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Zhang T, Wan Y, Geng L. Unraveling the core and bridge menopausal symptoms of perimenopausal women: a network analysis. Menopause 2024:00042192-990000000-00370. [PMID: 39162480 DOI: 10.1097/gme.0000000000002431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
OBJECTIVE Perimenopause is the period from the early menopausal transition to 12 months after the final menstrual period. The clustering of menopausal symptoms poses a challenge for perimenopausal management. Core symptoms are targets for interventions that can alleviate other related symptoms. Bridge symptoms are connectors that link related symptom clusters and can improve the effectiveness of interventions. This study aims to construct a network structure of menopausal symptoms and to identify core and bridge symptoms as a reference for future management. METHODS Two hundred forty-two Chinese perimenopausal women were included in the survey. The structure and associations of the menopausal symptoms assessed by the Greene Climacteric Scale were analyzed using a network analysis. We generated the network structure graph using R software and checked its accuracy and stability. RESULTS In the menopausal transition, the most prevalent symptoms were feeling tired or lacking in energy, excitability, and irritability. Sexual dysfunction was common among early postmenopausal women. Irritability (S = 7.16, C = 0.0167, B = 8) was a core symptom of the network. The depressive symptom cluster was a core symptom cluster, most of which have high centrality indices. Excitability (B = 6) was a bridge symptom connecting the anxiety and depressive symptom clusters. CONCLUSIONS Our study has highlighted the crucial significance of irritability and excitability in perimenopausal management. Overcoming the challenges of perimenopausal management requires the public to ameliorate the prejudice and stigma associated with emotional symptoms.
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Affiliation(s)
| | - Yinglu Wan
- From the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Geng
- From the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Sikes-Keilp C, Rubinow DR. GABA-ergic Modulators: New Therapeutic Approaches to Premenstrual Dysphoric Disorder. CNS Drugs 2023; 37:679-693. [PMID: 37542704 DOI: 10.1007/s40263-023-01030-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
Premenstrual dysphoric disorder (PMDD) is characterized by the predictable onset of mood and physical symptoms secondary to gonadal steroid fluctuation during the luteal phase of the menstrual cycle. Although menstrual-related affective dysfunction is responsible for considerable functional impairment and reduction in quality of life worldwide, currently approved treatments for PMDD are suboptimal in their effectiveness. Research over the past two decades has suggested that the interaction between allopregnanolone, a neurosteroid derivative of progesterone, and the gamma-aminobutyric acid (GABA) system represents an important relationship underlying symptom genesis in reproductive-related mood disorders, including PMDD. The objective of this narrative review is to discuss the plausible link between changes in GABAergic transmission secondary to the fluctuation of allopregnanolone during the luteal phase and mood impairment in susceptible individuals. As part of this discussion, we explore promising findings from early clinical trials of several compounds that stabilize allopregnanolone signaling during the luteal phase, including dutasteride, a 5-alpha reductase inhibitor; isoallopregnanolone, a GABA-A modulating steroid antagonist; and ulipristal acetate, a selective progesterone receptor modulator. We then reflect on the implications of these therapeutic advances, including how they may promote our knowledge of affective regulation more generally. We conclude that these and other studies of PMDD may yield critical insight into the etiopathogenesis of affective disorders, considering that (1) symptoms in PMDD have a predictable onset and offset, allowing for examination of affective state kinetics, and (2) GABAergic interventions in PMDD can be used to better understand the relationship between mood states, network regulation, and the balance between excitatory and inhibitory signaling in the brain.
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Affiliation(s)
- Christopher Sikes-Keilp
- Department of Psychiatry, University of North Carolina Hospitals, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina Hospitals, 101 Manning Drive, Chapel Hill, NC, 27514, USA
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Lu W, Sun Y, Gao H, Qiu J. A review of multi-modal magnetic resonance imaging studies on perimenopausal brain: a hint towards neural heterogeneity. Eur Radiol 2023; 33:5282-5297. [PMID: 36977851 DOI: 10.1007/s00330-023-09549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/05/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
The population ageing process worldwide is leading to an increasing number of women in the perimenopausal phase. Many of the perimenopausal symptoms, such as headache, depression, insomnia, and cognitive decline, are neurological in nature. Therefore, the study of the perimenopausal brain is of great importance. In addition, relevant studies can also provide an imaging basis for multiple therapies to treat perimenopausal symptoms. Because of its non-invasive nature, magnetic resonance imaging (MRI) has now been widely applied to the study of perimenopausal brains, revealing alterations in the brain associated with symptoms during the menopause transition. In this review, we collected papers and works of literature on the perimenopausal brain using MRI techniques in the Web of Science database. We firstly described the general principles and analysis methods of different MRI modalities briefly and then reviewed the structural, functional, perfusion, and metabolic compounds changes in the brain of perimenopausal women respectively, and described the latest advances in probing the perimenopausal brain using MRI, resulting in summary diagrams and figures. Based on the summary of existing works of the literature, this review further provided a perspective on multi-modal MRI studies in the perimenopausal brain, suggesting that population-based, multi-center, and longitudinal studies will be beneficial to the comprehensive understanding of changes in the perimenopausal brain. In addition, we found a hint towards neural heterogeneity in the perimenopausal brain, which should be addressed by future MRI studies to provide more help for the precise diagnosis and personalized treatment of perimenopausal symptoms. KEY POINTS: • Perimenopause is not only a physiological transition but also a period of neurological transition. • Multi-modal MRI studies have revealed that perimenopause is accompanied by alterations in the brain, which is implicated in many perimenopausal symptoms. • The diversity in the multi-modal MRI findings may give a hint to neural heterogeneity in the perimenopausal brain.
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Affiliation(s)
- Weizhao Lu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No. 366 Taishan Street, Taian, 271000, China
| | - Yuanyuan Sun
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, No. 619 Changcheng Road, Taian, 271016, China
| | - Hui Gao
- Department of Gynaecology, Beijing Tian Tan Hospital, Beijing, China
| | - Jianfeng Qiu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No. 366 Taishan Street, Taian, 271000, China.
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Wang XY, Wang LH, Di JL, Zhang XS, Zhao GL. Association of menopausal status and symptoms with depressive symptoms in middle-aged Chinese women. Climacteric 2021; 25:453-459. [PMID: 34783275 DOI: 10.1080/13697137.2021.1998435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aims to examine the association of menopausal status and symptoms with depressive symptoms. METHODS A community-based cross-sectional survey recruited 6745 women aged 40-55 years in the eastern, central and western regions of China in 2018. Menopausal status was categorized into reproductive stage, perimenopause or postmenopause according to the Stages of Reproductive Aging Workshop classification. Menopausal symptoms were determined by the modified Kupperman Menopausal Index and classified as none (total score < 15), mild (15 ≤ total score ≤ 24) or moderate to severe (total score ≥ 25). Logistic regression models were used to examine the associations of menopausal status and symptoms with depressive symptoms assessed by the Patient Health Questionnaire-9. RESULTS The prevalence of depressive symptoms among women in the reproductive stage, perimenopause and postmenopause was 15.4%, 23.9% and 22.8%, respectively. After multivariable adjustment, perimenopause (odds ratio [OR] = 1.21, 95% confidence interval [CI]: 1.01-1.47) and postmenopause (OR = 1.28, 95% CI: 1.04-1.58) were associated with higher risk for depressive symptoms than during the reproductive stage. Mild (OR = 5.55, 95% CI: 4.68-6.59) and moderate-to-severe (OR = 14.77, 95% CI: 10.94-19.94) menopausal symptoms were associated with increased likelihood of depressive symptoms compared to the group reporting no menopausal symptoms. CONCLUSIONS Menopausal status and symptoms were independently associated with the risk of depressive symptoms in middle-aged Chinese women.
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Affiliation(s)
- X Y Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - L H Wang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - J L Di
- National Centre for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - X S Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - G L Zhao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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Musial N, Ali Z, Grbevski J, Veerakumar A, Sharma P. Perimenopause and First-Onset Mood Disorders: A Closer Look. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2021; 19:330-337. [PMID: 34690602 DOI: 10.1176/appi.focus.20200041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Perimenopause is often a time of social, emotional, and physical change. Various factors contribute to the development of mood disorders during this time. There is a known association among women with previous history of major depressive disorder or bipolar disorder and relapse during the menopausal transition. First-onset mood disorders during this time have been less studied. A literature review in PsycInfo Ovid of records pertaining to first-onset mood disorders during perimenopause showed that this multifactorial process involves hormonal fluctuations, with estrogen being a key player. In addition, vasomotor symptoms, previous negative life events, and socioeconomic status were found to contribute to first-onset mood disorders during perimenopause. Treatment options include established medication regimens for psychiatric conditions; however, hormone therapy also has proven beneficial for this patient population. Further research, particularly on bipolar disorder, is needed to develop a clear association between perimenopause and first-onset mood disorders.
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Affiliation(s)
- Natalie Musial
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Zinnia Ali
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Jennifer Grbevski
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Ashan Veerakumar
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Priya Sharma
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Ontario, Canada
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Fu JX, Luo Y, Chen MZ, Zhou YH, Meng YT, Wang T, Qin S, Xu C. Associations among menopausal status, menopausal symptoms, and depressive symptoms in midlife women in Hunan Province, China. Climacteric 2020; 23:259-266. [DOI: 10.1080/13697137.2019.1703936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J.-X. Fu
- Xiangya Nursing School of Central South University, Changsha, China
| | - Y. Luo
- Xiangya Nursing School of Central South University, Changsha, China
| | - M.-Z. Chen
- Xiangya Nursing School of Central South University, Changsha, China
| | - Y.-H. Zhou
- Xiangya Nursing School of Central South University, Changsha, China
| | - Y.-T. Meng
- Xiangya Nursing School of Central South University, Changsha, China
| | - T. Wang
- Xiangya Nursing School of Central South University, Changsha, China
| | - S. Qin
- Xiangya Nursing School of Central South University, Changsha, China
| | - C. Xu
- Xiangya Nursing School of Central South University, Changsha, China
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Kranz GS, Seiger R, Kaufmann U, Hummer A, Hahn A, Ganger S, Tik M, Windischberger C, Kasper S, Lanzenberger R. Effects of sex hormone treatment on white matter microstructure in individuals with gender dysphoria. Neuroimage 2017; 150:60-67. [DOI: 10.1016/j.neuroimage.2017.02.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/02/2016] [Accepted: 02/10/2017] [Indexed: 11/28/2022] Open
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Near-Infrared Spectroscopy Reveals Abnormal Hemodynamics in the Left Dorsolateral Prefrontal Cortex of Menopausal Depression Patients. DISEASE MARKERS 2017; 2017:1695930. [PMID: 28293062 PMCID: PMC5331417 DOI: 10.1155/2017/1695930] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/05/2017] [Accepted: 01/23/2017] [Indexed: 12/14/2022]
Abstract
Background/Objective. Menopausal depression (MD) is characterized by depressive symptoms along with hormonal fluctuations. We investigate brain function alteration between major depressive disorder (MDD) and MD. Methods. The difference in oxygenated hemoglobin (Oxy-Hb) for the prefrontal cortex (PFC) was compared retrospectively among 90 females presented with 30 MDD, 30 MD, and 30 healthy controls (HCs) using verbal fluency task (VFT) with near-infrared spectroscopy (NIRS). Results. We observed a significant difference in Oxy-Hb alteration in the left dorsolateral PFC (DLPFC) using VFT with NIRS (channel 18, P = 0.007) between the MD and MDD groups. A significant difference in Oxy-Hb levels was observed among the three groups in the bilateral DLPFC (channels 18, 27, 33, 39, 41, and 45; P < 0.05). Compared to the HCs, the MD group presented lower Oxy-Hb activation in the right DLPFC (channel 41; P = 0.048) and the left DLPFC (channels 18, 39, and 45; P < 0.05), and the MDD group presented lower Oxy-Hb activation in the right DLPFC (channels 27, 33, and 41; P < 0.05) and the left DLPFC (channels 39 and 45; P < 0.05). Conclusion. Abnormal hemodynamics of the left DLPFC can differentiate MD from MDD by NIRS.
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Plasma DNA Mediate Autonomic Dysfunctions and White Matter Injuries in Patients with Parkinson's Disease. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:7371403. [PMID: 28232858 PMCID: PMC5292395 DOI: 10.1155/2017/7371403] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/08/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022]
Abstract
Background. Cardiovascular autonomic dysfunction is well known in Parkinson's disease (PD) presentation and it produces hypoperfusion of vital organs. The association between cardiovascular autonomic dysfunction and oxidative stress was examined in previous animal models. Oxidative stress and neuroinflammation were thought to have roles in PD pathogenesis. Owing to the relative low intrinsic antioxidative properties, brain white matter (WM) is vulnerable to the oxidative stress. This study is conducted to examine possible relationships by using a hypothesis-driven mediation model. Methods. Twenty-nine patients with PD and 26 healthy controls participated in this study, with complete examinations of cardiac autonomic parameters, plasma DNA level, and WM integrity. A single-level three-variable mediation model was used to investigate the possible relationships. Results. The elevated serum oxidative stress biomarkers include plasma nuclear DNA and mitochondrial DNA, and poorer cardiac autonomic parameters and multiple regional microstructural WM changes are demonstrated. Further mediation analysis shows that plasma nuclear DNA served as the mediators between poorer baroreflex sensitivity and mean diffusivity changes in cingulum. Conclusions. These results provide a possible pathophysiology for how the poor baroreflex sensitivity and higher oxidative stress adversely impacted the WM integrity. This model could provide us with a piece of the puzzle of the entire PD pathogenesis.
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Tao J, Wang X, Zhong Z, Han H, Liu S, Wen S, Guan N, Li L. Alterations of white matter fractional anisotropy in unmedicated obsessive-compulsive disorder. Neuropsychiatr Dis Treat 2017; 13:69-76. [PMID: 28096674 PMCID: PMC5207449 DOI: 10.2147/ndt.s123669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Abnormalities in white matter (WM) have previously been reported in patients with obsessive-compulsive disorder (OCD). However, there was some inconsistency in the results obtained for altered regions of WM. The aim of this study was to investigate fractional anisotropy (FA) in the WM of the whole brain in patients with OCD by using diffusion tensor imaging (DTI). METHODS In total, 28 unmedicated patients with OCD and 28 healthy volunteers underwent DTI scan. A voxel-based analysis was used to compare FA values in WM of the two groups at a voxel threshold of P<0.005 with an extent threshold of k>72 voxels (P<0.05; Alphasim correction). Subsequently, correlation analysis was conducted in order to find the correlation between the mean FA values in significantly altered brain regions and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores of the OCD patients. RESULTS Compared with healthy volunteers, the OCD patients had lower FA value in the left lingual gyrus, right midbrain, and right precuneus. There were no regions with significantly higher FA values in OCD patients compared with healthy volunteers. The mean FA values in the above regions (left lingual, r=0.019, P=0.923; right midbrain, r=-0.208, P=0.289; and right precuneus, r=-0.273, P=0.161) had no significant correlation with the Y-BOCS scores of the OCD patients. CONCLUSION The findings of this study suggest that alterations in WM of the left lingual gyrus, right midbrain, and right precuneus are associated with the pathophysiology mechanism of OCD, and these microstructural alterations do not correlate with symptom severity of OCD.
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Affiliation(s)
- Jiong Tao
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha; Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University
| | - Xianglan Wang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University
| | - Zhiyong Zhong
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha; Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University
| | - Hongying Han
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University
| | - Sha Liu
- Department of Radiology, Guangzhou Huiai Hospital, Guangzhou
| | - Shenglin Wen
- Department of Psychiatry, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Nianhong Guan
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University
| | - Lingjiang Li
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha
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