1
|
Barbagallo F, Cucinella L, Tiranini L, Chedraui P, Calogero AE, Nappi RE. Obesity and sexual health: focus on postmenopausal women. Climacteric 2024; 27:122-136. [PMID: 38251874 DOI: 10.1080/13697137.2024.2302429] [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: 09/03/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024]
Abstract
Menopause is a cardiometabolic transition with many women experiencing weight gain and redistribution of body fat. Hormonal changes may affect also several dimensions of well-being, including sexual function, with a high rate of female sexual dysfunction (FSD), which displays a multifactorial etiology. The most important biological factors range from chronic low-grade inflammation, associated with hypertrophic adipocytes that may translate into endothelial dysfunction and compromised blood flow through the genitourinary system, to insulin resistance and other neuroendocrine mechanisms targeting the sexual response. Psychosocial factors include poor body image, mood disorders, low self-esteem and life satisfaction, as well as partner's health and quality of relationship, and social stigma. Even unhealthy lifestyle, chronic conditions and putative weight-promoting medications may play a role. The aim of the present narrative review is to update and summarize the state of the art on the link between obesity and FSD in postmenopausal women, pointing to the paucity of high-quality studies and the need for further research with validated end points to assess both biomarkers of obesity and FSD. In addition, we provide general information on the diagnosis and treatment of FSD at menopause with a focus on dietary interventions, physical activity, anti-obesity drugs and bariatric surgery.
Collapse
Affiliation(s)
- F Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - L Cucinella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - L Tiranini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - P Chedraui
- Escuela de Posgrados en Salud, Universidad Espíritu Santo, Samborondón, Ecuador
| | - A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - R E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| |
Collapse
|
2
|
Donohoe F, O’Meara Y, Roberts A, Comerford L, Kelly CM, Walshe JM, Lundy D, Hickey M, Brennan DJ. Using menopausal hormone therapy after a cancer diagnosis in Ireland. Ir J Med Sci 2023; 192:45-55. [PMID: 35141870 PMCID: PMC9892117 DOI: 10.1007/s11845-022-02947-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Menopause may cause a constellation of symptoms that affect quality of life. Many women will have menopause induced or exacerbated by treatment for cancer whether that be through surgery, chemotherapy, radiotherapy, or anti-endocrine therapy. As treatments advance, the number of people living with and beyond a cancer diagnosis is set to increase over the coming years meaning more people will be dealing with the after effects of cancer and its treatment. AIMS This review aims to summarise available data to guide clinicians treating women with menopausal symptoms after the common cancer diagnoses encountered in Ireland. The use of menopausal hormone therapy is discussed as well as non-hormonal and non-pharmacological options. CONCLUSIONS Managing menopausal symptoms is an important consideration for all physicians involved in the care of people living with and beyond a cancer diagnosis. High-quality data may not be available to guide treatment decisions, and, thus, it is essential to take into account the impact of the symptoms on quality of life as well as the likelihood of recurrence in each individual case.
Collapse
Affiliation(s)
- Fionán Donohoe
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Yvonne O’Meara
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Aidin Roberts
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Louise Comerford
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Catherine M. Kelly
- Dept. of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Janice M. Walshe
- Dept. of Medical Oncology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
| | - Deirdre Lundy
- Reproductive and Sexual Health Co-Ordinator, Irish College of General Practitioners, Lincoln Place, Dublin 2, Ireland
| | - Martha Hickey
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women’s Hospital, Melbourne, VIC Australia
| | - Donal J. Brennan
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland ,UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Belfield, Dublin 4, Ireland
| |
Collapse
|
3
|
McCormick CA, Brennan A, Hickey M. Managing vasomotor symptoms effectively without hormones. Climacteric 2020; 23:532-538. [DOI: 10.1080/13697137.2020.1789093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- C. A. McCormick
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women’s Hospital, Parkville, VIC, Australia
| | - A. Brennan
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women’s Hospital, Parkville, VIC, Australia
| | - M. Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women’s Hospital, Parkville, VIC, Australia
| |
Collapse
|
4
|
Jäger P, Wolicki A, Spohnholz J, Senkal M. Review: Sex-Specific Aspects in the Bariatric Treatment of Severely Obese Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2734. [PMID: 32326591 PMCID: PMC7216185 DOI: 10.3390/ijerph17082734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/03/2020] [Accepted: 04/09/2020] [Indexed: 12/20/2022]
Abstract
This systematic literature review aims to point out sex-specific special features that are important in the bariatric treatment of women suffering from severe obesity. A systematic literature search was carried out according to Cochrane and Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines. After the literature selection, the following categories were determined: sexuality and sexual function; contraception; fertility; sex hormones and polycystic ovary syndrome; menopause and osteoporosis; pregnancy and breastfeeding; pelvic floor disorders and urinary incontinence; female-specific cancer; and metabolism, outcome, and quality of life. For each category, the current status of research is illuminated and implications for bariatric treatment are determined. A summary that includes key messages is given for each subsection. An overall result of this paper is an understanding that sex-specific risks that follow or result from bariatric surgery should be considered more in aftercare. In order to increase the evidence, further research focusing on sex-specific differences in the outcome of bariatric surgery and promising treatment approaches to female-specific diseases is needed. Nevertheless, bariatric surgery shows good potential in the treatment of sex-specific aspects for severely obese women that goes far beyond mere weight loss and reduction of metabolic risks.
Collapse
Affiliation(s)
- Pia Jäger
- Department of General and Visceral Surgery, Marien Hospital Witten, Teaching hospital of the Ruhr-University Bochum, Marienplatz 2, 58452 Witten, Germany
- Department of General and Visceral Surgery, Marien Hospital Herne, University hospital of the Ruhr-University Bochum, Hölkeskampring 40, 44625 Herne, Germany
| | - Annina Wolicki
- Department of General and Visceral Surgery, Marien Hospital Witten, Teaching hospital of the Ruhr-University Bochum, Marienplatz 2, 58452 Witten, Germany
- Department of General and Visceral Surgery, Marien Hospital Herne, University hospital of the Ruhr-University Bochum, Hölkeskampring 40, 44625 Herne, Germany
| | - Johannes Spohnholz
- Department of General and Visceral Surgery, Marien Hospital Witten, Teaching hospital of the Ruhr-University Bochum, Marienplatz 2, 58452 Witten, Germany
- Department of General and Visceral Surgery, Marien Hospital Herne, University hospital of the Ruhr-University Bochum, Hölkeskampring 40, 44625 Herne, Germany
| | - Metin Senkal
- Department of General and Visceral Surgery, Marien Hospital Witten, Teaching hospital of the Ruhr-University Bochum, Marienplatz 2, 58452 Witten, Germany
- Department of General and Visceral Surgery, Marien Hospital Herne, University hospital of the Ruhr-University Bochum, Hölkeskampring 40, 44625 Herne, Germany
| |
Collapse
|
5
|
Lu N, Adambekov S, Edwards RP, Ramanathan RC, Bovbjerg DH, Linkov F. Relationships Between a History of Abuse, Changes in Body Mass Index, Physical Health, and Self-Reported Depression in Female Bariatric Surgery Patients. Bariatr Surg Pract Patient Care 2019; 14:113-119. [PMID: 31572626 DOI: 10.1089/bari.2018.0051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background/Objectives: A history of physical and sexual abuse has been implicated in weight gain. Although bariatric surgery is effective for weight loss in severely obese individuals, we investigated whether bariatric surgery patients who self-report a history of physical and/or sexual abuse have differential outcomes regarding weight loss, body mass index (BMI), quality of life (SF-36), and depressive symptoms (Center for Epidemiologic Studies Depression [CESD]) compared with nonabused patients. Materials and Methods: Standardized assessments at baseline and follow-up visits were performed on 103 obese (BMI >35) female bariatric surgery patients (mean age: 44.11 years, standard deviation: 11.67 years). Results: In total 49.5% of participants reported abuse. Abused group had significantly higher BMI (p < 0.01) and depression scores (p < 0.01). After surgery, the BMI between the two groups was no longer significantly different, although the abused group remained significantly more depressed. Mixed models showed that abuse was associated with CESD scores (p < 0.01) and SF-36 mental composite scores (p = 0.03) after adjusting for smoking history. Conclusion: Bariatric surgery leads to a better weight loss in abused patients. Abuse history might be an additional factor for clinicians to consider when advising bariatric surgery, as our study suggests that women with history of abuse may have a higher weight loss benefit but less mental health improvement from the intervention.
Collapse
Affiliation(s)
- Nancy Lu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shalkar Adambekov
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert P Edwards
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ramesh C Ramanathan
- Minimally Invasive Bariatric and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Dana H Bovbjerg
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Faina Linkov
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| |
Collapse
|
6
|
Partain N, Mokdad A, Puzziferri N, Porembka J, Seiler S, Christie A, Farr D, Rivers A, Marilyn Leitch A, Wooldridge R, Huth J, Rao R. Mammographic density changes in surgical weight loss-an indication for personalized screening. BMC Med Imaging 2018; 18:10. [PMID: 29743035 PMCID: PMC5941592 DOI: 10.1186/s12880-017-0242-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/15/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Obesity and high radiologic breast density independently increase breast cancer risk. We evaluated the effect of surgical weight loss on mammographic density (MD). METHODS Patients undergoing bariatric surgery and screening mammography (MG) were identified, data regarding demographics, comorbidities, calculated and genetic breast cancer risk was collected. Patients had a MG before and after surgery. Fellowship-trained breast radiologists assigned Breast Imaging Reporting and Data System density categories. RESULTS Patients underwent sleeve gastrectomy (n = 56) or gastric bypass (n = 7), 78% had hypertension, 48% had diabetes. Four had deleterious BRCA mutations, four were calculated high risk. Mean weight loss = 28.7 kg. Mean initial BMI = 44.3 kg/m2 (range:33-77), final BMI = 33.6 kg/m2 (range:20-62;p < 0.01). Density was unchanged in 53, decreased in 1, increased in 9. Of these 9(14%), 5 changed from almost entirely fatty to scattered MD, and 4 changed from scattered MD to heterogeneously dense. Mean weight loss of the 9 with increased MD was greater than the cohort (37.7vs.28.7 kg;p < 0.01). CONCLUSIONS Surgical weight loss increased MD in 14%. Increased MD masks malignancies, patients may benefit from additional screening based on calculated risk assessments that include MD.
Collapse
Affiliation(s)
- Natalia Partain
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Ali Mokdad
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Nancy Puzziferri
- Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Jessica Porembka
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Stephen Seiler
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Alana Christie
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Deborah Farr
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Aeisha Rivers
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - A Marilyn Leitch
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Rachel Wooldridge
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - James Huth
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8548, USA
| | - Roshni Rao
- Division of Breast Surgery, Columbia University Medical Center/New York Presbyterian, 161 Fort Washington Ave 10th floor, New York, NY, 10032, USA.
| |
Collapse
|