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Hurtado MD, Saadedine M, Kapoor E, Shufelt CL, Faubion SS. Weight Gain in Midlife Women. Curr Obes Rep 2024; 13:352-363. [PMID: 38416337 PMCID: PMC11150086 DOI: 10.1007/s13679-024-00555-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW To summarize the evidence and clinical implications of weight and body composition changes during midlife in women and provide an overview of weight gain prevention and management in this population. RECENT FINDINGS Aging-related changes such as decreased energy expenditure and physical activity are important culprits for weight gain in midlife women. The hormonal changes of menopause also influence body adiposity distribution and increase central adiposity. These body changes can have health consequences including the development of cardiometabolic diseases, osteoarthritis, cancer, worsening in cognition, mental health, and menopause symptoms. Midlife women experience changes related to aging, menopause, and lifestyle which favor weight gain. Clinical practice should focus on early counseling and anticipatory guidance on the importance of dietary changes and physical activity to attenuate this phenomenon. Future research should focus on the longitudinal relationship between weight trends in midlife and health consequences and mortality.
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Affiliation(s)
- Maria D Hurtado
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mariam Saadedine
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
- Mayo Clinic Center for Women's Health, Rochester, MN, USA
| | - Ekta Kapoor
- Mayo Clinic Center for Women's Health, Rochester, MN, USA
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Women's Health Research Center, Mayo Clinic, Rochester, MN, USA
| | - Chrisandra L Shufelt
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
- Mayo Clinic Center for Women's Health, Rochester, MN, USA
| | - Stephanie S Faubion
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA.
- Mayo Clinic Center for Women's Health, Rochester, MN, USA.
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2
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Babadi RS, Williams PL, Preston EV, Li Z, Smith RL, Strakovsky RS, Mahalingaiah S, Hauser R, Flaws JA, James-Todd T. Phthalates and sex steroid hormones across the perimenopausal period: A longitudinal analysis of the Midlife Women's Health Study. ENVIRONMENT INTERNATIONAL 2024; 188:108770. [PMID: 38821016 DOI: 10.1016/j.envint.2024.108770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND The menopausal transition involves significant sex hormone changes. Environmental chemicals, such as urinary phthalate metabolites, are associated with sex hormone levels in cross-sectional studies. Few studies have assessed longitudinal associations between urinary phthalate metabolite concentrations and sex hormone levels during menopausal transition. METHODS Pre- and perimenopausal women from the Midlife Women's Health Study (MWHS) (n = 751) contributed data at up to 4 annual study visits. We quantified 9 individual urinary phthalate metabolites and 5 summary measures (e.g., phthalates in plastics (∑Plastic)), using pooled annual urine samples. We measured serum estradiol, testosterone, and progesterone collected at each study visit, unrelated to menstrual cycling. Linear mixed-effects models and hierarchical Bayesian kernel machine regression analyses evaluated adjusted associations between individual and phthalate mixtures with sex steroid hormones longitudinally. RESULTS We observed associations between increased concentrations of certain phthalate metabolites and lower testosterone and higher sub-ovulatory progesterone levels, e.g., doubling of monoethyl phthalate (MEP), monobenzyl phthalate (MBzP), di-2-ethylhexyl phthalate (∑DEHP) metabolites, ∑Plastic, and ∑Phthalates concentrations were associated with lower testosterone (e.g., for ∑DEHP: -4.51%; 95% CI: -6.72%, -2.26%). For each doubling of MEP, certain DEHP metabolites, and summary measures, we observed higher mean sub-ovulatory progesterone (e.g., ∑AA (metabolites with anti-androgenic activity): 6.88%; 95% CI: 1.94%, 12.1%). Higher levels of the overall time-varying phthalate mixture were associated with lower estradiol and higher progesterone levels, especially for 2nd year exposures. CONCLUSIONS Phthalates were longitudinally associated with sex hormone levels during the menopausal transition. Future research should assess such associations and potential health impacts during this understudied period.
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Affiliation(s)
- Ryan S Babadi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paige L Williams
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Emma V Preston
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zhong Li
- Roy J. Carver Biotechnology Center, University of Illinois, Urbana, IL, USA
| | - Rebecca L Smith
- Department of Pathobiology, Institute for Genomic Biology, and Carle Illinois College of Medicine, University of Illinois, Urbana, IL, USA
| | - Rita S Strakovsky
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA; Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, USA
| | - Shruthi Mahalingaiah
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jodi A Flaws
- Department of Comparative Biosciences, University of Illinois, Urbana, IL, USA; Institute for Genomic Biology, University of Illinois, Urbana, IL, USA
| | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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3
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Nichols AR, Chavarro JE, Oken E. Reproductive risk factors across the female lifecourse and later metabolic health. Cell Metab 2024; 36:240-262. [PMID: 38280383 PMCID: PMC10871592 DOI: 10.1016/j.cmet.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/08/2023] [Accepted: 01/05/2024] [Indexed: 01/29/2024]
Abstract
Metabolic health is characterized by optimal blood glucose, lipids, cholesterol, blood pressure, and adiposity. Alterations in these characteristics may lead to the development of type 2 diabetes mellitus or dyslipidemia. Recent evidence suggests that female reproductive characteristics may be overlooked as risk factors that contribute to later metabolic dysfunction. These reproductive traits include the age at menarche, menstrual irregularity, the development of polycystic ovary syndrome, gestational weight change, gestational dysglycemia and dyslipidemia, and the severity and timing of menopausal symptoms. These risk factors may themselves be markers of future dysfunction or may be explained by shared underlying etiologies that promote long-term disease development. Disentangling underlying relationships and identifying potentially modifiable characteristics have an important bearing on therapeutic lifestyle modifications that could ease long-term metabolic burden. Further research that better characterizes associations between reproductive characteristics and metabolic health, clarifies underlying etiologies, and identifies indicators for clinical application is warranted in the prevention and management of metabolic dysfunction.
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Affiliation(s)
- Amy R Nichols
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Emily Oken
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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4
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Anagnostis P, Stevenson JC. Cardiovascular health and the menopause, metabolic health. Best Pract Res Clin Endocrinol Metab 2024; 38:101781. [PMID: 37183085 DOI: 10.1016/j.beem.2023.101781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Estrogen depletion following menopause predisposes to increased risk of cardiovascular disease (CVD), mainly due to ischemic heart disease. This is mostly evident in cases with premature menopause. The pathophysiological basis for this atherosclerotic process is the accumulation of several risk factors, such as abdominal obesity, atherogenic dyslipidemia, insulin resistance and arterial hypertension. The presence of vasomotor symptoms may further augment this risk, especially in women younger than 60 years. Menopausal hormone therapy (MHT) exerts many beneficial effects on lipid profile and glucose homeostasis as well as direct arterial effects, and may reduce CVD risk if initiated promptly (i.e.,<60 years or within ten years of the final menstrual period). Transdermal estradiol and micronized progesterone or dydrogesterone are the safest regimens in terms of venous thromboembolic events (VTE) and breast cancer risk. In any case, an individualized approach, taking into account the patient's total CVD, VTE and breast cancer risk, is recommended.
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Affiliation(s)
- Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - John C Stevenson
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 6NP, UK.
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5
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Witten T, Staszkiewicz J, Gold L, Granier MA, Klapper RJ, Lavespere G, Dorius B, Allampalli V, Ahmadzadeh S, Shekoohi S, Kaye AD, Varrassi G. Nonhormonal Pharmacotherapies for the Treatment of Postmenopausal Vasomotor Symptoms. Cureus 2024; 16:e52467. [PMID: 38371081 PMCID: PMC10870088 DOI: 10.7759/cureus.52467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
An average of 60-80% of all menopausal women experience bothersome vasomotor symptoms (VMSs), such as flushing and sweating, within the first seven years of onset. However, despite increasing prevalence, these hot flashes remain hard to treat and have a negative effect on the quality of life. Though hormone replacement therapy is commonly utilized as a standard treatment for VMSs, this therapy is not recommended for all women. Specifically, the oral form of hormone replacement therapy is associated with several contraindications, including a history of thromboembolic disease, migraine headache with aura, liver failure, heart disease, and hormone-dependent cancers. For women with these medical conditions, current literature indicates that nonhormonal therapies such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are suitable alternatives to reduce the frequency and intensity of VMSs. Currently, the only SSRI that is FDA-approved for the treatment of VMSs is paroxetine, but studies show that fluoxetine, citalopram, escitalopram, and sertraline are also proven to provide similar benefits. Similarly, the SNRI venlafaxine has also been well tolerated and has been shown to reduce the frequency and severity of hot flashes. The present investigation reviews the physiology of VMSs and examines the evidence for the use of nonhormonal pharmacologic therapies as treatment for women experiencing hot flashes. These interventions should be considered whenever hormone replacement therapy is contraindicated, with therapy individualized based on the severity of symptoms.
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Affiliation(s)
- Taylor Witten
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Julia Staszkiewicz
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Logan Gold
- School of Medicine, Louisiana State University Health New Orleans, New Orleans, USA
| | - Mallory A Granier
- School of Medicine, Louisiana State University Health New Orleans, New Orleans, USA
| | - Rachel J Klapper
- Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Gabriel Lavespere
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Bradley Dorius
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Varsha Allampalli
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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Abstract
PURPOSE OF REVIEW Vasomotor symptoms are frequently experienced by women during menopause and have been linked to obesity. Severity of menopausal symptoms is a distinct construct from presence of symptoms, and the relation between severity of symptoms and obesity is less established. The purpose of this brief narrative review was to summarize evidence from recent studies on associations between menopausal symptom severity and measures of obesity. RECENT FINDINGS Sixteen articles were identified that specifically assessed and reported on the severity of menopausal symptoms in relation to measures of obesity including body mass index (BMI), waist circumference, and waist-to-hip ratio. Most studies to date show that greater BMI, waist size, and waist-to-hip ratio are associated with greater severity of menopausal symptoms. Given the large segment of women who will experience symptoms and that severity of symptoms influences treatment decisions, future studies are needed to determine how weight management efforts may reduce the severity of menopausal symptoms.
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Affiliation(s)
- Vivian Cao
- Touro College of Osteopathic Medicine, New York, NY, USA
| | - Alisha Clark
- Touro College of Osteopathic Medicine, New York, NY, USA
| | - Brooke Aggarwal
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
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Hutchings HA, Taylor N, Remesh A, Rafferty J. A study evaluating quality of life and factors affecting it before, during and after menopause. Eur J Obstet Gynecol Reprod Biol 2023; 289:100-107. [PMID: 37657139 DOI: 10.1016/j.ejogrb.2023.08.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/31/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE To determine if quality of life (QoL) changes before, during and after menopause and whether these changes are linked to symptoms, demographics, and/or lifestyle factors. METHODS We undertook a cross-sectional online survey. We invited women aged between 35 and 60Â years to complete the survey which included the Short-Form 36 (SF-36) generic quality of life measure, the menopause specific Utian-Quality of life (UQOL) measure, and questions about health and wellbeing, menopause symptoms and hormonal stage. The data were analysed with one-way ANOVA analysis and multivariate regression modelling. RESULTS 279 women completed the survey. Most were aged between 51 and 55Â years. In the unadjusted analysis there was a tendency for QoL to deteriorate from pre to peri to menopause and then increase slightly post menopause. This was however not significant in multivariate analysis. Multivariate analysis identified that lifestyle factors significantly influenced QoL. Regular exercise resulted in better QoL scores across a number of the UQol and SF-36 sub-scales. Being very overweight and having more menopause symptoms resulted in worse QoL. CONCLUSIONS Although there was a trend towards worse quality of life in the peri and menopause stages this was not significantly different in adjusted multivariate analyses. Those experiencing more symptoms had significantly worse QoL. Lifestyle factors may affect QoL, but the picture is not straightforward. It is promising that there was a trend toward improved QoL in the post-menopausal stage. These findings should inform education material and promote awareness of the menopause and its impact on QoL. (245).
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Affiliation(s)
- Hayley A Hutchings
- School of Medicine, Faculty of Medicine, Health and Life Science, Swansea University, Swansea University, Singleton Park, SA2 8PP, Wales.
| | - Nia Taylor
- School of Medicine, Faculty of Medicine, Health and Life Science, Swansea University, Swansea University, Singleton Park, SA2 8PP, Wales
| | - Anagha Remesh
- School of Medicine, Faculty of Medicine, Health and Life Science, Swansea University, Swansea University, Singleton Park, SA2 8PP, Wales
| | - James Rafferty
- School of Medicine, Faculty of Medicine, Health and Life Science, Swansea University, Swansea University, Singleton Park, SA2 8PP, Wales
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8
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Keye C, Varley J, Patton D. The impact of menopause education on quality of life among menopausal women: a systematic review with meta-analysis. Climacteric 2023; 26:419-427. [PMID: 37477236 DOI: 10.1080/13697137.2023.2226318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 07/22/2023]
Abstract
A systematic review with meta-analysis was conducted to establish the impact of menopause health education on quality of life (QoL) among menopausal women. Research suggests that specific educational programs can support and enable women during the physical and emotional transition through menopause. The CINAHL, Medline, APA, Embase and Google Scholar databases were searched between 30 November 2021 and 9 January 2022 using the PRISMA guidelines. The Cochrane risk of bias tool was used to critically evaluate the included studies. Review Manager software was used to conduct the meta-analysis of suitable studies. Eight papers were eligible for this review. The participants were aged between 40 and 60 years, with diagnosis of menopause stemming from changes in the menstrual cycle to a last menstrual period of 7 years. Follow-up data were collected between 1 and 4 months post education. Meta-analysis of both the primary outcome (QoL) and secondary outcome (symptom control) demonstrated statistically significant improvements post intervention. Papers not suitable for meta-analysis were reviewed narratively; two papers assessing the primary outcome (QoL) demonstrated an improvement, but only one to a statistically significant level. Secondary outcomes revealed improvements, with all bar one paper doing so to statistical significance. Menopause health education demonstrated an improvement in both QoL and symptom control in menopausal women; however, given some weaknesses in the included studies, further research is justified. Limitations include participants' level of education, geographical location, risk of bias, that only half of the papers addressed participant use of hormone replacement therapy and length of follow-up.
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Affiliation(s)
- C Keye
- RCSI School of Nursing and Midwifery, Dublin, Ireland
| | - J Varley
- RCSI School of Nursing and Midwifery, Dublin, Ireland
| | - D Patton
- RCSI School of Nursing and Midwifery, Dublin, Ireland
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9
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Opoku AA, Abushama M, Konje JC. Obesity and menopause. Best Pract Res Clin Obstet Gynaecol 2023:102348. [PMID: 37244787 DOI: 10.1016/j.bpobgyn.2023.102348] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/30/2023] [Indexed: 05/29/2023]
Abstract
The global obesity pandemic continues to rise, with figures from the World Health Organization showing that 13% of the world's adult population was obese in 2016. Obesity has significant implications, with an increased risk of cardiovascular diseases, diabetes mellitus, metabolic syndrome, and several malignancies. The menopausal transition is associated with increased obesity, a transition from a gynecoid to an android body shape, and increased abdominal and visceral fat, which further worsens the associated cardiometabolic risks. Whether this increased obesity is a consequence of menopause, age, genetics, or environmental factors has long been debated. Increasing life expectancy means women spend a significant part of their lives in the menopause. As such, understanding this complex interplay of obesity and menopause is important to providing the right advice/management. We review the current evidence on obesity and menopause, focusing on the implications of increased obesity during menopause, the impact of menopause on obesity, and the effect of available treatments on associated morbidities.
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Affiliation(s)
- Albert A Opoku
- Consultant Obstetrician and Gynecologist, Hamad Medical Corporation, Al Wakra Hospital, P O Box 82228, Al Wakra, Qatar; Assistant Professor in Clinical Obstetrics and Gynecology, Weill Cornell, Medicine, P O Box 24144, Doha, Qatar.
| | - Mandy Abushama
- Assistant Professor in Clinical Obstetrics and Gynecology, Weill Cornell Medicine, Qatar; Senior Consultant Obstetrician and Gynecologist, Feto Maternal Center, Al Markhiya, Doha, Qatar.
| | - Justin C Konje
- Senior Consultant Obstetrician and Gynecologist, Feto Maternal Center, Al Markhiya, Doha, Qatar; Professor of Obstetrics and Gynecology, Weill Cornell Medicine, Qatar; Emeritus Professor, Obstetrics and Gynecology, Department of Health Sciences, University of Leicester, United Kingdom.
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Zhang T, Yue Y, Jeong SJ, Ryu MS, Wu X, Yang HJ, Li C, Jeong DY, Park S. Improvement of Estrogen Deficiency Symptoms by the Intake of Long-Term Fermented Soybeans (Doenjang) Rich in Bacillus Species through Modulating Gut Microbiota in Estrogen-Deficient Rats. Foods 2023; 12:foods12061143. [PMID: 36981070 PMCID: PMC10048008 DOI: 10.3390/foods12061143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Traditionally made doenjang (TMD) produced by the long-term fermentation of soybeans with salt may improve symptoms of estrogen deficiency. We aimed to evaluate the effects of four TMD types, containing low and high amounts of Bacillus species and biogenic amines (HBHA, HBLA, LBHA, and LBLA), on energy, glucose, and lipid metabolism, by altering the gut microbiota in estrogen-deficient ovariectomized (OVX) rats. Their mechanisms were also examined. The OVX rats were divided into the control, cooked soybean (CSB), HBHA, LBHA, HBLA, and LBLA groups. Sham-operated rats were the normal control group. Serum 17β-estradiol concentrations were similar among all OVX groups. Tail skin temperatures, which are indicative of hot flashes, were higher in the control than the HBHA and HBLA groups and were similar to the normal control group. Weight gain and visceral fat mass were lower in the TMD and CSB intake groups but not as low as in the normal control group. Lean body mass showed a trend opposite to that of visceral fat in the respective groups. The hepatic triglyceride content decreased with the TMD intake compared to the control and CSB groups. mRNA expressions of the peroxisome proliferator-activated receptor-γ (PPAR-γ) and carnitine palmitoyltransferase-1 in the TMD and CSB groups were as high as in the normal control group, and the PPAR-γ mRNA expression was more elevated in the HBLA group than in the normal control group. The morphology of the intestines improved in the TMD groups compared to the control, and the HBHA and HBLA groups showed an enhanced improvement compared to the CSB group. The HBHA, HBLA, and LBHA groups increased the α-diversity of the cecal microbiota compared to the control. Akkermenia and Lactobacillus were higher in the HBLA and LBLA groups compared to the control. The expression of the estrogen, forkhead box proteins of the class-O subgroup, and insulin-signaling pathways were lower in the control group, and HBHA and HBLA prevented their decrement. In conclusion, long-term treatment with TMD containing high amounts of Bacillus potentially improves estrogen deficiency symptoms more than unfermented soybeans.
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Affiliation(s)
- Ting Zhang
- Department of Bioconvergence, Hoseo University, 20 hoseoro79bun-gil, Baebang-yup, Asan 31499, Republic of Korea
| | - Yu Yue
- Obesity/Diabetes Research Center, Department of Food and Nutrition, Hoseo University, Asan 31499, Republic of Korea
| | - Su-Ji Jeong
- Sunchang Research Center for Fermentation Microbes, Department of R & D, Microbial Institute for Fermentation Industry, 61-27 Minsokmaeul-gil, Sunchang-Gun 56048, Republic of Korea
| | - Myeong-Seon Ryu
- Sunchang Research Center for Fermentation Microbes, Department of R & D, Microbial Institute for Fermentation Industry, 61-27 Minsokmaeul-gil, Sunchang-Gun 56048, Republic of Korea
| | - Xuangao Wu
- Department of Bioconvergence, Hoseo University, 20 hoseoro79bun-gil, Baebang-yup, Asan 31499, Republic of Korea
| | - Hee-Jong Yang
- Sunchang Research Center for Fermentation Microbes, Department of R & D, Microbial Institute for Fermentation Industry, 61-27 Minsokmaeul-gil, Sunchang-Gun 56048, Republic of Korea
| | - Chen Li
- Obesity/Diabetes Research Center, Department of Food and Nutrition, Hoseo University, Asan 31499, Republic of Korea
| | - Do-Youn Jeong
- Sunchang Research Center for Fermentation Microbes, Department of R & D, Microbial Institute for Fermentation Industry, 61-27 Minsokmaeul-gil, Sunchang-Gun 56048, Republic of Korea
| | - Sunmin Park
- Department of Bioconvergence, Hoseo University, 20 hoseoro79bun-gil, Baebang-yup, Asan 31499, Republic of Korea
- Obesity/Diabetes Research Center, Department of Food and Nutrition, Hoseo University, Asan 31499, Republic of Korea
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Khan SJ, Kapoor E, Faubion SS, Kling JM. Vasomotor Symptoms During Menopause: A Practical Guide on Current Treatments and Future Perspectives. Int J Womens Health 2023; 15:273-287. [PMID: 36820056 PMCID: PMC9938702 DOI: 10.2147/ijwh.s365808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/18/2023] [Indexed: 02/16/2023] Open
Abstract
Vasomotor symptoms affect as many as 80% of midlife women, but only about one in four women receive treatment due to many factors. Menopausal hormone therapy remains the most effective treatment for vasomotor symptoms, and current professional guidelines conclude that the benefits of treatment typically outweigh the risks for healthy, symptomatic women under age 60 years and those within 10 years from their final menstrual period. For women with medical comorbidities, an individualized approach to treatment is recommended. For women who cannot use or choose not to use menopausal hormone therapy, there are many evidence-based non-hormonal options available including pharmacologic therapies. This review aims to summarize treatment options for bothersome vasomotor symptoms to guide clinicians caring for midlife women.
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Affiliation(s)
- Saira J Khan
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Ekta Kapoor
- Mayo Clinic Women’s Health, Rochester, MN, USA,Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA,Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Stephanie S Faubion
- Mayo Clinic Women’s Health, Rochester, MN, USA,Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Juliana M Kling
- Mayo Clinic Women’s Health, Rochester, MN, USA,Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA,Correspondence: Juliana M Kling, Division of Women’s Health Internal Medicine, Mayo Clinic, 13737 N 92 23 nd St, Scottsdale, AZ, 85260, USA, Tel +1-480-614-6001, Fax +1-480-614-6021, Email
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12
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Sreenivas SB, Kashyap PB. Effects of Obesity on Severity of Menopausal Symptoms in Urban and Rural Women. J Midlife Health 2022; 13:304-309. [PMID: 37324786 PMCID: PMC10266575 DOI: 10.4103/jmh.jmh_220_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/05/2023] [Accepted: 01/25/2023] [Indexed: 06/17/2023] Open
Abstract
Background According to the WHO, obesity is an epidemic and is quantified by obesity indices. Menopause is a crucial period with a tendency toward weight gain and has profound implications on the morbidity and mortality of women. This study provides a greater insight into the aggravating adverse effects of obesity on the lifestyles of urban and rural women during their menopausal phase. Hence, this cross-sectional study aims at analyzing the effects of obesity indices on the severity of menopausal symptoms in urban and rural women. Objectives 1. To compare the obesity indices in rural and urban women and to study the severity of menopausal symptoms in them. 2. To assess the influence of the area and body mass index (BMI) on menopausal symptoms. Materials and Methods This cross-sectional study comprised 120 women, of which 60 healthy women volunteers between the age group of 40 and 55 years from the urban area and 60 age-matched healthy women volunteers from the rural area were recruited. The sample size was calculated based on stratified random sampling. After obtaining informed consent anthropometric measurements were recorded and the Menopausal Rating Scale was used for assessing the severity of menopausal symptoms. Results A positive correlation was observed between the severity of menopausal symptoms and BMI as well as waist circumference in urban women. The problems related to menopausal symptoms were milder in rural women. Conclusions Our study concludes that obesity worsens the severity of several menopausal symptoms which is greater among obese urban women owing to the urban lifestyle and increased stress levels.
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Affiliation(s)
| | - Pranav Balaji Kashyap
- Department of Physiology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
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Factors of Obesity and Metabolically Healthy Obesity in Asia. Medicina (B Aires) 2022; 58:medicina58091271. [PMID: 36143948 PMCID: PMC9500686 DOI: 10.3390/medicina58091271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/14/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
The East Asian region (China, Japan, and South Korea) is comprised of almost 1.5 billion people and recent industrialization has brought with it a pandemic of rising obesity, even in children. As these countries are rapidly aging and functioning at sub-replacement birthrates, the burgeoning costs of obesity-related care may threaten socialized healthcare systems and quality of life. However, a condition called metabolically healthy obesity (MHO) has been found to be without immediate cardiopulmonary or diabetic risk. Thus, maintenance of the MHO condition for the obese in East Asia could buffer the burden of long-term obesity care on medical systems and knowledge of the biochemical, genetic, and physiological milieu associated with it could also provide new targets for intervention. Diverse physiological, psychological, environmental, and social factors play a role in obesogenesis and the transition of MHO to a metabolically unhealthy obesity. This review will give a broad survey of the various causes of obesity and MHO, with special emphasis on the East Asian population and studies from that region.
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Depressive symptoms and suicidality by menopausal stages among middle-aged Korean women. Epidemiol Psychiatr Sci 2022; 31:e60. [PMID: 36017644 PMCID: PMC9428901 DOI: 10.1017/s2045796022000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS There has been increasing evidence of hormonal changes during reproductive events that lead to mood changes. However, studies on the severity of psychological problems according to the menopausal stage are limited. Thus, this study aimed to investigate the association between menopausal stages, depression and suicidality. METHODS A total of 45 177 women who underwent regular health check-ups between 2015 and 2018 at Kangbuk Samsung Hospital were included. Participants were stratified into four groups (pre-menopause, early transition, late transition and post-menopause) based on the Stages of Reproductive Aging Workshop Criteria. The Center for Epidemiological Studies-Depression scale (CESD) was used to evaluate depressive symptoms, and the degree of depressive symptoms was classified as moderate (CESD score 16-24) or severe (CESD score ⩾ 25). To measure suicide risk, we administered questionnaires related to suicidal ideation. RESULTS Overall, the prevalence of CESD scores of 16-24 and ⩾ 25 was 7.6 and 2.8%, respectively. Menopausal stages were positively associated with depressive symptoms in a dose-dependent manner. Multivariable-adjusted prevalence ratios (PRs, 95% confidence intervals) for CESD scores of 16-24 comparing the stages of the early menopausal transition (MT), late MT and post-menopause to pre-menopause was 1.28 (1.16-1.42), 1.21 (1.05-1.38) and 1.58 (1.36-1.84), respectively. The multivariable-adjusted PRs for CESD scores ⩾ 25 comparing the stages of the early MT, late MT and post-menopause to pre-menopause were 1.31 (1.11-1.55), 1.39 (1.12-1.72), 1.86 (1.47-2.37), respectively. In addition, the multivariable-adjusted PRs for suicidal ideation comparing the early MT, late MT and post-menopause stages to the pre-menopause stage were 1.24 (1.12-1.38), 1.07 (0.93-1.24) and 1.46 (1.25-1.70) (p for trend <0.001), respectively. CONCLUSIONS These findings indicate that the prevalence of depressive symptoms and suicidal ideation increases with advancing menopausal stage, even pre-menopause.
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Chou HF, Weng LC, Wang Y. Exploring physical activity behavior in middle-aged Taiwanese women based on the theory of planned behavior. Women Health 2022; 62:603-611. [DOI: 10.1080/03630242.2022.2098893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Hsueh-Fen Chou
- Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Li-Chueh Weng
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan
| | - Yafen Wang
- College of Nursing, Kent State University, Kent, Ohio, USA
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Nagaraj D, Ramesh N, Devraj D, Umman M, John AK, Johnson AR. Experience and Perceptions Regarding Menopause among Rural Women: A Cross-Sectional Hospital-Based Study in South Karnataka. J Midlife Health 2021; 12:199-205. [PMID: 34759701 PMCID: PMC8569466 DOI: 10.4103/jmh.jmh_196_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/26/2020] [Accepted: 08/31/2021] [Indexed: 12/05/2022] Open
Abstract
Background: There is a culture of silence around menopause in India, more so among rural women. This study was conducted to assess the prevalence of menopausal symptoms, factors associated with the severity of menopausal symptoms, and perceptions regarding menopause among rural perimenopausal women. Methodology: A cross-sectional study was conducted at a rural hospital, among women aged 40 years or more, having experienced at least one menstrual cycle in the past 1 year. Structured interview schedule was administered to capture perceptions of menopause. Symptoms of menopause and severity were assessed using the Menopause Rating Scale (MRS) and participants screened for depression using patient health questionnaire-9. Results: Among 200 women, the prevalence of symptoms of menopause was 70%. Commonly reported symptoms were somatic symptoms: Joint/muscular pain, hot flushes, and psychological symptoms: Physical/mental exhaustion, anxiety. Median overall MRS score was low (4 [interquartile range = 1, 7]), pointing out to lesser severity. Significant association was found between MRS score and higher body mass index (P = 0.007), tobacco-chewing (P = 0.023), and depression (P < 0.001). Perception of menopause was generally positive, but we also documented some myths and misconceptions regarding menopause that indicate a need for health awareness in this population. Conclusion: This study found high prevalence but low severity of menopausal symptoms. Our findings point to a need for mitigating symptoms of menopause through diet, physical activity, tobacco cessation, and counseling for depression. Targeted interventions using community women's groups and village-level health workers are recommended to provide not only awareness regarding menopause but also an opportunity to screen for comorbidities with appropriate referrals.
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Affiliation(s)
- Deepika Nagaraj
- Department of Community Medicine, St. John's Medical College, Bengaluru, Karnataka India
| | - Naveen Ramesh
- Department of Community Medicine, St. John's Medical College, Bengaluru, Karnataka India
| | - Divya Devraj
- Department of Community Medicine, St. John's Medical College, Bengaluru, Karnataka India
| | - Marciya Umman
- Department of Community Medicine, St. John's Medical College, Bengaluru, Karnataka India
| | - Anila K John
- Department of Community Medicine, St. John's Medical College, Bengaluru, Karnataka India
| | - Avita Rose Johnson
- Department of Community Medicine, St. John's Medical College, Bengaluru, Karnataka India
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Hickey M, Moss KM, Krejany EO, Wrede CD, Brand A, Kirk J, Symecko HL, Domchek SM, Tejada-Berges T, Trainer A, Mishra GD. What happens after menopause? (WHAM): A prospective controlled study of vasomotor symptoms and menopause-related quality of life 12 months after premenopausal risk-reducing salpingo-oophorectomy. Gynecol Oncol 2021; 163:148-154. [PMID: 34312002 DOI: 10.1016/j.ygyno.2021.07.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To measure menopausal symptoms and quality of life up to 12 months after risk-reducing salpingo-oophorectomy (RRSO) and to measure the effects of hormone therapy. METHODS Prospective observational study of 95 premenopausal women planning RRSO and a comparison group of 99 who retained their ovaries. Vasomotor symptoms and menopausal-related quality of life (QoL) were measured by the Menopause-Specific QoL Intervention scale at baseline, 3, 6 and 12 months. Chi-square tests measured differences in prevalence of vasomotor symptoms between RRSO vs the comparison group and by hormone therapy use. Change in QoL were examined with multilevel modelling. RESULTS Three months after RRSO hot flush prevalence increased from 5.3% to 56.2% and night sweats from 20.2% to 47.2%. Symptoms did not worsen between 3 and 12 months and remained unchanged in the comparison group (p<0.001). After RRSO, 60% commenced hormone therapy. However, 40% of hormone therapy uses continued to experience vasomotor symptoms. After RRSO, 80% of non-hormone therapy users reported vasomotor symptoms. Regardless of hormone therapy use, 86% categorized their vasomotor symptoms as "mild" after RRSO. Following RRSO, Menopause-related QoL deteriorated but was stable in the comparison group (adjusted coefficient = 0.75, 95%CI = 0.55-0.95). After RRSO, QoL was better in hormone therapy users vs non-users (adjusted coefficient = 0.49, 95%CI = 0.20-0.78). CONCLUSIONS Vasomotor symptoms increase by 3 months after RRSO but do not worsen over the next 12 months. Hormone Therapy reduces but does not resolve vasomotor symptoms and may improve QoL, but not to pre-oophorectomy levels.
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Affiliation(s)
- Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, Victoria, Australia.
| | - Katrina M Moss
- Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Efrosinia O Krejany
- Gynaecology Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - C David Wrede
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, Victoria, Australia; Gynae-oncology and Dysplasia Unit, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Alison Brand
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia; Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Judy Kirk
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Heather L Symecko
- Basser Center for BRCA, University of Pennsylvania, Philadelphia, USA
| | - Susan M Domchek
- Basser Center for BRCA, University of Pennsylvania, Philadelphia, USA
| | - Trevor Tejada-Berges
- Gynaecological Oncology Service, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Alison Trainer
- Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Gita D Mishra
- Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
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Is Breast Cancer Risk Associated with Menopausal Hormone Therapy Modified by Current or Early Adulthood BMI or Age of First Pregnancy? Cancers (Basel) 2021; 13:cancers13112710. [PMID: 34072619 PMCID: PMC8199436 DOI: 10.3390/cancers13112710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
Menopausal hormone therapy (MHT) has an attenuated effect on breast cancer (BC) risk amongst heavier women, but there are few data on a potential interaction with early adulthood body mass index (at age 20 years) and age of first pregnancy. We studied 56,489 women recruited to the PROCAS (Predicting Risk of Cancer at Screening) study in Manchester UK, 2009-15. Cox regression models estimated the effect of reported MHT use at entry on breast cancer (BC) risk, and potential interactions with a. self-reported current body mass index (BMI), b. BMI aged 20 and c. First pregnancy >30 years or nulliparity compared with first pregnancy <30 years. Analysis was adjusted for age, height, family history, age of menarche and menopause, menopausal status, oophorectomy, ethnicity, self-reported exercise and alcohol. With median follow up of 8 years, 1663 breast cancers occurred. BC risk was elevated amongst current users of combined MHT compared to never users (Hazard ratioHR 1.64, 95% CI 1.32-2.03), risk was higher than for oestrogen only users (HR 1.03, 95% CI 0.79-1.34). Risk of current MHT was attenuated by current BMI (interaction HR 0.80, 95% CI 0.65-0.99) per 5 unit increase in BMI. There was little evidence of an interaction between MHT use, breast cancer risk and early and current BMI or with age of first pregnancy.
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Kim B, Kang S. Regular Leisure-Time Physical Activity is Effective in Boosting Neurotrophic Factors and Alleviating Menopause Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228624. [PMID: 33233633 PMCID: PMC7699735 DOI: 10.3390/ijerph17228624] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 10/30/2020] [Accepted: 11/19/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The study investigated the effects of regular leisure-time physical activity on the parameters of cognitive function (plasma brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), and cathepsin B) and menopausal symptoms (the climacterium, depression, and cognitive impairment) in obese middle-aged women. METHODS All subjects were middle-aged and obese women (n = 52, % body fat > 30%). The participants were divided into premenopausal (PRM) (n = 18, age = 47.56 ± 6.11 years) and postmenopausal (POM) (n = 34, age = 57.79 ± 5.68 years) groups. The participants completed a survey questionnaire related to depression and the climacterium, as well as cognitive tests. Physical activity was performed for 12 weeks. Blood samples from the forearm vein were analyzed after 12 h of fasting. Blood levels of BDNF, NGF, and cathepsin B were analyzed using an R&D kit. RESULTS Regular leisure-time physical activity had a positive effect on reducing the percentage of body fat in premenopausal and postmenopausal obese women. In addition, the results of the questionnaire showed that regular exercise had a positive effect on body composition caused by lifestyle change and enhanced psychological stability. The BDNF concentration was significantly lower in postmenopausal than in premenopausal obese women. In addition, regular physical activity significantly increased the cathepsin B and NGF levels in postmenopausal obese women. CONCLUSIONS Continuous leisure-time physical activity improved body composition and neurotrophic factors and alleviated menopausal symptoms in obese Korean women.
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Affiliation(s)
- Boram Kim
- Researcher of Leisure and Recreation, Division of Sport Science, Kangwon National University, Chuncheon 24341, Korea;
| | - Sunghwun Kang
- Laboratory of Exercise Physiology, Division of Sport Science, Kangwon National University, Chuncheon 24341, Korea
- Interdisciplinary Program in Biohealth-Machinery Convergence Engineering, Kangwon National University, Chuncheon 24341, Korea
- Correspondence: ; Tel.: +82-33-250-6788
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Javadivala Z, Allahverdipour H, Asghari Jafarabadi M, Emami A. An Interventional strategy of physical activity promotion for reduction of menopause symptoms. Health Promot Perspect 2020; 10:383-392. [PMID: 33312934 PMCID: PMC7722991 DOI: 10.34172/hpp.2020.57] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/10/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Physical activity (PA) programs are inexpensive, non-pharmaceutical and universally accessible options with demonstrated efficacy in reducing menopausal symptoms. The purpose of this study was to determine the effectiveness of a behavioral strategy for initiating and sustaining PA with the hope to reduce or eliminate menopausal symptoms. Methods : Menopausal and perimenopausal women (n=190) were randomly assigned to intervention (n=95) and non-intervention (n=95) groups using a random-numbers table. The intervention group consisted of 18 neighborhood network subgroups, each consisting of five to six women known to one another. They participated in a 12-week regular PA program, augmented by eight interactive group education and discussion sessions. The Menopause Rating Scale (MRS) self-report instrument was used to determine perceived severity of menopausal symptoms. Results: The intervention group showed a significant reduction in the frequency and severity of menopausal symptoms (P < 0.001). Those whose symptoms rated severe/very severe for hot flushes were reduced from 30.1% to 11.8%. Also, participants whose sleep problems and joint discomfort rated severe/very severe declined from 28% to 6.5% and joint discomfort rated severe or very severe was reduced from 52.7% to 4.4%, respectively. Conversely in the nonintervention group, hot flushes, sleep problems and joint problems got significantly worse(P < 0.05). Conclusion: Implementing educational program that increases awareness of PA benefits in combination with existing neighborhood networks that facilitate communication and cooperation may increase PA levels and decrease menopausal symptoms. Such networks offer alow-cost means of improving quality of life (QOL) for perimenopausal and menopausal women.
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Affiliation(s)
- Zeinab Javadivala
- Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Allahverdipour
- Research Center for Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Azita Emami
- Dean, University of Washington School of Nursing, Seattle, Washington, USA
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He Y, Tian J, Oddy WH, Blizzard L, Dwyer T, Hickey M, Venn AJ. The associations of childhood adiposity with menopausal symptoms in women aged 45-49 years: An Australian Cohort Study. Maturitas 2020; 143:81-88. [PMID: 33308641 DOI: 10.1016/j.maturitas.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/18/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To examine the associations of childhood adiposity with menopausal symptoms in women aged 45-49 years. STUDY DESIGN National population-based cohort study of 334 girls prospectively followed from childhood (aged 11-15) through to midlife (aged 45-49). Childhood overweight and obesity were defined by international age- and sex-specific standards for body mass index (BMI), and abdominal obesity was defined as waist/height ratio≥0.5. MAIN OUTCOME MEASURES Vasomotor symptoms (VMS), vaginal dryness, total menopausal symptoms and domain-specific symptoms (somatic, psychological and urogenital) were measured during 2018-19 using the Menopause Rating Scale (MRS) and classified as none, mild, moderate or severe. RESULTS The prevalence of mild, moderate and severe VMS was 24.0 %, 9.0 % and 3.9 %, and of vaginal dryness was 12.6 %, 4.8 % and 2.4 %. No significant associations of childhood overweight/obesity or abdominal obesity with VMS or vaginal dryness were found after adjustment for childhood age, follow-up length, smoking, socioeconomic status and diet quality. Childhood overweight/obesity was associated with increased risks of more severe total (RR:1.17, 95 % CI:1.02-1.36), psychological (RR:1.19, 95 % CI:1.04-1.35) and urogenital (RR:1.29, 95 % CI:1.14-1.46) symptoms measured using the MRS. Associations with childhood abdominal obesity were mostly stronger with more severe total (RR:2.19, 95 % CI:1.48-3.23), somatic (RR:1.52, 95 % CI:1.15-2.02), psychological (RR:1.21, 95 % CI:1.04-1.42) and urogenital (RR:2.11, 95 % CI:1.39-3.20) symptoms. CONCLUSIONS Childhood adiposity was not associated with increased risks of more severe VMS or vaginal dryness in women aged 45-49 years. Childhood adiposity, especially abdominal obesity, was associated with more severe total, somatic, psychological and urogenital symptoms. However, the association between these symptoms and menopause is not established.
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Affiliation(s)
- Ye He
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jing Tian
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Wendy H Oddy
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Terence Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Martha Hickey
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Australia; The Royal Women's Hospital, Victoria, Australia
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
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Singhania K, Kalhan M, Choudhary P, Kumar T. Association of Menopausal Symptoms with Overweight and Obesity among Rural Middle Aged Women in North India: A Population Based Study. J Midlife Health 2020; 11:137-143. [PMID: 33384536 PMCID: PMC7718937 DOI: 10.4103/jmh.jmh_123_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 04/11/2020] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background: Overweight and obesity are important determinant of increasing morbidity among all age groups, including menopausal women. The symptoms of menopause have a negative impact on the quality of life. Objectives: The aim of this study is to assess the prevalence of overweight and obesity in menopausal women and also to find its association with menopausal symptoms and sociodemographic variables. Materials and Methods: The study was conducted among middle-aged women (40–60 years) from April 2018 to March 2019. The Menopausal Rating Scale was used to assess the severity of menopausal symptoms in 400 women, and data were collected for sociodemographic factors, menstrual history in the past month, and personal history. Results: About 35.5% of menopausal women were overweight/obese (26% overweight and 9.5% obese) with average body mass index of 23.9 ± 4.84 and mean age of 53.65 ± 5.11 years Joint and muscular discomfort (P = 0.001), hypertension (P = 0.014), literacy level (P = 0.009), and socioeconomic status (P = 0.01) were significantly associated with overweight/obesity. With reference to women with no/little somatic and urogenital complaints, the odds of developing obesity was more (adjusted odds) in patients with mild (odds ratio [OR] - 2.8), moderate (OR - 2.1), and severe (2.19) somatic complaints and also higher risk in patients with mild (OR-3.2), moderate (OR - 1.1), and severe (OR - 1.74) urogenital symptoms. The age of menopause was significantly more among overweight than normal-weight women (P = 0.033). Conclusion: Overweight and obesity associated with menopause require increased attention and a multidisciplinary approach to women's health to prevent morbidity in this population group.
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Affiliation(s)
- Komal Singhania
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
| | - Meenakshi Kalhan
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
| | - Priyanka Choudhary
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
| | - Tarun Kumar
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
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Linguistic translation and validation of the Menopause-specific Quality of Life (MENQOL) questionnaire in Greek menopausal women. ACTA ACUST UNITED AC 2020; 27:808-815. [PMID: 32217885 DOI: 10.1097/gme.0000000000001527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to translate the Menopause-specific Quality of Life (MENQOL) questionnaire in Greek and validate it for usage in the Greek population both in written and electronic form. METHODS The original English questionnaire MENQOL with 1-month recall period was translated by our team. According to instructions by Mapi Research Trust, the questionnaire was forward and back-translated, followed by patient testing and proofreading. Then it was transcripted electronically. Validation was performed with the following tests: internal consistency (reliability), stability (test-retest reliability) with Cronbach's alpha correlations, independent and paired t tests, and Pearson's correlation coefficients. RESULTS A total of 105 women, the majority recently menopausal, participated in the study. Internal consistency using the Cronbach's alpha showed high reliability ranging between 0.833 (physical domain) and 0.896 (vasomotor domain) for the written, and 0.720 (physical domain) and 0.868 (vasomotor domain) for the online form. Test-retest reliability was also high for both forms. The sexual domain of MENQOL had the higher mean, indicating the highest impact on quality of life (3.80 ± 2.35). CONCLUSIONS The Greek version of MENQOL is a reliable instrument for evaluating menopausal women. Availability of an online form will allow wider dissemination of the questionnaire. Further use of the questionnaire in Greece may lead to better understanding of the bothersome symptoms of menopause; a prerequisite to develop intervention studies for amelioration of quality of life.
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Kim GD, Chun H, Doo M. Associations Among BMI, Dietary Macronutrient Consumption, and Climacteric Symptoms in Korean Menopausal Women. Nutrients 2020; 12:nu12040945. [PMID: 32235325 PMCID: PMC7230980 DOI: 10.3390/nu12040945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 11/16/2022] Open
Abstract
Many postmenopausal women individually experience varying degrees of climacteric symptoms. Among the many influencing factors, body weight and diet are recognized as important contributors to the incidence and severity of these symptoms. This study was performed to investigate the interaction effect of BMI (body mass index) and dietary consumption on the risk of climacteric symptoms among Korean women. Approximately half of the subjects (48.8%) experienced climacteric symptoms. After adjusting for the covariates, the subjects who are overweight or obese showed significantly greater total scores of climacteric symptoms (p = 0.010) and subscales of symptoms (p = 0.027 for physical climacteric symptoms and p = 0.007 for psychological climacteric symptoms), except for urogenital climacteric symptoms (p = 0.085), than those subjects at a normal weight. When subjects were divided into groups according to dietary macronutrient consumption, those who are overweight or obese were 2.84-fold (adjusted odds ratio, 95% CI = 1.18-6.80, p = 0.019) more likely to experience climacteric symptoms than those at a normal weight among the subjects with high fat consumption. However, the BMI category did not affect the adjusted odds ratio for experiencing climacteric symptoms among subjects who consumed a low-fat diet.
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Affiliation(s)
- Gi Dae Kim
- Department of Food and Nutrition, Kyungnam University, Kyungnamdaehak-ro 7, Changwon, Gyeongnam 51767, Korea;
| | - Hyejin Chun
- Department of Family Medicine, Bundang CHA Medical Center, CHA University, Yatap-ro 59, Seongnam, Gyeonggi 13496, Korea;
| | - Miae Doo
- Department of Food and nutrition, Kunsan National University, Daehak-ro 558, Gunsan, Jeonbuk 54150, Korea
- Correspondence: ; Tel.: +82-63-469-4631; Fax: +82-63-469-2085
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Moradpour F, Koushkie Jahromi M, Fooladchang M, Rezaei R, Sayar Khorasani MR. Association between physical activity, cardiorespiratory fitness, and body composition with menopausal symptoms in early postmenopausal women. Menopause 2020; 27:230-237. [PMID: 31999652 DOI: 10.1097/gme.0000000000001441] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between daily physical activity (daily activities, exercise, and sitting time), cardiorespiratory fitness (CRF), and body composition (body mass index [BMI], waist to hip ratio [WHR)] with menopausal symptoms and to determine the strongest predictor(s) of menopausal symptoms. METHODS The Menopause Rating Scale questionnaire was used to examine somatic, psychological, urogenital, and total symptoms of menopause. The energy expenditure of daily physical activity, exercise, and sitting time was measured by the International Physical Activity Questionnaire, and CRF was measured by estimating the maximal oxygen intake (VO2max) through the Rockport test. Statistical methods of the Pearson correlation coefficient and hierarchical multiple linear regression were used for data analysis. RESULTS Fifty-six women, aged 50 to 65 years, voluntarily participated in the study. Exercise energy expenditure was inversely correlated with total (r = -0.403, P = 0.002), somatic (r = -0.293, P = 0.023), and urogenital (r = -0.343, P = 0.009) symptoms of menopause. VO2max was inversely correlated with urogenital symptoms of menopause (r = -0.414, P = 0.002). WHR was positively correlated with somatic symptoms of menopause (r = 0.286, P = 0.032); sitting was correlated with total (r = 0.40, P = 0.002), somatic (r = 0.325, P = 0.015), and psychological (r = 0.274, P = 0.015) symptoms of menopause. Among the study variables, sitting (β=0.365, P = 0.004) and VO2max (β=-0.286, P = 0.030) were the most important predictors of total symptoms of menopause; sitting was the predictor of somatic symptoms (β=0.265, P = 0.045), and VO2max was the predictor of urogenital symptoms of menopause (β=-0.332, P = 0.014). The inclusion of age, BMI, WHR, and duration of menopause as confounding variables in regression analysis did not change the findings related to the predictions of menopausal symptoms. CONCLUSION Reducing sitting time, improving VO2max, decreasing WHR, and exercise can be recommended by priority to alleviate menopausal symptoms. Considering the small number of participants in this investigation, future studies are, however, recommended.
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Affiliation(s)
- Fatemeh Moradpour
- Department of Sport Sciences, School of Education and Psychology, Shiraz University, Shiraz, Iran
| | - Maryam Koushkie Jahromi
- Department of Sport Sciences, School of Education and Psychology, Shiraz University, Shiraz, Iran
| | - Mahboobeh Fooladchang
- Department of Educational Psychology, School of Education and Psychology, Shiraz University, Shiraz, Iran
| | - Rasoul Rezaei
- Department of Sport Sciences, School of Education and Psychology, Shiraz University, Shiraz, Iran
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Affiliation(s)
- Roshna Thapa
- School of Nursing, Research Institute of Nursing Science, Sustainable Development Center, Chonbuk National University, Jeonju, Korea
| | - Youngran Yang
- School of Nursing, Research Institute of Nursing Science, Sustainable Development Center, Chonbuk National University, Jeonju, Korea
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Chopra S, Sharma KA, Ranjan P, Malhotra A, Vikram NK, Kumari A. Weight Management Module for Perimenopausal Women: A Practical Guide for Gynecologists. J Midlife Health 2019; 10:165-172. [PMID: 31942151 PMCID: PMC6947726 DOI: 10.4103/jmh.jmh_155_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Menopause has been identified as a high-risk stage for weight gain in a woman's lifecycle. Menopause-related weight gain is a consequence of low circulating estrogen levels due to progressive loss of ovarian function. Moreover, the changes in the hormonal milieu, chronological aging, decline in physical activity coupled with westernized dietary pattern, and recurrent emotional eating episodes associated with psychological distress also contribute to the increase in total body fat and waist circumference. Higher waist circumference is an independent risk factor for cardiovascular and metabolic disease in menopausal women. These obesity-related cardiometabolic risk factors and menopausal symptoms can be effectively managed by achieving clinically significant weight loss through lifestyle modification. Behavioral lifestyle intervention uses behavioral techniques for counseling corrective dietary and physical activity practices in achieving sustainable weight loss outcomes. Majority of menopausal women seek this counseling from gynecologist, especially in primary care settings due to nonavailability of multidisciplinary teams. Thus, the aim of the review is to understand the menopause-obesity link, associated risk factors, and its health-related burden in perimenopausal women to devise a practical women-centric weight management module based on lifestyle modification techniques to address the burden of menopausal obesity in regular gynecological practice.
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Affiliation(s)
- Sakshi Chopra
- Department of Home Science, University of Delhi, New Delhi, India
| | - K Aparna Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Malhotra
- Department of Home Science, University of Delhi, New Delhi, India
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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