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Andrews R, Lacey A, Bache K, Kidd EJ. The role of menopausal symptoms on future health and longevity: A systematic scoping review of longitudinal evidence. Maturitas 2024; 190:108130. [PMID: 39366170 DOI: 10.1016/j.maturitas.2024.108130] [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: 04/24/2024] [Revised: 08/20/2024] [Accepted: 09/25/2024] [Indexed: 10/06/2024]
Abstract
Women live longer than men but spend more years in poor health. Menopausal symptoms are not generally associated with adverse health outcomes. However, increasingly, evidence suggests they can significantly impact future health and longevity. Understanding the long-term effects of menopausal symptoms will enable clinicians to identify risk factors and intervene with modifications to support healthy aging. This review examined the scope of research investigating the association between menopausal symptoms and future health outcomes. We searched for longitudinal cohort studies. Date and geographical restrictions were not applied. Articles were screened and data extracted using standardised methods. Included studies examined the role of menopausal symptoms on future health developments using a sample who had experienced menopause and were deemed healthy at baseline, with clear reporting of their menopausal status at symptom assessment. We identified 53 eligible studies with data from over 450,000 women enrolled in 28 longitudinal cohorts. Cardiovascular disease, psychiatric disorders, diabetes, and reduced bone mineral density were positively associated with menopausal symptoms. Breast cancer was associated with an asymptomatic menopause. Psychological menopausal symptoms and cognitive decline improved after menopause, except among women from low socioeconomic backgrounds. These findings demonstrate that menopausal symptoms are important indicators for future health risks. Future work should investigate the impact of underexplored menopausal symptoms on future health, such as sleeping problems and urogenital issues, and evaluate whether treating menopausal symptoms could lead to improvements in future health outcomes. Should future research continue to support these findings, clinical guidelines should be updated to support clinical decision-making in menopause care.
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Affiliation(s)
- Robin Andrews
- Cardiff University Welsh School of Pharmacy and Pharmaceutical Sciences, Redwood Building, King Edward VII Ave, Cardiff, Wales CF10 3NB, United Kingdom.
| | - Arron Lacey
- Swansea University Institute of Life Science, Swansea University Medical School, Institute of Life Science 2, Sketty, Swansea, Wales SA2 8QA, United Kingdom.
| | - Kate Bache
- Health & Her Unit D, Tramshed Tech, Pendyris St, Cardiff, Wales CF11 6BH, United Kingdom.
| | - Emma J Kidd
- Cardiff University Welsh School of Pharmacy and Pharmaceutical Sciences, Redwood Building, King Edward VII Ave, Cardiff, Wales CF10 3NB, United Kingdom.
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Hao H, Pang Y, Wang S, Liu Q, Liu Y, Bao L, Niu Y, Liu Y, Zhang R. The prevalent trajectory of early menopause associated with PM 2.5 exposure across 1956-2018 extrapolated from LightGBM algorithm. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 285:117107. [PMID: 39332195 DOI: 10.1016/j.ecoenv.2024.117107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 09/20/2024] [Accepted: 09/23/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND Fine particulate matter (PM2.5) is noxious to female reproductive development and facilitates the occurrence of subsequent diseases. Early menopause is initiative factor of female aging. But due to the lack of historical exposure of PM2.5, we could not gain insight into the linkage between ambient PM2.5 exposure and early menopause. METHODS We conducted a community-based retrospective cross-sectional study and pooled 1173 postmenopausal women. The machine learning algorithm of LightGBM was processed to derive the historical concentrations of PM2.5 based on aerography of 1956-2022. The quantile g-computation and binary logistic regression were employed to estimate the mixed and single associations between PM2.5 and early menopause. RESULTS The visibility topped the most important feature for derivations of historical PM2.5 concentrations. The R2 of 10-fold cross-validation and predictive capability during processing were all above 0.8. The prevalence of early menopause was 7.3 %. Each 10 µg/m3 PM2.5 increased the prevalence of early menopause during prior 2 years exposure (OR: 1.49, 95 %CI: 1.03-2.16) and spring and autumn (OR: 1.28, 95 %CI: 1.07-1.54). After adjusting the reverse effects of temperature, the prior 2 years exposure of PM2.5 remained positively associated with early menopause in the fourth quantile vs the first quantile (OR: 3.36, 95 %CI: 1.53-7.36) in the spring and autumn. The higher BMI (OR: 1.40, 95 %CI: 1.14-1.72), waistline (OR: 1.42, 95 %CI: 1.09-1.85) and unfavourable dietary habits of less meat (OR: 1.72, 95 %CI: 1.11-2.68), more fried food (OR: 2.39, 95 %CI: 1.15-4.99) elevated the prevalence of early menopause. CONCLUSIONS The accurate environmental exposure assessment of historical PM2.5 vigorously promoted the researches on the relationship between PM2.5 and early menopause. It sounds the alarm on female infertility menace associated with particulate matter especially during the turbulent 2 years before menopause.
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Affiliation(s)
- Haiyan Hao
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China; Institute of Environmental Health Monitoring and Evaluation, Hebei Province Center for Disease Prevention and Control, Shijiazhuang 050021, PR China
| | - Yaxian Pang
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Suwei Wang
- Institute of Environmental Health Monitoring and Evaluation, Hebei Province Center for Disease Prevention and Control, Shijiazhuang 050021, PR China
| | - Qingping Liu
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Yuecai Liu
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Lei Bao
- Occupational Health and Environmental Health, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Yujie Niu
- Occupational Health and Environmental Health, Hebei Medical University, Shijiazhuang 050017, PR China; Hebei Key Laboratory of Environment and Human Health, Shijiazhuang 050017, PR China
| | - Yigang Liu
- Institute of Environmental Health Monitoring and Evaluation, Hebei Province Center for Disease Prevention and Control, Shijiazhuang 050021, PR China.
| | - Rong Zhang
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China; Hebei Key Laboratory of Environment and Human Health, Shijiazhuang 050017, PR China.
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Yang L, Toriola AT. Menopausal Hormone Therapy Use Among Postmenopausal Women. JAMA HEALTH FORUM 2024; 5:e243128. [PMID: 39331372 PMCID: PMC11437377 DOI: 10.1001/jamahealthforum.2024.3128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/16/2024] [Indexed: 09/28/2024] Open
Abstract
Importance Menopausal hormone therapy (MHT) is the treatment of choice for symptoms of menopause. However, its adoption is hindered by the risk-benefit trade-off in relation to acute and chronic diseases. Objective To evaluate trends in and correlates of MHT use among postmenopausal women in the US from 1999 to March 2020. Design, Setting, and Participants This serial cross-sectional analysis of MHT use used data from the nationally representative National Health and Nutrition Examination Survey (NHANES). Participants included noninstitutionalized US postmenopausal women from 10 NHANES study cycles (1999-2000 to 2017-March 2020 [pre-COVID-19 pandemic]). Data were analyzed from December 2023 to April 2024. Exposures NHANES study cycle. Main Outcomes and Measures Prevalence of MHT use was extracted from the prescription medication data collected during NHANES household interviews. MHT formulations were determined by hormone type. Results Data on 13 048 US postmenopausal women (47.1% ≥65 years old) were analyzed. From 1999 to 2020, the prevalence of MHT use decreased among women of all age groups, from 26.9% (95% CI, 22.6%-31.7%) in 1999 to 4.7% (95% CI, 3.4%-6.5%) in 2020. Until 2002, MHT use was highest among women aged 52 to 65 years, but since 2005, MHT use has been highest among women younger than 52 years. MHT use decreased by 23.5% (95% CI, 11.4%-35.6%), 31.4% (95% CI, 23.4%-39.5%), and 10.6% (95% CI, 6.3%-14.8%) for women younger than 52 years, 52 years to younger than 65 years, and 65 years and older, respectively. Prevalence of MHT use decreased from 13.8% (95% CI, 8.5%-21.7%) to 2.6% (95% CI, 1.5%-4.6%) for Hispanic women, 11.9% (95% CI, 8.5%-16.3%) to 0.5% (95% CI, 0.2%-1.1%) for non-Hispanic Black women, and 31.4% (95% CI, 27.1%-36.1%) to 5.8% (95% CI, 4.1%-8.2%) for non-Hispanic White women. Non-Hispanic White women consistently had the highest prevalence of MHT use. Estrogen-only formulation accounted for more than 50% of the MHT for most study periods. The prevalence of MHT use varied by family income-to-poverty ratio, health insurance coverage in all racial and ethnic groups, weight, and smoking status among non-Hispanic White women, as well as by education attainment among non-Hispanic Black and Hispanic women. Conclusions and Relevance Results of this cross-sectional study show that over the past 2 decades, MHT use declined among US postmenopausal women of all age and racial and ethnic groups. Women of racial and ethnic minority groups had lower prevalence of MHT use compared to non-Hispanic White women.
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Affiliation(s)
- Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Research and Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adetunji T. Toriola
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
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Avis NE, Colvin A, Chen Y, Joffe H, Kravitz HM. Depressive symptoms over the final menstrual period: Study of Women's Health Across the Nation (SWAN). J Affect Disord 2024; 367:426-433. [PMID: 39233250 DOI: 10.1016/j.jad.2024.08.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 07/22/2024] [Accepted: 08/31/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Women may be vulnerable to elevated depressive symptoms during the menopause transition (MT). Studies generally have not considered premenopausal depressive symptom history or examined symptoms in relation to the final menstrual period (FMP). OBJECTIVE To identify specific time points in relation to the FMP when depressive symptoms increase or decrease. METHODS Participants were 1582 multiracial/ethnic women from the longitudinal Study of Women's Health Across the Nation (SWAN). Biological, psychosocial, and depressive symptom data were collected approximately annually. Depressive symptoms were measured by the Center for Epidemiological Studies-Depression (CESD) scale. RESULTS Women with high baseline depressive symptoms (CES-D ≥ 16) declined in symptoms (M = -1.04/yr., 95 % CI = -1.58, -0.50) until 4 years before the FMP, followed by a smaller decrease (M = -0.50/yr., 95 % CI = -0.72, -0.28) until 18 months after the FMP. Depressive symptoms increased (M = 0.21/yr., 95 % CI = 0.11, 0.30) in those with low baseline symptoms until 1 year before the FMP, and decreased (M = -0.06/yr., 95 % CI = -0.11, -0.008) going forward. Greater social support, higher levels of follicle stimulating hormone and estradiol, and less sleep disturbance contributed to greater decline in depressive symptoms among those with high baseline depressive symptoms. Anxiety, experiencing stressful life events, lower body mass index, and poor role-physical function contributed to an increase in depressive symptoms among those with low baseline symptoms. LIMITATIONS Excluded women had higher baseline CES-D scores. Lacked pre-MT depression for pre/early perimenopausal women at baseline. CONCLUSION Accounting for baseline depressive symptom level and focusing on the FMP more precisely characterize depressive symptom change over the MT.
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Affiliation(s)
- Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Alicia Colvin
- Epidemiology Department, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yuqing Chen
- Epidemiology Department, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hadine Joffe
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School and Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Howard M Kravitz
- Department of Psychiatry and Behavioral Sciences and Department of Family and Preventive Medicine, Rush Medical College, Rush University Medical Center, Chicago, IL, USA
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Cortés YI, Altemus M, Reame NE. From maca to marijuana: cultural influences on joint pain symptoms and management in urban perimenopausal and early postmenopausal Latinas. Menopause 2024; 31:756-763. [PMID: 39078653 PMCID: PMC11469668 DOI: 10.1097/gme.0000000000002396] [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: 03/03/2024] [Revised: 04/24/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE The purpose of this qualitative study was to explore the symptom experience and coping strategies for managing joint pain during the menopause transition in urban Latina women. METHODS We conducted focus groups with 13 English-speaking peri and early postmenopausal Latinas living in Upper Manhattan in New York City in 2014. Eligible participants were self-identified Latinas aged 45 to 60 years with new onset or worsening joint pain and spontaneous amenorrhea, recruited through flyers and snowball sampling. Focus group interviews conducted in English were audiotaped, transcribed, and analyzed by a bilingual research team, using NVivo software (QSR International) to organize and code themes. RESULTS On average, participants were aged 51.7 ± 4.8 years and overweight (body mass index of 29.3 ± 6.7 kg/m 2 ); 10 (76.9%) were Puerto Rican, and the last menstrual period was 1 month to 5 years ago. The following four themes emerged: 1) menopause and joint pain are an alarming package; 2) pain disrupts life and livelihood; 3) medical management is unsatisfactory and raises worries about addiction; and 4) home remedies for coping with pain-from maca to marijuana. Despite access to a world-class medical facility in their neighborhood, women seeking pain relief preferred to self-manage joint pain with exercise, over-the-counter products, and other culturally valued home remedies. Many suffered through it. CONCLUSIONS For midlife Latinas, joint pain symptoms may emerge or worsen unexpectedly as part of the menopause transition and carry distressing consequences for daily activities and quality of life. There is a need to develop more culturally specific approaches for menopause-related pain management in this underserved population.
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Schrager S, Williams M, Ward E, Henningfield MF, Yuroff A, Johnson G, Sullivan-Wade L, Hawkins J, Turnquist A. African American women's experiences of menopause: A focus group study. Maturitas 2024; 187:108043. [PMID: 38905863 DOI: 10.1016/j.maturitas.2024.108043] [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: 10/26/2023] [Revised: 04/25/2024] [Accepted: 06/02/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES This study aimed to characterize African American women's experiences of menopause and their interactions with the health care system related to menopausal symptoms. STUDY DESIGN We conducted four focus groups with community-dwelling midlife African American women. MAIN OUTCOMES MEASURES Women who consented to participate completed demographic surveys. Transcripts of the four focus groups (n = 26) were analyzed and themes were elucidated. RESULTS In total, 26 midlife African American women participated in the four focus groups. Participants revealed unmet needs regarding obtaining menopause information from their clinicians. Clinician discussions about menopause tended to be initiated by patients based on their symptoms. Some women reported feeling ignored and/or dismissed by the clinician when they initiated discussions of menopause. Women wanted their clinicians to provide information on menopause, which included receiving information prior to the menopause transition to help them know what to expect. CONCLUSION Women wanted their clinicians to initiate discussions of menopause rather than wait for women to mention symptoms. Prioritizing menopause training for clinicians taking care of midlife African American women may help to improve discussions of menopause.
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Affiliation(s)
- Sarina Schrager
- Wisconsin Research and Education Network (WREN), 610 N Whitney Way, Madison, WI 53505, United States of America; Wisconsin Department of Health and Family Services, Wisconsin Well Woman Program, Madison, WI, United States of America.
| | - Makeba Williams
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St Louis, MO, United States of America
| | - Earlise Ward
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 610 N Whitney Way, Madison, WI 53505, United States of America
| | - Mary F Henningfield
- Wisconsin Research and Education Network (WREN), 610 N Whitney Way, Madison, WI 53505, United States of America; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 610 N Whitney Way, Madison, WI 53505, United States of America
| | - Alice Yuroff
- Wisconsin Research and Education Network (WREN), 610 N Whitney Way, Madison, WI 53505, United States of America; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 610 N Whitney Way, Madison, WI 53505, United States of America
| | - Gale Johnson
- Wisconsin Department of Health and Family Services, Wisconsin Well Woman Program, Madison, WI, United States of America
| | - Lucretia Sullivan-Wade
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 610 N Whitney Way, Madison, WI 53505, United States of America
| | - Jennifer Hawkins
- Wisconsin Research and Education Network (WREN), 610 N Whitney Way, Madison, WI 53505, United States of America; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 610 N Whitney Way, Madison, WI 53505, United States of America
| | - Alyssa Turnquist
- Wisconsin Research and Education Network (WREN), 610 N Whitney Way, Madison, WI 53505, United States of America; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 610 N Whitney Way, Madison, WI 53505, United States of America
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Williams M. Culturally responsive care for menopausal women. Maturitas 2024; 185:107995. [PMID: 38663163 DOI: 10.1016/j.maturitas.2024.107995] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 06/03/2024]
Abstract
The experience of menopause is not "one size fits all." Instead, biologic, physiologic, and sociocultural factors strongly affect women's experiences of menopause symptoms and the ways in which they would like to manage their care. By providing culturally sensitive and patient-centered care, clinicians may be able to improve menopause experiences for all of their patients. However, a literature review revealed a lack of information about culturally responsive care for menopause. The first objective of this review is to discuss the ways in which sociocultural identity influences menopause care-seeking and management. The second objective is to introduce a framework of culturally responsive care for menopause.
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Affiliation(s)
- Makeba Williams
- Washington University St. Louis School of Medicine, St. Louis, MO, USA.
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Mayne GB, Ghidei L. The impact of devaluing Women of Color: stress, reproduction, and justice. Birth 2024; 51:245-252. [PMID: 38695278 DOI: 10.1111/birt.12825] [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] [Received: 12/31/2023] [Accepted: 04/11/2024] [Indexed: 05/18/2024]
Abstract
This commentary is in response to the Call for Papers put forth by the Critical Midwifery Studies Collective (June 2022). We argue that due to a long and ongoing history of gendered racism, Women of Color are devalued in U.S. society. Devaluing Women of Color leads maternal healthcare practitioners to miss and even dismiss distress in Women of Color. The result is systematic underdiagnosis, undertreatment, and the delivery of poorer care to Women of Color, which negatively affects reproductive outcomes generally and birth outcomes specifically. These compounding effects exacerbate distress in Women of Color leading to greater distress. Stress physiology is ancient and intricately interwoven with healthy pregnancy physiology, and this relationship is a highly conserved reproductive strategy. Thus, where there is disproportionate or excess stress (distress), unsurprisingly, there are disproportionate and excess rates of poorer reproductive outcomes. Stress physiology and reproductive physiology collide with social injustices (i.e., racism, discrimination, and anti-Blackness), resulting in pernicious racialized maternal health disparities. Accordingly, the interplay between stress and reproduction is a key social justice issue and an important site for theoretical inquiry and birth equity efforts. Fortunately, both stress physiology and pregnancy physiology are highly plastic-responsive to the benefits of increased social support and respectful maternity care. Justice means valuing Women of Color and valuing their right to have a healthy, respected, and safe life.
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Affiliation(s)
- Gabriella B Mayne
- Department of Health and Behavioral Sciences, University of Colorado, Denver, Colorado, USA
| | - Luwam Ghidei
- Reproductive Specialists of the Carolinas, Charlotte, North Carolina, USA
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Williams M. In the heat of the night. Menopause 2024; 31:474-475. [PMID: 38787352 DOI: 10.1097/gme.0000000000002379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Affiliation(s)
- Makeba Williams
- From the Washington University School of Medicine in St. Louis, Madison, MO
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Kochersberger A, Coakley A, Millheiser L, Morris JR, Manneh C, Jackson A, Garrison JL, Hariton E. The association of race, ethnicity, and socioeconomic status on the severity of menopause symptoms: a study of 68,864 women. Menopause 2024; 31:476-483. [PMID: 38652870 DOI: 10.1097/gme.0000000000002349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE This study aimed to evaluate if and how race, ethnicity, and socioeconomic status (SES) are associated with the severity of menopause symptoms in a large, diverse sample of women. METHODS For this cross-sectional study conducted between March 24, 2019, and January 13, 2023, a total of 68,864 women were enrolled from the Evernow online telehealth platform. Participants underwent a clinical intake survey, which encompassed demographic information, detailed medical questionnaires, and a modified Menopause Rating Scale. The modified scale was adapted for ease of use online and is available in the supplementary material along with the full intake. Symptom severity was evaluated using a multivariate binomial generalized linear model, accounting for factors such as race, ethnicity, age, body mass index, smoking status, bilateral oophorectomy status, and SES. Odds ratios (OR) and CIs were calculated based on the linear regression coefficients. RESULTS Of the participants, 67,867 (98.6%) were included in the analysis after excluding outliers and those with unknown oophorectomy status. The majority of respondents identified as White (77.4%), followed by Hispanic (9.0%), Black (6.7%), two or more races/ethnicities (4.4%), Asian (1.2%), Indigenous/First Nations (0.8%), Middle Eastern (0.3%), and South Asian (0.2%). Notably, individuals identifying as Black (hot flashes OR, 1.91; 97.5% CI, 1.75-2.09; P < 0.001), Hispanic (skin/hair changes OR, 1.58; 97.5% CI, 1.45-1.71; P < 0.001), Indigenous/First Nations (painful sex OR, 1.39; 97.5% CI, 1.19-2.75; P = 0.007), Middle Eastern (weight changes OR, 2.22; 97.5% CI, 1.25-4.37; P = 0.01), or with two or more races/ethnicities (skin/hair changes OR, 1.41; 97.5% CI, 1.26-1.58; P < 0.001) reported higher levels of symptom severity compared with their White counterparts. Conversely, Asian and South Asian participants reported lower symptom severity. Even after incorporating SES into the linear model, racial and ethnic groups with lower SES (Black, Hispanic, Indigenous, and multiple ethnicities) exhibited slight shifts in OR while maintaining high statistical significance (Black [hot flashes OR, 1.87; 97.5% CI, 1.72-2.04; P < 0.001], Hispanic [skin/hair changes OR, 1.54; 97.5% CI, 1.42-1.68; P < 0.001], Indigenous/First Nations [painful sex OR, 1.74; 97.5% CI, 1.17-2.70; P = 0.009], multiple ethnicities [skin/hair changes OR, 1.41; 97.5% CI, 1.26-1.58; P < 0.001]). CONCLUSIONS Our study suggests that the relationship between race and ethnicity and the severity of menopause symptoms is not solely explained by differences in SES but is itself an independent factor. Understanding and addressing social, cultural, and economic factors are crucial to reduce disparities in menopausal symptoms.
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Affiliation(s)
| | | | | | | | | | | | | | - Eduardo Hariton
- Reproductive Science Center of the San Francisco Bay Area, Oakland, CA
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Reame NK. Direct-to-consumer menopause care: what do we know about its subscribers? Menopause 2024; 31:471-473. [PMID: 38787351 DOI: 10.1097/gme.0000000000002381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
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Reeves AN, Lewis TT, Hood MM, Thurston RC, Avis NE, Burnett-Bowie SAM, Cortés YI, Neal-Perry G, Harlow SD. Does everyday discrimination account for the increased risk of vasomotor symptoms in Black women?: the Study of Women's Health Across the Nation (SWAN). Menopause 2024; 31:484-493. [PMID: 38595299 PMCID: PMC11126360 DOI: 10.1097/gme.0000000000002357] [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] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Vasomotor symptoms (VMS), including hot flashes and night sweats, are hallmark symptoms of the menopause transition. Previous research has documented greater frequency, duration, and severity of VMS in Black women compared with women from other racial/ethnic groups, even after accounting for other factors. This analysis examined the association between discrimination and VMS and the extent to which discrimination accounts for the disproportionate burden of VMS in Black women. METHODS Using available discrimination and VMS data from the SWAN cohort study (n = 2,377, 48% White, 32% Black, 6% Japanese, 4% Chinese, and 9% Hispanic women) followed approximately yearly in midlife from premenopause (42-52 y) through postmenopause (~20 y), we assessed concurrent associations between discrimination and VMS frequency in the past 2 weeks using weighted generalized mixed models. We also assessed associations between chronic discrimination across first four visits and VMS trajectories from premenopause to postmenopause using weighted multinomial logistic regression. Models were adjusted for known risk factors for VMS. RESULTS Higher levels of discrimination were associated with concurrent reporting of any (odds ratio [OR], 1.57 [1.31-1.89]) and frequent (≥6 d) VMS (OR, 1.55 [1.21-1.99]). After adjustment, associations remained significant for any (OR, 1.30 [1.09-1.54]) but not frequent VMS. For any VMS trajectories, chronic discrimination was associated with "continuously high" (OR, 1.69 [1.03-2.77]) and "high pre-FMP-decline post-FMP" (OR, 1.70 [1.01-2.88]) versus "FMP-onset low" trajectories. After adjusting for discrimination, odds of reporting any, frequent, and of being in the "continuously high" any VMS trajectory remained elevated for Black versus White women. CONCLUSIONS Discrimination is associated with greater concurrent risk of any (but not frequent) VMS, and chronic discrimination is associated with a continuously high reporting of any VMS over time, independent of known risk factors. Adjusting for discrimination attenuates but does not eliminate the increased risk of VMS for Black women.
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Affiliation(s)
- Alexis N Reeves
- Department of Epidemiology, School of Public Health, University of Michigan
- Epidemiology and Population Health, School of Medicine, Stanford University
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Michelle M Hood
- Department of Epidemiology, School of Public Health, University of Michigan
| | - Rebecca C. Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health
- Department of Psychology, University of Pittsburgh
| | - Nancy E. Avis
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine
| | | | | | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina – Chapel Hill
| | - Siobán D. Harlow
- Department of Epidemiology, School of Public Health, University of Michigan
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Cortés YI. Does neighborhood socioeconomic status impact ovarian reserve? Moving beyond individual-level factors. Menopause 2024; 31:361-362. [PMID: 38669624 DOI: 10.1097/gme.0000000000002365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Affiliation(s)
- Yamnia I Cortés
- From the College of Nursing, University of Iowa, Iowa City, IA
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14
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Dixon JS, Wang D, Ready RE. Discrimination and Cognition in Midlife Black Women: The Roles of Social Support and Spirituality. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbad201. [PMID: 38165061 PMCID: PMC10939168 DOI: 10.1093/geronb/gbad201] [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: 04/23/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES Black women are at high risk for discrimination and cognitive impairment in late life. It is not known if discrimination is a risk factor for cognitive decline in Black women and if so, what factors are protective against the adverse cognitive effects of discrimination. Using the biopsychosocial model of gendered racism, we determined if discrimination is associated with poorer cognition in midlife Black women and if social support and/or spirituality would protect against the deleterious effects of discrimination on cognition. METHODS Participants were midlife Black women (N = 669) from the Study of Women's Health Across the Nation. Discrimination was measured by the Everyday Discrimination scale. Cognitive outcomes included episodic memory, processing speed, and working memory. Total social support, emotional support, instrumental support, and spirituality were assessed as protective factors. RESULTS Contrary to expectations, structural equation modeling indicated that discrimination was associated with better immediate recall. For women with more emotional support, greater discrimination was associated with better immediate recall than for women with lower emotional support. Spirituality was not a significant moderator in the association between discrimination and cognition. DISCUSSION Discrimination had unexpected positive associations with learning and attention-based cognitive skills for midlife Black women. Discrimination might enhance vigilance, which could be facilitated by higher levels of emotional support. There is an opportunity for clinical and public health interventions for cognitive health and discrimination focused on Black women to better incorporate emotional support as a coping resource.
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Affiliation(s)
- Jasmine S Dixon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Dongwei Wang
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Rebecca E Ready
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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15
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Pleasant V. Gynecologic Care of Black Breast Cancer Survivors. CURRENT BREAST CANCER REPORTS 2024; 16:84-97. [PMID: 38725438 PMCID: PMC11081127 DOI: 10.1007/s12609-024-00527-4] [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] [Accepted: 01/15/2024] [Indexed: 05/12/2024]
Abstract
Purpose of Review Black patients suffer from breast cancer-related racial health disparities, which could have implications on their gynecologic care. This review explores considerations in the gynecologic care of Black breast cancer survivors. Recent Findings Black people have a higher risk of leiomyoma and endometrial cancer, which could confound bleeding patterns such as in the setting of tamoxifen use. As Black people are more likely to have early-onset breast cancer, this may have implications on long-term bone and heart health. Black patients may be more likely to have menopausal symptoms at baseline and as a result of breast cancer treatment. Furthermore, Black patients are less likely to utilize assisted reproductive technology and genetic testing services. Summary It is important for healthcare providers to be well-versed in the intersections of breast cancer and gynecologic care. Black breast cancer survivors may have unique considerations for which practitioners should be knowledgeable.
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Affiliation(s)
- Versha Pleasant
- University of Michigan Hospital, Mott Children & Women’s Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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16
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O'Neill SM, Travers CM, Otahal P, Khoo SK, Sharman JE. Menopause and accelerated aortic stiffness. Maturitas 2024; 180:107900. [PMID: 38101308 DOI: 10.1016/j.maturitas.2023.107900] [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: 06/25/2023] [Revised: 11/05/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND The menopausal transition is widely believed to increase the risk of cardiovascular disease, based on the notion that estrogen is cardioprotective in women. While aortic stiffness is an independent predictor of cardiovascular disease, it has been unclear whether this risk increases during menopause. OBJECTIVE This study aimed to determine the association between changes in menopausal status and aortic stiffness. MAIN OUTCOME MEASURES Menopausal status was classified using the Stages of Reproductive Aging in Women criteria in a stratified random sample of Australian women aged 40-80 years, at three time-points over 14 years (n = 469 in 2001-02 and 2005, and n = 323 in 2014). Aortic stiffness was measured non-invasively via carotid-femoral pulse wave velocity at each time point. Mixed modeling was employed to determine the independent associations between menopausal status and aortic stiffness accounting for multiple covariates including age, systolic blood pressure, heart rate, medications, cholesterol, waist circumference, smoking and diabetes status. RESULTS There was no evidence to support an association between the menopausal transition and an acceleration of aortic stiffness. However, there was an acceleration of aortic stiffness in the late (8+ years) postmenopause phase, after accounting for age and traditional cardiovascular risk factors (0.122 [95%CI: 0.106, 0.139] m/s/year; p < 0.001). CONCLUSIONS The menopausal transition is not associated with major changes in aortic stiffness beyond normal age-related effects. However, the clinically significant acceleration in aortic stiffness observed in late postmenopause may contribute to greater cardiovascular risk in this later life phase. Study registered in the Australian and New Zealand Clinical Trials Registry, reference ACTRN12618000005257.
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Affiliation(s)
- Sheila M O'Neill
- Betty Byrne Henderson Women's Health Research Centre, Royal Brisbane & Women's Hospital, Brisbane, Australia; Australian National University, Canberra, Australian Capital Territory, Australia. sheila.o'
| | - Catherine M Travers
- Betty Byrne Henderson Women's Health Research Centre, Royal Brisbane & Women's Hospital, Brisbane, Australia; School of Health & Rehabilitation Sciences, University of Queensland Australia, Australia
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Soo-Keat Khoo
- Betty Byrne Henderson Women's Health Research Centre, Royal Brisbane & Women's Hospital, Brisbane, Australia; Mayne Academy of Obstetrics & Gynaecology, Faculty of Medicine, University of Queensland, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Australia
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17
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Lewis Johnson T, Rowland LM, Ashraf MS, Clark CT, Dotson VM, Livinski AA, Simon M. Key Findings from Mental Health Research During the Menopause Transition for Racially and Ethnically Minoritized Women Living in the United States: A Scoping Review. J Womens Health (Larchmt) 2024; 33:113-131. [PMID: 38079223 PMCID: PMC10880275 DOI: 10.1089/jwh.2023.0276] [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] [Indexed: 02/18/2024] Open
Abstract
Background: Racially and ethnically minoritized (REM) women experience social and structural factors that may affect their response to mental health treatment and menopausal symptoms during the menopause transition (MT). This scoping review on mental health during the MT for REM women in the United States was conducted to characterize factors associated with mental health challenges. Materials and Methods: Five databases were searched. Articles were included if focused on MT in REM women in the United States and its territories with specific mental illnesses and published in English from 2005 to 2021. Titles and abstracts and full text were screened. Screening and data collection were completed in duplicate by two reviewers in Covidence. Results: Sixty-five articles were included and indicate that REM women experience a disproportionate burden of depressive symptoms during the MT. Less evidence is reported about anxiety, Post-Traumatic Stress Disorder, psychosis, schizophrenia, and other mental illnesses. The risk factors associated with mental illness during MT are social, structural, and biological. Treatment response to therapeutic interventions is often underpowered to explain REM differences. Conclusion: Depression during the MT is associated with negative outcomes that may impact REM women differentially. Incorporating theoretical frameworks (e.g., intersectionality, weathering) into mental health research will reduce the likelihood that scientists mislabel race as the cause of these inequities, when racism and intersecting systems of oppression are the root causes of differential expression of mental illness among REM women during the MT. There is a need for interdisciplinary research to advance the mental health of REM women.
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Affiliation(s)
- Tamara Lewis Johnson
- Women's Mental Health Research Program, Office of Disparities Research and Workforce Diversity, National Institute of Mental Health, NIH, Rockville, Maryland, USA
| | - Laura M. Rowland
- Neuroscience of Mental Disorders and Aging Program, Division of Translational Research, National Institute of Mental Health, NIH, Rockville, Maryland, USA
| | - Mahela S. Ashraf
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Crystal T. Clark
- Department of Psychiatry, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Vonetta M. Dotson
- Department of Psychology and Gerontology Institute, Georgia State University, Atlanta, Georgia, USA
| | - Alicia A. Livinski
- National Institutes of Health Library, Office of Research Services, Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Melissa Simon
- Department of Obstetrics and Gynecology, Institute for Public Health, and Medicine (IPHAM)—Center for Health Equity Transformation, Northwestern University, Chicago, Illinois, USA
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18
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Taylor-Swanson L, Stoddard K, Fritz J, Anderson B(B, Cortez M, Conboy L, Sheng X, Flake N, Sanchez-Birkhead A, Stark LA, Farah L, Farah S, Lee D, Merkley H, Pacheco L, Tavake-Pasi F, Sanders W, Villalta J, Moreno C, Gardiner P. Midlife Women's Menopausal Transition Symptom Experience and Access to Medical and Integrative Health Care: Informing the Development of MENOGAP. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241268355. [PMID: 39092447 PMCID: PMC11292722 DOI: 10.1177/27536130241268355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 06/14/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024]
Abstract
Background Individuals with a uterus experience menopause, the cessation of menses, on average at age 51 years in the United States. While menopause is a natural occurrence for most, over 85% of women experience multiple interfering symptoms. Menopausal women face health disparities, including a lack of access to high-quality healthcare and greater disparities are experienced by women who are black, indigenous, and people of color. Some women are turning away from hormone therapy, and some seek integrative health interventions. Objective Some menopausal women who seek healthcare do not receive it as they lack access to medical and integrative healthcare providers. A potential solution to this problem is a medical group visit (MGV), during which a provider sees multiple patients at once. The aims of this study were to gather women's opinions about the menopause, provider access, and conventional and integrative health interventions for later use to develop a menopause MGV. Methods We conducted a Community Engagement Session and a Return of Results (RoR) with midlife women to learn about their menopause experiences, barriers and facilitators to accessing health providers, and their interest in and suggestions for designing a future integrative MGV (IMGV). Thematic qualitative research methods were used to summarize session results. Results Nine women participated in the Session and six attended the RoR. Participants were well-educated and diverse in race and ethnicity. Themes included: an interest in this topic; unfamiliar medical terms; relevant social factors; desired whole person care; interest in integrative health; barriers and facilitators to accessing healthcare. The group expressed interest in ongoing participation in the future process of adapting an IMGV, naming it MENOGAP. Conclusion These findings highlight the importance of stakeholder engagement before designing and implementing MENOGAP and the great need among midlife women for education about the menopausal transition, integrative self-care, and healthcare.
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Affiliation(s)
| | - Kari Stoddard
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Julie Fritz
- College of Health, University of Utah, Salt Lake City, UT, USA
| | | | - Melissa Cortez
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Lisa Conboy
- Instructor in Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Xiaoming Sheng
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Naomi Flake
- Utah Clinical and Translational Science Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Louisa A. Stark
- Utah Clinical and Translational Science Institute, University of Utah, Salt Lake City, UT, USA
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Luul Farah
- University of Utah, Salt Lake City, UT, USA
| | - Sara Farah
- University of Utah, Salt Lake City, UT, USA
| | | | - Heather Merkley
- College of Health Professions, Weber State University, Ogden, UT, USA
| | | | | | | | | | - Camille Moreno
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Paula Gardiner
- University of Massachusetts Medical School and Director of Primary Care Implementation Research, Cambridge Health Alliance, Cambridge, MA, USA
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19
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Kingsberg SA, Schulze-Rath R, Mulligan C, Moeller C, Caetano C, Bitzer J. Global view of vasomotor symptoms and sleep disturbance in menopause: a systematic review. Climacteric 2023; 26:537-549. [PMID: 37751852 DOI: 10.1080/13697137.2023.2256658] [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: 06/06/2023] [Accepted: 09/03/2023] [Indexed: 09/28/2023]
Abstract
Studies have shown racial/ethnic differences in the prevalence of vasomotor symptoms (VMS), sleep disturbance and VMS treatment in menopause. To assess the reproducibility of these differences, we systematically reviewed observational studies, published in 2000-2021, reporting the prevalence/incidence of VMS, sleep disturbance or treatment use in menopausal women stratified by race/ethnicity. We screened 3799 records from PubMed and Embase and included 27 papers (19 studies). No incidence data were found. Prevalence data varied widely, but some common patterns emerged. In all five studies comparing VMS between Black women and White, Hispanic and/or East Asian women, the prevalence was highest in Black women and lowest in East Asian women. The prevalence of sleep disturbance overall was compared among Black, White and East Asian women in two study populations, and was highest in White women in both papers. Sleep disturbance was more common than VMS in East Asian women. In all four studies comparing hormone therapy use between White women and Black and/or East Asian women, treatment use was more common in White women. These results highlight the need for individualized counseling and treatment, outreach to under-served minorities, and standardized definitions and outcome measures for VMS and sleep disturbance for future studies.
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Affiliation(s)
- S A Kingsberg
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - R Schulze-Rath
- Medical Affairs & Pharmacovigilance, Pharmaceuticals, Bayer AG, Berlin, Germany
| | - C Mulligan
- Evidence Synthesis, Beacon Medical Communications, Brighton, UK
| | - C Moeller
- Medical Affairs & Pharmacovigilance, Pharmaceuticals, Bayer AG, Berlin, Germany
| | - C Caetano
- Pharmaceuticals, Medical Affairs Women's Healthcare, Bayer AG, Basel, Switzerland
| | - J Bitzer
- Department of Obstetrics and Gynecology, University Hospital, University of Basel, Basel, Switzerland
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20
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Harlow SD, Sievert LL, LaCroix AZ, Mishra GD, Woods NF. Women's midlife health: the unfinished research agenda. Womens Midlife Health 2023; 9:7. [PMID: 37784201 PMCID: PMC10546728 DOI: 10.1186/s40695-023-00090-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Affiliation(s)
- Sioban D Harlow
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
| | | | - Andrea Z LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, USA
| | - Gita D Mishra
- Australian Women and Girls' Health Research Center, School of Public Health, University of Queensland, Seattle, Australia
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21
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Abstract
Most women worldwide experience menopausal symptoms during the menopause transition or postmenopause. Vasomotor symptoms are most pronounced during the first four to seven years but can persist for more than a decade, and genitourinary symptoms tend to be progressive. Although the hallmark symptoms are hot flashes, night sweats, disrupted sleep, and genitourinary discomfort, other common symptoms and conditions are mood fluctuations, cognitive changes, low sexual desire, bone loss, increase in abdominal fat, and adverse changes in metabolic health. These symptoms and signs can occur in any combination or sequence, and the link to menopause may even be elusive. Estrogen based hormonal therapies are the most effective treatments for many of the symptoms and, in the absence of contraindications to treatment, have a generally favorable benefit:risk ratio for women below age 60 and within 10 years of the onset of menopause. Non-hormonal treatment options are also available. Although a symptom driven treatment approach with individualized decision making can improve health and quality of life for midlife women, menopausal symptoms remain substantially undertreated by healthcare providers.
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Affiliation(s)
- Erin R Duralde
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Talia H Sobel
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - JoAnn E Manson
- Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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22
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Cappola AR, Auchus RJ, El-Hajj Fuleihan G, Handelsman DJ, Kalyani RR, McClung M, Stuenkel CA, Thorner MO, Verbalis JG. Hormones and Aging: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1835-1874. [PMID: 37326526 DOI: 10.1210/clinem/dgad225] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 06/17/2023]
Abstract
Multiple changes occur across various endocrine systems as an individual ages. The understanding of the factors that cause age-related changes and how they should be managed clinically is evolving. This statement reviews the current state of research in the growth hormone, adrenal, ovarian, testicular, and thyroid axes, as well as in osteoporosis, vitamin D deficiency, type 2 diabetes, and water metabolism, with a specific focus on older individuals. Each section describes the natural history and observational data in older individuals, available therapies, clinical trial data on efficacy and safety in older individuals, key points, and scientific gaps. The goal of this statement is to inform future research that refines prevention and treatment strategies in age-associated endocrine conditions, with the goal of improving the health of older individuals.
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Affiliation(s)
- Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Richard J Auchus
- Departments of Pharmacology and Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI 48109, USA
- Endocrinology and Metabolism Section, Medical Service, LTC Charles S. Kettles Veteran Affairs Medical Center, Ann Arbor, MI 48015, USA
| | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology, Department of Internal Medicine, American University of Beirut, Beirut 1107-2020, Lebanon
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Andrology Department, Concord Repatriation General Hospital, Sydney 2139, Australia
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Michael McClung
- Oregon Osteoporosis Center, Portland, OR 97213, USA
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Cynthia A Stuenkel
- Department of Medicine, University of California, San Diego, School of Medicine, La Jolla, CA 92093, USA
| | - Michael O Thorner
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA 22903, USA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Joseph G Verbalis
- Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, DC 20057, USA
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23
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Ledford H. Brain-based treatment for menopausal hot flushes approved by FDA. Nature 2023:10.1038/d41586-023-01628-3. [PMID: 37188949 DOI: 10.1038/d41586-023-01628-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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24
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Valencia CI, Saunders D, Daw J, Vasquez A. DNA methylation accelerated age as captured by epigenetic clocks influences breast cancer risk. Front Oncol 2023; 13:1150731. [PMID: 37007096 PMCID: PMC10050548 DOI: 10.3389/fonc.2023.1150731] [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: 01/24/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction Breast cancer continues to be the leading form of cancer among women in the United States. Additionally, disparities across the breast cancer continuum continue to increase for women of historically marginalized populations. The mechanism driving these trends are unclear, however, accelerated biological age may provide key insights into better understanding these disease patterns. Accelerated age measured by DNA methylation using epigenetic clocks is to date the most robust method for estimating accelerated age. Here we synthesize the existing evidence on epigenetic clocks measurement of DNA methylation based accelerated age and breast cancer outcomes. Methods Our database searches were conducted from January 2022 to April 2022 and yielded a total of 2,908 articles for consideration. We implemented methods derived from guidance of the PROSPERO Scoping Review Protocol to assess articles in the PubMed database on epigenetic clocks and breast cancer risk. Results Five articles were deemed appropriate for inclusion in this review. Ten epigenetic clocks were used across the five articles demonstrating statistically significant results for breast cancer risk. DNA methylation accelerated age varied by sample type. The studies did not consider social factors or epidemiological risk factors. The studies lacked representation of ancestrally diverse populations. Discussion DNA methylation based accelerated age as captured by epigenetic clocks has a statistically significant associative relationship with breast cancer risk, however, important social factors that contribute to patterns of methylation were not comprehensively considered in the available literature. More research is needed on DNA methylation based accelerated age across the lifespan including during menopausal transition and in diverse populations. This review demonstrates that DNA methylation accelerated age may provide key insights for tackling increasing rates of U.S. breast cancer incidence and overall disease disparities experienced by women from minoritized backgrounds.
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Affiliation(s)
- Celina I. Valencia
- Department of Family and Community Medicine, College of Medicine—Tucson, University of Arizona, Tucson, AZ, United States
| | - Devin Saunders
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, United States
| | - Jennifer Daw
- Cancer Biology Program, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Adria Vasquez
- Department of Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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25
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Andrews RAF, John B, Lancastle D. Symptom monitoring improves physical and emotional outcomes during menopause: a randomized controlled trial. Menopause 2023; 30:267-274. [PMID: 36727773 DOI: 10.1097/gme.0000000000002144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Objectives: A recent systematic review suggested that symptom monitoring can result in reductions in menopausal symptoms and improvements in health-related behaviors. To date, no studies have experimentally investigated whether symptom monitoring could be a beneficial intervention during the menopause transition.Methods: One hundred perimenopausal and postmenopausal women (mean age, 46 y; SD, 8 y) were randomized into either a monitoring-intervention or control group. A mixed between/within design was used, with group membership (ie, monitoring-intervention or control) as the between-subjects component and time (ie, baseline and 2-wk follow-up) as the within-subjects component. Dependent variables included symptom reductions and emotional reactions as measured via the Daily Record Keeping form. Secondary outcomes included help-seeking, communication, medical decision making, health awareness, self-efficacy, and health anxiety.Results: A linear mixed-effects model demonstrated that the monitoring-intervention group reported a 42% reduction in physical symptoms at follow-up versus a 12% reduction in the control group: ρ = 0.009, β = 6.3, 95% CI (1.5-11). Negative emotions also significantly reduced in the monitoring-intervention group but did not alter in the control group: ρ < 0.001, β = 3.4, and 95% CI (1.6-5.2). These effects remained significant after controlling for potential moderator variables such as trait neuroticism and coping preferences and potential confounders such as medical and demographic characteristics. Variances in other health outcomes were nonsignificant.Conclusions: Findings demonstrated that symptom monitoring reduced symptoms and negative emotions within a perimenopausal and postmenopausal sample, and these outcomes endured after controlling for key moderators and covariates. However, symptom monitoring was not related to improvements in health-related behavioral outcomes, which contrasts with previous findings. These findings show that symptom monitoring may be useful within healthcare settings by providing perimenopausal and postmenopausal women with a simple and accessible means of symptom alleviation while they await treatment or medical consultation.
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Affiliation(s)
| | - Bev John
- From the University of South Wales, Pontypridd, United Kingdom
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26
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Mitchell CM, Larson JC, Crandall CJ, Bhasin S, LaCroix AZ, Ensrud KE, Guthrie KA, Reed SD. Association of Vaginal Estradiol Tablet With Serum Estrogen Levels in Women Who Are Postmenopausal: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2241743. [PMID: 36374501 PMCID: PMC9664265 DOI: 10.1001/jamanetworkopen.2022.41743] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Half of women who are postmenopausal have genitourinary discomfort after menopause. Recommended therapies include low-dose vaginal estrogen. Individuals with a history of breast cancer or venous thromboembolism may have concerns about the safety of this intervention. OBJECTIVE To compare serum estrogen concentrations with the use of vaginal estrogen, 10 μg, tablet vs placebo in women who are postmenopausal. DESIGN, SETTING, AND PARTICIPANTS This is a secondary, post hoc analysis of data from a randomized clinical trial of treatment for moderate to severe genitourinary syndrome in women who are postmenopausal. The study was conducted at Kaiser Permanente Washington Health Research Institute and the University of Minnesota from April 11, 2016, to April 23, 2017. Measurements and data analysis were performed from November 3, 2020, to September 23, 2022. INTERVENTIONS Participants were randomly assigned to vaginal estradiol tablet (10 μg/d for 2 weeks and then twice weekly) plus placebo gel (3 times weekly) or dual placebo for 12 weeks. MAIN OUTCOMES AND MEASURES In this post hoc analysis, baseline and week 12 serum estradiol, estrone, and sex hormone-binding globulin (SHBG) concentrations were measured by a chemiluminescent assay. Week 12 values of the 3 analytes were compared by baseline participant characteristics. Linear models compared week 12 estradiol concentrations between treatment groups, adjusted for baseline characteristics. RESULTS A total of 174 women, mean (SD) age 61 (4) years, were included. Those in the estrogen group (n = 88) were more likely to have higher geometric mean (SD) week 12 serum estradiol concentrations (4.3 [2.2 pg/mL]) than those in the placebo group (n = 86) (3.5 [2.1] pg/mL) (P = .01). Adjusted for pretreatment hormone concentrations, age, clinical site, and body mass index, assignment to the estrogen vs placebo treatment group was significantly associated with higher week 12 estradiol concentrations (23.8% difference; 95% CI, 6.9%-43.3%). Most (121 of 174 [69.5%]) participants had enrollment serum estradiol concentrations higher than 2.7 pg/mL. Of women starting treatment at estradiol levels lower than or equal to 2.7 pg/mL, 38.1% (8 of 21) in the estrogen group and 34.4% (11 of 32) in the placebo group had estradiol concentrations higher than 2.7 pg/mL after 12 weeks of study participation (P = .78). Treatment assignment was not associated with week 12 estrone or SHBG concentrations. CONCLUSIONS AND RELEVANCE In this secondary analysis of a randomized clinical trial, a significant, although small, increase in serum estradiol levels was noted after 12 weeks of vaginal estrogen administration. The clinical relevance of this small increase is uncertain. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02516202.
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Affiliation(s)
| | - Joseph C. Larson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Carolyn J. Crandall
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Shalender Bhasin
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrea Z. LaCroix
- Herbert Wertheim School of Public Health, University of California, San Diego
| | - Kristine E. Ensrud
- Departments of Medicine and Epidemiology and Community Health, University of Minnesota, Minneapolis
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Katherine A. Guthrie
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Susan D. Reed
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Obstetrics and Gynecology, University of Washington, Seattle
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Williams M, Richard-Davis G, Williams PL, Christensen L, Ward E, Schrager S. A review of African American women's experiences in menopause. Menopause 2022; 29:1331-1337. [PMID: 36126249 DOI: 10.1097/gme.0000000000002060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE AND OBJECTIVE Little is known and reported about the experiences of African American women as they transition to and experience menopause. Accepted norms are based on the experience of a predominantly White population. The aim of this study is to review available data about the distinct experiences of African American women during the menopause transition and menopause. METHODS A literature search was developed and executed by the review team in collaboration with a health sciences librarian. The search combined controlled vocabulary and title/abstract terms related to the health status disparities of African Americans in the menopause transition and menopause. The following databases were searched from inception through April 28, 2022: PubMed, Scopus (Elsevier), and Web of Science Core Collection (Clarivate). DISCUSSION AND CONCLUSION African American women experience distinct differences in physical, psychological, social, and quality of life measures during menopause. Increasing awareness about the unique menopause experiences of African American women is critically important to improve the health of this underserved population.
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Affiliation(s)
- Makeba Williams
- From the Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Gloria Richard-Davis
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Leslie Christensen
- Department of Library Science, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Earlise Ward
- Department of Nursing, University of Wisconsin-Madison, WI
| | - Sarina Schrager
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Reeves A, Elliott MR, Lewis TT, Karvonen-Gutierrez CA, Herman WH, Harlow SD. Study Selection Bias and Racial or Ethnic Disparities in Estimated Age at Onset of Cardiometabolic Disease Among Midlife Women in the US. JAMA Netw Open 2022; 5:e2240665. [PMID: 36342714 PMCID: PMC9641536 DOI: 10.1001/jamanetworkopen.2022.40665] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/21/2022] [Indexed: 11/09/2022] Open
Abstract
Importance Racial disparities in cardiometabolic health are consistently observed in cohort studies. However, most studies neither evaluate differences in age at onset nor account for systematic exclusion stemming from "weathering" (accelerated health declines for minoritized groups due to structural social and economic marginalization). Objective To evaluate racial or ethnic disparities in age at onset of 4 cardiometabolic outcomes (hypertension, isolated systolic hypertension [ISH], insulin resistance [IR], and diabetes), accounting for multiple forms of potential selection bias. Design, Setting, and Participants This cohort study used data from the Study of Women's Health Across the Nation longitudinal cohort (1995-2016) and a cross-sectional screening sample (1995-1997). Data were analyzed from July 2019 to October 2021. Participants were eligible for the cohort if they were aged 42 to 52 years, had not received hormone therapy in the past 3 months, were not pregnant, had an intact uterus and at least 1 ovary, and were premenopausal or early perimenopausal (most recent menses ≤3 months). Exposures Self-reported racial or ethnic group (Black, Chinese, Hispanic, Japanese, or White). Main Outcomes and Measures The main outcomes were hypertension (systolic blood pressure [BP] ≥140 mm Hg and diastolic BP ≥90 mm Hg or use of antihypertensive medication), ISH (systolic BP ≥140 mm Hg and diastolic BP <90 mm Hg or use of antihypertensive medication), IR (homeostasis model assessment for IR value >5.9 or insulin use), and diabetes (fasting serum glucose level ≥126 mg/dL [to convert to mmol/L, multiply by 0.0555], use of insulin or oral antidiabetic medication, or physician diagnosis). Selection into the cohort was addressed via inverse probability weighting and interval-censored survival models and selection out via multiple imputation. Accelerated failure time models were used to examine racial or ethnic differences in age at disease onset and estimate the median age at onset. Results A total of 3302 women were included in the study, with a median age of 46.2 years (range, 42-52 years) at baseline. In the sample, 42.6% had a bachelor's degree or higher and 36.3% self-rated their health as "very good" at baseline; 23.9% had hypertension, 43.7% had ISH, 13.5% had IR, and 4.6% had diabetes at baseline. Hypertension occurred a median of 5.0 years (95% CI, 5.4-5.5 years) earlier and metabolic outcomes (diabetes and IR) a median of 11.3 years (95% CI, 9.7-12.9 years) earlier for Black and Hispanic women vs White women; ISH occurred a median of 7.7 years (95% CI, 7.3-8.1 years) earlier for Black women vs White women. Adjustment for selection was associated with a mean 20-year decrease in estimated median age at onset, with greater decreases among Black and Hispanic women. Conclusions and Relevance In this multiracial cohort of midlife women, failure to account for selection biases, especially at study onset, was associated with falsely high estimates of age at cardiometabolic onset, with greater misestimation among Black and Hispanic women. The results suggest that hypertension and metabolic interventions, particularly for Black and Hispanic women, should be targeted to women aged as young as 30 years for hypertension and 40 years for metabolic interventions. Considering the timing of disease and fully addressing inherent selection biases in research are critical to understanding aging and disease risk, especially for racial and ethnic minoritized populations.
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Affiliation(s)
- Alexis Reeves
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Michael R. Elliott
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Tené T. Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - William H. Herman
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Siobán D. Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
- Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor
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29
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Harlow SD, Burnett-Bowie SAM, Greendale GA, Avis NE, Reeves AN, Richards TR, Lewis TT. Correction: Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women's Health Across the Nation (SWAN). Womens Midlife Health 2022; 8:10. [PMID: 36271444 PMCID: PMC9587535 DOI: 10.1186/s40695-022-00082-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Siobán D Harlow
- Department of Epidemiology, University of Michigan, School of Public Health, United States, 1415 Washington Heights, Ann Arbor, MI, 48104-2029, USA.
| | - Sherri-Ann M Burnett-Bowie
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Gail A Greendale
- Division of Geriatrics, David Gefen School of Medicine, University of California at Los Angeles, Los Angeles, USA
| | - Nancy E Avis
- Department of Social Sciences & Health Policy Wake Forest School of Medicine, Winston-Salem, USA
| | - Alexis N Reeves
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Thomas R Richards
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
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30
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A call for health equity when addressing menopausal symptoms. Menopause 2022; 29:1235-1236. [PMID: 36256951 DOI: 10.1097/gme.0000000000002103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Prevalence and quality-of-life burden of vasomotor symptoms associated with menopause: A European cross-sectional survey. Maturitas 2022; 167:66-74. [DOI: 10.1016/j.maturitas.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/25/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022]
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32
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Nguyen PN, Nguyen VT. Evaluating Clinical Features in Intracavitary Uterine Pathologies among Vietnamese Women Presenting with Peri-and Postmenopausal Bleeding: A Bicentric Observational Descriptive Analysis. J Midlife Health 2022; 13:225-232. [PMID: 36950211 PMCID: PMC10025815 DOI: 10.4103/jmh.jmh_81_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: 04/15/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 03/24/2023] Open
Abstract
Background Intracavitary uterine pathologies (IUPs) may be resulting in vaginal bleeding in perimenopausal and postmenopausal women. Especially, malignant disease needed to be investigated due to its adverse impact on the quality of mid-life women as well as the burden of health-care costs in low- and middle-income countries such as Vietnam. Objective Thereby, through this study, we aimed to assess the major clinical features of IUPs in women with perimenopausal and postmenopausal bleeding women. Materials and Methods This was a cross-sectional observational study at Hue University Hospital and Hue Central Hospital from June 2016 to June 2019. The study enrolled 150 women above 40 years old involving with intrauterine bleeding. Results The mean age of the study population was 51.51 ± 7.65. The most common symptom in perimenopausal women was menorrhagia, up to 62.2% of cases. In addition to intrauterine bleeding, there were 54.7% of cases had at least one other functional symptom, they were pale skin (35.9%), and lower abdominal pain (31.3). Endometrial hyperplasia (EH) was the most common pathology in both groups with perimenopausal and postmenopausal bleeding (PMB), respectively, 66.7% and 51.7%. In PMB group, endometrial cancer (EC) occupied approximately 38.3% following EH. Our study revealed age, menstrual characteristics, and diabetes in relation to malignant disease. Other factors seemed to be less associated with EC. Conclusions Menorrhagia was the most common type of abnormal uterine bleeding in perimenopausal women. Besides vaginal bleeding, others symptoms such as pale skin, pelvic pain, and fatigue were also common. Length day and blood loss before hospitalization in perimenopausal women were greater significantly than that in postmenopausal women. Age, menstrual characteristics, and diabetes increased the risk of EC in women with PMB.
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Affiliation(s)
- Phuc Nhon Nguyen
- Department of High-Risk Pregnancy and Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Van Tuan Nguyen
- Department of Obstetrics and Gynecology, Hue Medical College, Thua Thien Hue, Vietnam
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Affiliation(s)
- Martha Hickey
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Victoria, Australia
| | - Myra S Hunter
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jane Ussher
- Translational Health Research Institute and School of Medicine, Western Sydney University, New South Wales, Australia
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