Cigarettes, genetic background, and menopausal timing: the presence of single nucleotide polymorphisms in cytochrome P450 genes is associated with increased risk of natural menopause in European-American smokers

Tobacco or marijuana use and infertility: a committee opinion

In the United States, approximately 21% of adults report some form of tobacco use, although 18% report marijuana use. Although the negative impact of tobacco use in pregnancy is well documented, the impact of tobacco and marijuana on fertility and reproduction is less clear. This committee opinion reviews the potential deleterious effects of tobacco, nicotine, and marijuana use on conception, ovarian follicular dynamics, sperm parameters, gamete mutations, early pregnancy, and assisted reproductive technology outcomes. It also reviews the current status of tobacco smoking cessation strategies. This document replaces the 2018 American Society for Reproductive Medicine Practice Committee document entitled Smoking and Infertility: a committee opinion (Fertil Steril 2018).

Smoking and Its Consequences on Male and Female Reproductive Health

Smoking contributes to the death of around one in 10 adults worldwide. Specifically, cigarettes are known to contain around 4000 toxins and chemicals that are hazardous in nature. The negative effects of smoking on human health and interest in smoking-related diseases have a long history. Among these concerns are the harmful effects of smoking on reproductive health. Thirteen percent of female infertility is due to smoking. Female smoking can lead to gamete mutagenesis, early loss of reproductive function, and thus advance the time to menopause. It has been also associated with ectopic pregnancy and spontaneous abortion. Even when it comes to assisted reproductive technologies cycles, smokers require more cycles, almost double the number of cycles needed to conceive as non-smokers. Male smoking is shown to be correlated with poorer semen parameters and sperm DNA fragmentation. Not only active smokers but also passive smokers, when excessively exposed to smoking, can have reproductive problems comparable to those seen in smokers. In this book chapter, we will approach the effect of tobacco, especially tobacco smoking, on male and female reproductive health. This aims to take a preventive approach to infertility by discouraging smoking and helping to eliminate exposure to tobacco smoke in both women and men.

Age at natural menopause in women with a history of chronic diseases-A population-based cohort study

OBJECTIVE

This study was carried out to determine whether chronic diseases can influence age at natural menopause (ANM).

STUDY DESIGN AND MAIN OUTCOME MEASURES

This population-based prospective study recruited all eligible women from participants in the Tehran Lipid and Glucose Study (TLGS). The Cox proportional-hazards model (unadjusted and adjusted) was used to assess associations of ANM with chronic diseases, including diabetes mellitus (DM), hypertension (HTN), dyslipidemia, metabolic syndrome (MetS), cardiovascular disease (CVD), chronic kidney disease (CKD), and thyroid disorders, which were not included simultaneously in the model because there were correlations between chronic diseases.

RESULTS

A total of 4662 women, aged 15-50 years, who had not reached menopause at initiation of the TLGS were included. Of these women, 1220 (26.2%) experienced menopause during the study follow-up. In the multivariable Cox regression model adjusted for potential confounders, women with DM [HR:1.75; 95%CI: (1.32, 2.32)], HTN [HR: 2.11; 95%CI: (1.64, 2.72)], MetS [HR: 2.01; 95%CI: (1.57, 2.58)], CVD [HR: 3.02; 95%CI: (1.93, 4.73)], CKD [HR: 2.64; 95%CI: (2.16, 3.22)], and thyroid disorders [HR: 1.41; 95%CI: (1.06, 1.88)] reached menopause earlier, while dyslipidemia was not associated with ANM.

CONCLUSION

This study demonstrates that women with a history of chronic diseases, such as metabolic disorders, cardiovascular events, and CKD, experience menopause earlier than their counterparts without such a history.

The Effects of Environmental Contaminant Exposure on Reproductive Aging and the Menopause Transition

PURPOSE OF REVIEW

Menopause marks the end of a woman's reproductive lifetime. On average, natural menopause occurs at 51 years of age. However, some women report an earlier age of menopause than the national average. This can be problematic for women who delay starting a family. Moreover, early onset of menopause is associated with increased risk of cardiovascular disease, depression, osteoporosis, and premature death. This review investigates associations between exposure to endocrine-disrupting chemicals (EDCs) and earlier onset of menopause.

RECENT FINDINGS

Recent data suggest exposure to certain EDCs may accelerate reproductive aging and contribute to earlier onset of menopause. Human and rodent-based studies identify positive associations between exposure to certain EDCs/environmental contaminants and reproductive aging, earlier onset of menopause, and occurrence of vasomotor symptoms. These findings increase our understanding of the detrimental effects of EDCs on female reproduction and will help lead to the development of strategies for the treatment/prevention of EDC-induced reproductive aging.

Age of Natural Menopause Among Jordanian Women and Factors Related to Premature and Early Menopause

OBJECTIVE

The aim of this study was to assess factors related to the onset of premature/early natural menopause among Jordanian women.

METHODS

A cross-sectional study was conducted in early 2016. Subjects were enrolled based on random drop-off technique to the Obstetrics and Gynecology clinics at the Jordan University Hospital. Women 18 years of age and above were initially eligible to enroll, and women who had surgically induced menopause or specific disease were excluded from the analysis. Relevant data were collected using a questionnaire that included 30 questions. The following variables were collected: socio-demographic, body mass index, chronic conditions, diseases, reproductive characteristics, and health status. Hormone indicators of menopause were tested by measuring estrogen (E2) and follicle-stimulating hormone (FSH) levels. Age at natural menopause (ANM) was self-reported retrospectively and considered an independent variable against BMI, smoking, hormone therapy, and concomitant diseases. Association analysis and multinomial logistic regression were used to examine the associated factors of ANM with adjusted odds ratios (ORs), and their 95% confidence intervals (CIs) were reported.

RESULTS

A total of 409 women were included in the analysis, aged between 20-75 years. The mean ANM in our sample was 48.5±5.0, with 2.7% of the women experienced premature menopause (ANM <40) and 7.8% early menopause (ANM 40-44). Within the menopause women (n=242), the percentage of women who had premature menopause was 4.5%, 13.6% with early menopause, and 21.1% with late menopause (ANM >52). Smoking was the major risk factor for premature/early menopausal age among Jordanian women with an OR of 2.46 (95% CI: 1.08-5.59, p<0.05). On the other hand, women with occasional arthritis symptoms and diseases such as hypertension, diabetes, dyslipidemia, and their combination were associated with average (45-52 years) or late menopause (>52 years).

CONCLUSION

Smoking is the main contributor of premature/early menopause in Jordanian women. Increased awareness and public health policy about the adverse effects of smoking on women's reproductive health are needed.

Transitioning to the menopausal transition: a scoping review of research on the late reproductive stage in reproductive aging

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.

Genetic Variation and Hot Flashes: A Systematic Review

CONTEXT

Approximately 70% of women report experiencing vasomotor symptoms (VMS, hot flashes and/or night sweats). The etiology of VMS is not clearly understood but may include genetic factors.

EVIDENCE ACQUISITION

We searched PubMed and Embase in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. We included studies on associations between genetic variation and VMS. We excluded studies focused on medication interventions or prevention or treatment of breast cancer.

EVIDENCE SYNTHESIS

Of 202 unique citations, 18 citations met the inclusion criteria. Study sample sizes ranged from 51 to 17 695. Eleven of the 18 studies had fewer than 500 participants; 2 studies had 1000 or more. Overall, statistically significant associations with VMS were found for variants in 14 of the 26 genes assessed in candidate gene studies. The cytochrome P450 family 1 subfamily A member 1 (CYP1B1) gene was the focus of the largest number (n = 7) of studies, but strength and statistical significance of associations of CYP1B1 variants with VMS were inconsistent. A genome-wide association study reported statistically significant associations between 14 single-nucleotide variants in the tachykinin receptor 3 gene and VMS. Heterogeneity across trials regarding VMS measurement methods and effect measures precluded quantitative meta-analysis; there were few studies of each specific genetic variant.

CONCLUSIONS

Genetic variants are associated with VMS. The associations are not limited to variations in sex-steroid metabolism genes. However, studies were few and future studies are needed to confirm and extend these findings.

Factors related to age at menopause among Korean women: the Korean Longitudinal Survey of Women and Families

OBJECTIVE

The purpose of this study was to explore factors influencing age of menopause among Korean women.

METHODS

For this secondary analysis study, panel data for Waves 4 through 6 of the Korean Longitudinal Survey of Women were used. Women aged 40 to 60 who were menstruating at Wave 4 were included in the analysis (N = 5,437). Sociodemographic, health status, and health behavioral factors were examined to explore their influence on menopause using Kaplan-Meier analysis and Cox regression analysis.

RESULTS

Korean women who perceived themselves to be overweight or obese, who had depressive symptoms, or who smoked or were current smokers had higher probabilities of experiencing the onset of menopause, whereas those who had educational achievement lower than high school had a lower probability of experiencing the onset menopause.

CONCLUSIONS

Various factors influenced menopause, including sociodemographic, health status, and health behaviors. Specific tailored interventions for the management of depressive symptoms and smoking cessation could be developed to target modifying variables for Korean women, in preparation for menopause. Also, the role of perceived body weight on menopause could be further explored to identify sociocultural factors for age at menopause.

Environmental pollutants, a possible etiology for premature ovarian insufficiency: a narrative review of animal and human data

BACKGROUND

Because only 25% of cases of premature ovarian insufficiency (POI) have a known etiology, the aim of this review was to summarize the associations and mechanisms of the impact of the environment on this pathology. Eligible studies were selected from an electronic literature search from the PUBMED database from January 2000 to February 2016 and associated references in published studies. Search terms included ovary, follicle, oocyte, endocrine disruptor, environmental exposure, occupational exposure, environmental contaminant, pesticide, polyaromatic hydrocarbon, polychlorinated biphenyl PCB, phenol, bisphenol, flame retardant, phthalate, dioxin, phytoestrogen, tobacco, smoke, cigarette, cosmetic, xenobiotic. The literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We have included the human and animal studies corresponding to the terms and published in English. We have excluded articles that included results that did not concern ovarian pathology and those focused on ovarian cancer, polycystic ovary syndrome, endometriosis or precocious puberty. We have also excluded genetic, auto-immune or iatrogenic causes from our analysis. Finally, we have excluded animal data that does not concern mammals and studies based on results from in vitro culture. Data have been grouped according to the studied pollutants in order to synthetize their impact on follicular development and follicular atresia and the molecular pathways involved. Ninety-seven studies appeared to be eligible and were included in the present study, even though few directly address POI. Phthalates, bisphenol A, pesticides and tobacco were the most reported substances having a negative impact on ovarian function with an increased follicular depletion leading to an earlier age of menopause onset. These effects were found when exposure occured at different times throughout the lifetime from the prenatal to the adult period, possibly due to different mechanisms. The main mechanism seemed to be an increase in atresia of pre-antral follicles.

CONCLUSION

Environmental pollutants are probably a cause of POI. Health officials and the general public must be aware of this environmental effect in order to implement individual and global preventive actions.

Methods in a longitudinal cohort study of late reproductive age women: the Penn Ovarian Aging Study (POAS)

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.

Smoking-Associated Site-Specific Differential Methylation in Buccal Mucosa in the COPDGene Study

DNA methylation is a complex, tissue-specific phenomenon that can reflect both endogenous factors and exogenous exposures. Buccal brushings represent an easily accessible source of DNA, which may be an appropriate surrogate tissue in the study of environmental exposures and chronic respiratory diseases. Buccal brushings were obtained from a subset of current and former smokers from the COPDGene study. Genome-wide DNA methylation data were obtained in the discovery cohort (n = 82) using the Illumina HumanMethylation450K array. Empirical Bayes methods were used to test for differential methylation by current smoking status at 468,219 autosomal CpG sites using linear models adjusted for age, sex, and race. Pyrosequencing was performed in a nonoverlapping replication cohort (n = 130). Current smokers were significantly younger than former smokers in both the discovery and replication cohorts. Seven CpG sites were associated with current smoking at a false discovery rate less than 0.05 in the discovery cohort. Six of the seven significant sites were pyrosequenced in the replication cohort; five CpG sites, including sites annotated to CYP1B1 and PARVA, were replicated. Correlations between cumulative smoke exposure and time since smoking cessation were observed in a subset of the significantly associated CpG sites. A significant correlation between reduced lung function and increased radiographic emphysema with methylation at cg02162897 (CYP1B1) was observed among female subjects. Site-specific methylation of DNA isolated from buccal mucosa is associated with exposure to cigarette smoke, and may provide insights into the mechanisms underlying differential susceptibility toward the development of smoking-related chronic respiratory diseases.

Endocrinology of the Menopause

In women, age-related changes in ovarian function begin in the mid-30s with decreased fertility and compensatory hormonal changes in the hypothalamus-pituitary-gonadal axis that maintain follicle development and estrogen secretion in the face of a waning pool of ovarian follicles. The menopause transition is characterized by marked variability in follicle development, ovulation, bleeding patterns, and symptoms of hyper- and hypoestrogenism. The menopause, which is clinically defined by the last menstrual period, is followed by the consistent absence of ovarian secretion of estradiol.

Factors affecting age of onset of menopause and determination of quality of life in menopause

Menopause is a process in the climacteric period, characterized by a reduction in ovarian activity, a fall in the fertility rate, and a range of symptoms including irregular menstruation intervals. Most women enter menopause in their 40s, but this can vary from one individual to another. Although there are many factors affecting the age of menopause onset, there is no general agreement on them. Studies have shown many factors to affect the age of menopause, such as the mother’s age at menopause, the age at menarche, gestational age, use of oral contraceptives, irregular menstrual cycle, number of pregnancies, body mass index, use of tobacco and alcohol, physical activity, unilateral oophorectomy, serum lead levels, consumption of polyunsaturated fat, socioeconomic status and educational level. During this period, hormonal and biochemical changes give rise to various symptoms in the woman’s body. In menopause period, physical, psychological, social and sexual changes have a negative effect on quality of life in women. Recently, different measures have been used to assess women’s quality of life in this period of change. The purpose of this review was to examine the factors affecting the onset age of menopause and the measures of quality of life related to menopause.