1
|
Prior JC, Cameron A, Fung M, Hitchcock CL, Janssen P, Lee T, Singer J. Oral micronized progesterone for perimenopausal night sweats and hot flushes a Phase III Canada-wide randomized placebo-controlled 4 month trial. Sci Rep 2023; 13:9082. [PMID: 37277418 PMCID: PMC10241804 DOI: 10.1038/s41598-023-35826-w] [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: 09/12/2022] [Accepted: 05/24/2023] [Indexed: 06/07/2023] Open
Abstract
This study tested progesterone for perimenopausal hot flush ± night sweat (vasomotor symptom, VMS) treatment. It was a double-blind, randomized trial of 300 mg oral micronized progesterone@bedtime versus placebo for 3-months (m) after a 1-m untreated baseline during 2012/1-2017/4. We randomized untreated, non-depressed, screen- and baseline-eligible by VMS, perimenopausal women (with flow within 1-year), ages 35-58 (n = 189). Participants aged 50 (± SD = 4.6) were mostly White, educated, minimally overweight with 63% in late perimenopause; 93% participated remotely. The 1° outcome was 3rd-m VMS Score difference. Participants recorded VMS number and intensity (0-4 scale)/24 h on a VMS Calendar. Randomization required VMS (intensity 2-4/4) of sufficient frequency and/or ≥ 2/week night sweat awakenings. Baseline total VMS Score (SD) was 12.2 (11.3) without assignment difference. Third-m VMS Score did not differ by therapy (Rate Difference - 1.51). However, the 95% CI [- 3.97, 0.95] P = 0.222, did not exclude 3, a minimal clinically important difference. Women perceived progesterone caused decreased night sweats (P = 0.023) and improved sleep quality (P = 0.005); it decreased perimenopause-related life interference (P = 0.017) without increased depression. No serious adverse events occurred. Perimenopausal night sweats ± hot flushes are variable; this RCT was underpowered but could not exclude a minimal clinically important VMS benefit. Perceived night sweats and sleep quality significantly improved.
Collapse
Affiliation(s)
- Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia (UBC), 2775 Laurel Street, Suite 4111, Vancouver, BC, Canada.
- School of Population and Public Health, UBC, Vancouver, Canada.
- British Columbia Women's Health Research Institute, Vancouver, Canada.
- Endocrinology and Metabolism, Department of Medicine, UBC, Vancouver, BC, Canada.
| | - Andrea Cameron
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia (UBC), 2775 Laurel Street, Suite 4111, Vancouver, BC, Canada
| | - Michelle Fung
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia (UBC), 2775 Laurel Street, Suite 4111, Vancouver, BC, Canada
- Etobicoke General Hospital, William Osler Health System, Etobicoke, ON, Canada
| | - Christine L Hitchcock
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia (UBC), 2775 Laurel Street, Suite 4111, Vancouver, BC, Canada
- Hitchcock Consulting, Oakville, ON, Canada
| | - Patricia Janssen
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia (UBC), 2775 Laurel Street, Suite 4111, Vancouver, BC, Canada
- School of Population and Public Health, UBC, Vancouver, Canada
- British Columbia Women's Health Research Institute, Vancouver, Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Joel Singer
- School of Population and Public Health, UBC, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| |
Collapse
|
2
|
Lee E, Anselmo M, Tahsin CT, Vanden Noven M, Stokes W, Carter JR, Keller-Ross ML. Vasomotor symptoms of menopause, autonomic dysfunction, and cardiovascular disease. Am J Physiol Heart Circ Physiol 2022; 323:H1270-H1280. [PMID: 36367692 PMCID: PMC9744645 DOI: 10.1152/ajpheart.00477.2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
Cardiovascular disease (CVD), the leading cause of death among US adults, is more prevalent in menopausal females compared with age-matched males. Vasomotor symptoms of menopause (VMS; hot flashes/flushes and night sweats) are common among females undergoing menopausal transition and have been associated with elevated blood pressure (BP) and increased CVD risk. Autonomic dysregulation of BP has been posited as a contributing factor to the elevated CVD risk in menopausal females with VMS. This review includes 1) a brief overview of the relationship between VMS and CVD, 2) mechanisms of hot flushes and their potential impact on short- and long-term BP regulation, and 3) how the disruption of autonomic function associated with VMS might provide a mechanistic pathway to CVD development. Finally, this review will highlight knowledge gaps and future directions toward better understanding of hot flush physiology and VMS contributions to CVD.
Collapse
Affiliation(s)
- Emma Lee
- Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Miguel Anselmo
- Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Chowdhury Tasnova Tahsin
- Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, Minnesota
| | | | - William Stokes
- Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Jason R Carter
- Department of Health and Human Development, Montana State University, Bozeman, Montana
- Robbins College of Health and Human Sciences, Baylor University, Waco, Texas
| | - Manda L Keller-Ross
- Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, Minnesota
- Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
3
|
King EM, Prior JC, Pick N, van Schalkwyk J, Kestler M, Tkachuk S, Loutfy M, Murray MCM. Menopausal hormone therapy for women living with HIV. Lancet HIV 2021; 8:e591-e598. [PMID: 34384545 DOI: 10.1016/s2352-3018(21)00148-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/11/2021] [Accepted: 06/18/2021] [Indexed: 01/13/2023]
Abstract
People living with HIV are ageing, and a growing number of women living with HIV are entering menopause. Women living with HIV commonly have bothersome vasomotor symptoms and onset of menopause at earlier ages; both factors go on to affect quality of life and systemic health. Vasomotor symptoms and early menopause are both indications for menopausal hormone therapy; however, current evidence suggests that this therapy is seldom offered to women living with HIV. Additionally, women living with HIV have several risks to bone health and are likely to benefit from the bone-strengthening effects of menopausal hormone therapy. We present an assessment of the benefits and risks of menopausal hormone therapy in the context of HIV care and propose a practical approach to its prescription. If considered in the appropriate clinical context with discussion of risks and benefits, menopausal hormone therapy might provide substantial benefits to symptomatic menopausal women living with HIV and improve health-related quality of life.
Collapse
Affiliation(s)
- Elizabeth Marie King
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.
| | - Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, University of British Columbia, Vancouver, BC, Canada; Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Neora Pick
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada; Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Julie van Schalkwyk
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada; Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Mary Kestler
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada; Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Stacey Tkachuk
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada; Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Dalla School of Public Health, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada
| | - Melanie C M Murray
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada; Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| |
Collapse
|
4
|
Zhu D, Chung HF, Dobson AJ, Pandeya N, Anderson DJ, Kuh D, Hardy R, Brunner EJ, Avis NE, Gold EB, El Khoudary SR, Crawford SL, Mishra GD. Vasomotor menopausal symptoms and risk of cardiovascular disease: a pooled analysis of six prospective studies. Am J Obstet Gynecol 2020; 223:898.e1-898.e16. [PMID: 32585222 DOI: 10.1016/j.ajog.2020.06.039] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/18/2020] [Accepted: 06/18/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Menopausal vasomotor symptoms (ie, hot flashes and night sweats) have been associated with unfavorable risk factors and surrogate markers of cardiovascular disease, but their association with clinical cardiovascular disease events is unclear. OBJECTIVE To examine the associations between different components of vasomotor symptoms, timing of vasomotor symptoms, and risk of cardiovascular disease. STUDY DESIGN We harmonized and pooled individual-level data from 23,365 women in 6 prospective studies that contributed to the International Collaboration for a Life Course Approach to Women's Reproductive Health and Chronic Disease Events consortium. Women who experienced cardiovascular disease events before baseline were excluded. The associations between frequency (never, rarely, sometimes, and often), severity (never, mild, moderate, and severe), and timing (before or after age of menopause; ie, early or late onset) of vasomotor symptoms and incident cardiovascular disease were analyzed. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals. RESULTS In the adjusted model, no evidence of association was found between the frequency of hot flashes and incident cardiovascular disease, whereas women who reported night sweats "sometimes" (hazard ratio, 1.22; 95% confidence interval, 1.02-1.45) or "often" (hazard ratio, 1.29; 95% confidence interval, 1.05-1.58) had higher risk for cardiovascular disease. Increased severity of either hot flashes or night sweats was associated with higher risk of cardiovascular disease. The hazards ratios of cardiovascular disease in women with severe hot flashes, night sweats, and any vasomotor symptoms were 1.83 (95% confidence interval, 1.22-2.73), 1.59 (95% confidence interval, 1.07-2.37), and 2.11 (95% confidence interval, 1.62-2.76), respectively. Women who reported severity of both hot flashes and night sweats had a higher risk for cardiovascular disease (hazard ratio, 1.55; 95% confidence interval, 1.24-1.94) than those with hot flashes alone (hazard ratio, 1.33; 95% confidence interval, 0.94-1.88) and night sweats alone (hazard ratio, 1.32; 95% confidence interval, 0.84-2.07). Women with either early-onset (hazard ratio, 1.38; 95% confidence interval, 1.10-1.75) or late-onset (hazard ratio, 1.69; 95% confidence interval, 1.32-2.16) vasomotor symptoms had an increased risk for incident cardiovascular disease compared with women who did not experience vasomotor symptoms. CONCLUSION Severity rather than frequency of vasomotor symptoms (hot flashes and night sweats) was associated with increased risk of cardiovascular disease. Vasomotor symptoms with onset before or after menopause were also associated with increased risk of cardiovascular disease.
Collapse
|
5
|
Palla G, Ramírez-Morán C, Montt-Guevara MM, Salazar-Pousada D, Shortrede J, Simoncini T, Grijalva-Grijalva I, Pérez-López FR, Chedraui P. Perimenopause, body fat, metabolism and menopausal symptoms in relation to serum markers of adiposity, inflammation and digestive metabolism. J Endocrinol Invest 2020; 43:809-820. [PMID: 31925754 DOI: 10.1007/s40618-019-01168-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/19/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Perimenopausal women gain weight that may alter inflammatory status, endocrine equilibrium, and the intensity of vasomotor symptoms. OBJECTIVE To measure serum levels of markers related to adiposity, inflammation/angiogenesis and digestive metabolism and correlate them with body mass index (BMI), waist-to-hip ratio (WHR), metabolic parameters and menopausal symptoms (assessed with the 10-item Cervantes Scale [CS-10]). METHODS Serum of perimenopausal women (n = 24), STRAW stages-2 and -1, was analyzed using the Bio-Plex 200 System technology to assess 30 proposed analytes. The MetS was defined by the American Heart Association criteria and women were divided as: normal BMI (NBMI), excessive BMI (EBMI), and EBMI with MetS (EBMI-MetS). RESULTS Weight, BMI, abdominal circumference, WHR, systolic blood pressure, glucose and triglyceride levels were significantly higher and high-density lipoprotein cholesterol (HDL-C) was lower in EBMI-MetS women compared to NBMI ones. Insulin, C-peptide, resistin, adipsin, GIP, leptin, IL-6, FGF21 and PAI-1 levels were significantly higher and ghrelin and IGFBP-1 lower in EBMI-MetS women as compared to NBMI ones. Spearman's correlation of pooled data showed a significant positive correlation between abdominal perimeter and WHR and C-peptide, insulin, adipsin, resistin, leptin, PAI-1 and FGF21 and a negative correlation with IGFBP-1 levels. Total CS-10 scores and hot flush intensity did not differ between studied groups, yet positively correlated with anthropometric values but not with studied analytes. CONCLUSION Perimenopausal women with EBMI and the MetS showed an altered metabolic profile, but no differences in menopausal symptoms which also did not correlate with changes in studied biomarkers.
Collapse
Affiliation(s)
- G Palla
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Ramírez-Morán
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - M M Montt-Guevara
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - D Salazar-Pousada
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - J Shortrede
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - T Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - I Grijalva-Grijalva
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - F R Pérez-López
- Red de Investigación de Obstetricia, Ginecología y Reproducción, Instituto de Investigaciones Sanitarias de Aragón, University of Zaragoza, Faculty of Medicine, Zaragoza, Spain
| | - P Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.
- Facultad de Ciencias de la Salud, Universidad Católica "Nuestra Señora de la Asunción", Asunción, Paraguay.
| |
Collapse
|
6
|
Abstract
OBJECTIVE Although menopause is a natural event in a woman's life, some of its symptoms can be severe enough to adversely affect her health. There is some evidence to suggest that diet has an influence on menopausal symptoms, but less attention has been paid to dietary patterns. The purpose of this study is to determine the association of dietary patterns with physical, mental, and genitourinary menopausal symptoms. METHODS A cross-sectional study design was applied using a sample of 400 postmenopausal women who attended health centers in the south of Tehran, Iran. The menopausal symptoms were assessed by a Menopause Rating Scale (MRS) questionnaire; a 147-item, semi-quantitative food-frequency questionnaire was used to collect dietary information, and major dietary patterns were identified by principal component analysis. Linear regression was used to evaluate the relationship between menopausal symptoms and dietary patterns. RESULTS Three major dietary patterns were identified: vegetables and fruits (VF); mayonnaise, liquid oils, sweets, and desserts (MLSD); and solid fats and snacks (SFS). It has been found that the VF dietary pattern is inversely associated with general (β = -1.37; SE = 1.08; P for trend <0.001), physical (β = -1.54; SE = 1.09; P for trend <0.001), and mental (β = -1.58; SE = 1.11; P for trend <0.001) symptoms. A stronger adherence to the MLSD dietary pattern was directly associated with general (β = 1.15; SE = 1.08; P for trend <0.001) and genitourinary symptoms (β = 1.54; SE = 1.1; P for trend <0.001). Moreover, the SFS dietary pattern was directly related to the general (β = 1.23; SE = 1.09; P for trend = 0.01), physical (β = 1.24; SE = 1.09; P for trend = 0.04), and mental (β = 1.29; SE = 1.12; P for trend < 0.001) symptoms. CONCLUSION The present study demonstrated that there is an inverse association between VF dietary pattern and menopausal symptoms. In contrast, the MLSD and SFS dietary patterns were correlated to an increased risk of these symptoms.
Collapse
|
7
|
What's in a name: are menopausal "hot flashes" a symptom of menopause or a manifestation of neurovascular dysregulation? Menopause 2019; 25:700-703. [PMID: 29381665 DOI: 10.1097/gme.0000000000001065] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hot flashes have typically been classified as "symptoms of menopause" that should be tolerated or treated until they resolve. However, mounting evidence points to hot flashes as a manifestation of one or several underlying pathophysiological processes. Associations exist between the presence, timing of onset, severity, and duration of hot flashes, and the risk of several neurological (affecting sleep, mood, and cognition) and cardiovascular conditions. In addition, four consistent patterns of vasomotor disturbances have been identified across different countries, making it unlikely that these patterns are solely explained by socioeconomic or cultural factors. The changing hormonal environment of menopause may unmask differences in the autonomic neurovascular control mechanisms that put an individual woman at risk for chronic conditions of aging. These differences may have a genetic basis or may be acquired across the life span and are consistent with the variability of the clinical manifestations of aging observed in women after bilateral oophorectomy. It is time to investigate the pathophysiological mechanisms underlying the four patterns of vasomotor symptoms more closely, and to shift from describing hot flashes as symptoms to be tolerated to manifestations of an underlying autonomic neurovascular dysregulation that need to be addressed.
Collapse
|
8
|
Cardiovascular reactivity and psychological hyperarousal in hot flash-associated insomnia disorder. Menopause 2019; 26:728-740. [DOI: 10.1097/gme.0000000000001298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Prior JC. Progesterone Is Important for Transgender Women's Therapy-Applying Evidence for the Benefits of Progesterone in Ciswomen. J Clin Endocrinol Metab 2019; 104:1181-1186. [PMID: 30608551 DOI: 10.1210/jc.2018-01777] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/28/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although the 2017 Endocrine Society Guidelines for gender dysphoria stipulated that cross-sex hormone therapy (CHT) achieve gonadal steroid levels equivalent to those of a cisperson of the chosen sex, for transgender women (male-to-female gender dysphoria), current gonadal therapy is usually estradiol. Accumulated evidence indicates that normally ovulatory menstrual cycles are necessary for ciswomen's current fertility, as well as for later-life bone and cardiovascular health and the prevention of breast and endometrial cancers. EVIDENCE ACQUISITION Extensive past clinical experience with transgender women's CHT using estradiol/estrogen combined with progesterone/medroxyprogesterone and pioneering the addition of spironolactone. Comprehensive progesterone physiology research plus a brief review of transgender women's literature to assess current therapy and clinical outcomes, including morbidity and mortality. PURPOSE To emphasize that both ovarian hormones, progesterone as well as estradiol, are theoretically and clinically important for optimal transgender women's CHT. EVIDENCE SYNTHESIS It is important to add progesterone to estradiol and an antiandrogen in transgender women's CHT. Progesterone may add the following: (i) more rapid feminization, (ii) decreased endogenous testosterone production, (iii) optimal breast maturation to Tanner stages 4/5, (iv) increased bone formation, (v) improved sleep and vasomotor symptom control, and (vi) cardiovascular health benefits. CONCLUSIONS Evidence has accrued that normal progesterone (and ovulation), as well as physiological estradiol levels, is necessary during ciswomen's premenopausal menstrual cycles for current fertility and long-term health; transgender women deserve progesterone therapy and similar potential physiological benefits.
Collapse
Affiliation(s)
- Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, Department of Medicine/Division of Endocrinology, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Women's Health Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
10
|
El Khoudary SR, Thurston RC. Cardiovascular Implications of the Menopause Transition: Endogenous Sex Hormones and Vasomotor Symptoms. Obstet Gynecol Clin North Am 2018; 45:641-661. [PMID: 30401548 DOI: 10.1016/j.ogc.2018.07.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The menopause transition (MT) is a critical period of women's lives marked by several physiologic changes and menopause-related symptoms that have implications for health. Risk for cardiovascular disease, the leading cause of death in women, increases after menopause, suggesting a contribution of the MT to its development. This article focuses on the relationship between 2 main features of the MT and women's cardiovascular health: (1) dynamic alterations of sex hormones, particularly endogenous estradiol and follicle-stimulating hormone, and (2) vasomotor symptoms, the cardinal symptom of the menopause. Limitations and future directions are discussed.
Collapse
Affiliation(s)
- Samar R El Khoudary
- Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15260, USA.
| | - Rebecca C Thurston
- Departments of Psychiatry and Epidemiology, School of Medicine, Graduate School of Public Health, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| |
Collapse
|
11
|
Women's Mid-Life Night Sweats and 2-Year Bone Mineral Density Changes: A Prospective, Observational Population-Based Investigation from the Canadian Multicentre Osteoporosis Study (CaMos). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061079. [PMID: 29861446 PMCID: PMC6025051 DOI: 10.3390/ijerph15061079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/14/2018] [Accepted: 05/19/2018] [Indexed: 11/17/2022]
Abstract
Women’s hot flushes and night sweats, collectively called vasomotor symptoms (VMS), are maximal (79%) in late perimenopause. The evidence describing whether VMS are associated with loss of areal bone mineral density (BMD) is mixed. We examined baseline and 2-year data for 1570 randomly selected women aged 43–63 in the Canadian Multicentre Osteoporosis Study (CaMos), a prospective Canada-wide study; we used linear regression to assess the relationship of night sweats (VMSn) with BMD and its changes. Clinically important VMSn occurred for 12.2%. Women with VMSn were slightly younger (54.5 vs. 55.3 years, p = 0.02) and less likely to use sex steroid therapies (39.8% vs. 51.4%, p < 0.05). BMD at the lumbar spine (L1-4), femoral neck (FN) and total hip (TH) were similar between those with/without VMSn. In adjusted models, we did not find a significant association between VMSn and 2-year change in L1-4, FN and TH BMD. Age, reproductive status, weight, sex steroid therapy and smoking status were associated with 2-year change in BMD. Incident fractures over 2 years also did not differ by VMSn. Our analyses were restricted to VMSn and may not truly capture the relationship between VMS and BMD. Additional research involving VMS, bone loss and fracture incidence is needed.
Collapse
|
12
|
Gao CC, Kapoor E, Lipford MC, Miller VM, Schroeder DR, Mara KC, Faubion SS. Association of vasomotor symptoms and sleep apnea risk in midlife women. Menopause 2018; 25:391-398. [PMID: 29088020 PMCID: PMC5866162 DOI: 10.1097/gme.0000000000001020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to determine the association between self-reported vasomotor symptoms (VMS) and obstructive sleep apnea (OSA) risk. METHODS The STOP-BANG to evaluate OSA and Menopause Rating Scale (MRS) were administered to 2,935 women seen in the Women's Health Clinic at Mayo Clinic in Rochester, MN, between May 2015 and December 2016. Of these, 1,691 women were included in the analysis. Total MRS and VMS ratings were compared using logistic regression, with age, smoking, and body mass index (BMI) included as covariates between women at intermediate/high risk versus low risk for OSA. RESULTS Total MRS scores were significantly higher in women with intermediate/high-risk OSA scores versus those with low-risk scores [mean (SD): 16.8 (8.0) vs 12.9 (7.0), P < 0.001]. Women at intermediate/high OSA risk were older, had more education, self-reported hypertension, BMI >35 kg/m, and were less likely to be married or employed. Self-reported severe/very severe VMS were significantly associated with intermediate/high risk versus low risk for OSA (26.6% vs 15.0%; P < 0.001). After adjusting for age, BMI, smoking status, and self-reported hypertension, the odds of having intermediate/high risk for OSA were 1.87 times higher for those with severe/very severe VMS compared with those with none/mild/moderate VMS (95% CI, 1.29-2.71, P < 0.001). This association persisted upon subgroup analysis based on BMI <25 kg/m (odds ratio 2.15; 95% CI, 1.12-4.16, P = 0.022). CONCLUSIONS Self-reported severe/very severe VMS were associated with intermediate/high risk for OSA in midlife women, even in women with BMI <25 kg/m. Given the limitations of the STOP-BANG tool, OSA risk may, however, have been overestimated.
Collapse
Affiliation(s)
| | - Ekta Kapoor
- Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, MN
| | - Melissa C. Lipford
- Center for Sleep Medicine and Department of Neurology, Mayo Clinic, Rochester, MN
| | - Virginia M. Miller
- Women’s Health Research Center, Mayo Clinic, Rochester, MN
- Departments of Surgery and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Darrell R. Schroeder
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Kristin C. Mara
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Stephanie S. Faubion
- Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
13
|
Hot flashes and the heart: an ongoing enigma. Menopause 2017. [DOI: 10.1097/gme.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Huang WY, Chang CC, Chen DR, Kor CT, Chen TY, Wu HM. Circulating leptin and adiponectin are associated with insulin resistance in healthy postmenopausal women with hot flashes. PLoS One 2017; 12:e0176430. [PMID: 28448547 PMCID: PMC5407749 DOI: 10.1371/journal.pone.0176430] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 04/10/2017] [Indexed: 02/01/2023] Open
Abstract
Introduction Hot flashes have been postulated to be linked to the development of metabolic disorders. This study aimed to evaluate the relationship between hot flashes, adipocyte-derived hormones, and insulin resistance in healthy, non-obese postmenopausal women. Participants and design In this cross-sectional study, a total of 151 women aged 45–60 years were stratified into one of three groups according to hot-flash status over the past three months: never experienced hot flashes (Group N), mild-to-moderate hot flashes (Group M), and severe hot flashes (Group S). Variables measured in this study included clinical parameters, hot flash experience, fasting levels of circulating glucose, lipid profiles, plasma insulin, and adipocyte-derived hormones. Multiple linear regression analysis was used to evaluate the associations of hot flashes with adipocyte-derived hormones, and with insulin resistance. Settings The study was performed in a hospital medical center. Results The mean (standard deviation) of body-mass index was 22.8(2.7) for Group N, 22.6(2.6) for Group M, and 23.5(2.4) for Group S, respectively. Women in Group S displayed statistically significantly higher levels of leptin, fasting glucose, and insulin, and lower levels of adiponectin than those in Groups M and N. Multivariate linear regression analysis revealed that hot-flash severity was significantly associated with higher leptin levels, lower adiponectin levels, and higher leptin-to-adiponectin ratio. Univariate linear regression analysis revealed that hot-flash severity was strongly associated with a higher HOMA-IR index (% difference, 58.03%; 95% confidence interval, 31.00–90.64; p < 0.001). The association between hot flashes and HOMA-IR index was attenuated after adjusting for leptin or adiponectin and was no longer significant after simultaneously adjusting for leptin and adiponectin. Conclusion The present study provides evidence that hot flashes are associated with insulin resistance in postmenopausal women. It further suggests that hot flash association with insulin resistance is dependent on the combination of leptin and adiponectin variables.
Collapse
Affiliation(s)
- Wan-Yu Huang
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Chu Chang
- Department of Nephrology, Changhua Christian Hospital, Changhua, Taiwan
| | - Dar-Ren Chen
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chew-Teng Kor
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Ting-Yu Chen
- Inflammation Research & Drug Development Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Hung-Ming Wu
- Inflammation Research & Drug Development Center, Changhua Christian Hospital, Changhua, Taiwan
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
- * E-mail:
| |
Collapse
|
15
|
Sturdee DW, Hunter MS, Maki PM, Gupta P, Sassarini J, Stevenson JC, Lumsden MA. The menopausal hot flush: a review. Climacteric 2017; 20:296-305. [DOI: 10.1080/13697137.2017.1306507] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- D. W. Sturdee
- Department of Gynaecology, Solihull Hospital, Birmingham, UK
| | - M. S. Hunter
- Unit of Psychology, Institute of Psychiatry (at Guy's), King's College London, London, UK
| | - P. M. Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - P. Gupta
- Women's Unit, Solihull Hospital, Birmingham Heartlands & Solihull NHS Trust, Birmingham, UK
| | - J. Sassarini
- Department of Obstetrics & Gynaecology, University of Glasgow, College of Medicine, Western Infirmary, Glasgow, UK
| | - J. C. Stevenson
- National Heart & Lung Institute, Royal Brompton Hospital, London, UK
| | - M. A. Lumsden
- Reproductive and Maternal Medicine, University of Glasgow, Glasgow, UK
| |
Collapse
|
16
|
|
17
|
Tuomikoski P, Savolainen-Peltonen H. Vasomotor symptoms and metabolic syndrome. Maturitas 2017; 97:61-65. [PMID: 28159064 DOI: 10.1016/j.maturitas.2016.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 12/16/2016] [Indexed: 12/28/2022]
Abstract
A vast majority of menopausal women suffer from vasomotor symptoms, such as hot flushes and night sweats, the mean duration of which may be up to 7-10 years. In addition to a decreased quality of life, vasomotor symptoms may have an impact on overall health. Vasomotor symptoms are associated with overactivity of the sympathetic nervous system, and sympathetic overdrive in turn is associated with metabolic syndrome, which is a known risk factor for cardiovascular disease. Menopausal hot flushes have a complex relationship to different features of the metabolic syndrome and not all data point towards an association between vasomotor symptoms and metabolic syndrome. Thus, it is still unclear whether vasomotor symptoms are an independent risk factor for metabolic syndrome. Research in this area is constantly evolving and we present here the most recent data on the possible association between menopausal vasomotor symptoms and the metabolic syndrome.
Collapse
Affiliation(s)
| | - Hanna Savolainen-Peltonen
- University of Helsinki, Helsinki, Finland; Helsinki University Hospital, Department of Obstetrics and Gynecology, 00029 Helsinki, Finland
| |
Collapse
|
18
|
Katainen RE, Engblom JR, Siirtola TJ, Erkkola RU, Polo-Kantola P. Climacteric symptoms in middle-aged women with chronic somatic diseases. Maturitas 2016; 86:17-24. [PMID: 26921923 DOI: 10.1016/j.maturitas.2016.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Chronic diseases may aggravate or simulate climacteric symptoms. Although acknowledged in clinical practice, there is a lack of research systematically analysing the association between chronic diseases and climacteric symptoms. STUDY DESIGN AND MAIN OUTCOME MEASURES Our study was a cross-sectional population-based study, which included 3421 women, aged 41-54 years. Climacteric symptoms were evaluated using the Women's Health Questionnaire (WHQ), of which we included seven symptom domains (vasomotor, sleep, depressive, anxiety/fears, cognitive, sexual, and menstrual) and a question concerning whether the women were worried about growing old. The occurrence of various diseases (cardiovascular, neurological, sensory organ, bronchopulmonary, musculoskeletal, gastrointestinal, urological, dermatological, and thyroid disease, diabetes, and cancer) was recorded. The associations between the diseases and symptoms were defined with multivariable analyses, adjusting for various confounding factors. RESULTS The women with the diseases had more symptoms. Vasomotor symptoms and sleep problems were associated only with gastrointestinal diseases, and lower sexual functioning only with diabetes. The remaining symptoms were associated with several diseases, except being worried about growing old, which was not associated with any. CONCLUSIONS Many symptoms connected to the climacteric may manifest also due to chronic diseases. Thus, health-care professionals should consider the origin of the symptoms when treating middle-aged women with chronic diseases.
Collapse
Affiliation(s)
- Riina E Katainen
- Department of Obstetrics and Gynaecology, Turku University Hospital and University of Turku, Turku, Finland.
| | - Janne R Engblom
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Tiina J Siirtola
- Department of Obstetrics and Gynaecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Risto U Erkkola
- Department of Obstetrics and Gynaecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynaecology, Turku University Hospital and University of Turku, Turku, Finland
| |
Collapse
|
19
|
Whole plant foods intake is associated with fewer menopausal symptoms in Chinese postmenopausal women with prehypertension or untreated hypertension. Menopause 2015; 22:496-504. [DOI: 10.1097/gme.0000000000000349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
20
|
Vascular function and cardiovascular risk factors in women with severe flushing. Maturitas 2015; 80:379-83. [PMID: 25704326 DOI: 10.1016/j.maturitas.2015.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 01/19/2015] [Indexed: 11/23/2022]
Abstract
Cardiovascular disease is the leading cause of death in women of postmenopausal age worldwide. It is a relatively rare occurrence before the menopause and the increase in incidence coincides with the most common symptom associated with menopausal transition, hot flushing. Interest in cardiovascular disease post-menopause has largely focused on the effect of hormone therapy on risk of coronary events and stroke, with vasomotor symptoms considered merely a nuisance symptom, but recent work suggests that the presence of flushing may be a marker of underlying cardiovascular disease.
Collapse
|
21
|
Herber-Gast G, Brown WJ, Mishra GD. Hot flushes and night sweats are associated with coronary heart disease risk in midlife: a longitudinal study. BJOG 2014; 122:1560-7. [PMID: 25377022 DOI: 10.1111/1471-0528.13163] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate associations between vasomotor menopausal symptoms (VMS), i.e. hot flushes and night sweats, and the incidence of coronary heart disease (CHD). DESIGN A prospective cohort study. SETTING AND POPULATION 11 725 women, aged 45-50 years at baseline in 1996, were followed up at 3-year intervals for 14 years. METHODS Self-reported VMS and incident CHD were measured at each survey. MAIN OUTCOME MEASURE We determined the association between VMS and CHD at the subsequent survey, using generalised estimating equation analysis, adjusting for time-varying covariates. RESULTS At baseline, 14% reported rarely, 17% reported sometimes, and 7% reported often having night sweats. During follow-up, 187 CHD events occurred. In the age-adjusted analysis, women who reported their frequency of experiencing hot flushes and night sweats as 'often' had a greater than two-fold increased odds of CHD (OR hot flushes 2.18, 95% CI 1.49-3.18; OR night sweats 2.38, 95% CI 1.62-3.50) compared with women with no symptoms (P trend < 0.001 for frequency of symptoms). Adjustment for menopausal status, lifestyle factors, body mass index, diabetes, and hypertension attenuated the associations (OR hot flushes 1.70, 95% CI 1.16-2.51, P trend = 0.01; OR night sweats 1.84, 95% CI 1.24-2.73), P trend = 0.004). CONCLUSIONS Women who report having hot flushes or night sweats 'often' have an increased risk of developing CHD over a period of 14 years, even after taking the effects of age, menopause status, lifestyle, and other chronic disease risk factors into account.
Collapse
Affiliation(s)
- Gcm Herber-Gast
- Centre for Longitudinal and Life Course Research, School of Population Health, University of Queensland, Brisbane, Qld, Australia
| | - W J Brown
- School of Human Movement Studies, University of Queensland, Brisbane, Qld, Australia
| | - G D Mishra
- Centre for Longitudinal and Life Course Research, School of Population Health, University of Queensland, Brisbane, Qld, Australia
| |
Collapse
|
22
|
Van Kempen TA, Gorecka J, Gonzalez AD, Soeda F, Milner TA, Waters EM. Characterization of neural estrogen signaling and neurotrophic changes in the accelerated ovarian failure mouse model of menopause. Endocrinology 2014; 155:3610-23. [PMID: 24926825 PMCID: PMC4138565 DOI: 10.1210/en.2014-1190] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Accelerated ovarian failure (AOF) can be induced in young mice with low doses of 4-vinylcyclohexene diepoxide (VCD), modeling the hormone changes observed across menopause. We assessed markers of synaptic plasticity in the hippocampus, anxiety-like behavior, and spatial learning longitudinally at 4 time points across the AOF model: premenopause, early perimenopause, late perimenopause, and postmenopause (POST). As others have shown, VCD administration decreased ovarian follicle counts and increased acyclicity as the model progressed to POST but with no impact on organ or body weights. The morphology of Iba1 immunoreactive microglia did not differ between vehicle- and VCD-administered mice. Hippocampal postsynaptic density 95 levels were minimally altered across the AOF model but decreased at POST in CA3b 24 hours after exogenous estradiol benzoate (EB). In contrast, hippocampal phosphorylated AKT levels transiently decreased in premenopause but increased at POST after 24 hours of EB in select subregions. Electron microscopy revealed fewer estrogen receptor α containing dendritic spines and terminals in CA1 stratum radiatum at POST. mRNA levels of most brain-derived neurotrophic factor exons (except V and VI) were lower in POST compared with ovariectomized mice. Exon V was sensitive to 24 hours of EB administration in POST-VCD. Anxiety-like behavior was unaffected at any menopause phase. Spatial learning was unaffected in all groups, but POST-VCD mice performed below chance. Our results suggest that the AOF model is suitable for longitudinal studies of neurobiological changes across the menopause transition in mice. Our findings also point to complex interactions between estrogen receptors and pathways involved in synaptic plasticity.
Collapse
Affiliation(s)
- Tracey A Van Kempen
- Brain and Mind Research Institute (T.A.V.K., T.A.M.) and Graduate Program in Neuroscience (T.A.V.K., A.D.G.), Weill Cornell Medical College, and Laboratory of Neuroendocrinology (J.G., T.A.M., E.M.W.), The Rockefeller University, New York, New York 10065; and Department of Environmental and Molecular Health Sciences (F.S.), Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto 862-0973, Japan
| | | | | | | | | | | |
Collapse
|
23
|
Progesterone therapy, endothelial function and cardiovascular risk factors: a 3-month randomized, placebo-controlled trial in healthy early postmenopausal women. PLoS One 2014; 9:e84698. [PMID: 24465425 PMCID: PMC3897380 DOI: 10.1371/journal.pone.0084698] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/16/2013] [Indexed: 02/08/2023] Open
Abstract
Background Progesterone is effective treatment for hot flushes/night sweats. The cardiovascular effects of progesterone therapy are unknown but evidence suggests that premenopausal normal estradiol with also normal progesterone levels may provide later cardiovascular protection. We compared the effects of progesterone to placebo on endothelial function, weight, blood pressure, metabolism, lipids, inflammation and coagulation. Methods and Results We conducted a randomized, double-blind, 3-month placebo-controlled trial of progesterone (300 mg daily) among 133 healthy postmenopausal women in Vancouver, Canada from 2003–2009. Endothelial function by venous occlusion plethysmography was a planned primary outcome. Enrolled women were 1–11 y since last menstruation, not using hormones (for >6 months), non-smoking, without diabetes, hypertension, heart disease or their medications. Randomized (1∶1) women (55±4 years, body mass index 25±3) initially had normal blood pressure, fasting lipid, glucose and electrocardiogram results. Endothelial function (% forearm blood flow above saline) was not changed with progesterone (487±189%, n = 18) compared with placebo (408±278%, n = 16) (95% CI diff [−74 to 232], P = 0.30). Progesterone (n = 65) and placebo (n = 47) groups had similar changes in systolic and diastolic blood pressure, resting heart rate, weight, body mass index, waist circumference, total cholesterol, low-density lipoprotein cholesterol and triglyceride levels. High-density lipoprotein was lower (−0.14 mmol/L, P = 0.001) on progesterone compared with placebo. Fasting glucose, hs-C-reactive protein, albumin and D-dimer changes were all comparable to placebo. Framingham General Cardiovascular Risk Profile scores were initially low and remained low with progesterone therapy and not statistically different from placebo. Conclusions Results indicate that progesterone has short-term cardiovascular safety. Endothelial function, weight, blood pressure, waist circumference, inflammation and coagulation were unchanged as were lipids except for HDL-C. The statistically significant decrease in HDL-C levels was not clinically important (based on lack of Cardiovascular Risk Profile change). Trial Registration ClinicalTrials.gov NCT00152438
Collapse
|
24
|
Vasomotor menopausal symptoms are not associated with incidence of breast cancer in a population-based cohort of mid-aged women. Eur J Cancer 2013; 50:824-30. [PMID: 24361228 DOI: 10.1016/j.ejca.2013.11.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/25/2013] [Accepted: 11/26/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recently, two case-control studies showed that vasomotor menopausal symptoms (VMS), i.e. hot flushes (HF) and night sweats (NS), are associated with a decreased risk of breast cancer. Until now, however, no prior studies have prospectively examined the association between VMS and breast cancer incidence. We investigated this in a population-based cohort of mid-aged women in Australia. METHODS We included 11,297 women without a history of breast cancer aged 47-52 years from the Australian Longitudinal Study on Women's Health, surveyed every 3 years from 1998 to 2010. Information regarding first invasive breast cancer events and date of diagnosis was obtained from cancer registries. We determined the association between HF and NS and breast cancer occurrence before the subsequent survey, using time-dependent cox regression analysis, adjusting for time-varying lifestyle factors. RESULTS At baseline 33.1% of the women reported experiencing HF and 24.6% reported NS. During a mean follow-up of 13.7 years, 348 cases of breast cancer occurred. VMS were not associated with breast cancer; adjusted hazard ratios were 1.09; 95% confidence interval (CI) 0.87-1.35 for HF and 1.06; 95% CI 0.84-1.33 for NS. No significant interactions were found between each of body mass index, alcohol use, current hormone therapy use, menopausal status and VMS and breast cancer (p-values>0.05). CONCLUSIONS We did not find an association between VMS and breast cancer incidence. Research in this area is scarce and additional large prospective population-based studies are required to confirm or refute these findings.
Collapse
|
25
|
Herber-Gast GCM, Mishra GD. Fruit, Mediterranean-style, and high-fat and -sugar diets are associated with the risk of night sweats and hot flushes in midlife: results from a prospective cohort study. Am J Clin Nutr 2013; 97:1092-9. [PMID: 23553160 DOI: 10.3945/ajcn.112.049965] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Diet has been suggested to be a potential risk factor for vasomotor menopausal symptoms (VMSs), ie, hot flushes and night sweats. OBJECTIVE We investigated the associations between dietary patterns and risk of VMSs by using data from middle-aged women born between 1946 and 1951 in the Australian Longitudinal Study on Women's Health. DESIGN A prospective cohort study of 6040 women with a natural menopause were followed up at 3-y intervals over 9 y. Dietary intake was assessed at baseline in 2001, and the presence of VMSs was assessed at baseline and follow-up. Factor analysis and generalized estimating equation models for binary repeated measures were performed. RESULTS Six dietary patterns were identified from factor analysis: cooked vegetables, fruit, Mediterranean style, meat and processed meat, dairy, and high fat and sugar. A higher consumption of the fruit or Mediterranean-style diet was inversely associated with VMSs in a comparison of the top with the bottom quintile, with adjusted ORs of 0.81 (95% CI: 0.71, 0.93; P-trend = 0.0009) and 0.80 (95% CI: 0.69, 0.92; P-trend = 0.0004), respectively. The high-fat and -sugar pattern increased the risk of VMSs in a comparison of the top with the bottom quintile, with an adjusted OR of 1.23 (95% CI: 1.05, 1.44; P-trend = 0.02). CONCLUSIONS Consumption of a fruit or Mediterranean-style diet decreased the risk of reporting VMSs, whereas consumption of a high-fat and -sugar diet increased the risk of VMSs. These results may eventually lead to a basis for the development of dietary preventive measures for VMSs.
Collapse
|