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Menopausal symptoms in mid-aged women from Paraguay

2023-11-29T04:01:04+11:00

27 November 2023

Summary

Recently, Sánchez-Zarza et al. [1] aimed at determining the prevalence of menopausal symptoms and factors related to severity in mid-aged women from Asunción, Paraguay. For this, they carried out a cross-sectional study in which 216 urban-living women (40-60 years) were surveyed with the 10 item Cervantes Scale (CS-10) and a general questionnaire containing personal and partner data. They found that the median age of the sample of 48 years, 48.1% were postmenopausal, 8.8% used menopausal hormone therapy, 39.4% psychotropic drugs, 43.5% had hypertension, 6.5% diabetes, 51.9% abdominal obesity, and 89.3% had a partner (n = 193). A history of sexual abuse was present in 2.8%. The median total CS-10 score was 8.5. Overall, 93.3% (180/193) of women having a partner were sexually active, with a median coital frequency of 8 times per month. According to the CS-10, the three most prevalent menopausal symptoms were: aching in muscles and/or joints (70.8%), anxiety and nervousness (70.8%) and hot flashes/night sweats (54.2%). Factors associated with higher CS-10 scores were: female age and educational level, marital status, menopausal status, and marital sexual aspects. Multiple linear regression analysis found that higher total CS-10 scores (more severe menopausal symptoms) negatively correlated to coital frequency and positively correlated with peri- and postmenopausal status, parity, sedentary lifestyle and a history of sexual abuse. The authors conclude that menopausal symptoms of this mid-aged urban female Paraguayan sample were related to hormonal, sexual and other female aspects.

Substantial lipid increases during the menopausal transition in Korean mid-aged women

2023-11-21T04:01:04+11:00

21 November 2023

Summary

During the postmenopausal stage women often display adverse lipid profiles; however, evidence is insufficient regarding the association between lipids and reproductive aging in Korean women. Bearing this in mind, Park et al. [1] aimed to characterize lipid changes in relation to the timing of menopause in 1,436 Korean mid-aged (premenopausal) women who had a natural menopause during the follow-up period (median = 15.76 years) from the Korean Genome and Epidemiology Study (KoGES) Ansan and Anseong cohort. Lipid levels were measured every 2 years, and the magnitudes of annual lipid changes and differences in the changes by premenopausal body mass index were estimated using piecewise linear mixed-effects models. The authors found that all lipid levels increased greatly from 3 or 5 years before menopause to 1 year after menopause in all women, regardless of their premenopausal body mass index (BMI). During the period, HDL-C levels increased at 0.42 mg/dL per year (95% CI, 0.29 to 0.55). Nevertheless, non-HDL-C levels simultaneously increased at 3.42 mg/dL per year (95% CI, 3.11 to 3.72), and an annual change in the non-HDL-C to HDL-C ratio was 0.05 (95% CI, 0.04 to 0.06). One year after menopause, changes in all lipid parameters significantly slowed down, except for the non-HDL-C to HDL-C ratio (p < 0.001 for all). The ratio continued to increase until 3 years after menopause, but thereafter, the change leveled off. The researchers conclude that women experienced remarkable increases in lipid levels during menopausal transition, highlighting the need for early intervention strategies for cardiovascular disease (CVD) prevention in women.

Understanding the brain during menopause

2023-10-24T04:01:04+11:00

24 October 2023

Summary

Zhu and colleagues [1] have undertaken a study to address the lack of a specific cognitive assessment in relation to menopause by evaluating the Everyday Memory Questionnaire-Revised (EMQ-R). The EMQ-R was first developed as a 35-item questionnaire to be used after closed head injury that was subsequently reduced to a 13-item questionnaire for broader use. The latter was what the authors evaluated in a “menopausal population” of women aged 30-60 years, recruited by targeted advertising to achieve a sample of women experiencing menopausal symptoms (i.e brain fog, hot flushes, and night sweats). Menopausal hormone therapy (MHT) users and women using therapies that would mask or inhibit menstrual bleeding, and hysterectomised women were not excluded. However, menopause staging was based on STRAW+10 bleeding criteria [2]. A total of 417 women completed the questionnaire, subdivided into premenopausal (n=107), perimenopausal (n=149), and early postmenopausal (n=161) groups and hormonal contraceptive (HC)/MHT use was 37%, 27% and 40%, respectively. The majority (>85%) had graduate education. The analysis focused on retrieval and attention domains of the EMQ-R as cognitive components of “brain fog”. The main findings were that there were no differences between the three groups for the total EMQ-R score or the attention subscale. However, the perimenopausal group had a poorer total score for the EMQ-R retrieval domain (mean 13.58, SD 6.99) compared with pre- (11.8, SD 7.36) and postmenopausal (11.73, SD 7.17) groups (p=0.043).

Vaginal laser therapy for GSM/VVA: where we stand now - a review by the EUGA Working Group on Laser by the EUGA Working Group on Laser

2023-10-16T04:01:04+11:00

16 October 2023

Summary

Due to the increase in female life expectancy (around 80 years) observed in the different continents and with an average age at menopause onset of 48.6 years, it is becoming very important to seek new strategies to maintain an adequate quality of life in the different aspects of mid-life women's health. In this regard, it has been observed that the Genitourinary Syndrome of Menopause (GSM) can affect up to 75% of postmenopausal women, seriously altering different aspects of their lives. The most frequently reported symptoms include vaginal dryness, pruritus, burning, dyspareunia, altered urination frequency, urgency, dysuria and different degrees of stress urinary incontinence. Sexuality is one of the most affected aspects. In July of this year, Salvatore et al. [1], as part of the working group of the European Urogynecology Association (EUGA), published a review on a still controversial topic comparing the 2 types of lasers most frequently used in gynecology to manage the GSM. In this regard, it clarifies that the current indication for its use is mainly the treatment of symptoms of vulvovaginal atrophy and/or the GSM, and not in the area of gynecological cosmetology where it has been widely used with very different results.

Continuous transdermal nitroglycerin does not decrease hot flush frequency and severity in peri- and postmenopausal women: results of a Randomized Placebo Controlled Clinical Trial

2023-09-19T04:01:04+10:00

September 18th, 2023

Summary

There has been an increase in the use of non-hormonal options to treat hot flashes among many menopausal women, basically due to the potential risks of long-term systemic estrogen therapy. Physiologic studies have shown that nitric oxide is pivotal in mediating vasodilation related to hot flash. Hence, it can be suggested that non-hormonal medications that induce nitrate tolerance in the vasculature may offer therapeutic benefit for vasomotor symptoms. Bearing this in mind, recently, Huang et al. [1] carried out a randomized, double-blinded, placebo-controlled clinical trial that included peri- or postmenopausal women that reported 7 or more hot flashes per day, in order to determine if the uninterrupted administration of transdermal nitroglycerin (NTG, aimed to induce nitrate cross-tolerance) would decrease the frequency or severity of menopause-related hot flashes.

Women used daily NTG patches (dose titrated from 0.2-0.6 mg/h; n=65) or identical placebo patches (n=69), registering daily frequency and severity of their hot flashes for 12 weeks. At baseline women reported a daily mean of 10.8 ± 3.5 hot flashes and 8.4 ± 3.6 were moderate-to-severe. Over 5 weeks, the estimated change in any hot flash frequency associated with NTG vs placebo was -0.9 (95% CI, -2.1 to 0.3) episodes per day (P = .10), and change in moderate-to-severe hot flash frequency with NTG vs placebo was -1.1 (95% CI, -2.2 to 0) episodes per day (P = .05). At 12 weeks, treatment with NTG did not significantly decrease the frequency of any hot flashes or moderate-to-severe hot flashes relative to placebo. Even upon combining 5-week and 12-week data analysis, no significant differences in change in the frequency of any hot flashes or moderate-to-severe hot flashes were detected with NTG vs placebo. The authors conclude that the continuous use of NTG did not result in sustained improvements in hot flash frequency or severity relative to placebo and was associated with more early but not persistent headache.

Associations between dietary patterns and an array of inflammation biomarkers and plasma lipid profile in postmenopausal women

2023-09-12T04:01:04+10:00

September 11th, 2023

Summary

Recently, Ilesanmi-Oyelere et al. [1] reported the results of a cross-sectional study that evaluated the association between four dietary patterns, nutrients and food intakes and an array of systemic inflammation biomarkers and lipid profile among 80 postmenopausal women from New Zealand. The authors used a food frequency questionnaire to collect nutrients and food intake. Four dietary patterns were identified by principal component analysis (PCA) and plasma samples collected for the measuring of inflammatory biomarkers and lipid profile. The authors found that there were negative correlations between intake of dietary fiber, soluble and insoluble non-starch polysaccharides (NSP), vitamin C and niacin and almost all the inflammatory markers for the whole group. Vegetables, tea/coffee and especially fruit intake were negatively correlated with the inflammatory biomarkers in the whole group. A high intake of Pattern 1 (potato, bread, and fruit pattern) was associated with a low risk of high interferon (IFN)-α2, IFN-λ, interleukin (IL)-6 and IL-8 levels while a high intake of Pattern 3 (fast-food pattern) was associated with a high risk of IFN-α2 levels. Multiple linear regression showed a negative correlation between Pattern 2 (soups and vegetables pattern) and levels of C-reactive protein (CRP) as well as ferritin. A positive association was observed between Pattern 3 (fast-food pattern) and CRP levels. Positive correlation was also observed between Pattern 2 and high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC) levels; however, Pattern 4 (meat and vegetables pattern) was negatively correlated with total cholesterol (TC), LDL-C and TC/HDL-C ratio. The researchers conclude that their findings reinforce the contribution and role of the diet in modifying inflammation in postmenopausal women.

The reverse of reproductive aging: ovarian recovery through autologous platelet-rich plasma

2023-07-24T04:01:04+10:00

September 4th, 2023

Summary

With the increase in health and life expectancy, the number of menopausal women has increased significantly. In parallel, there has been a reduction of birth rates influenced by women having their first maternity in an advanced age. Both trends have an impact on national demographics and impose a socioeconomic challenge for which there is no current solution. Women with symptomatic menopause and those with infertility/miscarriage may take advantage of standard therapies such as menopause hormone therapy (MHT) or in vitro fertilization, respectively. Although these interventions are effective, both are expensive, have low yield, and not free of controversial issues. As women age, the output of ovarian steroids and competent oocyte availability approach unrecoverable loss beyond the age of 35 years, no matter the treatment. Currently there is interest in native sex steroid rejuvenation, de novo euploid oogenesis, ovulation, blastocyst development, fetal growth, and healthy term livebirths-all apparently possible with intraovarian insertion of platelet-rich plasma (PRP). Discrete functional analysis of the full platelet-derived cytokine array carried with PRP, unfortunately for now, is incomplete. Here, the release of constituents of selected platelets and measured effects are framed to address advances in wellness and women's health. Emphasis is on cytokines best positioned to enable recovery of senescent ovarian function sufficient to suspend synthetic MHT dependency and/or permit egg retrieval and pregnancy.

The vagina as a source and target of androgens: implications for the treatment of the genitourinary syndrome of menopause

2023-07-24T04:01:04+10:00

24 July 2023

Summary

The vagina has traditionally been conceived as a passive female reproductive organ that serves basically as a passageway for menstrual blood, sexual intercourse and childbirth. However, recent research, as revised by Cipriani et al. [1], has provided insights on the role of the vagina as an endocrine organ that plays a crucial role in female hormonal balance and overall health. Current evidence, taking into account the novel concept of “intracrinology”, highlights the fact that the human vagina may be considered both as a source and target of androgens. Aside from the well-known role of estrogens, androgens are also pivotal for the development and maintenance in women of healthy genitourinary tissues. During the female menopausal transition and the aging process per se, androgen and estrogen levels decline, thus exerting changes in the genitourinary system. Indeed, tissues become thinner, drier and less elastic, leading to a variety of uncomfortable and sometimes painful symptoms, clustered in the genitourinary syndrome of menopause (GSM). Due to the lack of testosterone-based or androstenedione-based products approved by regulatory agencies to treat GSM, the possibility of using intravaginal prasterone, which exerts effects by providing a local source of dehydroepiandrosterone (DHEA) to the vaginal tissues, appears to be a reasonable targeted treatment; however, further studies are needed to better assess its safety and efficacy. In this commentary I would like summarize main points revised by the authors [1].

Age at natural menopause and risk of type 2 diabetes: a prospective cohort study

2023-07-14T04:01:04+10:00

10 July 2023

Summary

Recently, Muka et al. [1] carried out a prospective cohort study that aimed at examining the association between the age at natural menopause and the risk of developing type 2 diabetes. For this, 3,639 postmenopausal women of the Rotterdam population based study were included. Age of natural menopause was retrospectively self-reported and was treated as a continuous variable and in categories: premature < 40 years, early 40-44 years, normal 45-55 years, and late > 55 years. Other potential mediators such as obesity, C-reactive protein (CRP), blood glucose, insulin level, total estradiol, and androgens were also included. Women were followed for a period of 9.2 years, time in which 348 women who developed type 2 diabetes were identified. After adjusting for the data, the results showed a hazard ratio (HR) of 3.7 (95% CI: 1.8, 7.5), 2.4 (95% CI: 1.3, 4.3), and 1.60 (95% Cl: 1.0, 2.8) for women with premature, early, and normal menopause, respectively, in developing type 2 diabetes, in comparison to those with late menopause. The HR for type 2 diabetes per 1 year older at menopause was 0.96 (95% CI 0.94, 0.98). Further adjustment for body mass index, glycaemic traits, metabolic risk factors, C-reactive protein, endogenous sex hormone levels or shared genetic factors did not affect this association. The authors conclude that early onset of natural menopause is an independent marker for type 2 diabetes in postmenopausal women.

Evaluation of the visceral adiposity index with cardiovascular risk factors, biomarkers in postmenopausal women to predict cardiovascular disease

2023-06-26T04:01:04+10:00

26 June 2023

Summary

Reports indicate that the visceral adiposity index (VAI) is useful to predict cardiovascular disease (CVD) and the metabolic syndrome (MetS). Despite this, long-term studies that analyze the efficacy of the VAI in the prediction of CVD risk are limited and the association between the VAI and electrolytes is unclear. In this sense, Gulbahar et al. [1] reported results of a study aimed at determining if the VAI can be used as a predictor of CVD and provide the possibility of early diagnosis for future CVD. In addition, the authors also analyzed the impact of biomarkers and electrolytes on VAI as an indirect association with CVD. For this, postmenopausal women (aged >40 years; n=50) were included and categorized into two groups according to their VAI scores: mild/moderate and severe. The groups were compared in terms of insulin resistance, biochemical parameters, and anthropometric measurements. After ten years, women were re-assessed and surveyed for additional disease and cardiovascular risk. The study found that VAI scores of women with the MetS as compared to those without the syndrome were significantly higher (7.30 ± 4.75 vs. 2.95 ± 1.05, p < 0.01). In the sever group, serum magnesium levels were found significantly lower and serum zinc (Zn) and high sensitivity C-reactive protein (hsCRP) levels were higher. Correlation analysis showed significant positive correlations between VAI scores and total cholesterol, Zn, and fasting insulin levels and no significant association with the 10-year CVD incidence. The authors conclude that previous VAI results cannot assist in predicting the 10-year CVD risk. Additionally, including serum measurements of Zn, total cholesterol, fasting insulin, and glucose levels are a reasonable approach for managing postmenopausal women with unfavorable CVD risk profiles.

Hysterectomy with and without oophorectomy, tubal ligation, and risk of cardiovascular disease in the Nurses' Health Study II

2023-06-14T04:01:04+10:00

12 June 2023

Summary

Hysterectomy, oophorectomy, and tubal ligation are common surgical procedures; however, reports linking cardiovascular disease (CVD) risk after these surgeries have basically focused on oophorectomy with limited research on hysterectomy or tubal ligation. Recently, Farland et al. [1] reported on data of participants of the Nurses' Health Study II (n = 116,429) who were followed from 1989 to 2017. Self-reported gynecologic surgery was categorized as follows: no surgery, hysterectomy alone, hysterectomy with unilateral oophorectomy, and hysterectomy with bilateral oophorectomy; the authors separately investigated tubal ligation alone. The primary outcome was CVD based on medical-record confirmed fatal and non-fatal myocardial infarction, fatal coronary heart disease, or fatal and nonfatal stroke. Secondary outcome expanded CVD to include coronary revascularization (coronary artery bypass graft surgery, angioplasty, stent placement). The authors used Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CIs), a priori adjusted for confounding factors. Differences by age at surgery (≤50, >50) and menopausal hormone therapy usage was analyzed. Average age of participants at baseline was 34 years. During 2,899,787 person-years, the investigators observed 1,864 CVD cases. Hysterectomy in combination with any oophorectomy (unilateral or bilateral) was associated with a greater risk of CVD in multivariable-adjusted models. Hysterectomy alone, hysterectomy with oophorectomy (unilateral and bilateral), and tubal ligation were also associated with an increased risk of combined CVD and coronary revascularization (HR 1.19; HR 1.29; HR 1.22, and HR 1.16, respectively). The association between hysterectomy/oophorectomy and the risk of CVD and coronary revascularization varied by age when surgery was performed, with the strongest association observed if surgery was before age 50. The authors finally conclude that hysterectomy, alone or in combination with oophorectomy (any type), as well as tubal ligation, seems to be associated with a higher risk of CVD and coronary revascularization; indicating that these findings extend previous research finding that oophorectomy is associated with CVD.

Efficacy and safety of fezolinetant for the treatment of moderate-to-severe menopausal related vasomotor symptoms

2023-05-23T04:01:04+10:00

22 May 2023

Summary

Vasomotor symptoms (VMS) are common, bothersome, and can persist for years before and after menopause. Recently, Johnson et al. [1] published the results of SKYLIGHT 2, a phase 3 double-blind placebo controlled RCT aimed at assessing the efficacy and safety of fezolinetant for the treatment of moderate-to-severe menopause related VMS. Women, age 40-65 years with a minimum mean of 7 moderate-to-severe VMS per day, were randomized to receive 12 weeks once-daily fezolinetant 30 mg, fezolinetant 45 mg or placebo. Those who completed 12 weeks were re-randomized to fezolinetant 30mg or 45 mg for 40 additional weeks. Primary endpoints were mean daily change of frequency and severity of VMS from baseline to W4 and W12. The study reported that both fezolinetant doses significantly reduced moderate-to-severe VMS frequency and severity at W4 and W12 in comparison to placebo. For VMS frequency, W4 least squares mean (SE) reduction vs placebo was: fezolinetant 30 mg, -1.82 (0.46; p < 0.001); 45 mg, -2.55 (0.46; p < 0.001); W12: 30 mg, -1.86 (0.55; p < 0.001); 45 mg, -2.53 (0.55; p < 0.001). For VMS severity (scale 0-3) results were: W4: 30 mg, -0.15 (0.06; p< 0.05); 45 mg, -0.29 (0.06; p < 0.001); W12: 30 mg, -0.16 (0.08; p <0.05); 45 mg, -0.29 (0.08; p < 0.001). Significant improvement in VMS frequency (30 and 45 mg) and severity (45 mg) was observed by W1 and was maintained through W12. Serious treatment-emergent adverse events were infrequent: 2%, 1%, and 0% of those receiving fezolinetant 30 mg, fezolinetant 45 mg, and placebo, respectively; liver function abnormalities were rare and transient. The authors concluded that daily fezolinetant 30 mg and 45 mg were efficacious and well-tolerated for the treatment of moderate-to-severe menopause related VMS.

Rhythm-centered music making in community living elderly: a randomized pilot study

2023-05-19T04:01:04+10:00

19 May 2023

Summary

Rhythm-centered music making (RMM) has shown to improve physical, psychological and social health. Yap et al. [1] carried out a pilot randomized controlled trial with cross over aimed to explore the effects of RMM on quality of life, depressive mood, sleep quality and social isolation in elder individuals. A total of 54 participants were enrolled (27 in each arm). During phase 1, group A underwent the intervention with group B as the control; in phase 2 cross-over was performed. The intervention involved 10 weekly RMM sessions. Before intervention, at the 11th and at the 22nd week participants were evaluated with the European Quality of Life-5 Dimensions (EQ5D), the Geriatric Depression Scale (GDS), the Pittsburg Sleep Quality Index (PSQI) and the Lubben Social Network Scale (LSNS). At the end of the study 31 participants were analyzed. Mean age was 74.65 ± 6.40 years. Participation in RMM resulted in a non-significant reduction in the EQ5D by 0.004 (95% CI: -0.097-0.105), the GDS score by 0.479 (95% CI: -0.329-1.287), the PSQI score by 0.929 (95% CI: - 0.523-2.381) and an improvement in the LSNS by 1.125 (95% CI: -2.381-0.523). Upon binary analysis, participation in RMM resulted in a 37% (OR = 1.370, 95% CI: 0.355-5.290), 55.3% (OR = 1.553, 95% CI: 0.438-5.501), 124.1% (OR = 2.241, 95% CI = 0.677-7.419) and 14.5% (OR = 1.145, 95% CI = 0.331-3.963) non-significant increase in odds of improvement in the EQ5D, GDS, PSQI and LSNS scores respectively. The authors conclude that participation in RMM did not show any statistically significant difference in the quality of life of the participants; however, as they mention it is an interesting alternative tool to use in the field of integrative medicine. They recommend moving forward to a larger study that will better aid at investigating the effects of RMM on elder individuals with the inclusion of a qualitative component.

Obesity indicators as mediators of the association between age at menopause and blood pressure values

2023-04-11T04:01:04+10:00

11 April 2023

Summary

A later age at menopause onset has been associated with presenting a higher blood pressure (BP) value, although the mediation pathways remain unclear. Recently Wu et al. [1] examined in quantitative manner the mediation effects of various obesity indicators using baseline data from the Guangzhou Biobank Cohort Study (Phase 4). Authors used product of coefficients approach and bootstrapping procedures to assess the mediation effects of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) on the association between age at menopause and BP values. They adjusted for various co-variates such as age, education, occupation, family income, smoking, drinking, diet, physical activity, age at menarche, number of births, fasting glucose, triglycerides, and HDL-C. Of a total of 5,429 women with natural menopause, the mean age and mean age at menopause were 60.0 ± 5.8 and 50.3 ± 3.1 years, respectively. The prevalence of hypertension was 29.6%. In women with an age at menopause onset of ≥ 50 years, BMI, WC, WHR and WHtR showed significant mediation effects on the positive association between menopausal age and BP. The adjusted proportion (95% confidence interval) of the mediation effects for those variables were 26.04% (10.40-116.82%), 25.92% (10.19-108.57%), 14.11% (3.59-62.78%), and 23.17% (8.70-95.81%), respectively, for systolic BP values and 22.59% (10.72-53.60%), 20.67% (9.83-49.31%), 9.21% (2.73-23.92%), and 17.19% (7.56-41.31%) for diastolic BP values. In women with a menopausal age of <50 years, no significant association between age at menopause and systolic/diastolic BP values was found. The authors conclude that obesity indicators showed significant mediating effects on the association between having a later age at menopause (50 years or more) and having a higher BP value. They recommend that further longitudinal studies with detailed and accurate measurements of metabolic changes after menopause and sufficient follow-up are needed to confirm these results.

Lower back pain is worsened by inadequate vitamin D and obesity in postmenopausal women

2023-03-20T04:01:04+11:00

13 March 2023

Summary

Postmenopausal women are significantly more likely to suffer from vitamin D deficiency and obesity. It is common for postmenopausal women to have lower back pain (LBP), impaired muscle strength, and poor muscle function due to 25(OH)D deficiency. Obesity may also have a relationship with reduced muscle strength. On the basis of serum 25(OH)D concentration and body mass index (BMI), In an observational study, Chen et al. [1] studied 365 postmenopausal women with chronic LBP who were divided into four groups. Serum 25(OH)D concentrations in combination with BMI were assessed for their influence on paraspinal muscle (PSM) atrophy, fat infiltration, and severity of LBP. Results show that people with increased BMI and vitamin D inadequacy have less sun exposure time, decreased hand grip strength (HGS), decreased level of physical activity (lower Short Physical Performance Battery [SPPB] score), and PSM cross-sectional area than controls. However, this group's fat infiltration degree of the PSMs and visual analog scale (VAS) score was significantly increased. The authors conclude that high BMI and vitamin D insufficiency/deficiency have a significant positive additive interaction in terms of fat infiltration and impaired muscle strength of PSM.

Menopausal vasomotor symptoms and white matter hyperintensities in midlife women

2023-02-14T14:01:04+11:00

13 February 2023

Summary

Recently, Thurston et al. [1] investigated whether vasomotor symptoms (VMS), when rigorously assessed using physiologic measures, were associated among midlife women with greater white matter hyperintensity volume (WMHV). The authors considered a range of potential explanatory factors in these associations and explored whether VMS were associated with the spatial distribution of WMHV. For this, women aged 45-67 (n=226) who were free of hormone therapy underwent 24 hours of physiologic VMS monitoring (sternal skin conductance), actigraphy assessment of sleep, physical measures, phlebotomy, and 3 Tesla neuroimaging. Associations between VMS (24-hour, wake, and sleep VMS, with wake and sleep intervals defined by actigraphy) and whole brain WMHV were analyzed in linear regression models adjusted for age, race, education, smoking, body mass index, blood pressure, insulin resistance, and lipids. Secondary models considered WMHV in specific brain regions (deep, periventricular, frontal, temporal, parietal, occipital) and additional covariates including sleep. The investigators found that physiologically-assessed VMS were associated with greater whole brain WMHV in multivariable models, with the strongest significant associations observed for sleep VMS [24-hour VMS, wake VMS, sleep VMS]. Associations were not accounted for by additional covariates including actigraphy-assessed sleep (wake after sleep onset). When considering the spatial distribution of WMHV, sleep VMS were associated with both deep, periventricular and frontal lobe WMHV. The authors conclude that VMS, particularly those occurring during sleep, were associated with greater WMHV. In addition, they recommend the crucial need of finding female-specific midlife markers of poor brain health later in life in order to identify women who warrant early intervention and prevention. VMS have the potential to serve as this female-specific midlife marker of brain health in women.

Impact of hormone therapy on the bone density of women with premature ovarian insufficiency

2023-01-31T14:01:04+11:00

31 January 2023

Summary

Women with premature ovarian insufficiency (POI) are exposed to a long period of estrogenic deficiency, which potentially brings higher health risks, especially regarding bone health. Recently Costa et al. [1] performed a systematic review of the literature to evaluate the effect of hormone therapy (HT) on bone mineral density (BMD) in women with POI. They performed a search in MEDLINE and EMBASE databases up to September 2021 and included studies that analyzed women with spontaneous idiopathic POI treated with HT, to whom BMD was evaluated. Analysis of risk of bias of the selected studies was also performed. The authors found 335 articles and selected 16 studies according to the inclusion criteria. Most of the studies revealed lower bone density in both the femoral neck and lumbar spine in women with POI compared with healthy women. Bone mass had the tendency to remain stable in women treated with estrogen + progestin therapy; however, in those already with bone mass loss, the therapy - in the doses most frequently used - was not able to revert the loss. Higher estrogenic doses seemed to have a positive impact on BMD, as did combined oral contraceptives used continuously. In addition, the interruption of HT for longer than one year was associated with significant bone loss. The authors conclude that although HT brings clear benefits, further studies are needed to establish its long-term effects, as well as doses and formulations with better protective effects on the bone mass of women with POI.

Risk of endometrial polyps, hyperplasia, carcinoma, and uterine cancer after tamoxifen treatment in premenopausal women with breast cancer

2023-01-25T14:01:04+11:00

23 January 2023

Summary

Recently, Rye et al. [1] investigated the association of the use of tamoxifen with the risk of endometrial cancer and other uterine diseases in premenopausal women with breast cancer (BC). For this the authors carried out a nationwide, population-based, retrospective longitudinal cohort study with an 18-year study period using data obtained from the Korean National Health Insurance Service. Premenopausal women aged 20 to 50 years with BC diagnoses between January 2003 and December 2018 were included, with data analysis being performed from April to December 2021. Tamoxifen treatment was the main exposure variable and outcomes included: the incidence of uterine diseases, including endometrial cancer (EC), endometrial hyperplasia (EH), endometrial polyps (EP), and other uterine cancers. The incidence of uterine diseases was compared between tamoxifen users and non-users. A total 78,320 female participants were included (mean age 42.1), 34,637 (44.2%) were tamoxifen users and 43,683 (55.8%) were non-users. During the mean follow-up 6.13 years, among tamoxifen users the incidence of newly diagnosed EP, EH, EC and uterine cancers was 20.13, 13.49, 2.01 and 0.45 cases per 1,000 person-years, respectively. The risk of EC was higher in the tamoxifen group than in the control group after adjusting for age, body mass index, history of diabetes, and other co-variates. The authors conclude that premenopausal Korean women with BC who received tamoxifen as adjuvant hormone therapy, as compared to those who did not, had a significantly increased risk of studied uterine diseases, suggesting that clinicians should consider this risk in premenopausal women.

Early and surgical menopause associated with higher Framingham Risk Scores for cardiovascular disease in the Canadian Longitudinal Study on Aging

2023-01-19T14:01:04+11:00

17 January 2023

Summary

The risk of cardiovascular disease (CVD) is higher in the postmenopausal period. The effect that the type of menopause, natural versus surgical, or the age at natural onset of menopause has on CVD needs further investigation. This prompted Price et al. [1] to study of the association between the type and timing of menopause and the 10-year office based Framingham Risk Score (FRS) in women (45 to 85 years) from the Canadian Longitudinal Study on Aging. Women included were menopausal at time of recruitment and had no prior CVD. As main covariates, the authors examined age, education, province of residency, and the use of hormone therapy. A total of 10,090 women (8,200 natural menopausal and 1,890 surgical menopausal) were eligible for the study. Surgical menopause was associated with a higher mean FRS compared with natural menopause (CVD risk 12.4% vs 10.8%, p<0.001). Compared to women with an age at natural menopause from 50 to 54 years (CVD risk 10.2%), natural menopause before age 40, 40 to 44, or 45 to 49 years had a higher CVD risk (12.2%, 11.4%, and 10.6%, respectively, p<0.001). The author conclude that their study supports an association between the type of menopause and its timing over CVD risk prediction and highlights the need to be judicious about surgical menopause.

Loss of muscle mass in women with premature ovarian insufficiency as compared with healthy controls

2022-12-20T00:00:00+11:00

19 December 2022

Summary

Estrogen, mediated by both genomic and non-genomic pathways, contributes to the preservation of muscle mass and strength via effects on mitochondrial function, satellite cell regeneration, apoptosis, protein turnover, inflammation and myosin binding [1]. Earlier age at natural menopause is associated with reduced physical function parameters [2]. Although bone loss and osteoporosis are well recognised and feared consequences of premature ovarian insufficiency (POI) [3], data regarding muscle is lacking [1]; with previous investigations in women with POI showing conflicting results. The recent cross-sectional study by Li and co-workers [4] helps to address this knowledge gap by demonstrating in Chinese women with spontaneous POI (n=59) a greater prevalence of decreased muscle mass as well as lower appendicular skeletal muscle mass (ASM) and total skeletal muscle mass (TSMM), which was independent of age, body mass index (BMI) and lifestyle factors as compared with premenopausal controls (n=57).

Vaginal laser therapy versus hyaluronic acid suppositories for women with symptoms of urogenital atrophy after treatment for breast cancer: A randomized controlled trial

2022-11-29T16:40:44+11:00

28 November 2022

Summary

Urogenital atrophy affects more than half of women after breast cancer (BC) and in this population there is reluctance to use local estrogen. Therapies free of hormones such as intravaginal laser and hyaluronic acid suppositories have shown to produce symptom relief in women with BC and urogenital atrophy. However, they have not been tested against each other. In sense, recently, Gold et al. [1] have published data of randomized controlled trial aimed at comparing these non-hormonal modalities in women with urogenital atrophy after BC. They randomly assigned 43 women (aged 49-58 years, mean 54) with urogenital atrophy and a history of BC to receive intravaginal laser therapy (n=22, 2 courses within 1 month) or hyaluronic acid suppositories (n=21, 3 times/week continuously for three months). Their primary endpoint was the score of the Vaginal Health Index (VHI) after 3 months. Secondary endpoints were subjective bother on a numeric rating scale for all urogenital atrophy domains, quality of life, sexual health and pelvic organ prolapse symptoms using validated questionnaires. After 3 months VHI scores improved significantly in both groups, without significant differences observed between treatment groups. Significant improvement was also seen in both groups for subjective bother of urogenital atrophy, quality of life and sexual health, without significant differences seen between both groups. The authors conclude that both, intravaginal laser therapy and hyaluronic acid suppositories, were effective treatment options for women after BC suffering from urogenital atrophy.

Menopause impacts the human brain structure, connectivity, energy metabolism, and amyloid‑beta deposition

2022-11-23T16:40:44+11:00

21 November 2022

Summary

The menopause transition (MT) is a neuro-endocrine process that impacts the aging trajectories of multiple organ and systems including the brain. The MT occurs over time and is characterized by clinically defined stages with specific neurological symptoms. However, the way this process impacts the human brain remains unclear. Recently Mosconi et al. [1] reported a multi-modality neuroimaging study that indicates substantial differences in brain structure, connectivity, and energy metabolism across MT stages (pre-, peri- and post-menopause). These effects involved brain regions sub-serving higher-order cognitive processes and were specific to menopausal endocrine aging rather than chronological aging, as determined by comparison to age-matched males. Brain biomarkers largely stabilized during postmenopause, and gray matter volume (GMV) recovered in key brain regions for cognitive aging. Notably, GMV recovery and in vivo brain mitochondria ATP production correlated with preservation of cognitive performance in the postmenopausal stage, suggesting adaptive compensatory processes. In parallel to the adaptive process, amyloid-β deposition was more pronounced in peri- and postmenopausal women carrying the apolipoprotein E-4 (APOE-4) genotype, the major genetic risk factor for late-onset Alzheimer’s disease (AD), relative to genotype-matched males.

Disruption of Sleep continuity during the Perimenopause - is there an association with female reproductive hormone?

2022-11-03T10:50:04+11:00

31 October 2022

Summary

Sleep problems are frequently encountered during the menopausal transition, which have been related to various factors and can impair female quality of life [1]; however, direct relation with hormonal changes of the menopausal transition is still unclear. Recently Coborn et al. [2] reported a study that aimed at determining the association between female reproductive hormones and sleep discontinuity independent of night vasomotor symptoms (VMS) and depressive symptoms (DepS) in perimenopausal women. For this, daily sleep and VMS diaries, as well as weekly serum measurements of female reproductive hormones were obtained for 8 consecutive weeks among 45 perimenopausal women with night VMS and mild DepS. Women with primary sleep problems were excluded. Estimating equations were used to examine associations of estradiol, progesterone, and FSH with the mean number of nightly awakenings, wakefulness after sleep onset (WASO) and sleep-onset latency (SOL), adjusting for night VMS and DepS. The authors found that sleep disruption was common (awakenings/night, WASO and SOL). In adjusted models, a higher rate of awakenings was associated with postmenopausal estradiol levels and higher FSH levels, but not with progesterone. Female reproductive hormones were not associated with WASO or SOL. The authors conclude that the relationship of more awakenings with lower estradiol and higher FSH levels gives support for sleep discontinuity in the perimenopause linked with female reproductive hormone changes, independent of night VMS and DepSx.

Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: recommendation statement of the US Preventive Services Task Force

2022-10-24T10:50:04+11:00

24 October 2022

Summary

The US Preventive Services Task Force (USPSTF) published a recommendation on statin use for primary prevention in 2016 [1]. Now the task force has commissioned a new review of the evidence on the benefits and harms of statins as the basis for an update of the 2016 guidelines [2]. There were 26 studies included in the review, 23 randomised trials and three observational studies. Since the 2016 review, there was only one new trial but separate primary prevention data had become available from some other studies. The main finding was that there is moderate certainty that statin use offers moderate net benefit (in terms of reduced risk of cardiovascular disease (CVD) events and all-cause mortality) for adults aged 40-75 years with no history of cardiovascular disease but have at least one CVD risk factor and an estimated 10-year risk of a CVD event of at least 10% [3]. This recommendation does not apply to people with a LDL cholesterol level above 4.92 mmol/L, those with familial hypercholesterolaemia or adults aged over 75 years. The USPSTF also recommends that statins could be considered for adults aged 40-75 years with no history of CVD and at least one CVD risk factor and an estimated 10-year risk of a CVD event of between 7.5 and 10%.

Cow's milk intake and risk of coronary heart disease in Korean postmenopausal women

2022-10-19T10:50:04+11:00

17 October 2022

Summary

Numerous publications have reported conflicting results on the association between cow's milk intake and coronary heart disease (CHD). However, studies involving postmenopausal women are very limited. Recently, Ha et al. [1] reported the results of a study that aimed to identify the relationship between cow's milk intake and the risk of CHD in postmenopausal women. For this purpose, the authors used data from the 6^th Korean National Health and Nutrition Assessment Survey, including in the analysis 1,825 postmenopausal women aged 50 to 64 years. The frequency of cow's milk consumption for each participant was determined using the semi-quantitative food frequency questionnaire, classifying women into four groups: Q1, those who did not drink milk (n= 666); Q2, frequency of milk intake per week ≤ 1 (n=453); Q3, milk consumption per week ≤ 3 (n=319); and Q4, milk intake >3 times per week (n=387). General characteristics such as education, region (large city, medium or small city, rural), family income, and level of obesity were compared among the 4 groups. Percentages of daily nutrient intake were estimated in comparison with the Korean Dietary Reference Intake recommendations, determining as indicators of CHD risk: the Framingham risk score (FRS), the atherogenic index (AI) and atherogenic index of plasma (AIP). Except for family income, there were no differences among the four groups in terms of age, education, area of residence, or obesity. Comparing the Dietary Reference Intake, the proportion of intake of calcium, phosphorus and riboflavin was higher in the Q4 group than in the Q1-Q3 groups. HDL cholesterol (HDL-C) was higher in Q4 than in Q1. CHD risk factors, represented by FRS, AI, and AIP, were lower in the Q4 group compared to the other groups (FRS [%]: Q1 9.4, Q4 8.5; AI: Q1 3.06, Q4 2.83, and AIP: Q1 0.37, Q2 0.31, Q4 0.32). It was observed that the FRS had a significant positive correlation with the AI or the AIP, and a negative correlation with the frequency of consumption of cow's milk and calcium intake. The authors conclude that compared to women who have not consumed cow's milk, those who have -and frequently- had a better nutritional status of calcium, phosphorus and vitamin B12, higher levels of HDL-C and lower values of CHD risk indicators, such as FRS, AI, and AIP, which would contribute to a decrease in CHD risk over a 10-year period. Therefore, to prevent the risk of CHD in postmenopausal women, it is recommended that there should be a greater emphasis on the consumption of cow's milk, four or more times per week.

Bisphosphonate treatment and drug holiday

2022-10-11T10:50:04+11:00

10 October 2022

Summary

Hayes et al. [1] recently reported a study that aimed at examining the comparative risks of drug holidays after long-term (≥3 years, 80% adherence) oral bisphosphonate treatment. This was a population-based cohort study that used province-wide health care administrative databases that provided comprehensive coverage to 120,000 Ontario residents aged 65 years or older. Data were collected between November 2000 and March 2020 in those who had long-term risedronate therapy and a drug holiday matched 1:1 with those who had long-term alendronate therapy and a drug holiday. Primary outcome was hip fracture within 3 years after at least 120-day ascertainment period, with exclusion of those who died, had a hip or vertebral fracture, entered long-term care, or started another osteoporosis therapy during this 120-day time window. Secondary analyses included shorter follow-up and sex-specific estimates. A total of 25,077 propensity score-matched pairs were eligible (average age 81 years; 81% women). Hip fracture rates were higher among risedronate than alendronate drug holidays (12.4 and 10.6 events, respectively, per 1,000 patient-years). The association was attenuated with shorter drug holidays (1 year: HR, 1.03 [95% CI, 0.85-1.24]; 2 years: HR, 1.14 [95% CI, 0.96-1.32]). Finally, the researchers concluded that drug holidays after long-term treatment with risedronate were associated with a small increase in risk for hip fracture compared to alendronate drug holidays. The authors noted that they used health care administrative data that did not contain certain important fracture risk factors, which were therefore not included in the study analyses.

Pelvic floor muscle strength and female sexual function

2022-09-27T00:00:00+10:00

27 September 2022

Summary

Sexual dysfunction is a common problem around the menopause and postmenopause which is multifactorial. In this retrospective cross-sectional study from Brazil the authors looked at female sexual function (as measured by the Female Sexual Function Index: FSFI) in relation to pelvic floor muscle strength, as well as age and other demographic data [1]. The sample of almost 1,000 women were volunteers selected from previous studies on the databases from laboratories. All had given their prior consent and only those with a complete data set were included in the final analysis. Women with neurological, collagen or muscle related diseases were excluded as were those with prolapse (> grade 3), those with apical prolapse and those with previous pelvic floor muscle training (PFMT) by a health professional. Pelvic floor muscle strength (PFMS) was tested by vaginal examination using the modified oxford scale (MOS) which is a recognized scale that runs from 0-5: 0 = no contraction; 1 = minor muscle ‘flicker’; 2 = weak muscle contraction; 3 = moderate muscle contraction; 4 = good muscle contraction and 5 = strong muscle contraction. Sexual function was assessed using the FSFI with scores that range from 2-36. The higher the score the better the sexual function. A total score of 26.55 was taken as a cut off value so any woman with a score <26.55 was considered to have sexual dysfunction. Finally, 982 women were included in the study with an average age of 45.76 (range: 30.51 -61.01). 69% had a total FSFI score < 26.55 i.e. sexual dysfunction, 31% had FSFI > 26.55 i.e. normal sexual function. Characteristics of those with highest scores when compared with the lower scores: had age < 45, were white, single, had higher education, higher income, a body mass index ( BMI) < 25, lower parity, undertook regular physical activity and had a higher PFMS (MOS 4-5). Women with MOS 4-5 had higher desire, arousal, lubrication and orgasm and those with MOS 3-5 had higher satisfaction and less pain. The authors conclude that women good PFMS had less complaints about sexual dysfunction.

Behavioral interventions to improve sleep outcomes in menopausal women: a systematic review and meta-analysis

2022-09-26T10:50:04+10:00

20 September 2022

Summary

Lam et al. [1] recently reported a systematic review and meta-analysis aimed at assessing the efficacy of behavioral interventions on sleep outcomes among peri- and postmenopausal women, as measured by standardized scales and objective methods (polysomnography, actigraphy). Secondarily they evaluated the safety of these methods through the occurrence of adverse events. The authors performed searches within MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PubMed, and Web of Science using an appropriate search strategy in order to retrieve relevant papers of randomized controlled trials (RCTs) evaluating the effects of behavioral interventions on sleep quality. Risk of bias was also assessed with classical tools used for this purpose. All data were pooled in a meta-analysis using a random-effects model. A total of nineteen articles reporting results from 16 RCTs were included, representing a total of 2,108 peri- and postmenopausal women. Overall, behavioral interventions showed a statistically significant effect on sleep outcomes. Subgroup analyses revealed that cognitive behavioral therapy (CBT), physical exercise and mindfulness/relaxation improved sleep, as measured using both subjective (i.e the Pittsburg Sleep Quality Index) and objective measures. Low- and moderate-intensity exercise also improved sleep outcomes. No serious adverse events were reported. Overall risk of bias ranged from some concern to serious, and the certainty of the body of evidence was assessed to be of very low quality. The investigators conclude that their meta-analysis provides evidence that behavioral interventions, specifically, CBT, physical exercise, and mindfulness/relaxation, are effective treatments to improving sleep outcomes among peri- and postmenopausal women.

Endometriosis in women undergoing ovarian tissue transplantation due to spontaneous or induced premature menopause

2022-09-20T10:49:09+10:00

12 September 2022

Summary

Recently, Lotz et al. [1] reported the results of a retrospective study carried out on 17 women with premature menopause (spontaneous or induced) who had undergone ovarian tissue transplantation to restore their fertility, and were diagnosed with endometriosis during laparoscopic transplantation. The authors were interested in determining how endometriotic lesions after cytotoxic treatment and premature menopause might be explained, and whether endometriosis affects pregnancy rates. During surgery, it was found that twelve women had stage I endometriosis and five stage II endometriosis according to the rASRM classification; endometriosis foci were completely removed and ovarian tissue was transplanted into the pelvic peritoneum. Of the 17 women with endometriosis, 4 women were reported to have dysmenorrhea complaints, but none of the women reported general pelvic pain or dyspareunia. Prior to transplantation, four women who had taken hormone replacement therapy, four oral contraceptives and two tamoxifen. Following ovarian transplantation, pregnancy rate was 41.2% and the live birth rate was 35.3%. Pregnancy occurred in three cases after spontaneous conception, in four women after a natural cycle IVF/ICSI. The investigators concluded that there is an under-researched association between endometriosis in women entering premature or early menopause either after gonadotoxic treatment or due to primary ovarian insufficiency, recommending that specialists need to be aware of this condition as more and more women will use cryopreserved ovarian tissue transplant as an option to fulfill their desire to have children.

The effects of exercise on vasomotor symptoms in menopausal women:

2022-08-23T11:33:10+10:00

a systematic review and meta-analysis

22 August 2022

Summary

Liu et al. [1] recently reported a systematic review and meta-analysis that evaluated the potential of structured exercise to alleviate the subjective frequency and severity of vasomotor symptoms (VMS). For this, the authors searched four databases in order to identify randomized controlled trials (RCTs) that evaluated the effect of structured exercise (i.e. aerobic training) on the severity and/or frequency of VMS in menopausal women. Two reviewers independently screened records for eligibility, extracted data and assessed risks of bias and evidence certainty using the Cochrane and the GRADE tools (Grading of Recommendations Assessment, Development and Evaluation). Data were pooled, when appropriate, using random-effect meta-analyses. The researchers appraised a total of twenty-one RCTs involving 2,884 participants. Compared to no-treatment (controls), exercise significantly improved severity of VMS (10 studies, standardized mean difference [SMD] = 0.25; 95% CI: 0.04 to 0.47, p = 0.02, very low certainty of evidence). The effect size was attenuated when studies with a high risk of bias were excluded (SMD = 0.11, 95% CI: -0.03 to 0.26, p = 0.13). No significant changes in vasomotor frequency were found between exercise and controls (SMD = 0.14, 95% CI: -0.03 to 0.31, p = 0.12, high certainty of evidence). The authors conclude that exercise might improve VMS severity, indicating that future rigorous randomized clinical trials (RCTs) addressing the limitations of their review are warranted to explore the optimal exercise prescription to target the severity of VMS.