Efficacy of exercise for menopausal symptoms: a randomized controlled trial

Exercise and Sexuality in Women With Menopausal Symptoms: A Systematic Review and Meta-Analyses of Randomized Controlled Trials

AIMS

This systematic review and meta-analysis study aim to assess the impact of different exercise modalities interventions in postmenopausal women on sexuality and the severity of menopausal symptoms.

METHODS

The preparation of this systematic review and meta-analysis rigorously adhered to the PRISMA 2020. This systematic review of the literature was conducted between May and June 2023, utilizing four electronic databases: PubMed, Cochrane Library, Web of Science and ULAKBİM. Articles were screened using MeSH-based keywords. Randomized Controlled Trials conducted within the last decade were included in the screening. Data analysis was performed using the Review Manager computer program.

RESULTS

The analysis encompassed eight studies involving 1127 postmenopausal women. According to the results of the pooled random-effects model, applied to women after 12 weeks of exercise, the data were significant, indicating a positive impact on sexuality (MD: 0.86, 95% CI: 0.72 to 1.01, Z = 11.47, p < 0.00001). Concerning the psychological symptoms of menopause, the data were also found to be significant, with improvements observed after 12 weeks of exercise in women (MD: 0.25, 95% CI: 0.02 to 0.49, Z = 2.15, p = 0.03).

CONCLUSION

This study provides evidence that a 12-week exercise regimen administered during the postmenopausal period positively influences postmenopausal women's sexuality and ameliorates psychological menopausal symptoms. However, it does not appear to have an effect on vasomotor menopausal symptoms.

PROSPERO NUMBER

CRD42023427991.

Experience of the menopause transition in Irish women and how it impacts motivators, facilitators, and barriers to physical activity engagement

BACKGROUND

Research shows a decline in physical activity (PA) in women during the menopause transition (MT). Therefore, the purpose of this study was to explore experiences of the MT in Irish women and how it impacts motivators, facilitators, and barriers to PA engagement.

METHODS

Twelve Irish women (age: 49 ± 4 years) who were in the MT participated in individual, online, semi-structured interviews. During each interview participants were asked about their experience of the MT and its influence on PA engagement to identify motivators, facilitators and barriers. All interviews were digitally recorded and transcribed verbatim, resulting in ≈ 72,610 words for descriptive and thematic analysis.

RESULTS

The MT had a notable influence on PA engagement in Irish women. The main motivators to engage in PA throughout the MT included managing menopause symptoms, optimising future health, the opportunity for social engagement and rewards, as well as relatable role models. Many women discussed that menopause fraternities focused on community and collective experience, adapting and modifying PA, and medical supports were key factors that facilitated engagement in PA throughout this life stage. There were a multitude of barriers that women in midlife faced before they could engage in PA, such as perceived reduced capability, symptoms associated with the MT, the busyness of life and competing demands, as well as a lack of supportive environments.

CONCLUSION

The motivators, facilitators, and barriers to PA engagement throughout the MT are unique. These factors are important considerations for stakeholders when facilitating women to either continue or (re)introduce PA during this life stage.

The effect of aerobic exercise on sleep disorder in menopausal women: a systematic review and meta-analyses

OBJECTIVE

This study systematically evaluated the effect of aerobic exercise on sleep disorders in menopausal women and proposed a practical program from the perspective of "what to practice," "how much to practice," and "how to practice." We proposed the program from the standpoint of training science.

METHODS

Up to March 20, 2023, a total of 16 articles and 19 RCT studies were retrieved from Web of Science, PubMed, Springer, Science Direct, China Knowledge Network, Wanfang, and VIP. The Cochrane Risk of Bias Assessment Tool was used to assess the quality of the literature, and We used RevMan5.3and STATA 16.0 software to provide a systematic review of included studies.

RESULTS

The overall effect of low- and moderate-intensity aerobic exercise interventions for sleep disorders in menopausal women had a moderate effect size (SMD = -0.52, P < 0.001), and the effect values between different intervention frequencies (I2 = 60%), intervention duration (I2 = 60), intervention periods (I2 = 70), exercise forms (I2 = 70), and practice methods (I2 = 70) had moderate heterogeneity. The most significant effect sizes were found for intervention frequency of 3 times/week (SMD = -0.57, P < 0.001); intervention duration of 70-90 min/session (SMD = -0.64, P = 0.004); intervention period of 8-10 weeks (SMD = -0.59, P = 0.35); and exercise form of static exercise ( SMD = -0.55, P = 0.003); and the practice mode was an individual exercise with the most significant effect size (SMD = -0.66, P < 0.01).

CONCLUSION

Low- and medium-intensity aerobic exercise intervention for sleep disorders in menopausal women has a good effect, but it is affected by training factors such as intervention frequency, intervention time, intervention period, exercise form, and practice mode; the best effect is achieved by adopting the dosage of 3 times/week, 70-90 min/times, and lasting for 8-10 weeks; aerobic intervention in the form of static exercise is the most effective; the best intervention effect is achieved by adopting the mode of individual exercise; but a group exercise approach improved exercise persistence in menopausal women.

Early Life Trauma, Emotion Dysregulation and Hormonal Sensitivity Across Female Reproductive Life Events

PURPOSE OF REVIEW

To explore the relationship between early life trauma, hormonal sensitivity, and psychiatric disorders across female-reproductive life events, with a focus on the neurobiological mechanisms.

RECENT FINDINGS

Childhood trauma significantly increases the risk of subsequent mood disorders during periods of intense hormonal fluctuation such as premenstrual, pregnancy, postpartum, and perimenopause. Neurobiological changes resulting from early trauma influence emotion regulation, which emerges as a key predisposing, exacerbating, and perpetuating factor to hormonal sensitivity and subsequent psychiatric symptoms. We identified altered stress response and allopregnanolone imbalance, bias in cognitive processing of emotions, neuroimage correlates and sleep disturbances as potential underlying neurobiological mechanisms. This review integrates cumulative findings supporting a theoretical framework linking early life trauma to hormonal sensitivity and mood disorders. We propose that some women might be more susceptible to such hormonal fluctuations because of emotion dysregulation following significant early life trauma.

The role of cardiorespiratory fitness and body composition in the association between physical activity and menopausal symptoms

OBJECTIVE

The aim of the study was to conduct exploratory analyses on the role of cardiorespiratory fitness (CRF) and body composition in the association between physical activity and menopausal symptoms.

METHODS

This was a cross-sectional (N = 298) study of women aged 51-59 years including a subsample of 82 women followed for 4 years. The severity of menopausal symptoms was assessed with the Menopause Rating Scale in total symptoms as well as using the somato-vegetative, psychological, and urogenital subscales. Physical activity was assessed with accelerometers and self-reports, body composition with dual-energy x-ray absorptiometry, and CRF with a custom-made prediction model based on the six-minute walking distance and spiroergometry. The associations of interest were studied using unstandardized regression coefficients derived from multiple linear regression models with the severity of menopausal symptoms as the outcome.

RESULTS

Higher total body and fat mass (kg) were associated with more severe total symptoms (B = 0.06 [95% CI, 0.01 to 0.12] and 0.07 [0.01 to 0.14], respectively) as well as somato-vegetative (0.03 [0.01 to 0.05]; 0.04 [0.01 to 0.06]) and psychological symptoms (0.03 [0.00 to 0.05]; 0.03 [0.00 to 0.06]) in cross-sectional design. Total and lean body mass interacted with physical activity in total and psychological symptoms with stronger indirect associations being observed in participants with lower total and lean body mass. CRF was not associated with menopausal symptoms and did not interact with physical activity.

CONCLUSIONS

Maintaining a healthy weight is associated with less severe menopausal symptoms in middle-aged women. The association between physical activity and the severity of menopausal symptoms varied based on the differences in total and lean body mass.

Advances in Exercise in the Clinical Trials of Migraine: A Scoping Review

PURPOSE OF REVIEW

This review aimed to investigate emerging evidence regarding the effectiveness of exercise for migraines, focusing on the results of recent trials. Additionally, it explored the possibility of exercise as a treatment for migraines.

RECENT FINDINGS

Between 2020 and 2023, five, four, one, and two trials were conducted regarding the effect of aerobic exercise, anaerobic exercise, Tai Chi, and yoga, respectively, on migraine; all studies showed significant effects. Two trials on aerobic exercise showed that high-intensity exercise was similar to or slightly more effective than moderate-intensity exercise as a treatment for migraines. Three trials on anaerobic exercise reported its effectiveness in preventing migraines. Regarding efficacy, side effects, and health benefits, aerobic exercises and yoga are potentially beneficial strategies for the prevention of migraines. Further studies are needed to develop evidence-based exercise programs for the treatment of migraines.

The influence of habitual physical activity and sedentary behavior on objective and subjective hot flashes at midlife

OBJECTIVE

The purpose of this study was to evaluate relationships between physical activity, sedentary time, and hot flashes during both waking and sleeping periods using concurrent objective and subjective measures of hot flashes in midlife women.

METHODS

Women aged 45 to 55 years (n = 196) provided self-reported data on physical activity and underwent 24 hours of hot flash monitoring using sternal skin conductance. Participants used event marking and logs to indicate when hot flashes were perceived. Wake and sleep periods were defined by actigraphy. Mean ambient temperature and humidity were recorded during the study period. Generalized linear regression modeling was used to evaluate the effect of physical activity types and sedentary time on hot flash outcomes. Isotemporal substitution modeling was used to study the effect of replacing sedentary time with activity variables on hot flash frequency.

RESULTS

Modeled results indicated that increasing sitting by 1 hour was associated with a 7% increase in the rate of objectively measured but not subjectively reported hot flashes during sleep. Replacing 1 hour of sitting with 1 hour of vigorous activity was associated with a 100% increase in subjectively reported but not objectively measured waking hot flashes. There was little evidence for an effect of temperature or humidity on any hot flash outcome.

CONCLUSIONS

These data provide support for relations between sedentary time, physical activity, and hot flashes and highlight the importance of using objective and subjective assessments to better understand the 24-hour hot flash experience.

Body composition, physical activity, and menopause symptoms: how do they relate?

OBJECTIVE

This study characterized the impact of physical activity (light, moderate, and vigorous [VIG] active minutes per day) and body composition (percent body fat [%BF] and fat-free mass index) on total menopausal symptoms (TMSs) in 72 premenopausal, perimenopausal (PERI), or postmenopausal women.

METHODS

Activity minutes were collected from wearable fitness trackers. Body composition was evaluated using a whole-body dual-energy x-ray absorptiometry scan. TMSs were quantified using The North American Menopause Society Questionnaire.

RESULTS

Significant associations were observed between TMSs and %BF ( r = 0.464, P < 0.001) and VIG ( r = -0.245, P = 0.038). %BF and VIG were significant predictors for TMSs across groups ( R2 = 0.146 and R2 = 0.092, respectively), but only %BF maintained for PERI ( R2 = 0.421, P < 0.001).

CONCLUSIONS

%BF predicted nearly half of the variance in PERI TMSs, whereas VIG predicted 9% of the sample variance, demonstrating an important influence of body fat accumulation and intense physical activity in the menopause transition. High-intensity exercise interventions to alleviate body composition changes may also reduce menopausal-related symptoms for PERI women.

Lifestyle Medicine and Vasomotor Symptoms: An Analytic Review

This paper is an literature evaluation of the treatments based on the 6 pillars of Lifestyle Medicine (nutrition, physical activity, restorative sleep, stress management, positive social connection, and avoidance of risky substances) to improve vasomotor symptoms. Main findings were: (1) the Mediterranean diet and other plant-forward approaches may effectively reduce vasomotor symptoms; (2) stress can directly impact menopausal symptoms by increasing the frequency and intensity of hot flashes and other symptoms; (3) the incidence of sleep disturbances are high during the menopause transition; (4) evidence on the impact of physical activity and exercise on vasomotor symptoms is mixed, although moderate activity and strength training may be better for vasomotor symptom optimization than vigorous exercise and part of a healthy aging process; (5) evidence on the impact of social support on VMS is mixed with some studies suggesting benefit; and (6) evidence on the impact of risky substances is mixed but appears stronger for the effects of tobacco cessation than for alcohol cessation. In summary, while there is a variety of quality of evidence depending on the pillar, lifestyle medicine may be generally considered to improve vasomotor symptoms for patients that cannot use or decline hormone therapy.

Trajectories of physical activity from mid to older age in women: 21 years of data from the Australian Longitudinal Study on Women's Health

BACKGROUND

Women's physical activity varies across the adult lifespan. However, changes in physical activity among mid-aged women are not well understood. We analysed 21 years of data from women born in 1946-51 to identify: (1) trajectories of physical activity in the transition from mid- to old-age and (2) determinants of different physical activity trajectories.

METHODS

Data were from the 1946-51 cohort of the Australian Longitudinal Study on Women's Health (N = 10,371). Surveys were mailed at three-year intervals from 1998 (age 47-52) to 2019 (age 68-73) to collect data on physical activity, sociodemographic factors (country of birth, area of residence, educational attainment, marital status, income management, paid work hours, living with children age < 18, providing care), health indicators (menopause status, BMI, physical and mental health, chronic conditions), and health behaviours (smoking, alcohol status). Group-based trajectory modelling was used to identify trajectories of physical activity. Multinomial logistic regression models were used to examine the determinants of physical activity trajectories.

RESULTS

Five trajectories were identified: Low-stable (13.3% of participants), Moderate-stable (50.4%), Moderate-increasing (22.2%), High-declining (7.7%), and High-stable (6.6%). Sociodemographic characteristics (area of residence, education, income management, living with children, and providing care) were determinants of physical activity trajectories, but the strongest factors were BMI, physical and mental health. Women who were overweight/obese and had poor physical and mental health were less likely to be in the High-stable group than in any other group. Changes in these variables (increasing BMI, and declining physical and mental health) and in marital status (getting married) were positively associated with being in trajectories other than the High-stable group.

CONCLUSIONS

Although most women maintained physical activity at or above current guidelines, very low physical activity levels in the Low-stable group, and declining levels in the High-declining group are concerning. The data suggest that physical activity promotion strategies could be targeted to these groups, which are characterised by socioeconomic disadvantage, high (and increasing) BMI, and poor (and worsening) physical and mental health. Removing barriers to physical activity in these women, and increasing opportunities for activity, may reduce chronic disease risk in older age.

Correlations among Core Outcomes in Menopause-recommended vasomotor symptom outcomes in MsFLASH trials

OBJECTIVE

This study aimed to advance understanding of vasomotor symptom (VMS) outcomes measurement using pooled data from three Menopause Strategies Finding Lasting Answers to Symptoms and Health (MsFLASH) trials.

METHODS

Participants self-reported VMS frequency, severity, and bother using daily diaries; completed standardized measures of VMS interference, insomnia severity, and sleep quality/disturbance; and completed four treatment satisfaction items. Analyses included descriptive statistics, Pearson correlations (baseline pooled sample, posttreatment pooled sample, posttreatment placebo only), t tests, and analysis of variance.

RESULTS

Participants were mostly postmenopausal (82.9%) and a mean of 54.5 years old. VMS frequency was fairly correlated with severity, bother, and interference for pooled baseline and placebo posttreatment samples ( r values = 0.21-0.39, P values < 0.001) and moderately correlated with severity, bother, and interference for pooled posttreatment ( r values = 0.40-0.44, P values < 0.001). VMS severity, bother, and interference were moderately correlated ( r values = 0.37-0.48, P values < 0.001), with one exception. VMS severity and bother were strongly correlated ( r values = 0.90-0.92, P values < 0.001). VMS interference was moderately correlated with insomnia ( r values = 0.45-0.54, P values < 0.001) and fairly to moderately correlated with sleep quality/disturbance ( r values = 0.31-0.44, P values < 0.001). Other VMS outcomes were weakly to fairly correlated with insomnia ( r values = 0.07-0.33, P values < 0.001 to < 0.05) and sleep quality/disturbance ( r values = 0.06-0.26, P values < 0.001 to > 0.05). Greater improvement in VMS and sleep over time was associated with higher treatment satisfaction ( P values < 0.001).

CONCLUSIONS

This pooled analysis advances understanding of VMS outcomes measurement and has implications for selecting measures and creating future research.

Effects of exercise on sleep in perimenopausal women: A meta-analysis of randomized controlled trials

Whether an exercise intervention has significant effects on improving the sleep quality in perimenopausal women is controversial. This review explores different ways of exercise interventions (intervention item, intervention period, intervention frequency, and intervention duration of each time) on the improvement of sleep in perimenopausal women. Based on the PICOS method, two researchers independently searched the PubMed database, Excerpta Medica database (EMBASE), Cochrane Library database, Web of Science (WoS) database, Chinese National Knowledge Infrastructure (CNKI) database, Wanfang database and VIP database, evaluated the literature quality using the Cochrane system evaluation manual, and performed a meta-analysis of the included literature. A total of 12 randomized controlled trials involving 1493 subjects were included in the study. Exercise intervention items included yoga, walking, fitness Qigong, and aerobic exercise. The meta-analysis showed that exercise could effectively improve sleep in perimenopausal women (SMD = -0.44, 95%CI (-0.66, -0.22), P < 0.00001), and had significant effects on the sleep quality and insomnia symptoms in perimenopausal women. Subgroup analysis showed that fitness Qigong with a period of 10 to 12 weeks, a frequency of more than 3 times a week, and a duration of each time of 30 to 60 min was the most effective in improving sleep.

Effects of different physiotherapy modalities on insomnia and depression in perimenopausal, menopausal, and post-menopausal women: a systematic review

BACKGROUND

Menopause is the time that marks passing 12 months after the last menstruation cycle in women between ages 40-50. Menopausal women often experience depression and insomnia that significantly impact their overall well-being and quality of life. This systematic review aims to determine the effects of different therapeutic physiotherapy modalities on insomnia and depression in perimenopausal, menopausal, and post-menopausal women.

METHODOLOGY

After identifying our inclusion/exclusion criteria, we conducted a database search in Ovid Embase, MIDRIS, PubMed, Cochrane, and ScienceOpen, where 4007 papers were identified. By using EndNote software, we excluded duplicates, unrelated, and non-full text papers. Adding more studies from manual search, we finally included 31 papers including 7 physiotherapy modalities: exercise, reflexology, footbath, walking, therapeutic and aromatherapy massage, craniofacial message, and yoga.

RESULTS

Reflexology, yoga, walking and aromatherapy massage showed an overall significant impact on decreasing insomnia and depression in menopausal women. Most of exercise and stretching interventions also showed improvement in sleep quality but inconsistent findings regarding depression. However, insufficient evidence was found regarding the effect of craniofacial massage, footbath, and acupressure on improving sleep quality and depression in menopausal women.

CONCLUSION

Using non-pharmaceutical interventions such as therapeutic and manual physiotherapy have an overall positive impact on reducing insomnia and depression in menopausal women.

Detrimental Changes in Health during Menopause: The Role of Physical Activity

Midlife women experience changes in cardiometabolic, physical, and psychosocial health during menopause that negatively impacts their overall quality of life. Factors that contribute to these increases in cardiometabolic risk include weight gain as well as increases in fat mass (particularly abdominal adiposity), insulin resistance, and vascular dysfunction. Other deleterious changes in physical health (e. g. reduced sleep health, bone density, and balance) as well as changes in psychosocial health (e. g. mood, anxiety, and depression) often coincide and are linked to these increases in cardiometabolic risk. Physical activity and exercise are important lifestyle components that have been demonstrated to improve cardiometabolic, physical, and psychosocial health, yet physical activity and exercise is known to decline during perimenopause and into the postmenopausal years. In this narrative review, we summarize these changes in overall health during menopause as well as how declining physical activity contributes to these changes. Additionally, we discuss how incorporating physical activity and exercise during menopause can potentially ameliorate health declines. We conclude that there exists a significant, positive impact of physical activity on cardiometabolic, physical, and psychological health among midlife women, particularly if undertaken during the perimenopausal and postmenopausal years.

The 2023 nonhormone therapy position statement of The North American Menopause Society

OBJECTIVE

To update the evidence-based Nonhormonal Management of Menopause-Associated Vasomotor Symptoms: 2015 Position Statement of The North American Menopause Society.

METHODS

An advisory panel of clinicians and research experts in women's health were selected to review and evaluate the literature published since the Nonhormonal Management of Menopause-Associated Vasomotor Symptoms: 2015 Position Statement of The North American Menopause Society. Topics were divided into five sections for ease of review: lifestyle; mind-body techniques; prescription therapies; dietary supplements; and acupuncture, other treatments, and technologies. The panel assessed the most current and available literature to determine whether to recommend or not recommend use based on these levels of evidence: Level I, good and consistent scientific evidence; Level II, limited or inconsistent scientific evidence, and Level III, consensus and expert opinion.

RESULTS

Evidence-based review of the literature resulted in several nonhormone options for the treatment of vasomotor symptoms. Recommended: Cognitive-behavioral therapy, clinical hypnosis, selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors, gabapentin, fezolinetant (Level I); oxybutynin (Levels I-II); weight loss, stellate ganglion block (Levels II-III). Not recommended: Paced respiration (Level I); supplements/herbal remedies (Levels I-II); cooling techniques, avoiding triggers, exercise, yoga, mindfulness-based intervention, relaxation, suvorexant, soy foods and soy extracts, soy metabolite equol, cannabinoids, acupuncture, calibration of neural oscillations (Level II); chiropractic interventions, clonidine; (Levels I-III); dietary modification and pregabalin (Level III).

CONCLUSION

Hormone therapy remains the most effective treatment for vasomotor symptoms and should be considered in menopausal women within 10 years of their final menstrual periods. For women who are not good candidates for hormone therapy because of contraindications (eg, estrogen-dependent cancers or cardiovascular disease) or personal preference, it is important for healthcare professionals to be well informed about nonhormone treatment options for reducing vasomotor symptoms that are supported by the evidence.

The effect of exercise intervention on improving sleep in menopausal women: a systematic review and meta-analysis

Background

Sleep disturbance is common in menopausal women and negatively affects their quality of life and could cause increased risks of other menopause-related diseases.

Objective

This systematic review aims to synthesize evidence regarding the effects of exercise interventions on improving sleep in menopausal women.

Methods

A comprehensive search in seven electronic databases for randomized controlled trials (RCTs) was performed on June 3, 2022. The systematic review included seventeen trials, ten of which provided data for the meta-analysis. The effects on outcomes were presented as mean differences (MDs) or standard mean differences (SMDs) and their 95% confidence intervals (CI). Cochrane risk-of-bias tool was used in quality assessment.

Results

The results suggest that exercise intervention significantly reduces insomnia severity (SMD = -0.91, 95% CI = -1.45 to -0.36, Z = 3.27, P = 0.001) and alleviates sleep problems (MD = -0.09, 95% CI = -0.17 to -0.01, Z = 2.20, P = 0.03). For sleep quality, the results showed that insignificant differences were found between the exercise intervention and the control groups (MD = -0.93, 95% CI = -2.73 to 0.87, Z = 1.01, P = 0.31). The results of the subgroup analysis indicated that more apparent effects of exercise intervention were found among women with sleep disorders than among women without sleep disorders. Which exercise intervention duration was more beneficial to sleep outcomes could not be judged. Overall, there was a moderate risk of bias in the primary studies.

Conclusion

According to this meta-analysis, exercise interventions can be recommended for menopausal women to improve their sleep. High-quality RCTs applying different types of exercise (e.g., walking, yoga, meditative exercise and so on) with different intervention durations as well as subjective and objective sleep assessment are warranted.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022342277, identifier: CRD42022342277.

Insomnia Severity Index: A reliability generalisation meta-analysis

The aim of the current study was to conduct a reliability generalisation (RG) meta-analysis of Cronbach's alpha for the Insomnia Severity Index (ISI). A systematic search of three databases (PubMed, Scopus, and Web of Science) from inception to 12 March 2021 was performed. Publications that reported Cronbach's alpha for the total ISI score were included. Only psychometric-focussed studies were considered. Meta-analysis was carried out using a random-effects model to derive a pooled estimate of Cronbach's alphas. The number of participants in the included publications ranged from 25 to 12,056, with 33 studies (42 estimates) comprising internal consistency coefficients, and a combined sample size of N = 29,688. The age range of the included publications was from 13.4 to 74.3 years. Data extraction implied 33 publications out of 706 found through the database search. Cronbach's alphas ranged from 0.65 to 0.92. The majority of the reported coefficients were ≥0.7 and presented a low risk of bias (n = 32). The pooled alpha coefficient was 0.83 (IC [0.81-0.85]; SE = 0.009) with high heterogeneity among the included publications (I²  = 97%). Subgroup analyses including moderators such as continent, setting, risk of bias, and age did not affect significantly the overall result. In general, the cumulative estimate of Cronbach's alpha for the ISI is good. However, this finding should be interpreted with caution since there is a high heterogeneity level and some of the studies might not have checked the assumptions underlying Cronbach's alphas.

Physical activity and exercise for hot flashes: trigger or treatment?

IMPORTANCE AND OBJECTIVE

Hot flashes (HFs) are a prevalent feature of menopause. Hot flashes can be bothersome and affect quality of life. However, HFs have also been associated with the risk for cardiovascular disease. Therefore, providing current evidence on the effect of therapies to reduce HFs can help patients and providers with decision making. This review provides details on the scientific evidence to date related to the effect of physical activity (PA) and exercise to alter the HF experience in women.

METHODS

The PubMed database was searched between June 2020 and June 2022 for currently available evidence regarding the relation between PA and exercise and HFs. Our analysis included randomized control trials on exercise training, epidemiological studies, and studies evaluating acute exercise on the self-reported and objectively measured HF experience in addition to systematic reviews on the topic published as of June 2022.

DISCUSSION AND CONCLUSIONS

The majority of evidence from randomized control trials indicates that aerobic and resistance exercise training lead to a decrease in subjectively experienced HFs. The limited available studies on acute exercise indicate that a bout of moderate-intensity exercise may decrease objectively measured and self-reported HFs but acute increases in PA intensity above accustomed levels may influence subjective HF experience. Some evidence suggests that for those with depression, habitual PA may be an effective way to reduce HF symptoms. Weighing the available evidence, for people who experience HFs, engaging in regular moderate-intensity PA, including aerobic and resistance exercise, may be an effective therapy to reduce HFs and women should be counseled on the benefits of regular, moderate exercise. However, significant gaps in knowledge remain about the optimal exercise prescription, effectiveness for a diverse population, meaning of differences between objective and subjective experience, and mechanisms that lead to changes in HFs.

Prevalence and risk factors for depressive and anxiety symptoms in middle-aged Chinese women: a community-based cross-sectional study

Background

Depression and anxiety have become main public health concerns globally. However, risk factors for depression and anxiety remain unclear. This study was to examine the prevalence and risk factors of depressive and anxiety symptoms in middle-aged Chinese women.

Methods

This cross-sectional study, conducted in 2018, included 7,727 women aged 40–60 years from the eastern, central and western regions of China. Depressive and anxiety symptoms were determined by the Patient Health Questionnaire-9 and the Generalized Anxiety Disorders-7, respectively. Logistic regression models were used to estimate odds ratios (ORs) for depressive and anxiety symptoms in relation to sociodemographic, lifestyle and menopausal factors.

Results

Among all participants, 19.5% (1 422/7 275) and 14.2% (1 035/7 275) of participants experienced depressive and anxiety symptoms, respectively. The multivariable logistic regression models showed that age, household income, regular physical activity, chronic diseases, menopausal status, vasomotor symptoms, somatic symptoms and urogenital symptoms were associated with depressive symptoms, while place of residence, regular physical activity, chronic diseases, vasomotor, somatic and urogenital symptoms were associated with anxiety symptoms.

Conclusion

Depressive and anxiety symptoms were common among middle-aged Chinese women, and certain sociodemographic, lifestyle and menopausal symptoms have an important impact on the risk of depressive and anxiety symptoms.

Chronotype and Sleep Quality in Obesity: How Do They Change After Menopause?

PURPOSE OF REVIEW

This review primarily provides an overview of the current evidence on chronotype (which reflects an individual's preference for the timing of sleeping, eating, and activity in a 24-h period) and sleep quality changes in obesity in postmenopausal women. It also explores possible nutritional strategies to manage these changes in this phase of a woman's life.

RECENT FINDINGS

Menopause is a life stage frequently associated with sleep disturbances and changes in circadian rhythms. Sleep disturbances are one of the main symptoms of menopause and are caused by several factors such as hormonal changes, obesity, and melatonin reduction. In addition, the chronotype also changes following menopause. Nutritional strategies are essential because they could help manage menopausal sleep disturbances and circadian misalignment, particularly by tackling obesity and overweight. In the management of postmenopausal women, especially those experiencing obesity, careful assessment of sleep disturbances and chronotype and subsequent development of the most appropriate treatment, including nutritional management, should be part of the treatment routine.

Qigong for mental health and sleep quality in postmenopausal women: A randomized controlled trial

BACKGROUND

Menopause is one of the stages in a woman's life that affects her psychological health, the most frequent being anxiety and depression. In addition, another problem related to this stage is the lack of sleep that causes a decrease in the quality of sleep. The purpose of this randomized controlled trial was to analyze the effectiveness of a Qigong exercise program on sleep quality, anxiety, and depression in Spanish postmenopausal women.

METHODS

A total of 125 women were randomly assigned to an experimental group (EG) (n = 63) that carried out a Qigong exercise program for 12 weeks, or a control group (CG) (n = 62), which did not perform any type of intervention. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and anxiety and depression using the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Women who underwent an intervention program experienced significant improvements for all measured variables, except for the use of sleeping medication and daytime dysfunctions that did not show any significant effect with respect to the group and group × time interaction.

CONCLUSIONS

After an intervention based on a BaDuanJin Qigong exercise program for 12 weeks, improvements were observed in sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, the total score of the PSQI, anxiety and depression in postmenopausal Spanish women.

Behavioral interventions for improving sleep outcomes in menopausal women: a systematic review and meta-analysis

IMPORTANCE

Perimenopausal and postmenopausal women commonly report sleep disruption and insomnia. Behavioral interventions may be safe alternatives for patients who are unwilling to begin pharmacological treatments because of adverse effects, contraindications, or personal preference.

OBJECTIVE

The primary objective is to assess the efficacy of behavioral interventions on sleep outcomes among perimenopausal and postmenopausal women, as measured using standardized scales and objective methods (polysomnography, actigraphy). The secondary objective is to evaluate the safety of these methods through occurrence of adverse events.

EVIDENCE REVIEW

Searches were performed within MEDLINE (OVID interface, 1946 onward), Embase (OVID interface, 1974 onward), Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Web of Science (Core collection) using a search strategy developed in consultation with a health sciences librarian. Title/abstract and full-text screenings were performed in duplicate, and relevant studies were selected based on inclusion and exclusion criteria set to identify randomized controlled trials evaluating the effects of behavioral interventions on sleep quality. Risk of bias assessments were done using the Cochrane Risk of Bias 2 tool, and the Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of the body of evidence. Data were pooled in a meta-analysis using a random-effects model.

FINDINGS

Nineteen articles reporting results from 16 randomized controlled trials were included, representing a total of 2,108 perimenopausal and postmenopausal women. Overall, behavioral interventions showed a statistically significant effect on sleep outcomes (standardized mean difference [SMD], -0.62; 95% confidence interval [CI], -0.88 to -0.35; I2 = 93.4%). Subgroup analyses revealed that cognitive behavioral therapy (SMD, -0.40; 95% CI, -0.70 to -0.11; I2 = 72.7%), physical exercise (SMD, -0.57; 95% CI, -0.94 to -0.21; I2 = 94.0%), and mindfulness/relaxation (SMD, -1.28; 95% CI, -2.20 to -0.37; I2 = 96.0%) improved sleep, as measured using both subjective (eg, Pittsburg Sleep Quality Index) and objective measures. Low-intensity (SMD, -0.91; 95% CI, -1.59 to -0.24; I2 = 96.8) and moderate-intensity exercise (SMD, -0.21; 95% CI, -0.34 to -0.08; I2 = 0.0%) also improved sleep outcomes. No serious adverse events were reported. Overall risk of bias ranged from some concern to serious, and the certainty of the body of evidence was assessed to be of very low quality.

CONCLUSIONS AND RELEVANCE

This meta-analysis provides evidence that behavioral interventions, specifically, cognitive behavioral therapy, physical exercise, and mindfulness/relaxation, are effective treatments for improving sleep outcomes among perimenopausal and postmenopausal women.

Effects of exercise on vasomotor symptoms in menopausal women: a systematic review and meta-analysis

The frequency and severity of menopausal vasomotor symptoms negatively impact quality of life. This systematic review evaluates the potential of exercise to relieve the subjective frequency and severity of vasomotor symptoms. We searched four databases to identify randomized controlled trials (RCTs) that evaluated the effect of structured exercise (e.g. aerobic training) on the severity and/or frequency of vasomotor symptoms in menopausal women. Two reviewers independently screened records for eligibility, extracted data and assessed risks of bias and evidence certainty using the Cochrane tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE). When suitable, data were pooled using random-effect meta-analyses. We appraised 21 RCTs involving 2884 participants. Compared to no-treatment control, exercise significantly improved severity of vasomotor symptoms (10 studies, standardized mean difference [SMD] = 0.25; 95% confidence interval [CI]: 0.04 to 0.47, p = 0.02, very low certainty of evidence); the effect size was attenuated when studies with a high risk of bias were excluded (SMD = 0.11, 95% CI: -0.03 to 0.26, p = 0.13). No significant changes in vasomotor frequency were found between exercise and control (SMD = 0.14, 95% CI: -0.03 to 0.31, p = 0.12, high certainty of evidence). In conclusion, exercise might improve vasomotor symptom severity. Future rigorous RCTs addressing the limitations of current review are warranted to explore the optimal exercise prescription principles to target the severity of vasomotor symptoms.

The relationship between sleep quality, neck pain, shoulder pain and disability, physical activity, and health perception among middle-aged women: a cross-sectional study

BACKGROUND

Sleep quality is an important physical requirement for a healthy life, and good sleep quality has been recognized as a significant component in physical and mental health and well-being. The purpose of this study was to identify the factors that affect sleep quality as well as the relationship between sleep quality and neck pain, shoulder pain and disability, physical activity, and health perception.

METHODS

We conducted surveys on 494 women between the age of 35 and 64 years. The study evaluated neck pain, shoulder pain and disability, physical activity, self-health perception and sleep quality with self-reported questionnaires in middle-aged women. Data were analyzed using SPSS 23.0.

RESULTS

The results showed that the more severe the neck pain and shoulder pain and disability, the worse the sleep quality was in middle-aged women and the better the health perception, the lower the sleep quality score was, indicating good sleep quality. Shoulder pain, self-perceived task difficulty, and health perception were identified as variables that affected the sleep quality in middle-aged women. The explanatory power of the model in explaining sleep quality was 22.9%.

CONCLUSIONS

Worsened shoulder pain, self-perceived task difficulty, and negative health perception can affect poor sleep quality; therefore, it is necessary to develop health interventions for pain management and emotional and social support for improving daily sleep quality. To improve the sleep quality in middle-aged women, healthcare workers should consider the subjects' pain and functional disability, in accordance with their health perception.

Comparing the Effectiveness of Multicomponent Sleep-Promoting Interventions on the Sleep Quality of Menopausal Women: A Quasi-Experimental Study

Sleep disturbance is considered one of the hallmarks of the common symptoms experienced by women during and after menopause. This study aimed to compare the effectiveness of two different multiple-component, sleep-promoting interventions on the sleep quality of menopausal women. A quasi-experimental study and repeated measured design, with a four-week sleep-promoting intervention, was conducted. A total of 123 eligible participants were recruited from a health center in northern Taiwan and divided into the progressive muscle relaxation plus sleep hygiene (PMRS), the meditative movement relaxation plus sleep hygiene (MMRS), or control group at a 1:1:1 ratio. The Chinese version of Pittsburgh sleep quality index and actigraphy were used to assess the sleep disturbances of menopausal women. The subjective sleep data was collected before, immediately after the intervention, 8 weeks, and 12 weeks after the intervention. The results showed that the global score of subjective sleep quality and its components were significantly improved after both interventions. Additionally, the MMRS was superior to the PMRS for subjective sleep quality. Moreover, the objective sleep indices indicated that sleep latency was reduced after both the interventions. These findings can serve as a reference for nurses when caring for menopausal women with sleep disturbance.

Toward a better measure of midlife sexual function: pooled analyses in nearly 1,000 women participating in MsFLASH randomized trials

OBJECTIVE

Evaluate appropriateness of the current Female Sexual Function Index (FSFI)-19 value of <26.6 to designate female sexual dysfunction (FSD) in postmenopausal women, using the Female Sexual Distress-Revised (FSDS-R) scale to measure distress.

METHODS

Participant-level data containing standardized measures from five completed Menopause Strategies: Finding Lasting Answers for Symptoms and Health trials was pooled. Baseline characteristics and FSFI-19 scores were compared across trials (F-test, homogeneity). FSFI-19 score associations with the FSDS-R were described. Receiver operating characteristic (ROC) curves were plotted to illustrate the choice of optimal FSFI-19 value to predict sexual distress. ROC curves were also estimated adjusting for trial number, clinical center, age, education, race, smoking, and BMI.

RESULTS

Nine hundred ninety eight women (79.2% postmenopausal), mean age 55.9 (SD 4.8) had complete FSFI-19, FSDS-R, and covariate data. Baseline mean FSFI-19 score among all participants and sexually active participants was 18.7 (SD 9.5) and 22.0 (SD 7.2), respectively. There was a consistent pattern across the trials of inverse association between poorer sexual function (FSFI-19) and greater sexual distress. Based on the ROC curve showing the likelihood of FSDS-R frequent or greater distress according to cut points of FSFI, the optimal cut point for FSD was FSFI-19 <21 for all participants. This cut point corresponded to sensitivity 87.2% (95% CI, 83.4-91.0), specificity 57.9% (95% CI, 54.3-61.6) and adjusted area under the ROC curve 78.8% (95% CI, 75.8-81.8).

CONCLUSIONS

A new FSFI-19 cut point of ≥21 should be considered to describe normal sexual function in periand postmenopausal women as opposed to the standard cut point of >26.6.

VIDEO SUMMARY

http://links.lww.com/MENO/A915.

Efficacy of the Complementary and Alternative Therapies for the Management of Psychological Symptoms of Menopause: A Systematic Review of Randomized Controlled Trials

Menopause is not a high-risk period for psychiatric illness but can cause psychological issues; the most common of which are anxiety and depression, which can impair coping and reduce women’s quality of life. Thus, many women have leaned toward complementary and alternative medicine (CAM) for the relief of menopause-related symptoms. No rigorous study exists in the literature on the effects of CAMs on the psychological symptoms of menopause despite this growing patient interest. This systematic review aimed to assess the efficacy of CAM interventions on psychological symptoms of menopause. Databases (PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar) were searched from January 2000 to May 2021 using the keywords: menopause, menopausal symptoms, psychological symptoms, and complementary and alternative medicine. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) for randomized clinical trials. Of the 704 articles found, 33 articles with 3,092 participants entered the final review. Aromatherapy, massage, yoga, and acupuncture, as well as some dietary and herbal supplements improved psychological symptoms during menopause based on the findings of the current study. However, the effectiveness of reflexology and exercise was debatable. However, necessary precautions should be taken when using them in clinical settings despite the positive effect of various CAM interventions on reducing psychological symptoms. More studies with a higher methodology quality are required to make better decisions about the effect of various CAM interventions on the psychological symptoms of menopause.

Evaluating the Effects of Symptom Monitoring on Menopausal Health Outcomes: A Systematic Review and Meta-Analysis

Evidence suggests that monitoring and appraising symptoms can result in increased engagement in medical help-seeking, improved patient-doctor communication, and reductions in symptom prevalence and severity. To date, no systematic reviews have investigated whether symptom monitoring could be a useful intervention for menopausal women. This review explored whether symptom monitoring could improve menopausal symptoms and facilitate health-related behaviours. Results suggested that symptom monitoring was related to improvements in menopausal symptoms, patient-doctor communication and medical decision-making, heightened health awareness, and stronger engagement in setting treatment goals. Meta-analyses indicated large effects for the prolonged use of symptom diaries on hot flush frequencies. Between April 2019 and April 2021, PsychInfo, EMBASE, MEDLINE, CINAHL, Cochrane, ProQuest, PsychArticles, Scopus, and Web of Science were searched. Eighteen studies met the eligibility criteria and contributed data from 1,718 participants. Included studies quantitatively or qualitatively measured the impact of symptom monitoring on menopausal populations and symptoms. Research was narratively synthesised using thematic methods, 3 studies were examined via meta-analysis. Key themes suggest that symptom monitoring is related to improvements in menopausal symptoms, improved patient-doctor communication and medical decision-making, increased health awareness, and stronger engagement in goal-setting behaviours. Meta-analysis results indicated large effects for the prolonged use of symptom diaries on hot flush frequency: 0.73 [0.57, 0.90]. This review is limited due to the low number of studies eligible for inclusion, many of which lacked methodological quality. These results indicate that symptom monitoring has potential as an effective health intervention for women with menopausal symptoms. This intervention may be beneficial within healthcare settings, in order to improve patient-doctor relations and adherence to treatment regimes. However, findings are preliminary and quality assessments suggest high risk of bias. Thus, further research is needed to support these promising outcomes. Systematic Review Registration Number: https://www.crd.york.ac.uk/prospero/display_record.php?, PROSPERO, identifier: CRD42019146270.

MsFLASH analysis of diurnal salivary cortisol and palpitations in peri- and postmenopausal women

OBJECTIVE

To evaluate the relationship between diurnal salivary cortisol patterns and distress from heart palpitations in midlife women.

METHODS

We analyzed baseline data from 293 women who were eligible for a 3 × 2 factorial trial of exercise or yoga versus routine activity, and omega-3 fish oil versus placebo for vasomotor symptoms. Women self-collected salivary cortisol using swabs at four time points over 2 consecutive days and reported distress from heart racing or pounding during the past 2 weeks using a single item. Sample description and covariate data included demographics, clinical data, vasomotor symptom frequency from daily diaries, medication use, and validated questionnaires on depression, stress, and insomnia (Patient Health Questionnaire-8, Perceived Stress Scale, and Insomnia Severity index). Data were analyzed using descriptive statistics, chi-square and t tests, and repeated measure linear regression models.

RESULTS

Participants were on average 54.6 (SD = 3.6) years old, most were White (67%) postmenopausal (84%), and 26% reported distress related to palpitations. In adjusted models, the morning (wake plus 30-min) geometric mean daily salivary cortisol concentrations were significantly more blunted in those with distress from palpitations compared with those without distress (P ≤ 0.03). When all covariates were controlled, distress from palpitations was the sole significant predictor of wake plus 30-minute cortisol (-0.25 [-0.45 to -0.04], P = 0.02).

CONCLUSIONS

Palpitations among midlife women may be associated with blunted morning cortisol, and this relationship is not explained by demographics, clinical variables, vasomotor symptoms, medications, depression, stress, or insomnia.

Association of depression, anxiety and menopausal-related symptoms with demographic, anthropometric and body composition indices in healthy postmenopausal women

Background

The termination of the menstrual cycle is correlated with a number of physiological alterations and symptoms that can negatively impact emotion and mood. We aimed to investigate the association of anxiety, depression, and menopausal related symptoms with demographic, anthropometric, and body composition indices in healthy postmenopausal women.

Methods

A total of 320 menopausal women were selected randomly from referrals of health centers between January and June 2018 in Tabriz/Iran. All participants completed a demographic questionnaire. Bioelectrical impedance analysis was applied to evaluate body fat mass (BFM), soft lean mass (SLM), and lean body mass (LBM) of participants. The modified Kupperman index, Beck's depression inventory-II, and Spielberger’s state-trait anxiety inventory were applied to measure the severity of menopausal-related symptoms, the frequency, and severity of the symptoms of depression and state (SA) and trait anxiety (TA), respectively.

Results

Finally, 245 postmenopausal women with age of 55.33 ± 4.48 years and body mass index (BMI) of 27.96 ± 3.22 kg/m² were studied. Women with the age of 55 years and older (OR 3.928, 95% CI 1.504–10.256) and also women with mild physical activity (OR 10.104, 95% CI 3.785–26.976) had a greater possibility of having mild and moderate depression in comparison with women less than 50 years old and women with moderate and severe physical activity. Moderate and severe physical activity was correlated with a lower possibility of having medium upward, relatively severe and severe TA in comparison with participants with mild physical activity in these women (OR 0.372, 95% CI 0.151–0.917). Women with higher BMI and BFM had and more severe menopause-related symptoms (r = 0.143, p = 0.025 and r = 0.139, p = 0.030, respectively) and more severe TA symptoms (r = 0.198, p = 0.018 and r = 0.151, p = 0.021, respectively). Women with lower LBM (r =  − 0.139, p = 0.031) and lower SLM (r =  − 0.128, p = 0.047) had more severe depressive symptoms.

Conclusion

Postmenopausal women with higher age and lower physical activity had a greater possibility of having mild and moderate depression. Lower physical activity was also correlated with a greater possibility of having medium upward to severe TA symptoms. Postmenopausal women with higher BMI and BFM had more severe menopause-related and TA symptoms. Women with lower LBM and SLM had more severe depressive symptoms.

Can walking exercise programs improve health for women in menopause transition and postmenopausal? Findings from a scoping review

OBJECTIVE

Our goal was to explore the range and characteristics of published papers on therapeutic walking programs for menopausal women and to identify program features that resulted in successful outcomes including reduced symptoms and improved long-term wellness.

METHODS

We searched biomedical and exercise-related databases for articles published up to June 1, 2017, using keywords related to menopause and walking. Data were collected into EndNote X8 reference manager to identify and remove duplicates. The final selection included all articles that studied walking as a health intervention for women in menopause transition or postmenopausal.

RESULTS

A total of 3,244 papers were collected from the six databases. After removing duplicates and applying inclusion and exclusion criteria, 96 articles were charted, including 77 different walking programs. Walking interventions ranged from 4 weeks to 3 years with an average weekly frequency of 3.8 ± 1.8 and were applied to a variety of symptoms and their biological markers and risk factors. Overall, 91% of the programs showed a beneficial outcome in at least one menopause-related medical issue. Information on menopause-specific symptoms, especially vasomotor symptoms and sleep problems, was scarce.

CONCLUSION

The scoping review highlights the growing interest in walking programs as therapies for menopause and related symptoms and provides evidence of their possible benefit as a wellness option for women in menopause and beyond. Further research would be recommended to establish the therapeutic value of walking programs for women with specific focus on typical menopause symptoms at different stages of menopause. : Video Summary:http://links.lww.com/MENO/A587.

Effects of pharmacologic and nonpharmacologic interventions on menopause-related quality of life: a pooled analysis of individual participant data from four MsFLASH trials

OBJECTIVE

The Menopause Strategies: Finding Lasting Answers for Symptoms and Health network conducted three randomized clinical trials (RCTs) testing six interventions treating vasomotor symptoms (VMS), and also collected menopause-related quality of life (QOL) measures. A fourth RCT assessed an intervention for insomnia symptoms among women with VMS. We describe these seven interventions' effects on menopause-related QOL relative to control in women with VMS.

METHODS

We pooled individual-level data from 1,005 peri- and postmenopausal women with 14 or more VMS/week across the four RCTs. Interventions included escitalopram 10 to 20 mg/d; yoga/aerobic exercise; 1.8 g/d omega-3-fatty acids; oral 17-beta-estradiol 0.5 mg/d; venlafaxine XR 75 mg/d; and cognitive behavioral therapy for insomnia (CBT-I). Outcomes measures were the Menopause-specific Quality of Life scale and its subscales.

RESULTS

Significant improvements in total Menopause-specific Quality of Life from baseline were observed with estradiol, escitalopram, CBT-I, and yoga, with mean decreases of 0.3 to 0.5 points relative to control. The largest improvement in the vasomotor subscale was observed with estradiol (-1.2 points), with more modest but significant effects seen with escitalopram, yoga, and CBT-I. Significant improvements in the psychosocial subscale were observed for escitalopram, venlafaxine, and CBT-I. For the physical subscale, the greatest improvement was observed for CBT-I and exercise, whereas for the sexual subscale, the greatest improvement was observed for CBT-I, with yoga and estradiol demonstrating smaller effects.

CONCLUSIONS

These results suggest that for menopause-related QOL, women have a variety of treatment strategies to choose from and can select an approach based on most bothersome symptoms and individual preferences.

A meta-analysis on the prevalence of depression in perimenopausal and postmenopausal women in India

INTRODUCTION

The mental health of perimenopausal and postmenopausal women is a relatively understudied area. This review formally explores the prevalence of depression in perimenopausal and postmenopausal women in India.

METHODS

Databases like PubMed, Embase, Cochrane library, Web of Science and Scopus were systematically searched for cross-sectional or cohort studies, providing prevalence of depression in Indian perimenopausal and postmenopausal women. Systematic study selection and data extraction procedures were followed. Quality assessment of individual study was done using AXIS tool. For pooling of effect sizes, the random effects model was used. Funnel plot and Egger's test were used to ascertain publication bias. Subgroup analyses and meta-regression analysis were used to explore heterogeneity in the summary estimates.

RESULTS

After a thorough search, ten studies were found to be eligible and included in this review. Pooled estimate for prevalence of depression (random effects model) in perimenopausal and postmenopausal women in India is 42.47 % (95 % CI: 28.73-57.49, I² = 97.7 %). On visual inspection of the funnel plot and interpreting egger's test (bias: 3.49, SE bias: 3.68, p = 0.37), there was absence of publication bias.

CONCLUSION

We documented 42.47 % pooled prevalence of depression in perimenopausal and postmenopausal women in India.

Effects of Exercise on Sleep Quality and Insomnia in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Study Objectives: We conducted a meta-analysis to assess the effects of different regular exercise (lasting at least 2 months on a regular basis) on self-reported and physiological sleep quality in adults. Varied exercise interventions contained traditional physical exercise (e.g., walking, cycling) and mind-body exercise characterized by gentle exercise with coordination of the body (e.g., yoga). Methods: Procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Systematical searches were conducted in three electronic databases (PubMed, Embase, and Web of Science) for relevant research that involved adult participants without pathological diseases receiving exercise intervention. The search strategy was based on the population, intervention, comparison, and outcome study design (PICOS) framework. The self-reported outcomes included varied rating scales of Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleepiness Scale (ESS). Subgroup meta-analyses of PSQI scores were conducted based on type of exercise, duration of intervention, and participants' age and gender. The physiological outcomes were measured by Actigraph. All meta-analyses were performed in a fixed or random statistic model using Revman software. Results: Twenty-two randomized controlled trials were included in the analysis. The overall analysis on subjective outcomes suggests that exercise interventions significantly improved sleep quality in adults compared with control interventions with lower PSQI (MD -2.19; 95% CI -2.96 to -1.41), ISI (MD -1.52; 95% CI -2.63 to -0.41), and ESS (MD -2.55; 95% CI -3.32 to -1.78) scores. Subgroup analyses of PSQI scores showed both physical and mind-body exercise interventions resulted in improvements of subjective sleep to the same extent. Interestingly, short-term interventions (≤3 months) had a significantly greater reduction in sleep disturbance vs. long-term interventions (>3 months). Regarding physiological sleep, few significant effects were found in various sleep parameters except the increased sleep efficiency in the exercise group vs. control group. Conclusions: Results of this systematic review suggest that regular physical as well as mind-body exercise primarily improved subjective sleep quality rather than physiological sleep quality in adults. Specifically, self-reported sleep quality, insomnia severity, and daytime sleepiness could be improved or ameliorated with treatment of exercise, respectively, evaluated by PSQI, ISI, and ESS sleep rating scales.

The Menopause Transition: Signs, Symptoms, and Management Options

CONTEXT

Menopause, the permanent cessation of menses, reflects oocyte depletion and loss of gonadal steroids. It is preceded by a transition state, the perimenopause, which is characterized by the gradual loss of oocytes, altered responsiveness to gonadal steroid feedback, wide hormonal fluctuations, and irregular menstrual patterns. The goal of this mini-review is to discuss the basic pathophysiology of the menopausal transition and the hormonal and nonhormonal management of clinicopathology attributed to it.

EVIDENCE ACQUISITION

A Medline search of epidemiologic, population-based studies, and studies of reproductive physiology was conducted. A total of 758 publications were screened.

EVIDENCE SYNTHESIS

The reproductive hormonal milieu of the menopausal transition precipitates bothersome vasomotor symptoms, mood disruption, temporary cognitive dysfunction, genitourinary symptoms, and other disease processes that reduce the quality of life of affected women. The endocrine tumult of the menopause transition also exposes racial and socioeconomic disparities in the onset, severity, and frequency of symptoms. Hormone therapy (HT) treatment can be effective for perimenopausal symptoms but its use has been stymied by concerns about health risks observed in postmenopausal HT users who are older than 60 and/or women who have been postmenopausal for greater than 10 years.

CONCLUSIONS

The menopause transition is a disruptive process that can last for over a decade and causes symptoms in a majority of women. It is important for clinicians to recognize early signs and symptoms of the transition and be prepared to offer treatment to mitigate these symptoms. Many safe and effective options, including HT, are available.

Lights on MsFLASH: a review of contributions

OBJECTIVE

The Menopause Strategies: Finding Lasting Answers for Symptoms and Health clinical trials network was funded by the National Institutes of Health to find new ways to alleviate the most common, bothersome menopausal symptoms by designing and conducting multiple concurrent clinical intervention studies, accommodating a wide scope of populations and intervention strategies.

METHODS

Trials were conducted in Boston, Indianapolis, Minneapolis, Oakland, Philadelphia, and Seattle, with the Data Coordinating Center in Seattle, and were designed with standardized eligibility criteria and endpoints. Primary outcomes focused on vasomotor symptoms, sleep quality and insomnia symptoms, and vaginal symptoms. Secondary outcomes included quality of life, sexual function, and mood.

RESULTS

We completed five randomized clinical trials and three ancillary studies, testing nine interventions in over 1,300 women and collecting nearly 16,000 bio-specimens. Escitalopram, venlafaxine hydrochloride extended release, and low-dose estradiol diminished hot flashes by approximately 50% as compared with a 30% decrease by placebo. No benefits on vasomotor symptoms were observed with yoga or exercise compared with usual activity, nor with omega-3 supplementation compared with placebo. Cognitive behavioral therapy for insomnia reduced self-reported insomnia symptoms and improved overall sleep quality compared with menopause education control. We did not find significant benefit from a vaginal estradiol tablet or a vaginal moisturizer compared with placebo tablet and gel in diminishing the severity of vaginal symptoms.

CONCLUSIONS

The MsFLASH trials contributed substantially to our understanding of bothersome menopausal symptom treatment. It is important that clinicians counseling women about available treatment options consider all therapies-both nonhormonal and hormonal.

Evaluation of the effect of Silybum marianum extract on menopausal symptoms: A randomized, double-blind placebo-controlled trial

The tendency to use herbs to manage menopausal symptoms has increased in recent years. The purpose of this study was to evaluate the effect of Silybum marianum (L.) compared with placebo in women with hot flashes. Eighty women were randomly allocated into two equal groups (S. marianum extract [400 mg/d] or placebo capsules). Hot flashes frequency and severity were evaluated in 12 weeks with the Greene Climacteric Scale (GCS) and the Hot Flash Related Daily Interference Scale (HFRDIS). The data were analyzed in SPSS software using t-test, Mann-Whitney, chi-square test and repeated measure analysis. Hot flashes frequency and severity decreased from 4.32 ± 0.20/day to 1.31 ± 0.15/day and from 5.25 ± 0.22 to 1.62 ± 0.08, respectively, during the study in test group (p < .001) which were significantly better than effects of placebo in all steps of study (p < .001). Significant decreases in GCS and HFRDIS scores were also detected in S. marianum group compared with placebo after 4, 8 and 12 weeks (p < .001). The results showed that S. marianum can decrease frequency and severity of hot flashes significantly. Considering the safety and high consumption of this herbal medicine worldwide, its use in women with menopausal symptoms can be helpful.

A Menopause Strategies-Finding Lasting Answers for Symptoms and Health (MsFLASH) Investigation of Self-Reported Menopausal Palpitation Distress

Background: Study to describe the degree of menopausal palpitation distress and its demographic, clinical, symptom, and quality-of-life (QOL) correlates. Analysis of existing, baseline, data from peri- and postmenopausal women, 42 to 62 years of age, who participated in the Menopause Strategies-Finding Lasting Answers for Symptoms and Health (MsFLASH) clinical trials testing interventions for vasomotor symptoms (n = 759). Up to 46.8% of menopausal women report having palpitations, yet the symptom is relatively understudied. Little is known about palpitation distress or its correlates. Materials and Methods: Degree of distress from "heart racing or pounding" was self-reported over the past two weeks as "not at all," "a little bit," "moderately," "quite a bit," or "extremely." Other measures included self-report forms, clinic-verified body mass index (BMI), vasomotor symptom diaries, and validated symptom and QOL tools. Results: The percentage who reported palpitation distress was 19.6%, 25.2%, and 33.5% in the three trials or 25.0% overall. In multivariate analysis, the odds of reporting palpitation distress was lower in past smokers (odds ratio [OR] = 0.59 [95% confidence interval (CI) 0.38-0.90]) and current smokers (OR = 0.48 [0.27-0.87]) relative to never-smokers and lower with every 5 kg/m² higher BMI (OR = 0.82 [0.69-0.98]).The odds of reporting palpitation distress was higher with every five point more severe insomnia (OR = 1.28 [1.05-1.54]), five point worse depressive symptoms (OR = 1.47 [1.11-1.95]), five point worse perceived stress (OR = 1.19 [1.01-1.39]), and one point worse menopausal QOL (OR = 1.29 [1.06-1.57]). Conclusions: Menopausal palpitation distress is common and associated with demographic, clinical, symptom, and QOL factors. Findings can be used for screening in clinical practice and to justify additional research on this understudied symptom.

Footbath as a safe, simple, and non-pharmacological method to improve sleep quality of menopausal women

Due to the adverse effects of medication we decided to provide a safe, economic, and easy intervention to decrease sleep problems in menopausal women. This trial aimed to determine the effect of footbath on sleep disturbance in postmenopausal women. One hundred menopausal women were randomly stratified using a permuted block randomization procedure by Random Allocation Software, and assigned to one of two study groups: control (without intervention, n = 50) and intervention (footbath, n = 50). The footbath group was asked to lie their feet into the warm water for 20 min in a container with a depth of 10 cm one hour before the usual sleeping time for 6 weeks. To assess sleep quality, we used the Pittsburgh sleep quality index (PSQI). To evaluate severity of menopause symptoms, the Greene scale was applied. Before the intervention, 96% of the subjects in the footbath group and 94% in the control group were poor sleepers. The results of analysis of covariance showed significant improvement in sleep quality and decrease in severity of menopause signs in the footbath group compared to the control group. At the baseline, there was a statistically significant correlation between the severity of menopause signs and the global score of PSQI in all study individuals (p ≤ .001, r = .464). The present study findings showed that footbath intervention enhanced sleep quality in menopausal women. Thus, footbath as a safe, simple, and non-pharmacological application can improve quality of life in postmenopausal women and inhibit problems due to inadequate sleep quality.

Nonpharmacological therapies for the management of menopausal vasomotor symptoms in breast cancer survivors

PURPOSE

Breast cancer affects millions of women worldwide, and for many, therapy results in treatment-induced menopause. Menopausal symptoms in breast cancer survivors are often more severe, frequent, and of greater duration compared with natural menopause. Hot flushes and night sweats pose a significant burden for many women, with limited therapeutic options as menopausal hormone therapy is contraindicated. Guidelines recommend non-hormonal pharmacological agents including clonidine, gabapentin, and some antidepressants. However, some women may be reluctant to use medications due to concerns about side effects. The aim of this narrative review was to appraise recent evidence for nonpharmacological treatments for vasomotor symptoms in breast cancer survivors including cognitive behavioural therapy, hypnosis, yoga, mindfulness, acupuncture, and lifestyle changes.

METHODS

A literature search was conducted. Studies were included if they were randomised and involved breast cancer survivors and nonpharmacological treatments for menopausal vasomotor symptoms.

RESULTS

Twelve studies met the criteria, and three studies of exercise in healthy menopausal women were included. Cognitive behavioural therapy reduces menopausal symptoms and perceived impact of hot flushes and night sweats in breast cancer survivors and is cost effective. The efficacy of hypnosis as a treatment for menopausal vasomotor symptoms in women with breast cancer is supported by two randomised controlled trials. Yoga and acupuncture may reduce vasomotor symptom frequency and/or burden. Studies of exercise as an intervention for vasomotor symptoms in healthy menopausal women have not shown benefit.

CONCLUSION

Evidence for nonpharmacological interventions supports cognitive behavioural therapy and hypnosis in the management of vasomotor symptoms in breast cancer survivors.

Women's views about physical activity as a treatment for vasomotor menopausal symptoms: a qualitative study

Background

Women commonly seek medical advice about menopausal symptoms. Although menopausal hormone therapy is the most effective treatment, many women prefer non-pharmacological treatments, such as physical activity. The effectiveness of physical activity has been inconclusive when assessed by randomised controlled trials, and it remains unclear how women feel about it as a possible treatment approach. The aim of the study was to explore symptomatic menopausal women’s views and experiences of physical activity as a treatment for vasomotor and other menopausal symptoms.

Methods

An in-depth qualitative study was embedded within a randomised controlled trial that assessed the effectiveness of physical activity as a treatment for vasomotor menopausal symptoms in previously inactive vasomotor symptomatic women. Participants were randomised to one of two physical activity interventions or a usual care group. Both physical activity interventions involved two one-to-one consultations, plus either supporting materials or access to physical activity support groups, over 6 months. Semi-structured interviews were conducted with 17 purposively selected participants from all three trial groups after they had completed trial follow-up. Interviews were audio recorded, transcribed verbatim, and analysed by constant comparison.

Results

All participants talked positively about physical activity as a treatment for their menopausal symptoms, with most reporting participation had improved their hot flushes and night sweats. They reported that they had experienced improved sleep, physical health and psychological well-being. Those who received the physical activity plus social-support intervention reported their ability to cope with their menopausal symptoms had improved. Many participants commented that they would prefer doctors to discuss physical activity as a possible treatment for their hot flushes and night sweats, before offering medication.

Conclusions

Based on the views and experiences of the women who participated in this study, healthcare professionals should continue discussing physical activity as a potential first treatment option with menopausal women. Furthermore, healthcare professionals should ensure they prepare, support, and encourage these women both physically and emotionally.

Trial registration

ISRCTN ISRCTN06495625 Registered 10/11/2010

Obstetric and Gynecologic Disorders and the Nervous System

PURPOSE OF REVIEW

This article highlights the multiple intersections between obstetric/gynecologic issues and neurologic disorders.

RECENT FINDINGS

Neurologic issues can arise related to contraceptive medications, infertility treatments, pregnancy, and menopause. This article explores these areas in chronologic order, beginning with women's neurologic conditions that overlap their reproductive years and those that may occur during pregnancy and continuing through menopause. For each disorder, the epidemiology, pathophysiology, complications, and best sex-based treatment are described. Recent findings and treatments are highlighted.

SUMMARY

Obstetric and gynecologic disorders may present with neurologic symptoms, so it is important for neurologists to understand these intersections to deliver the best care for our female patients.