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Monterrosa-Castro Á, Monterrosa-Blanco A, Sánchez-Zarza S. Possible association between subclinical hypothyroidism and age at menopause in Colombian women. Gynecol Endocrinol 2024; 40:2334798. [PMID: 38590105 DOI: 10.1080/09513590.2024.2334798] [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: 01/29/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVE To evaluate the association between subclinical hypothyroidism with early menopause, premature menopause, and last menstrual bleeding before the natural age of menopause. METHODS This was a cross-sectional study conducted in 643 postmenopausal women aged 40-69 years. Groups were formed according to last menstrual episode: ≥45 [Natural age at menopause], 40-44 and [Early menopause], <40 [Premature menopause], and <45 [last menstrual episode before the natural age of menopause]. The Zulewski scale was applied to identify manifestations related to hypothyroidism and subclinical hypothyroidism, diagnosed with a serum TSH > 4.5 µIU/mL plus T4-free between 0.7 and 1.9 ng/dL. RESULTS It was found that 24.4% had the last menstrual episode before the natural age of menopause, 18.6% had early menopause, and 5.7% had premature menopause. Subclinical hypothyroidism was diagnosed in 4.5% of patients. Among women with subclinical hypothyroidism, there was a higher frequency of early menopause, premature menopause, and last menstrual episode before the natural age of menopause, than in women without subclinical hypothyroidism (p < 0.05). Paresthesia (50%) and dry skin (40.7%) were the most reported hypothyroidism-related manifestations. Early menopause, premature menopause, and last menstrual episode before the natural age of menopause were associated with subclinical hypothyroidism, OR: 3.37 [95% CI: 1.40-8.10], OR: 4.31 [95% CI: 1.24-14.97], and OR: 3.57 [95% CI: 1.57-8.10], respectively. CONCLUSIONS The last menstrual episode before the natural age of menopause, early menopause, and premature menopause were significantly associated with a higher chance of subclinical hypothyroidism.
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Affiliation(s)
- Álvaro Monterrosa-Castro
- Grupo de investigación Salud de la Mujer, Facultad de Medicina, Universidad de Cartagena, Cartagena, Colombia
| | - Angelica Monterrosa-Blanco
- Grupo de investigación Salud de la Mujer, Facultad de Medicina, Universidad de Cartagena, Cartagena, Colombia
| | - Sandra Sánchez-Zarza
- Grupo de investigación Salud de la Mujer, Facultad de Medicina, Universidad de Cartagena, Cartagena, Colombia
- Instituto de Previsión Social (IPS). Hospital Central, Dr. Emilio Cubas, Facultad de Ciencias de la Salud, Universidad Católica Nuestra Señora de la Asunción', Asunción, Paraguay
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Jiao J, Hao J, Hou L, Luo Z, Shan S, Ding Y, Ma L, Huang Y, Ying Q, Wang F, Zhou J, Ning Y, Song P, Xu L. Age at natural menopause and associated factors with early and late menopause among Chinese women in Zhejiang province: A cross-sectional study. PLoS One 2024; 19:e0307402. [PMID: 39012896 PMCID: PMC11251616 DOI: 10.1371/journal.pone.0307402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/29/2024] [Indexed: 07/18/2024] Open
Abstract
OBJECTIVES Menopause is a significant life transition for women, impacting their physical and psychological health. The age at natural menopause (ANM) and its associated factors have differed by race and region. This study aimed to investigate ANM and associated factors of early and late menopause among Chinese women in Zhejiang province. METHODS A cross-sectional study was conducted using a multi-stage stratified cluster sampling method to recruit 8,006 women aged 40-69 years who had resided in Zhejiang province for over 6 months between July 2019 and December 2021. Self-reported ANM and sociodemographics, lifestyle behaviors, reproductive history, and health-related factors were collected using questionnaires in face-to-face surveys. ANM were categorized into three groups: early menopause (<45 years), normal menopause (45-54 years), and late menopause (≥55 years). Kaplan-Meier survival analysis was utilized to calculate the median ANM. Multivariable multinomial logistic regression was employed to explore the associated factors of early menopause and late menopause. RESULTS A total of 6,047 women aged 40-69 years were included for survival analysis, with 3,176 of them for the regression analysis. The overall median ANM was 51 years (Inter-quartile range [IQR]: 51-52). Women who were smokers (odds ratio [OR]:4.54, 95% confidence interval [CI]:1.6-12.84), had irregular menstrual cycles (OR:1.78, 95% CI:1.12-2.83) and hypertension (OR:1.55, 95% CI:1.09-2.21) had a higher odds ratio of early menopause, while central obesity (OR:1.33, 95% CI:1.03-1.73) and hyperlipidemia (OR:1.51, 95% CI:1.04-2.18) were factors associated with late menopause. CONCLUSIONS This study revealed the associations between ANM and various factors among Chinese women. These factors included socio-demographic factors such as age; life behavior factors like current or prior smoking status; reproductive history factors such as irregular menstrual cycles, miscarriages, and breastfeeding; and health-related factors like central adiposity, hypertension, and hyperlipidemia. These findings provided a basis for understanding factors associated with ANM.
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Affiliation(s)
- Jie Jiao
- Zhejiang Maternal, Child and Reproductive Health Center, Hangzhou, Zhejiang, China
| | - Jiajun Hao
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Leying Hou
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zeyu Luo
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shiyi Shan
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yuehong Ding
- Zhejiang Maternal, Child and Reproductive Health Center, Hangzhou, Zhejiang, China
| | - Linjuan Ma
- Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yizhou Huang
- Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qian Ying
- Institute of Basic Medicine and Cancer (IBMC), Zhejiang Cancer Hospital, Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Feixue Wang
- Zhejiang Maternal, Child and Reproductive Health Center, Hangzhou, Zhejiang, China
| | - Jianhong Zhou
- Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yumei Ning
- Zhejiang Maternal, Child and Reproductive Health Center, Hangzhou, Zhejiang, China
| | - Peige Song
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ling Xu
- Zhejiang Maternal, Child and Reproductive Health Center, Hangzhou, Zhejiang, China
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3
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Vallejo MS, Blümel JE, Chedraui P, Tserotas K, Salinas C, Rodrigues MA, Rodríguez DA, Rey C, Ojeda E, Ñañez M, Monterrosa-Castro Á, Gómez-Tabares G, Espinoza MT, Escalante C, Elizalde A, Dextre M, Calle A, Aedo S. Association of muscle disorders in late postmenopausal women according to the type of experienced menopause. Menopause 2024; 31:641-646. [PMID: 38688462 DOI: 10.1097/gme.0000000000002367] [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: 05/02/2024]
Abstract
OBJECTIVE Musculoskeletal disorders frequently affect postmenopausal women. This study aims to compare muscle disorders between women according to the type of experienced menopause: premature (PM) or normal age of menopause (NAM). METHODS This was a cross-sectional study conducted in nine Latin American countries in which late postmenopausal women (55 to 70 years) were surveyed with a general questionnaire, the Menopause Rating Scale (MRS: item #4 exploring musculoskeletal discomfort), and strength, assistance with walking, rising from a chair, climbing stairs, and falling questionnaire (risk of sarcopenia). RESULTS A total of 644 women were included: 468 who had NAM, and 176 who had PM (116 spontaneous and 60 surgical). The overall mean age of the participants was 60.9 ± 4.2 years. Women who had PM experienced more musculoskeletal discomfort (33.5% vs 20.9%, P < 0.001) and a higher likelihood of sarcopenia (35.2% vs 19.9%, P < 0.001) than women who had a NAM. Women who had surgical PM exhibited a higher prevalence of severe musculoskeletal discomfort (46.7% vs 29.3%, P < 0.02) and a higher likelihood of sarcopenia (45.0% vs 27.6%, P < 0.02) than women who had a NAM. After adjusting for covariates (age, body mass index, menopausal hormone therapy use, physical activity, education, cigarette consumption, use of antidepressants, sexual activity, comorbidities, and having a partner), our logistic regression model determined that spontaneous PM was not associated with higher odds of musculoskeletal discomfort and higher odds of sarcopenia. On the other hand, women who had surgical PM were more likely to experience musculoskeletal discomforts (odds ratio: 2.26; 95% confidence interval: 1.22-4.17) and higher odds for sarcopenia (odds ratio: 2.05; 95% confidence interval: 1.16-3.65) as compared to women who experienced a NAM. CONCLUSIONS Women experiencing surgical PM have a higher likelihood of developing muscle disorders. This underscores the potential significance of hormonal levels in influencing musculoskeletal health during postmenopause.
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Affiliation(s)
- María S Vallejo
- From the Servicio de Obstetricia y Ginecología, Hospital Clínico de la Universidad de Chile, Santiago de Chile, Chile
| | - Juan E Blümel
- Departamento de Medicina Interna Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | | | | | - Carlos Salinas
- Servicio de Obstetricia y Ginecología, Hospital Ángeles, Puebla, México
| | - Marcio A Rodrigues
- Department of Gynecology and Obstetrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Doris A Rodríguez
- Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Claudia Rey
- Asociación Argentina para el Estudio del Climaterio, Buenos Aires, Argentina
| | - Eliana Ojeda
- Departamento Académico de Medicina Humana, Universidad Andina del Cusco, Cusco, Perú
| | - Mónica Ñañez
- II Cátedra de Ginecología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | | | - Gustavo Gómez-Tabares
- Departamento de Ginecología, Escuela de Medicina, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - María T Espinoza
- Unidad de Ginecología Obstétrica, Clínica Los Ángeles, Cochabamba, Bolivia
| | - Carlos Escalante
- Departamento de Ginecología, Facultad de Medicina, Universidad de Costa Rica, San José, Costa Rica
| | - Alejandra Elizalde
- Departamento de la Mujer, Niñez y Adolescencia, Facultad de Medicina de la Universidad Nacional del Nordeste, Corrientes, Argentina
| | - Maribel Dextre
- Ginecología Obstetricia, Clínica Internacional - Clínica Javier Prado, Lima, Perú
| | - Andrés Calle
- Centro Integral de Salud Obstétrica y Femenina. Ginecología, Universidad Indoamérica, Academia Ecuatoriana de Medicina, Quito, Ecuador
| | - Sócrates Aedo
- Escuela Medicina, Universidad Finis Terra, Santiago de Chile, Chile
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van der Hoef C, Bawuah Dsane L, Schuur N, Louwers YV, Mens JW, Hikary-Bhal N, van Doorn HC. Hormone replacement therapy in women with iatrogenic premature ovarian insufficiency after radiotherapy for cervical cancer: A retrospective cohort and survey study. Maturitas 2024; 185:108004. [PMID: 38663162 DOI: 10.1016/j.maturitas.2024.108004] [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: 10/28/2023] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVES This study assessed the uptake of hormone replacement therapy (HRT) in cervical cancer patients with iatrogenic menopause. Survival in relation to HRT use was assessed via a retrospective chart study, and the severity of menopausal symptoms, motivations and barriers to starting HRT were examined via questionnaires. STUDY DESIGN In total, 293 women under the age of 51 and treated with radiotherapy for cervical cancer between 2010 and 2020 were identified. Medical records were searched for information on HRT use. If still living, women were sent digital questionnaires addressing menopausal symptoms, quality of life (QoL) and potential barriers and motivations concerning HRT use. Univariable data were analysed using Mann-Whitney U, chi-square, and Fisher's exact test, while logistical regression was used to analyse relationships between certain variables and use of HRT and survival. RESULTS Overall HRT uptake was 78.1 %, which was related to age and Charlson Comorbidity Index, but independent of the duration of radiotherapy or FIGO stage. Overall survival was higher for HRT users (χ2(1) = 4.3, p = 0.038). Questionnaires were sent to 193 patients and 100 completed it (response rate 51.8 %). Main reasons for HRT use were relief of hot flushes and improvement in QoL. For women below age 51, QoL was indeed higher for current HRT users than for non-HRT users (EQ-index 0.8 vs. 0.7, p = 0.008). CONCLUSIONS HRT prescription rate was inversely correlated with age. Survival was not negatively affected by HRT use. It is important to stress the benefits of HRT and address women's fears regarding its use.
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Affiliation(s)
- Charlotte van der Hoef
- Department of Gynaecologic Oncology, ErasmusMC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Lawrencia Bawuah Dsane
- Department of Gynaecologic Oncology, ErasmusMC Cancer Institute, University Medical Center Rotterdam, the Netherlands.
| | - Nicoline Schuur
- Department of Gynaecologic Oncology, ErasmusMC Cancer Institute, University Medical Center Rotterdam, the Netherlands.
| | - Yvonne V Louwers
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, ErasmusMC, University Medical Center Rotterdam, the Netherlands.
| | - Jan Willem Mens
- Department of Radiation Oncology, ErasmusMC Cancer Institute, University Medical Center Rotterdam, the Netherlands.
| | | | - Helena C van Doorn
- Department of Gynaecologic Oncology, ErasmusMC Cancer Institute, University Medical Center Rotterdam, the Netherlands.
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Theodorou A, Karagiannakis DS, Stefanaki K, Kassi E, Peppa M, Vryonidou A, Paschou SA. Female-specific risk factors for cardiovascular disease: an update. Hormones (Athens) 2024:10.1007/s42000-024-00576-5. [PMID: 38922384 DOI: 10.1007/s42000-024-00576-5] [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: 03/03/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024]
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. While it was previously believed that men have greater susceptibility to CVD, recent research suggests that women face an increased risk of CVD after the onset of menopause, primarily due to the loss of the protective effects of estrogens. Premature ovarian insufficiency (POI), polycystic ovarian syndrome (PCOS), and gestational factors, such as gestational diabetes mellitus (GDM), recurrent pregnancy loss, preterm delivery, and preeclampsia, are specific reproductive disorders that may contribute to an elevated risk of CVD at earlier ages, i.e., before the onset of menopause. This suggests that women with these conditions should be closely monitored for CVD risk factors even before reaching menopause. Such early intervention may help reduce the incidence of CVD and improve overall cardiovascular health in this population. The precise pathophysiological mechanism underlying the development of CVD in women with menopause, premature POI, PCOS, and gestational factors remains elusive. This review article seeks to elucidate the latest research on the relationship between these conditions and CVD in women, aiming to explore the underlying pathogenic mechanisms contributing to this association.
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Affiliation(s)
- Angeliki Theodorou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilisis Sophias Avenue, Athens, PC, 11528, Greece
| | - Dimitrios S Karagiannakis
- Academic Department of Gastroenterology, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Stefanaki
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilisis Sophias Avenue, Athens, PC, 11528, Greece
| | - Evanthia Kassi
- Endocrine Unit, First Department of Propaedeutic and Internal Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Melpomeni Peppa
- Endocrine Unit and Diabetes Center, Second Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andromachi Vryonidou
- Department of Endocrinology and Diabetes Center, Hellenic Red Cross Hospital, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilisis Sophias Avenue, Athens, PC, 11528, Greece.
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6
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Nash Z, Davies M. Premature ovarian insufficiency. BMJ 2024; 384:e077469. [PMID: 38508679 DOI: 10.1136/bmj-2023-077469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Zachary Nash
- University College London Hospitals, London, UK
- EGA Institute for Women's Health, University College London
| | - Melanie Davies
- University College London Hospitals, London, UK
- EGA Institute for Women's Health, University College London
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Mishra GD, Davies MC, Hillman S, Chung HF, Roy S, Maclaran K, Hickey M. Optimising health after early menopause. Lancet 2024; 403:958-968. [PMID: 38458215 DOI: 10.1016/s0140-6736(23)02800-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/09/2023] [Accepted: 12/11/2023] [Indexed: 03/10/2024]
Abstract
The typical age at menopause is 50-51 years in high-income countries. However, early menopause is common, with around 8% of women in high-income countries and 12% of women globally experiencing menopause between the ages of 40 years and 44 years. Menopause before age 40 years (premature ovarian insufficiency) affects an additional 2-4% of women. Both early menopause and premature ovarian insufficiency can herald an increased risk of chronic disease, including osteoporosis and cardiovascular disease. People who enter menopause at younger ages might also experience distress and feel less supported than those who reach menopause at the average age. Clinical practice guidelines are available for the diagnosis and management of premature ovarian insufficiency, but there is a gap in clinical guidance for early menopause. We argue that instead of distinct age thresholds being applied, early menopause should be seen on a spectrum between premature ovarian insufficiency and menopause at the average age. This Series paper presents evidence for the short-term and long-term consequences of early menopause. We offer a practical framework for clinicians to guide diagnosis and management of early menopause, which considers the nature and severity of symptoms, age and medical history, and the individual's wishes and priorities to optimise their quality of life and short-term and long-term health. We conclude with recommendations for future research to address key gaps in the current evidence.
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Affiliation(s)
- Gita D Mishra
- Australian Women and Girls' Health Research Centre, School of Public Health, University of Queensland, Brisbane, QLD, Australia.
| | - Melanie C Davies
- Institute for Women's Health, University College London, London, UK
| | - Sarah Hillman
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hsin-Fang Chung
- Australian Women and Girls' Health Research Centre, School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Subho Roy
- Department of Anthropology, University of Calcutta, Kolkata, India
| | - Kate Maclaran
- Department of Gynaecology, Chelsea and Westminster Hospital, London, UK
| | - Martha Hickey
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC, Australia
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Szakun N, Liva S, Bodner ME, Wolff A, Kim MY, Cote AT. Prevalence of Sex-Specific Cardiovascular Disease Risk Factors, Medical Risk, and Engagement in Health-Promoting Behaviours in Premenopausal Females. CJC Open 2024; 6:301-313. [PMID: 38487073 PMCID: PMC10935687 DOI: 10.1016/j.cjco.2023.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/04/2023] [Indexed: 03/17/2024] Open
Abstract
Background Several sex-specific risk factors (SS-RFs) increase a women's risk for cardiovascular disease (CVD) but are often overlooked during risk assessment. The purpose of this study was to identify the prevalence of SS-RFs and assess CVD risk, knowledge, perceptions and behaviours in premenopausal Canadian women. Methods An online survey was distributed across Canada to premenopausal biological females (19-49 years of age). The survey gathered demographics, medical history, engagement in health-promoting behaviours, and knowledge and perceptions of CVD risk. CVD risk was calculated using medical risk and SS-RFs were tabulated from medical history. Results A total of 2559 participants (33 ± 8 years) completed the survey. The majority of our sample (82%) was classified as low medical risk. Of those classified as low risk, 35% had at least 1 SS-RF. Of high-risk individuals, 70% underestimated their risk, 21% of whom perceived themselves as low risk. Engagement in health behaviours was suboptimal. Knowledge of traditional CVD risk factors and prevention was relatively high; however, less than one-half were aware of SS-RFs such as early menopause (39.4%). Conclusions Considering both traditional and SS-RFs, 47% of premenopausal Canadian women may be at risk for developing CVD. Of those deemed low medical risk for developing CVD, more than one-third reported having at least 1 SS-RF. Canadian women have poor knowledge of the risks associated with SS-RFs, lack sufficient awareness of the need for prevention of CVD, and are not engaging in sufficient health-promoting behaviours to mitigate future CVD risk.
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Affiliation(s)
- Natalie Szakun
- School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada
| | - Sarah Liva
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
| | - Michael E. Bodner
- School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada
| | - Angela Wolff
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
| | - Mi-Yeon Kim
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
| | - Anita T. Cote
- School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada
- Faculty of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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9
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Anagnostis P, Stevenson JC. Cardiovascular health and the menopause, metabolic health. Best Pract Res Clin Endocrinol Metab 2024; 38:101781. [PMID: 37183085 DOI: 10.1016/j.beem.2023.101781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Estrogen depletion following menopause predisposes to increased risk of cardiovascular disease (CVD), mainly due to ischemic heart disease. This is mostly evident in cases with premature menopause. The pathophysiological basis for this atherosclerotic process is the accumulation of several risk factors, such as abdominal obesity, atherogenic dyslipidemia, insulin resistance and arterial hypertension. The presence of vasomotor symptoms may further augment this risk, especially in women younger than 60 years. Menopausal hormone therapy (MHT) exerts many beneficial effects on lipid profile and glucose homeostasis as well as direct arterial effects, and may reduce CVD risk if initiated promptly (i.e.,<60 years or within ten years of the final menstrual period). Transdermal estradiol and micronized progesterone or dydrogesterone are the safest regimens in terms of venous thromboembolic events (VTE) and breast cancer risk. In any case, an individualized approach, taking into account the patient's total CVD, VTE and breast cancer risk, is recommended.
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Affiliation(s)
- Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - John C Stevenson
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 6NP, UK.
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10
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Kamińska MS, Schneider-Matyka D, Rachubińska K, Panczyk M, Grochans E, Cybulska AM. Menopause Predisposes Women to Increased Risk of Cardiovascular Disease. J Clin Med 2023; 12:7058. [PMID: 38002671 PMCID: PMC10672665 DOI: 10.3390/jcm12227058] [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: 10/10/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Menopause is an important event in women's lives, possibly contributing to the development of CVD, which is associated with changes in the cardiovascular risk profile, markers of metabolic health, and subclinical atherosclerosis. The aim of this study was to assess the association of menopause with CVD risk factors and subclinical markers of cardiometabolic disease. (2) Methods: The study involved 235 women from the general population at different stages of menopause. The methods used in this study were: diagnostic survey, anthropometric measurement (WC, height, BMI, WHtR), blood pressure measurement, biochemical analysis of venous blood (lipid profile, glucose, insulin, HbA1c), and CVD risk assessment (ASCVD Risk Calculator, POL-SCORE, SCORE-2). (3) Results: The vast majority of respondents had low cardiovascular risk, irrespective of the scale used for measuring the risk of CVD. The age at menopause was not an independent risk factor for CVD. In Model 1, the age at menopause and the time since menopause were found to be factors that increased CVD risk (OR = 1.186 and 1.267, respectively). In Models 2 and 3, the severity of menopausal symptoms was not a risk factor for CVD. Models 3 and 4 demonstrated that women with metabolic syndrome (MetS) were at a significantly higher risk of CVD. In model 5, the odds ratio of CVD with MetS as a standalone factor was 13.812. (4) Conclusions: Menopause predisposes women to an increased risk and MetS to a significantly higher risk of CVD.
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Affiliation(s)
- Magdalena Sylwia Kamińska
- Subdepartment of Long-Term Care and Palliative Medicine, Department of Social Medicine, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| | - Daria Schneider-Matyka
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| | - Kamila Rachubińska
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-518 Warsaw, Poland
| | - Elżbieta Grochans
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| | - Anna Maria Cybulska
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
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Li HF, Zhang JX, Chen WJ. Dissecting the efficacy of the use of acupuncture and Chinese herbal medicine for the treatment of premature ovarian insufficiency (POI): A systematic review and metaanalysis. Heliyon 2023; 9:e20498. [PMID: 37818004 PMCID: PMC10560776 DOI: 10.1016/j.heliyon.2023.e20498] [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: 12/15/2022] [Revised: 09/19/2023] [Accepted: 09/27/2023] [Indexed: 10/12/2023] Open
Abstract
Premature ovarian insufficiency is a multi-factor gynecological disease that has become a major global health problem. In recent years, several trials have explored the treatment of premature ovarian insufficiency using Chinese herbal medicine and acupuncture, but the efficacy and safety of this combination remains controversial. This systematic review and meta-analysis aimed to comprehensively evaluate the efficacy and safety of combining Chinese herbal medicine with acupuncture to treat premature ovarian insufficiency. From eight different databases, we retrieved randomized controlled trials wherein Chinese herbal medicine and acupuncture had been compared with western medicine in the treatment of premature ovarian insufficiency. The bias risk assessment stipulated by the Cochrane Collaboration's tool was utilized to evaluate the quality of the chosen randomized controlled trials. This meta-analysis was executed with the help of Review Manager 5.3 and Stata 10.0. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A total of 10 randomized controlled trials involving 594 premature ovarian insufficiency patients were included in the analysis. Compared with western medicine, co-treatment with acupuncture and Chinese herbal medicine exhibited a significantly higher total effective rate (relative risk: 1.21; 95% confidence interval: 1.12-1.31; P < 0.01, I2 = 0%), but lower levels of luteinizing hormone (standardized mean difference: -0.57; 95% confidence interval: -1.06, -0.08; P < 0.05, I2 = 80%), follicle-stimulating hormone, and Kupperman index score. Moreover, the combined intervention increased estradiol level in the serum. Overall, the data demonstrate that acupuncture plus Chinese herbal medicine is an efficacious and safe treatment option for POI patients. These findings must be verified by conducting large-scale, multicenter, high-quality, and long-term randomized controlled trials.
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Affiliation(s)
- Hui-fang Li
- Department of Gynecology, Tongxiang Maternal and Child Health-Care Center, Tongxiang, Zhejiang, 314500, PR China
| | - Jin-xia Zhang
- Department of Gynecology, Tongxiang Maternal and Child Health-Care Center, Tongxiang, Zhejiang, 314500, PR China
| | - Wen-jun Chen
- Hangzhou Medical College, Hangzhou, Zhejiang, 311399, China
- Department of Gynecology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310006, China
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12
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Zhang X, Huangfu Z, Wang S. Review of mendelian randomization studies on age at natural menopause. Front Endocrinol (Lausanne) 2023; 14:1234324. [PMID: 37766689 PMCID: PMC10520463 DOI: 10.3389/fendo.2023.1234324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Menopause marks the end of the reproductive phase of life. Based on epidemiological studies, abnormal age at natural menopause (ANM) is thought to contribute to a number of adverse outcomes, such as osteoporosis, cardiovascular disease, and cancer. However, the causality of these associations remains unclear. A powerful epidemiological method known as Mendelian randomization (MR) can be used to clarify the causality between ANM and other diseases or traits. The present review describes MR studies that included ANM as an exposure, outcome and mediator. The findings of MR analyses on ANM have revealed that higher body mass index, poor educational level, early age at menarche, early age at first live birth, early age at first sexual intercourse, and autoimmune thyroid disease appear to be involved in early ANM etiology. The etiology of late ANM appears to be influenced by higher free thyroxine 4 and methylene tetrahydrofolate reductase gene mutations. Furthermore, early ANM has been found to be causally associated with an increased risk of osteoporosis, fracture, type 2 diabetes mellitus, glycosylated hemoglobin, and the homeostasis model of insulin resistance level. In addition, late ANM has been found to be causally associated with an increased systolic blood pressure, higher risk of breast cancer, endometrial cancer, endometrioid ovarian carcinoma, lung cancer, longevity, airflow obstruction, and lower risk of Parkinson's disease. ANM is also a mediator for breast cancer caused by birth weight and childhood body size. However, due to the different instrumental variables used, some results of studies are inconsistent. Future studies with more valid genetic variants are needed for traits with discrepancies between MRs or between MR and other types of epidemiological studies.
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Affiliation(s)
- Xiao Zhang
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhao Huangfu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shaowei Wang
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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13
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Huttler A, Murugappan G, Stentz NC, Cedars MI. Reproduction as a window to future health in women. Fertil Steril 2023; 120:421-428. [PMID: 36641001 DOI: 10.1016/j.fertnstert.2023.01.005] [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: 10/19/2022] [Revised: 12/16/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
Cultivating awareness for reproduction as a window to future health presents an opportunity for early identification and modification of risk factors that can affect both individual and population-level morbidity and mortality. Infertility could serve as both a window into future health as well as a pathway to future pathology. The underlying mechanisms of infertility may share common pathways with long-term risk for health and well-being. Making this identification early in the disease process may improve opportunities for intervention, and deepen our understanding of long-term risk. Additionally, fertility treatments may increase individual risk. Only by making these associations and designing studies to understand how disease and treatment risk impact health can we truly fulfill our goal of building healthy families. The aim of this review is to discuss the short-term impact of fertility challenges and treatment, long-term associations of infertility with morbidity and mortality, and the role of parity in modifying these risk associations.
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Jaramillo Jaramillo L, Roldan Tabares M, Castañeda Palacio S, Martínez-Sánchez L. Fallo ovárico, una problemática para las mujeres en edad reproductiva y su relación genética. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2023.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
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15
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Li M, Zhu Y, Wei J, Chen L, Chen S, Lai D. The global prevalence of premature ovarian insufficiency: a systematic review and meta-analysis. Climacteric 2023; 26:95-102. [PMID: 36519275 DOI: 10.1080/13697137.2022.2153033] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objective of this review was to answer the global prevalence of premature ovarian insufficiency (POI), and explore the associated factors including etiopathology and regions with POI. METHODS The search was conducted on reports from a total of eight databases that comprised Chinese National Knowledge Infrastructure (CNKI), Wanfang, China BioMedical Literature Database (CBM), PubMed, the Cochrane Library, Embase, Web of Science and Ovid MEDLINE® between 1946 and 2021. To analyze the source of heterogeneity, we performed subgroup analysis based on different etiologies and regions. Meta-analysis was carried out by Stata14.0 software. RESULTS The results showed that the global overall prevalence of POI among women was 3.5%. By subgroup analysis, the prevalence of POI among women with iatrogenic etiology was 11.2%, followed by autoimmunity (10.5%); the prevalence of POI by region was 11.3% at the highest in North America followed by South America (5.4%); and the prevalence of POI was 5.3% in a developing country, higher than 3.1% in a developed country. The trend of prevalence of POI over the past 20 years was on the rise (although p > 0.05). CONCLUSION We recommend that health and medical institutions strengthen public health awareness, achieve health-education goals related to POI and increase women's awareness of and attention to POI.
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Affiliation(s)
- M Li
- Department of Nosocomial Infection, The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Y Zhu
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, P.R. China
- Department of Scientific Research, Children's Hospital of Fudan University, Shanghai, P.R. China
| | - J Wei
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai, P.R. China
| | - L Chen
- Department of Nosocomial Infection, The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - S Chen
- Department of Nosocomial Infection, The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - D Lai
- Department of Nosocomial Infection, The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
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16
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Liu F, Wan Q, Liu P, Miao D, Dai X, Chen L. Loss of p16 does not protect against premature ovarian insufficiency caused by alkylating agents. BMC Pregnancy Childbirth 2023; 23:151. [PMID: 36890528 PMCID: PMC9993597 DOI: 10.1186/s12884-023-05476-x] [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: 09/23/2022] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Chemical agents such as alkylating agents (AAs) that are commonly used for the treatment of cancer cause great damage to the ovaries, thereby significantly increasing the risk of premature ovarian insufficiency (POI). However, the exact molecules underlying AA-induced POI remain largely obscure. Upregulation of the p16 gene may contribute to the progression of POI. As yet, no in vivo data from p16-deficient (KO) mice are available to demonstrate a critical role of p16 in POI. In the present study, we employed p16 KO mice to investigate whether loss of p16 could protect against POI caused by AAs. METHODS WT mice and their p16 KO littermates received a single dose of BUL + CTX to establish an AA-induced POI mouse model. One month later, oestrous cycles were monitored. Three months later, some of the mice were sacrificed to collect sera for measurements of hormone levels and ovaries for measurements of follicle counts, the proliferation and apoptosis of granulosa cells, ovarian stromal fibrosis and vessels. The remaining mice were mated with fertile males for the fertility test. RESULTS Our results showed that treatment with BUL + CTX significantly disrupted the oestrous cycles, increased the levels of FSH and LH while decreasing the levels of E2 and AMH, decreased the counts of primordial follicles and growing follicles while increasing the counts of atretic follicles, reduced the vascularized area in the ovarian stroma, and decreased fertility. All of these results were comparable between WT and p16 KO mice treated with BUL + CTX. In addition, ovarian fibrosis was not increased significantly in WT and p16 KO mice treated with BUL + CTX. Growing follicles with normal appearance had normally proliferating granulosa cells (without apparent apoptosis). CONCLUSION We concluded that genetic ablation of the p16 gene did not attenuate ovarian damage or help preserve the fertility of mice challenged by AAs. This study demonstrated for the first time that p16 is dispensable for AA-induced POI. Our preliminary findings suggest that targeting p16 alone may not preserve the ovarian reserve and fertility of females treated with AAs.
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Affiliation(s)
- Fei Liu
- The Center for Reproductive Medicine, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China
| | - Qin Wan
- The Center for Reproductive Medicine, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China
| | - Pengfei Liu
- Kebiao Medical Testing Center, Changzhou, Jiangsu, China
| | - Dengshun Miao
- The Research Center for Aging, Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Xiuliang Dai
- The Center for Reproductive Medicine, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China.
| | - Li Chen
- The Center for Reproductive Medicine, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China.
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17
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Xu C, Ruan X, Mueck AO. Progress in genome-wide association studies of age at natural menopause. Reprod Biomed Online 2023; 46:607-622. [PMID: 36572578 DOI: 10.1016/j.rbmo.2022.11.017] [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: 09/06/2022] [Revised: 11/09/2022] [Accepted: 11/28/2022] [Indexed: 12/09/2022]
Abstract
Menopause is not only the end of reproductive life, it is also related to diseases such as hyperlipidaemia, atherosclerotic cardiovascular disease, osteoporosis and breast cancer. Traditional epidemiological studies have found that heredity is the main determinant of age at natural menopause (ANM). Early studies on genetic factors were limited to candidate gene studies. Menopause age is not inherited by a single gene, but is the result of multiple gene effects. With the development of genomic technology, the Reproductive Genetics Consortium conducted several genome-wide association studies on ANM in people of European descent, and found that defects in DNA damage repair pathways were the main genetic mechanism. In recent years, due to the ethnic heterogeneity of ANM, there has been further development of global studies into multi-ethnic and trans-ethnic genome-wide association studies. Further genetic and epidemiological studies, including polygenetic score and genetic mechanism research, should be conducted to investigate the pathogenesis and mechanism with respect to menopause and its related diseases.
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Affiliation(s)
- Che Xu
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University; Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xiangyan Ruan
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University; Beijing Maternal and Child Health Care Hospital, Beijing, China; University Women's Hospital and Research Centre for Women's Health, Department for Women's Health, University of Tuebingen, Tuebingen, Germany.
| | - Alfred O Mueck
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University; Beijing Maternal and Child Health Care Hospital, Beijing, China; University Women's Hospital and Research Centre for Women's Health, Department for Women's Health, University of Tuebingen, Tuebingen, Germany
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18
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Kapoor E. Premature Ovarian Insufficiency. CURRENT OPINION IN ENDOCRINE AND METABOLIC RESEARCH 2023; 28:100435. [PMID: 36936056 PMCID: PMC10022589 DOI: 10.1016/j.coemr.2023.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Natural menopause typically occurs between the ages of 46 to 55 years. Premature ovarian insufficiency or premature menopause refers to compromised ovarian follicular activity, occurring spontaneously or because of medical interventions, prior to the age of 40 years. The premature loss of estrogen leads to bothersome menopause symptoms and predisposes the women to multiple long-term health risks including a higher mortality risk. Hormone replacement therapy used until the natural age of menopause can help manage the symptoms effectively and can mitigate the long-term risk of estrogen deprivation to some extent. However, hormone replacement therapy is underutilized in this population due to the inappropriate extrapolation of potential risks that have been demonstrated with hormone therapy use in women after natural menopause. There is a large unmet need for educating patients and providers regarding the impact of premature ovarian insufficiency and the compelling need for its appropriate management.
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Affiliation(s)
- Ekta Kapoor
- Center for Women’s Health, Mayo Clinic, Rochester, MN, USA
- Menopause and Women’s Sexual Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic Rochester, MN, USA
- Women’s Health Research Center, Mayo Clinic, Rochester, MN, USA
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19
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Tucker EJ, Baker MJ, Hock DH, Warren JT, Jaillard S, Bell KM, Sreenivasan R, Bakhshalizadeh S, Hanna CA, Caruana NJ, Wortmann SB, Rahman S, Pitceathly RDS, Donadieu J, Alimi A, Launay V, Coppo P, Christin-Maitre S, Robevska G, van den Bergen J, Kline BL, Ayers KL, Stewart PN, Stroud DA, Stojanovski D, Sinclair AH. Premature Ovarian Insufficiency in CLPB Deficiency: Transcriptomic, Proteomic and Phenotypic Insights. J Clin Endocrinol Metab 2022; 107:3328-3340. [PMID: 36074910 PMCID: PMC9693831 DOI: 10.1210/clinem/dgac528] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Premature ovarian insufficiency (POI) is a common form of female infertility that usually presents as an isolated condition but can be part of various genetic syndromes. Early diagnosis and treatment of POI can minimize comorbidity and improve health outcomes. OBJECTIVE We aimed to determine the genetic cause of syndromic POI, intellectual disability, neutropenia, and cataracts. METHODS We performed whole-exome sequencing (WES) followed by functional validation via RT-PCR, RNAseq, and quantitative proteomics, as well as clinical update of previously reported patients with variants in the caseinolytic peptidase B (CLPB) gene. RESULTS We identified causative variants in CLPB, encoding a mitochondrial disaggregase. Variants in this gene are known to cause an autosomal recessive syndrome involving 3-methylglutaconic aciduria, neurological dysfunction, cataracts, and neutropenia that is often fatal in childhood; however, there is likely a reporting bias toward severe cases. Using RNAseq and quantitative proteomics we validated causation and gained insight into genotype:phenotype correlation. Clinical follow-up of patients with CLPB deficiency who survived to adulthood identified POI and infertility as a common postpubertal ailment. CONCLUSION A novel splicing variant is associated with CLPB deficiency in an individual who survived to adulthood. POI is a common feature of postpubertal female individuals with CLPB deficiency. Patients with CLPB deficiency should be referred to pediatric gynecologists/endocrinologists for prompt POI diagnosis and hormone replacement therapy to minimize associated comorbidities.
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Affiliation(s)
- Elena J Tucker
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Megan J Baker
- Department of Biochemistry and Pharmacology, The University of Melbourne, Parkville, VIC 3010, Australia
- Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Daniella H Hock
- Department of Biochemistry and Pharmacology, The University of Melbourne, Parkville, VIC 3010, Australia
- Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Julia T Warren
- Division of Hematology-Oncology, Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Sylvie Jaillard
- Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail)—UMR_S 1085, F-35000 Rennes, France
- CHU Rennes, Service de Cytogénétique et Biologie Cellulaire, F-35033 Rennes, France
| | - Katrina M Bell
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC 3052, Australia
| | - Rajini Sreenivasan
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Shabnam Bakhshalizadeh
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Chloe A Hanna
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Gynaecology, The Royal Children's Hospital, Melbourne, VIC 3052, Australia
| | - Nikeisha J Caruana
- Department of Biochemistry and Pharmacology, The University of Melbourne, Parkville, VIC 3010, Australia
- Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, 3011, Australia
| | - Saskia B Wortmann
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg 5020, Austria
- Radboud Center for Mitochondrial Medicine, Department of Pediatrics, Amalia Children's Hospital, Radboudumc, Nijmegen 6524, The Netherlands
| | - Shamima Rahman
- Mitochondrial Research Group, UCL Great Ormond Street Institute of Child Health, and Metabolic Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Robert D S Pitceathly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, WC1N 3BG, UK
| | - Jean Donadieu
- Sorbonne Université, Service d’Hémato-oncologie Pédiatrique, Assistance Publique-Hopitaux de Paris (AP-HP), Hôpital Trousseau, Paris 75006, France
- Registre Français des Neutropénies Congénitales, Hôpital Trousseau, Paris 75006, France
- Centre de Référence des Neutropénies Chroniques, AP-HP, Hôpital Trousseau, Paris 75006, France
| | - Aurelia Alimi
- Sorbonne Université, Service d’Hémato-oncologie Pédiatrique, Assistance Publique-Hopitaux de Paris (AP-HP), Hôpital Trousseau, Paris 75006, France
- Registre Français des Neutropénies Congénitales, Hôpital Trousseau, Paris 75006, France
- Centre de Référence des Neutropénies Chroniques, AP-HP, Hôpital Trousseau, Paris 75006, France
| | - Vincent Launay
- Hematologie, Centre Hospitalier de St Brieuc, Paris 22027, France
| | - Paul Coppo
- Sorbonne Université, Service d’hématologie Hôpital Saint-Antoine, AP-HP, Paris75006, France
| | - Sophie Christin-Maitre
- Sorbonne Université, Service d’Endocrinologie, diabétologie et médecine de la reproduction Hôpital Saint-Antoine, AP-HP, Paris75006, France
| | - Gorjana Robevska
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC 3052, Australia
| | - Jocelyn van den Bergen
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC 3052, Australia
| | - Brianna L Kline
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC 3052, Australia
| | - Katie L Ayers
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Phoebe N Stewart
- Department of Paediatrics, The Royal Hobart Hospital, Tasmania 7000, Australia
| | - David A Stroud
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC 3052, Australia
- Department of Biochemistry and Pharmacology, The University of Melbourne, Parkville, VIC 3010, Australia
- Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Diana Stojanovski
- Department of Biochemistry and Pharmacology, The University of Melbourne, Parkville, VIC 3010, Australia
- Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Andrew H Sinclair
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3010, Australia
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20
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Hagen-Lillevik S, Johnson J, Lai K. Early postnatal alterations in follicular stress response and survival in a mouse model of Classic Galactosemia. J Ovarian Res 2022; 15:122. [PMID: 36414970 PMCID: PMC9682695 DOI: 10.1186/s13048-022-01049-2] [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: 04/07/2022] [Accepted: 10/07/2022] [Indexed: 11/24/2022] Open
Abstract
Primary ovarian insufficiency is characterized by accelerated loss of primordial follicles, which results in ovarian failure and concomitant menopause before age 40. About 1-3% of females in the general population are diagnosed with POI; however, greater than 80% of females with the inherited disease Classic Galactosemia will develop POI. Classic Galactosemia is caused by mutations in the GALT gene encoding the enzyme galactose-1 phosphate uridylyltransferase. While dietary restriction of galactose is lifesaving in the neonatal period, the development of complications including primary ovarian insufficiency is not mitigated. Additionally, the pattern(s) of follicle loss have not been completely characterized. The chronic accumulation of aberrant metabolites such as galactose-1-phosphate and galactitol are suspected culprits in the development of the sequelae, yet the mechanisms remain elusive.Our group uses a GalT gene-trapped mouse model to study the pathophysiology of primary ovarian insufficiency in Classic Galactosemia. We recently showed that differences in the Integrated Stress Response pathway occur in mutant ovaries that likely contribute to their primary ovarian insufficiency phenotype. Using immunofluorescent staining of histological sections of ovaries at progressive ages, we saw evidence of altered Integrated Stress Response activity in granulosa cells and primordial oocytes consistent with accelerated primordial follicle growth activation, aberrant DNA damage and/or repair, and increased cellular stress/death. Overall, our findings indicate that abnormal Integrated Stress Response in the Classic Galactosemia model ovary results in accelerated primordial follicle growth activation, sometimes referred to as "burnout." These aberrant early events help further clarify when/how the primary ovarian insufficiency phenotype arises under galactosemic conditions.
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Affiliation(s)
- Synneva Hagen-Lillevik
- grid.223827.e0000 0001 2193 0096Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108 USA ,grid.223827.e0000 0001 2193 0096Department of Nutrition and Integrative Physiology, University of Utah College of Health, 250 South 1850 East Room 214, Salt Lake City, UT 84112 USA
| | - Joshua Johnson
- grid.430503.10000 0001 0703 675XDivision of Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Colorado Denver (AMC), Building RC2, Room P15 3103, Mail Stop 8613, Aurora, CO 80045 USA
| | - Kent Lai
- grid.223827.e0000 0001 2193 0096Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108 USA ,grid.223827.e0000 0001 2193 0096Department of Nutrition and Integrative Physiology, University of Utah College of Health, 250 South 1850 East Room 214, Salt Lake City, UT 84112 USA
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21
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Weyman EA, McDonald IR, Blocker ES, Welt CK, Dwyer AA. Approach to Evaluation and Comprehensive Care for Primary Ovarian Insufficiency. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Hagen-Lillevik S, Johnson J, Siddiqi A, Persinger J, Hale G, Lai K. Harnessing the Power of Purple Sweet Potato Color and Myo-Inositol to Treat Classic Galactosemia. Int J Mol Sci 2022; 23:ijms23158654. [PMID: 35955788 PMCID: PMC9369367 DOI: 10.3390/ijms23158654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 01/25/2023] Open
Abstract
Classic Galactosemia (CG) is a devastating inborn error of the metabolism caused by mutations in the GALT gene encoding the enzyme galactose-1 phosphate uridylyltransferase in galactose metabolism. Severe complications of CG include neurological impairments, growth restriction, cognitive delays, and, for most females, primary ovarian insufficiency. The absence of the GALT enzyme leads to an accumulation of aberrant galactose metabolites, which are assumed to be responsible for the sequelae. There is no treatment besides the restriction of dietary galactose, which does not halt the development of the complications; thus, additional treatments are sorely needed. Supplements have been used in other inborn errors of metabolism but are not part of the therapeutic regimen for CG. The goal of this study was to test two generally recognized as safe supplements (purple sweet potato color (PSPC) and myo-inositol (MI)) that may impact cellular pathways contributing to the complications in CG. Our group uses a GalT gene-trapped mouse model to study the pathophysiology in CG, which phenocopy many of the complications. Here we report the ability of PSPC to ameliorate dysregulation in the ovary, brain, and liver of our mutant mice as well as positive results of MI supplementation in the ovary and brain.
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Affiliation(s)
- Synneva Hagen-Lillevik
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, USA
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84108, USA
- Correspondence: (S.H.-L.); (K.L.); Tel.: +1-253-592-8692 (S.H.-L.)
| | - Joshua Johnson
- Division of Reproductive Sciences, Aurora, CO 80045, USA
- Division of Reproductive Endocrinology and Infertility, Aurora, CO 80045, USA
- Department of Obstetrics and Gynecology, Aurora, CO 80045, USA
| | - Anwer Siddiqi
- College of Medicine, University of Florida, Jacksonville, FL 32209, USA
| | - Jes Persinger
- Ecology and Evolutionary Biology, University of Colorado, Boulder, CO 80302, USA
| | - Gillian Hale
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Kent Lai
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, USA
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84108, USA
- Correspondence: (S.H.-L.); (K.L.); Tel.: +1-253-592-8692 (S.H.-L.)
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23
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Dam V, Onland-Moret NC, Burgess S, Chirlaque MD, Peters SAE, Schuit E, Tikk K, Weiderpass E, Oliver-Williams C, Wood AM, Tjønneland A, Dahm CC, Overvad K, Boutron-Ruault MC, Schulze MB, Trichopoulou A, Ferrari P, Masala G, Krogh V, Tumino R, Matullo G, Panico S, Boer JMA, Verschuren WMM, Waaseth M, Pérez MJS, Amiano P, Imaz L, Moreno-Iribas C, Melander O, Harlid S, Nordendahl M, Wennberg P, Key TJ, Riboli E, Santiuste C, Kaaks R, Katzke V, Langenberg C, Wareham NJ, Schunkert H, Erdmann J, Willenborg C, Hengstenberg C, Kleber ME, Delgado G, März W, Kanoni S, Dedoussis G, Deloukas P, Nikpay M, McPherson R, Scholz M, Teren A, Butterworth AS, van der Schouw YT. Genetically Determined Reproductive Aging and Coronary Heart Disease: A Bidirectional 2-sample Mendelian Randomization. J Clin Endocrinol Metab 2022; 107:e2952-e2961. [PMID: 35306566 PMCID: PMC9202700 DOI: 10.1210/clinem/dgac171] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Accelerated reproductive aging, in women indicated by early natural menopause, is associated with increased coronary heart disease (CHD) risk in observational studies. Conversely, an adverse CHD risk profile has been suggested to accelerate menopause. OBJECTIVES To study the direction and evidence for causality of the relationship between reproductive aging and (non-)fatal CHD and CHD risk factors in a bidirectional Mendelian randomization (MR) approach, using age at natural menopause (ANM) genetic variants as a measure for genetically determined reproductive aging in women. We also studied the association of these variants with CHD risk (factors) in men. DESIGN Two-sample MR, using both cohort data as well as summary statistics, with 4 methods: simple and weighted median-based, standard inverse-variance weighted (IVW) regression, and MR-Egger regression. PARTICIPANTS Data from EPIC-CVD and summary statistics from UK Biobank and publicly available genome-wide association studies were pooled for the different analyses. MAIN OUTCOME MEASURES CHD, CHD risk factors, and ANM. RESULTS Across different methods of MR, no association was found between genetically determined reproductive aging and CHD risk in women (relative risk estimateIVW = 0.99; 95% confidence interval (CI), 0.97-1.01), or any of the CHD risk factors. Similarly, no associations were found in men. Neither did the reversed analyses show evidence for an association between CHD (risk factors) and reproductive aging. CONCLUSION Genetically determined reproductive aging is not causally associated with CHD risk (factors) in women, nor were the genetic variants associated in men. We found no evidence for a reverse association in a combined sample of women and men.
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Affiliation(s)
- Veerle Dam
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, GA 3508 Utrecht, the Netherlands
- Netherlands Heart Institute, DG 3501 Utrecht, the Netherlands
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, GA 3508 Utrecht, the Netherlands
| | - Stephen Burgess
- MRC Biostatistics Unit, University of Cambridge, Cambridge CB2 0SR, UK
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Homerton College, Cambridge, UK
| | - Maria-Dolores Chirlaque
- Department of Epidemiology, Regional Health Authority, IMIB-Arrixaca, Murcia University, 30001 Murcia, Spain
- Department of Public Health and Clinical Medicine, Umea University, 901 87 Umea, Sweden
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, GA 3508 Utrecht, the Netherlands
- The George Institute for Global Health, Imperial College London, London W12 0BZ, UK
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, GA 3508 Utrecht, the Netherlands
| | - Kaja Tikk
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium, DKFZ, 69120 Heidelberg, Germany
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon, France
| | - Clare Oliver-Williams
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Homerton College, Cambridge, UK
| | - Angela M Wood
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Anne Tjønneland
- Danish Cancer Society Research Center, DK-2100 Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Christina C Dahm
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| | - Kim Overvad
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Marie-Christine Boutron-Ruault
- INSERM, Centre for Research in Epidemiology and Population Health, U1018, Nutrition, Hormones, and Women’s Health Team, Institut Gustave Roussy, 94 805 Villejuif, France
| | - Matthias B Schulze
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany; Institute of Nutritional Science, University of Potsdam, 14558 Nuthetal, Germany
| | - Antonia Trichopoulou
- Hellenic Health Foundation, 115 27 Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens 115 27, Greece
| | - Pietro Ferrari
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon, France
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, 50139 Florence, Italy
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, “Civic - M.P. Arezzo” hospital, ASPRagusa, 97100 Ragusa, Italy
| | - Giuseppe Matullo
- Department of Medical Sciences, University of Torino, 10124 Torino, Italy
- Italian Institute for Genomic Medicine–IIGM/HuGeF, 10126 Torino, Italy
| | - Salvatore Panico
- Dipartimento di medicina clinica e chirurgia, Federico II University, 80126 Naples, Italy
| | - Jolanda M A Boer
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, the Netherlands
| | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, GA 3508 Utrecht, the Netherlands
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, the Netherlands
| | - Marit Waaseth
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, N-9037 Tromsø, Norway
| | - Maria José Sánchez Pérez
- Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADA, Universidad de Granada, 18011 Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Pilar Amiano
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Public Health Division of Gipuzkoa, Biodonostia Research Institute, 20014 San Sebastian, Spain
| | - Liher Imaz
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Public Health Division of Gipuzkoa, Biodonostia Research Institute, 20014 San Sebastian, Spain
| | - Conchi Moreno-Iribas
- Instituto de Salud Pública de Navarra, IdiSNA, Navarre Institute for Health Research, REDISSEC, 31008, Pamplona, Spain
| | - Olle Melander
- Department of Clinical Sciences, Lund University, SE-221 00 Malmö, Sweden
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology, Umea University, 901 87 Umea, Sweden
| | - Maria Nordendahl
- Department of Public Health and Clinical Medicine, Umea University, 901 87 Umea, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Umea University, 901 87 Umea, Sweden
| | - Timothy J Key
- Nuffield Department of Population Health, University of Oxford, OX3 7LF Oxford, England
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, SW7 2AZ London, UK
| | - Carmen Santiuste
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Authority, IMIB-Arrixaca, 30001 Murcia, Spain
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, DKFZ, Foundation under Public Law, D-69120 Heidelberg, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology, DKFZ, Foundation under Public Law, D-69120 Heidelberg, Germany
| | - Claudia Langenberg
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, CB2 0SL Cambridge, UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, CB2 0SL Cambridge, UK
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, 80636 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 80636 Munich, Germany
| | - Jeanette Erdmann
- Institute for Cardiogenetics, University of Lübeck, 23562 Lübeck, Germany
| | | | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Marcus E Kleber
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Graciela Delgado
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Winfried März
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Synlab Academy, Synlab Holding Deutschland GmbH, 68167 Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, 8036 Graz, Austria
| | - Stavroula Kanoni
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | - George Dedoussis
- Department of Nutrition-Dietetics/Harokopio University, 17671 Athens, Greece
| | - Panos Deloukas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
- Centre for Genomic Health, Queen Mary University of London, London E1 4NS, UK
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Majid Nikpay
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Ruth McPherson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, 04107 Leipzig, Germany
- LIFE Research Center for Civilization Diseases, University of Leipzig, 04103 Leipzig, Germany
| | - Andrej Teren
- LIFE Research Center for Civilization Diseases, University of Leipzig, 04103 Leipzig, Germany
- Heart Center Leipzig, 04289 Leipzig, Germany
| | - Adam S Butterworth
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, GA 3508 Utrecht, the Netherlands
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Is premature ovarian insufficiency associated with mortality? A three-decade follow-up cohort. Maturitas 2022; 163:82-87. [PMID: 35752062 DOI: 10.1016/j.maturitas.2022.06.002] [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: 01/27/2022] [Revised: 04/28/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the association between premature ovarian insufficiency (POI) and mortality. MATERIALS AND METHODS This was a secondary analysis of a long-term cohort of Chilean women who received preventive health care between 1990 and 1993. The exposure variable was POI and the outcome was death, and follow-up time was 30 years. Patient data were extracted from medical records. Data related to deaths were obtained from the records of the official government registry as of January 2021. Cox regression proportional hazard models were used to estimate crude and adjusted hazard ratios (HR) and 95 % confidence intervals (CI). RESULTS Data for a total of 1119 women were included in the analysis. Median age was 47 years (interquartile range: 44-52). The baseline prevalence of POI was 6.7 %. At the end of the follow-up, 34.7 % of women with POI had died, compared with 19.3 % of women without the condition (p < 0.001). A larger proportion of women with POI died from cardiovascular disease (12.0 % vs. 5.1 %; OR: 2.55, 95 % CI: 1.21-5.39) whereas there was no significant difference in cancer mortality (6.7 % vs. 7.7 %; OR: 0.86, 95 % CI: 0.34-2.19). In the adjusted Cox model, POI was among the main factors associated with mortality (hazard ratio [HR] 1.60, 95 % CI: 1.03-2.47), after diabetes (HR 2.51, 95 % CI: 1.40-4.51) and arterial hypertension (HR 1.75, 95 % CI: 1.29-2.37). CONCLUSION Although POI affects a small group of women, its association with mortality seems to be relevant; hence it is necessary to implement measures that reduce this risk.
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25
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Vogt EC, Real FG, Husebye ES, Björnsdottir S, Benediktsdottir B, Bertelsen RJ, Demoly P, Franklin KA, de Aja Gallastegui LS, González FJC, Heinrich J, Holm M, Jogi NO, Leynaert B, Lindberg E, Malinovschi A, Martínez-Moratalla J, Mayoral RG, Oudin A, Pereira-Vega A, Semjen CR, Schlünssen V, Triebner K, Øksnes M. Premature menopause and autoimmune primary ovarian insufficiency in two international multi-center cohorts. Endocr Connect 2022; 11:e220024. [PMID: 35521804 PMCID: PMC9175594 DOI: 10.1530/ec-22-0024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/22/2022] [Indexed: 11/08/2022]
Abstract
Objective To investigate markers of premature menopause (<40 years) and specifically the prevalence of autoimmune primary ovarian insufficiency (POI) in European women. Design Postmenopausal women were categorized according to age at menopause and self-reported reason for menopause in a cross-sectional analysis of 6870 women. Methods Variables associated with the timing of menopause and hormone measurements of 17β-estradiol and follicle-stimulating hormone were explored using multivariable logistic regression analysis. Specific immunoprecipitating assays of steroidogenic autoantibodies against 21-hydroxylase (21-OH), side-chain cleavage enzyme (anti-SCC) and 17alpha-hydroxylase (17 OH), as well as NACHT leucine-rich-repeat protein 5 were used to identify women with likely autoimmune POI. Results Premature menopause was identified in 2.8% of women, and these women had higher frequencies of nulliparity (37.4% vs 19.7%), obesity (28.7% vs 21.4%), osteoporosis (17.1% vs 11.6%), hormone replacement therapy (59.1% vs 36.9%) and never smokers (60.1% vs 50.9%) (P < 0.05), compared to women with menopause ≥40 years. Iatrogenic causes were found in 91 (47%) and non-ovarian causes in 27 (14%) women, while 77 (39%) women were classified as POI of unknown cause, resulting in a 1.1% prevalence of idiopathic POI. After adjustments nulliparity was the only variable significantly associated with POI (odds ratio 2.46; 95% CI 1.63-3.42). Based on the presence of autoantibodies against 21 OH and SCC, 4.5% of POI cases were of likely autoimmune origin. Conclusion Idiopathic POI affects 1.1% of all women and almost half of the women with premature menopause. Autoimmunity explains 4.5% of these cases judged by positive steroidogenic autoantibodies.
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Affiliation(s)
- Elinor Chelsom Vogt
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Francisco Gómez Real
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Eystein Sverre Husebye
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Sigridur Björnsdottir
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Bryndis Benediktsdottir
- Medical Faculty, University of Iceland, Reykjavik, Iceland
- Department of Sleep, Landspitali University Hospital Reykjavík, Reykjavik, Iceland
| | | | - Pascal Demoly
- University Hospital of Montpellier, IDESP, Univ Montpellier-Inserm, Montpellier, France
| | - Karl Anders Franklin
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | | | | | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nils Oscar Jogi
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Benedicte Leynaert
- Université Paris-Saclay, Inserm U1018, Center for Epidemiology and Population Health, Integrative Respiratory Epidemiology Team, Villejuif, France
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Medicine, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Jesús Martínez-Moratalla
- Pneumology Service of the General University Hospital of Albacete, Albacete, Spain
- Albacete Faculty of Medicine, Castilla-La Mancha University, Albacete, Spain
| | - Raúl Godoy Mayoral
- Department of Respiratory Medicine, Albacete University Hospital, Albacete, Spain
| | - Anna Oudin
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | - Vivi Schlünssen
- Department of Public Health, Environment, Work and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
- The National Research Center for the Working Environment, Copenhagen, Denmark
| | - Kai Triebner
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Marianne Øksnes
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
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Nash Z, Al-Wattar BH, Davies M. Bone and heart health in menopause. Best Pract Res Clin Obstet Gynaecol 2022; 81:61-68. [PMID: 35400590 DOI: 10.1016/j.bpobgyn.2022.03.002] [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: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/02/2022]
Abstract
Age at menopause has been shown to have an impact on bone and heart health, with younger menopause age consistently associated with a higher risk of cardiovascular disease, osteoporosis, and fracture. These risks are particularly high increased among women who encountering menopause at an early age, including women with premature ovarian insufficiency (POI) and early menopause, due to a prolonged period of oestrogen deprivation. Several interventions are suggested to optimise the bone and cardiovascular health of women with menopause including lifestyle modification, dietary supplements, hormonal, and non-hormonal therapies. Hormone therapy (HT) is indicated for women with POI. For women with early menopause, there is a paucity of evidence for the management of bone and cardiovascular health. For women beyond the average age of menopause, HT is not indicated solely for bone protection and cardiovascular health. In this group, screening for bone and heart disease, as well as primary and secondary prevention, should be undertaken in line with national and international guidelines.
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Affiliation(s)
- Zachary Nash
- EGA Institute for Women's Health, University College London, London, UK; University College London Hospitals, London, UK.
| | - Bassel H Al-Wattar
- EGA Institute for Women's Health, University College London, London, UK; University College London Hospitals, London, UK
| | - Melanie Davies
- EGA Institute for Women's Health, University College London, London, UK; University College London Hospitals, London, UK
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Anagnostis P, Lambrinoudaki I, Stevenson JC, Goulis DG. Menopause-associated risk of cardiovascular disease. Endocr Connect 2022; 11:e210537. [PMID: 35258483 PMCID: PMC9066596 DOI: 10.1530/ec-21-0537] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 11/08/2022]
Abstract
Cardiovascular disease (CVD) is of major concern in women entering menopause. The changing hormonal milieu predisposes them to increased CVD risk, due to a constellation of risk factors, such as visceral obesity, atherogenic dyslipidemia, dysregulation in glucose homeostasis, non-alcoholic fatty liver disease and arterial hypertension. However, an independent association of menopause per se with increased risk of CVD events has only been proven for early menopause (<45 years). Menopausal hormone therapy (MHT) ameliorates most of the CVD risk factors mentioned above. Transdermal estrogens are the preferable regimen, since they do not increase triglyceride concentrations and they are not associated with increased risk of venous thromboembolic events (VTE). Although administration of MHT should be considered on an individual basis, MHT may reduce CVD morbidity and mortality, if commenced during the early postmenopausal period (<60 years or within ten years since the last menstrual period). In women with premature ovarian insufficiency (POI), MHT should be administered at least until the average age of menopause (50-52 years). MHT is contraindicated in women with a history of VTE and is not currently recommended for the sole purpose of CVD prevention. The risk of breast cancer associated with MHT is generally low and is mainly conferred by the progestogen. Micronized progesterone and dydrogesterone are associated with lower risk compared to other progestogens.
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Affiliation(s)
- Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Correspondence should be addressed to P Anagnostis:
| | - Irene Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - John C Stevenson
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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King EM, Kaida A, Mayer U, Albert A, Gormley R, de Pokomandy A, Nicholson V, Cardinal C, Islam S, Loutfy M, Murray MCM. Brief Report: Undertreated Midlife Symptoms for Women Living With HIV Linked to Lack of Menopause Discussions With Care Providers. J Acquir Immune Defic Syndr 2022; 89:505-510. [PMID: 34954716 DOI: 10.1097/qai.0000000000002897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasingly, women living with HIV are entering menopause (ie, cessation of menses for ≥1 year) and experiencing midlife symptoms. Menopausal hormone therapy (MHT) is first-line therapy for bothersome hot flashes and early menopause (ie, before age 45 years); however, its use in women living with HIV is poorly described. We conducted a cross-sectional assessment of MHT uptake and barriers to use in this group. SETTING This study was conducted across 3 Canadian provinces from 2015 to 2017. METHODS Perimenopausal and postmenopausal women living with HIV (35 years or older) in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study who answered questions related to MHT use were included. Univariable/multivariable logistic regression evaluated factors associated with MHT use, adjusted for age and contraindications. RESULTS Among 464 women, 47.8% (222 of 464) had a first-line indication for MHT; however, only 11.8% (55 of 464) reported ever using MHT and 5.6% (26 of 464) were current users. Only 44.8% had ever discussed menopause with their care provider despite almost all women having regular HIV care (97.8%). African/Caribbean/Black women had lower unadjusted odds of MHT treatment compared with White women [odds ratio (OR) 0.42 (0.18-0.89); P = 0.034]. Those who had discussed menopause with their care provider had higher odds of treatment [OR 3.13 (1.74-5.86); P < 0.001]. In adjusted analyses, only women having had a menopause discussion remained significantly associated with MHT use [OR 2.97 (1.62-5.61); P < 0.001]. CONCLUSION Women living with HIV are seldom prescribed MHT despite frequent indication. MHT uptake was associated with care provider-led menopause discussions underscoring the need for care provider education on menopause management within HIV care.
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Affiliation(s)
- Elizabeth M King
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada
| | - Angela Kaida
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada
| | - Ulrike Mayer
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada
| | - Arianne Albert
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada
| | - Rebecca Gormley
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | | | - Valerie Nicholson
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada
| | - Claudette Cardinal
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Shaz Islam
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; and
| | - Melanie C M Murray
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, British Columbia, Canada
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29
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Does the Value of FSH Predict Severity of Metabolic Complications in Females with POI? J Clin Med 2022; 11:jcm11072024. [PMID: 35407635 PMCID: PMC8999648 DOI: 10.3390/jcm11072024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 01/22/2023] Open
Abstract
Premature ovarian insufficiency (POI) is defined as a cessation of ovarian function before the age of 40. Such early deprivation of estrogens in women may be associated with several adverse cardiovascular and metabolic consequences. The aim of this retrospective study was to investigate whether women with POI and a serum follicle-stimulating hormone (FSH) level of 25−40 I/U (Group A) have the same metabolic profile as women with POI and a serum FSH level of >40 I/U (Group B). One hundred twenty-three women were included in the study group (Group A; n = 41; Group B; n = 82). The control group comprised 77 healthy women with regular menstruation. In the age- and BMI-adjusted model, no differences were found between the groups with respect to total cholesterol, high-density lipoproteins, triglycerides, HOMA-IR, glucose, and insulin. The only significant difference was found in terms of low-density lipoprotein cholesterol (LDL-C). The highest serum concentration was found in Group B, the second highest was found in Group A, and the lowest was in the controls. In conclusion, changing the threshold of FSH required to establish a POI diagnosis may have an impact on the level of serum LDL-C.
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30
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Wong ND, Budoff MJ, Ferdinand K, Graham IM, Michos ED, Reddy T, Shapiro MD, Toth PP. ATHEROSCLEROTIC CARDIOVASCULAR DISEASE RISK ASSESSMENT: An American Society for Preventive Cardiology Clinical Practice Statement. Am J Prev Cardiol 2022; 10:100335. [PMID: 35342890 PMCID: PMC8943256 DOI: 10.1016/j.ajpc.2022.100335] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/17/2022] [Accepted: 03/05/2022] [Indexed: 01/08/2023] Open
Abstract
Risk for atherosclerotic cardiovascular disease (ASCVD) shows considerable heterogeneity both in generally healthy persons and in those with known ASCVD. The foundation of preventive cardiology begins with assessing baseline ASCVD risk using global risk scores based on standard office-based measures. Persons at low risk are generally recommended for lifestyle management only and those at highest risk are recommended for both lifestyle and pharmacologic therapy. Additional “risk enhancing” factors, including both traditional risk factors and novel biomarkers and inflammatory factors can be used to further assess ASCVD risk, especially in those at borderline or intermediate risk. There are also female-specific risk enhancers, social determinants of health, and considerations for high-risk ethnic groups. Screening for subclinical atherosclerosis, especially with the use of coronary calcium screening, can further inform the treatment decision if uncertain based on the above strategies. Persons with pre-existing ASCVD also have variable risk, affected by the number of major ASCVD events, whether recurrent events have occurred recently, and the presence of other major risk factors or high-risk conditions. Current guidelines define high to very high risk ASCVD accordingly. Accurate ASCVD risk assessment is crucial for the appropriate targeting of preventive therapies to reduce ASCVD risk. Finally, the clinician-patient risk discussion focusing on lifestyle management and the risks and benefits of evidence-based pharmacologic therapies to best lower ASCVD risk is central to this process. This clinical practice statement provides the preventive cardiology specialist with guidance and tools for assessment of ASCVD risk with the goal of appropriately targeting treatment approaches for prevention of ASCVD events.
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Affiliation(s)
- Nathan D. Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, CA, United States
- Corresponding author.
| | - Matthew J. Budoff
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Keith Ferdinand
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA United States
| | - Ian M. Graham
- Department of Cardiology, Trinity College, Dublin, Ireland
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tina Reddy
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA United States
| | | | - Peter P. Toth
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- CGH Medical Center, Sterling, IL, United States
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31
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Tucker EJ, Bell KM, Robevska G, van den Bergen J, Ayers KL, Listyasari N, Faradz SMH, Dulon J, Bakhshalizadeh S, Sreenivasan R, Nouyou B, Carre W, Akloul L, Duros S, Domin-Bernhard M, Belaud-Rotureau MA, Touraine P, Jaillard S, Sinclair AH. Meiotic genes in premature ovarian insufficiency: variants in HROB and REC8 as likely genetic causes. Eur J Hum Genet 2022; 30:219-228. [PMID: 34707299 PMCID: PMC8821714 DOI: 10.1038/s41431-021-00977-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/29/2021] [Accepted: 09/27/2021] [Indexed: 02/03/2023] Open
Abstract
Premature ovarian insufficiency (POI), affecting 1 in 100 women, is characterised by loss of ovarian function associated with elevated gonadotropin, before the age of 40. In addition to infertility, patients face increased risk of comorbidities such as heart disease, osteoporosis, cancer and/or early mortality. We used whole exome sequencing to identify the genetic cause of POI in seven women. Each had biallelic candidate variants in genes with a primary role in DNA damage repair and/or meiosis. This includes two genes, REC8 and HROB, not previously associated with autosomal recessive POI. REC8 encodes a component of the cohesin complex and HROB encodes a factor that recruits MCM8/9 for DNA damage repair. In silico analyses, combined with concordant mouse model phenotypes support these as new genetic causes of POI. We also identified novel variants in MCM8, NUP107, STAG3 and HFM1 and a known variant in POF1B. Our study highlights the pivotal role of meiosis in ovarian function. We identify novel variants, consolidate the pathogenicity of variants previously considered of unknown significance, and propose HROB and REC8 variants as new genetic causes while exploring their link to pathogenesis.
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Affiliation(s)
- Elena J. Tucker
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, University of Melbourne, Melbourne, VIC Australia
| | - Katrina M. Bell
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia
| | - Gorjana Robevska
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia
| | - Jocelyn van den Bergen
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia
| | - Katie L. Ayers
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, University of Melbourne, Melbourne, VIC Australia
| | - Nurin Listyasari
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia ,grid.412032.60000 0001 0744 0787Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University/Diponegoro National Hospital, Semarang, Indonesia
| | - Sultana MH Faradz
- grid.412032.60000 0001 0744 0787Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University/Diponegoro National Hospital, Semarang, Indonesia
| | - Jérôme Dulon
- grid.50550.350000 0001 2175 4109Department of Endocrinology and Reproductive Medicine, AP‐HP, Sorbonne University Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Centre des Pathologies Gynécologiques Rares, Paris, France
| | - Shabnam Bakhshalizadeh
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, University of Melbourne, Melbourne, VIC Australia
| | - Rajini Sreenivasan
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, University of Melbourne, Melbourne, VIC Australia
| | - Benedicte Nouyou
- grid.411154.40000 0001 2175 0984CHU Rennes, Service de Cytogénétique et Biologie Cellulaire, F-35033 Rennes, France
| | - Wilfrid Carre
- grid.411154.40000 0001 2175 0984CHU Rennes, UF Bioinformatique et Génétique Computationnelle, Service de Génétique Moléculaire et Génomique, F-35033 Rennes, France
| | - Linda Akloul
- grid.411154.40000 0001 2175 0984CHU Rennes, Service de Génétique Clinique, CLAD Ouest, F-35033 Rennes, France
| | - Solène Duros
- grid.411154.40000 0001 2175 0984CHU Rennes, Département de Gynécologie Obstétrique et Reproduction Humaine, F-35033 Rennes, France
| | - Mathilde Domin-Bernhard
- grid.411154.40000 0001 2175 0984CHU Rennes, Département de Gynécologie Obstétrique et Reproduction Humaine, F-35033 Rennes, France
| | - Marc-Antoine Belaud-Rotureau
- grid.411154.40000 0001 2175 0984CHU Rennes, Service de Cytogénétique et Biologie Cellulaire, F-35033 Rennes, France ,grid.411154.40000 0001 2175 0984Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) – UMR_S 1085, F-35000 Rennes, France
| | - Philippe Touraine
- grid.50550.350000 0001 2175 4109Department of Endocrinology and Reproductive Medicine, AP‐HP, Sorbonne University Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Centre des Pathologies Gynécologiques Rares, Paris, France
| | - Sylvie Jaillard
- grid.411154.40000 0001 2175 0984CHU Rennes, Service de Cytogénétique et Biologie Cellulaire, F-35033 Rennes, France ,grid.411154.40000 0001 2175 0984Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) – UMR_S 1085, F-35000 Rennes, France
| | - Andrew H. Sinclair
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, University of Melbourne, Melbourne, VIC Australia
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Abstract
IMPORTANCE With improved HIV care, more women living with HIV (WLWH) are aging and entering menopause. Understanding any increased risk conferred by a potentially earlier menopause transition is important for the care of these women. OBJECTIVE There is conflicting literature regarding the association between HIV and an earlier onset of menopause. We conducted a systematic review to summarize the literature on the association between HIV and age at menopause. EVIDENCE REVIEW A search of Ovid MEDLINE, EMBASE, and Web of Science identified 894 articles. We included cohort studies that assessed age at menopause, primary ovarian insufficiency (POI), or early menopause among WLWH and used the World Health Organization definition of menopause as ≥12 months of amenorrhea. FINDINGS Nine studies were included and eight reported on age at menopause. Across studies, the age at menopause for WLWH fell between 46 and 50 years. Five of seven studies reported that WLWH had an earlier menopausal transition than HIV negative controls/the general population. Six studies reported on the prevalence of POI or early menopause among WLWH, with all studies demonstrating an increased prevalence of both among WLWH. CONCLUSIONS Our systematic review summarizes the literature around HIV and age at menopause. Many studies reported a high prevalence of POI and early menopause among WLWH; a factor that may partially account for the observed lower age at menopause. As only one study included biochemical confirmation of menopause, it remains unclear whether individuals with early menopause or POI were truly menopausal or had prolonged amenorrhea due to other causes. Overall, our findings highlight the need for further investigation with studies that include an HIV negative control group and biochemical confirmation of menopause to better understand whether menopause truly is occurring earlier among WLWH.
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Affiliation(s)
- Clara E Van Ommen
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth M King
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital, Vancouver, BC, Canada
| | - Melanie C M Murray
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital, Vancouver, BC, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
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33
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Beverley R, Snook ML, Brieño-Enríquez MA. Meiotic Cohesin and Variants Associated With Human Reproductive Aging and Disease. Front Cell Dev Biol 2021; 9:710033. [PMID: 34409039 PMCID: PMC8365356 DOI: 10.3389/fcell.2021.710033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022] Open
Abstract
Successful human reproduction relies on the well-orchestrated development of competent gametes through the process of meiosis. The loading of cohesin, a multi-protein complex, is a key event in the initiation of mammalian meiosis. Establishment of sister chromatid cohesion via cohesin rings is essential for ensuring homologous recombination-mediated DNA repair and future proper chromosome segregation. Cohesin proteins loaded during female fetal life are not replenished over time, and therefore are a potential etiology of age-related aneuploidy in oocytes resulting in decreased fecundity and increased infertility and miscarriage rates with advancing maternal age. Herein, we provide a brief overview of meiotic cohesin and summarize the human genetic studies which have identified genetic variants of cohesin proteins and the associated reproductive phenotypes including primary ovarian insufficiency, trisomy in offspring, and non-obstructive azoospermia. The association of cohesion defects with cancer predisposition and potential impact on aging are also described. Expansion of genetic testing within clinical medicine, with a focus on cohesin protein-related genes, may provide additional insight to previously unknown etiologies of disorders contributing to gamete exhaustion in females, and infertility and reproductive aging in both men and women.
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Affiliation(s)
- Rachel Beverley
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Meredith L Snook
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Miguel Angel Brieño-Enríquez
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
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34
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Shareghi-Oskoue O, Aghebati-Maleki L, Yousefi M. Transplantation of human umbilical cord mesenchymal stem cells to treat premature ovarian failure. Stem Cell Res Ther 2021; 12:454. [PMID: 34380572 PMCID: PMC8359553 DOI: 10.1186/s13287-021-02529-w] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/02/2021] [Indexed: 12/14/2022] Open
Abstract
As one of the problems and diseases for women before 40 years, premature ovarian failure (POF) could be characterized by amenorrhea, low estrogen levels, infertility, high gonadotropin levels, and lack of mature follicles. Causes of the disease involve some genetic disorders, autoimmunity diseases, and environmental factors. Various approaches have been employed to treat POF, however with limited success. Today, stem cells are used to treat POF, since they have the potential to self-repair and regenerate, and are effective in treating ovarian failure and infertility. As mesenchymal stem cell (MSC) could simultaneously activate several mechanisms, many researchers consider MSC transplantation to be the best and most effective approach in cell therapy. A good source for mesenchymal stem cells is human umbilical cord (HUCMSC). Animal models with cyclophosphamide are required for stem cell treatment and performance of HUCMSC transplantation. Stem cell therapy could indicate the levels of ovarian markers and follicle-stimulating hormone receptor. It also increases ovarian weight, plasma E2 levels, and the amount of standard follicles. Herein, the causes of POF, effective treatment strategies, and the effect of HUCMSC transplantation for the treatment of premature ovarian failure are reviewed. Many studies have been conducted in this field, and the results have shown that stem cell treatment is an effective approach to treat infertility.
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Affiliation(s)
- Oldouz Shareghi-Oskoue
- Stem Cell Research Center, Tabriz University of Medical Science, Tabriz, Iran
- Student's Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leili Aghebati-Maleki
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- Department of Immunology, School of Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mehdi Yousefi
- Stem Cell Research Center, Tabriz University of Medical Science, Tabriz, Iran.
- Department of Immunology, School of Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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35
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King EM, Prior JC, Pick N, van Schalkwyk J, Kestler M, Tkachuk S, Loutfy M, Murray MCM. Menopausal hormone therapy for women living with HIV. Lancet HIV 2021; 8:e591-e598. [PMID: 34384545 DOI: 10.1016/s2352-3018(21)00148-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/11/2021] [Accepted: 06/18/2021] [Indexed: 01/13/2023]
Abstract
People living with HIV are ageing, and a growing number of women living with HIV are entering menopause. Women living with HIV commonly have bothersome vasomotor symptoms and onset of menopause at earlier ages; both factors go on to affect quality of life and systemic health. Vasomotor symptoms and early menopause are both indications for menopausal hormone therapy; however, current evidence suggests that this therapy is seldom offered to women living with HIV. Additionally, women living with HIV have several risks to bone health and are likely to benefit from the bone-strengthening effects of menopausal hormone therapy. We present an assessment of the benefits and risks of menopausal hormone therapy in the context of HIV care and propose a practical approach to its prescription. If considered in the appropriate clinical context with discussion of risks and benefits, menopausal hormone therapy might provide substantial benefits to symptomatic menopausal women living with HIV and improve health-related quality of life.
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Affiliation(s)
- Elizabeth Marie King
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.
| | - Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, University of British Columbia, Vancouver, BC, Canada; Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Neora Pick
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada; Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Julie van Schalkwyk
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada; Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Mary Kestler
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada; Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Stacey Tkachuk
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada; Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Dalla School of Public Health, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada
| | - Melanie C M Murray
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada; Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
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36
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Wu PY, Lee SY, Chang KV, Chao CT, Huang JW. Gender-Related Differences in Chronic Kidney Disease-Associated Vascular Calcification Risk and Potential Risk Mediators: A Scoping Review. Healthcare (Basel) 2021; 9:healthcare9080979. [PMID: 34442116 PMCID: PMC8394860 DOI: 10.3390/healthcare9080979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
Vascular calcification (VC) involves the deposition of calcium apatite in vascular intima or media. Individuals of advanced age, having diabetes mellitus or chronic kidney disease (CKD) are particularly at risk. The pathogenesis of CKD-associated VC evolves considerably. The core driver is the phenotypic change involving vascular wall constituent cells toward manifestations similar to that undergone by osteoblasts. Gender-related differences are observed regarding the expressions of osteogenesis-regulating effectors, and presumably the prevalence/risk of CKD-associated VC exhibits gender-related differences as well. Despite the wealth of data focusing on gender-related differences in the risk of atherosclerosis, few report whether gender modifies the risk of VC, especially CKD-associated cases. We systematically identified studies of CKD-associated VC or its regulators/modifiers reporting data about gender distributions, and extracted results from 167 articles. A significantly higher risk of CKD-associated VC was observed in males among the majority of original investigations. However, substantial heterogeneity exists, since multiple large-scale studies yielded neutral findings. Differences in gender-related VC risk may result from variations in VC assessment methods, the anatomical segments of interest, study sample size, and even the ethnic origins of participants. From a biological perspective, plausible mediators of gender-related VC differences include body composition discrepancies, alterations involving lipid profiles, inflammatory severity, diversities in matrix Gla protein (MGP), soluble Klotho, vitamin D, sclerostin, parathyroid hormone (PTH), fibroblast growth factor-23 (FGF-23), and osteoprotegerin levels. Based on our findings, it may be inappropriate to monotonously assume that male patients with CKD are at risk of VC compared to females, and we should consider more background in context before result interpretation.
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Affiliation(s)
- Patrick Yihong Wu
- School of Medicine, National Taiwan University College of Medicine, Taipei 100233, Taiwan;
| | - Szu-Ying Lee
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County 640, Taiwan; (S.-Y.L.); (J.-W.H.)
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital BeiHu Branch, Taipei 10845, Taiwan;
| | - Chia-Ter Chao
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei 100233, Taiwan
- Nephrology Division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei 100233, Taiwan
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei 10845, Taiwan
- Correspondence: ; Tel.: +886-2-23717101 (ext. 6531); Fax: +886-2-23717101
| | - Jenq-Wen Huang
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County 640, Taiwan; (S.-Y.L.); (J.-W.H.)
- Nephrology Division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei 100233, Taiwan
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Stevenson JC, Collins P, Hamoda H, Lambrinoudaki I, Maas AHEM, Maclaran K, Panay N. Cardiometabolic health in premature ovarian insufficiency. Climacteric 2021; 24:474-480. [PMID: 34169795 DOI: 10.1080/13697137.2021.1910232] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Premature ovarian insufficiency (POI) is an increasing public health problem with a prevalence now approaching 4%. POI results in adverse effects on the skeleton and central nervous system as well as disturbances of metabolic and cardiological factors that predispose to a major increased risk of cardiovascular disease (CVD). This article reviews the effects of the premature loss of ovarian function on lipids and lipoproteins, glucose and insulin metabolism, body composition, hemostasis and blood pressure, together with effects on the development of metabolic syndrome and diabetes mellitus. The article examines the effects of POI on vascular endothelial function and inflammation that result in arterial disease, and reviews the effects of hormone replacement therapy (HRT) on these various metabolic processes and on cardiovascular outcomes. It is essential that women with POI receive hormonal treatment to help prevent the development of CVD, and that this treatment is continued at least until the normal age of menopause. It appears that HRT has a more favorable effect than the combined oral contraceptive, but larger clinical trials are needed to establish the optimal treatment. Other therapeutic measures may need to be added to correct existing metabolic abnormalities and, in particular, attention to lifestyle factors such as diet and exercise must be encouraged.
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Affiliation(s)
- J C Stevenson
- National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - P Collins
- National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - H Hamoda
- Department of Gynaecology, King's College Hospital, London, UK
| | - I Lambrinoudaki
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K Maclaran
- Department of Gynaecology, Chelsea & Westminster Hospital, London, UK
| | - N Panay
- Department of Gynaecology, Queen Charlotte's and Chelsea & Westminster Hospitals, Imperial College London, London, UK
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Piedade KC, Spencer H, Persani L, Nelson LM. Optimizing Fertility in Primary Ovarian Insufficiency: Case Report and Literature Review. Front Genet 2021; 12:676262. [PMID: 34249096 PMCID: PMC8261244 DOI: 10.3389/fgene.2021.676262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/12/2021] [Indexed: 12/31/2022] Open
Abstract
Primary ovarian insufficiency (POI) is a clinical spectrum of ovarian dysfunction. Overt POI presents with oligo/amenorrhea and hypergonadotropic hypogonadism before age 40 years. Overt POI involves chronic health problems to include increased morbidity and mortality related to estradiol deficiency and the associated osteoporosis and cardiovascular disease as well as psychological and psychiatric disorders related to the loss of reproductive hormones and infertility. Presently, with standard clinical testing, a mechanism for Overt POI can only be identified in about 10% of cases. Now discovery of new mechanisms permits an etiology to be identified in a research setting in 25-30% of overt cases. The most common genetic cause of Overt POI is premutation in FMR1. The associated infertility is life altering. Oocyte donation is effective, although many women prefer to conceive with their own ova. Surprisingly, the majority who have Overt POI still have detectable ovarian follicles (70%). The major mechanism of follicle dysfunction in Overt POI has been histologically defined by a prospective NIH study: inappropriate follicle luteinization due to the tonically elevated serum LH levels. A trial of physiologic hormone replacement therapy, clinically proven to suppress the elevated LH levels in these women, may improve follicle function and increase the chance of ovulation. Here, we report the case of a woman with Overt POI diagnosed at age 35 years. To attempt pregnancy, she elected a trial of intrauterine insemination (IUI) in conjunction with follicle monitoring and physiologic hormone replacement therapy. She conceived on the eighth cycle of treatment and delivered a healthy baby. Our report calls for a concerted effort to define the best methods by which to optimize fertility for women who have POI.
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Affiliation(s)
| | - Hillary Spencer
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Luca Persani
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
- Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, Milan, Italy
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Maas AHEM, Rosano G, Cifkova R, Chieffo A, van Dijken D, Hamoda H, Kunadian V, Laan E, Lambrinoudaki I, Maclaran K, Panay N, Stevenson JC, van Trotsenburg M, Collins P. Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists. Eur Heart J 2021; 42:967-984. [PMID: 33495787 PMCID: PMC7947184 DOI: 10.1093/eurheartj/ehaa1044] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/29/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022] Open
Abstract
Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease risk. Whereas the traditional cardiovascular risk factors dominate in older age, there are several female-specific risk factors and inflammatory risk variables that influence a woman’s risk at younger and middle age. Hypertensive pregnancy disorders and gestational diabetes are associated with a higher risk in younger women. Menopause transition has an additional adverse effect to ageing that may demand specific attention to ensure optimal cardiovascular risk profile and quality of life. In this position paper, we provide an update of gynaecological and obstetric conditions that interact with cardiovascular risk in women. Practice points for clinical use are given according to the latest standards from various related disciplines (Figure 1).
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Affiliation(s)
- Angela H E M Maas
- Department of Cardiology, Director Women's Cardiac Health Program, Radboud University Medical Center, Geert Grooteplein-Zuid 10, Route 616, 6525GA Nijmegen, The Netherlands
| | - Giuseppe Rosano
- St George's Hospitals NHS Trust University of London, Cranmer Terrace, London SW17 0RE, UK.,Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235 Rome, Italy
| | - Renata Cifkova
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Vídeňská 800, 140 59 Prague 4, Czech Republic.,Department of Internal Cardiovascular Medicine, First Medical Faculty, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Hospital, Olgettina Street, 60 - 20132 Milan (Milan), Italy
| | - Dorenda van Dijken
- Department of Obstetrics and Gynaecology, OLVG location West, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands
| | - Haitham Hamoda
- Department Gynaecology, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, M4:146 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
| | - Ellen Laan
- Department of Sexology and Psychosomatic Gynaecology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Irene Lambrinoudaki
- Menopause Clinic, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, 30 Panepistimiou Str., 10679 Athens, Greece
| | - Kate Maclaran
- Department Gynaecology, Chelsea and Westminster Hospital, NHS Foundation Trust, 69 Fulham Road London SW10 9NH, UK
| | - Nick Panay
- Department of Gynaecology, Queen Charlotte's & Chelsea and Westminster Hospitals, Imperial College, Du Cane Road, London W12 0HS, UK
| | - John C Stevenson
- Department of Cardiology, National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Mick van Trotsenburg
- Bureau Gender PRO Vienna and Department of Obstetrics and Gynaecology, University Hospital St. Poelten-Lilienfeld, Probst Führer Straße 4 · 3100 St. Pölten, Austria
| | - Peter Collins
- Department of Cardiology, National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
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Susceptibility of Women to Cardiovascular Disease and the Prevention Potential of Mind-Body Intervention by Changes in Neural Circuits and Cardiovascular Physiology. Biomolecules 2021; 11:biom11050708. [PMID: 34068722 PMCID: PMC8151888 DOI: 10.3390/biom11050708] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 12/28/2022] Open
Abstract
Women have been reported to be more vulnerable to the development, prognosis and mortality of cardiovascular diseases, yet the understanding of the underlying mechanisms and strategies to overcome them are still relatively undeveloped. Studies show that women's brains are more sensitive to factors affecting mental health such as depression and stress than men's brains. In women, poor mental health increases the risk of cardiovascular disease, and conversely, cardiovascular disease increases the incidence of mental illness such as depression. In connection with mental health and cardiovascular health, the presence of gender differences in brain activation, cortisol secretion, autonomic nervous system, vascular health and inflammatory response has been observed. This connection suggests that strategies to manage women's mental health can contribute to preventing cardiovascular disease. Mind-body interventions, such as meditation, yoga and qigong are forms of exercise that strive to actively manage both mind and body. They can provide beneficial effects on stress reduction and mental health. They are also seen as structurally and functionally changing the brain, as well as affecting cortisol secretion, blood pressure, heart rate variability, immune reactions and reducing menopausal symptoms, thus positively affecting women's cardiovascular health. In this review, we investigate the link between mental health, brain activation, HPA axis, autonomic nervous system, blood pressure and immune system associated with cardiovascular health in women and discuss the effects of mind-body intervention in modulating these factors.
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Pan W, Ye X, Zhu Z, Li C, Zhou J, Liu J. Urinary cadmium concentrations and risk of primary ovarian insufficiency in women: a case-control study. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2021; 43:2025-2035. [PMID: 33222148 DOI: 10.1007/s10653-020-00775-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 11/04/2020] [Indexed: 05/22/2023]
Abstract
Cadmium, a toxic heavy metal that occurs in the environment in large quantities through human activities, has been shown to have adverse effects on female reproductive health. However, the association between cadmium exposure and primary ovarian insufficiency (POI), one of the most prevalent ovarian diseases in women, has not been examined yet. This case-control study involving 169 POI cases and 209 healthy controls was conducted in Zhejiang Province, China. The urinary concentrations of cadmium were determined by inductively coupled plasma mass spectrometry (ICP-MS). In addition, serum levels of reproductive hormones, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Mullerian hormone (AMH) and estradiol, were measured. The median concentration of urinary cadmium in POI cases (0.43 μg/L, 0.58 μg/g for creatinine adjustment) was significantly higher than that of controls (0.29 μg/L, 0.43 μg/g for creatinine adjustment). The results of binary logistic regression models showed that the concentrations of urinary cadmium were positively significantly correlated with the odds ratio (ORs) of POI before the adjustment of confounders. After the adjustment, a significantly positive association was still present between the increased concentrations of cadmium and the ORs of POI (2.50, 95% CIs: 1.34-4.65 for the third tertile, p for trend = 0.001). The serum levels of FSH and LH were positively associated with urinary cadmium, while AMH and estradiol levels were inversely correlated. To the best of our knowledge, this is the first reported positive association of cadmium exposure with the risk of POI in women.
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Affiliation(s)
- Wuye Pan
- MOE Key Laboratory of Environmental Remediation and Ecosystem Health, College of Environmental and Resource Sciences, Zhejiang University, Hangzhou, 310058, China
| | - Xiaoqing Ye
- MOE Key Laboratory of Environmental Remediation and Ecosystem Health, College of Environmental and Resource Sciences, Zhejiang University, Hangzhou, 310058, China
- College of Medical Technology, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Zheying Zhu
- MOE Key Laboratory of Environmental Remediation and Ecosystem Health, College of Environmental and Resource Sciences, Zhejiang University, Hangzhou, 310058, China
| | - Chunming Li
- Women's Reproductive Health Key Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Jianhong Zhou
- Women's Reproductive Health Key Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Jing Liu
- MOE Key Laboratory of Environmental Remediation and Ecosystem Health, College of Environmental and Resource Sciences, Zhejiang University, Hangzhou, 310058, China.
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Christensen MW, Kesmodel US, Christensen K, Kirkegaard K, Ingerslev HJ. Early ovarian ageing: is a low number of oocytes harvested in young women associated with an earlier and increased risk of age-related diseases? Hum Reprod 2021; 35:2375-2390. [PMID: 32949236 DOI: 10.1093/humrep/deaa188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/26/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Do young women with early ovarian ageing (EOA), defined as unexplained, and repeatedly few oocytes harvested in ART have an increased risk of age-related events? SUMMARY ANSWER At follow-up, women with idiopathic EOA had an increased risk of age-related events compared to women with normal ovarian ageing (NOA). WHAT IS KNOWN ALREADY Early and premature menopause is associated with an increased risk of cardiovascular diseases (CVDs), osteoporosis and death. In young women, repeated harvest of few oocytes in well-stimulated ART cycles is a likely predictor of advanced menopausal age and may thus serve as an early marker of accelerated general ageing. STUDY DESIGN, SIZE, DURATION A register-based national, historical cohort study. Young women (≤37 years) having their first ART treatment in a public or private fertility clinic during the period 1995-2014 were divided into two groups depending on ovarian reserve status: EOA (n = 1222) and NOA (n = 16 385). Several national registers were applied to assess morbidity and mortality. PARTICIPANTS/MATERIALS, SETTING, METHODS EOA was defined as ≤5 oocytes harvested in a minimum of two FSH-stimulated cycles and NOA as ≥8 oocytes in at least one cycle. Cases with known causes influencing the ovarian reserve (endometriosis, ovarian surgery, polycystic ovary syndrome, chemotherapy etc.) were excluded. To investigate for early signs of ageing, primary outcome was an overall risk of ageing-related events, defined as a diagnosis of either CVD, osteoporosis, type 2 diabetes, cancer, cataract, Alzheimer's or Parkinson's disease, by death of any-cause as well as a Charlson comorbidity index score of ≥1 or by registration of early retirement benefit. Cox regression models were used to assess the risk of these events. Exposure status was defined 1 year after the first ART cycle to assure reliable classification, and time-to-event was measured from that time point. MAIN RESULTS AND THE ROLE OF CHANCE Median follow-up time from baseline to first event was 4.9 years (10/90 percentile 0.7/11.8) and 6.4 years (1.1/13.3) in the EOA and NOA group, respectively. Women with EOA had an increased risk of ageing-related events when compared to women with a normal oocyte yield (adjusted hazard ratio 1.24, 95% CI 1.08 to 1.43). Stratifying on categories, the EOA group had a significantly increased risk for CVD (1.44, 1.19 to 1.75) and osteoporosis (2.45, 1.59 to 3.90). Charlson comorbidity index (1.15, 0.93 to 1.41) and early retirement benefit (1.21, 0.80 to 1.83) was also increased, although not reaching statistical significance. LIMITATIONS, REASONS FOR CAUTION Cycles never reaching oocyte aspiration were left out of account in the inclusion process and we may therefore have missed women with the most severe forms of EOA. We had no information on the total doses of gonadotrophin administered in each cycle. WIDER IMPLICATIONS OF THE FINDINGS These findings indicate that oocyte yield may serve as marker of later accelerated ageing when, unexpectedly, repeatedly few oocytes are harvested in young women. Counselling on life-style factors as a prophylactic effort against cardiovascular and other age-related diseases may be essential for this group of women. STUDY FUNDING/COMPETING INTEREST(S) No external funding was received for this study. All authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M W Christensen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - U S Kesmodel
- Fertility Unit, Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - K Christensen
- Department of Public Health, The Danish Aging Research Center, University of Southern Denmark, Odense C, Denmark
| | - K Kirkegaard
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
| | - H J Ingerslev
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Fertility Unit, Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
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43
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The association between primary ovarian insufficiency and osteoporosis in the Canadian Longitudinal Study on Aging. ACTA ACUST UNITED AC 2021; 28:693-698. [PMID: 33651742 DOI: 10.1097/gme.0000000000001756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study is to describe the association of premature ovarian insufficiency (POI) and early menopause on bone mineral density (BMD) and osteoporosis in a large cohort of women living in Canada. METHODS Cross-sectional baseline data from a deeply characterized cohort (female participants) of the Canadian Longitudinal Study on Aging was used. Additional bio-psycho-social characteristics that may influence bone health and the development of osteoporosis were explored. RESULTS The mean age of women at the time of baseline assessment was 65 years (N = 12,339). When comparing women with POI to those with early and normal age of menopause, there was no difference in hip BMD between groups, but women in the POI group were more likely to have a higher rate of self-reported osteoporosis (21.9% vs 16.7%) and have used osteoporosis drugs (11.39% vs 7.63%). After adjustment, POI was found to increase the odds of osteoporosis, as diagnosed using BMD. Current cigarette smoking was found to influence this association. Protective factors included obesity and current hormone therapy use, but not the duration of hormone therapy use. Women in the POI group were more likely to be obese, have decreased physical activity, and were more likely to be current smokers. CONCLUSION These results confirm findings from smaller cohorts illustrating that POI is associated with osteoporosis. Increasing understanding of the sequelae associated with an earlier loss of ovarian function will aid in targeting earlier screening and intervention strategies for women in Canada and abroad.
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Premature ovarian insufficiency: pathogenesis and therapeutic potential of mesenchymal stem cell. J Mol Med (Berl) 2021; 99:637-650. [PMID: 33641066 DOI: 10.1007/s00109-021-02055-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 01/29/2021] [Accepted: 02/21/2021] [Indexed: 12/14/2022]
Abstract
Primary ovarian insufficiency (POI) is defined as a reduction in ovarian function before the expected age of menopause. POI is known to increase the risk of cardiovascular disorders, osteoporosis, cognitive decline, and mood disorders, resulting in a reduced quality of life. Appropriate hormone replacement for premenopausal women decreases these adverse health risks and improves quality of life for women with POI, but does not prolong life expectancy. The potential etiologies of POI include chromosomal abnormalities and genetic mutations, autoimmune factors, and iatrogenic causes, including surgery, chemotherapy, and radiation therapy. A major association is suggested to exist between reproductive longevity and the DNA damage pathway response genes. DNA damage and repair in ovarian granulosa cells is strongly associated with POI. Depletion of oocytes with damaged DNA occurs through different cell death mechanisms, such as apoptosis, autophagy, and necroptosis, mediated by the phosphatase and tensin homolog (PTEN)/phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/forkhead transcription factors 3 (FOXO3) pathway. Mesenchymal stem cells (MSCs) are characterized by the ability of self-renewal and differentiation and play an important role in the regeneration of injured tissues. Transplantation of MSCs has been shown to functionally restore ovarian reserve in a POI mouse model. Recent advances in stem cell therapy are likely to be translated to new therapeutic options bringing new hope to patients with POI. The aim of this review is to summarize the pathogenic mechanisms that involve cell death and DNA damage and repair pathways and to discuss the stem cell-based therapies as potential therapeutic options for this gynecologic pathology.
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45
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Peate M, Saunders C, Cohen P, Hickey M. Who is managing menopausal symptoms, sexual problems, mood and sleep disturbance after breast cancer and is it working? Findings from a large community-based survey of breast cancer survivors. Breast Cancer Res Treat 2021; 187:427-435. [PMID: 33575860 DOI: 10.1007/s10549-021-06117-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To determine the nature and severity of vasomotor symptoms, sexual problems, mood and sleep disturbance in community-dwelling breast cancer patients, whether and where they received treatment for these symptoms and their satisfaction with treatment received. METHODS Online cross-sectional survey distributed through Breast Cancer Network Australia (BCNA). RESULTS 524/2286 women responded to the invitation to participate. Of these, 74% (385/523) reported symptoms of interest and were included in the analysis. Mean age was 55.2 years and mean time since breast cancer diagnosis was 5.7 years. Most (66%) had received chemotherapy and were taking endocrine therapy (64%). The most common symptoms were hot flushes/night sweats and sleep disturbance (both 89%), vaginal dryness (75%), mood swings (62%) and sexual problems (60%). Symptoms were mild (21-33%) or moderate (21-38%) in around one third and severe in up to one quarter (8-26%). Symptoms affected the ability to "get on with their life" for 36%, predicted by severity of hot flushes (OR 1.4), sleep disturbance (OR 1.3), mood disturbance (OR 1.3), and sexual problems (OR 1.3). Only 32% were offered treatment, mostly delivered by GPs (33%) or oncologists (26%). Only 49% found this "somewhat effective" and 34% found it ineffective. The majority (60%) wanted more support to manage their symptoms. CONCLUSION Menopausal symptoms, sexual problems, mood and sleep difficulties are common after breast cancer and often not effectively managed. There is an unmet need for coordinated care providing effective treatments.
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Affiliation(s)
- Michelle Peate
- Department of Obstetrics & Gynaecology, University of Melbourne, Level 7, Royal Women's Hospital, 20 Flemington Road, Parkville, VIC, 3052, Australia.
| | - Christobel Saunders
- Division of Surgery, Faculty of Health and Medical Sciences, University of Western Australia School of Surgery, Murdoch, WA, 6150, Australia
| | - Paul Cohen
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, WA, 6009, Australia
| | - Martha Hickey
- Department of Obstetrics & Gynaecology, University of Melbourne, Level 7, Royal Women's Hospital, 20 Flemington Road, Parkville, VIC, 3052, Australia
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46
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Innan H, Vaiman D, Veitia RA. Predictable increase in female reproductive window: A simple model connecting age of reproduction, menopause, and longevity. Bioessays 2021; 43:e2000233. [PMID: 33569823 DOI: 10.1002/bies.202000233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 01/08/2023]
Abstract
With the ever-increasing lifespan along with societal changes, women can marry and procreate later than in previous centuries. However, pathogenic genetic variants segregating in the population can lead to female subfertility or infertility well before the average age of normal menopause, leading to counter-selection of such deleterious alleles. In reviewing this field, we speculate that a logical consequence would be the later occurrence of menopause and the extension of women's reproductive lifespan. We illustrate this point with a simple model that applies to other variants that contribute to female infertility, including epigenetic variation. We also consider the effect of medical interventions and lifestyle.
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Affiliation(s)
- Hideki Innan
- Graduate University for Advanced Studies, Hayama, Kanagawa, Japan
| | - Daniel Vaiman
- Université de Paris, Paris, France.,Institut Cochin, Paris, France
| | - Reiner A Veitia
- Université de Paris, Paris, France.,CNRS, Institut Jacques Monod, Paris, France.,Institut de Biologie François Jacob, Commissariat à l'Energie Atomique et aux Energies Alternatives, Université Paris-Saclay, Paris, France
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47
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Lersten I, Clain E, Santoro N. Use of Hormone Therapy in Women with Early Menopause and Premature Ovarian Insufficiency. Semin Reprod Med 2021; 38:302-308. [PMID: 33540459 DOI: 10.1055/s-0040-1721719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Women with early menopause or primary ovarian insufficiency (POI) experience a menopausal state a decade or more earlier than their peers. The health consequences for POI are vast and varied with detrimental effects seen on neurological, psychological, bone, and cardiovascular systems. The risk profile of POI patients requires special attention, as they differ from a typical menopausal population. This review will explore the health risks associated with POI and examine the various treatment options and also the risks associated with hormone therapy. Given the risks and benefits, POI patients should be strongly encouraged to start hormone therapy until the median age of menopause.
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Affiliation(s)
- Ivy Lersten
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Elizabeth Clain
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
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48
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Nelson SM, Anderson RA. Prediction of premature ovarian insufficiency: foolish fallacy or feasible foresight? Climacteric 2021; 24:438-443. [PMID: 33522318 DOI: 10.1080/13697137.2020.1868426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Prediction of premature ovarian insufficiency (POI) would be of substantial individual benefit, but being a heterogeneous and fluctuating condition, with an extensive range of complex etiologies and arbitrary diagnostic criteria, might make this seem foolhardy. However, contemporary and complementary genetic strategies assessing consanguineous and large POI pedigrees and cohorts with age at natural menopause have shown strong enrichment in genes regulating DNA damage repair, homologous recombination, and meiosis, processes that are critical to oogenesis and folliculogenesis. Recognition of the molecular architecture of POI and its contribution to baseline genotypic risk may enable these estimates to be refined further by estimation of the residual ovarian reserve. Increasing data derived from spontaneous and gonadotoxic-induced POI cohorts demonstrate the utility of anti-Müllerian hormone (AMH) to predict POI. This review presents current understanding of how genetics in combination with AMH may facilitate the prediction of POI.
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Affiliation(s)
- S M Nelson
- School of Medicine, University of Glasgow, Glasgow, UK.,NIHR Bristol Biomedical Research Centre, Bristol, UK.,The Fertility Partnership, London, UK
| | - R A Anderson
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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49
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Schipper I, Louwers YV. Premature and Early Menopause in Relation to Cardiovascular Disease. Semin Reprod Med 2021; 38:270-276. [PMID: 33511582 DOI: 10.1055/s-0040-1722318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Postmenopausal women have an increased risk for cardiovascular diseases. It has been postulated that the loss of ovarian function and subsequent deficiency of endogenous estrogens after menopause contributes to this elevated risk of cardiovascular disease in postmenopausal women. Compared with woman entering menopause at the mean age of 51 years, in women with early menopause or premature ovarian insufficiency the risk for cardiovascular disease is even greater. These women lack the cardioprotective effect of endogenous estrogens for many more years than do women entering natural menopause. The majority of data assessing the risk of cardiovascular disease in relation to age at menopause and specifically premature menopause are derived from large epidemiological cohort studies. In addition, observations in women undergoing bilateral oophorectomy at an early age provide convincing evidence regarding association between early menopause or POI and the development of cardiovascular events and mortality. Moreover, genetic variants associated with earlier age at menopause have also been found to increase the risk of cardiovascular events in women. It has been substantiated that hormone replacement therapy (HRT) decreases the risk for ischemic heart disease and eliminates the increased cardiovascular disease mortality. It is therefore crucial to start HRT as soon as possible, particularly in women with premature ovarian insufficiency.
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Affiliation(s)
- Izaäk Schipper
- Division of Reproductive Medicine and Endocrinology, Department of Obstetrics and Gynecology, Erasmus MC University Center, Rotterdam, The Netherlands
| | - Yvonne V Louwers
- Division of Reproductive Medicine and Endocrinology, Department of Obstetrics and Gynecology, Erasmus MC University Center, Rotterdam, The Netherlands
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Yuk JS, Kim M. Incidence and prevalence of primary ovarian insufficiency in South Korea: a population-based study. Arch Gynecol Obstet 2021; 304:823-831. [PMID: 33492427 DOI: 10.1007/s00404-021-05962-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/22/2020] [Indexed: 11/25/2022]
Abstract
AIM We investigated the incidence and prevalence of primary ovarian insufficiency (POI) in the Republic of Korea using population-based data. METHODS Data of patients diagnosed with POI from 2009 to 2017 were obtained from the Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS). The incidence and prevalence of POI were measured as defined using follicle stimulating hormone (FSH) test, POI diagnostic codes, and age. RESULTS Data from 6,617,139 women were extracted. Of those under the age of 40, 239 had been newly diagnosed with POI. The incidence of POI was 9.2 ± 0.6 per 100,000 (0.0092%). The mean age of the women with newly diagnosed POI was 22.2 ± 0.6 years. Logistic regression analysis determined that the incidence of POI decreased with increasing age at 5 year increments [odds ratio (OR) 0.82; 95% confidence interval (CI) 0.75-0.88]; however, socioeconomic status was not associated with POI (OR 1.12; 95% CI 0.5-2.53). Among diseases in the Charlson comorbidity index (CCI), cancer, diabetes mellitus (DM) without complications, and renal disease were associated with an increased incidence of POI (OR 5.54; 95% CI 2.92-10.49; OR 11.83; 95% CI 6.37-22; OR 7.08; 95% CI 1.41-35.5, respectively). When excluding the Q96 (Turner syndrome) diagnostic code, the incidence of POI was 3.7 ± 0.4 per 100,000 (0.0037%), and the prevalence of POI was 12.3 ± 0.4 per 100,000 (0.0123%). CONCLUSION We found the incidence of POI to be 9.2 ± 0.6 per 100,000 (0.0092%). Cancer, DM without complications, and renal disease were associated with the increased incidence of POI. The incidence and prevalence of POI is considerably lower than reported in previous studies.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, 1342, Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea
| | - Myounghwan Kim
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, 1342, Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea.
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