI: 10.1111/jog.14939] [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] [Received: 04/10/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022]
Abstract
AIM The menopause transition is experienced by women often involves troublesome symptoms due to changes in the level of reproductive hormones. Non-hormonal therapies are more commonly accepted by women than hormonal therapy for coping with the climacteric symptoms. The aim of the study was to evaluate the effects of yoga practice on menopausal symptoms, specific quality of life, and changes in hormonal levels among menopausal women. METHOD A single-blinded randomized control trial was conducted among 80 participants aged 40 of 50 years and was randomly divided into two study arms, that is, Sudarshan Kriya Yoga (SKY) and brisk walking intervention, to find the effect on the hormonal changes and menopausal quality of life (measured by MENQOL tool). The significant improvements in the outcome measures were measured by using repeated measures analysis of variance and McNemar's test. RESULTS Significant improvements in the menopausal-specific quality of life were observed in the domain of vasomotor, psychosocial, and physical symptoms (p < 0.05). The antioxidant enzymes (superoxide dismutase and glutathione peroxidase (GPX) were significantly elevated after 1 year of regular practice of SKY compared to walking intervention (p < 0.05). In contrast, no significant improvement was observed in follicle-stimulating hormone and dehydroepiandrosterone sulfate levels. The women reported no adverse events after SKY practice or brisk walking. CONCLUSION The study concluded that 1 year of SKY practice could be one of the preferred non-hormonal, lifestyle-modifying regimens for improving the overall quality of life in menopausal women.
Collapse
|
9
|
Khani S, Azizi M, Elyasi F, Kamali M, Moosazadeh M. The Prevalence of Sexual Dysfunction in the Different Menopausal Stages: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:439-472. [PMID: 38595744 PMCID: PMC10903585 DOI: 10.1080/19317611.2021.1926039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 04/17/2021] [Accepted: 04/25/2021] [Indexed: 04/11/2024]
Abstract
Objectives: Despite the noticeable advances in sexual dysfunction (SD) research in the menopausal period, scientific literature showed different reports on the prevalence of SD in the menopausal stages. The primary objective of this study was to systematically review and meta-analysis the prevalence of SD in the different menopausal stages and then meta-analysis the included studies in domains of SD separately. Methods: In this systematic review and meta-analysis, keywords were retrieved through MeSH strategy and databases such as PubMed/MEDLINE, PsycINFO, Web of Science (ISI), Scopus, ScienceDirect, SID (Scientific Information Database), Magiran, and Google scholar were searched. Manual review of retrieved citations identified additional citations. The quality of the included studies was assessed using The Newcastle-Ottawa Scale. The main outcome measure in this study was the prevalence of SD in three stages of menopause such as pre, peri, and postmenopause. Results: Of 54 included studies 81,227 menopausal aged women from different menopause stages participated and the sample sizes varied from 49 to 31,581 individuals. The articles from 17 countries worldwide were included in this study. The prevalence of SD in premenopausal aged women was ranged between 22.7% and 72.2%, in perimenopausal aged women, was 37.3-78.2% and also in postmenopausal aged women was extremely reported a wide variety of prevalence ranges and was estimated between 8.7% and 89.01%. The premenopausal women had a lower prevalence of SD compared to other stages of the menopausal period. Conclusion: The results indicated that the prevalence of SD and also domains of SD in different studies were reported much widely. This study can be used as a good resource for obstetricians to understand the high possibility of recurrence of SD and assess the sexual activity of menopausal aged women in the menopause clinic. However, based on the systematic review, more standard and high-quality studies are needed to perform regarding the prevalence of SD in menopausal periods.
Collapse
Affiliation(s)
- Soghra Khani
- Sexual and Reproductive Health Research Centre, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Marzieh Azizi
- Sexual and Reproductive Health Research Centre, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Forouzan Elyasi
- Department of Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahsa Kamali
- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| |
Collapse
|
10
|
Wu ZY, Lee YJ, Kim H, Lee J, Chung IY, Kim J, Lee S, Son BH, Kim SB, Jeong JH, Gong G, Ahn SH, Ko B. Effectiveness of a 6-Month 22.5-mg Leuprolide Acetate Depot Formulation With Tamoxifen for Postoperative Premenopausal Estrogen Suppression in Hormone Receptor-Positive Breast Cancer. Front Oncol 2021; 11:665426. [PMID: 33996592 PMCID: PMC8113853 DOI: 10.3389/fonc.2021.665426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/30/2021] [Indexed: 11/15/2022] Open
Abstract
Background In patients with hormone receptor-positive (HR+)/premenopausal breast cancer, luteinizing hormone-releasing hormone analogs (LHRHas) are used as standard endocrine treatment. Based on previous clinical studies, 1-month formulations are recommended in most breast cancer treatment guidelines, but long-acting formulations facilitate reductions in side effects and patient discomfort caused by frequent administration. However, few efficacy studies have been conducted on 6-month formulations. Therefore, this study aimed to evaluate the efficacy of 6-month formulations of LHRHas. Methods This retrospective study was conducted from January 2018 to December 2019 and involved premenopausal patients with HR+ breast cancer administered 6-month LHRHas as adjuvant treatment after surgery, and those previously administered chemotherapy or other LHRHa types were excluded. Patients’ estradiol (E2) and follicle-stimulating hormone (FSH) levels were measured before surgery, and their E2 levels were also measured at 3, 6, 12, 18, and 24 months at periodic postsurgical examinations. Results A total of 228 patients were included, and the median patient age was 44 (range, 25–54) years. The mean serum E2 and FSH levels before surgery were 69.7 (range, 4–683) pg/mL and 7.3 (range, 0.4–88.9) mIU/mL, respectively, whereas the mean serum E2 level monitored at intervals during the 6-month LHRHa administration was 5.5 (range, 4.0–52) pg/mL. No women menstruated during the follow-up period after the LHRHas administration, and the E2 levels were less than 30 pg/mL in all patients except one. Conclusions The 6-month LHRHa formulation adequately suppressed ovarian function in premenopausal patients with HR+ breast cancer. This indicates that long-acting LHRHas can be effectively used for patient convenience and that there is high compliance with long-term use.
Collapse
Affiliation(s)
- Zhen-Yu Wu
- Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Young-Jin Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Heejeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jongwon Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Saebyeol Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byung-Ho Son
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sei-Hyun Ahn
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - BeomSeok Ko
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
11
|
Cheng J, Ruan X, Zhou Q, Li Y, Du J, Jin F, Wang H, Gu M, Mueck AO. How much total ovarian tissue can be removed without compromising ovarian function? An animal study. Gynecol Endocrinol 2021; 37:240-245. [PMID: 32367735 DOI: 10.1080/09513590.2020.1760242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Removal of ovarian tissue is a new option for fertility preservation for certain cancer patients in China. The aim was to investigate the impact of stepwise removed tissue on hormone levels and follicles in rats. METHODS Six to ten-week old rats were divided into six groups (% total ovarian tissue): 1 = control (100%), 2 (75%), 3 (50%), 4 (25%), 5 (12.5%), 6 (0%, bilateral ovariectomy). Blood test was carried out fortnightly to assess estradiol (E2), progesterone (P), follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), and inhibin B (INHB). Ovaries are obtained from surgical resections and from rats sacrificed after 12 weeks. RESULTS During 12 weeks, groups 4, 5, and 6 had higher FSH and lower AMH and INHB values compared to control (p< .05), but in group 4 E2 and P was not significantly different from control (p> .05). All ovarian function parameters stopped in groups 5 and 6. Follicle morphology was not significantly different between baseline and 12 weeks after surgery in groups 1-5. CONCLUSIONS For the first time, we demonstrated that even up to 75% of total ovarian tissue can be removed without impact on E2 and P production in rats, which, if confirmed in women, would mean that hazardous (or possibly contraindicated in cancer patients) hormone therapy is not required to avoid the negative consequences of hormone depletion.
Collapse
Affiliation(s)
- Jiaojiao Cheng
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xiangyan Ruan
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Research Centre for Women's Health and University Women's Hospital of Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Qi Zhou
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yanglu Li
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Juan Du
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Fengyu Jin
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Husheng Wang
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Muqing Gu
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Alfred Otto Mueck
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Research Centre for Women's Health and University Women's Hospital of Tuebingen, University of Tuebingen, Tuebingen, Germany
| |
Collapse
|
12
|
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.
Collapse
|
13
|
Lee YJ, Wu ZY, Kim HJ, Lee JW, Chung IY, Kim J, Lee SB, Son BH, Kim SB, Jung JH, Gong G, Ahn SH, Ko B. Change in Estradiol Levels among Premenopausal Patients with Breast Cancer Treated Using Leuprolide Acetate 11.25 Milligrams 3-Month Depot and Tamoxifen. J Breast Cancer 2020; 23:553-559. [PMID: 33154830 PMCID: PMC7604376 DOI: 10.4048/jbc.2020.23.e57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
The combination of luteinizing hormone-releasing hormone analogs (LHRHa) with tamoxifen is used as a standard postoperative adjuvant therapy in patients with hormone receptor-positive/premenopausal breast cancer. Long-acting LHRHa formulations offer advantages in terms of patient convenience. However, data on the effectiveness of the 3-month (3M) acting formulation are still insufficient. This study was performed on patients who received the 3M LHRHa after surgery. The serum estradiol (E2) and follicle-stimulating hormone levels were measured before surgery, and periodically after surgery. In total, 318 patients were included in the study and analyzed. The mean E2 level before surgery was 63.7 pg/mL, while the mean E2 level during the administration of 3M LHRHa was 4.9 pg/mL. None of the patients were menstruating and had E2 values above 30.0 pg/mL. It is thought that the 3M LHRHa formulation can suppress the ovarian function effectively and be safely used to improve compliance.
Collapse
Affiliation(s)
- Young-jin Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Zhen-Yu Wu
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hee jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Ho Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sei-Hyun Ahn
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - BeomSeok Ko
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
14
|
NAMS 2019 Pre-Meeting Symposium, September 2019, Chicago Illinois: The Perimenopause. ACTA ACUST UNITED AC 2020; 27:735-745. [PMID: 32433263 DOI: 10.1097/gme.0000000000001571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The North American Menopause Society held the 2019 Pre-Meeting Symposium on September 25, 2019, in Chicago, Illinois, to review the current state of the science related to the physiology of the perimenopause and to address management of the most prevalent and pressing clinical issues. The perimenopause, as defined by the Stages of Reproductive Aging Workshop + 10, encompasses the menopause transition as well as the first year following menopause, the final menstrual period. This phase in the continuum of women's reproductive lives had been one of the least well understood. Fortunately, contributions from a number of prospective, longitudinal, decades-long studies have provided a better understanding of the perimenopause, whereas posing important new questions related to symptom interaction and linkages between symptoms and long-term health. There is now added clarity to distinguish the effects of reproductive hormonal changes from aging. The variation in symptoms, including vasomotor symptoms, among women over time including differences in experiences by ethnicity and race, provides paradigm shifts in clinical perspective. Refinements in understanding the character, timing, and potential predictive markers for menstrual cycles during the transition have emerged. From the perspective of myriad clinical management challenges, significant progress in recommendations for evaluation and therapeutic approaches has been achieved. Finally, recognizing the menopause transition as an opportunity to initiate positive lifestyle changes to enhance future health was emphasized.
Collapse
|
15
|
Rotolo O, Zinzi I, Veronese N, Cisternino AM, Reddavide R, Inguaggiato R, Leandro G, Notarnicola M, Tutino V, De Nunzio V, De Leonardis G, Guerra V, Donghia R, Fucilli F, Licinio R, Mastrosimini A, Rinaldi CCM, Daddabbo T, Giampaolo N, Iacovazzi PA, Giannico S, Caruso MG. Women in LOVe: Lacto-Ovo-Vegetarian Diet Rich in Omega-3 Improves Vasomotor Symptoms in Postmenopausal Women. An Exploratory Randomized Controlled Trial. Endocr Metab Immune Disord Drug Targets 2020; 19:1232-1239. [PMID: 31132980 DOI: 10.2174/1871530319666190528101532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES In the postmenopausal period, most women suffer vasomotor symptoms (VMS). It is well-known that VMS can worsen the quality of life. Diet seems to play a relevant role in the development of VMS, but the effect of diet on VMS is mainly limited to observational studies, and analyses of nutritional supplements. The aim of this study was thus to determine the efficacy of a lactoovo- vegetarian (LOVe) diet rich in omega-3 fatty acids vs. a lacto-ovo-vegetarian diet rich in EVO (extra-virgin olive oil) in reducing VMS frequency in postmenopausal women. METHODS A two-arms (lacto-ovo-vegetarian diet with EVO vs. lacto-ovo-vegetarian diet rich in omega-3) randomized-controlled trial with a follow-up period of 16 weeks. We considered as primary outcome the change in the Kupperman index (follow-up vs. baseline evaluation, reported as delta, D) and in its subscales. Secondary outcomes included changes in common anthropometric and biohumoral measurements. RESULTS Among 54 women randomly assigned to a study group, 40 (mean age 55.1±5.4 years) completed the study and complied with their assigned diet. Women randomized to the omega-3 group (n=18) showed significant improvements, compared to the EVO group (n=22), in Kupperman index (Δ=-11.4±9.8 vs. -5.9±8.2; p=0.045), hot flashes (Δ=-3.3±3.4 vs. -1.3±2.6; p=0.04), and a marginally significant improvement in nervousness (Δ=-1.7±1.7 vs. -0.8±1.5; p=0.07). No significant differences were observed for the secondary outcomes. No relevant side effects were reported. CONCLUSION After 16 weeks, a lacto-ovo-vegetarian diet rich in omega-3 reduced VMS frequency in postmenopausal women more than the lacto-ovo-vegetarian diet rich in EVO.
Collapse
Affiliation(s)
- Ornella Rotolo
- Ambulatory of Clinical Nutrition, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Iris Zinzi
- Ambulatory of Clinical Nutrition, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Nicola Veronese
- Ambulatory of Clinical Nutrition, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Anna M Cisternino
- Ambulatory of Clinical Nutrition, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Rosa Reddavide
- Ambulatory of Clinical Nutrition, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Rosa Inguaggiato
- Ambulatory of Clinical Nutrition, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Gioacchino Leandro
- Unit of Gastrenterology 1, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Maria Notarnicola
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Valeria Tutino
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Valentina De Nunzio
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Giampiero De Leonardis
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Vito Guerra
- Unit of Epidemiology and Biostatistics, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Rossella Donghia
- Unit of Gastrenterology 1, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Fabio Fucilli
- Unit of Radiology, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Raffaella Licinio
- Unit of Radiology, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Anna Mastrosimini
- Laboratory of Clinical Pathology, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Caterina C M Rinaldi
- Unit of Radiology, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Tiziana Daddabbo
- Unit of Radiology, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Nicola Giampaolo
- Unit of Radiology, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Palma A Iacovazzi
- Laboratory of Clinical Pathology, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Sara Giannico
- Ambulatory of Clinical Nutrition, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| | - Maria G Caruso
- Ambulatory of Clinical Nutrition, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy.,Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology, Research Hospital, IRCCS "Saverio de Bellis" of Castellana Grotte (BA), Italy
| |
Collapse
|
16
|
Harvey RE, Ranadive SM, Limberg JK, Baker SE, Nicholson WT, Curry TB, Barnes JN, Joyner MJ. Forearm vasodilatation to a β 2 -adrenergic receptor agonist in premenopausal and postmenopausal women. Exp Physiol 2020; 105:886-892. [PMID: 32170888 DOI: 10.1113/ep088452] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/10/2020] [Indexed: 01/08/2023]
Abstract
NEW FINDINGS What is the central question of this study? What is the role of β2 -adrenergic receptor (β2 AR) vasodilatation in older postmenopausal women as compared to premenopausal women and the role of nitric oxide (NO) in β2 AR-mediated vasodilatation in both groups of women? What is the main finding and its importance? β2 AR responsiveness is blunted in postmenopausal women compared to young premenopausal women. Additionally, NO may contribute to β2 AR-mediated vasodilatation in young premenopausal women. ABSTRACT β2 -Adrenergic receptor (β2 AR)-mediated vasodilatation, which is partially dependent on nitric oxide (NO) formation, is blunted in men at risk for developing hypertension. However, the role of β2 AR vasodilatation in hypertension pathophysiology in ageing postmenopausal women is unclear. Therefore, the goals of this study were to determine if forearm vasodilatation to the selective β2 AR agonist terbutaline is blunted in older postmenopausal women (59 ± 4 years) compared to young premenopausal women (27 ± 3 years) and to assess NO contribution to β2 AR-mediated vasodilatation in both groups of women. Forearm blood flow (FBF) and forearm vascular conductance (FVC) were measured using venous occlusion plethysmography at baseline and during intra-arterial infusions of terbutaline at 0.1-2.0 µg (100 ml tissue)-1 min-1 with and without the NO synthase inhibitor l-NG -monomethylarginine (l-NMMA). Mean arterial pressure was significantly greater in postmenopausal women than in young women at baseline (P = 0.01). Baseline FBF and FVC did not differ between young and postmenopausal women (P > 0.05) and rose significantly within each group during terbutaline infusion (P < 0.05). There were significant group × dose interactions for FBF (P = 0.01) and FVC (P = 0.001), indicating vasodilator responses were lower in postmenopausal women. In young women, FVC response to the highest dose of terbutaline tended to be lower with l-NMMA co-infusion vs. without l-NMMA (P = 0.05). There were no significant decreases in FBF or FVC responses to terbutaline in postmenopausal women with l-NMMA co-infusion (P > 0.05 for all). These data suggest that β2 AR responsiveness is blunted in postmenopausal women compared to young premenopausal women, and that NO may contribute to β2 AR-mediated vasodilatation in young premenopausal women.
Collapse
Affiliation(s)
- Ronée E Harvey
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sushant M Ranadive
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.,Department of Kinesiology, University of Maryland, College Park, MD, USA
| | - Jacqueline K Limberg
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.,Department of Nutrition and Exercise Physiology, University of Missouri Columbia, MO, USA
| | - Sarah E Baker
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | | | - Timothy B Curry
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Jill N Barnes
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.,Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | | |
Collapse
|
17
|
Blanken AE, Nation DA. Does Gender Influence the Relationship Between High Blood Pressure and Dementia? Highlighting Areas for Further Investigation. J Alzheimers Dis 2020; 78:23-48. [PMID: 32955459 PMCID: PMC8011824 DOI: 10.3233/jad-200245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gender differences have been noted in studies linking blood pressure to all-cause dementia, and the two most common forms of dementia: Alzheimer's disease (AD) and vascular dementia (VaD). However, how gender modifies the relationship between blood pressure and dementia remains unclear. OBJECTIVE To review evidence for a gender modifying effect on the link between blood pressure and all-cause dementia. METHODS A systematic review was conducted according to PRISMA guidelines. Sixteen out of 256 reviewed articles met inclusion criteria. RESULTS For women, higher midlife systolic blood pressure (SBP) and hypertension were both associated with greater risk of all-cause dementia, AD, and VaD, in six out of seven studies. Two of these studies reported higher midlife SBP/hypertension were associated with greater risk for all-cause dementia in women, but not men. One study reported higher midlife SBP associated with greater AD risk in women, but not men. However, another study reported that midlife hypertension associated with AD risk in men, but not women. No clear gender differences were reported in the relationship between late-life high blood pressure/hypertension with all-cause dementia or AD. CONCLUSION Studies rarely, and inconsistently, analyzed or reported gender effects. Therefore, interpretation of available evidence regarding the role of gender in blood pressure associated dementia was difficult. Several studies indicated higher midlife SBP was associated with greater risk of all-cause dementia for women, compared to men. Future studies should evaluate women-specific aging processes that occur in midlife when considering the association between blood pressure and dementia risk.
Collapse
Affiliation(s)
- Anna E. Blanken
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Daniel A. Nation
- Department of Psychological Science, University of California Irvine, Irvine, CA, USA
- Institute for Memory Disorders and Neurological Impairments, University of California Irvine, Irvine, CA, USA
| |
Collapse
|
18
|
Shipeng G, Yongning C, Yadi Z, Chanyuan LI, Qifan J. [Comparison of serum cancer antigen 125, human epididymis protein 4, ROMA, and CPH-I for diagnosis of ovarian cancer in Chinese patients with ovarian mass]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:1393-1401. [PMID: 31907150 DOI: 10.12122/j.issn.1673-4254.2019.12.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the performance of serum cancer antigen 125 (CA125), human epididymis protein 4 (HE4), Risk of Ovarian Malignancy Algorithm (ROMA) and Copenhagen index (CPH-I) for differential diagnosis of benign and malignant diseases in patients with ovarian mass. METHODS We retrospectively analyzed the data of 719 women with pelvic mass, and the performance of preoperative serum levels of CA125 and HE4, ROMA and CPH-I for differential diagnosis of the masses was compared. RESULTS Of the 710 women analyzed, 531 were diagnosed with benign ovarian lesions, 44 with borderline ovarian tumors (BOTs), 119 with epithelial ovarian cancers (EOCs), and 25 with non-EOCs. In differentiating ovarian cancer (OC) and BOT from benign lesions, the area under the receiver-operator characteristic (ROC) curve (AUC) was 0.854 for HE4, 0.856 for ROMA, 0.854 for CPH-I, and 0.792 for CA125, demonstrating better diagnostic performance of HE4, ROMA, and CPH-I than CA125 alone; the diagnostic sensitivity was 56.9% for HE4, 70.2% for CA125, 69.1% for ROMA, and 63.8% for CPH-I; the specificity was the best with HE4 (94.4%) and CPH-I (94.7%). In sub-analysis of EOC vs benign lesions, the AUCs of HE4, ROMA, and CPH-I increased to 0.946, 0.947, and 0.943, respectively, all greater than that of CA125 (0.888). In other sub-analyses, HE4, ROMA, and CPH-I all showed greater AUCs than CA125 alone. CONCLUSIONS This study confirms the accuracy of HE4, ROMA, and CPH-I for differentiating malignant from benign ovarian mass, and all these 3 tests show better performance than CA125. Furthermore, HE4 and CPH-I is superior to ROMA and CA125 in terms of specificity, while CA125 and ROMA have better diagnostic sensitivities.
Collapse
Affiliation(s)
- Gong Shipeng
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Chen Yongning
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.,Department of Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Zhang Yadi
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - L I Chanyuan
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jiang Qifan
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| |
Collapse
|
19
|
Abstract
OBJECTIVE The aim of the study was to examine the associations between 25-hydroxyvitamin D (25(OH)D) and biomarkers of ovarian reserve in a large community-based sample of women. METHODS In 2010 to 2016, women aged 30 to 44 years without any known fertility problems were recruited from the Chapel Hill, NC area for a prospective time-to-pregnancy cohort study. At enrollment 561 women provided a blood sample that was used to measure 25(OH)D, anti-Müllerian hormone (AMH), follicle-stimulating hormone, and inhibin-B. Unadjusted associations were estimated with Spearman correlation coefficients. Multivariable linear regression was used to estimate associations of 25(OH)D with ovarian reserve biomarkers, after adjusting for age, race, body mass index, smoking history, and recent use of hormonal birth control. RESULTS The mean 25(OH)D was 36 ng/mL (SD = 11 ng/mL). 25(OH)D was not correlated with AMH, follicle-stimulating hormone, or inhibin-B (all r < 0.03). Multivariable results with continuous hormonal outcomes were also null. For dichotomous outcomes, there was a tendency for insufficient 25(OH)D (<30 ng/mL) to be associated with low AMH (<0.7 ng/mL) (odds ratio [95% CI]: 1.8 [0.9-4]). CONCLUSIONS For the most part, 25(OH)D was not associated with ovarian reserve biomarkers in a group of women trying to become pregnant. We found some evidence that low 25(OH)D (<30 ng/mL) was associated with low AMH, but this should be confirmed in studies with a higher prevalence of low 25(OH)D.
Collapse
|
20
|
Li Q, Wang X, Ni Y, Hao H, Liu Z, Wen S, Shao X, Wu X, Yu W, Hu W. Epidemiological characteristics and risk factors of T2DM in Chinese premenopausal and postmenopausal women. Lipids Health Dis 2019; 18:155. [PMID: 31315681 PMCID: PMC6637604 DOI: 10.1186/s12944-019-1091-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 06/20/2019] [Indexed: 12/26/2022] Open
Abstract
Objective This study was to analyse the prevalence of type 2 diabetes mellitus (T2DM) in premenopausal and postmenopausal women. Methods A total of 3227 women met the requirements from June to December in 2014, including 207 cases of premenopausal women and 3020 cases of postmenopausal women. The prevalence of T2DM and the associated risk factors in the two groups were analysed. Results The prevalence of premenopausal women with T2DM was 12.1%, while the prevalence in postmenopausal women was 19.4% (P < 0.05). Total serum protein (TP) (OR = 1.164 95% CI = 1.023–1.324) (P = 0.021) is a major risk factor for premenopausal women with T2DM. The prevalence of T2DM increased with the increase in TP. In postmenopausal groups, the prevalence of T2DM was associated with age (OR = 1.037 95% CI = 1.024–1.051) (P < 0.001), BMI (OR = 1.076 95% CI = 1.044–1.109) (P < 0.001), blood pressure (OR = 1.521 95% CI = 1.234–1.875) (P < 0.001), triglycerides (TG) (OR = 1.106 95% CI = 1.027–1.190) (P = 0.008), blood urea nitrogen (BUN) (OR = 1.065 95% CI = 1.004–1.129) (P = 0.036), alanine aminotransferase (ALT) (OR = 1.009 95% CI = 1.003–1.016) (P = 0.004) and TP (OR = 1.031 95% CI = 1.005–1.057) (P = 0.018). Conclusions Postmenopausal women have a higher rate of type 2 diabetes than premenopausal women. TP is a major risk factor for premenopausal women with T2DM. TP, ALT, and BUN are postmenopausal risk factors in addition to traditional risk factors such as obesity, lipidaemia and blood pressure. We should monitor risk factors and take early prevention and intervention measures to reduce the prevalence of diabetes and improve the quality of life of postmenopausal women. Trial registration ChiCTR, ChiCTR-TRC-14005029. Registered 29 July 2014,http://www.chictr.org.cn/showproj.aspx?proj=4545
Collapse
Affiliation(s)
- Qingjun Li
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Xiaoqing Wang
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Yaojun Ni
- Department of Cardiothoracic Surgery, Hospital Affiliated to Nanjing Medical College and Huai'an First People's Hospital, Huai'an, 223001, China
| | - Hairong Hao
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Ziyu Liu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Surong Wen
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Xiaojuan Shao
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Xiaojuan Wu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Weinan Yu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China.
| | - Wen Hu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223001, China.
| |
Collapse
|
21
|
Facial Sadness Recognition is Modulated by Estrogen Receptor Gene Polymorphisms in Healthy Females. Brain Sci 2018; 8:brainsci8120219. [PMID: 30544539 PMCID: PMC6315436 DOI: 10.3390/brainsci8120219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/26/2018] [Accepted: 12/04/2018] [Indexed: 02/06/2023] Open
Abstract
Polymorphisms of the estrogen receptor ESR1 and ESR2 genes have been linked with cognitive deficits and affective disorders. The effects of these genetic variants on emotional processing in females with low estrogen levels are not well known. The aim was to explore the impact of the ESR1 and ESR2 genes on the responses to the facial emotion recognition task in females. Postmenopausal healthy female volunteers were genotyped for the polymorphisms Xbal and PvuII of ESR1 and the polymorphism rs1256030 of ESR2. The effect of these polymorphisms on the response to the facial emotion recognition of the emotions happiness, sadness, disgust, anger, surprise, and fear was analyzed. Females carrying the P allele of the PvuII polymorphism or the X allele of the Xbal polymorphism of ESR1 easily recognized facial expressions of sadness that were more difficult for the women carrying the p allele or the x allele. They displayed higher accuracy, fast response time, more correct responses, and fewer omissions to complete the task, with a large effect size. Women carrying the ESR2 C allele of ESR2 showed a faster response time for recognizing facial expressions of anger. These findings link ESR1 and ESR2 polymorphisms in facial emotion recognition of negative emotions.
Collapse
|
22
|
Allshouse A, Pavlovic J, Santoro N. Menstrual Cycle Hormone Changes Associated with Reproductive Aging and How They May Relate to Symptoms. Obstet Gynecol Clin North Am 2018; 45:613-628. [PMID: 30401546 PMCID: PMC6226272 DOI: 10.1016/j.ogc.2018.07.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Key cycle changes occur as women transition from reproductive life to menopause, and they can be roughly linked to menopausal staging. It is important to understand the types of studies that inform the current knowledge. Patterns of symptoms within menstrual cycles (sleep, headache) generally favor worsening in association with the perimenstrual phase of the cycle, and patterns of chronic symptoms, such as hot flashes and adverse mood, appear to be worse when hormones are more variable.
Collapse
Affiliation(s)
- Amanda Allshouse
- Department of Biostatistics, Colorado School of Public Health, 13001 E 17th Place, Aurora, CO 80045, USA
| | - Jelena Pavlovic
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, 12631 East 17th Avenue, Mail Stop B-198, Aurora, CO 80045, USA.
| |
Collapse
|
23
|
Abstract
Although more than 80% of women experience some degree of psychological or physical symptoms around menopause, both women and clinicians have misconceptions about how hormonal changes relate to menopausal symptoms and psychological conditions. Recently, several large-scale, longitudinal studies have been conducted to better characterize symptoms and changes that occur around menopause. This article offers current evidence for symptoms that occur in the early menopause transition, including vasomotor symptoms, mood changes, sleep problems, and changes in sexual functioning.
Collapse
|
24
|
Passildas J, Collard O, Savoye AM, Dohou J, Ginzac A, Thivat E, Durando X, Kwiatkowski F, Penault-Llorca F, Abrial C, Mouret-Reynier MA. Impact of Chemotherapy-induced Menopause in Women of Childbearing Age With Non-metastatic Breast Cancer - Preliminary Results From the MENOCOR Study. Clin Breast Cancer 2018; 19:e74-e84. [PMID: 30448088 DOI: 10.1016/j.clbc.2018.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/26/2018] [Accepted: 10/14/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Young patients with breast cancer treated with chemotherapy can experience ovarian failure, which can lead to chemotherapy-induced menopause (CIM) impacting the quality of life (QoL). A prospective study was set out to evaluate the impact of CIM on QoL in women of childbearing age with non-metastatic breast cancer, and this article reports results of the interim analysis conducted to evaluate feasibility and to see preliminary results. PATIENTS AND METHODS A total of 58 women (age, 18-46 years) with newly diagnosed breast cancer and treated with chemotherapy were eligible. QoL was assessed by self-administered questionnaires (Quality of Life Questionnaire-Core 30 [QLQ-C30], Quality of Life Questionnaire-Breast 23 [QLQ-BR23], and Kupperman index) and hormonal variations (anti-Müllerian hormone [AMH], follicle-stimulating hormone, and estradiol) were explored. We compared patients with ≥ 12 months amenorrhea (CIM) (n = 41) to patients with < 12 months of amenorrhea (non-CIM) (n = 17). RESULTS A good inclusion rate (approximately 4/month) and sufficient data enabled us to perform this analysis. QLQ-C30 failed to show any difference between CIM and non-CIM patients (P = .5). In contrast, at 6 months post-chemotherapy, CIM patients tended to have lower QoL as shown by QLQ-BR23 (P = .16) and more severe climacteric symptoms (P = .01). Regarding hormonal variations, AMH pre-treatment level was higher in non-CIM patients (P = .0032). We also noted that CIM patients were older (P = .00013), had shorter menstruation cycle (P = .082), and experienced faster amenorrhea (P = .088). CONCLUSIONS The study is technically feasible, and our preliminary results underline that age in association with pre-treatment AMH level could be helpful to predict ovarian function. QLQ-BR23 seemed to be stronger, more precise, and appropriate to evaluate QoL changes in patients with breast cancer than the QLQ-C30.
Collapse
Affiliation(s)
- Judith Passildas
- Université Clermont Auvergne, Centre Jean Perrin, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Clermont-Ferrand, France.
| | - Olivier Collard
- Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest en Jarez, France
| | | | - Joyce Dohou
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Angeline Ginzac
- Université Clermont Auvergne, Centre Jean Perrin, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Clermont-Ferrand, France
| | - Emilie Thivat
- Université Clermont Auvergne, Centre Jean Perrin, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Clermont-Ferrand, France
| | - Xavier Durando
- Université Clermont Auvergne, Centre Jean Perrin, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Clermont-Ferrand, France
| | - Fabrice Kwiatkowski
- Université Clermont Auvergne, Centre Jean Perrin, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Clermont-Ferrand, France
| | - Frédérique Penault-Llorca
- Université Clermont Auvergne, Centre Jean Perrin, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Clermont-Ferrand, France
| | - Catherine Abrial
- Université Clermont Auvergne, Centre Jean Perrin, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Clermont-Ferrand, France
| | - Marie-Ange Mouret-Reynier
- Université Clermont Auvergne, Centre Jean Perrin, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Clermont-Ferrand, France
| |
Collapse
|
25
|
Costa-Hong VA, Muela HCS, Macedo TA, Sales ARK, Bortolotto LA. Gender differences of aortic wave reflection and influence of menopause on central blood pressure in patients with arterial hypertension. BMC Cardiovasc Disord 2018; 18:123. [PMID: 29921220 PMCID: PMC6008932 DOI: 10.1186/s12872-018-0855-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/06/2018] [Indexed: 11/25/2022] Open
Abstract
Background Evidences suggest that central hemodynamics indexes are independent predictors of future cardiovascular events and all-cause mortality. Multiple factors have been pointed to have potential influence on central aortic function: height, heart rate, left ventricular ejection duration and blood pressure level. Data related to the influence of gender and postmenopausal status on aortic waveform reflection is scarce. We aim to evaluate the impact of gender and menopause on central blood pressure of hypertensive patients. Methods In a cross sectional study 122 hypertensive patients (52 men and 70 women) were studied. Hypertension was defined as blood pressure (BP) levels ≥140/90 mmHg or use of antihypertensive drugs. Central arterial pressure, augmentation index (AIx) and augmentation index normalized to 75 bpm (AIx75) were obtained using applanation tonometry. Menopause and postmenopause history were accessed by a direct series of questions. Postmenopause was defined as at least one year since last menstruation. Patients were paired by age, gender and menopausal status, and the data were compared considering gender and menopausal status. Results Height and weight were significantly lower in women than in men at the same age. Conversely, AIx (32.7 ± 9.8% vs. 20.1 ± 11.7%, p < 0.01), AIx75 (29.6 ± 6.7% vs. 18.3 ± 9.4%, p < 0.01) and central systolic blood pressure (136 ± 30 vs. 125 ± 23 mmHg, p = 0.03) were higher in women than men. The menopausal women (mean age of menopause = 48 years) had the worst indexes of aortic wave reflection, compared to men at the same age and younger women. Conclusion Hypertensive women had both higher reflected aortic pressure waveform and central blood pressure indexes than hypertensive men, and these findings were worsened by the menopausal status.
Collapse
Affiliation(s)
- Valeria Aparecida Costa-Hong
- Heart Institute (Incor), Hypertension Unit, University of São Paulo Medical School, 2nd floor, Room 8, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, 44 - Cerqueira César, 05403-900, Brazil
| | - Henrique Cotchi Simbo Muela
- Heart Institute (Incor), Hypertension Unit, University of São Paulo Medical School, 2nd floor, Room 8, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, 44 - Cerqueira César, 05403-900, Brazil. .,Department of Physiology, Faculty of Medicine, Agostinho Neto University, Luanda, Angola.
| | - Thiago Andrade Macedo
- Heart Institute (Incor), Hypertension Unit, University of São Paulo Medical School, 2nd floor, Room 8, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, 44 - Cerqueira César, 05403-900, Brazil
| | - Allan Robson Kluser Sales
- Heart Institute (Incor), Cardiovascular Rehabilitation and Exercise Physiology Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Aparecido Bortolotto
- Heart Institute (Incor), Hypertension Unit, University of São Paulo Medical School, 2nd floor, Room 8, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, 44 - Cerqueira César, 05403-900, Brazil
| |
Collapse
|
26
|
Hakimi S, Haggi HB, Shojai SK, Farahbakhsh M, Farhan F. Comparing the Pattern of Menopausal Symptoms, Concern and Attitudes in Urban and Rural Postmenopausal Iranian Women. J Menopausal Med 2018; 24:50-55. [PMID: 29765927 PMCID: PMC5949308 DOI: 10.6118/jmm.2018.24.1.50] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/27/2018] [Accepted: 02/22/2018] [Indexed: 11/05/2022] Open
Abstract
Objectives Although hormonal changes during menopause are inevitable in this period, the severity of the menopausal symptoms can be controlled. Accepting menopause and having a positive attitude toward it can also help. Given the results of previous studies, and since environmental factors affect the pattern of menopausal symptoms the present study was conducted to compare the pattern of menopausal symptoms, concern and attitudes in urban and rural postmenopausal women. Methods This cross-sectional study was conducted on urban and rural postmenopausal women residing in and around Tabriz, Iran. Cluster sampling was used to select the subjects. The data collection tools used included a demographic questionnaire to assess women's experiences during menopause. Results This study examined 544 urban and rural postmenopausal women between March and September 2015. The women had a mean age of 51.8 ± 3.1. After adjusting the basic variables, the mean scores of menopausal symptoms and their subscales showed significantly higher scores in the physical and psychological subscales in the urban women, while the rural women had significantly higher scores in the concern subscale. Conclusions Rural women were significantly different from urban women in terms of menopausal symptoms, concern and attitudes. Hot flushes, a common menopausal symptom, and decreased sexual desire were more common in the urban women; in contrast, the rural women experienced more concern about menopause and its consequences.
Collapse
Affiliation(s)
- Sevil Hakimi
- School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| | - Hurieh Badali Haggi
- School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| | | | - Mostafa Farahbakhsh
- School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| | - Faranak Farhan
- School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| |
Collapse
|
27
|
Vargas EA, Mahalingam R. Perceptions of control and improved psychological, physical, and social functioning in postmenopausal women. J Health Psychol 2018; 25:1259-1269. [PMID: 29376414 DOI: 10.1177/1359105318754643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Throughout life, social messages about women's bodies put them at greater risk of specific psychological health conditions than men; yet little is known about what psychological factors can help promote mental health in older women. In this study, we examine how perceptions of control relate to perceptions of psychological health, in addition to physical health, and social functioning in a sample of postmenopausal women. Results suggest that increased perceptions of control relate to improved perceptions of health via a reduction in negative affect. Implications for promoting health and reducing gendered mental health disparities are discussed.
Collapse
|
28
|
Navarro-Pardo E, Holland CA, Cano A. Sex Hormones and Healthy Psychological Aging in Women. Front Aging Neurosci 2018; 9:439. [PMID: 29375366 PMCID: PMC5767260 DOI: 10.3389/fnagi.2017.00439] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 12/19/2017] [Indexed: 01/13/2023] Open
Abstract
Besides their key role in reproduction, estrogens have effects in several organs in the body, as confirmed by the identification of estrogen receptors (ER) in multiple tissues. Experimental evidence has shown that estrogens have significant impacts on the central nervous system (CNS), and a key question is to what extent the fall in estrogen levels in the blood that occurs with increasing age, particularly around and following the menopause, has an impact on the cognitive function and psychological health of women, specifically regarding mood. This review will consider direct effects of menopausal changes in estrogens on the brain, including cognitive function and mood. Secondary pathways whereby health factors affected by changes in estrogens may interact with CNS functions, such as cardiovascular factors, will be reviewed as well insofar as they also have an impact on cognitive function. Finally, because decline in estrogens may induce changes in the CNS, there is interest in clarifying whether hormone therapy may offer a beneficial balance and the impact of hormone therapy on cognition will also be considered.
Collapse
Affiliation(s)
- Esperanza Navarro-Pardo
- Department of Developmental and Educational Psychology, Universitat de Valencia, Valencia, Spain
| | - Carol A Holland
- Division of Health Research, Centre for Ageing Research, Lancaster University, Lancaster, United Kingdom
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, Universitat de Valencia, Valencia, Spain
| |
Collapse
|
29
|
Yim G, Ahn Y, Cho J, Chang Y, Ryu S, Lim JY, Park HY. The "Jolly Fat" Effect in Middle-Aged Korean Women. J Womens Health (Larchmt) 2017; 26:1236-1243. [PMID: 28922089 DOI: 10.1089/jwh.2016.6254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND It has been hypothesized that depression and obesity are bi-directionally associated, and when overweight people appear to show a lower risk of depression, this supports the "Jolly Fat" hypothesis. The aim of this study was to examine the "Jolly Fat" hypothesis in middle-aged women in Korea, by different perceived stress levels. METHODS We performed a cross-sectional study of 44 to 56 aged Korean women (n = 2201) who underwent a health check-up program at the healthcare centers of Kangbuk Samsung Hospital (Seoul and Suwon centers) in Korea. General and abdominal obesity were defined as body mass index ≥25 kg/m2 and waist circumference ≥85 cm, respectively. Depressive symptoms were measured by a Korean version of the Center for Epidemiologic Studies-Depression scale. The association between obesity and depressive symptoms was investigated by using multiple logistic regression analyses by different levels of perceived stress, with adjustment for potential confounding factors. RESULTS The prevalence of general and abdominal obesity and depressive symptoms were 23.7%, 21.4%, and 16.5%, respectively. Women with general obesity were less likely to have depressive symptoms (odds ratio [OR]: 0.50; 95% confidence interval [CI]: 0.25-1.00; p-value: 0.049) in the low-stress group. We also found that women with abdominal obesity had a 60% decrease in the odds of having depressive symptoms (OR: 0.40; 95% CI: 0.18-0.87; p-value: 0.02) in the low-stress group. No significant association was found in the high-stress group. CONCLUSIONS These findings indicate that the relationship between obesity and depressive symptoms in the Korean middle-aged women supports the "Jolly Fat" hypothesis. Further, our results underscore the role of stress as an important potential mediator exerting effects on the association between obesity and depressive symptoms.
Collapse
Affiliation(s)
- Gyeyoon Yim
- 1 Division of Cardiovascular and Rare Diseases, Center for Biomedical Science, Korea National Institute of Health , Chungcheongbuk-do, Republic of Korea
| | - Younjhin Ahn
- 1 Division of Cardiovascular and Rare Diseases, Center for Biomedical Science, Korea National Institute of Health , Chungcheongbuk-do, Republic of Korea
| | - Juhee Cho
- 2 Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University , Seoul, Republic of Korea
- 3 Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea
- 4 Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University , School of Medicine, Seoul, Republic of Korea
| | - Yoosoo Chang
- 5 Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine , Seoul, Republic of Korea
| | - Seungho Ryu
- 5 Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine , Seoul, Republic of Korea
| | - Joong-Yeon Lim
- 1 Division of Cardiovascular and Rare Diseases, Center for Biomedical Science, Korea National Institute of Health , Chungcheongbuk-do, Republic of Korea
| | - Hyun-Young Park
- 1 Division of Cardiovascular and Rare Diseases, Center for Biomedical Science, Korea National Institute of Health , Chungcheongbuk-do, Republic of Korea
| |
Collapse
|
30
|
Santoro N, Crawford SL, El Khoudary SR, Allshouse AA, Burnett-Bowie SA, Finkelstein J, Derby C, Matthews K, Kravitz HM, Harlow SD, Greendale GA, Gold EB, Kazlauskaite R, McConnell D, Neal-Perry G, Pavlovic J, Randolph J, Weiss G, Chen HY, Lasley B. Menstrual Cycle Hormone Changes in Women Traversing Menopause: Study of Women's Health Across the Nation. J Clin Endocrinol Metab 2017; 102:2218-2229. [PMID: 28368525 PMCID: PMC5505186 DOI: 10.1210/jc.2016-4017] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/17/2017] [Indexed: 12/14/2022]
Abstract
CONTEXT Menstrual cycle hormone patterns in women approaching menopause are inadequately studied. OBJECTIVE To describe day-to-day menstrual cycle hormones in women as they approach menopause from the Study of Women's Health Across the Nation Daily Hormone Study (DHS). DESIGN DHS enrollees collected daily urine for one entire menstrual cycle or up to 50 days, whichever came first, annually, up to the final menstrual period (FMP) or for up to 10 years. SETTING Seven sites across the United States. PARTICIPANTS A total of 511 premenopausal or early perimenopausal women at enrollment, within 10 years before menopause. INTERVENTION Time-to-FMP measurement. MAIN OUTCOME MEASURES Evidence of luteal activity (ELA), determined using objective algorithms. Menstrual cycle/segment length; whole cycle, and segment integrated urinary luteinizing hormone, follicle-stimulating hormone, estrone conjugates, and pregnanediol glucuronide (Pdg) for each year, organized around the FMP. RESULTS Mean menstrual cycle length was remarkably preserved at 26 to 27 days in ELA cycles; non-ELA cycles had greater variability. The percentage of cycles that were ELA remained high until 5 years before the FMP (87.9%); only 22.8% of cycles within 1 year of the FMP were ELA. Whole cycle hormones remained relatively stable up to 3 years before the FMP, when gonadotropins began to increase. Pdg excretion declined slowly with progress to the FMP, but Pdg patterns of ELA cycles remained distinguishable from non-ELA. CONCLUSIONS Menstrual cycle hormone patterns in perimenopausal women resemble those of midreproductive-aged women until 5 years before menopause, and presumably ovulatory cycles retain a potentially fertile pattern up to the end of reproductive life.
Collapse
Affiliation(s)
- Nanette Santoro
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado 80045
| | - Sybil L. Crawford
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Samar R. El Khoudary
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
| | - Amanda A. Allshouse
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado 80045
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado 80045
| | | | - Joel Finkelstein
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Carol Derby
- Departments of Neurology and Epidemiology & Population Health, Albert Einstein College of Medicine, New York, New York 10461
| | - Karen Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
| | - Howard M. Kravitz
- Departments of Psychiatry and Preventive Medicine, Rush University Medical Center, Chicago, Illinois 60612
| | - Sioban D. Harlow
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan 48109-5624
| | - Gail A. Greendale
- Department of Medicine, University of California, Los Angeles Medical Center, Los Angeles, California 90095
| | - Ellen B. Gold
- Department of Public Health Sciences, University of California Davis Health, Davis, California 95817
| | - Rasa Kazlauskaite
- Departments of Psychiatry and Preventive Medicine, Rush University Medical Center, Chicago, Illinois 60612
| | - Dan McConnell
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan 48109-5624
| | | | - Jelena Pavlovic
- Departments of Neurology and Epidemiology & Population Health, Albert Einstein College of Medicine, New York, New York 10461
| | - John Randolph
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan 48109-5624
| | - Gerson Weiss
- Department of Obstetrics and Gynecology, Rutgers-New Jersey Medical School, Newark, New Jersey 07103
| | - Hsiang-Yu Chen
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
| | - Bill Lasley
- Department of Public Health Sciences, University of California Davis Health, Davis, California 95817
| |
Collapse
|
31
|
Hantsoo L, Epperson CN. Anxiety Disorders Among Women: A Female Lifespan Approach. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:162-172. [PMID: 28966563 DOI: 10.1176/appi.focus.20160042] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Anxiety symptoms may present differently between women and men, and at different points in the female lifespan. The female lifespan includes distinct epochs of hormonal function, including puberty, the premenstruum, in some women pregnancy or postpartum, and the menopausal transition. These stages give rise to important treatment considerations when treating anxiety in women. When making assessments, the clinician should consider reproductive events and hormonal status, as well as sex differences in anxiety presentation. This review is structured to: 1) Define major epochs of the female lifespan, 2) Provide a brief summary of the major anxiety disorders, with a focus on prevalence and presentation in the context of sex differences and at points in the female lifespan, 3) Describe potential biopsychosocial underpinnings of anxiety disorders among women, 4) Provide guidelines for assessment and differential diagnosis, and 5) Describe treatment options with attention to reproductive events such as pregnancy.
Collapse
Affiliation(s)
- Liisa Hantsoo
- Clinical Psychologist & Instructor, Penn Center for Women's Behavioral Wellness, Perelman School of Medicine, University of Pennsylvania
| | - C Neill Epperson
- Professor of Psychiatry and Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania and Director of the Penn Center for Women's Behavioral Wellness and Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine, University of Pennsylvania
| |
Collapse
|
32
|
Li J, Mao Q, He J, She H, Zhang Z, Yin C. Human umbilical cord mesenchymal stem cells improve the reserve function of perimenopausal ovary via a paracrine mechanism. Stem Cell Res Ther 2017; 8:55. [PMID: 28279229 PMCID: PMC5345137 DOI: 10.1186/s13287-017-0514-5] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/05/2017] [Accepted: 02/18/2017] [Indexed: 01/20/2023] Open
Abstract
Background Human umbilical cord mesenchymal stem cells (hUCMSCs) are a type of pluripotent stem cell which are isolated from the umbilical cord of newborns. hUCMSCs have great therapeutic potential. We designed this experimental study in order to investigate whether the transplantation of hUCMSCs can improve the ovarian reserve function of perimenopausal rats and delay ovarian senescence. Method We selected naturally aging rats confirmed by vaginal smears as models of perimenopausal rats, divided into the control group and the treatment group, and selected young fertile female rats as normal controls. hUCMSCs were transplanted into rats of the treatment group through tail veins. Enzyme-linked immunosorbent assay (ELISA) detected serum levels of sex hormones, H&E staining showed ovarian tissue structure and allowed follicle counting, immunohistochemistry and western blot analysis revealed ovarian expression of hepatocyte growth factor (HGF), vascular endothelial cell growth factor (VEGF), and insulin-like growth factor-1 (IGF-1), polymerase chain reaction (PCR) and western blot analysis revealed hUCMSCs expression of HGF, VEGF, and IGF-1. Results At time points of 14, 21, and 28 days after hUCMSCs transplantation, estradiol (E2) and anti-Müllerian hormone (AMH) increased while follicle-stimulating hormone (FSH) decreased; ovarian structure improved and follicle number increased; ovarian expression of HGF, VEGF, and IGF-1 protein elevated significantly. Meanwhile, PCR and western blot analysis indicated hUCMSCs have the capacity of secreting HGF, VEGF, and IGF-1 cytokines. Conclusions Our results suggest that hUCMSCs can promote ovarian expression of HGF, VEGF, and IGF-1 through secreting those cytokines, resulting in improving ovarian reserve function and withstanding ovarian senescence.
Collapse
Affiliation(s)
- Jia Li
- Department of Obstetrics and Gynecology, Graduate College, Guangdong Medical University, Zhanjiang, Guangdong, 524023, China.,Department of Obstetrics and Gynecology, Guangdong No.2 Provincial People's Hospital, NO.466 Xingangdong Road, Guangzhou, 510317, China
| | - QiuXian Mao
- Department of Obstetrics and Gynecology, Guangdong No.2 Provincial People's Hospital, NO.466 Xingangdong Road, Guangzhou, 510317, China
| | - JingJun He
- Department of Physical Examination, Guangdong No.2 Provincial People's Hospital, NO.466 Xingangdong Road, Guangzhou, 510317, China
| | - HaoQing She
- Department of Obstetrics and Gynecology, Medical College, NanHua University, Hengyang, Hunan, 421001, China
| | - Zhi Zhang
- Department of Laboratory Medicine, Guangdong No.2 Provincial People's Hospital, NO.466 Xingangdong Road, Guangzhou, 510317, China.
| | - ChunYan Yin
- Department of Obstetrics and Gynecology, Guangdong No.2 Provincial People's Hospital, NO.466 Xingangdong Road, Guangzhou, 510317, China.
| |
Collapse
|
33
|
Peinado AB, Harvey RE, Hart EC, Charkoudian N, Curry TB, Nicholson WT, Wallin BG, Joyner MJ, Barnes JN. Neural control of blood pressure in women: differences according to age. Clin Auton Res 2017; 27:157-165. [PMID: 28205011 DOI: 10.1007/s10286-017-0403-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/01/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The blood pressure "error signal" represents the difference between an individual's mean diastolic blood pressure and the diastolic blood pressure at which 50% of cardiac cycles are associated with a muscle sympathetic nerve activity burst (the "T50"). In this study we evaluated whether T50 and the error signal related to the extent of change in blood pressure during autonomic blockade in young and older women, to study potential differences in sympathetic neural mechanisms regulating blood pressure before and after menopause. METHODS We measured muscle sympathetic nerve activity and blood pressure in 12 premenopausal (25 ± 1 years) and 12 postmenopausal women (61 ± 2 years) before and during complete autonomic blockade with trimethaphan camsylate. RESULTS At baseline, young women had a negative error signal (-8 ± 1 versus 2 ± 1 mmHg, p < 0.001; respectively) and lower muscle sympathetic nerve activity (15 ± 1 versus 33 ± 3 bursts/min, p < 0.001; respectively) than older women. The change in diastolic blood pressure after autonomic blockade was associated with baseline T50 in older women (r = -0.725, p = 0.008) but not in young women (r = -0.337, p = 0.29). Women with the most negative error signal had the lowest muscle sympathetic nerve activity in both groups (young: r = 0.886, p < 0.001; older: r = 0.870, p < 0.001). CONCLUSIONS Our results suggest that there are differences in baroreflex control of muscle sympathetic nerve activity between young and older women, using the T50 and error signal analysis. This approach provides further information on autonomic control of blood pressure in women.
Collapse
Affiliation(s)
- Ana B Peinado
- LFE Research Group, Department of Health and Human Performance, Technical University of Madrid, Martín Fierro, 7, 28040, Madrid, Spain.
| | - Ronee E Harvey
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Emma C Hart
- School of Physiology and Pharmacology, University of Bristol, Bristol, UK
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Timothy B Curry
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | | | - B Gunnar Wallin
- Institute of Neuroscience and Physiology, The Sahlgren Academy at Gothenburg University, Gotheborg, Sweden
| | | | - Jill N Barnes
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
34
|
Harvey RE, Barnes JN, Hart ECJ, Nicholson WT, Joyner MJ, Casey DP. Influence of sympathetic nerve activity on aortic hemodynamics and pulse wave velocity in women. Am J Physiol Heart Circ Physiol 2016; 312:H340-H346. [PMID: 27923789 DOI: 10.1152/ajpheart.00447.2016] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/14/2016] [Accepted: 11/29/2016] [Indexed: 01/21/2023]
Abstract
Central (aortic) blood pressure, arterial stiffness, and sympathetic nerve activity increase with age in women. However, it is unknown if the age-related increase in sympathetic activity influences aortic hemodynamics and carotid-femoral pulse wave velocity (cfPWV), an index of central aortic stiffness. The goal of this study was to determine if aortic hemodynamics and cfPWV are directly influenced by sympathetic nerve activity by measuring aortic hemodynamics, cfPWV, and muscle sympathetic nerve activity (MSNA) in women before and during autonomic ganglionic blockade with trimethaphan camsylate. We studied 12 young premenopausal (23 ± 4 yr) and 12 older postmenopausal (57 ± 3 yr) women. These women did not differ in body mass index or mean arterial pressure (P > 0.05 for both). At baseline, postmenopausal women had higher aortic pulse pressure, augmented pressure, augmentation index adjusted for a heart rate of 75 beats/min, wasted left ventricular pressure energy, and cfPWV than young women (P < 0.05). During ganglionic blockade, postmenopausal women had a greater decrease in these variables in comparison to young women (P < 0.05). Additionally, baseline MSNA was negatively correlated with the reductions in aortic pulse pressure, augmented pressure, and wasted left ventricular pressure energy during ganglionic blockade in postmenopausal women (P < 0.05) but not young women. Baseline MSNA was not correlated with the changes in augmentation index adjusted for a heart rate of 75 beats/min or cfPWV in either group (P > 0.05 for all). Our results suggest that some aortic hemodynamic parameters are influenced by sympathetic activity to a greater extent in older postmenopausal women than in young premenopausal women.NEW & NOTEWORTHY Autonomic ganglionic blockade results in significant decreases in multiple aortic pulse wave characteristics (e.g., augmented pressure) and central pulse wave velocity in older postmenopausal women but not in young premenopausal women. Certain aortic pulse wave parameters are negatively influenced by sympathetic activity to a greater extent in older postmenopausal women.
Collapse
Affiliation(s)
- Ronée E Harvey
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota.,Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; and
| | - Jill N Barnes
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Wayne T Nicholson
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; and
| | - Michael J Joyner
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; and
| | - Darren P Casey
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| |
Collapse
|
35
|
Kim SW, Jeon JH, Lee WK, Lee S, Kim JG, Lee IK, Park KG. Long-term effects of oral contraceptives on the prevalence of diabetes in post-menopausal women: 2007-2012 KNHANES. Endocrine 2016; 53:816-22. [PMID: 27160817 DOI: 10.1007/s12020-016-0972-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 04/25/2016] [Indexed: 11/29/2022]
Abstract
There is little information on whether past use of oral contraceptives (OCs) at child-bearing age influences the incidences of diabetes and insulin resistance (IR) after menopause. This study aimed to evaluate the association of past use of OCs with the development of diabetes and IR in post-menopausal women. This cross-sectional study was based on data from the Korea National Health and Nutrition Examination Survey carried out from 2007 to 2012. Of the 50405 participants, 6554 post-menopausal women were included in the analysis. The associations of OC use with the prevalence of diabetes in post-menopausal women were examined using multivariate logistic analysis. In addition, fasting glucose and insulin levels were measured in 3338 nondiabetic post-menopausal women, and the association between IR and OCs was examined by the analysis of covariance. The prevalence of diabetes was significantly higher in post-menopausal participants who had taken OCs for more than 6 months than in those who had never taken OCs. The association remained significant after adjusting for multiple confounding factors (odd ratio 1.379; 95 % CI 1.115-1.707; P = 0.003). The duration of OC use was also positively associated with the prevalence of diabetes. Furthermore, taking OCs for more than 6 months led to a significant increase in fasting insulin levels and HOMA-IR in nondiabetic participants. Past use of OCs for more than 6 months led to a significant increase in the prevalence of diabetes in post-menopausal women, and increased IR in nondiabetic participants. These results suggested that the prolonged use of OCs at reproductive age may be an important risk factor for developing diabetes in post-menopausal women.
Collapse
Affiliation(s)
- Sung-Woo Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cha Gumi Medical Center, Cha University School of Medicine, Gumi, South Korea
| | - Jae-Han Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Won-Kee Lee
- Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Sungwoo Lee
- New Drug Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, South Korea
| | - Jung-Guk Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
| | - In-Kyu Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Keun-Gyu Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea.
| |
Collapse
|
36
|
Briant LJB, Burchell AE, Ratcliffe LEK, Charkoudian N, Nightingale AK, Paton JFR, Joyner MJ, Hart EC. Quantifying sympathetic neuro-haemodynamic transduction at rest in humans: insights into sex, ageing and blood pressure control. J Physiol 2016; 594:4753-68. [PMID: 27068560 DOI: 10.1113/jp272167] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/04/2016] [Indexed: 01/08/2023] Open
Abstract
KEY POINTS We have developed a simple analytical method for quantifying the transduction of sympathetic activity into vascular tone. This method demonstrates that as women age, the transfer of sympathetic nerve activity into vascular tone is increased, so that for a given level of sympathetic activity there is more vasoconstriction. In men, this measure decreases with age. Test-re-test analysis demonstrated that the new method is a reliable estimate of sympathetic transduction. We conclude that increased sympathetic vascular coupling contributes to the age-related increase in blood pressure that occurs in women only. This measure is a reliable estimate of sympathetic transduction in populations with high sympathetic nerve activity. Thus, it will provide information regarding whether treatment targeting the sympathetic nervous system, which interrupts the transfer of sympathetic nerve activity into vascular tone, will be effective in reducing blood pressure in hypertensive patients. This may provide insight into which populations will respond to certain types of anti-hypertensive medication. ABSTRACT Sex and age differences in the sympathetic control of resting blood pressure (BP) may be due to differences in the transduction of sympathetic nerve activity (SNA) into vascular tone. Current methods for dynamically quantifying transduction focus on the relationship between SNA and vasoconstriction during a pressor stimulus, which increases BP and may be contra-indicated in patients. We describe a simple analytical method for quantifying transduction under resting conditions. We performed linear regression analysis of binned muscle SNA burst areas against diastolic BP (DBP). We assessed whether the slope of this relationship reflects the transduction of SNA into DBP. To evaluate this, we investigated whether this measure captures differences in transduction in different populations. Specifically, we (1) quantified transduction in young men (YM), young women (YW), older men (OM) and postmenopausal women (PMW); and (2) measured changes in transduction during β-blockade using propranolol in YW, YM and PMW. YM had a greater transduction vs. OM (0.10 ± 0.01 mmHg (% s)(-1) , n = 23 vs. 0.06 ± 0.01 mmHg (% s)(-1) , n = 18; P = 0.003). Transduction was lowest in YW (0.02 ± 0.01 mmHg (% s)(-1) , n = 23) and increased during β-blockade (0.11 ± 0.01 mmHg (% s)(-1) ; P < 0.001). Transduction in PMW (0.07 ± 0.01 mmHg (% s)(-1) , n = 23) was greater compared to YW (P = 0.001), and was not altered during β-blockade (0.06 ± 0.01 mmHg (% s)(-1) ; P = 0.98). Importantly, transduction increased in women with age, but decreased in men. Transduction in women intersected that in men at 55 ± 1.5 years. This measure of transduction captures age- and sex-differences in the sympathetic regulation of DBP and may be valuable in quantifying transduction in disease. In particular, this measure may help target treatment strategies in specific hypertensive subpopulations.
Collapse
Affiliation(s)
- L J B Briant
- CardioNomics, CRIC Bristol, University of Bristol, Bristol, UK
| | - A E Burchell
- CardioNomics, CRIC Bristol, University of Bristol, Bristol, UK
| | - L E K Ratcliffe
- CardioNomics, CRIC Bristol, University of Bristol, Bristol, UK
| | - N Charkoudian
- US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - A K Nightingale
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - J F R Paton
- School of Physiology and Pharmacology, Biomedical Sciences, University of Bristol, Bristol, UK
| | | | - E C Hart
- CardioNomics, CRIC Bristol, University of Bristol, Bristol, UK.,School of Physiology and Pharmacology, Biomedical Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
37
|
Kim SW, Cho KH, Han KD, Roh YK, Song IS, Kim YH. Tooth Loss and Metabolic Syndrome in South Korea: The 2012 Korean National Health and Nutrition Examination Survey. Medicine (Baltimore) 2016; 95:e3331. [PMID: 27100416 PMCID: PMC4845820 DOI: 10.1097/md.0000000000003331] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED To evaluate the relationship between tooth loss and metabolic syndrome (MS) in South Korean adults. SUBJECTS AND METHODS A total of 3589 adults (1511 men and 2078 women aged over 40 years) from the 2012 Korean National Health and Nutrition Examination Survey were included and divided into 3 groups according to the number of remaining teeth (0-19, 20-27, and 28). We recorded the number of remaining teeth and measured MS components such as waist circumference, systolic and diastolic blood pressure, fasting blood glucose, serum high-density lipoprotein-cholesterol, and triglyceride concentration. We also calculated the number of subjects who met the inclusion criteria of MS in each group. Multiple logistic regression analysis was performed to estimate the prevalence of MS components according to the number of remaining teeth after adjusting for covariates. Women without MS had significantly more teeth than those with MS (24.5 ± 0.2 vs 21.0 ± 0.3). In men, the prevalence of high blood pressure and high fasting blood glucose levels were significantly different among the 3 groups (P = 0.003 and P < 0.001, respectively); however, the prevalence of MS and all MS components were significantly different in women (P < 0.001 for all comparisons). Men with 0 to 19 remaining teeth were most likely to have high blood pressure and high fasting blood glucose, while women with 0 to 19 remaining teeth had the highest prevalence of MS and each MS component. Multiple logistic regression analysis revealed that women with fewer remaining teeth had a higher prevalence of MS and MS components after adjusting for covariates. Having only a few remaining teeth was associated with MS in women in South Korea.
Collapse
Affiliation(s)
- Si-Wan Kim
- From the Department of Family Medicine, Ree and Jang Plastic Surgery Clinic (SWK, YHK); Department of Family Medicine, Korea University College of Medicine (KHC); Department of Medical Statistics, Catholic University College of Medicine (KDH); Department of Family Medicine, Hallym University College of Medicine (YKR); and Department of Dentistry, Korea University College of Medicine (ISS), Seoul, South Korea
| | | | | | | | | | | |
Collapse
|
38
|
Freeman EW, Sammel MD. Methods in a longitudinal cohort study of late reproductive age women: the Penn Ovarian Aging Study (POAS). Womens Midlife Health 2016; 2:1. [PMID: 30766699 PMCID: PMC6299955 DOI: 10.1186/s40695-016-0014-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/17/2016] [Indexed: 12/05/2022] Open
Abstract
Background This report describes the methods utilized in the Penn Ovarian Aging Study (POAS), which is a longitudinal cohort study of hormone dynamics and menopausal symptoms of women in the menopause transition. Methods/Design The cohort is a community-based sample of generally healthy women enrolled in the late reproductive years. The study population is a stratified random sample of African-American and Caucasian women, identified by random digit dialing. Of the 1427 women who were identified as potentially eligible, 578 women were eligible after full screening; 75 % of the eligible women enrolled in the study (436/578). At Period 14 (14 years after study enrollment), 67 % remained active and were fully evaluated (293/436). Attrition was non-differential with respect to the sample characteristics. The aims of the project overall are to 1) identify within-woman trends of reproductive hormones (estradiol, follicle stimulating hormone, hormone, lutinizing hormone, inhibin B, dehydroepiandrosterone, testosterone, and anti-mullerian hormone), cofactors such as race, body mass index (BMI), age, physical and behavioral symptoms, and their predictions of menopausal symptoms, and patterns around the final menstrual period; 2) identify associations of hormone dynamics with physical and behavioral symptoms that occur with ovarian aging and identify racial differences in these factors; 3) identify associations of genetic polymorphisms with levels and longitudinal trends in menopausal symptoms. The cohort consists of 436 late reproductive-age women at enrollment, and now has 18 years of approximately annual follow-up assessments. Menopausal stage based on concurrent menstrual dates is identified at each follow-up period. Discussion Studies of the cohort have shown that hot flashes can occur well before menopause and extend 10 or more years beyond menopause for sizeable numbers of women; provide evidence for new-onset depressed mood in the menopause transition and show that the final menstrual period is pivotal in the increases in depressive symptoms prior to menopause and decreases postmenopausal; suggest that poor sleep is common in the late reproductive years but increases in relation to the final menstrual period in only a small proportion of women; and show effects of obesity on reproductive hormones in the menopause transition. To date, more than 50 studies of the cohort are published in medical journals, demonstrating the relevance of these data to the clinical care of mid-life women. Electronic supplementary material The online version of this article (doi:10.1186/s40695-016-0014-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ellen W Freeman
- 1Department of Obstetrics/Gynecology and Department of Psychiatry, 3701 Market Street, Suite 820 (Mudd Suite), Philadelphia, PA 19104 USA
| | - Mary D Sammel
- 2Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, U.S, Philadelphia, USA
| |
Collapse
|
39
|
Martin VT, Pavlovic J, Fanning KM, Buse DC, Reed ML, Lipton RB. Perimenopause and Menopause Are Associated With High Frequency Headache in Women With Migraine: Results of the American Migraine Prevalence and Prevention Study. Headache 2016; 56:292-305. [PMID: 26797693 DOI: 10.1111/head.12763] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To examine the relationship of headache frequency to the stages of the menopausal transition in mid-life women with migraine. BACKGROUND Past studies suggest that the perimenopause is associated with an increased prevalence of migraine, particularly in those with a history of premenstrual syndrome. The effect of the menopausal transition on the frequency of headache attacks in women with migraine has not been explored. METHODS This was a cross-sectional observational study. Using data from the 2006 American Migraine, Prevalence and Prevention study survey, women meeting modified ICHD-3 beta criteria for migraine between the ages of 35-65 years were included in analyses. Women who had never menstruated or were pregnant, breastfeeding, or using exogenous sex hormones were excluded. The 2006 survey was selected because it included detailed questions on the menstrual cycle. The stages of the menopausal transition were defined based upon the self-reported cycle length and/or duration of amenorrhea. The primary outcome, high vs low headache frequency, was defined using a cut score of ≥10 headache days per month. Binary logistic regression models were used to assess the influence of menopausal stage on headache frequency category using premenopause as the reference group. Adjustments for stage of menopausal transition and sociodemographics (eg, age and income) were included in the first model, while the second model included sociodemographics, depression, body mass index, preventative medications, and medication overuse. RESULTS The study sample included 3664 women at a mean age of 46 years. Among women who were premenopausal, 8.0% (99/1242) were in the high frequency headache group in comparison with 12.2% (154/1266) of perimenopausal and 12.0% (131/1095) of postmenopausal women. Compared with premenopausal women, the adjusted odds of being in the high frequency headache group was 1.62 (95% CI = 1.23, 2.12) for perimenopausal and 1.76 (95% CI = 1.23, 2.52) for postmenopausal women (Model 1). In model 2, high frequency headache was only increased in perimenopausal women with an OR of 1.42 (95% CI = 1.03, 1.94). CONCLUSIONS The risk of high frequency headache is increased in women during the perimenopause compared to premenopause in the fully adjusted model. The fact that the increased risk of high frequency headache was not statistically significant for menopause in the fully adjusted models suggests that different mechanisms might account for the increased risk for this stage of the menopausal transition. Recognition of the increased risk of high frequency headache during the menopausal transition suggests a need for optimized preventive treatment of migraine during this time of women's life.
Collapse
Affiliation(s)
- Vincent T Martin
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA (V.T. Martin)
| | - Jelena Pavlovic
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY, USA (J. Pavlovic, D.C. Buse, and R.B. Lipton)
| | | | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY, USA (J. Pavlovic, D.C. Buse, and R.B. Lipton)
| | - Michael L Reed
- Vedanta Research, Chapel Hill, NC, USA (K.M. Fanning and M.L. Reed)
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY, USA (J. Pavlovic, D.C. Buse, and R.B. Lipton).,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton)
| |
Collapse
|
40
|
Yang CF, Kenney NJ, Chang TC, Chang SR. Sex life and role identity in Taiwanese women during menopause: a qualitative study. J Adv Nurs 2015; 72:770-81. [PMID: 26708447 DOI: 10.1111/jan.12866] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 11/28/2022]
Abstract
AIM Our goal was to examine Taiwanese women's perspectives on the way menopause affected their sexual behaviour to gain an in-depth understanding of their experiences during this transition. BACKGROUND Physical symptoms associated with menopause may affect women's sexual experiences. Little is known about how menopause-related changes in sexual behaviour may affect role identity of women living in a modernizing urban culture that is still strongly rooted in traditional beliefs and attitudes. DESIGN This was a qualitative study involving face-to-face interviews using open-ended questions. METHODS During 2011-2012, eighteen peri or postmenopausal women visiting a medical clinic for gynaecological examinations or treatment were interviewed about their sexual experiences. Responses were analysed for common themes. FINDINGS Four themes were identified about the effects of menopause on women's sex life: (1) changes in physical responses during sex; (2) the acceptance/non-acceptance of the current situation; (3) sexual pressure related to their marital role; (4) efforts to improve sexual interest or activity. Menopause-related physical changes often (but not always) made sexual interactions difficult. But women's responses to the changes varied. Some used sexual discomfort as a reason to avoid sexual intercourse. Others sought to improve their sexual encounters through behavioural modifications or hormone therapy. CONCLUSIONS Given the variety of reactions to the impact of menopause on sexual behaviour/relationships seen here, it is clear that health professionals need to assess of each woman's specific situation and be prepared to recommend a variety of behavioural or hormonal treatment options.
Collapse
Affiliation(s)
- Cheng-Fang Yang
- School of Nursing, Cardinal Tien Junior College of Healthcare & Management, Taipei, Taiwan.,School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Nancy J Kenney
- Departments of Psychology and Gender, Women & Sexuality Studies, University of Washington, Seattle, Washington, USA
| | - Ting-Chen Chang
- Department of Obstetrics and Gynecology, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shiow-Ru Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
41
|
Ghazanfarpour M, Sadeghi R, Roudsari RL, Khorsand I, Khadivzadeh T, Muoio B. Red clover for treatment of hot flashes and menopausal symptoms: A systematic review and meta-analysis. J OBSTET GYNAECOL 2015; 36:301-11. [PMID: 26471215 DOI: 10.3109/01443615.2015.1049249] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study evaluated the efficacy of red clover to relieve hot flashes and menopausal symptoms in peri/postmenopausal women. Electronic databases (MEDLINE, Scopus and the Cochrane Library) were searched. The mean frequency of hot flashes in red clover groups was lower compared with that in the control groups (close to statistical significance). Difference in means (MD) of hot flashes frequency was - 1.99 (- 4.12-0.139; p = 0.067; heterogeneity P > 0.01; I(2) = 94.93%; Random effect model). Subjective (vaginal dryness) and objective (maturation value) symptoms of vaginal atrophy showed a significant improvement with 80-mg dose of red clover. Red clover showed less therapeutic effect on psychology status, sexual problems and sleeping disorders. Red clover consumption may decrease frequency of hot flashes, especially in women with severe hot flashes (≥ 5 per day). Red clover may reduce other menopausal symptoms. Further trials are needed to confirm the current systematic review findings.
Collapse
Affiliation(s)
- M Ghazanfarpour
- a Department of Midwifery , Student Research Committee, Nursing and Midwifery School, Mashhad University of Medical Science , Mashhad , Iran
| | - R Sadeghi
- b Nuclear Medicine Research Center, Mashhad University of Medical Sciences , Mashhad , Iran
| | - R Latifnejad Roudsari
- c Department of Midwifery , Evidence-Based Care Research Centre, School of Nursing and Midwifery, Mashhad University of Medical Sciences , Mashhad , Iran
| | - I Khorsand
- d Department of Microbiology , Islamic Azad University of Varamin-pishva , Pishva, Tehran , Iran
| | - T Khadivzadeh
- e Student Research Committee.,f Evidence-Based Care Research Centre, Department of Midwifery , School of Nursing and Midwifery, Mashhad University of Medical Sciences , Mashhad , Iran
| | - B Muoio
- f Evidence-Based Care Research Centre, Department of Midwifery , School of Nursing and Midwifery, Mashhad University of Medical Sciences , Mashhad , Iran
| |
Collapse
|
42
|
Ağan K, Özmerdivenli R, Değirmenci Y, Çağlar M, Başbuğ A, Balbay EG, Sungur MA. Evaluation of sleep in women with menopause: results of the Pittsburg Sleep Quality Index and polysomnography. J Turk Ger Gynecol Assoc 2015; 16:149-52. [PMID: 26401107 PMCID: PMC4560471 DOI: 10.5152/jtgga.2015.15087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/07/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate subjective sleep quality among women in the menopausal period and to confirm and diagnose the possible sleep disturbances with polysomnographic (PSG) evaluation objectively. MATERIAL AND METHODS Sixty-seven women with menopause were enrolled in the study. Sociodemographic characteristics and the features of menopause were recorded. We assessed subjective sleep quality with Pittsburg Sleep Quality Index (PSQI). To confirm sleep disturbances and further diagnose the underlying cause, PSG evaluation was performed to women with PSQI scores of >5 who gave their approval. RESULTS Mean PSQI score of women with normal PSG evaluation was 12.00±3.16, while it was 11.00±2.32 in women with abnormal PSG evaluation (p=0.466); 59.7% (n=40) of women had poor sleep quality. Among these, 11 (64.7%) had abnormal results in the PSG evaluation and were diagnosed with obstructive sleep apnea syndrome (OSAS); 54.5% had mild OSAS, 27.3% had moderate, and 18.2% had severe OSAS. CONCLUSION PSQI and PSG evaluations would give a chance to demonstrate sleep problems and shed a light on treatment options according to the underlying causes of sleep disturbances in menopause.
Collapse
Affiliation(s)
- Kağan Ağan
- Department of Physiology, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Recep Özmerdivenli
- Department of Physiology, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Yıldız Değirmenci
- Department of Neurology, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Mete Çağlar
- Department of Gynecology and Obstetrics, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Alper Başbuğ
- Department of Gynecology and Obstetrics, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Ege Güleç Balbay
- Department of Chest Disease, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics and Medical Informatics, Düzce University Faculty of Medicine, Düzce, Turkey
| |
Collapse
|
43
|
Kornstein SG, Clayton AH, Bao W, Guico-Pabia CJ. A pooled analysis of the efficacy of desvenlafaxine for the treatment of major depressive disorder in perimenopausal and postmenopausal women. J Womens Health (Larchmt) 2015; 24:281-90. [PMID: 25860107 DOI: 10.1089/jwh.2014.4900] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Few studies in the literature have examined the efficacy of antidepressant drugs in perimenopausal and postmenopausal women. The objective of the current study was to assess the efficacy of desvenlafaxine (administered as desvenlafaxine succinate) separately in perimenopausal and postmenopausal women with major depressive disorder (MDD). METHODS Data were pooled from two double-blind, placebo-controlled clinical trials enrolling perimenopausal and postmenopausal women (40-70 years old) diagnosed with MDD. Patients were randomly assigned to receive desvenlafaxine 100 to 200 mg/day or placebo (8 weeks) or desvenlafaxine 50 mg/day or placebo (10 weeks). The primary efficacy end point for each trial was change from baseline in Hamilton Rating Scale for Depression (HAM-D17) total score at week 8. Secondary end points included change from baseline in Sheehan Disability Scale (SDS) and Menopause Rating Scale (MRS) scores. Changes from baseline in continuous variables were analyzed using analysis of covariance with treatment, region, and baseline in the model. All treatment comparisons were carried out separately in perimenopausal or postmenopausal women, in individual studies, and in the pooled population, adjusting for menopausal status and study. RESULTS A total of 798 patients were included in the full analysis set (perimenopausal, n=252; postmenopausal, n=546). Desvenlafaxine significantly reduced HAM-D17 total scores versus placebo at week 8 in both perimenopausal (-10.3 vs. -6.5; p<0.001) and postmenopausal women (-10.1 vs. -7.6; p<0.001). Significant improvements in SDS and MRS total scores were also observed for desvenlafaxine versus placebo in perimenopausal (p ≤ 0.024) and postmenopausal women (p ≤ 0.009). A significant treatment by menopausal status interaction was observed for SDS only (p=0.036). CONCLUSIONS Desvenlafaxine demonstrated antidepressant efficacy in both perimenopausal and postmenopausal subgroups of women with MDD. DISCLAIMER In September 2011, Pfizer received a Complete Response Letter from the United States Food and Drug Administration on its application for approval to market desvenlafaxine for the treatment of moderate to severe vasomotor symptoms associated with menopause. The Complete Response Letter states that the data included in the application are not sufficient to establish an acceptable risk/benefit profile for the treatment of vasomotor symptoms in the general population of postmenopausal women, and therefore desvenlafaxine is not approved for the treatment of vasomotor symptoms in the United States at this time. This decision does not impact desvenlafaxine's approval for the treatment of MDD in adults.
Collapse
Affiliation(s)
- Susan G Kornstein
- 1 Department of Psychiatry and Institute for Women's Health, Virginia Commonwealth University , Richmond, Virginia
| | | | | | | |
Collapse
|
44
|
Low bone mass in human immunodeficiency virus–infected climacteric women receiving antiretroviral therapy. Menopause 2015; 22:224-30. [DOI: 10.1097/gme.0000000000000282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Harvey RE, Barnes JN, Charkoudian N, Curry TB, Eisenach JH, Hart EC, Joyner MJ. Forearm vasodilator responses to a β-adrenergic receptor agonist in premenopausal and postmenopausal women. Physiol Rep 2014; 2:2/6/e12032. [PMID: 24907296 PMCID: PMC4208635 DOI: 10.14814/phy2.12032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Beta‐adrenergic vasodilator responses may be blunted in humans who are at an increased risk for hypertension. Because menopause is associated with an increase in blood pressure, we tested the hypothesis that forearm blood flow responses to the β‐adrenergic receptor agonist isoproterenol are blunted in older, postmenopausal women compared to young, premenopausal women. We used venous occlusion plethysmography to measure forearm blood flow in young premenopausal (26 ± 1 years; n = 13) and postmenopausal (61 ± 2 years; n = 12) women. Forearm blood flow and mean arterial pressure were measured at baseline and during isoproterenol infusion at 1.0, 3.0, 6.0, and 12.0 ng/100 mL tissue/min. The two groups did not differ in body mass index or mean arterial pressure. Baseline forearm blood flow was similar between young and postmenopausal women (3.7 ± 0.5 vs. 2.9 ± 0.4 mL/100 mL tissue/min, respectively; P > 0.05). At the lowest dose of isoproterenol, forearm blood flow vasodilator responses were lower in postmenopausal women compared with young women (5.8 ± 0.4 vs. 7.4 ± 0.3 mL/100 mL tissue/min, respectively; P < 0.05). Thereafter, forearm blood flow remained similar between the groups for the remaining isoproterenol doses. In conclusion, β‐adrenergic receptor‐mediated forearm vasodilator responses are blunted in healthy, older postmenopausal women at lower but not higher doses of isoproterenol. This suggests that in aging women, β‐adrenergic receptor‐mediated vasodilator responses may be blunted at a moderate level of stimulation while maximum receptor responses are preserved. This study assessed potential differences in β‐adrenergic receptor responsiveness to forearm isoproterenol infusion in young premenopausal and older postmenopausal women. Our data showed that β‐receptor vasodilator responses to low‐dose isoproterenol are blunted in postmenopausal women in comparison to young women, and responses to higher doses of isoproterenol are similar between the two groups. These results suggest that there is some attenuation of β‐receptor responsiveness in aging women while maximum vasodilator responses remain intact.
Collapse
Affiliation(s)
| | - Jill N Barnes
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - Nisha Charkoudian
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Timothy B Curry
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - John H Eisenach
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - Emma C Hart
- School of Physiology and Pharmacology, University of Bristol, Bristol, UK
| | | |
Collapse
|
46
|
Relationship between sympathetic nerve activity and aortic wave reflection characteristics in postmenopausal women. Menopause 2014; 20:967-72. [PMID: 23531685 DOI: 10.1097/gme.0b013e3182843b59] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Aortic wave reflection characteristics, such as augmentation index, are positively related to muscle sympathetic nerve activity in young men. In young women, there is an inverse relationship. We investigated whether this inverse relationship persisted in postmenopausal women. METHODS Muscle sympathetic nerve activity (peroneal microneurography) and arterial pressure (brachial catheter) were measured in 16 postmenopausal women (mean [SEM] age, 60 [2] y). Aortic blood pressure and wave form characteristics were synthesized from radial arterial pressure waves (applanation tonometry). Specifically, augmentation index, wave reflection amplitude, and estimated wasted left ventricular energy were calculated. These data were compared with our previously published work from an identical protocol in 23 young women (mean [SEM] age, 25 [1] y). RESULTS Tonic sympathetic activity was higher in postmenopausal women than in young women (64 [3] vs 24 [4] bursts/100 heartbeats). All indices of aortic wave reflection were higher in postmenopausal women than in young women (P < 0.05). Baseline sympathetic activity was inversely related to augmentation index (r = -0.63, P < 0.05), augmented pressure (r = -0.62, P < 0.05), and wasted left ventricular energy (r = -0.61, P < 0.05) in young women. Conversely, baseline sympathetic activity was positively related to augmentation index (r = 0.63, P = 0.09), augmented pressure (r = 0.69, P < 0.05), and wasted left ventricular energy (r = 0.79, P < 0.05) in postmenopausal women. CONCLUSIONS High levels of sympathetic activity are associated with higher indices of aortic wave reflection in postmenopausal women. Consequently, postmenopausal women with high sympathetic activity may be more at risk for developing cardiovascular diseases or experiencing adverse cardiovascular system-related events.
Collapse
|
47
|
Classifying menopause stage by menstrual calendars and annual interviews: need for improved questionnaires. Menopause 2014; 20:727-35. [PMID: 23481122 DOI: 10.1097/gme.0b013e3182825ff2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aims to assess the agreement between the menopausal transition stages defined by annual interviews or annual follicle-stimulating hormone levels and the menopausal transition stages defined by monthly menstrual calendars, as well as factors associated with discordance. METHODS These analyses used daily self-recorded menstrual calendar data from 1996 to 2006, annual interviews, and annual follicle-stimulating hormone levels. Participants were recruited from four study sites of the Study of Women's Health Across the Nation (Boston, southeastern Michigan, Oakland, and Los Angeles) and four racial/ethnic groups (African American, white, Chinese, and Japanese). Women who had a defined final menstrual period and who never had hormone therapy were included (n = 379). Cohen's κ statistics for 2 × 2 tables were calculated for two definitions of agreement. Logistic regression was used to identify factors associated with discordance. RESULTS Poor agreement between annual interview and menstrual calendar data was found for early menopausal transition (κ = -0.13; 95% CI, -0.25 to -0.02) and late menopausal transition (κ = -0.18; 95% CI, -0.26 to -0.11). For late stage, Chinese women (odds ratio [OR], 2.16; 95% CI, 1.08 to 4.30), African-American women (OR, 2.39; 95% CI, 1.00 to 5.71), and women with high school education or less (OR, 2.16; 95% CI, 1.08 to 4.30) were more likely to be discordant. Poor agreement between annual follicle-stimulating hormone levels and menstrual calendars was also found for early menopausal transition (κ = -0.44; 95% CI, -0.57 to -0.30) and late menopausal transition (κ = -0.32; 95% CI, -0.42 to -0.23). CONCLUSIONS New questions need to be developed to accurately identify the start of the menopausal transition and should be evaluated in a multiethnic population with varying educational backgrounds.
Collapse
|
48
|
Burger H, Woods NF, Dennerstein L, Alexander JL, Kotz K, Richardson G. Nomenclature and endocrinology of menopause and perimenopause. Expert Rev Neurother 2014; 7:S35-43. [DOI: 10.1586/14737175.7.11s.s35] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
49
|
Barnes JN, Hart EC, Curry TB, Nicholson WT, Eisenach JH, Wallin BG, Charkoudian N, Joyner MJ. Aging enhances autonomic support of blood pressure in women. Hypertension 2013; 63:303-8. [PMID: 24324040 DOI: 10.1161/hypertensionaha.113.02393] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The autonomic nervous system plays a central role in both acute and chronic blood pressure regulation in humans. The activity of the sympathetic branch of the autonomic nervous system is positively associated with peripheral resistance, an important determinant of mean arterial pressure in men. In contrast, there is no association between sympathetic nerve activity and peripheral resistance in women before menopause, yet a positive association after menopause. We hypothesized that autonomic support of blood pressure is higher after menopause in women. We examined the effect of ganglionic blockade on arterial blood pressure and how this relates to baseline muscle sympathetic nerve activity in 12 young (25±1 years) and 12 older postmenopausal (61±2 years) women. The women were studied before and during autonomic blockade using trimethaphan camsylate. At baseline, muscle sympathetic nerve activity burst frequency and burst incidence were higher in the older women (33±3 versus 15±1 bursts/min; 57±5 versus 25±2 bursts/100 heartbeats, respectively; P<0.05). Muscle sympathetic nerve activity bursts were abolished by trimethaphan within minutes. Older women had a greater decrease in mean arterial pressure (-29±2 versus -9±2 mm Hg; P<0.01) and total peripheral resistance (-10±1 versus -5±1 mm Hg/L per minute; P<0.01) during trimethaphan. Baseline muscle sympathetic nerve activity was associated with the decrease in mean arterial pressure during trimethaphan (r=-0.74; P<0.05). In summary, our results suggest that autonomic support of blood pressure is greater in older women compared with young women and that elevated sympathetic nerve activity in older women contributes importantly to the increased incidence of hypertension after menopause.
Collapse
Affiliation(s)
- Jill N Barnes
- Department of Anesthesiology, Mayo Clinic, 200 1st St SW, SMH, Joseph 4-184, Rochester, MN 55905.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Senapati S, Gracia CR, Freeman EW, Sammel MD, Lin H, Kim C, Schwab RJ, Pien GW. Hormone variations associated with quantitative fat measures in the menopausal transition. Climacteric 2013; 17:183-90. [DOI: 10.3109/13697137.2013.845876] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|