The evolutionary origin and significance of menopause

DNA methylation as a window into female reproductive aging

People with ovaries experience reproductive aging as their reproductive function and system declines. This has significant implications for both fertility and long-term health, with people experiencing an increased risk of cardiometabolic disorders after menopause. Reproductive aging can be assessed through markers of ovarian reserve, response to fertility treatment or molecular biomarkers, including DNA methylation. Changes in DNA methylation with age associate with poorer reproductive outcomes, and epigenome-wide studies can provide insight into genes and pathways involved. DNA methylation-based epigenetic clocks can quantify biological age in reproductive tissues and systemically. This review provides an overview of hallmarks and theories of aging in the context of the reproductive system, and then focuses on studies of DNA methylation in reproductive tissues.

Appropriateness of premature ovarian insufficiency recommendations provided by ChatGPT

OBJECTIVE

This study aimed to evaluate the appropriateness of ChatGPT's responses to frequently asked queries regarding the prevention and treatment of premature ovarian insufficiency (POI).

METHODS

A set of 25 questions covering topics related to disease risk factors, screening, symptoms, treatment, and treatment adverse effects were posed to ChatGPT, and the responses were evaluated by two experienced obstetrician/gynecologists.

RESULTS

Of the responses given by ChatGPT, 19 of 25 (76%) were deemed appropriate, five (20%) were rated as inappropriate, and the remaining one (4%) was considered unreliable. There was no question that ChatGPT answered completely incorrectly; answers that were considered inappropriate included partially correct information.

CONCLUSIONS

The study's findings suggest that ChatGPT provides patients with mostly accurate information about the POI but might present significantly inaccurate information. However, it is important to note that further research is needed to validate the use of artificial intelligence chatbots in the context of reproductive health, especially for individuals who may be highly impacted by the emotional and psychological effects of POI. In addition, given the complexity and individuality of medical care, AI chatbots should not be considered a replacement for medical professionals but rather a supplementary tool that can help patients access reliable information and support. Overall, this study contributes to the growing body of research on AI chatbots and their potential use in reproductive health, highlighting both the benefits and limitations of these technologies.

Using evolutionary principles to make clinical decisions: a case series of urinary tract infections

The principles of evolutionary medicine have significant potential to be useful in a wide variety of clinical situations. Despite this, few demonstrations of clinical applications exist. To address this paucity, a case series applying evolutionary medicine principles to urinary tract infections, a common medical condition is presented. This series demonstrates how applying evolutionary medicine principles can be used to augment clinical decision-making.

Unraveling female reproductive senescence to enhance healthy longevity

In a society where women often want successful careers and equal opportunities to men, the early nature of ovarian aging often forces women to make difficult life choices between career and family development. Fertility in women begins to decline after the age of 37 years and it is rare for pregnancies to occur after 45. This reproductive decline in women is inevitable and culminates in menopause, which is a major driver of age-related diseases. In a world where biomedical advances are leading to modifiable biological outcomes, it is time to focus on mitigating female reproductive senescence to maintain fertility and preserve age-related hormonal functions, with the goal of providing increased life choices and enhancing healthspan. To date, reproductive longevity research remains an understudied field. More needs to be done to unravel the biology of the ovarian follicles, which are the functional units of reproductive lifespan and are comprised of cell types including the oocyte (female gamete) and a group of specialized supporting somatic cells. Biological attempts to maintain the quality and quantity of follicles in animal models through manipulating pathways involved in aging can potentially prolong female reproductive lifespan and healthspan. Here, we summarize the molecular events driving ovarian aging and menopause and the interventional strategies to offset these events. Developing solutions to female reproductive senescence will open doors to discover ways to enhance true healthy longevity for both men and women.

Out of step societal and Darwinian adaptation during evolution is the cause of multiple women's health issues

During human evolution, major changes in our societal conditions and environment took place without sufficient time for concomitant genetic alterations, leading to out of step adaptation and diseases in women. We first discuss recent societal adaptation mismatch (menstrual bleeding; increases in cancers of reproductive organs, endometriosis; mother's nursing; polycystic ovarian syndrome; transgenerational epigenetic modifications), followed by Darwinian out of step adaptation (labor difficulties; sex chromosomes, human diseases and sex disparity in genomic DNA). We discuss the evolutionary basis of menstrual bleeding, followed by recent increases in cancers of reproductive organs and endometriosis. The importance of breastfeeding by mothers is also emphasized. Earlier onset of menarche, decreased rates of childbirths and breastfeeding resulted in increased number of menstrual cycles in a lifetime, coupled with excess estrogen exposure and incessant ovulation, conditions that increased the susceptibility to mammary and uterine cancers as well as ovarian epithelial cancer and endometriosis. Shorter lactation duration in mothers also contributed to more menstrual cycles. We further discuss the evolutionary basis of the prevalent polycystic ovary syndrome. During the long-term Darwinian evolution, difficulties in childbirth evolved due to a narrowed pelvis, our upright walking and enlarged fetal brain sizes. Because there are 1.5% genomic DNA differences between woman and man, it is of significance to investigate sex-specific human physiology and diseases. In conclusion, understanding out of step adaptation during evolution could allow the prevention and better management of female reproductive dysfunction and diseases.

Is menopause still evolving? Evidence from a longitudinal study of multiethnic populations and its relevance to women's health

Background

To reflect on the impact of changing patterns of delayed marriage and reproduction and to seek evidence as to whether menopause is still evolving, characteristics of the menopause transition were investigated within and between ethnic populations in this study.

Methods

A cross-sectional analysis was conducted using data on 747 middle-aged women obtained from the Study of Women’s Health Across the Nation (SWAN) from 1996 to 2008. The ethnic groups included: Afro-American, Chinese, Japanese, Caucasian, and Hispanic. Perimenopause age and duration, menopause age, and hormonal indicators of menopause were examined across five ethnicities.

Results

We found a similar window of menopause age within populations, but no significant difference in perimenopause and menopause age between populations. The rate of increase of follicle-stimulating hormone and testosterone differed significantly in Hispanics and African-Americans during the menopause transition period.

Conclusions

The broad window of variation in age at menopause within the population and the absence of significant differences between populations, in combination with population variation in menopause symptoms, suggest that menopause is a relatively recently evolved and still evolving trait. Under the mate choice theory of menopause, menopause is the result of the accumulation of infertility mutations in older women due to men’s preference for younger mates. We propose a shifting mate choice-shifting menopause model which posits that, as the age of mate choice/marriage shifts to older ages, so will the age at menopause, and that menopause is a transient phase of female fertility; it can de-evolve, be delayed, if not disappear completely. Integrated longitudinal menopausal studies linked with genomics and hormonal studies on diverse ethnic populations can provide valuable information bearing on women’s health and personalized medicine.

The effects of Elaeagnus angustifolia L. whole fruit on the sex hormone profile in menopausal women: A double-blind, randomized, placebo-controlled study

ETHNOPHARMACOLOGICAL RELEVANCE

Menopause is a product of interrupted ovarian activity and decrease in its estradiol production. Herbal medicines as an alternative to hormone therapy are increasingly used by menopausal women. Elaeagnus angustifolia L. (Senjed in Persian) is a well-known herbal remedy with various therapeutic effects according to Iranian traditional medicine which is recommended to relieve the menopausal side effects. The aim of present study was to evaluate the effects of oral intake of whole fruit powder of E. angustifolia on the sex hormones profile in menopausal women.

MATERIALS AND METHODS

In present double-blind randomized placebo-controlled trial, 58 eligible women who were referred to Kamali Women Hospital (Karaj, Iran, 2017) were randomly assigned into herbal medicine (15 g E. angustifolia) and placebo (7.5 g cornstarch +7.5 g isomalt) groups. Initially and after 10 weeks of the treatment, serum levels of estradiol, progesterone, testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) hormones were measured.

RESULTS

According to between-group analyses, the changes in the studied parameters were not significant between herbal medicine and placebo groups, except for joint pain that improved significantly in herbal medicine group. However, by within-group analysis the levels of FSH and FSH to testosterone showed a significant increase, whereas the level of progesterone decreased significantly after 10 weeks of E. angustifolia consumption.

CONCLUSIONS

The improvement of the sex hormone profile was not in a full accordance with Iranian folklore after E. angustifolia consumption in the present menopausal participants. However, considering a strong belief on the beneficial effects of E. angustifolia in Iranian folklore, a long-term studies of larger group participants are needed to evaluate the efficacy.

Proceedings of the 2018 Santa Fe Bone Symposium: Advances in the Management of Osteoporosis

The Santa Fe Bone Symposium is an annual meeting devoted to clinical applications of recent advances in skeletal research. The 19th Santa Fe Bone Symposium convened August 3-4, 2018, in Santa Fe, New Mexico, USA. Attendees included physicians of many specialties, fellows in training, advanced practice providers, clinical researchers, and bone density technologists. The format consisted of lectures, case presentations by endocrinology fellows, and panel discussions, with all involving extensive interactive discussions. Topics were diverse, including an evolutionary history of calcium homeostasis, osteoporosis treatment in the very old, optimizing outcomes with orthopedic surgery, microbiome and bone, new strategies for combination and sequential therapy of osteoporosis, exercise as medicine, manifestations of parathyroid hormone excess and deficiency, parathyroid hormone as a therapeutic agent, cell senescence and bone health, and managing patients outside clinical practice guidelines. The National Bone Health Alliance conducted a premeeting on development of fracture liaison services. A workshop was devoted to Bone Health TeleECHO (Bone Health Extension for Community Healthcare Outcomes), a strategy of ongoing medical education for healthcare professions to expand capacity to deliver best practice skeletal healthcare in underserved communities and reduce the osteoporosis treatment gap.

ASSOCIATION OF AGE AT MENOPAUSE WITH POST-MENOPAUSAL SYMPTOMS, MENARCHE AGE AND OTHER REPRODUCTIVE FACTORS AMONG RURAL FEMALES IN SHIMLA, HIMACHAL PRADESH

This study analysed the association between menopause, menarche and number of live births using cross-sectional primary data for 75 post-menopausal rural women from Shimla in the Indian state of Himachal Pradesh. The mean/median ages at menarche of the 75 women were 14.23/14 years, and those at menopause 45.35/45 years. There were no significant differences in these values between women in the age groups 40–55 and 56–65 years. Age at menopause was found to be significantly associated with age at menarche and maternal age at birth of the first and last child, but not with menopausal symptom severity score. The majority of the 75 post-menopausal women (70.7%) had very mild or no menopausal symptoms. Three principal components were identified that explained 72.43% of the underlying variation in menopausal symptoms.

Melatonin: a "Higgs boson" in human reproduction

As the Higgs boson could be a key to unlocking mysteries regarding our Universe, melatonin, a somewhat mysterious substance secreted by the pineal gland primarily at night, might be a crucial factor in regulating numerous processes in human reproduction. Melatonin is a powerful antioxidant which has an essential role in controlling several physiological reactions, as well as biological rhythms throughout human reproductive life. Melatonin, which is referred to as a hormone, but also as an autocoid, a chronobiotic, a hypnotic, an immunomodulator and a biological modifier, plays a crucial part in establishing homeostatic, neurohumoral balance and circadian rhythm in the body through synergic actions with other hormones and neuropeptides. This paper aims to analyze the effects of melatonin on the reproductive function, as well as to shed light on immunological and oncostatic properties of one of the most powerful hormones.

Gaps in menopause knowledge

The average middle aged woman goes through a volatile period of endocrine fluctuations as she passes through menopause and the stages that precede and follow it. Ovarian hormones are steroid hormones. They readily cross the cell and nuclear membranes and influence transcription of numerous genes. Such influences are tissue specific and state specific. In short, changes in ovarian hormones mean that a women will experience changes in her entire body systems. When an individual woman's constitutional factors, pathologic states, medications, environmental exposures are taken into consideration, the integrated changes become too complex to predict. Inter-study sampling differences with the complexities in the backdrop may have led to conflicting conclusions in menopause research. This paper reviews some of the controversies in the care of menopausal women.

Are menopausal hot flashes an evolutionary byproduct of postpartum warming?

OBJECTIVE

Hot flashes are commonly associated with menopause, and some researchers have questioned whether the widespread phenomenon may somehow be adaptive. It has been hypothesized that hot flashes were selected to occur during the hypoestrogenic postpartum period as a mechanism to warm infants. The purpose of this study was to test whether postpartum hot flashes are similar to hot flashes associated with menopause and whether postpartum hot flashes are concordant with breast-feeding episodes.

METHODS

Women who gave birth within the past year (n = 20) and a comparison group of women who had not given birth in the past 2 years (n = 14) participated in interviews and anthropometric measures. All wore ambulatory skin conductance monitors for a mean of 6.5 hours during afternoons and early evenings. New mothers also recorded breast-feeding episodes. Objectively measured and subjectively reported hot flashes were compared between groups and in relation to breast-feeding and other variables.

RESULTS

Age of infants ranged from 4 days to 11 months. New mothers were more likely to report feeling warmer than the comparison group (100% vs 7%) but were not significantly more likely to demonstrate hot flashes (35% vs 50%) or to report hot flashes (30% vs 21%) during the study period. Of 75 breast-feeding episodes, only 4% were concurrent with an objective hot flash, and only 9% were concurrent with a subjective hot flash.

CONCLUSIONS

This study does not support the hypothesis that menopausal-like hot flashes evolved to warm infants during the postpartum period.

Pharmacokinetics of continuous once-a-week combination 17β-Estradiol/Low- or high-dose levonorgestrel transdermal delivery systems in postmenopausal women

Two open-label, randomized, two-period, crossover studies were performed to determine the safety, delivery rates, and pharmacokinetic properties of a combination estradiol (E2)/levonorgestrel (LNG) transdermal delivery system (TDS). Study 1 enrolled 24 postmenopausal women who received a single TDS containing 4.4 mg E2 and 1.39 mg of LNG (E2/LNG Low) or E2 0.050 mg/24 hours TDS and 0.090 mg LNG oral tablet. Study 2 enrolled 44 postmenopausal women who received either E2/LNG Low or TDS containing 4.4 mg E2 and 2.75 mg LNG (E2/LNG High) weekly for a period of 4 weeks. E2, estrone (E1), LNG, and sex hormone-binding globulin (SHBG) serum concentrations were determined. Overall, both E2/LNG TDS were well tolerated and had excellent adhesion properties. The average daily delivery for E2/LNG Low was 0.045 mg for E2 and 0.0132 mg for LNG. Following weekly delivery of E2/LNG Low or High for 4 weeks, the combination of E2 with two different strengths of LNG did not alter the pharmacokinetic profile of E2. SHBG, total cholesterol, and triglycerides concentrations significantly decreased compared to baseline. Both E2/LNG Low and High TDSs were well tolerated and provided continuous drug delivery over 7 days supporting the benefits of the transdermal route of administration in optimally delivering hormonal therapy.

Decreased oxidant profile and increased antioxidant capacity in naturally postmenopausal women

Recent works have shown a dual side of estrogens, and research on the relationship between oxidative stress and menopausal status remains unclear and has produced controversial results. In this work, we aimed to evaluate by sensitive methods the oxidant and antioxidant changes that develop after natural menopause. Thirty premenopausal and 28 naturally postmenopausal women volunteered for this study. Blood was collected and plasma used. 17-OH estradiol levels in plasma were estimated. Plasma levels of advanced oxidation protein products (AOPP), lipid peroxidation products (such as hydroperoxides and malondialdehyde (MDA)), and nitrites were measured, and total radical antioxidant parameter testing was performed to determine the oxidant and antioxidant profiles, respectively. Estrogen levels were significantly increased (p < 0.02) in premenopausal women (54.28 ± 9.34 pg/mL) as compared with postmenopausal women (18.10 ± 1.49 pg/mL). Postmenopausal women had lower levels of lipid hydroperoxide oxidation (p < 0.0001), lipid hydroperoxide levels evaluated by the area under the curve (AUC; 1,366,000 ± 179,400 AUC; p < 0.01), and hydroperoxides as measured by the ferrous oxidation-xylenol orange method (31.48 ± 2.7 μM; p < 0.0001). The MDA levels did not differ between pre- and postmenopausal women whether measured by thiobarbituric acid-reactive substances or high-performance liquid chromatography assays. No differences in AOPP and nitrite levels were observed between pre- and postmenopausal women. Postmenopausal women also exhibited a higher total radical antioxidant level (0.89 ± 0.08 μM Trolox; p < 0.0001). Postmenopausal women demonstrated lower levels of oxidative damage and a higher antioxidant capacity than premenopausal women.

Evolutionary medicine and its implications for endocrinological issues (e.g. menopause)

Evolutionary medicine, which was formalized in the early 1990s, investigates evolutionary causes of recent human disease, disorders and malfunctions but also the influence of changing living conditions and modernization on health and disease. Evolutionary medicine can also provide insights into endocrinological disorders and in particular in the process of female reproductive senescence. Female reproductive senescence, i.e. menopausal transition is physiologically caused by the decline of estrogen secretion, which is associated with various somatic and psychic discomforts making this stage of life extremely uncomfortable. From the viewpoint of evolutionary medicine, these menopausal symptoms are the result from the sudden decrease of very high lifetime estrogen levels to zero during postmenopause, a situation which is quite new in our evolution and history. While women in recent developed countries experience menarche early, menopause late, few pregnancies, short periods of lactation and consequently low life time estrogen levels. The opposite is true of women living in traditional societies, whose living conditions may be interpreted as a mirror of the situation in our history. From this viewpoint we can conclude that menopausal symptoms may are the result of a mismatch between female reproductive physiology and recent living conditions.

Osteoporosis: screening and treatment in women

Osteoporosis is frequently called the silent disease because it lacks symptoms or signs until a fracture has occurred. Osteoporosis is common in aging women because of progressive postmenopausal bone loss. Fractures related to bone loss can result in reduced quality of life, lengthy hospital stays, long-term institutionalization, and death. Early diagnosis and treatment of low bone mass to reduce fracture risk is a cost-effective element of routine health care for women. With appropriate patient screening, ObGyn care providers can implement effective interventions before fractures occur, thereby improving patients' quality of life and reducing society's osteoporosis-related costs.