Relation between climacteric symptoms and ovarian hypofunction in middle-aged and older Japanese women

Effect of Flavanol-Rich Cacao Extract on the Profile of Mood State in Healthy Middle-Aged Japanese Women: A Randomized, Double-Blind, Placebo-Controlled Pilot Study

To investigate the effects of flavanol-rich cacao extract on healthy middle-aged women's fatigue and mood conditions, we conducted a randomized, double-blind, placebo-controlled study in women aged 40-60 years who had reported fatigue and had shown high levels of a serum oxidative stress marker. We randomized the participants (n = 60) into equal groups receiving either a beverage containing cacao flavanols (240 mg/200 mL/day) or a placebo for 8 weeks. Before and after the 8-week treatment, we determined the participants' Chalder fatigue scale (CFS) scores, various mood states, autonomic nervous system (ANS) activity levels, and their ANS balance. The results demonstrated that among the mood states, the indicators of negative mood (e.g., depression, fatigue, and anger) and the total mood disturbance score were significantly lower in the cacao group compared to the placebo group after the treatment (p < 0.05). The change in the index of positive mood (i.e., vigor) from baseline to 8 weeks was significantly higher in the cacao group versus the placebo group (p < 0.05). There were no significant between-group differences in the changes in the CFS score or ANS activity level. The consumption of flavanol-rich cacao extract both suppressed negative moods and promoted positive moods in healthy middle-aged women. These results suggest that cacao flavanols may be a useful food material that can improve variable mood conditions in middle-aged women and support their active lives.

Climacteric symptoms in postoperative patients among endometrial cancer, cervical cancer, and ovarian cancer: a cross-sectional study

Purpose

To date, no studies have assessed climacteric symptoms after hystero-adnexectomy for endometrial, cervical, or ovarian cancer. Thus, this study aimed to compare climacteric symptoms among patients who underwent surgery for these three cancer types.

Methods

In this cross-sectional study, we interviewed patients who were registered at a menopausal outpatient clinic between January 1999 and July 2016 after undergoing total hysterectomy, intrapelvic only or intrapelvic plus para-aortic lymph node dissection, and bilateral adnexectomy performed via laparotomy as a cancer treatment. Climacteric symptoms were assessed using a patient-reported questionnaire covering core domains with five symptoms only at the initial consultation. Each symptom was graded from 0 (no symptoms) to 3 (severe symptoms). We evaluated the frequency of symptom severity according to the time elapsed since surgery and the cancer type.

Results

The numbers of patients with endometrial, ovarian, and cervical cancer were 328, 90, and 107, respectively. Overall, climacteric symptoms were more severe in patients with cervical cancer than in those with endometrial or ovarian cancer; symptom severity decreased with increasing time since surgery. However, symptom severity did not decrease significantly over time in patients with cervical cancer even after > 5 years had elapsed since surgery.

Conclusion

The climacteric symptoms were less severe in patients with endometrial or ovarian cancer with longer time elapsed since surgery but not in those with cervical cancer. Patients with cervical cancer may require more prompt interventions, including symptomatic treatment and longer follow-up period, than those with endometrial or ovarian cancer.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-022-07117-z.

Menopausal symptoms among Chinese and Japanese women: differences and similarities

OBJECTIVES

This study aimed to identify the characteristics of menopausal symptoms among Japanese and Chinese women and to determine the correlation between menopausal symptoms and self-efficacy.

METHODS

We surveyed 40- to 59-year-old women, 329 of whom were from an urban area in Northwest China (Xi'an) and 310 were from an urban area in Western Japan (Ehime), using a menopausal symptoms inventory and a self-efficacy scale. Comparison analysis was conducted among pre-, peri-, and postmenopausal status, within and between the two cultural groups. Following a two-way ANOVA, multiple comparisons were performed using the Tukey-Kramer test. The correlation between severity of menopause symptoms and self-efficacy scores was evaluated using canonical correlation analysis.

RESULTS

The most frequently reported symptoms were fatigue (93.6%) among Japanese women and memory loss (76.6%) among Chinese women. Japanese women showed significantly higher severity scores across all factors than Chinese, sexual function: 19.58 (SE = 0.73) versus 15.04 (SE = 0.67); mental health condition: 35.44 (SE = 1.15) versus 27.12 (SE = 0.95); interpersonal anxiety: 27.45 (SE = 0.95) versus 21.92 (SE = 0.86); autonomic balance: 42.76 (SE = 1.27) versus 35.75 (SE = 1.17); other subjective symptoms: 39.68 (SE = 1.20) versus 33.07 (SE = 1.12) in the premenopausal group (P < 0.01); and mental health conditions 35.14 (SE = 1.41) versus 29.60 (SE = 1.25), interpersonal anxiety: 27.34 (SE = 1.18) versus 20.79 (SE = 1.02), autonomic balance factors: 45.81 (SE = 1.79) versus 38.05 (SE = 1.67) in the postmenopausal group (P < 0.01). No significant differences of the factors among menopausal stages within Japanese women were found. Among Chinese women, peri- and postmenopausal women showed significantly higher severity scores on sexual function, while perimenopausal women scored higher on mental health conditions and autonomic balance factors (P < 0.01). A negative correlation was found between menopausal symptoms and self-efficacy among both Japanese and Chinese women (P < 0.01).

CONCLUSIONS

Japanese women reported more severe symptoms compared with their Chinese counterparts, and for Chinese women, symptoms might be specifically associated with menopausal status. Menopausal experience is associated with self-efficacy and vice versa.

Prevalence and risk factors for menopausal symptoms in middle-aged Chinese women: a community-based cross-sectional study

OBJECTIVES

To examine the prevalence and risk factors of menopausal symptoms in middle-aged Chinese women.

METHODS

A cross-sectional, community-based study recruited 6,745 women aged 40 to 55 years in the eastern, central, and western regions of China during 2018. Menopausal status was categorized into reproductive stage (defined as regular menstruation or subtle changes in menstrual cycle characteristics), menopausal transition (the beginning of a persistent difference of 7 d in the length of consecutive cycles, or the last menstruation having occurred no more than 12 mo), or postmenpause (the end of the 12 mo period of amenorrhea) according to the Stages of Reproductive Aging Workshop classification. Menopausal symptoms were determined by the modified Kupperman Menopausal Index (KMI) questionnaire and considered nonmenopausal symptoms (total KMI score<15) and menopausal symptoms (total KMI score≥15). Demographic, lifestyle, physical, and menopausal characteristics were collected by face-to-face interviews. Logistic regression models were used to identify factors associated with the risk of menopausal symptoms.

RESULTS

Among all participants, the mean age was 46.9 years, and 15.7% (1,001/6,364) of participants reported experiencing menopausal symptoms. The prevalence of menopausal symptoms was 9.3% (303/3,256), 23.9% (293/1,227), and 21.5% (405/1,881) in the reproductive stage, menopausal transition, and postmenopausal stage, respectively. Overall, the three most prevalent menopausal symptoms were insomnia (44.7%), fatigue (40.4%), and mood swings (37.2%). The multivariable logistic regression model showed that menopausal status, residence, nulliparity, and chronic diseases were associated with the risk of menopausal symptoms (all P < 0.05). Women during menopausal transition (OR = 2.66, 95% CI: 2.21-3.20) or postmenopause (OR = 2.26, 95% CI: 1.82-2.80) had significantly increased risk of menopausal symptoms compared with those in the reproductive stage.

CONCLUSIONS

Menopausal status, residence, nulliparity, and chronic diseases were associated with menopausal symptoms in middle-aged Chinese women.

Menopausal Symptoms and Sleep Quality During Menopausal Transition and Postmenopause

BACKGROUND

Menopausal symptoms and sleep difficulty were physiological processes that were affected by genetic and other factors. This study was to investigate the prevalence of menopausal symptoms and sleep quality in menopausal transition (MT) and postmenopause (PM) women in Taiyuan, Shanxi.

METHODS

A community-based survey of women's menopausal symptoms and sleep quality was conducted between July 2012 and May 2013 at six municipal districts of Taiyuan, Shanxi. A sample of 2429 women aged 40-59 years was divided into four groups: early MT, late MT, early PM, and late PM. Sleep quality in the past 2 weeks before the interview was recorded. The data were analyzed using SPSS 16.0.

RESULTS

The prevalence of menopausal symptoms was 49.8%. Mild, moderate, and severe symptoms were observed in 28.9%, 18.5%, and 2.5% of participants, respectively. The highest prevalence of menopausal symptoms occurred in the early postmenopausal stage; the subsequences were the late postmenopausal stage and the early MT stage. Interestingly, among the 13 items of modified Kupperman index, the five most common symptoms were fatigue, arthralgia and myalgia, decreased libido, insomnia, and nervousness. Meanwhile, 55% perimenopausal women had poor sleep.

CONCLUSIONS

Menopausal symptoms are common but mild among women in Taiyuan, Shanxi during MT and PM. In these stages, the prevalence of poor sleep is high.

Factors associated with menopausal symptoms among middle-aged registered nurses in Beijing

OBJECTIVE

To determine factors related to menopause symptoms among middle-aged registered nurses in Beijing.

METHODS

Self-administered questionnaires that included closed-ended questions on many factors possibly related to menopausal symptoms were distributed to 2100 registered nurses aged 40-55 at 20 hospitals in Beijing, China.

RESULTS

Menopausal status was most associated with menopausal symptoms (p < 0.01), including hot flashes and sweating, paresthesiae, insomnia, arthralgia/myalgia, palpitations, skin formication and an unsatisfactory sexual life. The odds ratios (ORs) were highest for hot flashes and sweating. Upsetting events in the past year and being pessimistic were significantly inversely correlated with almost all the symptoms analyzed. Hot flashes and sweating (p < 0.01), paresthesiae (p < 0.01), unsatisfactory sexual life (p < 0.01), irritability (p < 0.05), depression or suspicion (p < 0.05) and dizziness (p < 0.05) were negatively correlated with the frequency of sexual activity.

CONCLUSION

Many factors may influence symptoms of the menopause. We found that menopausal status was most strongly associated with most menopausal symptoms, especially hot flashes and sweating. Psychosocial factors also played an important role. A higher frequency of sexual activity negatively correlated with most menopausal symptoms.

The treatment of menopausal symptoms by traditional East Asian medicines: review and perspectives

This article provides an overview and critical evaluation of the management of menopausal symptoms by traditional East Asian medicines (TEAMs). For this purpose we utilise an interdisciplinary perspective that draws on social history, medical anthropology, and clinical research. Our goal is threefold. First, we examine the research literature regarding evidence for the effectiveness of TEAMs in the management of menopausal symptoms. The failure of all studies reviewed to address the problematic articulation between tradition and modernity in the case of menopausal syndrome leads us to examine more closely how this connection has been constructed. In the second part of this review we explain how during the late 20th century various TEAMs currents such as traditional Chinese medicine (TCM), Japanese Kampō, and Korean medicine, explored different responses to a biomedically defined disorder, namely menopause, that was until then not discussed in these traditions. Third, based on the findings of the previous sections we make a number of recommendations as to how research in this field might be improved. We argue that while robust evidence for the efficacy of TEAMs in treating menopausal symptoms is currently lacking, existing studies provide sufficient evidence to warrant further research. A new interdisciplinary research framework that takes account of the actual realities of TEAMs practice will be required however for meaningful answers regarding the two most urgent problems in the field to emerge. These are, first the issue of actual treatment effects, and second the more general problem of how TEAMs might be integrated into personalised health care.

The influence of premenopausal hormones on severity of climacteric symptoms and use of HRT

OBJECTIVES

There is wide variation in the severity of climacteric symptoms and we hypothesized that this could be a reflection of premenopausal hormone levels.

METHODS

As part of a long-term cohort study of endocrine risk factors for breast cancer, blood had been collected between 1986 and 1990 from 1882 premenopausal women aged >or=35 years. Questionnaires on menopausal symptom severity were sent to 1,843 surviving women in 2001, of whom 1,434 replied. Estradiol, progesterone and testosterone levels were measured by radioimmunoassay in 680 women who reported a natural menopause and completed the symptom severity section in full.

RESULTS

Symptom severity fell with rising premenopausal estradiol levels and women with higher premenopausal testosterone levels had more severe vasomotor symptoms. Over 70% of women with above-median severity of symptoms had used hormone replacement therapy (HRT). Those with higher testosterone levels were less likely to take HRT.

CONCLUSIONS

Premenopausal hormone levels may predict risk of severe menopausal symptoms, which in turn influences use of HRT. Paradoxically, a high testosterone level was associated with more vasomotor symptoms but reduced use of HRT. Those at greatest risk of climacteric symptoms may be at lower risk of breast cancer because of premenopausal reduced estrogen exposure.

Prevalence of hot flushes and night sweats around the world: a systematic review

OBJECTIVE

Many studies have evaluated the relationships between ethnicity and culture, prevalence of menopausal symptoms, and attitudes toward them, but few have assessed menopausal symptoms across cultures world-wide. This paper aims to systematically review the prevalence of hot flushes and night sweats, two prevalent symptoms of menopause, across the menopausal stages in different cultures and considers potential explanations for differences in prevalence rates.

DESIGN

Sixty-six papers formed the basis for this review. Studies were organized by geographic region, and results are presented for North America, Europe, East Asia, Southeast Asia, Australia, Latin America, South Asia, Middle East, and Africa. Studies were included if they provided quantitative information on the occurrence of hot flushes. This report focuses on hot flushes and night sweats, the most common menopausal symptoms reported in epidemiologic studies.

RESULTS

Studies reviewed indicate that vasomotor symptoms are highly prevalent in most societies. The prevalence of these symptoms varies widely and may be influenced by a range of factors, including climate, diet, lifestyle, women's roles, and attitudes regarding the end of reproductive life and aging. Patterns in hot flush prevalence were apparent for menopausal stages and, to a lesser degree, for regional variation.

CONCLUSIONS

Caregivers should recognize that variations exist and ask patients specific questions about symptoms and their impact on usual functioning.

Medial frontal cortex perfusion abnormalities as evaluated by positron emission tomography in women with climacteric symptoms

OBJECTIVE

To identify functional changes in the brains of women with climacteric symptoms. Images of regional cerebral blood flow (rCBF) were compared statistically between women with and women without symptoms to identify changes in rCBF. Results may provide a better understanding of the neural basis of the symptoms, which are divided into three symptom clusters: vasomotor, psychological, and somatic.

DESIGN

The study participants consisted of 12 women with moderate to severe climacteric symptoms (age 47.5 +/- 5.9 years, mean +/- SD) and 7 women with no symptoms (control group; age 49.6 +/- 4.2 years, mean +/- SD). The study participants were patients at a menopause clinic, and the latter were healthy volunteer nurses and hospital staff. Climacteric symptoms were evaluated by an assessment of the severity of 17 symptoms immediately before positron emission tomography examination of rCBF. The symptoms had been used previously to generate the Kupperman Kohnenki Shogai Index, a modified Kupperman Menopausal Index adapted to Japanese women. rCBF was measured by positron emission tomography with the CO2 dynamic inhalation method.

RESULTS

Reductions in relative rCBF in the patient group were observed in the bilateral rectal gyrus and in the left subcallosal gyrus on a voxel-by-voxel basis as compared with the control group.

CONCLUSIONS

The present study revealed reductions in relative rCBF of the prefrontal cortex of Japanese women with moderate to severe climacteric symptoms. This area is close to that previously addressed in studies of familial bipolar depression and familial unipolar depression, although our participants did not satisfy criteria for depression. This reduction of rCBF may be related to the three climacteric symptom clusters, but further studies are needed for evaluation of its significance. Our results should stimulate investigations into the positron emission tomography rCBF change of these women as to the integration of multiple entities in climacteric symptoms.

Finished herbal product as an alternative treatment for menopausal symptoms in climacteric women

BACKGROUND

There is a paucity of scientific evidence supporting the efficacy of herbal medicines in treating menopausal symptoms.

OBJECTIVE

The aim of this study was to evaluate safety and efficacy of the finished herbal product TMN-1 in the treatment of menopausal symptoms in climacteric women.

DESIGN AND SETTING

A multicenter, prospective, observational follow-up study was conducted from July 2003 to December 2004 in four hospitals in Taiwan.

PARTICIPANTS

Initially, 126 women were included who were between 45 and 55 years of age, were experiencing hot flashes, and were without hormone replacement therapy. Women were excluded if they had any signs of active cancer. Of the participants, 82% completed the study. The reasons for withdrawal included adverse effects (n = 7), failed to return (n = 7), lack of efficacy (n = 6), and from protocol deviation (n = 3).

INTERVENTION

Every participant received TMN-1 treatment 4 g, 3 times per day, for 12 weeks.

MAIN OUTCOME MEASURE

Primary measures were change in frequency of hot flashes and severity of menopausal symptoms measured by Kupperman Index (KI). Secondary outcomes included changes in quality of life and adverse events.

RESULTS

Significant improvement in scores of hot flashes and KI were found at weeks 4 and 12 in the 50 peri- and 53 postmenopausal women who completed this study (p < 0.001). Logistic regression analyses showed that perimenopausal women with hot flashes had sevenfold (95% confidence interval [CI], 1.8-28.0) odds of improvement in favor of treatment, whereas that of the postmenopausal group was 1.5 (95% CI, 0.5 to 4.2). Further analyses showed that TMN-1 produced superior benefit in women with moderate and severe menopausal symptoms (KI > or = 21), compared to those with mild symptoms. It also improved symptoms of insomnia, nervousness, melancholia, and palpitation in perimenopausal women. Five (5) adverse drug reactions were detected: three single events of nausea, abdominal pain, and abdominal fullness; and two events of diarrhea.

CONCLUSIONS

This study provides evidence that 12 weeks of TMN-1 therapy is a viable alternative treatment to consider in perimenopausal women with hot flashes, particularly in those with palpitations, emotional disturbance, and insomnia.

Climacteric symptoms and hormones

Climacteric symptoms are so closely associated with the menopause to be practically considered its hallmark. However, symptoms can already appear before the onset of menopause. The frequency, extent and intensity of symptoms are dependent on social factors, body composition, race and geographical region. In about 20-25% of menopausal women they do not occur at all. These symptoms are most prominent in women who are suddenly deprived of their endogenous estrogen secretion, for instance by bilateral ovariectomy, particularly in younger women. Climacteric symptoms can to be subdivided into five categories: menstrual bleeding disorders; vegetative symptoms; psychosomatic symptoms; somatotrophic changes; and metabolic changes. For prevention and treatment of the various symptoms, estrogen/progestogen replacement therapy (HRT) or estrogen replacement therapy (ERT) in individualized dosages and various forms of applications are the most cost-effective modalities in order to control menopausal symptoms and restore organic function, or prevent all of this and improve women's quality of life. Recent publications indicate that gene polymorphisms may be associated with severe and persistent climacteric symptoms. This is also true for current and ever cigarette smokers.

A universal menopausal syndrome?

A variety of symptoms are reported frequently as being part of a menopausal syndrome. These include hot flashes, night sweats, menstrual irregularities, vaginal dryness, depression, nervous tension, palpitations, headaches, insomnia, lack of energy, difficulty concentrating, and dizzy spells. The question of whether and how symptoms occur together is important for women who want to know which symptoms can be attributed to menopause and which to aging generally or to other physical or psychosocial factors. To address this question, the present article examines the following avenues of research: (1) the clustering or grouping of symptoms; (2) the temporal association of different symptoms with stages of the menopausal transition; (3) the consistency of symptom reporting across cultures, race, and ethnicity; and (4) the consistency of risk factors for symptoms. Results of the factor analysis studies do not support a single syndrome consisting of menopausal and psychological or somatic symptoms. The prevalence of symptom reporting across the transition also argues against a menopausal syndrome because vasomotor symptoms follow a unique pattern that differs from that of other symptoms. Cross-cultural differences suggest that symptom reporting is not universal. Finally, although there is some overlap in risk factors for symptoms, menopausal status is more consistently related to vasomotor symptoms than to psychological or physical ones. Results of these investigations all argue against a universal menopausal syndrome. Future research should focus on how symptoms are interrelated, what factors are uniquely related to vasomotor symptoms, and identifying whether there is a subgroup of women who are more likely to report symptoms.

Factor analysis of climacteric symptoms in Japan

OBJECTIVES

To identify menopausal and climacteric symptoms among midlife Japanese women by factor analysis of symptom frequency and severity data.

METHODS

Demographic information, anthropometric data, 2-week recalls of 82 symptoms, and assessment of epidemiological menopausal and self-defined konenki (climacteric) status were collected from 140 Japanese women living in Kyoto and Fukushima prefectures. Factor analysis was performed using symptom frequency scores and frequency-severity scores. To identify the symptoms constituting menopausal and climacteric syndromes in Japan, regression scores for individual factors were compared by menopausal and konenki status groups using non-parametric tests.

RESULTS

Among 140 women aged 49.5+/-3.0 years (mean+/-S.D.), the three most prevalent symptoms were shoulder stiffness, memory loss, and stress. Analysis of frequency data resulted in an eight-factor solution, and frequency-severity data in a seven-factor solution. Anxiety and depression factors and a sexual-vasomotor factor were observed in almost all factor solutions, with additional factors comprised of psychosomatic and somatic symptoms. Anxiety scores differed by menopausal status, depression scores by konenki status, and sexual-vasomotor scores by both. Chilliness was highly correlated with sexual-vasomotor symptoms and frequency scores differed significantly between menopausal but not konenki groups.

CONCLUSIONS

Sexual-vasomotor symptoms constitute a robust menopausal and konenki symptom grouping among Japanese women, but do not include night sweats or the foreign word hotto furasshu, yet do include chilliness, which may reflect thermoregulatory instability. Overlap of factors displaying significant differences between menopausal and konenki groups indicate a transition to a more medicalized concept of konenki in use by Japanese women.