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Herrera-Pérez JJ, Hernández-Hernández OT, Flores-Ramos M, Cueto-Escobedo J, Rodríguez-Landa JF, Martínez-Mota L. The intersection between menopause and depression: overview of research using animal models. Front Psychiatry 2024; 15:1408878. [PMID: 39081530 PMCID: PMC11287658 DOI: 10.3389/fpsyt.2024.1408878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/28/2024] [Indexed: 08/02/2024] Open
Abstract
Menopausal women may experience symptoms of depression, sometimes even progressing clinical depression requiring treatment to improve quality of life. While varying levels of estrogen in perimenopause may contribute to an increased biological vulnerability to mood disturbances, the effectiveness of estrogen replacement therapy (ERT) in the relief of depressive symptoms remains controversial. Menopausal depression has a complex, multifactorial etiology, that has limited the identification of optimal treatment strategies for the management of this psychiatric complaint. Nevertheless, clinical evidence increasingly supports the notion that estrogen exerts neuroprotective effects on brain structures related to mood regulation. Indeed, research using preclinical animal models continues to improve our understanding of menopause and the effectiveness of ERT and other substances at treating depression-like behaviors. However, questions regarding the efficacy of ERT in perimenopause have been raised. These questions may be answered by further investigation using specific animal models of reduced ovarian function. This review compares and discusses the advantages and pitfalls of different models emulating the menopausal stages and their relationship with the onset of depressive-like signs, as well as the efficacy and mechanisms of conventional and novel ERTs in treating depressive-like behavior. Ovariectomized young rats, middle-to-old aged intact rats, and females treated with reprotoxics have all been used as models of menopause, with stages ranging from surgical menopause to perimenopause. Additionally, this manuscript discusses the impact of organistic and therapeutic variables that may improve or reduce the antidepressant response of females to ERT. Findings from these models have revealed the complexity of the dynamic changes occurring in brain function during menopausal transition, reinforcing the idea that the best approach is timely intervention considering the opportunity window, in addition to the careful selection of treatment according to the presence or absence of reproductive tissue. Additionally, data from animal models has yielded evidence to support new promising estrogens that could be considered as ERTs with antidepressant properties and actions in endocrine situations in which traditional ERTs are not effective.
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Affiliation(s)
- José Jaime Herrera-Pérez
- Laboratorio de Farmacología Conductual, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Olivia Tania Hernández-Hernández
- Consejo Nacional de Humanidades, Ciencias y Tecnologías Research Fellow. Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Mónica Flores-Ramos
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Jonathan Cueto-Escobedo
- Departamento de Investigación Clínica, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa-Enríquez, Mexico
| | | | - Lucía Martínez-Mota
- Laboratorio de Farmacología Conductual, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
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Kotsopoulos J, Gronwald J, Huzarski T, Møller P, Pal T, McCuaig JM, Singer CF, Karlan BY, Aeilts A, Eng C, Eisen A, Bordeleau L, Foulkes WD, Tung N, Couch FJ, Fruscio R, Neuhausen SL, Zakalik D, Cybulski C, Metcalfe K, Olopade OI, Sun P, Lubinski J, Narod SA. Bilateral Oophorectomy and All-Cause Mortality in Women With BRCA1 and BRCA2 Sequence Variations. JAMA Oncol 2024; 10:484-492. [PMID: 38421677 PMCID: PMC10905374 DOI: 10.1001/jamaoncol.2023.6937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 08/22/2023] [Indexed: 03/02/2024]
Abstract
Importance Preventive bilateral salpingo-oophorectomy is offered to women at high risk of ovarian cancer who carry a pathogenic variant in BRCA1 or BRCA2; however, the association of oophorectomy with all-cause mortality has not been clearly defined. Objective To evaluate the association between bilateral oophorectomy and all-cause mortality among women with a BRCA1 or BRCA2 sequence variation. Design, Setting, and Participants In this international, longitudinal cohort study of women with BRCA sequence variations, information on bilateral oophorectomy was obtained via biennial questionnaire. Participants were women with a BRCA1 or BRCA2 sequence variation, no prior history of cancer, and at least 1 follow-up questionnaire completed. Women were followed up from age 35 to 75 years for incident cancers and deaths. Cox proportional hazards regression was used to estimate the hazard ratios (HRs) and 95% CIs for all-cause mortality associated with a bilateral oophorectomy (time dependent). Data analysis was performed from January 1 to June 1, 2023. Exposures Self-reported bilateral oophorectomy (with or without salpingectomy). Main Outcomes and Measures All-cause mortality, breast cancer-specific mortality, and ovarian cancer-specific mortality. Results There were 4332 women (mean age, 42.6 years) enrolled in the cohort, of whom 2932 (67.8%) chose to undergo a preventive oophorectomy at a mean (range) age of 45.4 (23.0-77.0) years. After a mean follow-up of 9.0 years, 851 women had developed cancer and 228 had died; 57 died of ovarian or fallopian tube cancer, 58 died of breast cancer, 16 died of peritoneal cancer, and 97 died of other causes. The age-adjusted HR for all-cause mortality associated with oophorectomy was 0.32 (95% CI, 0.24-0.42; P < .001). The age-adjusted HR was 0.28 (95% CI, 0.20-0.38; P < .001) and 0.43 (95% CI, 0.22-0.90; P = .03) for women with BRCA1 and BRCA2 sequence variations, respectively. For women with BRCA1 sequence variations, the estimated cumulative all-cause mortality to age 75 years for women who had an oophorectomy at age 35 years was 25%, compared to 62% for women who did not have an oophorectomy. For women with BRCA2 sequence variations, the estimated cumulative all-cause mortality to age 75 years was 14% for women who had an oophorectomy at age 35 years compared to 28% for women who did not have an oophorectomy. Conclusions and Relevance In this cohort study among women with a BRCA1 or BRCA2 sequence variation, oophorectomy was associated with a significant reduction in all-cause mortality.
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Affiliation(s)
- Joanne Kotsopoulos
- Women’s College Research Institute, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jacek Gronwald
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Huzarski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Pål Møller
- Department of Tumour Biology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Tuya Pal
- Vanderbilt-Ingram Cancer Center, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeanna M. McCuaig
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Christian F. Singer
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Beth Y. Karlan
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles
| | - Amber Aeilts
- Comprehensive Cancer Center, Division of Human Genetics, The Ohio State University Medical Center, Columbus
| | - Charis Eng
- Genomic Medicine Institute and Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, Ohio
| | - Andrea Eisen
- Sunnybrook Odette Cancer Center, Department of Medical Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Louise Bordeleau
- Department of Oncology, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada
| | - William D. Foulkes
- McGill Program in Cancer Genetics, Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Nadine Tung
- Cancer Risk and Prevention Program, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Fergus J. Couch
- Division of Experimental Pathology and Laboratory Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Susan L. Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, California
| | - Dana Zakalik
- Grosfeld Cancer Genetics Center, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Cezary Cybulski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Kelly Metcalfe
- Women’s College Research Institute, University of Toronto, Toronto, Ontario, Canada
- Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Ping Sun
- Women’s College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Jan Lubinski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Steven A. Narod
- Women’s College Research Institute, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Hassan H, Allen I, Sofianopoulou E, Walburga Y, Turnbull C, Eccles DM, Tischkowitz M, Pharoah P, Antoniou AC. Long-term outcomes of hysterectomy with bilateral salpingo-oophorectomy: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:44-57. [PMID: 37364803 DOI: 10.1016/j.ajog.2023.06.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/15/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE This study aimed to provide an up-to-date systematic review of "the long-term outcomes of bilateral salpingo-oophorectomy at the time of hysterectomy" and perform a meta-analysis for the reported associations. DATA SOURCES Our study updated a previous systematic review by searching the literature using PubMed, Web of Science, and Embase for publications between January 2015 and August 2022. STUDY ELIGIBILITY CRITERIA Our study included studies of women who had a hysterectomy with bilateral salpingo-oophorectomy vs women who had a hysterectomy with ovarian conservation or no surgery. METHODS The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations. Adjusted hazard ratios were extracted and combined to obtain fixed effect estimates. RESULTS Compared with hysterectomy or no surgery, hysterectomy with bilateral salpingo-oophorectomy in young women was associated with decreased risk of breast cancer (hazard ratio, 0.78; 95% confidence interval, 0.73-0.84) but with an increased risk of colorectal cancer (hazard ratio, 1.27; 95% confidence interval, 1.10-1.47). In addition, it was associated with an increased risk of total cardiovascular diseases, coronary heart disease, and stroke with hazard ratios of 1.18 (95% confidence interval, 1.11-1.25), 1.17 (95% confidence interval, 1.10-1.25), and 1.20 (95% confidence interval, 1.10-1.31), respectively. Compared with no surgery, hysterectomy with bilateral salpingo-oophorectomy before the age of 50 years was associated with an increased risk of hyperlipidemia (hazard ratio, 1.44; 95% confidence interval, 1.25-1.65), diabetes mellitus (hazard ratio, 1.16; 95% confidence interval, 1.09-1.24), hypertension (hazard ratio, 1.13; 95% confidence interval, 1.06-1.20), dementia (hazard ratio, 1.70; 95% confidence interval, 1.07-2.69), and depression (hazard ratio, 1.39; 95% confidence interval, 1.22-1.60). The evidence on the association with all-cause mortality in young women showed substantial heterogeneity between the studies (I2=85%; P<.01). CONCLUSION Hysterectomy with bilateral salpingo-oophorectomy was associated with multiple long-term outcomes. The benefits of the addition of bilateral salpingo-oophorectomy to hysterectomy should be balanced against the risks.
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Affiliation(s)
- Hend Hassan
- Department of Public Health and Primary Care, Center for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom.
| | - Isaac Allen
- Department of Public Health and Primary Care, Center for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Eleni Sofianopoulou
- Department of Public Health and Primary Care, Center for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Yvonne Walburga
- Department of Public Health and Primary Care, Center for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Clare Turnbull
- Translational Genetics Team, Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom
| | - Diana M Eccles
- Faculty of Medicine, Department of Cancer Sciences, University of Southampton, Southampton, United Kingdom
| | - Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research, Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Paul Pharoah
- Department of Public Health and Primary Care, Center for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Antonis C Antoniou
- Department of Public Health and Primary Care, Center for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
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Chen IJ, Shoupe D, Karim R, Stanczyk FZ, Kono N, Sriprasert I, Hodis HN, Mack WJ. The association of hysterectomy with or without ovarian conservation with subclinical atherosclerosis progression in healthy postmenopausal women. Menopause 2023; 30:692-702. [PMID: 37192828 PMCID: PMC10313726 DOI: 10.1097/gme.0000000000002192] [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: 05/18/2023]
Abstract
OBJECTIVE While the deleterious associations of surgical menopause after bilateral oophorectomy with cardiovascular disease are documented, less is specifically known concerning subclinical atherosclerosis progression. METHODS We used data from 590 healthy postmenopausal women randomized to hormone therapy or placebo in the Early versus Late Intervention Trial with Estradiol (ELITE), which was conducted from July 2005 to February 2013. Subclinical atherosclerosis progression was measured as annual rate of change in carotid artery intima-media thickness (CIMT) over a median 4.8 years. Mixed-effects linear models assessed the association of hysterectomy and bilateral oophorectomy compared with natural menopause with CIMT progression adjusted for age and treatment assignment. We also tested modifying associations by age at or years since oophorectomy or hysterectomy. RESULTS Among 590 postmenopausal women, 79 (13.4%) underwent hysterectomy with bilateral oophorectomy and 35 (5.9%) underwent hysterectomy with ovarian conservation, a median of 14.3 years before trial randomization. Compared with natural menopause, women who underwent hysterectomy with and without bilateral oophorectomy had higher fasting plasma triglycerides while women who underwent bilateral oophorectomy had lower plasma testosterone. The CIMT progression rate in bilaterally oophorectomized women was 2.2 μm/y greater than natural menopause ( P = 0.08); specifically, compared with natural menopause, the associations were significantly greater in postmenopausal women who were older than 50 years at the time of bilateral oophorectomy ( P = 0.014) and in postmenopausal women who underwent bilateral oophorectomy more than 15 years before randomization ( P = 0.015). Moreover, the CIMT progression rate in hysterectomized women with ovarian conservation was 4.6 μm/y greater than natural menopause ( P = 0.015); in particular, compared with natural menopause, the association was significantly greater in postmenopausal women who underwent hysterectomy with ovarian conservation more than 15 years before randomization ( P = 0.018). CONCLUSIONS Hysterectomy with bilateral oophorectomy and ovarian conservation were associated with greater subclinical atherosclerosis progression relative to natural menopause. The associations were stronger for later age and longer time since oophorectomy/hysterectomy. Further research should continue to examine long-term atherosclerosis outcomes related to oophorectomy/hysterectomy.
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Affiliation(s)
- Irene J. Chen
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Donna Shoupe
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Roksana Karim
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Frank Z. Stanczyk
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Naoko Kono
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Intira Sriprasert
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Howard N. Hodis
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Wendy J. Mack
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Kapoor E. Premature Ovarian Insufficiency. CURRENT OPINION IN ENDOCRINE AND METABOLIC RESEARCH 2023; 28:100435. [PMID: 36936056 PMCID: PMC10022589 DOI: 10.1016/j.coemr.2023.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Natural menopause typically occurs between the ages of 46 to 55 years. Premature ovarian insufficiency or premature menopause refers to compromised ovarian follicular activity, occurring spontaneously or because of medical interventions, prior to the age of 40 years. The premature loss of estrogen leads to bothersome menopause symptoms and predisposes the women to multiple long-term health risks including a higher mortality risk. Hormone replacement therapy used until the natural age of menopause can help manage the symptoms effectively and can mitigate the long-term risk of estrogen deprivation to some extent. However, hormone replacement therapy is underutilized in this population due to the inappropriate extrapolation of potential risks that have been demonstrated with hormone therapy use in women after natural menopause. There is a large unmet need for educating patients and providers regarding the impact of premature ovarian insufficiency and the compelling need for its appropriate management.
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Affiliation(s)
- Ekta Kapoor
- Center for Women’s Health, Mayo Clinic, Rochester, MN, USA
- Menopause and Women’s Sexual Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic Rochester, MN, USA
- Women’s Health Research Center, Mayo Clinic, Rochester, MN, USA
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Long-Term Non-Cancer Risks in People with BRCA Mutations following Risk-Reducing Bilateral Salpingo-Oophorectomy and the Role of Hormone Replacement Therapy: A Review. Cancers (Basel) 2023; 15:cancers15030711. [PMID: 36765666 PMCID: PMC9913268 DOI: 10.3390/cancers15030711] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023] Open
Abstract
Risk-reducing bilateral salpingo-oophorectomy (RRBSO) is the gold standard preventative option for BRCA mutation carriers at high risk for ovarian and breast cancer. However, when performed at the recommended ages of 35-45 years, RRBSO induces immediate premature surgical menopause, along with the accompanying adverse psychosocial, cardiovascular, bone, and cognitive health consequences. While these health consequences have been thoroughly studied in the general population, little is known about the long-term health outcomes in the BRCA population. Hormone replacement therapy (HRT) until the average age of natural menopause can help mitigate these health risks, yet the initiation of HRT is a complex decision among BRCA carriers due to concern of increasing the already high risk of breast cancer in these people. This review summarizes the current research on long-term non-cancer risks in BRCA carriers following RRBSO-induced premature surgical menopause, and highlights the existing evidence in support of HRT use in this population.
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Behavioral Despair Is Blocked by the Flavonoid Chrysin (5,7-Dihydroxyflavone) in a Rat Model of Surgical Menopause. Molecules 2023; 28:molecules28020587. [PMID: 36677645 PMCID: PMC9862461 DOI: 10.3390/molecules28020587] [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: 11/16/2022] [Revised: 01/01/2023] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
Women have a high susceptibility to the negative effects of stress. Hormonal changes experienced throughout their reproductive life partially contribute to a higher incidence of anxiety and depression symptoms, particularly, during natural or surgical menopause. In preclinical research, the flavonoid chrysin (5,7-dihydroxyflavone) exerts anxiolytic- and anti-despair-like effects; however, it is unknown whether chrysin exerts a protective effect against the behavioral changes produced by acute stress on locomotor activity and behavioral despair in rats at 12-weeks post-ovariectomy. Ovariectomized female Wistar rats were assigned to eight groups: vehicle group (10% DMSO), three groups with chrysin and three groups with the same dose of allopregnanolone (0.5, 1, and 2 mg/kg), and one group with diazepam (2 mg/kg). The treatments were administered for seven consecutive days and the effects were evaluated in the locomotor activity and swimming tests. Chrysin (2 mg/kg) increased the latency to first immobility and decreased the total immobility time in the swimming test as the reference drugs allopregnanolone and diazepam (2 mg/kg); while locomotor activity prevented the behavioral changes produced by swimming. In conclusion, chrysin exerts a protective effect against the behavioral changes induced by acute stress, similarly to the neurosteroid allopregnanolone and the benzodiazepine diazepam in rats subjected to a surgical menopause model.
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Laham BJ, Murthy SS, Hanani M, Clappier M, Boyer S, Vasquez B, Gould E. The estrous cycle modulates early-life adversity effects on mouse avoidance behavior through progesterone signaling. Nat Commun 2022; 13:7537. [PMID: 36476469 PMCID: PMC9729614 DOI: 10.1038/s41467-022-35068-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
Early-life adversity (ELA) increases the likelihood of neuropsychiatric diagnoses, which are more prevalent in women than men. Since changes in reproductive hormone levels can also increase the probability of anxiety disorders in women, we examined the effects of ELA on adult female mice across the estrous cycle. We found that during diestrus, when progesterone levels are relatively high, ELA mice exhibit increased avoidance behavior and increased theta oscillation power in the ventral hippocampus (vHIP). We also found that diestrus ELA mice had higher levels of progesterone and lower levels of allopregnanolone, a neurosteroid metabolite of progesterone, in the vHIP compared with control-reared mice. Progesterone receptor antagonism normalized avoidance behavior in ELA mice, while treatment with a negative allosteric modulator of allopregnanolone promoted avoidance behavior in control mice. These results suggest that altered vHIP progesterone and allopregnanolone signaling during diestrus increases avoidance behavior in ELA mice.
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Affiliation(s)
- Blake J Laham
- Princeton Neuroscience Institute, Princeton, NJ, 08450, USA
| | | | - Monica Hanani
- Princeton Neuroscience Institute, Princeton, NJ, 08450, USA
| | - Mona Clappier
- Princeton Neuroscience Institute, Princeton, NJ, 08450, USA
| | - Sydney Boyer
- Princeton Neuroscience Institute, Princeton, NJ, 08450, USA
| | - Betsy Vasquez
- Princeton Neuroscience Institute, Princeton, NJ, 08450, USA
| | - Elizabeth Gould
- Princeton Neuroscience Institute, Princeton, NJ, 08450, USA.
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Krell-Roesch J, Syrjanen JA, Bezold J, Trautwein S, Barisch-Fritz B, Kremers WK, Fields JA, Scharf EL, Knopman DS, Stokin GB, Petersen RC, Jekauc D, Woll A, Vassilaki M, Geda YE. Mid- and Late-Life Physical Activity and Neuropsychiatric Symptoms in Dementia-Free Older Adults: Mayo Clinic Study of Aging. J Neuropsychiatry Clin Neurosci 2022; 35:133-140. [PMID: 36464975 DOI: 10.1176/appi.neuropsych.20220068] [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] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study examined associations between physical activity (PA) and neuropsychiatric symptoms (NPS) in older adults free of dementia. METHODS This cross-sectional study included 3,222 individuals ≥70 years of age (1,655 men; mean±SD age=79.2±5.6; cognitively unimpaired, N=2,723; mild cognitive impairment, N=499) from the population-based Mayo Clinic Study of Aging. PA (taken as a presumed predictor) in midlife (i.e., when participants were 50-65 years of age) and late life (i.e., the year prior to assessment) was assessed with a self-reported, validated questionnaire; PA intensity and frequency were used to calculate composite scores. NPS (taken as presumed outcomes) were assessed with the Neuropsychiatric Inventory Questionnaire, Beck Depression Inventory (BDI-II), and Beck Anxiety Inventory (BAI). Regression analyses included midlife and late-life PA in each model, which were adjusted for age, sex, education, apolipoprotein E ɛ4 status, and medical comorbidity. RESULTS Higher late-life PA was associated with lower odds of having apathy (OR=0.89, 95% CI=0.84-0.93), appetite changes (OR=0.92, 95% CI=0.87-0.98), nighttime disturbances (OR=0.95, 95% CI=0.91-0.99), depression (OR=0.94, 95% CI=0.90-0.97), irritability (OR=0.93, 95% CI=0.89-0.97), clinical depression (OR=0.92, 95% CI=0.88-0.97), and clinical anxiety (OR=0.90, 95% CI=0.86-0.94), as well as lower BDI-II (β estimate=-0.042, 95% CI=-0.051 to -0.033) and BAI (β estimate=-0.030, 95% CI=-0.040 to -0.021) scores. Higher midlife PA was associated only with higher BDI-II scores (β estimate=0.011, 95% CI=0.004 to 0.019). Sex modified the associations between PA and NPS. CONCLUSIONS Late-life PA was associated with a lower likelihood of clinical depression or anxiety and subclinical NPS. These findings need to be confirmed in a cohort study.
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Affiliation(s)
- Janina Krell-Roesch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany (Krell-Roesch, Bezold, Trautwein, Barisch-Fritz, Jekauc, Woll); Department of Quantitative Health Sciences (Krell-Roesch, Syrjanen, Kremers, Vassilaki), Department of Psychiatry and Psychology (Fields), and Department of Neurology (Scharf, Knopman, Petersen), Mayo Clinic, Rochester, Minn.; International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic (Stokin); Department of Neurology, Barrow Neurological Institute, Phoenix (Geda)
| | - Jeremy A Syrjanen
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany (Krell-Roesch, Bezold, Trautwein, Barisch-Fritz, Jekauc, Woll); Department of Quantitative Health Sciences (Krell-Roesch, Syrjanen, Kremers, Vassilaki), Department of Psychiatry and Psychology (Fields), and Department of Neurology (Scharf, Knopman, Petersen), Mayo Clinic, Rochester, Minn.; International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic (Stokin); Department of Neurology, Barrow Neurological Institute, Phoenix (Geda)
| | - Jelena Bezold
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany (Krell-Roesch, Bezold, Trautwein, Barisch-Fritz, Jekauc, Woll); Department of Quantitative Health Sciences (Krell-Roesch, Syrjanen, Kremers, Vassilaki), Department of Psychiatry and Psychology (Fields), and Department of Neurology (Scharf, Knopman, Petersen), Mayo Clinic, Rochester, Minn.; International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic (Stokin); Department of Neurology, Barrow Neurological Institute, Phoenix (Geda)
| | - Sandra Trautwein
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany (Krell-Roesch, Bezold, Trautwein, Barisch-Fritz, Jekauc, Woll); Department of Quantitative Health Sciences (Krell-Roesch, Syrjanen, Kremers, Vassilaki), Department of Psychiatry and Psychology (Fields), and Department of Neurology (Scharf, Knopman, Petersen), Mayo Clinic, Rochester, Minn.; International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic (Stokin); Department of Neurology, Barrow Neurological Institute, Phoenix (Geda)
| | - Bettina Barisch-Fritz
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany (Krell-Roesch, Bezold, Trautwein, Barisch-Fritz, Jekauc, Woll); Department of Quantitative Health Sciences (Krell-Roesch, Syrjanen, Kremers, Vassilaki), Department of Psychiatry and Psychology (Fields), and Department of Neurology (Scharf, Knopman, Petersen), Mayo Clinic, Rochester, Minn.; International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic (Stokin); Department of Neurology, Barrow Neurological Institute, Phoenix (Geda)
| | - Walter K Kremers
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany (Krell-Roesch, Bezold, Trautwein, Barisch-Fritz, Jekauc, Woll); Department of Quantitative Health Sciences (Krell-Roesch, Syrjanen, Kremers, Vassilaki), Department of Psychiatry and Psychology (Fields), and Department of Neurology (Scharf, Knopman, Petersen), Mayo Clinic, Rochester, Minn.; International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic (Stokin); Department of Neurology, Barrow Neurological Institute, Phoenix (Geda)
| | - Julie A Fields
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany (Krell-Roesch, Bezold, Trautwein, Barisch-Fritz, Jekauc, Woll); Department of Quantitative Health Sciences (Krell-Roesch, Syrjanen, Kremers, Vassilaki), Department of Psychiatry and Psychology (Fields), and Department of Neurology (Scharf, Knopman, Petersen), Mayo Clinic, Rochester, Minn.; International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic (Stokin); Department of Neurology, Barrow Neurological Institute, Phoenix (Geda)
| | - Eugene L Scharf
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany (Krell-Roesch, Bezold, Trautwein, Barisch-Fritz, Jekauc, Woll); Department of Quantitative Health Sciences (Krell-Roesch, Syrjanen, Kremers, Vassilaki), Department of Psychiatry and Psychology (Fields), and Department of Neurology (Scharf, Knopman, Petersen), Mayo Clinic, Rochester, Minn.; International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic (Stokin); Department of Neurology, Barrow Neurological Institute, Phoenix (Geda)
| | - David S Knopman
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany (Krell-Roesch, Bezold, Trautwein, Barisch-Fritz, Jekauc, Woll); Department of Quantitative Health Sciences (Krell-Roesch, Syrjanen, Kremers, Vassilaki), Department of Psychiatry and Psychology (Fields), and Department of Neurology (Scharf, Knopman, Petersen), Mayo Clinic, Rochester, Minn.; International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic (Stokin); Department of Neurology, Barrow Neurological Institute, Phoenix (Geda)
| | - Gorazd B Stokin
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany (Krell-Roesch, Bezold, Trautwein, Barisch-Fritz, Jekauc, Woll); Department of Quantitative Health Sciences (Krell-Roesch, Syrjanen, Kremers, Vassilaki), Department of Psychiatry and Psychology (Fields), and Department of Neurology (Scharf, Knopman, Petersen), Mayo Clinic, Rochester, Minn.; International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic (Stokin); Department of Neurology, Barrow Neurological Institute, Phoenix (Geda)
| | - Ronald C Petersen
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany (Krell-Roesch, Bezold, Trautwein, Barisch-Fritz, Jekauc, Woll); Department of Quantitative Health Sciences (Krell-Roesch, Syrjanen, Kremers, Vassilaki), Department of Psychiatry and Psychology (Fields), and Department of Neurology (Scharf, Knopman, Petersen), Mayo Clinic, Rochester, Minn.; International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic (Stokin); Department of Neurology, Barrow Neurological Institute, Phoenix (Geda)
| | - Darko Jekauc
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany (Krell-Roesch, Bezold, Trautwein, Barisch-Fritz, Jekauc, Woll); Department of Quantitative Health Sciences (Krell-Roesch, Syrjanen, Kremers, Vassilaki), Department of Psychiatry and Psychology (Fields), and Department of Neurology (Scharf, Knopman, Petersen), Mayo Clinic, Rochester, Minn.; International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic (Stokin); Department of Neurology, Barrow Neurological Institute, Phoenix (Geda)
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany (Krell-Roesch, Bezold, Trautwein, Barisch-Fritz, Jekauc, Woll); Department of Quantitative Health Sciences (Krell-Roesch, Syrjanen, Kremers, Vassilaki), Department of Psychiatry and Psychology (Fields), and Department of Neurology (Scharf, Knopman, Petersen), Mayo Clinic, Rochester, Minn.; International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic (Stokin); Department of Neurology, Barrow Neurological Institute, Phoenix (Geda)
| | - Maria Vassilaki
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany (Krell-Roesch, Bezold, Trautwein, Barisch-Fritz, Jekauc, Woll); Department of Quantitative Health Sciences (Krell-Roesch, Syrjanen, Kremers, Vassilaki), Department of Psychiatry and Psychology (Fields), and Department of Neurology (Scharf, Knopman, Petersen), Mayo Clinic, Rochester, Minn.; International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic (Stokin); Department of Neurology, Barrow Neurological Institute, Phoenix (Geda)
| | - Yonas E Geda
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany (Krell-Roesch, Bezold, Trautwein, Barisch-Fritz, Jekauc, Woll); Department of Quantitative Health Sciences (Krell-Roesch, Syrjanen, Kremers, Vassilaki), Department of Psychiatry and Psychology (Fields), and Department of Neurology (Scharf, Knopman, Petersen), Mayo Clinic, Rochester, Minn.; International Clinical Research Center, St. Anne University Hospital, Brno, Czech Republic (Stokin); Department of Neurology, Barrow Neurological Institute, Phoenix (Geda)
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Thong E, Hart R, Teede H, Vincent A, Enticott J. Increased mortality and non-cancer morbidity risk may be associated with early menopause and varies with aetiology: An exploratory population-based study using data-linkage. Maturitas 2022; 164:60-66. [DOI: 10.1016/j.maturitas.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/15/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
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11
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Monterrosa-Castro Á, Prada-Tobar M, Monterrosa-Blanco A, Pérez-Romero D, Salas-Becerra C, Redondo-Mendoza V. Clinical suspicion of sarcopenic obesity and probable sarcopenic obesity in Colombian women with a history of surgical menopause: a cross-sectional study. Menopause 2022; 29:664-670. [PMID: 35674647 DOI: 10.1097/gme.0000000000001960] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify the frequency of clinical suspicion of sarcopenic obesity (CSSO) and probable sarcopenic obesity (PSO) and to estimate the association between them and surgical menopause. METHODS A cross-sectional study carried out in women residing in Colombia, ages 60 to 75 years. Body mass index, the SARC-F scale, SARC-CalF < 31, and SARC-CalF <33 versions adding the calf circumference measurement in the last two were used to identify CSSO. Muscle strength measurement was added to the above measures to establish PSO. Surgical menopause was defined in women who underwent bilateral oophorectomy simultaneously with hysterectomy before natural menopause. Adjusted and unadjusted logistic regression were performed between CSSO or PSO with surgical menopause, bilateral oophorectomy after natural menopause, and abdominal hysterectomy with ovarian preservation. All participants provided informed consent. P < 0.05 was statistically significant. RESULTS Seven hundred women 67.0 ± 4.8 years old were included; 23.7% were obese, 68.1% had reduced muscle strength, and 4.2% had surgical menopause. CSSO was found in 3.0% with SARC-F and with SARC-CalF < 31; whereas 2.0% were found with SARC-CalF <33. PSO was found in 2.4%, 1.5%, and 2.2% with SARC-F, SARC-CalF <31, and SARC-CalF <33, respectively. Surgical menopause was associated with PSO but was not associated with CSSO. Bilateral oophorectomy after menopause and hysterectomy with ovarian preservation were not associated with CSSO or PSO. CONCLUSIONS In a group of older adult women, the frequency of CSSO was up to 3.0% and PSO up to 2.4%. Surgical menopause was statistically significantly associated with PSO. On the contrary, CSSO was not associated.
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Affiliation(s)
- Álvaro Monterrosa-Castro
- Grupo de Investigación Salud de la Mujer, Faculty of Medicine, University of Cartagena, Cartagena, Colombia
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Pharmacological, Neurochemical, and Behavioral Mechanisms Underlying the Anxiolytic- and Antidepressant-like Effects of Flavonoid Chrysin. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27113551. [PMID: 35684488 PMCID: PMC9182416 DOI: 10.3390/molecules27113551] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 01/03/2023]
Abstract
Chrysin (5,7-dihydroxyflavone) is a flavonoid isolated from plants, such as Passiflora coerulea, Passiflora incarnata, and Matricaria chamomilla. This natural molecule exerts diverse pharmacological effects, which includes antioxidant, anti-inflammatory, anti-cancer, neuroprotective, and anti-apoptotic effects. Additionally, in brain structures, such as the hippocampus, prefrontal cortex, raphe nucleus, and striatum, involved in the physiopathology of anxiety and depression disorders, several neuropharmacological activities, including the activation of neurotransmitter systems (GABAergic, serotonergic, dopaminergic, and noradrenergic), neurotrophic factors, such as brain-derived neurotrophic factor and the nerve growth factor, and some signaling pathways are affected. The results showed that the anxiolytic and antidepressant-like effects of chrysin occurs through its interaction with specific neurotransmitter systems, principally the GABAergic and the serotonergic, and activation of other neurotrophic factors. However, it is not possible to discard the antioxidant and anti-inflammatory activities of chrysin while producing its anxiolytic- and antidepressant-like effects. Although these results have been obtained principally from pre-clinical research, they consistently demonstrate the potential therapeutic use of flavonoid chrysin as an anxiolytic and antidepressant agent. Therefore, this flavonoid could be considered as a promising novel therapy for anxiety and depression disorders.
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Rodríguez-Landa JF. Considerations of Timing Post-ovariectomy in Mice and Rats in Studying Anxiety- and Depression-Like Behaviors Associated With Surgical Menopause in Women. Front Behav Neurosci 2022; 16:829274. [PMID: 35309685 PMCID: PMC8931748 DOI: 10.3389/fnbeh.2022.829274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/09/2022] [Indexed: 11/29/2022] Open
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Farkas S, Szabó A, Török B, Sólyomvári C, Fazekas CL, Bánrévi K, Correia P, Chaves T, Zelena D. Ovariectomy-induced hormone deprivation aggravates Aβ 1-42 deposition in the basolateral amygdala and cholinergic fiber loss in the cortex but not cognitive behavioral symptoms in a triple transgenic mouse model of Alzheimer's disease. Front Endocrinol (Lausanne) 2022; 13:985424. [PMID: 36303870 PMCID: PMC9596151 DOI: 10.3389/fendo.2022.985424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Alzheimer's disease is the most common type of dementia, being highly prevalent in elderly women. The advanced progression may be due to decreased hormone synthesis during post-menopause as estradiol and progesterone both have neuroprotective potentials. We aimed to confirm that female hormone depletion aggravates the progression of dementia in a triple transgenic mouse model of Alzheimer's disease (3xTg-AD). As pathological hallmarks are known to appear in 6-month-old animals, we expected to see disease-like changes in the 4-month-old 3xTg-AD mice only after hormone depletion. Three-month-old female 3xTg-AD mice were compared with their age-matched controls. As a menopause model, ovaries were removed (OVX or Sham surgery). After 1-month recovery, the body composition of the animals was measured by an MRI scan. The cognitive and anxiety parameters were evaluated by different behavioral tests, modeling different aspects (Y-maze, Morris water maze, open-field, social discrimination, elevated plus maze, light-dark box, fox odor, operant conditioning, and conditioned fear test). At the end of the experiment, uterus was collected, amyloid-β accumulation, and the cholinergic system in the brain was examined by immunohistochemistry. The uterus weight decreased, and the body weight increased significantly in the OVX animals. The MRI data showed that the body weight change can be due to fat accumulation. Moreover, OVX increased anxiety in control, but decreased in 3xTg-AD animals, the later genotype being more anxious by default based on the anxiety z-score. In general, 3xTg-AD mice moved less. In relation to cognition, neither the 3xTg-AD genotype nor OVX surgery impaired learning and memory in general. Despite no progression of dementia-like behavior after OVX, at the histological level, OVX aggravated the amyloid-β plaque deposition in the basolateral amygdala and induced early cholinergic neuronal fiber loss in the somatosensory cortex of the transgenic animals. We confirmed that OVX induced menopausal symptoms. Removal of the sexual steroids aggravated the appearance of AD-related alterations in the brain without significantly affecting the behavior. Thus, the OVX in young, 3-month-old 3xTg-AD mice might be a suitable model for testing the effect of new treatment options on structural changes; however, to reveal any beneficial effect on behavior, a later time point might be needed.
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Affiliation(s)
- Szidónia Farkas
- Institute of Physiology, Medical School, University of Pécs, Centre for Neuroscience, Szentágothai Research Centre, Pécs, Hungary
- Laboratory of Behavioral and Stress Studies, Institute of Experimental Medicine, Budapest, Hungary
| | - Adrienn Szabó
- Institute of Physiology, Medical School, University of Pécs, Centre for Neuroscience, Szentágothai Research Centre, Pécs, Hungary
- Laboratory of Behavioral and Stress Studies, Institute of Experimental Medicine, Budapest, Hungary
- János Szentágothai School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Bibiána Török
- Institute of Physiology, Medical School, University of Pécs, Centre for Neuroscience, Szentágothai Research Centre, Pécs, Hungary
- Laboratory of Behavioral and Stress Studies, Institute of Experimental Medicine, Budapest, Hungary
| | - Csenge Sólyomvári
- Institute of Physiology, Medical School, University of Pécs, Centre for Neuroscience, Szentágothai Research Centre, Pécs, Hungary
| | - Csilla Lea Fazekas
- Institute of Physiology, Medical School, University of Pécs, Centre for Neuroscience, Szentágothai Research Centre, Pécs, Hungary
- Laboratory of Behavioral and Stress Studies, Institute of Experimental Medicine, Budapest, Hungary
- János Szentágothai School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Krisztina Bánrévi
- Laboratory of Behavioral and Stress Studies, Institute of Experimental Medicine, Budapest, Hungary
| | - Pedro Correia
- Institute of Physiology, Medical School, University of Pécs, Centre for Neuroscience, Szentágothai Research Centre, Pécs, Hungary
- Laboratory of Behavioral and Stress Studies, Institute of Experimental Medicine, Budapest, Hungary
- János Szentágothai School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Tiago Chaves
- Institute of Physiology, Medical School, University of Pécs, Centre for Neuroscience, Szentágothai Research Centre, Pécs, Hungary
- Laboratory of Behavioral and Stress Studies, Institute of Experimental Medicine, Budapest, Hungary
- János Szentágothai School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Dóra Zelena
- Institute of Physiology, Medical School, University of Pécs, Centre for Neuroscience, Szentágothai Research Centre, Pécs, Hungary
- Laboratory of Behavioral and Stress Studies, Institute of Experimental Medicine, Budapest, Hungary
- *Correspondence: Dóra Zelena,
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Chiuve SE, Huisingh C, Petruski-Ivleva N, Owens C, Kuohung W, Wise LA. Uterine fibroids and incidence of depression, anxiety and self-directed violence: a cohort study. J Epidemiol Community Health 2022; 76:92-99. [PMID: 34301795 PMCID: PMC8666805 DOI: 10.1136/jech-2020-214565] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression and anxiety are prevalent among women with uterine fibroids (UF). The rate of mental health diagnoses in women with UF has not been studied. METHODS Women aged 18-50 years with diagnosed UF were identified in the Optum Clinformatics commercial insurance claims database (OptumInsight, Eden Prairie, Minnesota) from 1 May 2000 to 31 March 2020 (n=313 754) and were matched 1:2 on age and calendar time to women without (n=627 539). Cox proportional hazards models estimated HRs and 95% CIs between UF and diagnosed depression, anxiety and self-directed violence, adjusting for demographics and comorbidities. Among women with diagnosed UF, the association between hysterectomy and mental health outcomes was estimated. RESULTS After adjusting for confounders, women with diagnosed UF had a higher rate of depression (HR: 1.12; 95% CI 1.10 to 1.13), anxiety (HR: 1.12; 95% CI 1.10 to 1.13) and self-directed violence (HR: 1.46; 95% CI 1.29 to 1.64) than women without. Among women with pain symptoms and heavy menstrual bleeding, the HR comparing women with diagnosed UF to women without was 1.21 (95% CI 1.18 to 1.25) for depression, 1.18 (95% CI 1.15 to 1.21) for anxiety and 1.68 (95% CI 1.35 to 2.09) for self-directed violence. Among women with diagnosed UF, the HR comparing women who underwent a hysterectomy to women who did not was 1.22 (95% CI 1.17 to 1.27) for depression, 1.13 (95% CI 1.09 to 1.17) for anxiety and 1.86 (95% CI 1.39 to 2.49) for self-directed violence. CONCLUSIONS Rates of depression, anxiety and self-directed violence were higher among women with diagnosed UF, particularly among those who experienced pain symptoms or who underwent hysterectomy.
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Affiliation(s)
| | | | | | | | - Wendy Kuohung
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Ovarian tissue and oocyte cryopreservation prior to iatrogenic premature ovarian insufficiency. Best Pract Res Clin Obstet Gynaecol 2021; 81:119-133. [PMID: 34887172 DOI: 10.1016/j.bpobgyn.2021.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 11/21/2022]
Abstract
Gonadotoxic treatments like chemotherapy or radiotherapy and ovarian surgery may result in an accelerated depletion of the ovarian reserve and subsequent premature ovarian insufficiency. Important determinants of this severe risk that require fertility preservation strategies are patient age, ovarian reserve, type of treatment, and administered dose. Oocytes and ovarian tissue can both be cryopreserved, with encouraging results in terms of pregnancy and live birth rates according to recent publications. Moreover, since ovarian tissue transplantation also results in long-term endocrine resumption, it represents a potential future therapeutic option for complete ovarian function restoration in patients with premature ovarian insufficiency.
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Hickey M, Moss KM, Brand A, Wrede CD, Domchek SM, Meiser B, Mishra GD, Joffe H. What happens after menopause? (WHAM): A prospective controlled study of depression and anxiety up to 12 months after premenopausal risk-reducing bilateral salpingo-oophorectomy. Gynecol Oncol 2021; 161:527-534. [PMID: 33583580 DOI: 10.1016/j.ygyno.2021.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/02/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Risk-reducing bilateral salpingo-oophorectomy (RRBSO) substantially reduces ovarian cancer risk in women with pathogenic gene variants and is generally recommended by age 34-45 years. Natural menopause is a vulnerable period for mood disturbance, but the risk of depression and anxiety in the first 12 months after RRBSO and potential modifying effect of hormone therapy are uncertain. METHODS Prospective controlled observational study of 95 premenopausal women planning RRBSO and a Comparison group of 99 premenopausal women who retained their ovaries,- 95% of whom were at population level risk of ovarian cancer. Clinically significant symptoms of depression and anxiety were measured using standardised instruments at baseline, 3, 6 and 12 months. Chi-square tests and adjusted logistic regression models compared differences between groups. RESULTS Baseline symptoms and previous depression or anxiety did not differ between groups. At 3 months after RRBSO clinically significant depressive symptoms were doubled (14.5% vs 27.1%, p = 0.010), which persisted at 12 months. Depressive symptoms were stable in comparisons. At 3 months after RRBSO, clinically significant anxiety symptoms almost trebled (6.1% vs 17.7%, p = 0.014) before plateauing at 6 months and returning to baseline at 12 months. Compared to comparisons, RRBSO participants were at 3.0-fold increased risk of chronic depressive symptoms (Wald 95% CI 1.27-7.26), 2.3-fold increased risk of incident depression (95% Wald CI 1.08-5.13) and 2.0-fold increase of incident anxiety (Wald 95% CI 0.78-5.00). Depression and anxiety were slightly more common in Hormone Therapy users after RRBSO vs non-users. CONCLUSIONS RRBSO leads to a rapid increase in clinically significant depressive and anxiety symptoms despite Hormone Therapy use.
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Affiliation(s)
- Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, Victoria, Australia.
| | - Katrina M Moss
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Alison Brand
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia; Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - C David Wrede
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, Victoria, Australia; Gynae-oncology and Dysplasia Unit, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Susan M Domchek
- Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Gita D Mishra
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Hadine Joffe
- Psychiatry Department and Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
Perimenopause often represents a physiologically challenging phase in women's lives. The clinical presentation of the perimenopause includes infertility, irregular menstrual cycles, menorrhagia, and new onset of or worsening of mood disorders. Unlike menopause, which is characterized by low levels of estradiol and progesterone, the hallmark of perimenopause is highly variable levels of estradiol and progesterone with abrupt increases and decreases that are often described as a hormonal roller coaster. This chapter invites general gynecologists to understand the hormonal basis of the common complaints of perimenopause and offers information about the physiology of these issues and helpful treatment options.
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Panay N, Anderson RA, Nappi RE, Vincent AJ, Vujovic S, Webber L, Wolfman W. Premature ovarian insufficiency: an International Menopause Society White Paper. Climacteric 2020; 23:426-446. [PMID: 32896176 DOI: 10.1080/13697137.2020.1804547] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this International Menopause Society White Paper on premature ovarian insufficiency (POI) is to provide the latest information regarding this distressing condition. The impact of POI has far-reaching consequences due to its impact on general, psychological, and sexual quality of life, fertility prospects, and long-term bone, cardiovascular, and cognitive health. Progress in fully understanding the etiology, diagnosis, and optimal management options has been slow thus far due to the complexity of the condition and fragmented research. Recent advances in epidemiological and genetic research have improved our understanding of this condition and randomized prospective trials are being planned to determine the intervention strategies, which will optimize quality of life and long-term well-being. The International Menopause Society has commissioned a number of experts at the forefront of their specialty to define the state of the art in the understanding of this condition, to advise on practical management strategies, and to propose future research strategies. It is hoped that a global task force will subsequently be convened in order to formulate a consensus statement across key societies, to accelerate date collection and analysis of a global POI registry, and to facilitate progress in the key defined areas of research.
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Affiliation(s)
- N Panay
- Queen Charlotte's & Chelsea and Chelsea & Westminster Hospitals, Imperial College, London, UK
| | - R A Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - R E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - A J Vincent
- Department of Endocrinology, Monash Health, Clayton, VIC, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC, Australia
| | - S Vujovic
- Faculty of Medicine, Clinic of Endocrinology, Diabetes and Diseases of Metabolism, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - L Webber
- St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - W Wolfman
- Department of Obstetrics and Gynaecology, Mt. Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Association between hysterectomy and depression: a longitudinal follow-up study using a national sample cohort. ACTA ACUST UNITED AC 2020; 27:543-549. [DOI: 10.1097/gme.0000000000001505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Laughlin-Tommaso SK, Satish A, Khan Z, Smith CY, Rocca WA, Stewart EA. Long-term risk of de novo mental health conditions after hysterectomy with ovarian conservation: a cohort study. Menopause 2020; 27:33-42. [PMID: 31479034 PMCID: PMC7089568 DOI: 10.1097/gme.0000000000001415] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this research was to study the long-term risk of de novo mental health conditions in women who underwent hysterectomy with bilateral ovarian conservation compared with age-matched referent women. METHODS Using the Rochester Epidemiology Project records-linkage system, we identified a historical cohort of 2,094 women who underwent hysterectomy with ovarian conservation for benign indications at age ≥18 years and with an index date between 1980 and 2002 in Olmsted County, Minnesota. Each woman was age-matched (±1 y) to a referent woman residing in the same county who had not undergone hysterectomy or any oophorectomy before the index date. These two cohorts were followed historically to identify de novo mental health conditions. We estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) using Cox proportional hazards models adjusted for 20 preexisting chronic conditions and other potential confounders. We also calculated absolute risk increases (ARIs) and reductions (ARRs) at 30 years of follow-up. RESULTS Over a median follow-up of 21.9 years, women who underwent hysterectomy at any age experienced increased risks of de novo depression (adjusted HR 1.26; 95% CI, 1.12-1.41; ARI 6.6%) and anxiety (adjusted HR 1.22; 95% CI, 1.08-1.38; ARI 4.7%). The association for depression increased significantly with younger age at hysterectomy, but did not vary significantly by indication. Interactions were not significant for anxiety. CONCLUSIONS Hysterectomy, even with ovarian conservation, is associated with an increased long-term risk of de novo depression and anxiety, especially when performed in women who are younger. : Video Summary:http://links.lww.com/MENO/A465.
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Affiliation(s)
- Shannon K Laughlin-Tommaso
- Division of Gynecology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - Anisha Satish
- Division of Gynecology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Zaraq Khan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Carin Y Smith
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Walter A Rocca
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
- Department of Neurology, Mayo Clinic, Rochester, MN
| | - Elizabeth A Stewart
- Department of Surgery, Mayo Clinic, Rochester, MN
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
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