Perimenopause: More Than Hot Flushes and Night Sweats for Some Australian Women

Assessment of menopausal symptoms with changing hormone milieus in different menopausal transitional stages

The present cross-sectional study is an attempt to evaluate menopausal symptoms with changing hormone milieus among women of different menopausal transitional stages. Out of all the symptoms, sexual dysfunction was the most commonly occurring symptom. Results of the correspondence analysis exhibited a significant association of symptoms like 'feeling unhappy', 'feeling dizzy', 'parts of body feeling numb' and 'muscle & joint pain' with late postmenopausal stage. Therefore, the assessment of menopausal health of women in rural settings of developing countries like India is of considerable significance for promoting their post reproductive health as well as for enhancing their quality of life.

Caffeine consumption improves motor and cognitive performances during dual tasking in middle-aged women

The aim of the present study was to explore the effect of caffeine consumption (CC) on cognitive motor interference while walking and maintaining balance in middle-aged women. Twenty middle-aged women (52 ± 2.0 years; height 158 ± 2.0 cm; body mass 77 ± 14.9 kg; body mass index ±3.4 kg/m², mean ± SD) participated in this study. Participants completed measures of a single task (ST) cognitive, a ST motor and a dual task (DT) cognitive-motor tests before and after either caffeine (100 mg) or placebo ingestion. Results showed that before CC, both motor (P < 0.0005) and cognitive (P < 0.05) performances decreased in the DT condition compared to the ST one. After CC, no significant difference in the motor performances between ST and DT conditions was observed. In fact, both standing and walking DT performances were improved as indicated by a significant (P < 0.05) decrease in the dual task cost (DTC) of motor performances. In conclusion, middle-aged women showed difficulties to manage DT situations in which a cognitive and a motor task must be performed concurrently. Caffeine is an effective ergogenic aid to improve both cognitive and motor performances during DT conditions and could be an alternative to nullify the deteriorating effect of DT when maintaining balance and walking in middle-aged women. These enhancements could offer great potential for everyday functioning.

The management of menopausal symptoms in women following treatment for cancer at a specialist menopause service

OBJECTIVE

The aim of this study was to identify prescribing patterns at a specialist menopause service in a central London teaching hospital for women following treatment for a malignancy.

STUDY DESIGN

This was a prospective cohort study with data collected over a seven-month period from December 2019 to June 2020. All women reviewed at the specialist menopause services following treatment of a malignancy, BRCA carriers and Lynch syndrome were included in the study, with management options divided into three categories: hormonal, non-hormonal and no treatment.

MAIN OUTCOME MEASURES

The primary outcome of this study was to identify prescribing patterns for all women reviewed following a diagnosis of a malignancy, as well as those with genetic mutations necessitating risk-reducing prophylactic bilateral salpingo-oopherectomy (BSO).

RESULTS

Altogether 71 women were included in this study, with the majority of women post management of a non-gynaecological malignancy (51/71, 72%), of which breast cancer was the most common (37/71, 52%). While non-hormonal treatment was the most popular among those treated for breast cancer, for all other malignancies, hormonal treatment was more widespread. Fourteen women also had genetic mutations, with all of these women commencing hormonal treatment post risk reducing surgery.

CONCLUSION

With the exception of those with a history of hormone-sensitive breast cancer, the use of hormonal treatment for menopausal symptoms remained widespread. While this was a relatively small study, the need for long-term follow-up across specialist menopause services, to assess the risk of recurrence is vital.

Functional and cognitive responses to caffeine intake in middle-aged women are dose depending

Middle-aged women display many physiological and cognitive alterations resulting from aging and physical inactivity as well as other changes that occur as a function of menopause. Caffeine consumption is highest in this age with women having a particular greater sensitivity to caffeine than men. Its effects on functional and cognitive functions are controversial and seem to depend on the dose intake. This study aimed to assess the effect of low (100mg) and high (400mg) doses of caffeine consumption on cognitive (simple reaction time) and functional (upper and low body muscle endurance, aerobic endurance and functional mobility) performances. These performances were evaluated in 19 healthy middle-aged women by the 30-Second Chair Stand test for lower body muscle endurance, the 30sec Arm Curl Test for upper body muscle endurance, the 2-Minute Step test for aerobic endurance, The Timed Up and Go test for functional mobility and the simple reaction time test for reaction time, 60min after a treatment capsule intake (100mg caffeine/400mg caffeine/placebo). Low caffeine consumption significantly improved (p<.005) cognitive performance, while high caffeine consumption did not. However, the functional performance significantly improved (p<.05) after high caffeine consumption but not after low caffeine consumption. Except, the functional mobility performance significantly improved (p<.05) after both low and high caffeine consumption with better improvement (p<.05) after the high dose. In conclusion, low caffeine consumption improved cognitive performance and high caffeine consumption improved functional performance but the functional mobility improved after both low and high caffeine consumption in middleaged women.

Twelve-week exercise training and the quality of life in menopausal women - clinical trial

INTRODUCTION

The menopause transition is associated with decreased health functioning. About 80-90% of women experience mild to severe physical or physiological menopause-related complaints per year when approaching menopause. Physical activity may reduce some climacteric symptoms and improve the quality of life.

AIM OF THE STUDY

Aim of the study was to investigate the influence of a 12-week training programme on the quality of life (QoL) in menopausal-aged women living in a rural area.

MATERIAL AND METHODS

Participants were 80 women aged 40-65 years and divided into two randomly selected groups in training sessions (exercising group, n = 40 and control group, n = 40). SF36 was used to assess the quality of life in both groups before and after 12 weeks. Exercising women participated in training session 3 times a week. Each 60-minute exercise session included warming-up exercises, walking, stretching, strengthening exercises with an elastic band and cooling down exercises.

RESULTS

A non-significant positive difference in all SF36 domains in the exercising group was observed. The results of the study showed a statistically significant higher QoL in the exercising group compared to the control group after 12-week training in two domains: vitality and mental health. The improvement in the quality of life in the study group was 0.19 points (role limits - physical domain, least change) and 4.96 (vitality domain, most change).

CONCLUSIONS

Controlled and regular exercise for 12 weeks was significantly correlated with a positive change in vitality and mental health. Sedentary women should consider modification of their lifestyle to include physical activity as it leads to improvement of their quality of life.

Compounded progesterone: why is it acceptable to Australian women?

OBJECTIVES

To determine factors influencing compounded progesterone products' acceptability amongst Australian women who use them.

STUDY DESIGN

A cross-sectional survey of 366 women from all states of Australia who had been dispensed a compounded progesterone product, using the 'Perspectives on Progesterone' questionnaire.

MAIN OUTCOME MEASURES

Descriptive statistics and a logistic regression model of acceptability. Acceptability was measured by respondents' willingness to recommend progesterone therapy to other women with a similar condition to their own and whether they had talked about their experience to other women.

RESULTS

Australian women who use compounded progesterone tend to be highly educated. They were treating symptoms associated with menopause transition or hormone deficiency. The most common dosage form being used was transdermal cream. More than half the respondents reported improvement for mood swings or irritability (73%), foggy thinking (58%), hot flushes (56%), sleeping problems (55%), and anxiety (54%). Side effects were minimal with the weight gain being the most frequently reported (10%). There was no difference in symptom improvement between those who use progesterone alone or in combination with other hormones. The compounded progesterone acceptability model contains symptom improvement (very large effect size) perception that progesterone is natural and safe (large effect size), number of unexpected benefits (medium effect size) and treatment tailored to suit them (medium effect size). Concerns about other treatments or other treatments being ineffective did not contribute to acceptability.

CONCLUSIONS

Acceptance of compounded progesterone therapy depends on symptom improvement, perception of safety and naturalness and tailored therapy.

Interactive effects of estrogen and serotonin on brain activation during working memory and affective processing in menopausal women

While cognitive changes and mood instability are frequent symptoms reported by menopausal women, the degree to which the decline in estrogen production is responsible is not yet clear. Several lines of evidence suggest that estrogen may produce its effects on cognition and mood through modulation of serotonergic function. To test this hypothesis, we used the tryptophan depletion (TD) paradigm to lower central serotonin levels and pharmacologically manipulated estrogen levels in healthy menopausal women. We examined the individual and combined effects of estradiol and serotonin on working memory, emotion processing and task-related brain activation. Eight healthy predominantly early postmenopausal women underwent TD or sham depletion followed by functional magnetic resonance imaging (fMRI) both before and after short-term transdermal estradiol 75-150 μg/d administration. There was an estradiol treatment by TD interaction for brain activation during performance on both the N-back Task (working memory) and Emotion Identification Task (affective processing). During the 2-back condition, TD attenuated activation prior to, but not after, estradiol treatment in the right and left dorsal lateral prefrontal and middle frontal/cingulate gyrus. During emotion identification, TD heightened activation in the orbital frontal cortex and bilateral amygdala, and this effect was attenuated by estradiol treatment. These results provide preliminary evidence that serotonergic effects directly mediate the impact of estrogen on brain activation during working memory and affective processing.

Physical activity and change in quality of life during menopause--an 8-year follow-up study

Background and objectives

The aim of this study was to study the role of menopausal status and physical activity on quality of life.

Methods

A total of 1,165 Finnish women aged 45-64 years from a national representative population-based study were followed up for 8 years. Study participants completed the Health 2000 study questionnaire and follow-up questionnaire in 2008. Ordinal logistic regression analysis was used to measure the effect of menopausal status on global quality of life (QoL). Other variables included in the analyses were age, education, change of physical activity as assessed with metabolic equivalents, change of weight and hormone therapy (HRT) use.

Results

Peri- and postmenopausal women increased their physical activity (28% and 27%) during the eight-year follow up period slightly more often than premenopausal (18%) women (p = 0.070). Menopausal status was not significantly correlated with change of QoL. QoL of the most highly educated women was more likely to improve than among the less educated (e^b = 1.28, 95%CI 1.08 to 1.51 p = 0.002). Women whose physical activity increased or remained stable had greater chances for improved QoL than women whose physical activity decreased (e^b = 1.49, 95%CI 1.23 p < 0.001 to 1.80, e^b = 1.46, 95%CI 1.24 to 1.73 p < 0.001 respectively). Women whose weight remained stable during follow-up also improved their QoL compared to women who gained weight (e^b = 1.26, 95%CI 1.07 to 1.50 p > 0.01). Women who had never used HRT had 1.26 greater odds for improved QoL (95%CI 1.02 to 1.56 p = < 0.05).

Conclusion

Improvement of global QoL is correlated with stable or increased physical activity, stable weight and high education, but not with change in menopausal status.

"It's my hormones, doctor"--does physical activity help with menopausal symptoms?

OBJECTIVE

Many women experience health problems when going through menopause, and these health problems may result in a substantial reduction in quality of life. There are some indications that physical activity may play a role in ameliorating menopausal symptoms, but there is conflicting evidence about this. To assess the relationship between changes in physical activity and self-reported vasomotor, somatic, and psychological symptoms.

DESIGN

Data from the third (2001) and fourth (2004) surveys of the Australian Longitudinal Study on Women's Health were used. Data from 3,330 middle-aged women were included in the analyses. In linear regression models, the relationships between changes in physical activity of at least moderate intensity and total menopausal, vasomotor, somatic, and psychological symptoms were determined.

RESULTS

Physical activity was not associated with total menopausal symptoms, vasomotor or psychological symptoms. A weak association with somatic symptoms (B = -0.003; 95% CI: -0.005 to -0.001) was found. Weight gain was associated with increased total, vasomotor, and somatic symptoms. Weight loss was associated with a reduction in total and vasomotor symptoms.

CONCLUSION

Changes in physical activity were not related to vasomotor or psychological symptoms and only marginally to somatic symptoms. Changes in weight showed a stronger relationship with menopausal symptoms. The relationship between weight change and menopausal symptoms merits further exploration.

Prevalence of hot flushes and night sweats around the world: a systematic review

OBJECTIVE

Many studies have evaluated the relationships between ethnicity and culture, prevalence of menopausal symptoms, and attitudes toward them, but few have assessed menopausal symptoms across cultures world-wide. This paper aims to systematically review the prevalence of hot flushes and night sweats, two prevalent symptoms of menopause, across the menopausal stages in different cultures and considers potential explanations for differences in prevalence rates.

DESIGN

Sixty-six papers formed the basis for this review. Studies were organized by geographic region, and results are presented for North America, Europe, East Asia, Southeast Asia, Australia, Latin America, South Asia, Middle East, and Africa. Studies were included if they provided quantitative information on the occurrence of hot flushes. This report focuses on hot flushes and night sweats, the most common menopausal symptoms reported in epidemiologic studies.

RESULTS

Studies reviewed indicate that vasomotor symptoms are highly prevalent in most societies. The prevalence of these symptoms varies widely and may be influenced by a range of factors, including climate, diet, lifestyle, women's roles, and attitudes regarding the end of reproductive life and aging. Patterns in hot flush prevalence were apparent for menopausal stages and, to a lesser degree, for regional variation.

CONCLUSIONS

Caregivers should recognize that variations exist and ask patients specific questions about symptoms and their impact on usual functioning.

Estradiol and tryptophan depletion interact to modulate cognition in menopausal women

Despite an abundance of data in animals, there is little research in humans regarding how estrogen and serotonin (5-HT) may interact to influence cognition. Through the use of estrogen treatment (ET) and tryptophan depletion (TRP-D) in a within-subject design involving healthy menopausal women, we have manipulated both estrogen and 5-HT in order to evaluate their individual and joint effects. Although neither manipulation influenced visuospatial learning, a significant interaction suggested that estrogen exerted a protective effect on verbal memory, such that TRP-D impaired performance to a greater extent before the administration of ET. In consonance with this finding, ET was associated with a small, but positive mood effect on the day following active TRP-D. In addition, ET significantly improved letter-cued verbal fluency with and without TRP-D. Finally, time since last menstrual period was significantly associated with verbal memory scores, such that longer length of hypogonadism resulted in decreased verbal memory performance. These data support the interaction of estrogen and 5-HT in nonreproductive behavior in humans as well as highlight the role of ovarian steroids in cognition.

Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: a comprehensive review

Many women experience vasomotor symptoms at or around the time of menopause. Hot flushes and night sweats are considered primary menopausal symptoms that may also be associated with sleep and mood disturbances, as well as decreased cognitive function. All of these symptoms may lead to social impairment and work-related difficulties that significantly decrease overall quality of life. Hot flushes have shown a great deal of variability in their frequency and severity in women. In some women, hot flushes persist for several months; in others, they may last for more than 10 years. Traditionally vasomotor symptoms were reported to begin 5 to 10 years prior to the cessation of the final menstrual cycle, corresponding with the initial decline in circulating gonadal hormones; however, night sweats in particular most often begin in perimenopause. The pathogenesis of hot flushes has not yet been fully elucidated, but the circuitry involving estrogen and neurotransmitters, norepinephrine and serotonin specifically, are hypothesized to play a major role in the altered homeostatic thermoregulatory mechanisms underlying these events.

Menopause-associated vasomotor symptoms are associated with significant direct and indirect costs. Overall costs of traditional pharmacotherapy or complementary and alternative medicine modalities, including over-the-counter treatments and dietary supplements, for managing menopause-related vasomotor symptoms are substantial and include initial and follow-up physician visits and telephone calls. Additional costs include laboratory testing, management of adverse events, loss of productivity at work, and personal and miscellaneous costs. Pharmacoeconomic analyses, including those that consider risks identified by the Women's Health Initiative, generally support the cost-effectiveness of hormonal therapy for menopause-associated vasomotor symptoms, which have been the mainstay for the management of these symptoms for more than 50 years. However, because many women now want to avoid hormone therapy, there is a need for additional targeted therapies, validated by results from controlled clinical trials that are safe, efficacious, cost-effective, and well tolerated by symptomatic menopausal women.