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Liang B, Chen X, Li M, Zhang L, Yang X, Shi L, Gong Y, Gong Y, Xu H, Wu X, Jin Z, Wang Y, Liu L, Yi X, Xie L, Zhong H, Shen C, Wang Y, Yang L. Liuwei Dihuang pills attenuate ovariectomy-induced bone loss by alleviating bone marrow mesenchymal stem cell (BMSC) senescence via the Yes-associated protein (YAP)-autophagy axis. PHARMACEUTICAL BIOLOGY 2024; 62:42-52. [PMID: 38112463 DOI: 10.1080/13880209.2023.2291675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
CONTEXT Liuwei Dihuang pill (LWDH) has been used to treat postmenopausal osteoporosis (PMOP). OBJECTIVE To explore the effects and mechanisms of action of LWDH in PMOP. MATERIALS AND METHODS Forty-eight female Sprague-Dawley rats were divided into four groups: sham-operated (SHAM), ovariectomized (OVX), LWDH high dose (LWDH-H, 1.6 g/kg/d) and LWDH low dose (LWDH-L, 0.8 g/kg/d); the doses were administered after ovariectomy via gavage for eight weeks. After eight weeks, the bone microarchitecture was evaluated. The effect of LWDH on the differentiation of bone marrow mesenchymal stem cells (BMSCs) was assessed via osteogenesis- and lipogenesis-induced BMSC differentiation. The senescence-related biological indices were also detected using senescence staining, cell cycle analysis, quantitative real-time polymerase chain reaction and western blotting. Finally, the expression levels of autophagy-related proteins and Yes-associated protein (YAP) were evaluated. RESULTS LWDH-L and LWDH-H significantly modified OVX-induced bone loss. LWDH promoted osteogenesis and inhibited adipogenesis in OVX-BMSCs. Additionally, LWDH decreased the positive ratio of senescence OVX-BMSCs and improved cell viability, cell cycle, and the mRNA and protein levels of p53 and p21. LWDH upregulated the expression of autophagy-related proteins, LC3, Beclin1 and YAP, in OVX-BMSCs and downregulated the expression of p62. DISCUSSION AND CONCLUSIONS LWDH improves osteoporosis by delaying the BMSC senescence through the YAP-autophagy axis.
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Affiliation(s)
- Bing Liang
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiongbin Chen
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Min Li
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lingling Zhang
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xia Yang
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Liangqin Shi
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yanju Gong
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuanyuan Gong
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huan Xu
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao Wu
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhong Jin
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yanru Wang
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Luwei Liu
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaohong Yi
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lushuang Xie
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hua Zhong
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chongyang Shen
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yong Wang
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lan Yang
- Basic Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Akhtar SMM, Ali A, Khan MS, Khan V, Fareed A, Saleem SZ, Mumtaz M, Ahsan MN, Iqbal S, Asghar MS. Efficacy and safety of fezolinetant for vasomotor symptoms in postmenopausal women: A systematic review and meta-analysis of randomized controlled trials. Int J Gynaecol Obstet 2024; 166:969-983. [PMID: 38563867 DOI: 10.1002/ijgo.15467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/10/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Vasomotor symptoms (VMS), such as hot flashes and night sweats, are highly prevalent and burdensome for women experiencing menopausal transition. Fezolinetant, a selective neurokinin 3 receptor (NK3R) antagonist, is a potential therapeutic option for mitigating VMS. OBJECTIVES Our aim is to assess the efficacy and evaluate the safety profile of fezolinetant compared with placebo in post-menopausal women suffering from VMS, by pooling all the relevant data and reflecting the most current evidence. SEARCH STRATEGY/SELECTION CRITERIA An extensive literature search was performed in the PubMed, Medline and Cochrane Library databases from inception until June 2023 to identify relevant trials. DATA COLLECTION AND ANALYSIS Mean differences (MDs) and 95% confidence intervals (CIs) were calculated for continuous outcomes. Risk ratios (RRs) were calculated for dichotomous outcomes. All statistical analyses were performed using R Statistical Software. MAIN RESULTS A total of six randomized controlled trials were added. For the frequency of daily VMS, the combined pooled result favored the fezolinetant group over placebo (MD -2.38, 95% CI -2.64 to -2.12; P < 0.001, I2 = 0%). For the severity of daily VMS, fezolinetant was again found to be superior to the placebo group (MD -0.40, 95% CI -0.51 to -0.29; P < 0.001, I2 = 70%). Fezolinetant (120 mg) consistently demonstrated a significant reduction in the severity of daily moderate/severe VMS compared with other doses at both 4 and 12 weeks. Patient-reported outcomes (PROs) of Greene Climacteric Scale (GCS), PROMIS the Sleep Disturbance Short Form 8b and Menopause-Specific Quality of Life (MENQoL) scores indicated significant improvement with fezolinetant. No significant difference in efficacy of fezolinetant at 4 and 12 weeks were observed in any outcome. As for safety, no significant differences in the treatment emergent adverse events at 12 weeks were found between fezolinetant and placebo. CONCLUSIONS Our study significantly favors fezolinetant over placebo regarding the primary efficacy outcomes of daily moderate to severe VMS frequency and severity, including PROs, while both the groups are comparable in terms of treatment emergent adverse events. Further studies are needed to confirm these findings.
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Affiliation(s)
| | - Abraish Ali
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Vareesha Khan
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Areeba Fareed
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Syed Zia Saleem
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Munazza Mumtaz
- Department of Obstetrics and Gynecology, Civil Hospital, Karachi, Pakistan
| | | | - Sadia Iqbal
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
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Yuk JS, Kim GS, Byun YS, Yang SW, Kim MH, Yoon SH, Seo YS, Kim BG. Effect of menopausal hormonal therapy on cardiovascular risks in Korean postmenopausal women: A nationwide cohort study. BJOG 2024; 131:1306-1317. [PMID: 38465460 DOI: 10.1111/1471-0528.17803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To evaluate the association between menopausal hormonal therapy (MHT) and the risk of cardiovascular disease (CVD), according to various regimens, dosages, routes of administration and starting ages of MHT. DESIGN A population-based cohort study using the Korean National Health Insurance Services database. SETTING Nationwide health insurance database. POPULATION Women who reported entering menopause at an age of ≥40 years with no history of CVD in the national health examination. METHODS The study population comprised 1 120 705 subjects enrolled between 2002 and 2019, categorised according to MHT status (MHT group, n = 319 007; non-MHT group, n = 801 698). MAIN OUTCOME MEASURES Incidence of CVD (a composite of myocardial infarction and stroke). RESULTS The incidence of CVD was 59 266 (7.4%) in the non-MHT group and 17 674 (5.5%) in the MHT group. After adjusting for confounding factors, an increased risk of CVD was observed with the administration of tibolone (hazard ratio, HR 1.143, 95% CI 1.117-1.170), oral estrogen (HR 1.246, 95% CI 1.198-1.295) or transdermal estrogen (HR 1.289, 95% CI 1.066-1.558), compared with the non-MHT group; the risk was based on an increased risk of stroke. The risk trends were consistent regardless of the age of starting MHT or the physicians' specialty. Among tibolone users, a longer period from entering menopause to taking tibolone and the use of any dosage (1.25 or 2.5 mg) were linked with a higher risk of CVD, compared with non-MHT users. CONCLUSIONS This nationwide cohort study demonstrated an increased risk of CVD, driven mainly by an increased risk of stroke, among tibolone and oral or transdermal estrogen users, compared with that of non-MHT users.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynaecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Gwang Sil Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Seung-Woo Yang
- Department of Obstetrics and Gynaecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Hwan Kim
- Department of Obstetrics and Gynaecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hee Yoon
- Department of Obstetrics and Gynaecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Yong-Soo Seo
- Medi-i Women's Hospital, Seoul, Republic of Korea
| | - Byung Gyu Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
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Zipperer M, Enciso J, Wood M, Crousillat D. The comprehensive care of the post-SCAD patient. Curr Probl Cardiol 2024; 49:102758. [PMID: 39059782 DOI: 10.1016/j.cpcardiol.2024.102758] [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: 07/16/2024] [Accepted: 07/23/2024] [Indexed: 07/28/2024]
Abstract
Spontaneous coronary artery dissection (SCAD) is the nonatherosclerotic, nontraumatic dissection of an epicardial coronary artery which is predominantly caused by intramural hematoma formation or intimal disruption. SCAD is an increasingly recognized cause of acute coronary syndrome (ACS) in young women and its true prevalence may be underestimated due to its underdiagnosis. The pathogenesis of SCAD is multifaceted and influenced by gender-specific factors, hormonal fluctuations, genetics, arteriopathies, and physical and emotional stressors. Although the pathogenesis of SCAD is multifaceted, current guidance on the care of the post-SCAD patient is limited. Moreover, it is necessary to address each of the different components contributing to the pathogenesis of SCAD in order to improve outcomes and quality of life in this patient population. This literature review aims to consolidate the current knowledge on the medical management, rehabilitation, reproductive and mental health care, and comorbidities that affect SCAD survivors.
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Affiliation(s)
- Madeline Zipperer
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Juan Enciso
- Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, FL USA
| | | | - Daniela Crousillat
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, FL USA; Heart and Vascular Institute, Tampa General Hospital, Tampa, FL, USA.
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Collins J, Duvall A, Dworkin E, Castiel M. A systematic approach to the management of menses prophylaxis and suppression in pre-menopausal hematologic cancer patients. J Oncol Pharm Pract 2024:10781552241266587. [PMID: 39043214 DOI: 10.1177/10781552241266587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
OBJECTIVE Hematologic malignancies in women of reproductive age carry significant additional morbidity due to menstrual bleeding in conjunction with disease and treatment-associated cytopenias. Several agents for menses prophylaxis and suppression exist, but there is a paucity of data comparing these therapies, particularly in the cancer setting. DATA SOURCES A thorough literature review and evaluation of available data was conducted via PubMed search and combined with clinical expertise. DATA SUMMARY The goal of prophylaxis therapy is to induce amenorrhea until it is considered safe to resume menstrual cycles. GnRH agonists remain the management of choice in achieving menses control and amenorrhea. Suppression is more likely achieved when the therapy is initiated in the late luteal phase or with the concomitant use of oral contraceptives. The effective use of oral contraceptives is achievable in appropriately selected patients. Although attractive as prophylactic agents, GnRH agonists have a slow onset of amenorrhea and can be associated with an initial increase in bleeding, thus are of limited value in immediate menorrhagia management. We recommend prioritizing estrogen therapy given its documented efficacy, and adding tranexamic acid as a secondary agent for severe or refractory bleeding. CONCLUSIONS Thus far in the literature, this is the most comprehensive proposed pathway for the prevention and suppression of menorrhagia in hematologic cancer patients. Our protocol provides a step-wise approach for the management of menses prophylaxis and suppression to provide standardization amongst clinicians and adaptations for patient-specific needs.
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Affiliation(s)
| | - Adam Duvall
- University of Chicago Medicine, Chicago, IL, USA
| | | | - Mercedes Castiel
- University of Chicago Medicine, Chicago, IL, USA
- The Cancer Care Concierge LLC New York City, NY, USA
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Zou SB, Zeng ZH. Effects of tibolone combined with zoledronic acid on bone density, bone metabolism, and pain in postmenopausal patients with osteoporosis. Am J Transl Res 2024; 16:3395-3404. [PMID: 39114689 PMCID: PMC11301455 DOI: 10.62347/ydkm2312] [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: 04/08/2024] [Accepted: 06/17/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To explore the efficacy and safety of tibolone combined with zoledronic acid in the treatment of postmenopausal osteoporosis (PMO). METHODS We conducted a retrospective analysis of 121 PMO patients from March 2019 to July 2021. Patients were divided into two groups based on treatment regimen: an observation group (n=62) receiving zoledronic acid combined with tibolone and a control group (n=59) receiving tibolone monotherapy. We evaluated and compared therapeutic efficacy, bone mineral density, bone metabolism markers (osteocalcin, serum C-terminal telopeptide of type I collagen, and bone alkaline phosphatase), pain, knee joint function, incidence of fragility fractures, and adverse reactions. Logistic regression analysis was used to evaluate risk factors affecting treatment efficacy. RESULTS The observation group showed a significantly higher therapeutic effect (96.77%) compared to the control group (83.05%), and a lower incidence of fragility fractures (P=0.012). Before treatment, there were no significant differences in bone mineral density, bone metabolism markers, pain status, or knee function between the two groups (all P>0.05). However, after treatment, evaluations showed marked improvements in these parameters in both groups, with more significant enhancements observed in the observation group (all P<0.001). The incidence of adverse reactions did not significantly differ between the groups (20.97% vs 13.56%, P=0.282). Logistic regression analysis identified the use of tibolone combined with zoledronic acid as a protective factor for effective treatment. CONCLUSIONS Tibolone combined with zoledronic acid significantly increases bone mineral density, improves bone metabolism, and reduces pain in PMO patients, with a safety profile comparable to that of monotherapy. This regimen should be considered for clinical use in treating PMO.
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Affiliation(s)
- San-Bao Zou
- Department of Pain, Zhejiang Jiashan County First People's Hospital Jiashan County, Jiaxing 314100, Zhejiang, China
| | - Zhen-Hua Zeng
- Department of Pain, Zhejiang Jiashan County First People's Hospital Jiashan County, Jiaxing 314100, Zhejiang, China
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Wei J, Li BWX, Han SJ, Zhuang HJ, Cao WH. Effect of continuous nursing on treatment compliance and side effect management of coronary heart disease. World J Clin Cases 2024; 12:3701-3707. [PMID: 38994285 PMCID: PMC11235468 DOI: 10.12998/wjcc.v12.i19.3701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/12/2024] [Accepted: 05/13/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND There are relatively few studies on continuing care of coronary heart disease (CHD), and its research value needs to be further clarified. AIM To investigate the effect of continuous nursing on treatment compliance and side effect management in patients with CHD. METHODS This is a retrospective study with patients from January 2021 to 2023. The study was divided into two groups with 30 participants in each group. Self-rating anxiety scale (SAS) and Self-rating depression scale (SDS) were used to assess patients' anxiety and depression, and medical coping questionnaire was used to assess patients' coping styles. The pelvic floor dysfunction questionnaire (PFDI-20) was used to assess the status of pelvic floor function, including bladder symptoms, intestinal symptoms, and pelvic symptoms. RESULTS SAS score decreased from 57.33 ± 3.01before treatment to 41.33 ± 3.42 after treatment, SDS score decreased from 50.40 ± 1.45 to 39.47 ± 1.57. The decrease of these two indexes was statistically significant (P < 0.05). PFDI-20 scores decreased from the mean 16.83 ± 1.72 before treatment to 10.47 ± 1.3the mean after treatment, which was statistically significant (P < 0.05). CONCLUSION The results of this study indicate that pioneering research in continuous care of CHD has a positive impact on improving patients' treatment compliance, reducing anxiety and depression levels, and improving coping styles and pelvic floor functional status.
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Affiliation(s)
- Juan Wei
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 750061, Hebei Province, China
| | - Bai-Wen-Xian Li
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 750061, Hebei Province, China
| | - Shao-Jie Han
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 750061, Hebei Province, China
| | - Hong-Jie Zhuang
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 750061, Hebei Province, China
| | - Wen-Hong Cao
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 750061, Hebei Province, China
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Klinaki E, Ogrodnik M. In the land of not-unhappiness: On the state-of-the-art of targeting aging and age-related diseases by biomedical research. Mech Ageing Dev 2024; 219:111929. [PMID: 38561164 DOI: 10.1016/j.mad.2024.111929] [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: 12/26/2023] [Revised: 03/12/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024]
Abstract
The concept of the Land of Not-Unhappiness refers to the potential achievement of eliminating the pathologies of the aging process. To inform of how close we are to settling in the land, we summarize and review the achievements of research on anti-aging interventions over the last hundred years with a specific focus on strategies that slow down metabolism, compensate for aging-related losses, and target a broad range of age-related diseases. We critically evaluate the existing interventions labeled as "anti-aging," such as calorie restriction, exercise, stem cell administration, and senolytics, to provide a down-to-earth evaluation of their current applicability in counteracting aging. Throughout the text, we have maintained a light tone to make it accessible to non-experts in biogerontology, and provide a broad overview for those considering conducting studies, research, or seeking to understand the scientific basis of anti-aging medicine.
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Affiliation(s)
- Eirini Klinaki
- Ludwig Boltzmann Research Group Senescence and Healing of Wounds, Vienna 1200, Austria; Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, Vienna 1200, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Mikolaj Ogrodnik
- Ludwig Boltzmann Research Group Senescence and Healing of Wounds, Vienna 1200, Austria; Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, Vienna 1200, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria.
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Ferreira Campos L, de Andrade Costa G, Domingues Feitosa M, Ferreira Félix I, Gabrielli L, C Almeida MDC, Ml Aquino E, Aras Júnior R. Effect of hormone therapy on blood pressure and hypertension in postmenopausal women: a systematic review and meta-analysis. Menopause 2024; 31:556-562. [PMID: 38688468 DOI: 10.1097/gme.0000000000002359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
IMPORTANCE Menopausal hormone therapy (HT) includes a wide variety of hormonal compounds, and its effect on blood pressure is still uncertain. OBJECTIVE The aim of this study was to assess evidence regarding the effect of HT on blood pressure in postmenopausal women and its association with arterial hypertension. EVIDENCE REVIEW This systematic review and meta-analysis included randomized clinical trials and prospective observational studies. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and the incidence of hypertension were assessed. All stages were independently performed by two reviewers. For blood pressure outcome, standardized mean differences (SMD) and 95% confidence intervals (95% CI) were calculated as effect measures. Heterogeneity was assessed using the I2 statistic. The results are presented based on the HT type. The incidence of hypertension was compared using descriptive analyses. FINDINGS Eleven studies were included with 81,041 women evaluated, of which 29,812 used HT. The meta-analysis, conducted with 8 studies and 1,718 women, showed an increase in SBP with the use of oral conjugated equine estrogens plus progestogen (SMD = 0.60 mm Hg, 95% CI = 0.19 to 1.01). However, oral or transdermal use of estradiol plus progestogen (SMD = -2.00 mm Hg, 95% CI = -7.26 to 3.27), estradiol alone, and tibolone did not show any significant effect. No significant effect on DBP was observed for any formulation. Women who used oral estrogen plus progestogen had a higher risk of incident hypertension than those who never used it. CONCLUSIONS AND RELEVANCE The effect of HT on blood pressure is influenced by the formulation used, especially the type of estrogen. The combined formulations of conjugated equine estrogens plus progestogen increased SBP and the risk of hypertension, which was not observed among estradiol plus progestogen, estradiol alone, and tibolone users.
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Affiliation(s)
- Luana Ferreira Campos
- From the Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | - Iuri Ferreira Félix
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Ligia Gabrielli
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Estela Ml Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Roque Aras Júnior
- From the Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Brazil
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Chavez MP, Pasqualotto E, Ferreira ROM, Hohl A, de Moraes FCA, Schmidt PHS, Rodrigues ALSDO, de Sa JR. Fezolinetant for the treatment of vasomotor symptoms associated with menopause: a meta-analysis. Climacteric 2024; 27:245-254. [PMID: 38619017 DOI: 10.1080/13697137.2024.2334083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/18/2024] [Indexed: 04/16/2024]
Abstract
This systematic review and meta-analysis investigated the efficacy and safety of fezolinetant for the treatment of moderate-to-severe vasomotor symptoms (VMS) associated with menopause. PubMed, Cochrane Library, Embase and Web of Science were searched for randomized controlled trials (RCTs) published from inception to June 2023, comparing fezolinetant to placebo in postmenopausal women suffering from moderate-to-severe VMS. The mean difference and risk ratio were calculated for continuous and binary outcomes, respectively. R software was used for the statistical analysis, and RoB-2 (Cochrane) to assess the risk of bias. We performed subgroup analysis based on different dosing regimens. Five RCTs comprising 3302 patients were included. Compared with placebo, at 12-week follow-up, fezolinetant significantly reduced the daily frequency of moderate-to-severe VMS (weighted mean difference [WMD] - 2.36; 95% confidence interval [CI] - 2.92, -1.81) and daily severity of moderate-to-severe VMS (WMD -0.22; 95% CI -0.31, -0.13). Also, fezolinetant significantly improved the quality of life (WMD -0.42; 95% CI -0.58, -0.26) and sleep disturbance (WMD -1.10; 95% CI -1.96, -0.24). There were no significant differences between groups in adverse events. These findings support the efficacy and safety of fezolinetant for the treatment of VMS related to menopause.
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Affiliation(s)
| | - Eric Pasqualotto
- Division of Medicine, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Alexandre Hohl
- Division of Endocrinology, Federal University of Santa Catarina, Florianópolis, Brazil
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Schultz NM, Morga A, Siddiqui E, Rhoten SE. Psychometric Evaluation of the MENQOL Instrument in Women Experiencing Vasomotor Symptoms Associated with Menopause. Adv Ther 2024; 41:2233-2252. [PMID: 38396203 PMCID: PMC11133125 DOI: 10.1007/s12325-024-02787-z] [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: 09/25/2023] [Accepted: 01/15/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Vasomotor symptoms (VMS) associated with menopause can negatively affect health-related quality of life (HRQoL). The Menopause-Specific Quality of Life (MENQOL) questionnaire has been developed to assess QOL specific to menopause. The objective of the current study was to assess the psychometric properties, sensitivity to change, and clinically meaningful within-patient change of the MENQOL using data from the fezolinetant SKYLIGHT 1 and 2 studies in individuals with VMS. METHODS Individuals aged ≥ 40 to ≤ 65 years with moderate-to-severe VMS (≥ seven hot flashes/day) were enrolled. In addition to MENQOL, eight patient-reported outcome (PRO) measures were used for the psychometric evaluation. All PRO assessments were completed at weeks 4 and 12 during the treatment period, and most were completed at baseline. Psychometric analyses included factor analysis and reliability, construct validity, and sensitivity to change assessments. The within-patient threshold for a clinically meaningful change in MENQOL was derived. RESULTS In total, 1022 individuals were included from SKYLIGHT 1 and 2. Mean MENQOL total score at baseline was 4.30, improving to 3.16 at week 12. The confirmatory factor analysis supported established MENQOL domain structure, including the overall score. The internal consistency of the MENQOL overall and domain scores was supported using Cronbach's alpha and McDonald's omega, and MENQOL construct validity was supported for overall and domain scores. Item-to-item and item-total correlations were generally sufficient, and moderate test-retest reliability was noted. The scales against which construct validity and responsiveness for MENQOL domains were examined were moderately related to the MENQOL domains in general, providing additional support for acceptable measurement properties of MENQOL in this population. A reduction in MENQOL overall score of ≥ 0.9 points was identified as responding to treatment (a clinically important threshold). Thresholds of 2.0 points for the vasomotor domain and 0.9 for the psychosocial domain were estimated, in addition to distribution-based threshold estimates of 0.8 and 1.2 for the physical and sexual domains, respectively. CONCLUSIONS The psychometric properties of the MENQOL overall and domain scores support use of this instrument to capture experiences among individuals with moderate-to-severe VMS associated with menopause and assess related endpoints in clinical trials. TRIAL REGISTRATION ClinicalTrials.gov identifiers NCT04003155 and NCT04003142.
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Affiliation(s)
| | - Antonia Morga
- Medical Affairs, Astellas Pharma Europe Ltd, Addlestone, KT15 2NX, UK.
| | - Emad Siddiqui
- Medical Affairs, Astellas Pharma Europe Ltd, Addlestone, KT15 2NX, UK
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Papadimitriou K, Mousiolis AC, Mintziori G, Tarenidou C, Polyzos SA, Goulis DG. Hypogonadism and nonalcoholic fatty liver disease. Endocrine 2024:10.1007/s12020-024-03878-1. [PMID: 38771482 DOI: 10.1007/s12020-024-03878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/12/2024] [Indexed: 05/22/2024]
Abstract
Nonalcoholic fatty liver disease (NAFLD), recently proposed to be renamed to metabolic dysfunction-associated steatotic liver disease (MASLD), is a major global public health concern, affecting approximately 25-30% of the adult population and possibly leading to cirrhosis, hepatocellular carcinoma, and liver transplantation. The liver is involved in the actions of sex steroids via their hepatic metabolism and production of the sex hormone-binding globulin (SHBG). Liver disease, including NAFLD, is associated with reproductive dysfunction in men and women, and the prevalence of NAFLD in patients with hypogonadism is considerable. A wide spectrum of possible pathophysiological mechanisms linking NAFLD and male/female hypogonadism has been investigated. As therapies targeting NAFLD may impact hypogonadism in men and women, and vice versa, treatments of the latter may affect NAFLD, and an insight into their pathophysiological pathways is imperative. This paper aims to elucidate the complex association between NAFLD and hypogonadism in men and women and discuss the therapeutic options and their impact on both conditions.
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Affiliation(s)
- Kasiani Papadimitriou
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Athanasios C Mousiolis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Gesthimani Mintziori
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Stergios A Polyzos
- First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Baudin J, Hernandez-Baixauli J, Quesada-Vázquez S, Mulero F, Puiggròs F, Arola L, Caimari A. Combined supplementation with hesperidin, phytosterols and curcumin decreases adiposity and improves metabolic health in ovariectomized rats. Food Funct 2024; 15:4905-4924. [PMID: 38598180 DOI: 10.1039/d3fo05122f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
In recent years many women have looked for alternative therapies to address menopause. Hesperidin, phytosterols and curcumin are bioactive compounds that can ameliorate some cardiovascular risk factors associated with menopause, although there are no data concerning the effects of their combined supplementation. We used ovariectomized (OVX) rats, a postmenopausal model with oestrogen deficiency, to evaluate whether supplementation with a multi-ingredient (MI) including hesperidin, phytosterols and curcumin for 57 days would display beneficial effects against fat mass accretion and metabolic disturbances associated with menopause. Twenty OVX rats were orally supplemented with either MI (OVX-MI) or vehicle (OVX). Furthermore, 10 OVX rats orally received the vehicle along with subcutaneous injections of 17β-oestradiol biweekly (OVX-E2), whereas 10 rats were sham operated and received oral and injected vehicles (control group; SH). MI supplementation partly counteracted the fat mass accretion observed in OVX animals, which was evidenced by decreased total fat mass, adiposity index, the weight of retroperitoneal, inguinal and mesenteric white adipose tissue (MWAT) depots and MWAT adipocyte hypertrophy. These effects were accompanied by a significant decrease in the circulating levels of leptin and the mRNA levels of the fatty acid uptake-related genes Lpl and Cd36 in MWAT. These results were very similar to those observed in OVX-E2 animals. OVX-MI rats also displayed a higher lean body mass, lean/fat mass ratio, adiponectin-to-leptin ratio and insulin sensitivity than their OVX counterparts. Our findings can pave the way for using this MI formulation as an alternative therapy to manage obesity and to improve the cardiometabolic health of menopausal women.
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Affiliation(s)
- Julio Baudin
- Eurecat, Centre Tecnològic de Catalunya, Technological Unit of Nutrition and Health, 43204 Reus, Spain
- Nutrigenomics Research Group, Department of Biochemistry and Biotechnology, Universitat Rovira i Virgili, 43007 Tarragona, Spain.
| | - Julia Hernandez-Baixauli
- Eurecat, Centre Tecnològic de Catalunya, Technological Unit of Nutrition and Health, 43204 Reus, Spain
| | - Sergio Quesada-Vázquez
- Eurecat, Centre Tecnològic de Catalunya, Technological Unit of Nutrition and Health, 43204 Reus, Spain
| | - Francisca Mulero
- Molecular Imaging Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Francesc Puiggròs
- Eurecat, Centre Tecnològic de Catalunya, Biotechnology Area, 43204 Reus, Spain.
| | - Lluís Arola
- Nutrigenomics Research Group, Department of Biochemistry and Biotechnology, Universitat Rovira i Virgili, 43007 Tarragona, Spain.
| | - Antoni Caimari
- Eurecat, Centre Tecnològic de Catalunya, Biotechnology Area, 43204 Reus, Spain.
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Gueldini de Moraes AV, Costa-Paiva L, da Costa Machado H, Maciel TF, Mariano FV, Pedro AO. Comparison of the effect of noninvasive radiofrequency with vaginal estrogen and vaginal moisturizer in the treatment of vulvovaginal atrophy in postmenopausal women: a randomized clinical trial. Menopause 2024; 31:288-302. [PMID: 38412393 DOI: 10.1097/gme.0000000000002326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To compare the effect of noninvasive radiofrequency (RF) with vaginal estrogen (E), and vaginal moisturizer (M) on improving vulvovaginal atrophy (VVA) in women with genitourinary syndrome of menopause. METHODS A total of 32 postmenopausal women who met the inclusion criteria were randomized into three intervention arms to receive one of the following treatments: three sessions of noninvasive RF therapy (RF arm); intravaginal estriol cream 1 mg applied daily for 2 weeks, followed by 1 mg applied two times weekly or 1 mg of estradiol vaginal fast-dissolving film applied daily for 2 weeks, followed by 1 mg applied two times weekly (E arm); and intravaginal moisturizer two times a week (M arm). Assessments at baseline and after 4 months were conducted using Vaginal Health Index score, Vaginal Maturation, visual analog scale for VVA symptoms (dyspareunia, dryness, and burning), and Menopause Rating Scale (MRS) for urogenital symptoms. Vaginal wall biopsies were administered to participants who consented, pretreatment and posttreatment (at baseline and after 4 months of follow-up). RESULTS After 4 months, the Vaginal Health Index showed an increase of 6.6 points in mean total score in the RF arm, also in the E arm (+7.3 points), with no significant improvement in the M arm (+1.5 points) (interaction effect: RF, E ≠ M, P < 0.001). Regarding vaginal maturation, there was a significant increase in superficial cells in the E arm (+31.3), with no significant changes in the RF (+9.3) and M (-0.5) arms (interaction effect: E ≠ M, P < 0.001). Vaginal pH decreased significantly in the E arm (-1.25), with a similar response in the RF arm (-1.7), with no significant improvement in the M arm (-0.25) (interaction effect: RF, E ≠ M, P < 0.001).There was a significant improvement in the MRS score for VVA symptoms in the three intervention arms, with no predominance of any arm, whereas the improvement in the total MRS score for urogenital symptoms showed a predominance of the RF arm (ΔRF: -7.8; ΔE: -3.5; ΔM: -2.3; RF ≠ E, M). According to histopathologic analysis, there was no statistically significant increase in glycogenation ( P = 0.691) or epithelial cone height ( P = 0.935), despite an increase in the median delta (difference between pretreatment and posttreatment) in the three intervention arms (glycogenation: RF arm Δ = +118.4%; E arm Δ = +130.9%; M arm Δ = +24.9%; epithelial cone height: RF arm Δ = +33.5%; E arm Δ = +18.6%; M arm Δ = +22.3%). CONCLUSION The effect of noninvasive RF on the treatment of vulvovaginal symptoms of genitourinary syndrome of menopause was similar to vaginal estrogen, except for hormonal cytology, and superior to vaginal moisturizer, with improvement in some histomorphometric parameters. These findings are promising, especially for the population that cannot or prefers not to use vaginal estrogen therapy.
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Affiliation(s)
- Anna Valéria Gueldini de Moraes
- From the Department of Obstetrics and Gynecology of Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, São Paulo, Brazil
| | - Lucia Costa-Paiva
- From the Department of Obstetrics and Gynecology of Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, São Paulo, Brazil
| | | | - Tayná Figueiredo Maciel
- Department of Pathological Anatomy of Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, São Paulo, Brazil
| | - Fernanda Viviane Mariano
- Department of Pathological Anatomy of Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, São Paulo, Brazil
| | - Adriana Orcesi Pedro
- From the Department of Obstetrics and Gynecology of Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, São Paulo, Brazil
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Tang R, Xie Z, Ruan X, Zhang Z, Ren M, Wu J, Shu K, Shi H, Xie M, Lv S, Yang X, Chen R, Yu Q. Changes in menopausal symptoms comparing oral estradiol versus transdermal estradiol. Climacteric 2024; 27:171-177. [PMID: 37942806 DOI: 10.1080/13697137.2023.2273530] [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: 07/10/2023] [Accepted: 10/04/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE This study aimed to compare the efficacy and safety of oral and transdermal estradiol in alleviating menopausal symptoms. METHOD A total of 257 recently menopausal women were randomized into two groups. The t-E2 group received transdermal estradiol (2.5 g per day) (n = 128) and the o-E2V group received oral estradiol valerate (2 mg per day) (n = 129) for 24 weeks; both groups received micronized progesterone (200 mg per day). The primary outcome measure is the change in the modified Kupperman Menopausal Index (KMI) after 24 weeks of treatment. Menopausal symptoms were recorded at screening and at 4, 12 and 24 weeks using both the KMI and the Menopause Rating Scale (MRS). RESULTS Significant amelioration was observed by KMI and MRS scores for both groups after treatment (p < 0.001). The mean KMI scores showed no difference between the two groups. The mean MRS scores were similar between the two groups at baseline and after 4 weeks of treatment. The results showed statistical differences after 12 weeks and 24 weeks of treatment (p = 0.005 and p = 0.011). Both the after-treatment scores minus the baseline scores of KMI and MRS and the incidence of adverse effects showed no difference between the two groups. CONCLUSIONS This study shows that both transdermal and oral estradiol are effective in relieving menopausal symptoms, with little difference in treatment efficacy and safety. CLINICAL TRIAL NUMBER ChiCTR2300073146.
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Affiliation(s)
- R Tang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Z Xie
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - X Ruan
- Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China
| | - Z Zhang
- Hangzhou Obstetrics and Gynecology Hospital, Hangzhou, China
| | - M Ren
- Zhongda Hospital affiliated to Southeast University, Nanjing, China
| | - J Wu
- Jiangsu Province Hospital, Jiangsu, China
| | - K Shu
- Jiangxi Maternal and Child Health Hospital, Jiangxi, China
| | - H Shi
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - M Xie
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - S Lv
- The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China
| | - X Yang
- Peking University People's Hospital, Beijing, China
| | - R Chen
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Q Yu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Chaikittisilpa S, Orprayoon N, Vallibhakara O, Vallibhakara SAO, Tanmahasamut P, Somboonporn W, Rattanachaiyanont M, Techatraisak K, Jaisamrarn U. Summary of the 2023 Thai Menopause Society Clinical Practice Guideline on Menopausal Hormone Therapy. J Menopausal Med 2024; 30:24-36. [PMID: 38714491 PMCID: PMC11103073 DOI: 10.6118/jmm.24006] [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: 03/19/2024] [Accepted: 04/01/2024] [Indexed: 05/10/2024] Open
Abstract
The Thai Menopause Society is an academic organization consisting of healthcare professionals engaged in menopause medicine. The position statement was first issued in 1994 and updated in 2003 and 2023. Herein, we reviewed the important updates of the 2023 position statement on menopausal hormone therapy (MHT) as an international reference for healthcare professionals in Thailand. An advisory panel of clinicians and research experts in the field of menopause reviewed the recommendation of published International Consensus Statements and updated the evidence using the MEDLINE database through PubMed. The evidence-based information and relevant publications were assessed, and a consensus on recommendations was subsequently achieved using the level of evidence to determine the recommendation strength and evidence quality. MHT remains the most effective treatment for vasomotor symptoms and genitourinary syndromes of menopause even after 20 years. Additionally, it is effective in preventing bone loss and fractures in postmenopausal women. The cardiovascular risk of MHT increased in women who initiated MHT after 60 years of age. Hormone therapy should be individualized following the hormone type, dose, administration route, use duration, and progestogen inclusion. The necessary pretreatment evaluation and appropriate follow-up recommendations were added for improved MHT standard care. The updated 2023 Clinical Practice Guideline on MHT is useful for gynecologists, general physicians, endocrinologists, and other healthcare professionals in treating menopausal women receiving hormone therapy in Thailand.
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Affiliation(s)
- Sukanya Chaikittisilpa
- Center of Excellence in Menopause and Aging Women Health, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | - Nalina Orprayoon
- Center of Excellence in Menopause and Aging Women Health, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | - Orawin Vallibhakara
- Menopause Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Sakda Arj-Ong Vallibhakara
- Child Safety Promotion and Injury Prevention Research Center (CSIP), and Safe Kids Thailand, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Prasong Tanmahasamut
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Woraluk Somboonporn
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Manee Rattanachaiyanont
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kitirat Techatraisak
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Unnop Jaisamrarn
- Center of Excellence in Menopause and Aging Women Health, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Abstract
The menopausal transition period spans, on average, 2-8 years before the final menstrual period and is associated with an increase in clinical and subclinical cardiovascular risk. In this Review, we discuss the metabolic and cardiovascular changes that occur during the menopausal transition period and the role of ovarian ageing, chronological ageing and other ageing-related risk factors in mediating these changes. Disentangling the relative contributions of chronological and reproductive ageing to cardiovascular risk is challenging, but data from longitudinal studies in women transitioning from premenopause to post-menopause have provided valuable insights. We also discuss evidence on how cardiovascular risk is altered by premature or early menopause, surgical menopause, and vasomotor and other menopausal symptoms. Whether targeted interventions can slow the progression of atherosclerosis and subclinical disease during the menopausal transition, thus delaying or preventing the onset of cardiovascular events, remains to be determined. Furthermore, we consider the recommended strategies for cardiovascular risk reduction in women undergoing menopausal transition using the framework of the American Heart Association's Life's Essential 8 key measures for improving and maintaining cardiovascular health, and discuss the cardiovascular risks and benefits of menopausal hormone therapy. Finally, we also discuss novel therapies that might benefit this population in reducing cardiovascular risk.
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Affiliation(s)
- Jaya M Mehta
- Allegheny General Hospital Internal Medicine, Primary Care Institute, Allegheny Health Network, Pittsburgh, PA, USA.
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Sundell M, Brynhildsen J, Fredrikson M, Hoffmann M, Spetz Holm AC. Insufficient use of menopausal hormone therapy in Swedish women with early or premature menopause caused by bilateral oophorectomy: a register-based study. BJOG 2024; 131:500-507. [PMID: 37667667 DOI: 10.1111/1471-0528.17647] [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: 06/05/2023] [Revised: 08/14/2023] [Accepted: 08/19/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To investigate the use of menopausal hormone therapy (MHT) in premenopausal women after bilateral oophorectomy. DESIGN Retrospective register-based cohort study. SETTING Sweden. POPULATION Swedish women aged 35-44 years without malignancy who underwent bilateral oophorectomy in 2005-2020 were identified using The Swedish National Quality Register of Gynaecological Surgery (GynOp). METHODS Data from GynOp were cross-linked with data on dispensed drugs extracted from the Swedish Prescribed Drug Register. MAIN OUTCOME MEASURES Proportion of women dispensed MHT at least once within 1 year after surgery. Repeated treatment episodes were defined, and the proportion of 'person time' covered by dispensations was analysed. RESULTS In total, 1231 of all women (n = 1706) were dispensed MHT at some point after surgery, with 1177 women dispensed MHT within 1 year. This proportion increased from 64% in 2005 to 84% in 2019 (p < 0.001). In the total population, 4537 'treatment years' transpired, corresponding to 43% of the mean time covered. In women dispensed MHT within 1 year, the proportion of time covered was 63%. CONCLUSIONS Only 69% of all women without malignancy of any kind who underwent bilateral oophorectomy were dispensed MHT within 1 year after surgery, and the duration of treatment was limited. It is important to study further the reasons behind the low dispensation rate in this group to increase adherence to current treatment guidelines, improve quality of life, and avoid increased morbidity and mortality.
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Affiliation(s)
- Micaela Sundell
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynaecology, Kalmar County Hospital, Kalmar, Sweden
| | - Jan Brynhildsen
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mats Fredrikson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mikael Hoffmann
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- The NEPI Foundation, Stockholm, Sweden
| | - Anna-Clara Spetz Holm
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynaecology, Linköping University Hospital, Linköping, Sweden
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Gulamhusein N, Miranda KT, Ahmed SB, Leung AA, Tang KL, Adekanye J, Butalia S. Measurements of Postmenopausal Serum Estradiol Levels and Cardiovascular Events: A Systematic Review. CJC Open 2024; 6:347-354. [PMID: 38487048 PMCID: PMC10935696 DOI: 10.1016/j.cjco.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/13/2023] [Indexed: 03/17/2024] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death among female patients and its likelihood increases following menopause. However, whether estradiol levels are related to CVD remains unknown. We aimed to determine the association between serum estradiol levels and cardiovascular (CV) events in postmenopausal females. Methods Electronic databases (MEDLINE, Embase) were searched systematically from inception to October 2022. Studies were eligible for inclusion if they included the following: (i) postmenopausal females; (ii) examination of the association between total serum estradiol levels and CV events (CV mortality, CVD, coronary heart disease, myocardial infarction, stroke, venous thromboembolism, heart failure, and CV hospitalization); (iii) original data (randomized controlled trial, quasi-experimental, cohort, case-control, or cross-sectional study). A narrative synthesis was completed because the data were not amenable to meta-analysis. Results Of the 9026 citations retrieved, 8 articles were included, representing a total of 5635 women. The risk-of-bias was fair, and considerable heterogeneity was present. In those not using menopausal hormone therapy, 3 studies demonstrated mixed results between estradiol levels and risk of coronary heart disease, and 1 study showed that higher estradiol levels were associated with an increased risk of myocardial infarction. No significant associations were present between estradiol levels and the remaining events (ie, CV mortality, heart failure, CVD, and stroke). Conclusions The association between serum estradiol levels and CV events in postmenopausal females remains unclear. Further studies assessing this association are warranted, given the elevated CVD risk in this population.
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Affiliation(s)
- Nabilah Gulamhusein
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Keila Turino Miranda
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Sofia B. Ahmed
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Kidney Disease Network, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Alexander A. Leung
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Karen L. Tang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joel Adekanye
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sonia Butalia
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Vesco KK, Brooks NB, Francisco MC, Leo MC, Anderson TM, Kalter M, Clark AL. Resident training to optimize patient-focused menopause management: a multispecialty menopause curriculum to enhance knowledge and preparedness. Menopause 2024; 31:93-100. [PMID: 38166240 DOI: 10.1097/gme.0000000000002291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
OBJECTIVE Surveys of residents in obstetrics and gynecology, internal medicine, and family medicine have demonstrated low levels of knowledge and comfort in treating patients with menopausal symptoms, suggesting a need for improved training during residency. To address this problem, we used a flipped classroom design to deliver a novel menopause curriculum for medical residents. The curriculum included six podcast episodes followed by an interactive case-based classroom session. We then assessed effects of the curriculum on the residents' knowledge and preparedness to manage menopause symptoms. METHODS We targeted 200 residents (43 obstetrics and gynecology, 86 internal medicine, and 71 family medicine) from six residency programs from 2019 to 2020. Of these, 115 (58%) completed both pre- and postcurriculum assessments, including a 15-item knowledge test and self-ratings of their knowledge, comfort, and preparedness to manage menopause. RESULTS Following the curriculum, the proportion of correctly answered knowledge questions rose from 60.8% to 79.1% (+18.3%; 95% confidence interval, 15.4-21.2; Cohen's d = 1.2). Improvement did not significantly differ by specialty or year of residency. There were higher gains for residents who listened to the entirety of all six podcast episodes ( b = 11.4, P < 0.001) and who attended the classroom session ( b = 11.6, P = 0.003). Residents' self-ratings of knowledge, comfort, and preparedness also improved following the curriculum across all medical specialties (Cohen's d = 0.47-1.2). Residents rated the podcast format as convenient (73%) and effective (65%) compared with an equivalent amount of reading. CONCLUSIONS Pairing a podcast with a classroom discussion was found to be an effective combination for improving menopause knowledge.
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Affiliation(s)
| | - Neon B Brooks
- From the Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Melanie C Francisco
- From the Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Michael C Leo
- From the Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Marlene Kalter
- From the Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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21
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Gu Y, Han F, Xue M, Wang M, Huang Y. The benefits and risks of menopause hormone therapy for the cardiovascular system in postmenopausal women: a systematic review and meta-analysis. BMC Womens Health 2024; 24:60. [PMID: 38263123 PMCID: PMC10804786 DOI: 10.1186/s12905-023-02788-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Menopause hormone therapy (MHT), as an effective method to alleviate the menopause-related symptoms of women, its benefits, risks, and potential influencing factors for the cardiovascular system of postmenopausal women are not very clear. OBJECTIVES To evaluate cardiovascular benefits and risks of MHT in postmenopausal women, and analyze the underlying factors that affect both. SEARCH STRATEGY The EMBASE, MEDLINE, and CENTRAL databases were searched from 1975 to July 2022. SELECTION CRITERIA Randomized Clinical Trials (RCTs) that met pre-specified inclusion criteria were included. DATA COLLECTION AND ANALYSIS Two reviewers extracted data independently. A meta-analysis of random effects was used to analyze data. MAIN RESULTS This systematic review identified 33 RCTs using MHT involving 44,639 postmenopausal women with a mean age of 60.3 (range 48 to 72 years). There was no significant difference between MHT and placebo (or no treatment) in all-cause death (RR = 0.96, 95%CI 0.85 to 1.09, I2 = 14%) and cardiovascular events (RR = 0.97, 95%CI 0.82 to 1.14, I2 = 38%) in the overall population of postmenopausal women. However, MHT would increase the risk of stroke (RR = 1.23, 95%CI 1.08 to 1.41,I2 = 0%) and venous thromboembolism (RR = 1.86, 95%CI 1.39 to 2.50, I2 = 24%). Compared with placebo, MHT could improve flow-mediated arterial dilation (FMD) (SMD = 1.46, 95%CI 0.86 to 2.07, I2 = 90%), but it did not improve nitroglycerin-mediated arterial dilation (NMD) (SMD = 0.27, 95%CI - 0.08 to 0.62, I2 = 76%). Compared with women started MHT more than 10 years after menopause, women started MHT within 10 years after menopause had lower frequency of all-cause death (P = 0.02) and cardiovascular events (P = 0.002), and more significant improvement in FMD (P = 0.0003). Compared to mono-estrogen therapy, the combination therapy of estrogen and progesterone would not alter the outcomes of endpoint event. (all-cause death P = 0.52, cardiovascular events P = 0.90, stroke P = 0.85, venous thromboembolism P = 0.33, FMD P = 0.46, NMD P = 0.27). CONCLUSIONS MHT improves flow-mediated arterial dilation (FMD) but fails to lower the risk of all-cause death and cardiovascular events, and increases the risk of stroke and venous thrombosis in postmenopausal women. Early acceptance of MHT not only reduces the risk of all-cause death and cardiovascular events but also further improves FMD, although the risk of stroke and venous thrombosis is not reduced. There is no difference in the outcome of cardiovascular system endpoints between mono-estrogen therapy and combination therapy of estrogen and progesterone.
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Affiliation(s)
- Yimeng Gu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Fangfang Han
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Mei Xue
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Miyuan Wang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuxiao Huang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
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22
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Tamlyn Anne R, Downes M, Simoncini T, Yu Q, Ren M, Wang Y, Graziano CM, Kim K. Evaluating the cost utility of estradiol plus dydrogesterone for the treatment of menopausal women in China. J Med Econ 2024; 27:16-26. [PMID: 38037348 DOI: 10.1080/13696998.2023.2289297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
AIM Evaluate the cost utility of menopausal hormone therapy for women in China. MATERIALS AND METHODS A bespoke Markov cost utility model was developed to evaluate a cohort of symptomatic perimenopausal women (>45 years) with intact uterus in China in accordance with China's Pharmacoeconomic guideline. Short (5-year) and long (10-year) treatment durations were evaluated over a lifetime model time horizon with 12-month cycle duration. Societal and healthcare payer perspectives were evaluated in the context of a primary care provider/prescriber, outpatient setting with inpatient care for patients with chronic conditions. Disease risk and mortality parameters were derived from focused literature searches, and China Diagnosis-related Group cost data was included. Comprehensive scenario, univariate and probabilistic sensitivity analysis were undertaken along with independent validation. This is the first model to include MHT-related disease risks. RESULTS According to base case results, the total cost for MHT was 22,516$ (150,106¥) and total quality adjusted life years 12.32 versus total cost of no MHT 30,824$ (205,495¥) and total quality adjusted life years 11.16 resulting in a dominant incremental cost effectiveness ratio of -7,184$ (-47,898¥) per QALY. Results hold true over a range of univariate deterministic sensitivity and scenario analyses. Probabilistic analysis showed a 91% probability of being cost effective at a willingness to pay threshold of three times Gross Domestic Product per capita in China. CONCLUSION Contingent on the structure and assumptions of the model, combination of estradiol plus dydrogesterone MHT is potentially cost saving in symptomatic women over the age of 45 years in China.
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Affiliation(s)
| | - Martin Downes
- Centre for Applied Health Economics, Griffith University, Griffith, Australia
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Molecular and Cellular Gynaecological Endocrinology Laboratory (MCGEL), University of Pisa, , Pisa, Italy
- European Menopause and Andropause Society, Geneva, Switzerland
| | - Qi Yu
- Centre of Gynaecological Endocrinology and Reproduction, Peking Union Medical College Hospital, Peking, China
- Asia Pacific Menopause Federation, Devon, United Kingdom of Great Britain and Northern Ireland
| | - Mulan Ren
- Department of Obstetrics and Gynaecology, Southeast University School of Medicine, Nanjing, Jiangsu, China
- Reproductive Centre, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China
- Gynaecologic Endocrinologist Training Base of Chinese Medical Doctor Association, Beijing, China
- Menopause Group, Obstetrics and Gynaecology Society of Chinese Medical Association, Beijing, China
- Jiangsu Obstetrics and Gynaecology Quality Control Centre, Nanjing, Jiangsu, China
- Osteoporosis and Bone Mineral Salt Disease, Nanjing Medical Association, Nanjing, China
- Reproductive Medicine, Jiangsu Association of Integrative Medicine, Nanjing, Jiangsu, China
| | - Yaping Wang
- Centre for Reproductive Endocrinology and Infertility, Peking Union Medical College Hospital, Peking, China
| | | | - Kyoo Kim
- Abbott Products Operations AG, Basel-Landschaft, Switzerland
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23
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Taylor-Swanson L, Stoddard K, Fritz J, Anderson B(B, Cortez M, Conboy L, Sheng X, Flake N, Sanchez-Birkhead A, Stark LA, Farah L, Farah S, Lee D, Merkley H, Pacheco L, Tavake-Pasi F, Sanders W, Villalta J, Moreno C, Gardiner P. Midlife Women's Menopausal Transition Symptom Experience and Access to Medical and Integrative Health Care: Informing the Development of MENOGAP. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241268355. [PMID: 39092447 PMCID: PMC11292722 DOI: 10.1177/27536130241268355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 06/14/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024]
Abstract
Background Individuals with a uterus experience menopause, the cessation of menses, on average at age 51 years in the United States. While menopause is a natural occurrence for most, over 85% of women experience multiple interfering symptoms. Menopausal women face health disparities, including a lack of access to high-quality healthcare and greater disparities are experienced by women who are black, indigenous, and people of color. Some women are turning away from hormone therapy, and some seek integrative health interventions. Objective Some menopausal women who seek healthcare do not receive it as they lack access to medical and integrative healthcare providers. A potential solution to this problem is a medical group visit (MGV), during which a provider sees multiple patients at once. The aims of this study were to gather women's opinions about the menopause, provider access, and conventional and integrative health interventions for later use to develop a menopause MGV. Methods We conducted a Community Engagement Session and a Return of Results (RoR) with midlife women to learn about their menopause experiences, barriers and facilitators to accessing health providers, and their interest in and suggestions for designing a future integrative MGV (IMGV). Thematic qualitative research methods were used to summarize session results. Results Nine women participated in the Session and six attended the RoR. Participants were well-educated and diverse in race and ethnicity. Themes included: an interest in this topic; unfamiliar medical terms; relevant social factors; desired whole person care; interest in integrative health; barriers and facilitators to accessing healthcare. The group expressed interest in ongoing participation in the future process of adapting an IMGV, naming it MENOGAP. Conclusion These findings highlight the importance of stakeholder engagement before designing and implementing MENOGAP and the great need among midlife women for education about the menopausal transition, integrative self-care, and healthcare.
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Affiliation(s)
| | - Kari Stoddard
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Julie Fritz
- College of Health, University of Utah, Salt Lake City, UT, USA
| | | | - Melissa Cortez
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Lisa Conboy
- Instructor in Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Xiaoming Sheng
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Naomi Flake
- Utah Clinical and Translational Science Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Louisa A. Stark
- Utah Clinical and Translational Science Institute, University of Utah, Salt Lake City, UT, USA
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Luul Farah
- University of Utah, Salt Lake City, UT, USA
| | - Sara Farah
- University of Utah, Salt Lake City, UT, USA
| | | | - Heather Merkley
- College of Health Professions, Weber State University, Ogden, UT, USA
| | | | | | | | | | - Camille Moreno
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Paula Gardiner
- University of Massachusetts Medical School and Director of Primary Care Implementation Research, Cambridge Health Alliance, Cambridge, MA, USA
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24
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Frankenthal D, Karni-Efrati Z, Zatlawi M, Keinan-Boker L, Bromberg M. Menopausal symptoms and attitudes toward hormone replacement therapy among Israeli women. J Women Aging 2024; 36:1-13. [PMID: 37319035 DOI: 10.1080/08952841.2023.2222048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/12/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Abstract
Menopause occurs around midlife and is an inevitable component of women's aging. The study aimed to investigate the associations between the lifetime prevalence of menopausal symptoms and health-related characteristics among Israeli postmenopausal women aged 55-75 years. Additionally, this study aimed to estimate the use of hormone replacement therapy (HRT) and women's attitudes toward this treatment. Data for this study were extracted from a cross-sectional national telephone survey conducted in Israel between 2018 and 2020. For the current study, only postmenopausal women aged 55-75 years were included. Multivariate analyses were used to identify demographic and health-related characteristics associated with menopausal symptoms. The study included 688 participants. Most (68.8%) reported one or more menopausal symptoms, specifically vasomotor symptoms (50.4%). According to the multivariate logistic regression analysis, menopausal symptoms were associated with moderate-high anxiety and/or depression symptoms (OR = 2.01, 95% CI 1.12-3.58) and with osteoporosis (OR = 1.78, 95% CI 1.08-2.92). Although most (78.3%) symptomatic women were bothered by their symptoms, 29.1% received any treatment for symptom relief and only 12.6% reported current or past use of HRT. The findings show that menopausal symptoms were associated with a higher prevalence of anxiety and/or depression symptoms and osteoporosis in the years following menopause. Most symptomatic women did not receive any treatment and the majority were against HRT. Knowledge and awareness about menopause and treatment options should be increased among Israeli women. Additionally, the promotion of positive attitudes toward menopause and HRT use among women and healthcare providers is strongly recommended.
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Affiliation(s)
- Dvora Frankenthal
- Israel Center for Disease Control (ICDC), Ministry of Health, Ramat-Gan, Israel
| | - Ziv Karni-Efrati
- Israel Center for Disease Control (ICDC), Ministry of Health, Ramat-Gan, Israel
- Faculty of Social Welfare and Health Sciences, School of Public Health, University of Haifa, Haifa, Israel
| | - Miri Zatlawi
- Israel Center for Disease Control (ICDC), Ministry of Health, Ramat-Gan, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control (ICDC), Ministry of Health, Ramat-Gan, Israel
- Faculty of Social Welfare and Health Sciences, School of Public Health, University of Haifa, Haifa, Israel
| | - Michal Bromberg
- Israel Center for Disease Control (ICDC), Ministry of Health, Ramat-Gan, Israel
- Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
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25
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Laing A, Hillard T. Oestrogen-based therapies for menopausal symptoms. Best Pract Res Clin Endocrinol Metab 2024; 38:101789. [PMID: 37453831 DOI: 10.1016/j.beem.2023.101789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
PURPOSE To summarise the dosing options, regimens, pharmacokinetics, risks and benefits of oestrogen-based therapies for the treatment of menopausal symptoms. METHODS A review of the literature was undertaken using multiple databases. Randomised trials, observational studies, meta-analyses and review papers were included. RESULTS Multiple systemic preparations of oestrogen exist and all appear comparable in terms of efficacy. They differ by pharmacokinetics and those preparations that avoid hepatic metabolism have a lower risk profile in general although their use can be limited by skin barriers or patient acceptability. All vaginal oestrogen treatments are comparable in efficacy and have not been associated with any health risks. Side-effects between all preparations differ. CONCLUSIONS With regards to oestrogen treatments there is not a one size fits all. Multiple treatments are available and a clinician's role is to guide and help women make evidence based, unbiased and informed choices.
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Affiliation(s)
- Abbie Laing
- Poole Menopause Centre, University Hospitals Dorset, Poole UK.
| | - Tim Hillard
- Poole Menopause Centre, University Hospitals Dorset, Poole UK.
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26
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Campos MLP, Bianchi-Ferraro AMHM, de Oliveira CD, Nogueira MCC, Sartori MGF, Fusco I, Lugollo AF, De Góis Speck NM. Fractional CO 2 Laser, Radiofrequency and Topical Estrogen for Treating Genitourinary Syndrome of Menopause: A Pilot Study Evaluating the Vulvar Vestibule. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:80. [PMID: 38256341 PMCID: PMC10818998 DOI: 10.3390/medicina60010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Genitourinary syndrome of menopause (GSM) affects more than half of postmenopausal women. This study aimed to evaluate the clinical and histological aspects of microablative fractionated CO2 laser (CO2L), microablative fractionated radiofrequency (RF) and intravaginal estrogen (ET) therapy as GSM treatments for the vulvar vestibule. Materials and Methods: This study included postmenopausal women with at least one moderate-to-severe complaint of GSM. Women in the CO2L and RF groups received three monthly sessions of outpatient vulvovaginal therapy. The procedures were performed 30 min after applying 4% lidocaine gel to the vulva and vaginal introitus. Vulvar vestibular pain was assessed after each application using a 10-point VAS. A follow-up evaluation was performed 120 days after beginning each treatment. Digital images of the vulva were obtained and a 5-point Likert scale (1 = much worse, 2 = worse, 3 = neutral, 4 = better, 5 = much better) was used to assess the global post-treatment women's impression of improvement regarding GSM. Results: A significant change in clinical aspects of the vulva was observed after all treatments with a reduction in the atrophic global vulvar aspect and an enhancement of the trophic aspect. High satisfaction was also reported after treatment according to the Likert scale evaluation: CO2L (4.55 ± 0.97), RF (4.54 ± 0.95), CT (4 ± 1.41), p = 0.066. Histological evaluation revealed enhanced dermal papillae before pre-treatment, significantly reducing post-treatment in all groups (p = 0.002). No unintended effects were reported. Conclusions: CO2L, RF, and ET significantly improved GSM concerning the vulvar vestibule at the 4 months follow-up.
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Affiliation(s)
| | | | - Carla Dias de Oliveira
- Departamento de Ginecologia, Universidade Federal de São Paulo (UNIFESP), 04024-002 São Paulo, Brazil
| | | | | | | | - Angela Flavia Lugollo
- Departamento de Patologia, Universidade Federal de São Paulo (UNIFESP), 04024-002 São Paulo, Brazil
| | - Neila Maria De Góis Speck
- Departamento de Ginecologia, Universidade Federal de São Paulo (UNIFESP), 04024-002 São Paulo, Brazil
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27
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Chen W, Chen M, Tang H, Wei W, Shao P, Dou S, Wu J, Lu B, Shi R, Chen J. Advances in diagnosis and treatment of perimenopausal syndrome. Open Life Sci 2023; 18:20220754. [PMID: 38152579 PMCID: PMC10751995 DOI: 10.1515/biol-2022-0754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 08/24/2023] [Accepted: 09/19/2023] [Indexed: 12/29/2023] Open
Abstract
With the development and progress of society, people's average life expectancy has increased, and relevant literature reports that the number of postmenopausal women in China continues to increase. With lifespans extended, the transition period and post-menopause period have become the longest essential period in every woman's life. The life quality of women troubled by perimenopausal syndrome has been significantly reduced, which also places a burden on families and society. It is well known that hormone replacement therapy plays a vital role in improving women's menopause-related symptoms and is the most effective medical measure. With research ongoing into the treatment of menopausal symptoms in different patients, dose size, treatment duration, and medication regimens for hormones are still hot topics of discussion. This article reviews the definition, clinical diagnosis, staging, clinical manifestations, and treatment of menopause and explores the current diagnosis and treatment scenarios of perimenopausal syndrome.
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Affiliation(s)
- Wanying Chen
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Mengjuan Chen
- Zhoukou Maternal and Child Health Hospital, Zhoukou, Henan, 466000, PR China
| | - Huimin Tang
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Weiwei Wei
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Panqiu Shao
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Shulan Dou
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Jia Wu
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Bingying Lu
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Ruxia Shi
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Jiming Chen
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
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28
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Lello S, Capozzi A, Scambia G, Franceschini G. Tibolone and Breast Tissue: a Review. Reprod Sci 2023; 30:3403-3409. [PMID: 37450250 DOI: 10.1007/s43032-023-01295-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
The safety profile of hormone replacement therapy (HRT) on breast is still controversial. Tibolone is an option of treatment for climacteric syndrome of postmenopausal women. Its risk profile on breast is debated. This is an updated narrative review focusing on the impact of tibolone on breast. Particularly, we will report data from major preclinical and clinical studies regarding the effects of the use of this compound on breast tissue and breast density. Moreover, we will analyze and discuss the most relevant findings of the principal studies evaluating the relationship between tibolone and breast cancer risk. Our purpose is making all clinicians who are particularly involved in women's health more aware of the effects of this compound on breast and, thus, more experienced in the management of menopausal symptoms with this drug. According to the available literature, tibolone seems to be characterized by an interesting safety profile on breast tissue.
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Affiliation(s)
- Stefano Lello
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Anna Capozzi
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.
| | - Giovanni Scambia
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Gianluca Franceschini
- Multidisciplinary Breast Centre, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
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29
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Gilmer G, Hettinger ZR, Tuakli-Wosornu Y, Skidmore E, Silver JK, Thurston RC, Lowe DA, Ambrosio F. Female aging: when translational models don't translate. NATURE AGING 2023; 3:1500-1508. [PMID: 38052933 PMCID: PMC11099540 DOI: 10.1038/s43587-023-00509-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/25/2023] [Indexed: 12/07/2023]
Abstract
For many pathologies associated with aging, female patients present with higher morbidity and more frequent adverse events from treatments compared to male patients. While preclinical models are the foundation of our mechanistic understanding of age-related diseases, the most common models fail to recapitulate archetypical female aging trajectories. For example, while over 70% of the top age-related diseases are influenced by the systemic effects of reproductive senescence, we found that preclinical studies that include menopausal phenotypes modeling those seen in humans make up <1% of published aging biology research. The long-term impacts of pregnancy, birthing and breastfeeding are also typically omitted from preclinical work. In this Perspective, we summarize limitations in the most commonly used aging models, and we provide recommendations for better incorporating menopause, pregnancy and other considerations of sex in vivo and in vitro. Lastly, we outline action items for aging biology researchers, journals, funding agencies and animal providers to address this gap.
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Affiliation(s)
- Gabrielle Gilmer
- Discovery Center for Musculoskeletal Recovery, Schoen Adams Research Institute at Spaulding Rehabilitation, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Medical Scientist Training Program, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Cellular and Molecular Pathology Graduate Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zachary R Hettinger
- Discovery Center for Musculoskeletal Recovery, Schoen Adams Research Institute at Spaulding Rehabilitation, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yetsa Tuakli-Wosornu
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elizabeth Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, MA, USA
| | - Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dawn A Lowe
- Divisions of Rehabilitation Science and Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Fabrisia Ambrosio
- Discovery Center for Musculoskeletal Recovery, Schoen Adams Research Institute at Spaulding Rehabilitation, Boston, MA, USA.
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA.
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA, USA.
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Isacco L, Ennequin G, Boisseau N. Influence of the different hormonal status changes during their life on fat mass localisation in women: a narrative review. Arch Physiol Biochem 2023; 129:1229-1234. [PMID: 34111377 DOI: 10.1080/13813455.2021.1933045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT Independently of the total body fat mass, upper body fat mass deposition is strongly associated with cardiometabolic comorbidities. The mechanisms underlying fat mass localisation are not fully understood, but evidences indicate sex-specific fat mass distribution. Currently, data on women are scarce and the link between hormonal status changes during their life and fat mass distribution is overlooked. METHOD For this narrative review, literature data were extracted from the PubMed and CENTRAL databases to examine the relationship between hormonal status and adipose tissue localisation in women. RESULTS Menopause strongly influences fat mass localisation, while the effect of the menstrual cycle phases, oral contraception use and pregnancy has not been unambiguously determined. CONCLUSION Reliable data are lacking on the relationship between hormonal variations throughout the lifespan and body fat mass localisation in women. Future studies should take into account the hormonal status of women to reduce the risk of cardiometabolic diseases.
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Affiliation(s)
- Laurie Isacco
- Université Clermont Auvergne, CRNH, AME2P, Clermont-Ferrand, France
- EA3920 Prognostic Markers and Regulatory Factors of Cardiovascular Diseases and Exercise Performance Health Innovation (EPSI) Platform, Univ. Bourgogne Franche-Comte, Besançon, France
| | - Gaël Ennequin
- Université Clermont Auvergne, CRNH, AME2P, Clermont-Ferrand, France
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Hachul H, Hachul de Campos B, Lucena L, Tufik S. Sleep During Menopause. Sleep Med Clin 2023; 18:423-433. [PMID: 38501515 DOI: 10.1016/j.jsmc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Postmenopause is defined retrospectively after 12 consecutive months of amenorrhea. It represents the end of the reproductive period and ovarian failure. A decrease in estrogen leads to several changes in the short and long term. Among the early changes, vasomotor symptoms (hot flashes) are particularly common, occurring in about 70% of women. In addition, there are changes in mood, anxiety, depression, and insomnia. Insomnia occurs in almost 60% of postmenopausal women. Psychosocial aspects may also affect sleep. Proper diagnosis may lead to adequate treatment of sleep disturbances during menopause. Hormonal or other complementary therapies can improve sleep quality.
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Affiliation(s)
- Helena Hachul
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Department of Ginecology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
| | | | - Leandro Lucena
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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Beshyah SA, Alwatban L, Ekhzaimy A, Mustafa HE, Abdelmannan DK, Merheb M, Bashir M. Management of menopause: a survey of physicians from the Middle East and Africa. Climacteric 2023; 26:455-464. [PMID: 36999573 DOI: 10.1080/13697137.2023.2190509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/14/2023] [Accepted: 03/04/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE This study evaluated physicians' perceptions, practices, confidence, comfort level and prior training in managing menopause. METHODS A survey was conducted of a convenience sample of physicians from the Middle East and Africa (MEA) in 2019. We covered knowledge of symptoms, menopausal hormone therapy (MHT), other menopause management strategies and prior training in menopause medicine. RESULTS Of the 254 participants, 64.2% were seniors in family medicine (36.4%), endocrinology (36.0%), gynecology (15.8%) and internal medicine (13.8%). Fewer than one-third (28.8%) correctly identified the diagnostic criteria of menopause. Almost all recognized vasomotor symptoms (99.5%), vaginal dryness (96.2%) and mood disturbance (94.3%), but to a lesser extent other symptoms. Inconsistency and critical gaps were identified in responses to competence questions on six case studies. They recalled having occasional (43.2%) or no training (19.4%) in menopause medicine and rated their preparedness to treat menopause widely. A total of 66.2% agreed that training is very important. Variation between specialties was identified. CONCLUSION Many physicians recognize the importance of education in menopause management, but their responses revealed critical knowledge gaps that underscored the need for comprehensive, evidence-based menopause management.
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Affiliation(s)
- S A Beshyah
- Department of Medicine, Dubai Medical College, Dubai, UAE
- Department of Endocrinology, Yas Clinic Khalifa City, Abu Dhabi, UAE
- Department of Medicine, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE
| | - L Alwatban
- Department of Family and Community Medicine, King Saud University, Medical City, Riyadh, Saudi Arabia
| | - A Ekhzaimy
- Department of Medicine, Endocrinology Division, King Saud University, Medical City, Riyadh, Saudi Arabia
- Health Plus, Center for Diabetes and Endocrinology, Abu Dhabi, UAE
| | - H E Mustafa
- Health Plus, Center for Diabetes and Endocrinology, Abu Dhabi, UAE
| | - D K Abdelmannan
- Department of PostGraduate Medical Education, Dubai Academic Health Corporation, Dubai, UAE
- Dubai Diabetes Center, Dubai Health Authority, Dubai, UAE
| | - M Merheb
- Department of Endocrinology, Mount Lebanon Hospital, Beirut, Lebanon
| | - M Bashir
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
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Dias RC, Costa EH, Chrisostomo KR, Junior JK, Paiva ES, Azevedo PM, Skare TL, Nisihara RM. Fibromyalgia and menopause: an open study on postmenopausal hormone therapy. Minerva Obstet Gynecol 2023; 75:424-431. [PMID: 35686636 DOI: 10.23736/s2724-606x.22.05085-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Fibromyalgia women (FM) seems to get worse at menopause suggesting some influence of estrogens on its pathophysiology. We aimed to study the influence of postmenopausal hormone therapy (HT) in FM, the relationship with sleep and FM impact. METHODS We analyzed prospectively 69 menopausal women, divided in two groups, FM group (FMG; N.=32) and comparison group (CG; N.=28) submitted to HT for twelve weeks (1.2 mg/g transdermal estradiol, 100 mg micronized natural progesterone oral/daily). Data on Utian Quality of Life Questionnaire (UQOL) and Pittsburgh Sleep Quality Index (PSQI) were obtained in both groups, at entrance and twelve weeks after HT. FM patients also completed the Fibromyalgia Impact Questionnaire - Revised (FIQ-R) and fibromyalgia severity (FS). RESULTS FM patients improved significantly the FIQ-R (P=0.0001, median FIQ-R score 30% lower), mainly the severity of FM, assessed by FS (P<0.0001). Both groups had improved quality of life and sleep (UQOL: P=0.0001; P=0.001, PSQI: P<0.0001; P=0.007, respectively). Differences between first and second PSQI were greater for CG than for FMG (P=0.008). CONCLUSIONS HT improving sleep and quality of life in both groups; it was a significant clinical improvement seen by FIQ and FS in FM patients. These changes characterize improvement of functional status and symptoms severity.
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Affiliation(s)
- Rejane Ca Dias
- Postgraduate Program in Gynecology and Obstetrics, Federal University of Paraná, Curitiba, Brazil -
| | - Eloise H Costa
- Mackenzie Evangelical School of Medicine, Curitiba, Brazil
| | | | - Jaime K Junior
- Postgraduate Program in Gynecology and Obstetrics, Federal University of Paraná, Curitiba, Brazil
| | - Eduardo S Paiva
- Department of Rheumatology, Federal University of Paraná, Curitiba, Brazil
| | - Pedro M Azevedo
- Department of Chronic Pain and Rheumatology, Vaud University Hospital Center, Lausanne, Switzerland
| | - Thelma L Skare
- Department of Medicine, Positivo University, Curitiba, Brazil
| | - Renato M Nisihara
- Postgraduate Program in Gynecology and Obstetrics, Federal University of Paraná, Curitiba, Brazil
- Mackenzie Evangelical School of Medicine, Curitiba, Brazil
- Department of Medicine, Positivo University, Curitiba, Brazil
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Pinho SC, Heinke T, Dutra PFSP, Carmo A, Salmeron C, Karoleski L, Focchi G, Speck NMG, Pennati BM, Silva I. Efficacy of Fractional Laser on Steroid Receptors in GSM Patients. Bioengineering (Basel) 2023; 10:1087. [PMID: 37760189 PMCID: PMC10525165 DOI: 10.3390/bioengineering10091087] [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: 08/03/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND To compare the efficacy of CO2 fractional laser with that of topical estriol for treating genitourinary syndrome of menopause and to investigate the relationship between epithelial thickness and vaginal atrophy. METHODS Twenty-five menopausal women were randomized to receive either laser or estrogen treatment. Vaginal biopsies before and after treatment were compared to assess the amount and distribution of estrogen and progesterone receptors. RESULTS Estrogen receptor levels were statistically similar between groups before and after treatment. Although there was no change over time in the estrogen group, an increase in receptor levels was confirmed in the laser group. Changes in estrogen receptor levels showed no association with treatment. Progesterone receptor levels were statistically similar between groups throughout treatment. There was no change over time in both groups. These changes displayed no association with the type of treatment. There was no significant correlation between epithelium thickness and estrogen or progesterone receptor levels. CONCLUSIONS Estrogen and progesterone receptor levels increased and were maintained, respectively, in the vaginal epithelium in both groups. There was no significant relationship between epithelium thickness and receptor density. Laser therapy had similar outcomes to the gold standard without involving the disadvantages of hormone therapy.
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Affiliation(s)
- Stella Catunda Pinho
- Department of Gynecology, Paulista Medical School, Federal University of Sao Paulo, UNIFESP/EPM, Sao Paulo 04021-001, Brazil; (S.C.P.); (T.H.); (P.F.S.P.D.); (A.C.); (C.S.); (L.K.); (G.F.); (N.M.G.S.); (I.S.)
| | - Thais Heinke
- Department of Gynecology, Paulista Medical School, Federal University of Sao Paulo, UNIFESP/EPM, Sao Paulo 04021-001, Brazil; (S.C.P.); (T.H.); (P.F.S.P.D.); (A.C.); (C.S.); (L.K.); (G.F.); (N.M.G.S.); (I.S.)
| | - Paula Fernanda Santos Pallone Dutra
- Department of Gynecology, Paulista Medical School, Federal University of Sao Paulo, UNIFESP/EPM, Sao Paulo 04021-001, Brazil; (S.C.P.); (T.H.); (P.F.S.P.D.); (A.C.); (C.S.); (L.K.); (G.F.); (N.M.G.S.); (I.S.)
| | - Andreia Carmo
- Department of Gynecology, Paulista Medical School, Federal University of Sao Paulo, UNIFESP/EPM, Sao Paulo 04021-001, Brazil; (S.C.P.); (T.H.); (P.F.S.P.D.); (A.C.); (C.S.); (L.K.); (G.F.); (N.M.G.S.); (I.S.)
| | - Camilla Salmeron
- Department of Gynecology, Paulista Medical School, Federal University of Sao Paulo, UNIFESP/EPM, Sao Paulo 04021-001, Brazil; (S.C.P.); (T.H.); (P.F.S.P.D.); (A.C.); (C.S.); (L.K.); (G.F.); (N.M.G.S.); (I.S.)
| | - Luciana Karoleski
- Department of Gynecology, Paulista Medical School, Federal University of Sao Paulo, UNIFESP/EPM, Sao Paulo 04021-001, Brazil; (S.C.P.); (T.H.); (P.F.S.P.D.); (A.C.); (C.S.); (L.K.); (G.F.); (N.M.G.S.); (I.S.)
| | - Gustavo Focchi
- Department of Gynecology, Paulista Medical School, Federal University of Sao Paulo, UNIFESP/EPM, Sao Paulo 04021-001, Brazil; (S.C.P.); (T.H.); (P.F.S.P.D.); (A.C.); (C.S.); (L.K.); (G.F.); (N.M.G.S.); (I.S.)
| | - Neila Maria Góis Speck
- Department of Gynecology, Paulista Medical School, Federal University of Sao Paulo, UNIFESP/EPM, Sao Paulo 04021-001, Brazil; (S.C.P.); (T.H.); (P.F.S.P.D.); (A.C.); (C.S.); (L.K.); (G.F.); (N.M.G.S.); (I.S.)
| | | | - Ivaldo Silva
- Department of Gynecology, Paulista Medical School, Federal University of Sao Paulo, UNIFESP/EPM, Sao Paulo 04021-001, Brazil; (S.C.P.); (T.H.); (P.F.S.P.D.); (A.C.); (C.S.); (L.K.); (G.F.); (N.M.G.S.); (I.S.)
- Department of Education, ICT and Learning, Østfold University College, 1757 Halden, Norway
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Zheng H, Xie X, Ling H, You X, Liang S, Lin R, Qiu R, Hou H. Transdermal drug delivery via microneedles for musculoskeletal systems. J Mater Chem B 2023; 11:8327-8346. [PMID: 37539625 DOI: 10.1039/d3tb01441j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
As the population is ageing and lifestyle is changing, the prevalence of musculoskeletal (MSK) disorders is gradually increasing with each passing year, posing a serious threat to the health and quality of the public, especially the elderly. However, currently prevalent treatments for MSK disorders, mainly administered orally and by injection, are not targeted to the specific lesion, resulting in low efficacy along with a series of local and systemic adverse effects. Microneedle (MN) patches loaded with micron-sized needle array, combining the advantages of oral administration and local injection, have become a potentially novel strategy for the administration and treatment of MSK diseases. In this review, we briefly introduce the basics of MNs and focus on the main characteristics of the MSK systems and various types of MN-based transdermal drug delivery (TDD) systems. We emphasize the progress and broad applications of MN-based transdermal drug delivery (TDD) for MSK systems, including osteoporosis, nutritional rickets and some other typical types of arthritis and muscular damage, and in closing summarize the future prospects and challenges of MNs application.
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Affiliation(s)
- Haibin Zheng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510280, P. R. China
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
| | - Xuankun Xie
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510280, P. R. China
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
| | - Haocong Ling
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510280, P. R. China
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
| | - Xintong You
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
| | - Siyu Liang
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
| | - Rurong Lin
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
| | - Renjie Qiu
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
| | - Honghao Hou
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
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Yuk JS, Lee JS, Park JH. Menopausal hormone therapy and risk of dementia: health insurance database in South Korea-based retrospective cohort study. Front Aging Neurosci 2023; 15:1213481. [PMID: 37744387 PMCID: PMC10512830 DOI: 10.3389/fnagi.2023.1213481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Menopausal hormone therapy (MHT) is used to alleviate the symptoms associated with menopause, despite the lack of recommendations for MHT in preventing dementia. Recent nationwide studies have explored the association between MHT and dementia risk, but the findings remain limited. This study aims to investigate the association between MHT and the incidence of Alzheimer's disease (AD) and non-AD dementia using national population data from Korea. Methods We conducted a retrospective study using data from the National Health Insurance Service in Korea between January 1, 2002, and December 31, 2019. Women over 40 years were eligible for this study and classified into the MHT or non-MHT groups. The MHT group consisted of women who used Tibolone (TIB), combined estrogen plus progestin by the manufacturer (CEPM), estrogen, combined estrogen plus progestin by a physician (CEPP), and transdermal estrogen during menopause. We compared the risk of dementia between the MHT and non-MHT groups. Results The study included 1,399,256 patients, of whom 387,477 were in the MHT group, and 1,011,779 were in the non-MHT group. The median duration of MHT was 23 months (range: 10-55 months). After adjusting for available confounders, we found that different types of MHT had varying effects on the occurrence of dementia. TIB (HR 1.041, 95% confidence interval (CI) 1.01-1.072) and oral estrogen alone (HR 1.081, 95% CI 1.03-1.134) were associated with a higher risk of AD dementia. In contrast, there was no difference in the risk of AD dementia by CEPM (HR 0.975, 95% CI 0.93-1.019), CEPP (HR 1.131, 95% CI 0.997-1.283), and transdermal estrogen (HR 0.989, 95% CI 0.757-1.292) use. The use of TIB, CEPM, and oral estrogen alone increased the risk of non-AD dementia (HR 1.335, 95% CI 1.303-1.368; HR 1.25, 95% CI 1.21-1.292; and HR 1.128, 95% CI 1.079-1.179; respectively), but there was no risk of non-AD dementia in the other MHT groups (CEPP and topical estrogen). Conclusion Our findings indicate that MHT has varying effects on the incidence of AD and non-AD dementia. Specifically, TIB, CEPM, and oral estrogen alone increase the risk of non-AD dementia, while transdermal estrogen is not associated with dementia risk. It is essential to consider the type of MHT used when assessing the risk of dementia in women.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Jin San Lee
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Joong Hyun Park
- Department of Neurology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
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Peila R, Xue X, LaMonte MJ, Shadyab AH, Wactawski-Wende J, Jung SY, Johnson KC, Coday M, Richey P, Mouton CP, Saquib N, Chlebowski RT, Pan K, Michael YL, LeBoff MS, Manson JE, Rohan TE. Menopausal hormone therapy and change in physical activity in the Women's Health Initiative hormone therapy clinical trials. Menopause 2023; 30:898-905. [PMID: 37527476 PMCID: PMC10527163 DOI: 10.1097/gme.0000000000002231] [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] [Indexed: 08/03/2023]
Abstract
OBJECTIVE The menopausal transition results in a progressive decrease in circulating estrogen levels. Experimental evidence in rodents has indicated that estrogen depletion leads to a reduction of energy expenditure and physical activity. It is unclear whether treatment with estrogen therapy increases physical activity level in postmenopausal women. METHODS A total of 27,327 postmenopausal women aged 50-79 years enrolled in the Women's Health Initiative randomized double-blind trials of menopausal hormone therapy. Self-reported leisure-time physical activity at baseline, and years 1, 3, and 6 was quantified as metabolic equivalents (MET)-h/wk. In each trial, comparison between intervention and placebo groups of changes in physical activity levels from baseline to follow-up assessment was examined using linear regression models. RESULTS In the CEE-alone trial, the increase in MET-h/wk was greater in the placebo group compared with the intervention group at years 3 ( P = 0.002) and 6 ( P < 0.001). Similar results were observed when analyses were restricted to women who maintained an adherence rate ≥80% during the trial or who were physically active at baseline. In the CEE + MPA trial, the primary analyses did not show significant differences between groups, but the increase of MET-h/wk was greater in the placebo group compared with the intervention group at year 3 ( P = 0.004) among women with an adherence rate ≥80%. CONCLUSIONS The results from this clinical trial do not support the hypothesis that estrogen treatment increases physical activity among postmenopausal women.
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Affiliation(s)
- Rita Peila
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York City, NY, USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York City, NY, USA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, University of Buffalo, NY, USA
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Su Yon Jung
- Translational Sciences Section, Jonsson Comprehensive Cancer Center, School of Nursing, University of California Los Angeles, CA, USA
| | - Karen C Johnson
- Department of Preventive Medicine, College of Medicine, University of Tennessee, Health Science Center, Memphis, TN, USA
| | - Mace Coday
- Department of Preventive Medicine, College of Medicine, University of Tennessee, Health Science Center, Memphis, TN, USA
| | - Phyllis Richey
- Department of Preventive Medicine, College of Medicine, University of Tennessee, Health Science Center, Memphis, TN, USA
| | - Charles P Mouton
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Nazums Saquib
- College of Medicine at Sulaiman Al Rajhi University, Bukariyah, Saudi Arabia
| | - Rowan T Chlebowski
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kathy Pan
- Department of Hematology/Oncology, Kaiser Permanente Southern California, Downey, CA, USA
| | - Yvonne L Michael
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Meryl S LeBoff
- Division of Endocrinology, Diabetes and Hypertension, Brigham’s and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York City, NY, USA
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Cetera GE, Merli CEM, Boero V, Caia C, Vercellini P. Topical estrogens for the treatment of superficial dyspareunia related to genitourinary syndrome of menopause in women with a history of endometriosis: A clinical dilemma. Eur J Obstet Gynecol Reprod Biol 2023; 288:12-17. [PMID: 37421742 DOI: 10.1016/j.ejogrb.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
Estrogen withdrawal, which occurs with the cessation of ovulation, causes genitourinary syndrome of menopause in up to 50-85% of women. Symptoms may profoundly impact quality of life and sexual function, interfering with enjoyment of sex in up to three out of four individuals. Topical estrogens have been found to provide symptom relief with minimal systemic absorption and appear to be superior to systemic therapy as what regards genitourinary symptoms. However, conclusive data on their appropriateness in postmenopausal women with a history of endometriosis is not available and the hypothesis that exogenous estrogen stimulation may reactivate endometriotic foci or even promote their malignant transformation is still open. On the other hand, endometriosis affects around 10% of premenopausal women, many of which may be exposed to an acute hypoestrogenic depletion even before spontaneous menopause occurs. This considered, excluding on principle patients with a history of endometriosis from first-line treatment for vulvovaginal atrophy would mean excluding a considerable percentage of the population from adequate care. More robust evidence is urgently needed in these regards. Meanwhile, it would appear reasonable to tailor the prescription of topical hormones in these patients, taking into account the entity of symptoms and the impact such symptoms have on patients' quality of life, as well as the form of endometriosis and the possible risks hormonal may entail. Moreover, the application of estrogens on the vulva instead of the vagina could be efficacious, while outweighing the possible biological cost of hormonal treatment in women with a history of endometriosis.
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Affiliation(s)
- G E Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C E M Merli
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - V Boero
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Caia
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - P Vercellini
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Hassanein MM, Huri HZ, Abduelkarem AR, Baig K. Therapeutic Effects of Vitamin D on Vaginal, Sexual, and Urological Functions in Postmenopausal Women. Nutrients 2023; 15:3804. [PMID: 37686835 PMCID: PMC10490181 DOI: 10.3390/nu15173804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Recent years have witnessed the emergence of growing evidence concerning vitamin D's potential role in women's health, specifically in postmenopausal women. This evidence also includes its connection to various genitourinary disorders and symptoms. Numerous clinical studies have observed improvements in vulvovaginal symptoms linked to the genitourinary syndrome of menopause (GSM) with vitamin D supplementation. These studies have reported positive effects on various aspects, such as vaginal pH, dryness, sexual functioning, reduced libido, and decreased urinary tract infections. Many mechanisms underlying these pharmacological effects have since been proposed. Vitamin D receptors (VDRs) have been identified as a major contributor to its effects. It is now well known that VDRs are expressed in the superficial layers of the urogenital organs. Additionally, vitamin D plays a crucial role in supporting immune function and modulating the body's defense mechanisms. However, the characterization of these effects requires more investigation. Reviewing existing evidence regarding vitamin D's impact on postmenopausal women's vaginal, sexual, and urological health is the purpose of this article. As research in this area continues, there is a potential for vitamin D to support women's urogenital and sexual health during the menopausal transition and postmenopausal periods.
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Affiliation(s)
- Mohammed M. Hassanein
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | - Hasniza Zaman Huri
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | - Abduelmula R. Abduelkarem
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, University City Road—University City, Sharjah P.O. Box 27272, United Arab Emirates;
- Research Institute for Medical and Health Sciences, University of Sharjah, University City Road—University City, Sharjah P.O. Box 27272, United Arab Emirates
| | - Kauser Baig
- Department of Obstetrics and Gynecology, University Hospital Sharjah, Sharjah P.O. Box 27272, United Arab Emirates;
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Lara LA, Cartagena-Ramos D, Figueiredo JB, Rosa-E-Silva ACJ, Ferriani RA, Martins WP, Fuentealba-Torres M. Hormone therapy for sexual function in perimenopausal and postmenopausal women. Cochrane Database Syst Rev 2023; 8:CD009672. [PMID: 37619252 PMCID: PMC10449239 DOI: 10.1002/14651858.cd009672.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND The perimenopausal and postmenopausal periods are associated with many symptoms, including sexual complaints. This review is an update of a review first published in 2013. OBJECTIVES We aimed to assess the effect of hormone therapy on sexual function in perimenopausal and postmenopausal women. SEARCH METHODS On 19 December 2022 we searched the Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, ISI Web of Science, two trials registries, and OpenGrey, together with reference checking and contact with experts in the field for any additional studies. SELECTION CRITERIA We included randomized controlled trials that compared hormone therapy to either placebo or no intervention (control) using any validated assessment tool to evaluate sexual function. We considered hormone therapy: estrogen alone; estrogen in combination with progestogens; synthetic steroids, for example, tibolone; selective estrogen receptor modulators (SERMs), for example, raloxifene, bazedoxifene; and SERMs in combination with estrogen. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. We analyzed data using mean differences (MDs) and standardized mean differences (SMDs). The primary outcome was the sexual function score. Secondary outcomes were the domains of sexual response: desire; arousal; lubrication; orgasm; satisfaction; and pain. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 36 studies (23,299 women; 12,225 intervention group; 11,074 control group), of which 35 evaluated postmenopausal women; only one study evaluated perimenopausal women. The 'symptomatic or early postmenopausal women' subgroup included 10 studies, which included women experiencing menopausal symptoms (symptoms such as hot flushes, night sweats, sleep disturbance, vaginal atrophy, and dyspareunia) or early postmenopausal women (within five years after menopause). The 'unselected postmenopausal women' subgroup included 26 studies, which included women regardless of menopausal symptoms and women whose last menstrual period was more than five years earlier. No study included only women with sexual dysfunction and only seven studies evaluated sexual function as a primary outcome. We deemed 20 studies at high risk of bias, two studies at low risk, and the other 14 studies at unclear risk of bias. Nineteen studies received commercial funding. Estrogen alone versus control probably slightly improves the sexual function composite score in symptomatic or early postmenopausal women (SMD 0.50, 95% confidence interval (CI) (0.04 to 0.96; I² = 88%; 3 studies, 699 women; moderate-quality evidence), and probably makes little or no difference to the sexual function composite score in unselected postmenopausal women (SMD 0.64, 95% CI -0.12 to 1.41; I² = 94%; 6 studies, 608 women; moderate-quality evidence). The pooled result suggests that estrogen alone versus placebo or no intervention probably slightly improves sexual function composite score (SMD 0.60, 95% CI 0.16 to 1.04; I² = 92%; 9 studies, 1307 women, moderate-quality evidence). We are uncertain of the effect of estrogen combined with progestogens versus placebo or no intervention on the sexual function composite score in unselected postmenopausal women (MD 0.08 95% CI -1.52 to 1.68; 1 study, 104 women; very low-quality evidence). We are uncertain of the effect of synthetic steroids versus control on the sexual function composite score in symptomatic or early postmenopausal women (SMD 1.32, 95% CI 1.18 to 1.47; 1 study, 883 women; very low-quality evidence) and of their effect in unselected postmenopausal women (SMD 0.46, 95% CI 0.07 to 0.85; 1 study, 105 women; very low-quality evidence). We are uncertain of the effect of SERMs versus control on the sexual function composite score in symptomatic or early postmenopausal women (MD -1.00, 95% CI -2.00 to -0.00; 1 study, 215 women; very low-quality evidence) and of their effect in unselected postmenopausal women (MD 2.24, 95% 1.37 to 3.11 2 studies, 1525 women, I² = 1%, low-quality evidence). We are uncertain of the effect of SERMs combined with estrogen versus control on the sexual function composite score in symptomatic or early postmenopausal women (SMD 0.22, 95% CI 0.00 to 0.43; 1 study, 542 women; very low-quality evidence) and of their effect in unselected postmenopausal women (SMD 2.79, 95% CI 2.41 to 3.18; 1 study, 272 women; very low-quality evidence). The observed heterogeneity in many analyses may be caused by variations in the interventions and doses used, and by different tools used for assessment. AUTHORS' CONCLUSIONS Hormone therapy treatment with estrogen alone probably slightly improves the sexual function composite score in women with menopausal symptoms or in early postmenopause (within five years of amenorrhoea), and in unselected postmenopausal women, especially in the lubrication, pain, and satisfaction domains. We are uncertain whether estrogen combined with progestogens improves the sexual function composite score in unselected postmenopausal women. Evidence regarding other hormone therapies (synthetic steroids and SERMs) is of very low quality and we are uncertain of their effect on sexual function. The current evidence does not suggest the beneficial effects of synthetic steroids (for example tibolone) or SERMs alone or combined with estrogen on sexual function. More studies that evaluate the effect of estrogen combined with progestogens, synthetic steroids, SERMs, and SERMs combined with estrogen would improve the quality of the evidence for the effect of these treatments on sexual function in perimenopausal and postmenopausal women.
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Affiliation(s)
- Lucia A Lara
- Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | | | - Jaqueline Bp Figueiredo
- Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
- Ultrasonography and Retraining Medical School of Ribeirao Preto (EURP), Ribeirao Preto, Brazil
| | - Ana Carolina Js Rosa-E-Silva
- Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Rui A Ferriani
- Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
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Lee HJ, Park MJ, Heo JD, Joo BS, Joo JK. Timing of hormone therapy and its association with cardiovascular risk and metabolic parameters in 4-vinylcyclohexene diepoxide-induced primary ovarian insufficiency mouse model. Gynecol Endocrinol 2023; 39:2247094. [PMID: 37599578 DOI: 10.1080/09513590.2023.2247094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/14/2022] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVE To evaluate the effects of various initiation time points and durations of hormone therapy (HT) on cardiovascular and metabolic parameters of premenarche, primary ovarian insufficiency (POI) mouse model, induced by 4-vinylcyclohexene diepoxide. METHODS A total of 50 mice at 4 weeks of age were developed into POI mouse model, further randomly categorized into 5 groups: control group without any intervention; no HT group with only high-fat diet (NT); group 1 with delayed estradiol treatment (T1); group 2 with on-time, continuous estradiol treatment (T2); and group 3 with on-time estradiol treatment but early stop (T3). Cardiovascular risk and metabolic parameters were measured. RESULTS Presenting with similar body weights, blood glucose levels of T1, T2, and T3 were all significantly lower than NT (p < .001). Serum total cholesterol and insulin were also significantly lower in all HT groups than in NT, especially in T2 (p < .001). For serum low-density lipoprotein-cholesterol, only T2 resulted in the statically lower level than those of NT, T1, and T3 (p < .001). Aortic thickness was significantly increased with aggravated fibrotic change of the intima in NT, and such consequence was significantly ameliorated in HT groups, mostly lowered in T2 (p < .05). Last, serum pro-inflammatory cytokines were significantly low in the HT groups than in NT, especially in T2 with the lowest level (p < .05). . CONCLUSIONS On-time, continuous E2 treatment immediately after a biologic estrogen deprivation event significantly reduced metabolic and cardiovascular risks in young, pre-menarche female mouse models of POI, confirming decreased serum levels of pro-inflammatory cytokines.
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Affiliation(s)
- Hyun Joo Lee
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Min Jung Park
- The Korea Institute for Public Sperm Bank, Busan, Republic of Korea
| | - Jeong-Doo Heo
- Korea Institute of Toxicology, Gyeongnam Branch Institute, Jinju, Gyeongsangnam-do, Republic of Korea
| | - Bo Sun Joo
- The Korea Institute for Public Sperm Bank, Busan, Republic of Korea
| | - Jong Kil Joo
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Abstract
Most women worldwide experience menopausal symptoms during the menopause transition or postmenopause. Vasomotor symptoms are most pronounced during the first four to seven years but can persist for more than a decade, and genitourinary symptoms tend to be progressive. Although the hallmark symptoms are hot flashes, night sweats, disrupted sleep, and genitourinary discomfort, other common symptoms and conditions are mood fluctuations, cognitive changes, low sexual desire, bone loss, increase in abdominal fat, and adverse changes in metabolic health. These symptoms and signs can occur in any combination or sequence, and the link to menopause may even be elusive. Estrogen based hormonal therapies are the most effective treatments for many of the symptoms and, in the absence of contraindications to treatment, have a generally favorable benefit:risk ratio for women below age 60 and within 10 years of the onset of menopause. Non-hormonal treatment options are also available. Although a symptom driven treatment approach with individualized decision making can improve health and quality of life for midlife women, menopausal symptoms remain substantially undertreated by healthcare providers.
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Affiliation(s)
- Erin R Duralde
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Talia H Sobel
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - JoAnn E Manson
- Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Johnson KA, Martin N, Nappi RE, Neal-Perry G, Shapiro M, Stute P, Thurston RC, Wolfman W, English M, Franklin C, Lee M, Santoro N. Efficacy and Safety of Fezolinetant in Moderate to Severe Vasomotor Symptoms Associated With Menopause: A Phase 3 RCT. J Clin Endocrinol Metab 2023; 108:1981-1997. [PMID: 36734148 PMCID: PMC10348473 DOI: 10.1210/clinem/dgad058] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
CONTEXT Vasomotor symptoms (VMS) are common, bothersome, and can persist for years before and after menopause. OBJECTIVE We aimed to assess efficacy/safety of fezolinetant for treatment of moderate to severe VMS associated with menopause. METHODS In this double-blind, placebo-controlled, 12-week phase 3 trial with a 40-week active treatment extension (NCT04003142; SKYLIGHT 2), women aged 40 to 65 years with minimum average 7 moderate to severe VMS/day were randomized to 12 weeks of once-daily placebo, fezolinetant 30 mg, or fezolinetant 45 mg. Completers were rerandomized to fezolinetant 30/45 mg for 40 additional weeks. Coprimary efficacy endpoints were mean daily change from baseline to week 4 (W4) and W12 in VMS frequency and severity. Safety was also assessed. RESULTS Both fezolinetant doses statistically significantly reduced VMS frequency/severity at W4 and W12 vs placebo. For VMS frequency, W4 least squares mean (SE) reduction vs placebo: fezolinetant 30 mg, -1.82 (0.46; P < .001); 45 mg, -2.55 (0.46; P < .001); W12: 30 mg, -1.86 (0.55; P < .001); 45 mg, -2.53 (0.55; P < .001). For VMS severity, W4: 30 mg, -0.15 (0.06; P < .05); 45 mg, -0.29 (0.06; P < .001); W12: 30 mg, -0.16 (0.08; P < .05); 45 mg, -0.29 (0.08; P < .001). Improvement in VMS frequency and severity was observed by W1 and maintained through W52. Serious treatment-emergent adverse events were infrequent, reported by 2%, 1%, and 0% of those receiving fezolinetant 30 mg, fezolinetant 45 mg, and placebo, respectively. CONCLUSION Daily fezolinetant 30 and 45 mg were efficacious and well tolerated for treating moderate to severe VMS associated with menopause.
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Affiliation(s)
| | - Nancy Martin
- Employee of Astellas Pharma Global Development at the Time of the Study, Northbrook, IL, USA
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, and Research Center for Reproductive Medicine and Gynecological Endocrinology – Menopause Unit, Fondazione Policlinico IRCCS S. Matteo, Pavia 27100, Italy
| | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, NC 27599, USA
| | - Marla Shapiro
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario M5S 1A1, Canada
| | - Petra Stute
- Department of Obstetrics and Gynecology, Inselspital, Bern CH-3010, Switzerland
| | - Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Wendy Wolfman
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario M5G 1E2, Canada
| | - Marci English
- Global Development, Astellas Pharma Global Development, Inc., Northbrook, IL 60062, USA
| | - Catherine Franklin
- Employee of Astellas Pharma Global Development at the Time of the Study, Northbrook, IL, USA
| | - Misun Lee
- Biostatistics, Astellas Pharma Global Development, Inc., Northbrook, IL 60062, USA
| | - Nanette Santoro
- Division of Reproductive Sciences, University of Colorado School of Medicine, Aurora, CO 80045, USA
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Fasero M, Quereda F, Andraca L, Coronado PJ. Pharmacological interactions and menopausal hormone therapy: a review. Menopause 2023:00042192-990000000-00211. [PMID: 37449718 DOI: 10.1097/gme.0000000000002219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
IMPORTANCE AND OBJECTIVE Menopausal hormone therapy (HT) is widely used, and there are several statements of international scientific societies to guide prescribers; however, a summary of existing literature about possible drug interactions with HT does not exist, although many midlife women take medications for other conditions. Therefore, our objective was to create a document that presents and synthesizes the most relevant interactions. The impact of the interaction itself and the number of candidates for HT who are likely to use other treatments are considered based on the best available evidence. METHODS A systematic review was performed to determine the best evidence of interaction effects on relevant outcomes of interest for decision making. A working framework was developed to formulate explicit and reasoned recommendations according to four predefined categories for coadministration: (1) can be used without expected risks, (2) acceptable use (no evidence of negative interaction), (3) alternative treatment should be considered, and (4) nonuse without express justification. The project protocol was registered in the Open Science Framework platform (doi: 10.17605/OSF.IO/J6WBC) and in PROSPERO (registration number CRD42020166658). RESULTS Studies targeting our objective are scarce, but 23 pharmacological groups were assigned to one of the predefined categories of recommendation for concomitant use of HT. Vaginal HT was assigned to category 1 for 21 of the analyzed pharmacological groups. For oral and transdermal HT (estrogen-only or combined) and tibolone, there were 12 pharmacological groups assigned to category 1, 12 to category 2, 5 to category 3, and 4 to category 4. Results are shown in crossed-tables that are useful for counseling and prescription. DISCUSSION AND CONCLUSIONS Available evidence of HT interactions with other drugs is scarce and mainly indirect. It comes from biological plausibility, knowledge of extensive concomitant use without reported incidents, and/or extrapolation from hormonal contraception, but there are pharmacological groups in all categories showing that information is useful. These eligibility criteria summarize it and can help in the decision process of HT coadministration with other drugs. Decisions should be taken based on these recommendations but also individualized risk/benefit evaluation, according to underlying pathology, patient's clinical requirements, and the existence or nonexistence of alternatives.
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Affiliation(s)
- Maria Fasero
- From the Menopause Unit, Clínica Corofas, Universidad Francisco de Vitoria, Madrid, Spain
| | - Francisco Quereda
- Hospital Universitario de San Juan de Alicante, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Leire Andraca
- Sociedad Española de Farmacia Comunitaria (SEFAC), Madrid, Spain
| | - Pluvio J Coronado
- Departamento de Obstetricia y Ginecología, Hospital clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
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Hoffman SR, Governor S, Daniels K, Seals RM, Ziyadeh NJ, Wang FT, Dai D, Mcmahill-Walraven CN, Shuminski P, Frajzyngier V, Zhou X, Shen R, Garg RK, Fournakis N, Lanes S, Beachler DC. Comparative safety of conjugated estrogens/bazedoxifene versus estrogen/progestin combination hormone therapy among women in the United States: a multidatabase cohort study. Menopause 2023:00042192-990000000-00210. [PMID: 37449720 PMCID: PMC10389232 DOI: 10.1097/gme.0000000000002217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To assess the risk of select safety outcomes including endometrial cancer, endometrial hyperplasia, and breast cancer among women using conjugated estrogens/bazedoxifene (CE/BZA) as compared with estrogen/progestin combination hormone therapy (EP). METHODS We conducted a new-user cohort study in five US healthcare claims databases representing more than 92 million women. We included CE/BZA or EP new users from May 1, 2014, to August 30, 2019. EP users were propensity score (PS) matched to users of CE/BZA. Incidence of endometrial cancer, endometrial hyperplasia, breast cancer, and eight additional cancer and cardiovascular outcomes were ascertained using claims-based algorithms. Rate ratios (RR) and differences pooled across databases were estimated using random-effects models. RESULTS The study population included 10,596 CE/BZA and 33,818 PS-matched EP new users. Rates of endometrial cancer and endometrial hyperplasia were slightly higher among CE/BZA users (1.6 and 0.4 additional cases per 10,000 person-years), although precision was limited because of small numbers of cases (endometrial cancer: RR, 1.50 [95% confidence interval {CI}, 0.79-2.88]; endometrial hyperplasia: RR, 1.69 [95% CI, 0.51-5.61]). Breast cancer incidence was lower in CE/BZA users (9.1 fewer cases per 10,000 person-years; RR, 0.79; 95% CI, 0.58-1.05). Rates of other outcomes were slightly higher among CE/BZA users, but with confidence intervals compatible with a wider range of possible associations. CONCLUSIONS CE/BZA users might experience slightly higher rates of endometrial cancer and endometrial hyperplasia, and a lower rate of breast cancer, than EP users in the first years of use.
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Affiliation(s)
- Sarah R Hoffman
- From the Carelon Research (formerly HealthCore, Inc.), Safety & Epidemiology, Wilmington, DE
| | - Samuel Governor
- From the Carelon Research (formerly HealthCore, Inc.), Safety & Epidemiology, Wilmington, DE
| | - Kimberly Daniels
- From the Carelon Research (formerly HealthCore, Inc.), Safety & Epidemiology, Wilmington, DE
| | | | | | | | - Dingwei Dai
- CVS Health Clinical Trial Services LLC (CVSH CTS; formerly Healthagen LLC), Blue Bell, PA
| | | | - Patty Shuminski
- CVS Health Clinical Trial Services LLC (CVSH CTS; formerly Healthagen LLC), Blue Bell, PA
| | | | | | | | | | - Nicole Fournakis
- From the Carelon Research (formerly HealthCore, Inc.), Safety & Epidemiology, Wilmington, DE
| | - Stephan Lanes
- From the Carelon Research (formerly HealthCore, Inc.), Safety & Epidemiology, Wilmington, DE
| | - Daniel C Beachler
- From the Carelon Research (formerly HealthCore, Inc.), Safety & Epidemiology, Wilmington, DE
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Shiozawa A, Thurston RC, Cook E, Yang H, King DD, Kristy RM, Mancuso S. Assessment of women's treatment preferences for vasomotor symptoms due to menopause. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1117-1128. [PMID: 37650213 DOI: 10.1080/14737167.2023.2250916] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Several therapies for vasomotor symptoms (VMS) due to menopause are available. Treatment preferences and willingness-to-pay for VMS treatment among US women with VMS were evaluated. METHODS An online survey of women with perimenopausal or postmenopausal VMS was conducted (3/15/21-4/23/21). A discrete choice experiment quantified the impact of 7 treatment attributes on VMS treatment choice: VMS frequency/severity reduction, sleep improvement, risk of breast cancer/cardiovascular events in 6 years, risk of short-term side effects, and out-of-pocket costs. Preference weights (PWs) with 95% confidence intervals (CIs) were estimated and reported. RESULTS Among 467 women, 86.5% and 87.8% reported moderate to very severe VMS and sleep problems during the preceding month, respectively. Sleep improvement (PW: 0.843; 95% CI: 0.721, 0.965) and reduction in VMS frequency (PW: 0.658; 95% CI: 0.520, 0.796) and severity (PW: 0.628; 95% CI: 0.500, 0.756) most influenced treatment preference; risk of cardiovascular events (PW: 0.150; 95% CI: 0.069, 0.232) or breast cancer (PW: 0.401; 95% CI: 0.306, 0.496) in 6 years had lesser effect. Willingness-to-pay was an additional $35-$46/month for substantially improved sleep, 80% VMS frequency reduction, and reduction from severe to mild VMS. CONCLUSIONS Sleep improvement and reductions in VMS frequency/severity were the most important treatment attributes.
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Affiliation(s)
- Aki Shiozawa
- Medical Affairs US, Astellas Pharma, Inc, Northbrook, IL, USA
| | - Rebecca C Thurston
- Departments of Psychiatry, Psychology, Clinical and Translational Science and Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erin Cook
- Analysis Group, Inc, Boston, MA, USA
| | | | - Deanna D King
- Medical Affairs US, Astellas Pharma, Inc, Northbrook, IL, USA
| | - Rita M Kristy
- Medical Affairs US, Astellas Pharma, Inc, Northbrook, IL, USA
| | - Shayna Mancuso
- Medical Affairs US, Astellas Pharma, Inc, Northbrook, IL, USA
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Daniel JM, Lindsey SH, Mostany R, Schrader LA, Zsombok A. Cardiometabolic health, menopausal estrogen therapy and the brain: How effects of estrogens diverge in healthy and unhealthy preclinical models of aging. Front Neuroendocrinol 2023; 70:101068. [PMID: 37061205 PMCID: PMC10725785 DOI: 10.1016/j.yfrne.2023.101068] [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: 02/16/2023] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023]
Abstract
Research in preclinical models indicates that estrogens are neuroprotective and positively impact cognitive aging. However, clinical data are equivocal as to the benefits of menopausal estrogen therapy to the brain and cognition. Pre-existing cardiometabolic disease may modulate mechanisms by which estrogens act, potentially reducing or reversing protections they provide against cognitive decline. In the current review we propose mechanisms by which cardiometabolic disease may alter estrogen effects, including both alterations in actions directly on brain memory systems and actions on cardiometabolic systems, which in turn impact brain memory systems. Consideration of mechanisms by which estrogen administration can exert differential effects dependent upon health phenotype is consistent with the move towards precision or personalized medicine, which aims to determine which treatment interventions will work for which individuals. Understanding effects of estrogens in both healthy and unhealthy models of aging is critical to optimizing the translational link between preclinical and clinical research.
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Affiliation(s)
- Jill M Daniel
- Department of Psychology and Brain Institute, Tulane University, New Orleans, LA, United States.
| | - Sarah H Lindsey
- Department of Pharmacology and Brain Institute, Tulane University, New Orleans, LA, United States
| | - Ricardo Mostany
- Department of Pharmacology and Brain Institute, Tulane University, New Orleans, LA, United States
| | - Laura A Schrader
- Department of Cell & Molecular Biology and Brain Institute, Tulane University, New Orleans, LA, United States
| | - Andrea Zsombok
- Department of Physiology and Brain Institute, Tulane University, New Orleans, LA, United States
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DiSilvestro JB, Haddad J, Robison K, Beffa L, Laprise J, Scalia-Wilbur J, Raker C, Clark M, Lokich E, Hofstatter E, Dalela D, Brown A, Bradford L, Toland M, Stuckey A. Barriers to hormone therapy following prophylactic bilateral salpingo-oophorectomy in BRCA1/2 mutation carriers. Menopause 2023; 30:732-737. [PMID: 37192837 DOI: 10.1097/gme.0000000000002201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE This study aimed to identify barriers to hormone therapy (HT) use among women with BRCA1/2 mutations after prophylactic bilateral salpingo-oophorectomy (BSO). METHODS A cross-sectional, electronic survey was conducted of BRCA1/2 mutation carriers at Women and Infants Hospital, Yale Medical Center, Hartford Healthcare, and Maine Medical Center. This study was a subanalysis of a subset of female BRCA1/2 mutation carriers who had undergone a prophylactic BSO. Data were analyzed using the Fisher's exact test or t test. RESULTS We performed a subanalysis of 60 BRCA mutation carriers who underwent a prophylactic BSO. Only 24 women (40%) reported ever using HT. HT use was higher in women who underwent their prophylactic BSO at age younger than 45 years (51% vs. 25%, P = 0.06). Among all women who had a prophylactic BSO, the majority (73%) reported that a provider talked to them about using HT. Two thirds reported having seen contradictory information in the media about long-term consequences of HT. Seventy percent listed their provider as the primary influence in their decision to start HT. The most common reasons for not starting HT included it not being recommended by their physician (46%) and that it was not necessary (37%). CONCLUSIONS BRCA mutation carriers frequently undergo prophylactic BSO at young ages, and less than half report using HT. This study highlights barriers to HT use, such as patient fears and physician discouragement, and identifies potential areas to improve educational efforts.
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Affiliation(s)
- Jessica B DiSilvestro
- From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI
| | - Jessica Haddad
- From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI
| | - Katina Robison
- From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI
| | - Lindsey Beffa
- From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI
| | - Jessica Laprise
- From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI
| | - Jennifer Scalia-Wilbur
- From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI
| | - Christina Raker
- From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI
| | - Melissa Clark
- From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI
| | - Elizabeth Lokich
- From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI
| | - Erin Hofstatter
- Cancer Genetics and Prevention Program, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Disha Dalela
- Cancer Genetics and Prevention Program, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Amy Brown
- Department of Medical Oncology, Hartford Healthcare Cancer Institute, Hartford, CT
| | - Leslie Bradford
- Division of Gynecologic Oncology, Maine Medical Partners, Scarborough, ME
| | - Maris Toland
- Division of Gynecologic Oncology, Maine Medical Partners, Scarborough, ME
| | - Ashley Stuckey
- From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI
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49
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Wang S, Yang W, Li X, Wang Z, Zhang L, Wang J, Qi X, Dove A, Xu W. Association of lifespan reproductive duration with depression in Swedish twins: The role of hormone replacement therapy. Int J Gynaecol Obstet 2023; 162:309-316. [PMID: 36645342 DOI: 10.1002/ijgo.14676] [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: 06/30/2022] [Revised: 12/16/2022] [Accepted: 01/12/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine the association between reproductive duration and postmenopausal depression (taking the use of hormone replacement therapy [HRT] into account). METHODS In this population-based cohort study, 11 320 postmenopausal women (mean age 63.6 years) were followed for up to 18 years. Reproductive duration was categorized into three groups: short (≤34 years), average (35-39 years), and long (≥40 years). Depression was ascertained from the Sweden National Patient Registry. RESULTS During the follow up, 593 (5.24%) women developed depression. In the multi-adjusted generalized estimating equation model, the odds ratios (ORs) of depression were 1.28 (95% confidence interval [CI] 1.05-1.55) and 1.25 (95% CI 1.01-1.55) for women with short and long reproductive durations, respectively, compared with those women with average reproductive duration. Women with a non-typical reproductive duration (≤34 or ≥40 years) who received HRT were at a higher risk of depression (OR 1.82, 95% CI 1.42-2.33). There was a significant additive interaction between non-typical reproductive duration and the use of HRT on depression (attributable proportion 0.26, 95% CI 0.03-0.50). CONCLUSION Women with a short or long reproductive duration, especially those with a history of HRT use, have a higher risk of depression after menopause compared with those with an average reproductive duration.
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Affiliation(s)
- Shuqi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin, China
- Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Wenzhe Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin, China
- Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Xuerui Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin, China
- Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Zhiyu Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin, China
- Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Lulu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin, China
- Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Jiao Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin, China
- Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin, China
- Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin, China
- Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden
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50
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Bernaud VE, Koebele SV, Northup-Smith SN, Willeman MN, Barker C, Schatzki-Lumpkin A, Sanchez MV, Bimonte-Nelson HA. Evaluations of memory, anxiety, and the growth factor IGF-1R after post-surgical menopause treatment with a highly selective progestin. Behav Brain Res 2023; 448:114442. [PMID: 37085118 PMCID: PMC11105077 DOI: 10.1016/j.bbr.2023.114442] [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: 08/18/2022] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 04/23/2023]
Abstract
Progestogens are a key component of menopausal hormone therapies. While some progestogens can be detrimental to cognition, there is preclinical evidence that progestogens with a strong progesterone-receptor affinity benefit some molecular mechanisms believed to underlie cognitive function. Thus, a progestin that maximizes progesterone-receptor affinity and minimizes affinities to other receptors may be cognitively beneficial. We evaluated segesterone-acetate (SGA), a 19-norprogesterone derivative with a strong progesterone-receptor affinity and no androgenic or estrogenic-receptor activity, hypothesizing that it would enhance cognition. Middle-aged rats underwent Sham or Ovariectomy (Ovx) surgery followed by administration of medroxyprogesterone-acetate (MPA; used as a positive control as we have previously shown MPA-induced cognitive deficits), SGA (low or high dose), or vehicle (one Sham and one Ovx group). Spatial working and reference memory, delayed retention, and anxiety-like behavior were assessed, as were memory- and hormone- related protein assays within the frontal cortex, dorsal hippocampus, and entorhinal cortex. Low-dose SGA impaired spatial working memory, while high-dose SGA had a more extensive detrimental impact, negatively affecting spatial reference memory and delayed retention. Replicating previous findings, MPA impaired spatial reference memory and delayed retention. SGA, but not MPA, alleviated Ovx-induced anxiety-like behaviors. On two working memory measures, IGF-1R expression correlated with better working memory only in rats without hormone manipulation; any hormone manipulation or combination of hormone manipulations used herein altered this relationship. These findings suggest that SGA impairs spatial cognition after surgical menopause, and that surgical menopause with or without progestin administration disrupts relationships between a growth factor critical to neuroplasticity.
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Affiliation(s)
- Victoria E Bernaud
- Department of Psychology, Arizona State University, 950 S. McAllister Ave., Tempe, AZ 85287, USA; Arizona Alzheimer's Consortium, 4745 N 7th St, Phoenix, AZ 85014, USA
| | - Stephanie V Koebele
- Department of Psychology, Arizona State University, 950 S. McAllister Ave., Tempe, AZ 85287, USA; Arizona Alzheimer's Consortium, 4745 N 7th St, Phoenix, AZ 85014, USA
| | - Steven N Northup-Smith
- Department of Psychology, Arizona State University, 950 S. McAllister Ave., Tempe, AZ 85287, USA; Arizona Alzheimer's Consortium, 4745 N 7th St, Phoenix, AZ 85014, USA
| | - Mari N Willeman
- Department of Psychology, Arizona State University, 950 S. McAllister Ave., Tempe, AZ 85287, USA; Arizona Alzheimer's Consortium, 4745 N 7th St, Phoenix, AZ 85014, USA; TGen Institute, 445 N 5th St, Phoenix, AZ 85004, USA
| | - Charlotte Barker
- Department of Psychology, Arizona State University, 950 S. McAllister Ave., Tempe, AZ 85287, USA; Arizona Alzheimer's Consortium, 4745 N 7th St, Phoenix, AZ 85014, USA
| | - Alex Schatzki-Lumpkin
- Department of Psychology, Arizona State University, 950 S. McAllister Ave., Tempe, AZ 85287, USA; Arizona Alzheimer's Consortium, 4745 N 7th St, Phoenix, AZ 85014, USA
| | - Maria Valenzuela Sanchez
- Department of Psychology, Arizona State University, 950 S. McAllister Ave., Tempe, AZ 85287, USA; Arizona Alzheimer's Consortium, 4745 N 7th St, Phoenix, AZ 85014, USA
| | - Heather A Bimonte-Nelson
- Department of Psychology, Arizona State University, 950 S. McAllister Ave., Tempe, AZ 85287, USA; Arizona Alzheimer's Consortium, 4745 N 7th St, Phoenix, AZ 85014, USA.
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