Complementary and Alternative Medicine for Menopause

Characterization of the volatile profile and its estrogenic activity in Kadsura coccinea fruit

ETHNOPHARMACOLOGICAL RELEVANCE

The fruit of Kadsura coccinea (Lem.) A. C. Smith is an ethnomedicine used to treat abnormal menstruation, menopausal syndrome, and female infertility among the Dong Nationality in China.

AIM OF THE STUDY

Our study aimed to identify the volatile oil profiles of the K. coccinea fruit and elucidate their estrogenic activity.

MATERIALS AND METHODS

The peel volatile oil (PeO), pulp volatile oil (PuO), and seed volatile oil (SeO) of K. coccinea were extracted using hydrodistillation and qualitatively analyzed using gas chromatography-mass spectrometry (GC-MS). Estrogenic activity was evaluated in vitro using cell assay and in vivo using immature female rats. Serum 17β-Estradiol (E2) and follicle-stimulating hormone (FSH) levels were detected using ELISA.

RESULTS

In total, 46 PeO, 27 PuO, and 42 SeO components representing 89.96%, 90.19%, and 97% of the total composition, respectively, were identified. The compounds with the highest content in PeO, PuO, and SeO were β-caryophyllene, γ-amorphene, and n-hexadecanoic acid, respectively. PeO induced proliferation of MCF-7 cells with an EC₅₀ of 7.40 μg/mL. Subcutaneous administration of 10 mg/kg PeO significantly increased the weight of the uteri in immature female rats, with no effect on serum E2 and FSH levels. PeO acted as an agonist of ERα and ERβ. PuO and SeO showed no estrogenic activity.

CONCLUSION

The chemical compositions of PeO, PuO, and SeO of K. coccinea are different. PeO is the main effective fraction for estrogenic activities, providing a new source of phytoestrogen for the treatment of menopausal symptoms.

Study on the mechanism of Baihe Dihuang decoction in treating menopausal syndrome based on network pharmacology

Menopausal syndrome (MS) refers to a series of symptoms with autonomic nervous system dysfunction caused by decreased sex hormones before and after menopause. Baihe Dihuang (BHDH) decoction positively affects MS, but its mechanism remains unclear. This study aimed to reveal the underlying mechanism through network pharmacology. The components of the BHDH Decoction were found through HERB, while corresponding targets were obtained from the HERB, Drug Bank, NPASS, Targetnet, and Swisstarget databases. The MS targets were obtained from GeneCards and OMIM. STRING was used to construct the protein-protein interaction networks. OmicShare tools were used for Gene Ontology and Kyoto encyclopedia of genes and genomes analyses. Finally, Autodock Vina 1.1.2 software (https://vina.scripps.edu/downloads/) was used for molecular alignment to verify whether the main active ingredients and key targets had good binding activity. We screened out 27 active ingredients and 251 effective targets of BHDH Decoction, 3405 MS-related targets, and 133 intersection targets between BHDH Decoction and MS. Protein-protein interaction network identified tumor protein P53, Serine/threonine-protein kinase AKT, epidermal growth factor receptor, Estrogen Receptor 1, and jun proto-oncogene as critical targets. Gene ontology analysis showed that these targets were mainly involved in the cellular response to chemical stimulus, response to oxygen-containing compound, cellular response to endogenous stimulus, response to an organic substance, and response to chemical, etc. Kyoto encyclopedia of genes and genomes pathways were mainly enriched in endocrine resistance, pathways in cancer, and the ErbB signaling pathway, etc. Molecular docking results showed that emodin and stigmasterol are strongly associated with Serine/threonine-protein kinase AKT, Estrogen Receptor 1, epidermal growth factor receptor, sarcoma gene, and tumor protein P53. This study preliminarily revealed the multi-component, multi-target, and multi-channel mechanism of BHDH Decoction in treating MS. It provides a reference for in vitro and in vivo research and clinical application of BHDH Decoction in the treatment of MS.

Effectiveness of workplace-based interventions to promote wellbeing among menopausal women: A systematic review

Menopausal symptoms are known to affect quality of life and work productivity. This systematic review aimed to describe the range and effectiveness of workplace-based interventions for menopause. MEDLINE, PubMed, Embase, CINAHL, Cochrane Library, Web of Science, PsycINFO, EconLit, and SCOPUS were searched from the inception until April 2022. Quantitative interventional studies evaluating physical/virtual workplace-based interventions aiming to improve well-being, work, and other outcomes, that involved women in menopausal transition, or their line managers/supervisors were eligible for inclusion. Two randomized controlled trials and three uncontrolled trials, comprising 293 women aged 40-60 years and 61, line managers/supervisors, were included in the review. Results were narratively synthesized due to the heterogeneity of interventions and outcomes and we found that only a limited range of interventions have been evaluated for their ability to support women going through menopausal transition in the workplace. Self-help cognitive behavioural therapy (CBT); Raja yoga; and health promotion (involving menopause consultations, work-life coaching and physical training) improved menopausal symptoms significantly. Self-help CBT was associated with a significant improvement in mental resources for work, presenteeism, and work and social adjustment. Awareness programs significantly improved knowledge and attitudes of both employees and line managers/supervisors about menopause. The interventions have mostly been evaluated in small studies with selected populations but have improved menopausal symptoms and work outcomes. A customizable menopause wellbeing intervention package incorporating these evidence-supported interventions should be developed and implemented on a wider scale within organizations alongside robust evaluation of its effectiveness.

Swimming training and herbal nanoformulations as natural remedies to improve sensory-motor impairment in rat midbrain tumor models: system biology, behavioral test, and experimental validation

Motor impairment worsens health-related quality of life in patients with primary and metastatic midbrain tumors. Here, 56-male-Wistar rats were divided into eight groups: Normal group, Midbrain Tomur Model group, Model + Exe group, Model + Lipo, Model + Extract, Model + Lipo-Extract, Model + Extract-Exe, Model + Lipo-Extract + Exe. According to the aim, mid-brain tumor models were conducted by injections of the C6 glioma cell line (5 × 105 cell suspension) and stereotaxic techniques in the substantia nigra area. Furthermore, consumption of nanoformulation of herbals extract (100 mg/kg/day), crude extract (100 mg/kg/day), and swimming training (30 min, 3 days/week) as interventional protocols were performed for 6 weeks. In addition, we evaluated the effect of polyherbal nanoliposomes containing four plant extracts and swimming training on the GABArα1/TRKB/DRD2/DRD1a/TH network in the substantia nigra of the midbrain tumor rat model. Data emphasized that DRD2 might be a druggable protein with the network's highest significance cut-point effect that could modulate sensory-motor impairment. Furthermore, we found Quercetin, Ginsenosides, Curcumin, and Rutin, as bioactive compounds present in Ginseng, Matthiola incana, Turmeric, and Green-Tea extracts, could bind over the DRD2 protein with approved binding affinity scores. Based on our data, swimming training, and nanoliposome-enriched combined supplements could consider effective complementary medicine for motor impairment recovery induced by the midbrain tumor in the substantia nigra area. Hence, regular swimming training and natural medicines rich in polyphenolic bioactive components and antioxidative effects could modify and improve the dopamine receptors' function.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13205-023-03574-3.

Effects of Nonpharmacological Interventions on Sleep Quality and Insomnia in Perimenopausal and Postmenopausal Women: A Meta-Analysis

This study aimed to analyze the effects of nonpharmacological interventions on perimenopausal and postmenopausal women with sleep problems. Eight databases (MEDLINE/PubMed, Cochrane Library, EMBASE, CINAHL, and four Korean databases) were searched, from their inception through to 30 November 2021, for randomized controlled trials (RCTs) evaluating the effects of nonpharmacological interventions versus control conditions on sleep quality and insomnia in perimenopausal and postmenopausal women. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and the severity of insomnia was assessed using the Insomnia Severity Index (ISI). In the meta-analysis, corrected standardized mean differences (SMDs; Hedges' g) and 95% confidence intervals (CIs) were calculated as effect measures by applying the random effects model and inverse variant method. Fifteen trials met our inclusion criteria. Nonpharmacological interventions were found to have positive effects on sleep quality, measured with the PSQI (SMD = -1.32; 95% CI = -1.78 to -0.86; p < 0.001), and on the severity of insomnia, measured using the ISI (SMD = -1.11; 95% CI = -1.82 to -0.41; p = 0.002), compared with the control groups. Among perimenopausal and postmenopausal women with sleep problems, nonpharmacological interventions improved sleep quality and reduced the severity of insomnia.

Neurokinin receptor antagonists as potential non-hormonal treatments for vasomotor symptoms of menopause

Vasomotor symptoms of menopause (VMS), otherwise known as hot flashes, can significantly impact women's quality of life. Up to 87% of women report hot flashes during or after their menopause transition, and can last for a median duration of 7.4 years. The current mainstay of treatment and the most effective treatment for VMS is hormone therapy with estrogen. However, hormone therapy is not without risk, and the discovery of an effective nonhormonal treatment option with neurokinin B receptor antagonists for VMS provides an encouraging and potentially practice-changing treatment option for all women. This review will discuss the pathophysiology and mechanism of action, as well as review the current compounds in development targeting the neurokinin receptors.

The Effect of Vitamin E Supplementation in Postmenopausal Women-A Systematic Review

Menopause is a physiological change in any woman. Nevertheless, its symptoms could be difficult to accept, and hormone therapy can be sometimes unattractive or contraindicated. Vitamin E components are phytoestrogens, so they are believed to be useful in some indications including menopause. This review aimed to assess the available evidence on the effectiveness of vitamin E in alleviating menopausal symptoms. The Pubmed/MEDLINE, Cochrane Library and Scopus databases were screened. All types of studies that assessed the effectiveness of vitamin E in alleviating menopausal symptoms were included. The PICO question was: "How does vitamin E supplementation affect menopausal symptom occurrence?" The PROSPERO ID number of this review is CRD42022328830. After quality assessment, 16 studies were included in the analysis. The studies were divided into three groups in which the influence of vitamin E on the genital syndrome of menopause, vasomotor symptoms and vascular and metabolic changes were assessed. Vitamin E influences postmenopausal hot flashes, vascular modulation, plasma lipid profile level and vaginal changes. Compared to vitamin E, estrogen administration leads to better clinical effects. Nevertheless, vitamin E might serve as additive to hormone therapy and its alternative in women with contraindications to estrogens. More quality data are necessary to draw final conclusions.

Efficacy, safety and mechanism of Honghua Xiaoyao Pill in the treatment of peri-menopausal syndrome: A study protocol for a randomized controlled trial

Background: Peri-menopausal syndrome (PMPS) has a high incidence rate and seriously affects the physical and mental health of women. Honghua Xiaoyao Pill (HHXYP) is a Chinese patent medicine, which has been reported to be used to treat PMPS. However, there is still a lack of randomized clinical trial to evaluate the efficacy and safety of HHXYP on life quality, mood and vasomotor symptoms for PMPS women. This study aims to investigate whether HHXYP is effective and safe in treating PMPS and the possible mechanism. Methods: A multicenter, randomized, controlled clinical trial will be conducted in China to evaluate the efficacy and safety of HHXYP. Sixty women with peri-menopausal syndrome will be recruited at three centers and randomly in a 1:1 ratio to a treatment group using HHXYP (HHXYP group) and a control group using oryzanol (OC group). Participants will be treated with HHXYP or oryzanol for 12 weeks and followed up for 4 weeks. The primary outcome is the modified Kupperman Index (KI), which will be measured at baseline and 4, 8, 12, 16 weeks after randomization. The secondary outcomes include Hot flash scale (HFs), Menopause-Specific Quality of Life Scale (MENQOL) and Hamilton Depression/Anxiety Scale (HAMD/HAMA). The HFs are measured at the same point as the KI, other secondary outcomes are measured at baseline and 12, 16 weeks after randomization. The other outcomes are the levels of serum sex hormone, monoamine neurotransmitter, vascular vasomotor factor and the expression of phosphatidylinositol 3-active enzyme (PI3K)/protein activator enzyme B (Akt), which will be measured at baseline and 12 weeks after randomization. Adverse events will also be reported. Discussion: HHXYP is a potential alternative Chinese patent medicine for PMPS. This trial will provide evidence for HHXYP on improving the quality of life, mood and vasomotor symptoms, and sex hormone levels of PMPS patients.

Comparison of Cinnamon and Vitex on Improving Sexual Function in Postmenopausal Women: A Triple-blind Randomized Clinical Trial

Background: Sexual dysfunction is one of the most common problems following menopause. This study aimed to evaluate the effect of cinnamon and vitex on improving sexual function in postmenopausal women. Methods: This study was a randomized triple-blind clinical trial with a control group. Randomized sampling was used to allocate postmenopausal women into three cinnamon, vitex, and placebo groups of 35. A sexual function index was utilized before and two and three months after the intervention to assess sexual functioning. SPSS version 21 software was used for analysis. Results: The mean age was 54.45 ± 3.73 years. The overall sexual function score in the two cinnamon and vitex groups showed a statistically significant difference before and after treatment compared to the placebo group (P < 0.00). In the vitex group, sexual desire (P = 0.00) and arousal (P = 0.02) increased significantly compared to pre-intervention, and this significant increase was observed in the cinnamon group in lubricity (P = 0.00) and sexual satisfaction (P = 0.03). Conclusions: Cinnamon and vitex are effective medicinal herbs to alleviate sexual function.

[Preventive activities in women. PAPPS update 2022]

In the 2022 PAPPS update we present those specific preventive activities for women's health, except those related to cancer prevention (which are included in another document) and those aspects related to differential gender morbidity, a cross-cutting aspect for all working groups. Contraception is an essential preventive activity, considering basic the right to decide both the number of children and the time to have them. We must inform about the possible contraceptive methods, guaranteeing the monitoring of their safety, efficacy and effectiveness (tables are included on changing from one method to another to preserve contraceptive protection). We must inform about emergency contraception and propose it in the event of unprotected intercourse. All this will be done through opportunistic screening without requiring screening for thrombophilia or dyslipidemia, but for arterial hypertension. Pregnancy is an important life experience and the family doctor should not remain oblivious. We must be competent both in the preconception consultation (recommending the intake of folic acid, avoiding exposure to occupational and environmental risks, screening for certain pathologies and assessing the intake of drugs not indicated during pregnancy) and in the monitoring of pregnancy. Whether or not we monitor the pregnancy, we must not disregard its control, taking advantage of this period to promote healthy lifestyles and participating in the intercurrent processes that may occur. Menopause in general and osteoporosis in particular exemplify the strategy of medicalization of vital processes that has been followed from different instances and organizations. In our update we address the prevention and treatment of symptoms secondary to estrogen deprivation. We also propose the prevention of osteoporosis, including carrying out densitometry based on the risk of fracture in the next 10 years, and therefore densitometric screening is not recommended in women under 60 years of age. In risk assessment we recommend the use of the frax tool or better, the calibration of the risk of hip fracture with prevalence data from our setting. We linked the indication for treatment with the Z-Score (bone mineral density compared with women of the same age), as it is a condition associated with aging.

Efficacy of Internet-based cognitive behavioral therapy on sleeping difficulties in menopausal women: A randomized controlled trial

Sleeping difficulties are the most significant cause of disability in menopausal women. Cognitive behavioral therapy (CBT) is the first line of management for sleeping difficulties and chronic insomnia.

PURPOSE

To evaluate the efficacy of an Internet-based CBT program on sleeping difficulties in menopausal women.

DESIGN

This was a randomized controlled trial. A total of 80 eligible menopausal women who fit the criteria of poor sleep quality were randomly and evenly assigned to the CBT intervention group or the control group.

TOOLS

The tools used for data collection were the demographic sheet, Pittsburgh Sleep Quality Index, Insomnia Severity Index, and sleep diary. Internet-based CBT modules were administered to the intervention group. Six consecutive modules were held weekly for each participant. Sleep quality scores and insomnia index scores were considered the primary outcomes, while sleep diaries were the secondary outcomes. Self-administered questionnaires were given at baseline and 6 weeks after randomization.

FINDINGS

Internet-based CBT is effective in reducing sleeping difficulties, particularly sleep quality scores (-3.60 ± 2.76) and insomnia index scores (-5.10 ± 3.54) from baseline. Moreover, the program induced significant changes in sleep parameters, such as increased total sleep hours (t = 2.734, p = 0.008), increased sleep efficiency ≥85%, (t = 3.558, p = 0.001), and decreased sleep latency (t = 2.180, p = 0.033) compared with the control group.

CONCLUSION

The strong predictors of having very poor sleep quality were short duration since last menopause, severity of hot flashes, and short duration of sleep difficulties.

PRACTICE IMPLICATION

Internet-based CBT is a useful practical intervention for managing sleeping difficulties in menopausal women. The current study provides evidence on the efficacy and cost-effectiveness of Internet-based cognitive behavioral intervention; thus, we recommend this method as a practical and accessible intervention to improve sleep in menopausal women.

Expression of oxytocin in hypothalamus and reduction of nociceptive stress following administration of Kamikihi-to in female rats

Hypothalamo-neurohypophysial oxytocin (OXT) plays an essential role in reproduction and in several socio-physiological functions, including stress reduction, anxiety relief, feeding suppression, social recognition, and trust building. Recent studies suggest that the central OXT system is also involved in antinociceptive and anti-inflammatory functions. Kamikihi-to (KKT), a Japanese traditional herbal (Kampo) medicine composed of 14 herbal ingredients, is clinically prescribed for patients with psychological symptoms, including anxiety, depression, and insomnia, and it has been associated with OXT expression. We investigated the antinociceptive response and OXT expression according to sex and the effects of KKT pre administration in a rat model. We found that nociceptive responses measured via the hot plate and formalin tests were attenuated following the administration of KKT-enriched feed for 4 weeks. The observation of mRFP1 fluorescence in OXT-mRFP1 transgenic rats revealed that KKT-administered rats showed increased expression of OXT in the magnocellular and parvocellular paraventricular nucleus of the hypothalamus. Food intake in the KKT-pre-administered group significantly decreased after cholecystokinin (CCK)-8 administration. Our results suggest that KKT is involved in the attenuation of nociceptive stress in female rats by enhancing the expression of OXT in the hypothalamus.

Menopause symptoms in women and its relation with using complementary and alternative medicines: A survey in southeast Iran

BACKGROUND

Postmenopausal women are interested in using complementary and alternative medicine because of their menopausal symptoms and the side effects of chemical medications and hormone therapy. Therefore, this study aimed to investigate the relationship between the use of complementary medicine (CAM) and menopausal symptoms among postmenopausal women.

METHODS

This cross-sectional study was conducted among 288 postmenopausal women who were referred to health centers in Kerman, southeastern Iran, from 2020 to 2021. Data were collected using a demographic questionnaire, the CAM questionnaire, and the Menopause Rating Scale (MRS).

RESULTS

The mean score for the menopausal symptoms of the participants was 8.73 ± 6.11. Only 28.8% of the participants had no/little symptoms. About 65.3% of the participants used at least one type of CAM in the previous year. The most commonly used types of CAM were nutritional supplements, prayer, and medicinal herbs. A significant association was found between the use of medicinal herbs, dry cupping, relaxation and meditation, prayer, and menopausal symptoms. Women experiencing menopausal symptoms used more CAM methods than those without menopausal symptoms (Odds ratio = 2.25, 95% confidence interval = 1.33-3.80).

CONCLUSION

The study results indicated that the severity of menopausal symptoms and scores in somatic-vegetative and urogenital domains were higher in CAM users compared to non-CAM users. But there was no significant difference in the psychological domain between CAM and non-CAM users. Based on the results, it is suggested that more research be done in different communities with different healthcare systems to find out how complementary and alternative medicine affects menopausal symptoms in women.

Prevalence of complementary and alternative medicine use in Brazil: results of the National Health Survey, 2019

BACKGROUND

In recent decades, it has been possible to observe an increase in Complementary and Alternative Medicine (CAM) usage globally for both disease prevention and health promotion purposes. we aim to estimate the prevalence of CAM use and analyze associated factors in Brazil.

METHODS

Observational study with data from the 2019 National Health Survey that evaluated a sample of Brazilian adults. The outcome was CAM use, such as acupuncture, homeopathy, medicinal plants and herbal medicines, meditation, and yoga in the last 12 months. A logistic regression model with a 99% confidence interval was used to assess factors associated with CAM use.

RESULTS

The prevalence of CAM use in 2019 was 5.2% (CI99% = 4.8-5.6%), the most used modalities: medicinal plants and herbal medicines, with a prevalence of 3.0% (CI99% = 2.7-3.33) followed by: acupuncture 1.4% (CI99% = 1.3-1.6) homeopathy 0.9% (CI99% = 0.7-1.0), meditation 0.7% (CI99% = 0.6-0.8) and yoga 0.4% (CI99% = 0.4-0.5). We observed important geographical differences in CAM use in Brazil, with a higher prevalence in the North Region, 3.7% (CI99% = 2.81-4.75), where herbal medicines were more frequent the in the other regions. After estimating an adjusted model, women, older people, and people with a higher level of education and per capita income were the ones who used all types of CAM the most. The practice of yoga stands out among women 3.6% (CI99% = 2.49-5.28) and among individuals with higher per capita income 7.5% (CI99% = 2.97-18.93); meditation among individuals with higher educational level 13.4% (CI99% = 6.41-28.33) and acupuncture for those who declared regular or poor health 1.9% (CI99% = 1.51-2.39).

CONCLUSIONS

We recommend that the Ministry of Health expand CAM access to Unified Health System users and promote health professionals' conscious and guided use for the Brazilian population.

Effect of resistance training with and without vitamin D calcium chitosan nanoparticle supplements on apoptosis markers in ovariectomized rats: An experimental study

BACKGROUND

Hormone therapy is one of the most effective treatments for menopausal disorders, but it may increase the risk of breast cancer, coronary heart disease, and pulmonary embolism.

OBJECTIVE

The present study investigated the effect of resistance training with and without vitamin D calcium(Ca+ + ) chitosan nanoparticles on apoptosis markers in ovariectomized rats.

MATERIALS AND METHODS

42 female Wistar rats were divided into 7 groups (n = 6/each). One group was assigned as the healthy controls to show the induction of menopause. The other 6 groups comprised ovariectomized (OVX) animals including: 1) vitamin D + calcium + chitosan + resistance training, 2) saline + estrogen + resistance training, 3) saline + resistance training, 4) vitamin D + calcium + chitosan, 5) saline + estrogen, and 6) OVX + control. 48 hr after the last intervention, the hippocampus tissue was extracted to measure the BCL-2-associated X (BAX), B-cell lymphoma 2 (BCL-2), and caspase-3 gene expression as well as the percentage of dead cells.

RESULTS

OVX rats demonstrated increased BAX gene expression, ratio of BAX gene expression to BCL-2, caspase-3 gene expression, and percentage of dead cells of hippocampal tissue, but decreased BCL-2 gene expression. Resistance training and vitamin D Ca+ + chitosan nanoparticle supplements seemed to reverse these changes.

CONCLUSION

The combination of resistance training and vitamin D Ca+ + chitosan nanoparticle supplements may be considered a non-pharmacological treatment for OVX-induced apoptosis.

Management of Breast Cancer Survivors by Gynecologists

Breast cancer patients commonly present to their OBGYN during the process of diagnosis and treatment of breast cancer both for specific gynecologic needs and for primary care follow up. These patients require counseling on contraception, hormone use, and fertility at diagnosis. During treatment and survivorship, patients will face a variety of side effects from treatments leading to vasomotor symptoms, vulvovaginal discomfort, sexual dysfunction, osteoporosis, and vaginal bleeding. This chapters aims to enlighten providers on the unique range of issues a gynecologist may face when caring for breast cancer patients.

Acupuncture in the real world: evaluating a 15-year NADA auricular acupuncture service for breast cancer survivors experiencing hot flushes and night sweats as a consequence of adjuvant hormonal therapies

PURPOSE

While clinical trials provide valuable data about efficacy of interventions, findings often do not translate into clinical settings. We report real world clinical outcomes of a 15-year service offering breast cancer survivors auricular acupuncture to manage hot flushes and night sweats (HFNS) associated with adjuvant hormonal treatments. This service evaluation aims to (1) assess whether usual practice alleviates symptoms in a clinically meaningful way and (2) compare these results with scientific evidence.

METHODS

Data were analysed from 415 referrals to a service offering women eight standardised treatments using the National Acupuncture Detoxification Association (NADA) protocol. Outcome measures administered at baseline, end of treatment (EOT), and 4 and 18 weeks after EOT included hot flush diaries, hot flush rating scale (HFRS) and women's health questionnaire (WHQ).

RESULTS

Over 2285 treatments were given to 300 women; 275 (92.3%) completed all eight treatments. Median daily frequency of HFNS reduced from 9.6 (IQR 7.3) to 5.7 (IQR 5.8) at EOT and 6.3 (IQR 6.5) 18 weeks after EOT. HFRS problem rating showed a clinically meaningful reduction of ≥ 2 points at all measurement points. WHQ showed improvements in several symptoms associated with the menopause. Two adverse events were reported, neither were serious. Results are comparable to published research.

CONCLUSION

This first analysis of a long-term auricular acupuncture service compares favourably with outcomes of other studies for reducing HFNS frequency and associated menopausal symptoms. In day-to-day clinical practice, NADA appears to be a safe effective intervention for breast cancer survivors.

Longitudinal Effects of a Combined Program of Pelvic Floor Muscle Training and Yoga on Genitourinary Symptoms in Asian Women of Older Age: A Randomized Experimental Study

This parallel-two-group randomized experimental study including a supervised group and an unsupervised group examined the longitudinal effects of pelvic floor muscle training (PFMT) combined with yoga on genitourinary symptoms and the health-related quality of life (HRQOL), and compared practice adherence rates of the two groups. A sample of women experiencing ≥1 genitourinary symptom(s) were recruited and assigned to a supervised group or an unsupervised group. The supervised group attended supervised group practice sessions and performed at-home practice of PFMT and yoga. The unsupervised group performed at-home practice of PFMT and yoga. Information was collected at five time points (n = 91). Generalized estimating equation procedures were used to examine the intervention effects. An independent t-test was conducted to compare the practice adherence rates. Both groups' genitourinary symptoms and HRQOL significantly improved over time. The supervised group displayed greater improvements in genitourinary symptoms and HRQOL and better adherence than did the unsupervised group.

n-3 PUFA Improve Emotion and Cognition during Menopause: A Systematic Review

Women show an increased risk of cognitive impairment and emotional disorders, such as anxiety and depression, when approaching menopause. Data on risk and protection factors have yielded robust evidence on the effects of lifestyle factors, such as diet, in preserving emotional and cognitive functioning. This review focused on the effects of omega-3 polyunsaturated fatty acids (n-3 PUFA) on anxiety, depression, and cognition during the menopausal transition. This systematic review considered all articles published until 31 December 2021, and the search was performed on two databases, PubMed and Scopus. The fields of interest were "menopause", "n-3 PUFA" and "emotional and cognitive aspects". Out of the 361 articles found on PubMed and 283 on Scopus, 17 met inclusion criteria. They encompassed 11 human and 6 animal studies. Most studies reported relieved depressive symptoms in relation to n-3 PUFA intake. While controversial results were found on anxiety and cognition in humans, n-3 PUFA consistently reduced anxiety symptoms and improved cognition in animal studies. Taken together, n-3 PUFA intake shows beneficial effects on emotional and cognitive behaviours during menopause transition. However, further investigations could increase knowledge about the effectiveness of n-3 PUFA on psychological well-being in this delicate period of feminine life.

Phytochemicals and Nano-Phytopharmaceuticals Use in Skin, Urogenital and Locomotor Disorders: Are We There?

Nanomedicines emerged from nanotechnology and have been introduced to bring advancements in treating multiple diseases. Nano-phytomedicines are synthesized from active phytoconstituents or plant extracts. Advancements in nanotechnology also help in the diagnosis, monitoring, control, and prevention of various diseases. The field of nanomedicine and the improvements of nanoparticles has been of keen interest in multiple industries, including pharmaceutics, diagnostics, electronics, communications, and cosmetics. In herbal medicines, these nanoparticles have several attractive properties that have brought them to the forefront in searching for novel drug delivery systems by enhancing efficacy, bioavailability, and target specificity. The current review investigated various therapeutic applications of different nano-phytopharmaceuticals in locomotor, dermal, reproductive, and urinary tract disorders to enhance bioavailability and efficacy of phytochemicals and herbal extracts in preclinical and in vitro studies. There is a lack of clinical and extensive preclinical studies. The research in this field is expanding but strong evidence on the efficacy of these nano-phytopharmaceuticals for human use is still limited. The long-term efficacy and safety of nano-phytopharmaceuticals must be ensured with priority before these materials emerge as common human therapeutics. Overall, this review provides up-to-date information on related contemporary research on nano-phytopharmaceuticals and nano-extracts in the fields of dermatological, urogenital, and locomotor disorders.

A Randomised, Double-Blind, Placebo-Controlled Crossover Trial of Resveratrol Supplementation for Prophylaxis of Hormonal Migraine

Resveratrol, a vasoactive phytoestrogen, has beneficial effects on cerebrovascular function. Previous research has shown that hormonal migraineurs have poorer cerebrovascular function than non-migraineur women. We aimed to investigate if resveratrol supplementation for three months could reduce the hormonal migraine burden index (HMBI: the number of days with menstrual migraine per month), reduce migraine-related disability and improve migraine-related quality of life. A randomised, double-blind, placebo-controlled, crossover, intervention trial was conducted in 62 hormonal migraineurs (mean age: 37.5 ± 0.8 years). Participants consumed 75 mg of resveratrol or matching placebo capsules twice daily for three months before crossing over to the other treatment arm. Participants completed a daily diary and the Headache Impact Test-6™, Migraine Disability Assessment and Migraine-Specific Quality of Life questionnaires at months 0, 3 and 6. The HMBI was the primary outcome and was calculated using data extracted from the participant’s diary. No differences in the HMBI (p = 0.895), the Headache Impact Test-6™, the Migraine Disability Assessment and Migraine-Specific Quality of Life were found between the resveratrol and placebo treatments. Resveratrol supplementation for three months did not affect the HMBI, the migraine-related disability or quality of life measures in our cohort of hormonal migraineurs.

The relationship between sleep quality and menopausal symptoms among postmenopausal women in Saudi Arabia

OBJECTIVES

To assess sleep quality and examine its relationship with menopausal symptoms among Saudi postmenopausal women.

METHODS

We carried out a cross-sectional study of 410 postmenopausal women, aged 50-60 years, visiting Prince Mutaib bin Abdulaziz Hospital, Maternity and Children Hospital, and primary health care clinics, Sakaka, Jouf, Saudi Arabia. The menopause rating scale (MRS) was used to assess menopause symptoms and severity, while the Pittsburgh sleep quality index (PSQI) was used to assess sleep quality.

RESULTS

The participants' age was 53.04±4.15 years, their mean age at natural menopause was 49.14±3.07, and the meantime since their menopause was 6.50±3.84 years. The PSQI total mean score was 6.10±4.17, classified into good versus poor sleepers; 65.4% scored ≤5, and 34.6% scored >5. The Mann-Whitney analysis revealed that somatic and urogenital symptoms, and total MRS score were associated with poor sleep quality (p<0.001).

CONCLUSION

The study findings revealed that more than one-third of Saudi postmenopausal women had poor sleep quality.

Vasomotor menopausal disorders as a possible result of dysfunction of the microbiota-intestine-brain axis

The study involved clinical and laboratory examination of 54 women with vasomotor menopausal disorders divided into 3 subgroups depending on the duration of symptoms (not more than 12 months, about 3 years, from 5 to 7 years). The control group included 21 patients without vasomotor disorders during the menopausal period. Data from the general and obstetric-gynecological anamnesis and the results of objective and general clinical examinations were analyzed. To assess the state of intestinal microbiocenosis in patients, a bacteriological study of feces was used according to modern methods. In women with menopausal vasomotor disorders, chronic arterial hypertension, overweight, diabetes mellitus, chronic enterocolitis, and chronic pyelonephritis prevailed among somatic diseases. The study also revealed that these patients had a pronounced imbalance of the intensive microbiota, which was characterized by a significant decrease in the main representatives of the obligate microflora (Bifidobacterium, Lactobacillus) and an increase in the number of opportunistic strains (Klebsiella and Clostridiodes difficile). Considering modern concepts, a change in the microbial composition of the intestine may be one of the possible trigger factors for the occurrence of vasomotor menopausal disorders. Further research will clarify the influence of the microbiome on the formation of the pathological menopausal symptom complex and improve the preventive and therapeutic measures in this category of women.

Long-term hypogonadism diminishes the neuroprotective effects of dietary genistein in young adult ovariectomized rats after transient focal ischemia

Increasing age disproportionately increases the risk of stroke among women compared to men of similar age, especially after menopause. One of the reasons for this observation is a sharp drop in circulating estrogens. However, the timing of initiation of estrogen replacement after menopause is associated with mixed beneficial and detrimental effects, hence contributing to widespread mistrust of estrogen use. Agents including soy isoflavones are being assessed as viable alternatives to estrogen therapy. In this study, we hypothesized that the neuroprotective effects of genistein, a soy isoflavone are less sensitive to the length of hypogonadism in young adult ovariectomized rats following cerebral ischemia. We expected that long-term hypogonadism will worsen motor and cognitive function, increase post-stroke inflammation with no effect on the neuroprotection of genistein. We compared the effect of treatment with dietary genistein (GEN) on short-term (2 weeks) and long-term hypogonadism (12 weeks) in young adult ovariectomized Sprague-Dawley rats on sensorimotor function, cognition and inflammation after focal ischemia. Dorsal Silastic implant of 17β-estradiol (E2) was used as a control for hormone therapy. Long-term hypogonadism stroked rats performed worse than the short-term hypogonadism stroked rats on the motor and cognitive function tests. GEN did not improve neurological assessment and motor learning after either short-term or long-term hypogonadism. GEN improved cognitive flexibility after short-term hypogonadism but not after the long-term. Both GEN and E2 reduced tissue loss after short-term hypogonadism and reduced GFAP expression at the contralateral side of ischemia after long-term hypogonadism. The length of hypogonadism may differentially influence the neuroprotective effects of both GEN and E2 on the motor and cognitive functions in young adult rats.

Guideline No. 422a: Menopause: Vasomotor Symptoms, Prescription Therapeutic Agents, Complementary and Alternative Medicine, Nutrition, and Lifestyle

OBJECTIVE

Provide strategies for improving the care of perimenopausal and postmenopausal women based on the most recent published evidence.

TARGET POPULATION

Perimenopausal and postmenopausal women.

BENEFITS, HARMS, AND COSTS

Target population will benefit from the most recent published scientific evidence provided via the information from their health care provider. No harms or costs are involved with this information since women will have the opportunity to choose among the different therapeutic options for the management of the symptoms and morbidities associated with menopause, including the option to choose no treatment.

EVIDENCE

Databases consulted were PubMed, MEDLINE, and the Cochrane Library for the years 2002-2020, and MeSH search terms were specific for each topic developed through the 7 chapters.

VALIDATION METHODS

The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE: physicians, including gynaecologists, obstetricians, family physicians, internists, emergency medicine specialists; nurses, including registered nurses and nurse practitioners; pharmacists; medical trainees, including medical students, residents, fellows; and other providers of health care for the target population.

SUMMARY STATEMENTS

RECOMMENDATIONS.

Directive clinique no 422a : Ménopause : symptômes vasomoteurs, agents thérapeutiques d'ordonnance, médecines douces et complémentaires, nutrition et mode de vie

OBJECTIF

Proposer des stratégies pour améliorer les soins aux femmes ménopausées ou en périménopause d'après les plus récentes données probantes publiées.

POPULATION CIBLE

Femmes ménopausées ou en périménopause. BéNéFICES, RISQUES ET COûTS: La population cible bénéficiera des plus récentes données scientifiques publiées que leur communiqueront les fournisseurs de soins de santé. Aucun coût ni préjudice ne sont associés à cette information, car les femmes seront libres de choisir parmi les différentes options thérapeutiques offertes pour la prise en charge des symptômes et morbidités associés à la ménopause, y compris l'abstention thérapeutique. DONNéES PROBANTES: Les auteurs ont interrogé les bases de données PubMed, Medline et Cochrane Library pour extraire des articles publiés entre 2002 et 2020 en utilisant des termes MeSH spécifiques à chacun des sujets abordés dans les 7 chapitres. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique d'évaluation, de développement et d'évaluation (GRADE). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: médecins, y compris gynécologues, obstétriciens, médecins de famille, internistes, urgentologues; infirmières, y compris infirmières autorisées et infirmières praticiennes; pharmaciens; stagiaires, y compris étudiants en médecine, résidents, moniteurs cliniques; et autres fournisseurs de soins auprès de la population cible. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.

The Effect of Mindfulness on Quality of Life among Women with Premature Ovarian Insufficiency: A Randomized Clinical Trial

Background:

Premature ovarian insufficiency may impair the quality of life and expose women to disorders such as cardiovascular disease, osteoporosis, and depression. This study aimed to evaluate the effect of mindfulness on the quality of life in women with premature ovarian insufficiency.

Methods:

This study involved 62 women who were randomly allocated into two groups of mindfulness and control. The mindfulness group received eight sessions of training. A demographic questionnaire, menopause-specific quality of life and a checklist (for assessing hot flashes) were used to collect the data. The quality of life, frequency, and intensity of hot flashes were measured before the intervention, immediately, and 3 months after it. Independent t-test, the Chi-square test, and the repeated measure test were used for data analysis.

Results:

The scores of quality of life dropped from 95.6 ± 9.77 at baseline to 77.32 ± 7.93 after intervention and 48.32 ± 4.96 at 3-months follow-up in the mindfulness group but rose from 99.5 ± 16.1 at baseline to 100.2 ± 15.33 after intervention, and 102.6 ± 14.9 3-months after it in the control group, P < 0.001. The scores of vasomotor, psychological, physical, and sexual domains also improved significantly in the mindfulness group compared to the control group. The mean of hot flashes in the mindfulness group was 1.30 ± 0.69 and decreased to 1.1 ± 0.56 and 0.66 ± 0.58 immediately and in 3 months after intervention, respectively. The frequency of hot flashes was 14.74 ± 10.4 per week before intervention in the mindfulness group which reduced to 12.38 ± 8.66 and 6.74 ± 6.34 per week, immediately and 3 months after the intervention, while in the control group, there was an increase in the frequency of hot flashes (P < 0.0001).

Conclusion:

According to the results of this study, mindfulness could improve quality of life and reduce hot flashes, so mindfulness training for women with premature ovarian insufficiency is strongly recommended.

Genistein: Dual Role in Women's Health

Advanced research in recent years has revealed the important role of nutrients in the protection of women's health and in the prevention of women's diseases. Genistein is a phytoestrogen that belongs to a class of compounds known as isoflavones, which structurally resemble endogenous estrogen. Genistein is most often consumed by humans via soybeans or soya products and is, as an auxiliary medicinal, used to treat women's diseases. In this review, we focused on analyzing the geographic distribution of soybean and soya product consumption, global serum concentrations of genistein, and its metabolism and bioactivity. We also explored genistein's dual effects in women's health through gathering, evaluating, and summarizing evidence from current in vivo and in vitro studies, clinical observations, and epidemiological surveys. The dose-dependent effects of genistein, especially when considering its metabolites and factors that vary by individuals, indicate that consumption of genistein may contribute to beneficial effects in women's health and disease prevention and treatment. However, consumption and exposure levels are nuanced because adverse effects have been observed at lower concentrations in in vitro models. Therefore, this points to the duplicity of genistein as a possible therapeutic agent in some instances and as an endocrine disruptor in others.

Safety and influence of a novel extract of fenugreek on healthy young women: a randomized, double-blinded, placebo-controlled study

Background

Fenugreek (Trigonella foenum-graecum) seed is a popular kitchen spice and medicinal herb with wide applications in Indian folklore. Earlier studies have shown that the hydro-ethanolic extracts of fenugreek are efficient in the management of a number of hormone related disorders in women, including post and peri-menopausal discomforts, sexual dysfunctions, lactation and even in amenorrhea. However, systematic informations on their safety and influence on hormonal balance are limited.

Results

Forty-eight healthy menstruating women aged 20 to 48 were randomized either to FHE (n = 24) or placebo (n = 24) and supplemented with 250 mg × 2/day for 42 days. FHE did not produce any side effects or adverse events. It offered significant (P < 0.05) beneficial effects to sexual problems (41.6%) and irritability (40%) among the participants who had higher sexual dysfunctions scores (> 1) when monitored by the validated Menopausal Rating Scale (MRS) scale. Further, hormone analysis indicated an enhancement in estradiol (P = 0.040), free testosterone (P = 0.025), and total testosterone (P = 0.012) in FHE group in comparison to placebo. There were no significant changes in progesterone (P = 0.174) and FSH (P = 0.879) upon FHE supplementation. The hematological and biochemical safety parameters were also at par with the safety of the extract.

Conclusion

Thus, the supplementation of FHE may be considered as a natural alternative for sexual issues in women.

Trial registration

CTRI/2018/09/015614 dated 05/09/2018.

Complementary and Alternative Medicine for Dysmenorrhea Caused by Endometriosis: A Review of Utilization and Mechanism

Endometriosis (EM) is a common and benign estrogen-dependent gynecological disorder among women of reproductive age, and secondary dysmenorrhea is one of the more severe symptoms. However, the mechanism behind the development of dysmenorrhea is poorly understood, and there is a lack of effective methods for diagnosing and treating EM dysmenorrhea. In this regard, complementary and alternative medicine (CAM) has recently come into widespread use due to its limited adverse reactions and high efficiency. This review updates the progress of CAM in the treatment of EM dysmenorrhea and seeks to identify the therapeutic efficacy as well as the mechanisms behind these effects based on the available clinical and experimental studies. According to the literature, CAM therapy for EM dysmenorrhea, including herbs (herbal prescriptions, extracts, and patents), acupuncture, and Chinese herbal medicine enema (CHM enema), is effective for relieving dysmenorrhea with fewer unpleasant side effects when compared to hormonal and surgical treatments. In addition, we discuss and analyze the existing gaps in the literature. We hope to provide some instructive suggestions for clinical treatment and experimental research in the future.

Hormone Replacement Therapy After Gynaecological Malignancies: a Review Article

Rapid advances in oncology have led to an increased survival rate in cancer patients, who live long enough to reach the natural age of menopause or experience the end of gonadal function as a side effect of oncological treatment. Survivors after gynaecological malignancies are a major challenge as these diseases are hormone-dependent and hormone replacement therapy (HRT) possibly increases the risk of recurrence. This article is based on a selective literature search for relevant studies and guidelines regarding HRT after gynaecological malignancies and provides a broad overview of current research. The data for assessing the oncological safety of HRT after gynaecological malignancy are insufficient overall. According to current knowledge, HRT is fundamentally contraindicated after breast and endometrial cancer. After ovarian cancer, HRT can be used after assessment of the risks and benefits, while there is usually no contraindication to HRT after vulvar, vaginal or cervical cancer.

Effect of Mind-Body Approaches on Menopausal Symptoms among Women: A Community-Based Pilot Study

Introduction The process of women aging is characterized by a gradual transition from reproductive to nonreproductive life period. These changes in aging during menopause are accompanied by a wide range of physiological as well as psychological disturbing symptoms. The traditional therapeutic approach toward menopause management is hormone replacement therapy, which increases the risk of breast cancer, stroke, and coronary heart disease. However, the efficacy of complementary and alternative therapies like mind-body approach to troublesome hot flashes, anxiety, and depression is widely proven and it is used by many women. This study aimed to evaluate the effectiveness of the mind-body approach on menopausal symptoms among women.

Methods A quantitative research approach with quasi-experimental pretest–post-test design was adopted in the study. A total of 20 samples between the ages of 48 to 55 years with menopausal symptoms were the participants. The intervention of mind body approach (Mindfulness meditation) was performed for 8 weeks, which includes 35 minutes of session per day.

Results The majority (80%) of the participants were in the age group of 51 to 53 years and 50% of the participants attained menopause between 49 and 50 years. The results showed that the mean post-test menopausal symptom score was 15.60 ± 2.633 which was lower than the mean pretest score 28.420 ± 1.476 and the calculated t-value, t = 10.157 is greater than the table value (p < 0.001) at 0.001 level of significance. Hence, it is evident that the practice of mind-body approach was effective in reducing the intensity of menopausal symptoms among women.

Conclusion The study concludes that the practice of mind-body approach helped in reducing the menopausal symptoms on the domain of psychological and Somato vegetative scale like anxiety, depression, reduction in the intensity of hot flushes, and improved the sleeping pattern. Overall, the practice of Mindfulness meditation helped the participants to have a better quality of life. The study was found to be cost-effective and feasible to be made as a routine intervention for women to manage menopausal symptoms.

Urinary Proteomics Reveals Promising Biomarkers in Menstrually Related and Post-Menopause Migraine

Migraine is an invalidating neuro-vascular disorder largely spread in the world population. Currently, its pathophysiology is not yet completely understood. The purpose of this study was to investigate the urinary proteome of women suffering from menstrually related migraine (MM) and post-menopause migraine (PM) in comparison with non-headache women as controls, to search potential biomarkers of these migraine sub-types. Urine samples were analyzed by mono-dimensional gel electrophoresis (SDS-PAGE) and two-dimensional gel electrophoresis (2DE) coupled to liquid chromatography-mass spectrometry (LC-MS/MS). Twenty-one urinary proteins were found significantly dysregulated in MM and PM (p < 0.05). The STRING Analysis database revealed interaction between 15 proteins, which were mainly involved in the immune and inflammatory response. Seven of the most considerable proteins were further quantified by western blot: protein S100A8 (S10A8), up-regulated in MM, uromodulin (UROM), alpha-1-microglobulin (AMBP), gelsolin (GELS), prostaglandin-H2 D-isomerase (PTGDS), over-expressed in PM, apolipoprotein A-I (APOA1), and transthyretin (TTHY), respectively down- and up-regulated in both migraineur groups vs controls. These candidate biomarkers might be involved in the neurophysiological network of MM and PM, thus helping to better understand the pathophysiology of these migraine forms. If validated in large-scale studies, this protein cluster could become a distinctive target for clinical applications in migraine diagnosis and treatment.

Effects of Menopause in Women With Multiple Sclerosis: An Evidence-Based Review

Over two thirds of all individuals who develop multiple sclerosis (MS) will be women prior to the age of menopause. Further, an estimated 30% of the current MS population consists of peri- or postmenopausal women. The presence of MS does not appear to influence age of menopausal onset. In clinical practice, symptoms of MS and menopause can frequently overlap, including disturbances in cognition, mood, sleep, and bladder function, which can create challenges in ascertaining the likely cause of symptoms to be treated. A holistic and comprehensive approach to address these common physical and psychological changes is often suggested to patients during menopause. Although some studies have suggested that women with MS experience reduced relapse rates and increased disability progression post menopause, the data are not consistent enough for firm conclusions to be drawn. Mechanisms through which postmenopausal women with MS may experience disability progression include neuroinflammation and neurodegeneration from age-associated phenomena such as immunosenescence and inflammaging. Additional effects are likely to result from reduced levels of estrogen, which affects MS disease course. Following early retrospective studies of women with MS receiving steroid hormones, more recent interventional trials of exogenous hormone use, albeit as oral contraceptive, have provided some indications of potential benefit on MS outcomes. This review summarizes current research on the effects of menopause in women with MS, including the psychological impact and symptoms of menopause on disease worsening, and the treatment options. Finally, we highlight the need for more inclusion of MS patients from underrepresented racial and geographic groups in clinical trials, including among menopausal women.

Fennel (Foeniculum vulgare Miller) for the management of menopausal women's health: A systematic review and meta-analysis

This review aimed to evaluate the current evidence on the effectiveness and safety of fennel (Foeniculum vulgare Miller) for managing menopausal women's health. Fourteen databases were searched. We included randomized controlled trials (RCTs) that evaluated any type of fennel treatment in menopausal women. Seven RCTs that met our inclusion criteria were identified and analyzed. The included RCTs had concerning risks of bias in general. Two RCTs compared the effects of fennel with placebo, and the meta-analysis results favored fennel for improving menopausal symptoms (n = 145, standard mean difference -1.32 [-1.76, -0.87], p < 0.00001). Other studies failed to show beneficial effects of fennel in terms of sexual function, quality of life (QoL), and psychological health. No serious adverse events were reported. Our review presented evidence for fennel improving menopausal symptoms. However, the effectiveness and safety of fennel in improving QoL, and psychological health remains unclear.

The Effectiveness of Melissa Officinalis L. versus Citalopram on Quality of Life of Menopausal Women with Sleep Disorder: A Randomized Double-Blind Clinical Trial

OBJECTIVE

 The present study aimed to assess the effect of Melissa Officinalis L. (a combination of lemon balm with fennel fruit extract) compared with citalopram and placebo on the quality of life of postmenopausal women with sleep disturbance.

METHODS

 The present study is a randomized, double-blind, placebo clinical trial among 60 postmenopausal women with sleep disturbance who were referred to a university hospital from 2017 to 2019. The participants were randomized to receive M. Officinalis L. (500 mg daily), citalopram (30 mg) or placebo once daily for 8 weeks. The Menopause-Specific Quality of Life (MENQOL) questionnaire was self-completed by each participant at baseline and after 8 weeks of the intervention and was compared between groups.

RESULTS

 The mean for all MENQOL domain scores were significantly improved in the M. Officinalis L. group compared with citalopram and placebo (p < 0.001). The mean ± standard deviation (SD) after 8 weeks in the M. Officinalis L., citalopram and placebo groups was 2.2 ± 0.84 versus 0.56 ± 0.58 versus 0.36 ± 0.55 in the vasomotor (p < 0.001), 1.02 ± 0.6 versus 0.28 ± 0.2 versus 0.17 ± 0.1 in the psychomotor-social (p < 0.001), 0.76 ± 0.4 versus 0.25 ± 0.1 versus 0.11 ± 0.1 in the physical and 2.3 ± 1.0 versus 0.35 ± 0.5 versus 0.41 ± 0.5 in the sexual domain, respectively.

CONCLUSIONS

 The results revealed that M. Officinalis L. may be recommended for improving the quality of life of menopausal women with sleep disturbance.

TRIAL REGISTRATION

 The present study was registered by the name "Comparison of the efficacy of citalopram and compound of Asperugo procumbens and foeniculum vulgare in treatment of menopausal disorders" with the code IRCT2013072714174N1 in the Iranian Registry of Clinical Trials (IRCT).

Approach to Managing a Postmenopausal Patient

The case of a symptomatic, postmenopausal woman is presented and a full discussion of the approach to her management is discussed. Pertinent guidelines and scientific evidence are emphasized as support for the recommendations.

Investigation the effect of jujube seed capsule on sleep quality of postmenopausal women: A double-blind randomized clinical trial

Bakground and objective

Sleep disorder is among the most common problems in the life of postmenopausal women. Because of the complications of chemical drugs, many women prefer to use herbal supplements for relieving sleep problems. So, the main objective of this study was to determine the effect of the jujube seed capsule on sleep quality in postmenopausal women.

Materials and methods

This study was a double-blind clinical trial conducted on 106 postmenopausal women in Khuzestan province, southwest of Iran. All participants were selected by a simple non-probability sampling method. Data were collected through a demographic data form and the Pittsburgh sleeps quality index (PSQI). Individuals were randomly divided into intervention (n = 53) and control (n = 53) groups. The intervention group received 250 mg oral jujube seed capsule and the control group received a placebo capsule twice a day for 21 days. After the treatment, the PSQI was completed in both intervention and control groups. Data were analyzed using the independent t-test and the Chi-square test using SPSS software version 24, and p-value < 0.05 was considered as the significance level.

Results

The results revealed that after treatment, the mean scores of sleep quality decreased in the intervention and control group. Although this difference was statistically significant in both intervention and control groups (p-value < 0.05), more reduction observed in the intervention group (p-value < 0.001).

Conclusion

Consumption of the jujube seed capsule had a positive impact on improving the sleep quality of postmenopausal women and could be recommended as a useful herbal medication.

An Interventional strategy of physical activity promotion for reduction of menopause symptoms

Background: Physical activity (PA) programs are inexpensive, non-pharmaceutical and universally accessible options with demonstrated efficacy in reducing menopausal symptoms. The purpose of this study was to determine the effectiveness of a behavioral strategy for initiating and sustaining PA with the hope to reduce or eliminate menopausal symptoms.

Methods : Menopausal and perimenopausal women (n=190) were randomly assigned to intervention (n=95) and non-intervention (n=95) groups using a random-numbers table. The intervention group consisted of 18 neighborhood network subgroups, each consisting of five to six women known to one another. They participated in a 12-week regular PA program, augmented by eight interactive group education and discussion sessions. The Menopause Rating Scale (MRS) self-report instrument was used to determine perceived severity of menopausal symptoms.

Results: The intervention group showed a significant reduction in the frequency and severity of menopausal symptoms (P < 0.001). Those whose symptoms rated severe/very severe for hot flushes were reduced from 30.1% to 11.8%. Also, participants whose sleep problems and joint discomfort rated severe/very severe declined from 28% to 6.5% and joint discomfort rated severe or very severe was reduced from 52.7% to 4.4%, respectively. Conversely in the nonintervention group, hot flushes, sleep problems and joint problems got significantly worse(P < 0.05).

Conclusion: Implementing educational program that increases awareness of PA benefits in combination with existing neighborhood networks that facilitate communication and cooperation may increase PA levels and decrease menopausal symptoms. Such networks offer alow-cost means of improving quality of life (QOL) for perimenopausal and menopausal women.

[Preventive activities in women's care]

A review is presented of the scientific evidence on preventive activities in women's care in relation to pregnancy follow-up, preventive activities in the planning and follow-up of contraceptive methods, preventive activities in menopause, and the prevention of osteoporotic fractures.

Climacteric symptoms and quality of life in yoga practitioners

BACKGROUND

Yoga is among the most commonly studied complementary therapies for managing climacteric symptoms. However, it is unclear whether yoga practices in premenopause can affect the occurrence of symptoms when women reach menopause.

OBJECTIVE

To assess climacteric symptoms and quality of life in regular yoga practitioners and to determine whether yoga practices before menopause may avoid or mitigate climacteric-related symptoms.

DESIGN

This study of 108 women between 40 and 65 years old included 28 women who started to practice yoga in premenopause and had already practiced for at least five years, and as controls 30 physical activity practitioners (PA) who had practiced for at least five years, and 50 sedentary women.

MAIN OUTCOME MEASURES

Climacteric symptoms were evaluated with the Kupperman Menopausal Index (KMI) and the Women's Health Questionnaire (WHQ). Moreover, we measured the quality of life with the WHQ.

RESULTS

The KMI showed that 39.3% of yoga practitioners had no menopausal symptoms, and none reported severe symptoms. The WHQ indicated a few symptoms and a good quality of life for yoga practitioners (3.56; 3.35-3.80). In addition, we found that the yoga group had significantly less moderate and severe symptoms (p = 0.002) compared with the sedentary group. We also observed that yoga practitioners had less vasomotor symptoms and memory/concentration disorders than PA practitioners (p = 0.010 and p = 0.047) and sedentary women (p = 0.001 and p = 0.001) and also used fewer drugs than the PA (p < 0.001) and the sedentary groups (p = 0.001).

CONCLUSIONS

Yoga practitioners who started to practice in premenopause had satisfactory results on the frequency and intensity of climacteric symptoms and quality of life. Although further research is required to support our findings, we conclude that yoga practice may represent an efficient non-pharmacological approach to manage and prevent climacteric symptoms.

Nonpharmacological therapies for the management of menopausal vasomotor symptoms in breast cancer survivors

PURPOSE

Breast cancer affects millions of women worldwide, and for many, therapy results in treatment-induced menopause. Menopausal symptoms in breast cancer survivors are often more severe, frequent, and of greater duration compared with natural menopause. Hot flushes and night sweats pose a significant burden for many women, with limited therapeutic options as menopausal hormone therapy is contraindicated. Guidelines recommend non-hormonal pharmacological agents including clonidine, gabapentin, and some antidepressants. However, some women may be reluctant to use medications due to concerns about side effects. The aim of this narrative review was to appraise recent evidence for nonpharmacological treatments for vasomotor symptoms in breast cancer survivors including cognitive behavioural therapy, hypnosis, yoga, mindfulness, acupuncture, and lifestyle changes.

METHODS

A literature search was conducted. Studies were included if they were randomised and involved breast cancer survivors and nonpharmacological treatments for menopausal vasomotor symptoms.

RESULTS

Twelve studies met the criteria, and three studies of exercise in healthy menopausal women were included. Cognitive behavioural therapy reduces menopausal symptoms and perceived impact of hot flushes and night sweats in breast cancer survivors and is cost effective. The efficacy of hypnosis as a treatment for menopausal vasomotor symptoms in women with breast cancer is supported by two randomised controlled trials. Yoga and acupuncture may reduce vasomotor symptom frequency and/or burden. Studies of exercise as an intervention for vasomotor symptoms in healthy menopausal women have not shown benefit.

CONCLUSION

Evidence for nonpharmacological interventions supports cognitive behavioural therapy and hypnosis in the management of vasomotor symptoms in breast cancer survivors.

Efficacy of Labisia pumila and Eurycoma longifolia standardised extracts on hot flushes, quality of life, hormone and lipid profile of peri-menopausal and menopausal women: a randomised, placebo-controlled study

Background

Interest in herbal medicines and non-hormonal therapies for the treatment of menopausal symptoms has increased since the publication of adverse effects of estrogen replacement therapy. Vasomotor symptoms are the most characteristic and notable symptoms of menopause.

Objective

To investigate the changes in the frequency and severity of hot flush and associated vasomotor symptoms experienced by peri-menopausal and menopausal women supplemented with the herbal formulation (Nu-femme™) comprising Labisia pumila (SLP+^®) and Eurycoma longifolia (Physta^®) or placebo.

Design

Randomised, double-blind, placebo-controlled, 24-week study enrolled 119 healthy women aged 41–55 years experiencing peri-menopausal or menopausal symptoms and supplemented with Nu-femme™ or placebo. The primary endpoint was comparative changes between treatment groups in the change in the frequency and severity of hot flushes. The secondary objectives were to assess the changes in the frequency and severity of joint pain, Menopause Rating Scale (MRS) and Menopause-Specific Quality of Life (MENQOL) questionnaire domain scores. Concentrations of serum hormone, lipid profile, bone markers, sleep quality and vitality were also studied as secondary objectives.

Results

At week 12, significant (P < 0.01) improvements in hot flush symptoms were observed in Nu-femme™ and placebo groups. Even though there was no significant difference between groups, higher percentage of improvement, 65%, was seen in Nu-femme™ compared to 60% in placebo. Significant improvements (P < 0.001) in MRS and MENQOL scores at weeks 12 and 24 were observed in both groups, respectively. Luteinising hormone and follicle-stimulating hormone levels were significantly reduced (P < 0.05) at weeks 12 and 24, respectively, compared to baseline in the Nu-femme™ group, with no significant changes observed in the placebo group. There were significant (P < 0.05) reductions in serum low-density lipid and triglycerides levels at week 12 in Nu-femme™ group, but no changes seen in placebo group. At the end of week 24, changes in haematology and clinical chemistry parameters remained within normal clinical ranges in both groups.

Conclusion

Herbal formulation consists of L. pumila and E. longifolia (Nu-femme™) may support reduction in hot flushes and improvements in hormone and lipid profile in healthy peri-menopausal and menopausal women.

The influence of phytoestrogens on different physiological and pathological processes: An overview

Functional foods have nutritional properties and organic functions, which are beneficial to health. Certain types of functional food components are so-called phytoestrogens, non-steroidal compounds derived from the metabolism of precursors contained in plants, which originate secondary metabotypes known to induce biological responses and by mimicry or modulating the action of endogenous estrogen. These molecules are involved in several physiological and pathological processes related to reproduction, bone remodeling, skin, cardiovascular, nervous, immune systems, and metabolism. This review aimed to present an overview of phytoestrogens regarding their chemical structure, actions, and effects in the organism given several pathologies. Several studies have demonstrated beneficial phytoestrogen actions, such as lipid profile improvement, cognitive function, menopause, oxidative stress, among others. Phytoestrogens effects are not completely elucidated, being necessary future research to understand the exact action mechanisms, whether they are via estrogen receptor or whether other hidden mechanisms produce these effects. Thus, this review makes a general approach to the phytoestrogen actions, beneficial effects, risk and limitations. However, the complexities of biological effects after ingestion of phytoestrogens and the differences in their metabolism and bioavailability indicate that interpretation of either risk or benefits needs to be made with caution.

The Effect of Lactobacillus acidophilus YT1 (MENOLACTO) on Improving Menopausal Symptoms: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial

This study evaluated the efficacy of Lactobacillus acidophilus YT1 (MENOLACTO) for alleviating menopausal symptoms. This study was a multi-center, randomized, double-blinded, placebo-controlled clinical trial involving female subjects (ages: 40-60 years) with menopausal symptoms and a Kupperman index (KMI) score ≥ 20. Subjects were administered 1 × 108 CFU/day MENOLACTO or placebo, with the primary endpoint being total KMI score, and the effect of secondary endpoints on alleviating menopausal symptoms according to individual categories of the modified KMI, as well as a quality of life questionnaire (MENQOL questionnaire). After 12 weeks, total KMI scores decreased significantly, demonstrating improved menopausal symptoms relative to placebo along with improved modified KMI scores. Additionally, quality of life, according to the MENQOL questionnaire, significantly improved in all four symptoms-physical, psychosocial, vasomotor, and sexual symptoms. Moreover, we observed no significant difference between the two groups or significant changes in blood follicle-stimulating hormone and estradiol levels or endometrial thickness. These results demonstrated that MENOLACTO alleviated menopausal symptoms without notable side effects and improved quality of life, suggesting its efficacy as an alternative supplement to alleviate menopausal symptoms in women ineligible for hormonal therapy.

Investigation of the role of herbal medicine, acupressure, and acupuncture in the menopausal symptoms: An evidence-based systematic review study

Background

Menopause is an important physiological phenomenon in women's lives. Women's concern about taking the hormone treatment to ease menopausal symptoms is increasing. Over the past decade, the use of complementary and alternative medicine for the treatment of menopausal problems instead of hormone therapy has increased.

Objective

This study aimed to investigate the role of herbal medicine, acupressure, and acupuncture in the menopausal symptoms.

Methods

Data source: related articles were searched from internal scientific databases and external databases of "Web of Scopus, Cochrane, PubMed, Science Direct, Ovid, and Google scholar."

Study Eligibility Criteria

The keywords such as menopause, menopausal symptoms, complementary menopausal medicine, acupuncture in menopause, herbal medicine in menopause, and acupuncture in menopause were searched in the studies from 1987 to 2019. Exclusion criteria were inadequate information in the study, lack of access to full-text articles, animal studies, and reports. At the end of the search, 145 articles out of a total of 400 articles were reviewed.

Results

In various studies, different herbs such as licorice, valerian, soy, sage, ginseng, etc., were used to improve menopausal symptoms. In addition, acupuncture and acupressure were used to reduce menopausal symptoms.

Conclusion

The efficacy and use of complementary and alternative medicine, along with other classical medicine care, can be a new model for improving menopausal symptoms in women. It is recommended that further clinical and review studies be conducted to develop complementary and alternative medicine.

Menopausal Hormone Therapy: a Comprehensive Review

PURPOSE OF REVIEW

For decades the medical community recommended menopausal hormone therapy (MHT) for prevention of atherosclerotic cardiovascular disease (ASCVD) and osteoporosis in addition to relieving unpleasant vasomotor and genitourinary symptoms. These recommendations were largely based on observational studies. Several large randomized placebo-controlled trials led to the surprising finding that postmenopausal women were at higher risk of cardiovascular disease (CVD) events compared with women in the placebo group. For the next decade, women were less frequently prescribed MHT and more often declined MHT.

RECENT FINDINGS

Today, there are more evidence-based guidelines utilizing sex-specific ASCVD risk factors to assess risk in women. More recent studies have shed new light on safety and potential benefits for women initiating MHT earlier with newer options for route of administration, dosing, and combinations. Recent studies suggest MHT safety in younger women, women within 10 years of menopause, and women who use low-dose MHT for short durations for menopause symptom relief. Transdermal, newer low-dose oral therapies and SERM therapies may also have lower risk and be reasonable considerations for women. Healthcare providers need to be aware of the current options for MHT, current indications, contraindications, long-term ASCVD risks, and nonhormonal options for high-risk women.