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Bayraktar E, Erel CT, Akturk H, Erkan IBO, Hamid R, Alper E, Adaletli I, Urfalioglu M. A novel objective evaluation method, shear wave elastography, in the treatment of atrophic vaginitis by nonablative intravaginal Er:YAG laser, a randomized-sham controlled pilot study. Menopause 2024:00042192-990000000-00337. [PMID: 38860935 DOI: 10.1097/gme.0000000000002380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVE The aim of the study was to investigate the effectiveness of intravaginal Er:YAG laser for treating atrophic vaginitis in postmenopausal women utilizing shear wave elastography. METHODS In this prospective randomized sham-controlled double-blind pilot study, 20 participants were included (laser group [n = 12] / sham-control group [n = 8]). A nonablative (Smooth mode) Er:YAG laser with a wavelength of 2,940 nm was used. Objective evaluation of laser treatment efficacy was conducted using a special ultrasonic technique: shear wave elastography. Ultrasonic velocity measurements were taken from the anterior and posterior vaginal walls. Mean elasticity (Emean) was expressed in kilopascals (kPa). Additional outcome parameters were vaginal pH, Vaginal Health Index (VHI), Female Sexual Function Index (FSFI), and visual analog scale (VAS) scores for dyspareunia. RESULTS Baseline clinical characteristics, vaginal pH, VHI, VAS and FSFI scores, and Emean values were comparable between the laser and sham-control groups. Statistically significant differences were observed in the final Emean values of the anterior vaginal wall (13.1 ± 6.3 vs 20.0 ± 3.3 kPA, P = 0.01) and posterior vaginal wall (12.7 ± 10.3 vs 19.4 ± 6.9 kPA, P = 0.04) between the laser and sham-control group. Despite comparable baseline Emean values, significant differences in vaginal wall stiffness posttreatment indicated a notable increase in tissue elasticity following laser treatment. Statistically significant differences were also observed in final vaginal pH values, VHI, VAS scores, and FSFI score improvement in favor of laser treatment. CONCLUSIONS Shear wave elastography may be considered as a reliable and objective technique for evaluating the efficacy of Er:YAG laser treatment in women with atrophic vaginitis. However, additional studies with larger sample sizes are necessary to establish conclusive evidence.
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Affiliation(s)
- Elif Bayraktar
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - C Tamer Erel
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Hayedeh Akturk
- Department of Radiology, American Hospital, Istanbul, Turkey
| | - Ipek Betul Ozcivit Erkan
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Rauf Hamid
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ebru Alper
- Department of Obstetrics and Gynecology, American Hospital, Istanbul, Turkey
| | - Ibrahim Adaletli
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Mert Urfalioglu
- From the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Reeves AN, Lewis TT, Hood MM, Thurston RC, Avis NE, Burnett-Bowie SAM, Cortés YI, Neal-Perry G, Harlow SD. Does everyday discrimination account for the increased risk of vasomotor symptoms in Black women?: the Study of Women's Health Across the Nation (SWAN). Menopause 2024; 31:484-493. [PMID: 38595299 PMCID: PMC11126360 DOI: 10.1097/gme.0000000000002357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Vasomotor symptoms (VMS), including hot flashes and night sweats, are hallmark symptoms of the menopause transition. Previous research has documented greater frequency, duration, and severity of VMS in Black women compared with women from other racial/ethnic groups, even after accounting for other factors. This analysis examined the association between discrimination and VMS and the extent to which discrimination accounts for the disproportionate burden of VMS in Black women. METHODS Using available discrimination and VMS data from the SWAN cohort study (n = 2,377, 48% White, 32% Black, 6% Japanese, 4% Chinese, and 9% Hispanic women) followed approximately yearly in midlife from premenopause (42-52 y) through postmenopause (~20 y), we assessed concurrent associations between discrimination and VMS frequency in the past 2 weeks using weighted generalized mixed models. We also assessed associations between chronic discrimination across first four visits and VMS trajectories from premenopause to postmenopause using weighted multinomial logistic regression. Models were adjusted for known risk factors for VMS. RESULTS Higher levels of discrimination were associated with concurrent reporting of any (odds ratio [OR], 1.57 [1.31-1.89]) and frequent (≥6 d) VMS (OR, 1.55 [1.21-1.99]). After adjustment, associations remained significant for any (OR, 1.30 [1.09-1.54]) but not frequent VMS. For any VMS trajectories, chronic discrimination was associated with "continuously high" (OR, 1.69 [1.03-2.77]) and "high pre-FMP-decline post-FMP" (OR, 1.70 [1.01-2.88]) versus "FMP-onset low" trajectories. After adjusting for discrimination, odds of reporting any, frequent, and of being in the "continuously high" any VMS trajectory remained elevated for Black versus White women. CONCLUSIONS Discrimination is associated with greater concurrent risk of any (but not frequent) VMS, and chronic discrimination is associated with a continuously high reporting of any VMS over time, independent of known risk factors. Adjusting for discrimination attenuates but does not eliminate the increased risk of VMS for Black women.
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Affiliation(s)
- Alexis N Reeves
- Department of Epidemiology, School of Public Health, University of Michigan
- Epidemiology and Population Health, School of Medicine, Stanford University
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Michelle M Hood
- Department of Epidemiology, School of Public Health, University of Michigan
| | - Rebecca C. Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health
- Department of Psychology, University of Pittsburgh
| | - Nancy E. Avis
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine
| | | | | | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina – Chapel Hill
| | - Siobán D. Harlow
- Department of Epidemiology, School of Public Health, University of Michigan
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Geller RJ, Wesselink AK. The limitations of oocyte donor data for studying reproductive health inequities. Fertil Steril 2024:S0015-0282(24)00448-5. [PMID: 38735555 DOI: 10.1016/j.fertnstert.2024.05.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Ruth J Geller
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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Cortés YI. Does neighborhood socioeconomic status impact ovarian reserve? Moving beyond individual-level factors. Menopause 2024; 31:361-362. [PMID: 38669624 DOI: 10.1097/gme.0000000000002365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Affiliation(s)
- Yamnia I Cortés
- From the College of Nursing, University of Iowa, Iowa City, IA
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Rulu P, Bertone-Johnson ER, Kamilar J, Dhall M, Sievert LL. Chronic stress, social support, and symptoms at midlife. Is there a buffering effect? AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024:e24936. [PMID: 38623810 DOI: 10.1002/ajpa.24936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/03/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES This study was designed to examine associations among measures of stress, social support, and symptoms at midlife. Specifically, the study examined whether support buffered against the negative effects of stress on severity of symptoms grouped via factor analyses into emotional instability, vaso-somatic symptoms, mood disturbances, and aches and pains. METHODS We used cross-sectional data from n = 119 women aged 40-55 in Nagaland, India. Midlife symptoms were measured with the help of questionnaires, and factor analysis was used to identify latent factors. Stress and social support were measured by Perceived Stress Scale and Multidimensional Scale of Perceived Social Support, respectively. Chronic stress was measured by fingernail cortisol. RESULTS After adjusting for menopausal status, tobacco use, body mass index, and socioeconomic status, cortisol level was positively associated with emotional instability (p < 0.01), vaso-somatic symptom score (p < 0.05), and total symptoms at midlife (p < 0.05). Familial support was negatively associated with emotional instability (p < 0.05) and total symptoms at midlife (p < 0.05). However, no significant associations were observed with spousal or friend support. Although no significant interactions between stress, social support, and symptoms at midlife were observed, spousal support when stratified as high and low support using the means, perceived stress and vaso-somatic symptoms indicated an interaction. CONCLUSION Cortisol level and support from family were independently associated with symptoms at midlife. The study highlights the importance of family ties and support for navigating the stressors of everyday life among women in Nagaland.
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Affiliation(s)
- Peteneinuo Rulu
- Department of Anthropology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | | | - Jason Kamilar
- Department of Anthropology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Meenal Dhall
- Department of Anthropology, University of Delhi, Delhi, India
| | - Lynnette Leidy Sievert
- Department of Anthropology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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Pasokh Z, Seif M, Ghaem H, Rezaianzadeh A, Ghoddusi Johari M. Age at natural menopause and its determinants in female population of Kharameh cohort study: Comparison of regression, conditional tree and forests. PLoS One 2024; 19:e0300448. [PMID: 38625988 PMCID: PMC11020934 DOI: 10.1371/journal.pone.0300448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/28/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Natural menopause is defined as the permanent cessation of menstruation that occurs after 12 consecutive months of amenorrhea without any obvious pathological or physiological cause. The age of this phenomenon has been reported to be associated with several health outcomes. OBJECTIVES This study aimed to estimate the Age at Natural Menopause (ANM) and to identify reproductive and demographic factors affecting ANM. METHODS This cross-sectional, population-based study was conducted on 2517 post-menopausal women aged 40-70 years participating in the first phase of the PERSIAN cohort study of Kharameh, Iran, during 2014-2017. To more accurately detect the determinants of ANM, we applied multiple linear regression beside some machine learning algorithms including conditional tree, conditional forest, and random forest. Then, the fitness of these methods was compared using Mean Squared Error (MSE) and Pearson correlation coefficient. RESULTS The mean±SD of ANM was 48.95±6.13. Both applied forests provided more accurate results and identified more predictors. However, according to the final comparison, the conditional forest was the most accurate method which recognized that more pregnancies, longer breastfeeding, Fars ethnicity, and urbanization have the greatest impact on later ANM. CONCLUSIONS This study found a wide range of reproductive and demographic factors affecting ANM. Considering our findings in decision-making can reduce the complications related to this phenomenon and, consequently, improve the quality of life of post-menopausal women.
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Affiliation(s)
- Zahra Pasokh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Seif
- Non-Communicable Diseases Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Haleh Ghaem
- Non-Communicable Diseases Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rezaianzadeh
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Jin Z, Tian C, Kang M, Hu S, Zhao L, Zhang W. The 100 top-cited articles in menopausal syndrome: a bibliometric analysis. Reprod Health 2024; 21:47. [PMID: 38589898 PMCID: PMC11003046 DOI: 10.1186/s12978-024-01770-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/10/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Significant scientific research has been conducted concerning menopausal syndrome(MPS), yet few bibliometric analyses have been performed. Our aim was to recognise the 100 most highly cited published articles on MPS and to analytically evaluate their key features. METHODS To identify the 100 most frequently cited articles, a search was conducted on Web of Science using the term 'menopausal syndrome'. Articles that matched the predetermined criteria were scrutinised to obtain the following data: citation ranking, year of publication, publishing journal, journal impact factor, country of origin, academic institution, authors, study type, and keywords. RESULTS The publication period is from January 1, 2000, to August 31, 2022. The maximum number of citations was 406 and in 2012. The median citations per year was 39.70. Most of the articles focused on treatment and complications. These articles were published in 36 different journals, with the Journal of MENOPAUSE having published the greatest number (14%). Forty-eight articles (48%) were from the United States, with the University of Pittsburgh being the leading institute (9%). Joann E. Manson was the most frequent first author (n = 6). Observational studies were the most frequently conducted research type (n = 53), followed by experimental studies (n = 33). Keyword analysis identified classic research topics, including genitourinary syndrome of menopause, bone mineral density (BMD), and anti-mullerian hormone (AMH) loci. CONCLUSION Using bibliometrics, we conducted an analysis to identify the inadequacies, traditional focal points, and potential prospects in the study of MPS across current scientific areas. Treatment and complications are at the core of MPS research, whereas prediction and biomarkers have less literature of high quality. There is a necessity for innovative analytical metrics to measure the real effect of these papers with a high level of citation on clinical application.
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Affiliation(s)
- Zishan Jin
- Beijing University of Chinese Medicine, Beijing, 100029, China
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Chuanxi Tian
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Mengjiao Kang
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Shiwan Hu
- Beijing University of Chinese Medicine, Beijing, 100029, China
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Linhua Zhao
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
| | - Wei Zhang
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
- Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China.
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Santoro N, Nappi RE, Neal-Perry G, English M, King DD, Yamaguchi Y, Ottery FD. Fezolinetant treatment of moderate-to-severe vasomotor symptoms due to menopause: effect of intrinsic and extrinsic factors in two phase 3 studies (SKYLIGHT 1 and 2). Menopause 2024; 31:247-257. [PMID: 38517210 DOI: 10.1097/gme.0000000000002340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVE This study aimed to assess the efficacy of the neurokinin 3 receptor antagonist, fezolinetant, according to several intrinsic (individual related) and extrinsic (external influence) factors that may influence the frequency and severity of moderate-to-severe vasomotor symptoms (VMS) using pooled 12-week data from SKYLIGHT 1 and 2. METHODS SKYLIGHT 1 and 2 were two phase 3, randomized, double-blind studies conducted from July 2019 to August 2021 (SKYLIGHT 1) or April 2021 (SKYLIGHT 2). Participants were initially randomized to receive daily doses of placebo, fezolinetant 30 mg, or fezolinetant 45 mg. After 12 weeks, placebo participants were rerandomized to receive fezolinetant 30 mg or 45 mg, whereas those receiving fezolinetant continued on the same dose. Change in VMS frequency from baseline to week 12 was used to assess efficacy according to several intrinsic and extrinsic factors. Overall efficacy and safety were also investigated. RESULTS Overall, 1,022 individuals were included. Fezolinetant was efficacious in reducing VMS frequency across all intrinsic and extrinsic factors. Efficacy was most notable for participants who self-identify as Black (least squares mean difference for fezolinetant 45 mg versus placebo, -3.67; 95% CI, -5.32 to -2.01), current smokers (-3.48; -5.19 to -1.77), and current alcohol users (-3.48; -4.42 to -2.54). Overall efficacy was -2.51 (95% CI, -3.20 to -1.82) for fezolinetant 45 mg versus placebo. Similar findings were observed for the fezolinetant 30 mg dose. Comparable incidences of treatment-emergent adverse events were observed for placebo (132 of 342 individuals [38.6%]), fezolinetant 30 mg (132 of 340 individuals [38.8%]), and fezolinetant 45 mg (135 of 340 individuals [39.7%]). CONCLUSIONS None of the intrinsic and extrinsic factors analyzed substantially reduced the efficacy response to fezolinetant in SKYLIGHT 1 and 2. These data provide additional confidence for using fezolinetant in a diverse population of individuals with VMS.
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Affiliation(s)
- Nanette Santoro
- From the Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
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Bae S, Park SM, Kim SR, Kim MN, Cho DH, Kim HD, Yoon HJ, Kim MA, Kim HL, Hong KS, Shin MS, Jeong JO, Shim WJ. Early menopause is associated with abnormal diastolic function and poor clinical outcomes in women with suspected angina. Sci Rep 2024; 14:6306. [PMID: 38491090 PMCID: PMC10943187 DOI: 10.1038/s41598-024-57058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/13/2024] [Indexed: 03/18/2024] Open
Abstract
Early identification of women at high risk for cardiovascular diseases (CVD), with subsequent monitoring, will allow for improved clinical outcomes and generally better quality of life. This study aimed to identify the associations between early menopause, abnormal diastolic function, and clinical outcomes. This retrospective study included 795 menopausal women from is a nationwide, multicenter, registry of patients with suspected angina visiting outpatient clinic. The patients into two groups: early and normal menopause (menopausal age ≤ 45 and > 45 years, respectively). If participants met > 50% of the diastolic function criteria, they were classified as having normal diastolic function. Multivariable-adjusted Cox models were used to test associations between menopausal age and clinical outcomes including the incidence of major adverse cardiovascular events (MACE), over a median follow-up period of 771 days. Early menopause was associated with increased waist circumference (p = 0.001), diabetes prevalence (p = 0.003), obstructive coronary artery disease (p = 0.005), abnormal diastolic function (p = 0.003) and greater incidences of MACE, acute coronary syndrome, and hospitalization for heart failure. In patients with abnormal diastolic function, early menopause increased MACE risk significantly, with no significant difference in normal diastolic function. These findings highlight early menopause and abnormal diastolic function as being potential risk markers in women for midlife CVD events.
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Affiliation(s)
- SungA Bae
- Department of Cardiology, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Gyeonggi-Do, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Goryeodae-Ro 73, Seongbuk-Gu, Seoul, 02841, Republic of Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Goryeodae-Ro 73, Seongbuk-Gu, Seoul, 02841, Republic of Korea.
| | - So Ree Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Goryeodae-Ro 73, Seongbuk-Gu, Seoul, 02841, Republic of Korea
| | - Mi-Na Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Goryeodae-Ro 73, Seongbuk-Gu, Seoul, 02841, Republic of Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Goryeodae-Ro 73, Seongbuk-Gu, Seoul, 02841, Republic of Korea
| | - Hee-Dong Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Goryeodae-Ro 73, Seongbuk-Gu, Seoul, 02841, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Hyun Ju Yoon
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Myung-A Kim
- Department of Cardiology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hack-Lyoung Kim
- Department of Cardiology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Kyung-Soon Hong
- Department of Cardiology, Hallym University Medical Center, Seoul, Chuncheon, Republic of Korea
| | - Mi-Seung Shin
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jin-Ok Jeong
- Department of Cardiology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Wan-Joo Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Goryeodae-Ro 73, Seongbuk-Gu, Seoul, 02841, Republic of Korea
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Xing Z, Kirby RS. Age at natural or surgical menopause, all-cause mortality, and lifespan among postmenopausal women in the United States. Menopause 2024; 31:176-185. [PMID: 38385730 DOI: 10.1097/gme.0000000000002314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVE This study investigated the association of age at natural menopause with or without undergoing hysterectomy and/or bilateral oophorectomy after menopause and age at surgical menopause with all-cause mortality and lifespan in postmenopausal women. METHODS The data stemmed from the National Health and Nutrition Examination Survey (NHANES) (1999-2018) and NHANES III (1988-1994), including 14,161 postmenopausal women over 40. Cox proportional hazard models were used to estimate unadjusted and adjusted hazard ratios (HRs) (95% confidence intervals [CIs]). We also used Cox proportional hazard models with penalized splines to depict the association between continuous age at menopause and all-cause mortality and nonparametric regression with smoothing splines to illustrate the association between age at menopause and lifespan in deceased participants. RESULTS The adjusted HRs (95% CIs) for age at natural menopause of <40, 40 to 44, and 55+ years in women without undergoing hysterectomy or bilateral oophorectomy after menopause were 1.48 (1.15-1.91), 1.16 (1.00-1.35), and 0.91 (0.77-1.07) compared with age at natural menopause of 45 to 54, respectively. The respective HRs (95% CIs) for age at surgical menopause were 1.39 (1.11-1.75), 1.09 (0.86-1.38), and 0.83 (0.53-1.32). However, no significant association was found between age at natural menopause and all-cause mortality among women undergoing hysterectomy and/or bilateral oophorectomy after menopause. When treated as continuous variables, age at natural menopause without undergoing hysterectomy or bilateral oophorectomy after menopause presented inverse and nonlinear associations with all-cause mortality, whereas age at surgical menopause was linearly inversely associated with all-cause mortality. The association between age at menopause and lifespan was linearly positive regardless of menopausal type. CONCLUSION Young age at menopause was associated with increased risks of all-cause mortality. The later menopause age was related to a longer lifespan.
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Affiliation(s)
- Zailing Xing
- From the Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL
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Stevens EB, Wolfman W, Hernandez-Galan L, Shea AK. The association of depressive symptoms and female sexual functioning in the menopause transition: a cross-sectional study. Menopause 2024; 31:186-193. [PMID: 38350036 DOI: 10.1097/gme.0000000000002309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
OBJECTIVE Sexual dysfunction is very common among middle-aged females. Several factors are considered to influence sexual functioning, including reproductive aging and associated physiological changes as well as life stressors, mental health, and other socioeconomic influences. The objectives of this study are to evaluate the effect of current depressive symptoms on sexual functioning during menopause and to further analyze whether socioeconomic status, age, and antidepressant usage impact this association. METHODS Perimenopausal and postmenopausal women aged 40 to 65 years seeking treatment from a specialized menopause clinic completed a self-report survey with the main outcome measure being the 19-item Female Sexual Function Index quantifying sexual dysfunction. We used the 10-item Center for Epidemiological Studies Depression Scale to estimate a major depressive episode. Statistical analyses were completed to assess the potential associations of socioeconomic factors, age, and antidepressant usage. RESULTS Of the 269 participants, 61.3% met criteria for a major depressive episode and 67.0% had low sexual function. As predicted, women currently experiencing depressive symptoms had a greater risk of low sexual function during perimenopause and postmenopause. Antidepressant usage, low household income, being postmenopausal, and age also predicted low sexual function. CONCLUSIONS Among perimenopausal and postmenopausal women, current depressive symptoms were associated with low sexual function. A biopsychosocial approach should be considered when exploring effective treatment strategies for sexual concerns among midlife women.
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Affiliation(s)
- Emily B Stevens
- From the Research Institute, St Joseph's Healthcare, Hamilton, Canada
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Ravi M, Lathan EC, Wallace S, Hinojosa CA, Jones D, Villalobos J, Karra S, Powers A, Michopoulos V. Indirect effect of negative evaluations of therapy on the association between racial stress and posttraumatic stress disorder symptoms in pregnant Black persons. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2024; 16:382-389. [PMID: 37824259 PMCID: PMC10842040 DOI: 10.1037/tra0001593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Black pregnant individuals are at disproportionate risk for posttraumatic stress disorder (PTSD) compared to other groups. A wealth of literature suggests racial stress contributes to this inequity, but cultural and structural mechanisms, such as perceived barriers to mental health treatment, underlying the relationship between racial stress and PTSD symptoms remain understudied. Negative evaluations of psychotherapy and stigma represent potential mechanisms, though no previous studies have examined these associations. To address this gap, we tested an indirect effect of racial stress on PTSD symptoms through perceived barriers to mental health treatment in pregnant Black individuals. METHOD Mediation analyses were used to assess an indirect relationship between racial stress and PTSD symptoms through perceived barriers to mental health treatment. RESULTS At the bivariate level, racial stress was significantly associated with PTSD symptoms (r = .20, p = .03) and negative evaluations of therapy (r = .22, p = .02), but not with stigma (r = .140, p = .147). Negative evaluations of therapy were also associated with PTSD symptoms (r = .43, p < .001). There was an indirect effect of racial stress on PTSD symptoms through a negative evaluation of therapy, β = .08, SE = 0.04, CI [0.01, 0.18]. More specifically, racial stress was associated with a more negative evaluation of therapy, which was in turn associated with more PTSD symptoms. CONCLUSIONS Results highlight the need for accessible and culturally competent mental health care for pregnant Black individuals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Meghna Ravi
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Emma C. Lathan
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Shimarith Wallace
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Cecilia A. Hinojosa
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Dominique Jones
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Jamie Villalobos
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Sriya Karra
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Abigail Powers
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
| | - Vasiliki Michopoulos
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States of America
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Cui J, Wang Y. Premature ovarian insufficiency: a review on the role of tobacco smoke, its clinical harm, and treatment. J Ovarian Res 2024; 17:8. [PMID: 38191456 PMCID: PMC10775475 DOI: 10.1186/s13048-023-01330-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/17/2023] [Indexed: 01/10/2024] Open
Abstract
Premature ovarian insufficiency (POI) is a condition in which the quantity of follicles and the quality of oocytes gradually decrease. This results in an estrogen secretion disorder and abnormal follicle development, which can lead to related diseases, early onset of menopause, sexual dysfunction, and an increased risk of cardiovascular issues, osteoporosis, and depression, among others. This disease significantly impacts the physical and mental health and overall quality of life of affected women. Factors such as genetic abnormalities, oophorectomy, radiotherapy for malignancy, idiopathic conditions, and an unhealthy lifestyle, including smoking, can accelerate the depletion of the follicular pool and the onset of menopause. Extensive research has been conducted on the detrimental effects of tobacco smoke on the ovaries. This article aims to review the advancements in understanding the impact of tobacco smoke on POI, both in vivo and in vitro. Furthermore, we explore the potential adverse effects of common toxicants found in tobacco smoke, such as polycyclic aromatic hydrocarbons (PAHs), heavy metals like cadmium, alkaloids like nicotine and its major metabolite cotinine, benzo[a]pyrene, and aromatic amines. In addition to discussing the toxicants, this article also reviews the complications associated with POI and the current state of research and application of treatment methods. These findings will contribute to the development of more precise treatments for POI, offering theoretical support for enhancing the long-term quality of life for women affected by this condition.
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Affiliation(s)
- Jinghan Cui
- Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang, 110004, China
| | - Ying Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang, 110004, China.
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14
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Davis SR, Taylor S, Hemachandra C, Magraith K, Ebeling PR, Jane F, Islam RM. The 2023 Practitioner's Toolkit for Managing Menopause. Climacteric 2023; 26:517-536. [PMID: 37902335 DOI: 10.1080/13697137.2023.2258783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVE The Practitioner's Toolkit for Managing the Menopause, developed in 2014, provided an accessible desk-top tool for health-care practitioners caring for women at midlife. To ensure the Toolkit algorithms and supporting information reflect current best practice, the Toolkit has been revised in accordance with the published literature. METHODS A systematic search for guidelines, position and consensus statements pertaining to the menopause and published after 2014 was undertaken, and key recommendations extracted from the Clinical Practice Guidelines determined to be the most robust by formal evaluation. The peer-reviewed literature was further searched for identified information gaps. RESULTS The revised Toolkit provides algorithms that guide the clinical assessment and care of women relevant to menopause. Included are the reasons why women present, information that should be ascertained, issues that may influence shared decision-making and algorithms that assist with determination of menopausal status, menopause hormone therapy (MHT) and non-hormonal treatment options for symptom relief. As clear guidelines regarding when MHT might be indicated to prevent bone loss and subsequent osteoporosis in asymptomatic women were found to be lacking, the Toolkit has been expanded to support shared decision-making regarding bone health. CONCLUSIONS The 2023 Toolkit and supporting document provide accessible desk-top information to support health-care providers caring for women at midlife.The Toolkit has been endorsed by the International Menopause Society, Australasian Menopause Society, British Menopause Society, Endocrine Society of Australia and Jean hailes for Women's Health.
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Affiliation(s)
- S R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, VIC, Australia
| | - S Taylor
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - C Hemachandra
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Ministry of Health, Colombo, Sri Lanka
| | - K Magraith
- Cascade Road General Practice, TAS, Australia
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - P R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - F Jane
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - R M Islam
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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15
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Reeves A, Elliott MR, Karvonen-Gutierrez CA, Harlow SD. Systematic exclusion at study commencement masks earlier menopause for Black women in the Study of Women's Health Across the Nation (SWAN). Int J Epidemiol 2023; 52:1612-1623. [PMID: 37382579 PMCID: PMC10555828 DOI: 10.1093/ije/dyad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 05/30/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Shorter average lifespans for minoritized populations are hypothesized to stem from 'weathering' or accelerated health declines among minoritized individuals due to systemic marginalization. However, evidence is mixed on whether racial/ethnic differences exist in reproductive ageing, potentially due to selection biases in cohort studies that may systematically exclude 'weathered' participants. This study examines racial/ethnic disparities in the age of menopause after accounting for differential selection 'into' (left truncation) and 'out of' (right censoring) a cohort of midlife women. METHODS Using data from the Study of Women's Health Across the Nation (SWAN) cross-sectional screener (N = 15 695) and accompanying ∼20-year longitudinal cohort (N = 3302) (1995-2016), we adjusted for potential selection bias using inverse probability weighting (left truncation) to account for socio-demographic/health differences between the screening and cohort study, and multiple imputation (right censoring) to estimate racial/ethnic differences in age at menopause (natural and surgical). RESULTS Unadjusted for selection, no Black/White differences in menopausal timing [hazard ratio (HR)=0.98 (0.86, 1.11)] were observed. After adjustment, Black women had an earlier natural [HR = 1.13 (1.00, 1.26)] and surgical [HR= 3.21 (2.80, 3.62)] menopause than White women with natural menopause-corresponding to a 1.2-year Black/White difference in menopause timing overall. CONCLUSIONS Failure to account for multiple forms of selection bias masked racial/ethnic disparities in the timing of menopause in SWAN. Results suggest that there may be racial differences in age at menopause and that selection particularly affected the estimated menopausal age for women who experienced earlier menopause. Cohorts should consider incorporating methods to account for all selection biases, including left truncation, as they impact our understanding of health in 'weathered' populations.
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Affiliation(s)
- Alexis Reeves
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Michael R Elliott
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | | | - Siobán D Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Obstetrics and Gynecology, School of Medicine, University of Michigan, Ann Arbor, MI, USA
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16
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Michopoulos V, Huibregtse ME, Chahine EB, Smith AK, Fonkoue IT, Maples-Keller J, Murphy A, Taylor L, Powers A, Stevens JS. Association between perimenopausal age and greater posttraumatic stress disorder and depression symptoms in trauma-exposed women. Menopause 2023; 30:1038-1044. [PMID: 37610715 PMCID: PMC10527101 DOI: 10.1097/gme.0000000000002235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVE This study aimed to determine the relationship between stages of the menopause transition (premenopausal, perimenopausal, and postmenopausal) on symptoms of posttraumatic stress disorder (PTSD) and depression in trauma-exposed women. METHODS A cross-sectional study conducted between 2005 and 2017 recruited and enrolled an urban community sample (n = 6,093) from nonpsychiatric medical clinic waiting rooms of Grady Memorial Hospital, a public safety net hospital in Atlanta, Georgia. Participants were female, 18 to 65 years old, and predominantly Black/African American. RESULTS Of the 6,093 participants, 93.8% were Black/African American, 2.5% were White, and 3.8% were of all other races (Hispanic/Latino, Asian, multiracial). Participants younger than 40 years were categorized as premenopausal (n = 3,166), between 40 and 55 years of age were categorized as perimenopausal (n = 2,127), and older than 55 years were categorized as postmenopausal (n = 790). Menopause status was associated with total PTSD symptom severity ( F2,5416 = 9.61, P < 0.001), symptom severity within all three PTSD symptom clusters (avoidance/numbing symptoms: F2,5416 = 7.10, P < 0.001; intrusive symptoms: F2,5416 = 7.04, P < 0.001; hyperarousal symptoms: F2,5409 = 8.31, P < 0.001), and depression symptom severity ( F2,5148 = 11.4, P < 0.001). Compared with both premenopausal and postmenopausal women, perimenopausal women reported significantly worse total PTSD symptoms, symptoms in the hyperarousal cluster, and depressive symptoms. CONCLUSIONS The current cross-sectional data show that symptoms of PTSD and depression in women are associated with reproductive age, such that perimenopausal women show higher symptom severity than premenopausal and postmenopausal women. Future longitudinal studies can reveal how changes in hormones over the course of the menopause transition impact the symptoms, neurobiology, and psychophysiology of PTSD.
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Affiliation(s)
- Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Megan E. Huibregtse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - E. Britton Chahine
- Department of Gynecology and Obstetrics, Emory University School of Medicine Atlanta, GA, United States of America
| | - Alicia K. Smith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
- Department of Gynecology and Obstetrics, Emory University School of Medicine Atlanta, GA, United States of America
| | - Ida T. Fonkoue
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Jessica Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Amy Murphy
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Linzie Taylor
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
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17
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Mailhot G, Denis MH, Beauchamp-Parent C, Jomphe V. Nutritional management of people living with cystic fibrosis throughout life and disease continuum: Changing times, new challenges. J Hum Nutr Diet 2023; 36:1675-1691. [PMID: 37515397 DOI: 10.1111/jhn.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
Cystic fibrosis (CF) is a genetic disease caused by mutations in the gene encoding for the ion channel cystic fibrosis transmembrane conductance regulator (CFTR). The management of CF disease has evolved in recent decades from treating downstream disease manifestations affecting the airways, the lungs and the gastrointestinal system to addressing the CFTR gene defect. The advent of CFTR modulators, which correct the functionality of the defective CFTR, contributes to reshaping the landscape of CF demographics, prognosis and therapies, including nutritional management. A spectrum of clinical manifestations is emerging within the same patient population where undernutrition and nutritional deficiencies coexist with excessive weight gain and metabolic derangements. Such contrasting presentations challenge current practices, require adjustments to traditional approaches, and involve more individualised interventions. This narrative review examines the current state of knowledge on the nutritional management of people living with cystic fibrosis from early life to adulthood in the era of CFTR modulation.
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Affiliation(s)
- Geneviève Mailhot
- Department of Nutrition, Faculty of Medicine, Montreal, QC, Canada
- CHU Sainte-Justine Research Center, Montreal, QC, Canada
| | | | | | - Valérie Jomphe
- Lung Transplant Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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18
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Ramli NZ, Yahaya MF, Mohd Fahami NA, Abdul Manan H, Singh M, Damanhuri HA. Brain volumetric changes in menopausal women and its association with cognitive function: a structured review. Front Aging Neurosci 2023; 15:1158001. [PMID: 37818479 PMCID: PMC10561270 DOI: 10.3389/fnagi.2023.1158001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/04/2023] [Indexed: 10/12/2023] Open
Abstract
The menopausal transition has been proposed to put women at risk for undesirable neurological symptoms, including cognitive decline. Previous studies suggest that alterations in the hormonal milieu modulate brain structures associated with cognitive function. This structured review provides an overview of the relevant studies that have utilized MRI to report volumetric differences in the brain following menopause, and its correlations with the evaluated cognitive functions. We performed an electronic literature search using Medline (Ovid) and Scopus to identify studies that assessed the influence of menopause on brain structure with MRI. Fourteen studies met the inclusion criteria. Brain volumetric differences have been reported most frequently in the frontal and temporal cortices as well as the hippocampus. These regions are important for higher cognitive tasks and memory. Additionally, the deficit in verbal and visuospatial memory in postmenopausal women has been associated with smaller regional brain volumes. Nevertheless, the limited number of eligible studies and cross-sectional study designs warrant further research to draw more robust conclusions.
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Affiliation(s)
- Nur Zuliani Ramli
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Department of Biomedical Sciences, Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Mohamad Fairuz Yahaya
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nur Azlina Mohd Fahami
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hanani Abdul Manan
- Functional Image Processing Laboratory, Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Meharvan Singh
- Department of Cell and Molecular Physiology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Hanafi Ahmad Damanhuri
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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19
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Eliot L, Beery AK, Jacobs EG, LeBlanc HF, Maney DL, McCarthy MM. Why and How to Account for Sex and Gender in Brain and Behavioral Research. J Neurosci 2023; 43:6344-6356. [PMID: 37704386 PMCID: PMC10500996 DOI: 10.1523/jneurosci.0020-23.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 09/15/2023] Open
Abstract
Long overlooked in neuroscience research, sex and gender are increasingly included as key variables potentially impacting all levels of neurobehavioral analysis. Still, many neuroscientists do not understand the difference between the terms "sex" and "gender," the complexity and nuance of each, or how to best include them as variables in research designs. This TechSights article outlines rationales for considering the influence of sex and gender across taxa, and provides technical guidance for strengthening the rigor and reproducibility of such analyses. This guidance includes the use of appropriate statistical methods for comparing groups as well as controls for key covariates of sex (e.g., total intracranial volume) and gender (e.g., income, caregiver stress, bias). We also recommend approaches for interpreting and communicating sex- and gender-related findings about the brain, which have often been misconstrued by neuroscientists and the lay public alike.
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Affiliation(s)
- Lise Eliot
- Stanson Toshok Center for Brain Function and Repair, Chicago Medical School, Rosalind Franklin University of Medicine & Science, North Chicago, Illinois 60064
| | - Annaliese K Beery
- Department of Integrative Biology, University of California-Berkeley, Berkeley, California 94720
| | - Emily G Jacobs
- Department of Psychological & Brain Sciences, University of California-Santa Barbara, Santa Barbara, California 93106
| | - Hannah F LeBlanc
- Division of the Humanities & Social Sciences, California Institute of Technology, Pasadena, California 91125
| | - Donna L Maney
- Department of Psychology, Emory University, Atlanta, Georgia 30322
| | - Margaret M McCarthy
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, Maryland 21201
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20
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Zhang X, Huangfu Z, Wang S. Review of mendelian randomization studies on age at natural menopause. Front Endocrinol (Lausanne) 2023; 14:1234324. [PMID: 37766689 PMCID: PMC10520463 DOI: 10.3389/fendo.2023.1234324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Menopause marks the end of the reproductive phase of life. Based on epidemiological studies, abnormal age at natural menopause (ANM) is thought to contribute to a number of adverse outcomes, such as osteoporosis, cardiovascular disease, and cancer. However, the causality of these associations remains unclear. A powerful epidemiological method known as Mendelian randomization (MR) can be used to clarify the causality between ANM and other diseases or traits. The present review describes MR studies that included ANM as an exposure, outcome and mediator. The findings of MR analyses on ANM have revealed that higher body mass index, poor educational level, early age at menarche, early age at first live birth, early age at first sexual intercourse, and autoimmune thyroid disease appear to be involved in early ANM etiology. The etiology of late ANM appears to be influenced by higher free thyroxine 4 and methylene tetrahydrofolate reductase gene mutations. Furthermore, early ANM has been found to be causally associated with an increased risk of osteoporosis, fracture, type 2 diabetes mellitus, glycosylated hemoglobin, and the homeostasis model of insulin resistance level. In addition, late ANM has been found to be causally associated with an increased systolic blood pressure, higher risk of breast cancer, endometrial cancer, endometrioid ovarian carcinoma, lung cancer, longevity, airflow obstruction, and lower risk of Parkinson's disease. ANM is also a mediator for breast cancer caused by birth weight and childhood body size. However, due to the different instrumental variables used, some results of studies are inconsistent. Future studies with more valid genetic variants are needed for traits with discrepancies between MRs or between MR and other types of epidemiological studies.
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Affiliation(s)
- Xiao Zhang
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhao Huangfu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shaowei Wang
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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21
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Kundu S, Acharya SS. Study on depletion of ovarian function and late-life chronic diseases in India. Int J Gynaecol Obstet 2023; 162:1057-1067. [PMID: 37158425 DOI: 10.1002/ijgo.14818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/28/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The current study aims to understand premature and early menopausal age in association with chronic conditions. METHODS The present cross-sectional study analyzed nationally representative data from LASI (Longitudinal Aging Study in India) from 2017 to 2018. Bivariate analysis including cross-tabulation and χ2 tests were performed. Further multiple regression analysis was performed, using the generalized linear model of logit link. RESULTS Approximately 2533 (8%) older women reported that they had experienced premature menopause (before age 40), while 3889 (12.4%) reported having early menopause (age 40-44). The likelihood of a woman with premature menopause developing cardiovascular diseases (CVDs) is 15% higher (adjusted odds ratio [AOR], 1.15; P < 0.05) than those who do not experience premature menopause, while women with early menopause have a 13% higher risk (AOR, 1.13; P < 0.05). For women who experienced premature menopause and were also smokers, the probability of developing CVDs was higher. Other chronic diseases such as bone or joint problems, diabetes, and eye vision problems were also shown to be significant health problems among women who had premature ovarian failure. CONCLUSION Our results show significant association between women with premature or early depletion of ovarian function and chronic health conditions such as cardiovascular diseases, bone or joint problems, vision problems, and neurological or psychiatric disorders at their later life ages. Comprehensive strategies in the form of lifestyle changes may regulate hormonal levels and allow the body to reach menopause at the appropriate age.
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Affiliation(s)
- Sampurna Kundu
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
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22
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Wu X, Wong KW, Gurvich C, Dong Y. Impact of COVID-19 on health of menopausal women: A scoping review. Gen Hosp Psychiatry 2023; 84:125-141. [PMID: 37473503 DOI: 10.1016/j.genhosppsych.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE This scoping review aims to map and summarize the direct impact of contracting COVID-19, and the indirect consequences of the pandemic on the health of peri- and postmenopausal women. METHODS Searches for published studies were conducted in CINAHL, Cochrane, EMBASE, PubMed, Scopus, Web of Science, PsycINFO and ProQuest from inception to 26 Oct, 2022. Grey literature and reference lists of included studies were searched. Results are presented as a narrative synthesis and tables. RESULTS Thirty-eight studies were selected in this review. Overall, a majority of studies (n = 31) suggest that menopausal women were negatively impacted, while lesser studies (n = 21) concluded that they were not and some studies (n = 14) produced both negative and neutral results. Twenty-three studies presented on the direct health impact of COVID-19 infections on menopausal women. Eleven studies focused on the indirect impact of COVID-19 in terms of contact restriction measures on menopausal health during the pandemic compared to before the pandemic. Six studies described the different indirect impact of COVID-19 on health of menopausal women with various characteristics or lifestyles. CONCLUSION The direct and indirect impacts of COVID-19 on menopausal women on physical, mental health and social wellbeing are largely negative.
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Affiliation(s)
- Xinyao Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kang Wei Wong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Caroline Gurvich
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Yanhong Dong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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23
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Xing Z, Alman AC, Kirby RS. Premature Menopause and All-Cause Mortality and Life Span Among Women Older Than 40 Years in the NHANES I Epidemiologic Follow-Up Study: Propensity Score Matching Analysis. J Womens Health (Larchmt) 2023; 32:950-959. [PMID: 37439866 DOI: 10.1089/jwh.2023.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Objective: Findings from studies of the long-term effect of premature menopause on risks of all-cause mortality in women are equivocal. We used the approach of propensity score matching to examine the causal association of premature menopause with all-cause mortality and life span among women older than 40 years. Methods: The data were from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. We calculated the propensity score of premature menopause using a logistic regression model, then matched premature menopause with nonpremature menopause according to the score and the ratio of 1:1. We estimated mortality hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazard models. We also analyzed and plotted the relationship between age at menopause and reproductive life span with all-cause mortality and life span. Results: The mean age of 1,210 women was 55.4 ± 10.8 years at baseline. The unadjusted and adjusted HRs of all-cause mortality for women with premature menopause were 1.46 (95% CI: 1.08-1.96) and 1.53 (95% CI: 1.13-2.08), respectively, compared to nonpremature menopause. Nonlinear associations were found between age at menopause, reproductive life span, all-cause mortality, and life span. Menopausal age <37.5 years of age or reproductive life span <24 years increased the risk of all-cause mortality. Women with menopausal age <39 years of age or reproductive life span <24 years had a lower mean life span than the overall average of 76 years. Conclusions: Premature menopause significantly increased all-cause mortality risk and shortened life span in women. As women's age at menopause or reproductive life span increases, their overall life span also tends to increase.
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Affiliation(s)
- Zailing Xing
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Amy C Alman
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
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24
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Thuraisingham C, Nalliah S. Is menopause managed well enough in general practice? MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2023; 18:49-100. [PMID: 37719692 PMCID: PMC10504900 DOI: 10.51866/cm.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Menopause is an important phase in the life of older women. Women's life expectancy has increased worldwide. As women experience and perceive menopause differently depending on their personal, family and sociocultural backgrounds, perimenopausal symptoms can often go unnoticed and missed by general practitioners. General practitioners are uniquely placed in the healthcare delivery pyramid to close this gap and improve patients' quality of life by identifying perimenopausal signs and symptoms early. This article shares knowledge about continuing medical education for general practitioners to close the existing gap. As there is great variability within each menopausal woman's experience as well as among individual women, there is a need to individualise and render personalised care. By being able to discuss accepted and safe standards of care and by advocating for a holistic approach incorporating both non-pharmacological and pharmacological strategies, general practitioners would be able to improve the confidence of their patients for better health outcomes.
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Affiliation(s)
- Chandramani Thuraisingham
- MBBS, FAFP, FRACGP, AM, DRM, PDOH, Department of Family Medicine, International Medical University, Clinical Campus Seremban, Seremban, Negeri Sembilan, Malaysia.
| | - Sivalingam Nalliah
- MBBS, MCGP, FRCOG, FAMM, FICS, M Ed, MIDT, Department of Obstetrics & Gynaecology, International Medical University, Clinical Campus Seremban, Seremban, Negeri Sembilan, Malaysia
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Haber HR, French HM, Movilla PR, Isaacson KB, Morris SN. Take it or leave it: oophorectomy at the time of benign hysterectomy. Curr Opin Obstet Gynecol 2023; 35:344-351. [PMID: 37266568 DOI: 10.1097/gco.0000000000000885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE OF REVIEW Previous modeling data suggest ovarian conservation up to age 65 for women without adnexal disease and at average risk of ovarian cancer because of an increase in mortality associated with ovarian removal. Recent modeling data challenges this practice. This review of recent literature will update providers regarding consideration for oophorectomy at time of benign hysterectomy. RECENT FINDINGS Oophorectomy at time of hysterectomy for women less than 50 years with estrogen supplementation and greater than 50 years without estrogen supplementation is not associated with increased mortality. SUMMARY Although not associated with increased mortality, the decision to remove the ovaries at time of hysterectomy in women older than 50 years is nuanced and requires careful shared decision-making, considering unique patient factors.
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Affiliation(s)
- Hilary R Haber
- Minimally Invasive Gynecologic Surgery, Women's Health Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA
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MacLellan J, Dixon S, Bi S, Toye F, McNiven A. Perimenopause and/or menopause help-seeking among women from ethnic minorities: a qualitative study of primary care practitioners' experiences. Br J Gen Pract 2023; 73:e511-e518. [PMID: 37130614 PMCID: PMC10170522 DOI: 10.3399/bjgp.2022.0569] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/20/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Each woman's experience of the perimenopause and/or menopause is individual and unique. Research shows women from ethnic minorities often have different experiences from their White peers, and these are not being considered in conversations about the menopause. Women from ethnic minorities already face barriers to help-seeking in primary care, and clinicians have expressed challenges in cross cultural communication including the risk that women from ethnic minorities' perimenopause and/or menopause health needs are not being met. AIM To explore primary care practitioners' experiences of perimenopause and/or menopause help-seeking among women from ethnic minorities. DESIGN AND SETTING A qualitative study of 46 primary care practitioners from 35 practices across 5 regions of England, with patient and public involvement (PPI) consultations with 14 women from three ethnic minority groups. METHOD Primary care practitioners were surveyed using an exploratory approach. Online and telephone interviews were conducted and the data were analysed thematically. The findings were presented to three groups of women from ethnic minorities to inform interpretation of the data. RESULTS Practitioners described a lack of awareness of perimenopause and/or menopause among many women from ethnic minorities, which they felt impacted their help-seeking and communication of symptoms. Cultural expressions of embodied experiences could offer challenges to practitioners to 'join the dots' and interpret experiences through a holistic menopause care lens. Feedback from the women from ethnic minorities provided context to practitioner findings through examples from their individual experiences. CONCLUSION There is a need for increased awareness and trustworthy information resources to help women from ethnic minorities prepare for the menopause, and clinicians to recognise their experiences and offer support. This could improve women's immediate quality of life and potentially reduce future disease risk.
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Affiliation(s)
- Jennifer MacLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Sharon Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Sultana Bi
- The Lister Surgery, Westbourne Green Community Health Centre, Bradford
| | - Francine Toye
- Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Abigail McNiven
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Yang BY, Coult J, Blackwood J, Kwok H, Rajah A, Goldenberg I, Sotoodehenia N, Harris JR, Kudenchuk PJ, Rea TD. Title: Age, sex, and survival following ventricular fibrillation cardiac arrest: a mechanistic evaluation of the ECG waveform: Short title: Age, sex, and survival via VF waveform in OHCA. Resuscitation 2023:109891. [PMID: 37390958 DOI: 10.1016/j.resuscitation.2023.109891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Studies of outcome differences by sex in out-of-hospital cardiac arrest (OHCA) have produced mixed results that may depend on age, a potential surrogate for menopausal status. OBJECTIVE We used quantitative measures of ventricular fibrillation (VF) waveforms - indicators of the myocardium's physiology - to assess whether survival differences according to sex and age group may be mediated via a biologic mechanism. METHODS We conducted a cohort study of VF-OHCA in a metropolitan EMS system. We used multivariable logistic regression to assess the association of survival to hospital discharge with sex and age group (<55, ≥55 years). We determined the proportion of outcome difference mediated by VF waveform measures: VitalityScore and amplitude spectrum area (AMSA). RESULTS Among 1526 VF-OHCA patients, the average age was 62 years, and 29% were female. Overall, younger women were more likely to survive than younger men (survival 67% vs 54%, p=0.02), while survival among older women and older men did not differ (40% vs 44%, p=0.3). Adjusting for Utstein characteristics, women <55 compared to men <55 had greater odds of survival to hospital discharge (OR=1.93, 95% CI 1.23-3.09), an association not observed between the ≥55 groups. Waveform measures were more favorable among women and mediated some of the beneficial association between female sex and survival among those <55 years: 47% for VitalityScore and 25% for AMSA. CONCLUSIONS Women <55 years were more likely to survive than men <55 years following VF-OHCA. The biologic mechanism represented by VF waveform mediated some, though not all, of the outcome difference.
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Affiliation(s)
- Betty Y Yang
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jason Coult
- Department of Medicine, Division of General Medicine, University of Washington, Seattle, WA, United States
| | - Jennifer Blackwood
- Emergency Medical Services Division of Public Health - Seattle & King County, Seattle, WA, United States
| | - Heemun Kwok
- Department of Emergency Medicine, University of Washington. Postal address: 326 9th Avenue, Seattle, WA, 98104, United States
| | - Anjali Rajah
- Department of Medicine, Division of General Medicine, University of Washington, Seattle, WA, United States
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, United States
| | - Nona Sotoodehenia
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, United States
| | - Jeffrey R Harris
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
| | - Peter J Kudenchuk
- Emergency Medical Services Division of Public Health - Seattle & King County, Seattle, WA, United States; Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, United States
| | - Thomas D Rea
- Department of Medicine, Division of General Medicine, University of Washington, Seattle, WA, United States; Emergency Medical Services Division of Public Health - Seattle & King County, Seattle, WA, United States
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28
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Woods NF, Coslov N, Richardson M. Anticipated age of perimenopausal experiences, stress, satisfaction, and health and well-being: observations from the Women Living Better Survey. Menopause 2023:00042192-990000000-00197. [PMID: 37279510 DOI: 10.1097/gme.0000000000002206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE People's expectations about the timing of developmental events, specifically the ages at which they will occur, are influenced by social and cultural contexts. When expected timing and lived experience are divergent, events such as menopause may be associated with greater stress or distress. We hypothesized that being "off-time," that is, experiencing perimenopause-related menstrual cycle changes or symptoms in a timeframe before a person expects them, would lead to worse ratings on measures of stress, satisfaction, and health. METHODS Participants responded to the online Women Living Better Survey during March to August 2020; 1,262 met the eligibility criteria for inclusion in hypothesis testing. Being "off-time" referred to experiencing changes related to perimenopause at a younger age than that at which participants anticipated experiencing such changes. Using a one-way analysis of variance (ANOVA), we examined differences in being "off-time" versus "on-time" on seven participant-rated measures: stress (overall and health-related stress), satisfaction with life roles and activities, and well-being and health ratings (interference with daily activities, interference with relationships, "not feeling like myself," and perceived health). Using 2-way ANOVA, we then tested hypothesized differences between being "off-time" and on-time and experiencing perimenopause-related menstrual cycle changes, vasomotor/sleep symptoms, or volatile mood symptoms on the same seven measures. RESULTS Those who were "off-time" versus "on-time" reported significantly poorer health ratings in a one-way ANOVA. Experiencing more noticeable perimenopause-related menstrual cycle changes was significantly related to greater health stress, overall stress, satisfaction with life roles and activities, interference with daily activities, interference with relationships, and "not feeling like myself" (all P < 0.05), but not to health ratings. Experiencing more bothersome vasomotor symptoms was significantly related to health stress, overall stress, interference with daily activities, interference with relationships, and "not feeling like myself" more of the time and to poorer perceived health (all P < 0.05). There were no significant interaction effects of being "off-time" and experiencing perimenopause-related menstrual cycle changes or vasomotor symptoms. In contrast, having more bothersome volatile mood symptoms significantly affected health stress, overall stress, satisfaction with life roles and activities, interference with daily activities, interference with relationships, "not feeling like myself" more of the time, and perceived health. Finally, there was a significant interaction effect of being "off-time" and volatile mood symptoms on health stress, satisfaction with life roles and activities, and perceived health (all P < 0.05). CONCLUSIONS Being "off-time" alone had little effect on studied measures with the exception of poorer perceived health. Experiencing more noticeable perimenopause-related menstrual cycle changes or having more bothersome vasomotor symptoms influenced several measures, but there were no interactive effects with being "off-time." In contrast, those who were "off-time" and experiencing more bothersome volatile mood symptoms reported greater health stress, lower satisfaction with life roles and activities, and poorer perceived health. These interactive effects of being "off-time" and experiencing volatile mood suggest a need for greater attention to the link between volatile mood and perimenopause. Furthermore, anticipatory guidance for those on the path to menopause should include the possibility of volatile mood symptoms.
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Affiliation(s)
- Nancy Fugate Woods
- From the Biobehavioral Nursing and Clinical Informatics, University of Washington, Seattle, WA
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Lee JJK, Jung YL, Cheong TC, Espejo Valle-Inclan J, Chu C, Gulhan DC, Ljungström V, Jin H, Viswanadham VV, Watson EV, Cortés-Ciriano I, Elledge SJ, Chiarle R, Pellman D, Park PJ. ERα-associated translocations underlie oncogene amplifications in breast cancer. Nature 2023; 618:1024-1032. [PMID: 37198482 PMCID: PMC10307628 DOI: 10.1038/s41586-023-06057-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 04/05/2023] [Indexed: 05/19/2023]
Abstract
Focal copy-number amplification is an oncogenic event. Although recent studies have revealed the complex structure1-3 and the evolutionary trajectories4 of oncogene amplicons, their origin remains poorly understood. Here we show that focal amplifications in breast cancer frequently derive from a mechanism-which we term translocation-bridge amplification-involving inter-chromosomal translocations that lead to dicentric chromosome bridge formation and breakage. In 780 breast cancer genomes, we observe that focal amplifications are frequently connected to each other by inter-chromosomal translocations at their boundaries. Subsequent analysis indicates the following model: the oncogene neighbourhood is translocated in G1 creating a dicentric chromosome, the dicentric chromosome is replicated, and as dicentric sister chromosomes segregate during mitosis, a chromosome bridge is formed and then broken, with fragments often being circularized in extrachromosomal DNAs. This model explains the amplifications of key oncogenes, including ERBB2 and CCND1. Recurrent amplification boundaries and rearrangement hotspots correlate with oestrogen receptor binding in breast cancer cells. Experimentally, oestrogen treatment induces DNA double-strand breaks in the oestrogen receptor target regions that are repaired by translocations, suggesting a role of oestrogen in generating the initial translocations. A pan-cancer analysis reveals tissue-specific biases in mechanisms initiating focal amplifications, with the breakage-fusion-bridge cycle prevalent in some and the translocation-bridge amplification in others, probably owing to the different timing of DNA break repair. Our results identify a common mode of oncogene amplification and propose oestrogen as its mechanistic origin in breast cancer.
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Affiliation(s)
- Jake June-Koo Lee
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
- Ludwig Center at Harvard, Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Youngsook Lucy Jung
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
| | - Taek-Chin Cheong
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Chong Chu
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Doga C Gulhan
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Ludwig Center at Harvard, Harvard Medical School, Boston, MA, USA
| | - Viktor Ljungström
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Hu Jin
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | | | - Emma V Watson
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Department of Systems Biology, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Isidro Cortés-Ciriano
- European Molecular Biology Laboratory, European Bioinformatics Institute, Hinxton, UK
| | - Stephen J Elledge
- Ludwig Center at Harvard, Harvard Medical School, Boston, MA, USA
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Roberto Chiarle
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - David Pellman
- Ludwig Center at Harvard, Harvard Medical School, Boston, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Department of Cell Biology, Harvard Medical School, Boston, MA, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Peter J Park
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
- Ludwig Center at Harvard, Harvard Medical School, Boston, MA, USA.
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Hulteen RM, Marlatt KL, Allerton TD, Lovre D. Detrimental Changes in Health during Menopause: The Role of Physical Activity. Int J Sports Med 2023; 44:389-396. [PMID: 36807278 PMCID: PMC10467628 DOI: 10.1055/a-2003-9406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Midlife women experience changes in cardiometabolic, physical, and psychosocial health during menopause that negatively impacts their overall quality of life. Factors that contribute to these increases in cardiometabolic risk include weight gain as well as increases in fat mass (particularly abdominal adiposity), insulin resistance, and vascular dysfunction. Other deleterious changes in physical health (e. g. reduced sleep health, bone density, and balance) as well as changes in psychosocial health (e. g. mood, anxiety, and depression) often coincide and are linked to these increases in cardiometabolic risk. Physical activity and exercise are important lifestyle components that have been demonstrated to improve cardiometabolic, physical, and psychosocial health, yet physical activity and exercise is known to decline during perimenopause and into the postmenopausal years. In this narrative review, we summarize these changes in overall health during menopause as well as how declining physical activity contributes to these changes. Additionally, we discuss how incorporating physical activity and exercise during menopause can potentially ameliorate health declines. We conclude that there exists a significant, positive impact of physical activity on cardiometabolic, physical, and psychological health among midlife women, particularly if undertaken during the perimenopausal and postmenopausal years.
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Affiliation(s)
- Ryan M. Hulteen
- Kinesiology, Louisiana State University, Baton Rouge, United States
| | - Kara L. Marlatt
- Clinical Science, Pennington Biomedical Research Center, Baton Rouge, United States
| | - Timothy D. Allerton
- Basic Science, Pennington Biomedical Research Center, Baton Rouge, United States
| | - Dragana Lovre
- School of Medicine, Tulane University Health Sciences Center, New Orleans, United States
- Medicine, Southeast Louisiana Veterans Health Care System, New Orleans, United States
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Leone T, Brown L, Gemmill A. Secular trends in premature and early menopause in low-income and middle-income countries. BMJ Glob Health 2023; 8:bmjgh-2023-012312. [PMID: 37308265 DOI: 10.1136/bmjgh-2023-012312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/20/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND While secular trends in high-income countries show an increase in the mean age at menopause, it is unclear if there is a similar pattern in low-income and middle-income countries (LMICs), where women's exposure to biological, environmental and lifestyle determinants of menopause may differ. Premature (before age 40 years) and early (ages 40-44 years) menopause could have negative repercussions on later life health outcomes which in ageing societies could mean further stress on low-resource health systems. An evaluation of such trends in LMICs has been hampered by the suitability, quality and comparability of data from these countries. METHODS Using 302 standardised household surveys from 1986 to 2019, we estimate trends and CIs using bootstrapping in the prevalence of premature and early menopause in 76 LMICs. We also developed a summary measure of age at menopause for women who experience menopause before the age of 50 years based on demographic estimation methods that can be used to measure menopausal status in surveys with truncated data. RESULTS Trends indicate an increasing prevalence of early and premature menopause in LMICs, in particular in sub-Saharan Africa and South/Southeast Asia. These regions also see a suggested decline of the mean age at menopause with greater variation across continents. CONCLUSIONS This study enables the analysis of menopause timing by exploiting data generally used for the study of fertility by methodologically allowing the use of truncated data. Findings show a clear increase in prevalence of premature and early menopause in the regions with the highest fertility with possible consequences for later life health. They also show a different trend compared with high-income regions, confirming a lack of generalisability and the importance of accounting for nutritional and health transitions at the local level. This study calls for further data and research on menopause on a global scale.
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Affiliation(s)
- Tiziana Leone
- Department of International Development, London School of Economics and Political Science, London, UK
| | - Laura Brown
- Institute for Global Health, University College London, London, UK
| | - Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland, USA
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Kim C, Wellons M. Sex Hormones and Cardiovascular Disease in Relation to Menopause. Endocrinol Metab Clin North Am 2023; 52:195-210. [PMID: 36948775 DOI: 10.1016/j.ecl.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Natural menopause is defined as the cessation of menstruation among women who have not undergone hysterectomy or bilateral oophorectomy. The implications of menopause management are particularly important with the aging of the population and increasing awareness of the importance of midlife risk upon longevity. Our understanding of the relationships between reproductive milestones and cardiovascular disease continues to evolve particularly regarding shared determinants of health.
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Affiliation(s)
- Catherine Kim
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA; Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.
| | - Melissa Wellons
- Department of Medicine, Vanderbilt University Medical Center, 3841 Green Hills Village Dr #200, Nashville, TN 37215, USA
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Opoku AA, Abushama M, Konje JC. Obesity and menopause. Best Pract Res Clin Obstet Gynaecol 2023:102348. [PMID: 37244787 DOI: 10.1016/j.bpobgyn.2023.102348] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/30/2023] [Indexed: 05/29/2023]
Abstract
The global obesity pandemic continues to rise, with figures from the World Health Organization showing that 13% of the world's adult population was obese in 2016. Obesity has significant implications, with an increased risk of cardiovascular diseases, diabetes mellitus, metabolic syndrome, and several malignancies. The menopausal transition is associated with increased obesity, a transition from a gynecoid to an android body shape, and increased abdominal and visceral fat, which further worsens the associated cardiometabolic risks. Whether this increased obesity is a consequence of menopause, age, genetics, or environmental factors has long been debated. Increasing life expectancy means women spend a significant part of their lives in the menopause. As such, understanding this complex interplay of obesity and menopause is important to providing the right advice/management. We review the current evidence on obesity and menopause, focusing on the implications of increased obesity during menopause, the impact of menopause on obesity, and the effect of available treatments on associated morbidities.
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Affiliation(s)
- Albert A Opoku
- Consultant Obstetrician and Gynecologist, Hamad Medical Corporation, Al Wakra Hospital, P O Box 82228, Al Wakra, Qatar; Assistant Professor in Clinical Obstetrics and Gynecology, Weill Cornell, Medicine, P O Box 24144, Doha, Qatar.
| | - Mandy Abushama
- Assistant Professor in Clinical Obstetrics and Gynecology, Weill Cornell Medicine, Qatar; Senior Consultant Obstetrician and Gynecologist, Feto Maternal Center, Al Markhiya, Doha, Qatar.
| | - Justin C Konje
- Senior Consultant Obstetrician and Gynecologist, Feto Maternal Center, Al Markhiya, Doha, Qatar; Professor of Obstetrics and Gynecology, Weill Cornell Medicine, Qatar; Emeritus Professor, Obstetrics and Gynecology, Department of Health Sciences, University of Leicester, United Kingdom.
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Kar D, Roy S. Factors associated with the CVD risk factors and body fat pattern of postmenopausal Hindu caste and Lodha tribal populations living in India: An exploratory study. Womens Midlife Health 2023; 9:4. [PMID: 37095574 PMCID: PMC10127089 DOI: 10.1186/s40695-023-00087-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/13/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Loss in ovarian function during mid-life results in adverse changes in the cardiovascular profile of women. The association between CVD risk factors and menopause differ cross-culturally since several modifiable factors play significant roles in explaining CVD mortality in addition to differences in endogenous estrogen. Very few of the studies from the Indian subcontinent have been concerned with the menopause-specific CVD risk factors, particularly among the tribal groups. Thus, we intended to study the variations in body fat pattern and CVD risk factors between Hindu caste and Lodha tribal postmenopausal women and how these risk factors were associated with differential socio-economic, reproductive and menstrual characteristics and lifestyle variables. The Lodha tribal populations is considered a Particularly Vulnerable Group (PVTG) in this country. METHODS This cross-sectional study was conducted among the Bengali Hindu caste and Lodha tribal populations of the State of West Bengal, India covering three districts namely Howrah, Jhargram and East Midnapure. A total of 197 postmenopausal participants were recruited for this study (urban caste 69, rural caste 65 and rural Lodha 63). Data on blood glucose and total cholesterol levels, blood pressure, muscle mass, body fat distribution and sociodemographic, reproductive and menstrual history and lifestyle variables were collected following standard protocols. Analysis of variance (ANOVA) was applied to compare blood glucose, total cholesterol and blood pressure levels and body fat measures across the three populations. Stepwise multiple linear regression analysis was performed to find out the factors associated with CVD risk factors. The data were analyzed with the Statistical Package for Social Science version 20.0(IBM corporation, 2011). RESULTS This cross-sectional comparison of women at midlife, though exploratory in nature showed significant differences in body fat pattern and CVD risk factors between caste and tribal groups owing to socioeconomic disparities and, differences in reproductive characteristics and lifestyle factors. CONCLUSION The caste and tribal populations differed significantly in body fat pattern and CVD risk factors and in the factors associated with CVD risk suggesting interplay between menopause and modifiable factors in explaining CVD risk factors during mid-life.
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Affiliation(s)
- Debasmita Kar
- Department of Anthropolgy, University of Calcutta, 35 Ballygunge Circular Road, 700019 Ballygunge, Kolkata, India
| | - Subho Roy
- Department of Anthropolgy, University of Calcutta, 35 Ballygunge Circular Road, 700019 Ballygunge, Kolkata, India
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Faubion SS, Enders F, Hedges MS, Chaudhry R, Kling JM, Shufelt CL, Saadedine M, Mara K, Griffin JM, Kapoor E. Impact of Menopause Symptoms on Women in the Workplace. Mayo Clin Proc 2023:S0025-6196(23)00112-X. [PMID: 37115119 DOI: 10.1016/j.mayocp.2023.02.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/20/2023] [Accepted: 02/16/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To evaluate the impact of menopause symptoms on work outcomes and to assess the estimated economic impact. PATIENTS AND METHODS Women aged 45 to 60 years receiving primary care at 1 of the 4 Mayo Clinic sites were invited to participate in a survey study (Hormones and ExpeRiences of Aging) from March 1 through June 30, 2021. A total of 32,469 surveys were sent, with 5219 responses (16.1% response rate). Of the 5219 respondents, 4440 (85.1%) reported current employment information and were included in the study. The primary outcome was self-reported adverse work outcomes related to menopause symptoms assessed by the Menopause Rating Scale (MRS). RESULTS The mean age of the 4440 participants was 53.9±4.5 years, with the majority being White (4127 [93.0%]), married (3398 [76.5%]), and educated (2632 [59.3%] college graduate or higher); the mean total MRS score was 12.1, signifying moderate menopause symptom burden. Overall, 597 women (13.4%) reported at least one adverse work outcome due to menopause symptoms; 480 women (10.8%) reported missing work in the preceding 12 months (median, 3 days missed). The odds of reporting an adverse work outcome increased with increasing menopause symptom severity; women in the highest quartile of total MRS scores were 15.6 (95% CI, 10.7 to 22.7; P<.001) times more likely to have an adverse work outcome vs those in the first quartile. Based on workdays missed due to menopause symptoms, we estimate an annual loss of $1.8 billion in the United States. CONCLUSION This large cross-sectional study identified a major negative impact of menopause symptoms on work outcomes and the need to improve medical treatment for these women and make the workplace environment more supportive. Additional studies are needed to confirm these findings in larger and more diverse groups of women.
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Affiliation(s)
- Stephanie S Faubion
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL; Mayo Clinic Women's Health, Mayo Clinic, Rochester, MN.
| | - Felicity Enders
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Mary S Hedges
- Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Rajeev Chaudhry
- Mayo Clinic Women's Health, Mayo Clinic, Rochester, MN; Division of Community Internal Medicine, Mayo Clinic Health System, Eau Claire, WI
| | - Juliana M Kling
- Mayo Clinic Women's Health, Mayo Clinic, Rochester, MN; Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Chrisandra L Shufelt
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL; Mayo Clinic Women's Health, Mayo Clinic, Rochester, MN
| | - Mariam Saadedine
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL; Mayo Clinic Women's Health, Mayo Clinic, Rochester, MN
| | - Kristin Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Joan M Griffin
- Division of Health Care Delivery Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Ekta Kapoor
- Mayo Clinic Women's Health, Mayo Clinic, Rochester, MN; Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
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Li M, Zhu Y, Wei J, Chen L, Chen S, Lai D. The global prevalence of premature ovarian insufficiency: a systematic review and meta-analysis. Climacteric 2023; 26:95-102. [PMID: 36519275 DOI: 10.1080/13697137.2022.2153033] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objective of this review was to answer the global prevalence of premature ovarian insufficiency (POI), and explore the associated factors including etiopathology and regions with POI. METHODS The search was conducted on reports from a total of eight databases that comprised Chinese National Knowledge Infrastructure (CNKI), Wanfang, China BioMedical Literature Database (CBM), PubMed, the Cochrane Library, Embase, Web of Science and Ovid MEDLINE® between 1946 and 2021. To analyze the source of heterogeneity, we performed subgroup analysis based on different etiologies and regions. Meta-analysis was carried out by Stata14.0 software. RESULTS The results showed that the global overall prevalence of POI among women was 3.5%. By subgroup analysis, the prevalence of POI among women with iatrogenic etiology was 11.2%, followed by autoimmunity (10.5%); the prevalence of POI by region was 11.3% at the highest in North America followed by South America (5.4%); and the prevalence of POI was 5.3% in a developing country, higher than 3.1% in a developed country. The trend of prevalence of POI over the past 20 years was on the rise (although p > 0.05). CONCLUSION We recommend that health and medical institutions strengthen public health awareness, achieve health-education goals related to POI and increase women's awareness of and attention to POI.
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Affiliation(s)
- M Li
- Department of Nosocomial Infection, The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Y Zhu
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, P.R. China
- Department of Scientific Research, Children's Hospital of Fudan University, Shanghai, P.R. China
| | - J Wei
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai, P.R. China
| | - L Chen
- Department of Nosocomial Infection, The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - S Chen
- Department of Nosocomial Infection, The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - D Lai
- Department of Nosocomial Infection, The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
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Prochownik K, Jain R, Taylor-Cousar JL, Lavage DR, Stransky OM, Thomas HN, Kazmerski TM. Menopause in people with cystic fibrosis. Menopause 2023; 30:401-405. [PMID: 36720079 DOI: 10.1097/gme.0000000000002155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Abstract
This is the first study to examine the perimenopausal experiences of women with cystic fibrosis (CF) in the era of modulator therapy. As the life expectancy of people with CF continues to grow, CF care teams need to be able to address the perimenopausal needs of their female patients as well as the interactions between the menopausal transition and CF.
Objective
This study aimed to describe the menopause experience of people with cystic fibrosis (CF).
Methods
We conducted a computer-based cross-sectional survey of women with CF 25 years or older at 10 US CF centers exploring a range of sexual and reproductive health concerns, including menopause. We used descriptive statistics to analyze results.
Results
Of 460 participants, 5 (3%) were perimenopausal and 34 (7%) were postmenopausal. Of participants perimenopausal or menopausal (n = 39), 97% reported the following menopausal symptoms occurring at least once a week: most commonly early wake-up (83%); stiffness/soreness in joints, neck, or shoulders (65%); and night sweats (65%). Among menopausal participants, the median self-reported age at menopause was 48.5 years (interquartile range, 5.5 y). Thirty percent experienced worsened CF symptoms during menopause, and 42% experienced worsening CF symptoms after menopause. Twenty-four percent of menopausal participants were on estrogen therapy and 15% on estrogen and progesterone therapy. Three-fourths of participants using hormone therapy reported no change in their CF symptoms. One percent of the 460 survey participants reported discussing menopause with their CF provider, despite 19% wanting to discuss this topic with their CF team.
Conclusions
This is the first study to describe menopause symptoms of people with CF. People with CF experience a variety of menopausal symptoms and often report a worsening of their CF symptoms after menopause, suggesting an interplay between female sex hormones and CF. Larger studies are needed comparing the sexual and reproductive health experiences and care needs of people with CF in the menopause transition to the general population.
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Affiliation(s)
| | | | | | - Daniel R Lavage
- From the Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | - Olivia M Stransky
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, PA
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Cho L, Kaunitz AM, Faubion SS, Hayes SN, Lau ES, Pristera N, Scott N, Shifren JL, Shufelt CL, Stuenkel CA, Lindley KJ. Rethinking Menopausal Hormone Therapy: For Whom, What, When, and How Long? Circulation 2023; 147:597-610. [PMID: 36780393 PMCID: PMC10708894 DOI: 10.1161/circulationaha.122.061559] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Menopausal hormone therapy (HT) was widely used in the past, but with the publication of seminal primary and secondary prevention trials that reported an excess cardiovascular risk with combined estrogen-progestin, HT use declined significantly. However, over the past 20 years, much has been learned about the relationship between the timing of HT use with respect to age and time since menopause, HT route of administration, and cardiovascular disease risk. Four leading medical societies recommend HT for the treatment of menopausal women with bothersome menopausal symptoms. In this context, this review, led by the American College of Cardiology Cardiolovascular Disease in Women Committee, along with leading gynecologists, women's health internists, and endocrinologists, aims to provide guidance on HT use, including the selection of patients and HT formulation with a focus on caring for symptomatic women with cardiovascular disease risk.
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Affiliation(s)
- Leslie Cho
- Cleveland Clinic Foundation, Cleveland OH
| | - Andrew M Kaunitz
- University of Florida College of Medicine-Jacksonville, Jacksonville, FL
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Santoro N, Flyckt R, Davis A, Finkelstein J, Crawford S, Sun F, Derby C, Morrison A, Sluss P, Zhang H. Anti-Müllerian Hormone Level Decline in Patients Undergoing Hysterectomy With and Without Oophorectomy Compared With Natural Menopause. Obstet Gynecol 2023; 141:331-340. [PMID: 36649324 PMCID: PMC9858351 DOI: 10.1097/aog.0000000000005049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate the relationship between hysterectomy with and without ovarian conservation and the onset of ovarian failure using anti-müllerian hormone (AMH) levels and imputed final menstrual period (FMP). METHODS A total of 1,428 women with an observed FMP and 232 women who underwent hysterectomy (159 with bilateral salpingo-oophorectomy [BSO], 13 with one ovary conserved, and 60 with both ovaries conserved) and who had serial AMH measurements were included from SWAN (The Study of Women's Health Across the Nation), a multi-ethnic, multi-site, community-based study. Anti-müllerian hormone levels were sampled annually with at least one presurgery or pre-FMP measurement at least one postsurgery or post-FMP measurement. Surgery-related differences in patterns of AMH levels with respect to surgery date or FMP were estimated using piecewise linear mixed modeling; differences in age at first undetectable AMH level were estimated using survival analyses. RESULTS Patients with conservation of one or both ovaries or natural menopause demonstrated similar patterns of decline in AMH levels when anchored to surgery or FMP. Patients with hysterectomy (all types) had a later counterfactual FMP (52.9±0.2 SEM) compared with the observed FMP in those with natural menopause (52.1±0.1 years, P =.002). Those undergoing BSO had an immediate reduction in AMH level to undetectable after surgery. CONCLUSION Hysterectomy does not lead to a more rapid decline in AMH levels postoperatively compared with natural menopause. Patients undergoing BSO have a rapid loss of AMH, consistent with complete removal of the ovaries. These data suggest that hysterectomy as currently performed does not compromise ovarian reserve.
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Affiliation(s)
- Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado 80045
| | - Rebecca Flyckt
- Division of Reproductive Endocrinology, Case Western Reserve University, Cleveland, Ohio 44106
| | - Anne Davis
- current address: IVI RMA Global, San Diego, California 92121
| | - Joel Finkelstein
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Sybil Crawford
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts 01605
| | - Fangbai Sun
- Department of Statistics and Data Science, Yale University School of Medicine, New Haven Connecticut 06511
| | - Carol Derby
- Departments of Neurology and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York 10461
| | | | - Patrick Sluss
- Department of Clinical Pathology, Massachusetts General Hospital, Boston, Massachusetts 01224
| | - Heping Zhang
- Department of Statistics and Data Science, Yale University School of Medicine, New Haven Connecticut 06511
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Scime NV, Shea AK, Faris P, Brennand EA. Impact of lifetime lactation on the risk and duration of frequent vasomotor symptoms: A longitudinal dose-response analysis. BJOG 2023; 130:89-98. [PMID: 35993429 PMCID: PMC9729369 DOI: 10.1111/1471-0528.17274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the association between lifetime lactation and risk and duration of frequent vasomotor symptoms (VMS). DESIGN Prospective cohort. SETTING USA, 1995-2008. SAMPLE 2356 parous midlife women in the Study of Women's Health Across the Nation. METHODS Lifetime lactation was defined as the duration of breastfeeding across all births in months. We used generalised estimating equations to analyse risk of frequent VMS and Cox regression to analyse duration of frequent VMS in years. MAIN OUTCOME MEASURES Frequent VMS (hot flashes and night sweats) were measured annually for 10 years, defined as occurring ≥6 days in the past 2 weeks. RESULTS Overall, 57.1% of women reported hot flashes and 43.0% reported night sweats during follow-up. Lifetime lactation was inversely associated with hot flashes plateauing at 12 months of breastfeeding (6 months: adjusted odds ratio [AOR] 0.85, 95% confidence interval (CI) 0.75-0.96; 12 months: AOR 0.78, 95% CI 0.65-0.93) and was inversely associated with night sweats in a downward linear fashion (6 months: AOR 0.93, 95% CI 0.81-1.08; 18 months: AOR 0.82, 95% CI 0.67-1.02; 30 months: AOR 0.73, 95% CI 0.56-0.97). Lifetime lactation was associated with shorter duration of hot flashes and night sweats in a quadratic (bell-shaped) fashion. The association was strongest at 12-18 months of breastfeeding and significant for hot flashes (6 months: adjusted hazard ratio [AHR] 1.35, 95% CI 1.11-1.65; 18 months: AHR 1.54, 95% CI 1.16-2.03; 30 months: AHR 1.18, 95% CI 0.83-1.68). CONCLUSIONS Longer lifetime lactation is associated with decreased risk and duration of frequent VMS.
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Affiliation(s)
- Natalie V. Scime
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Alison K. Shea
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging (MIRA), McMaster University, Hamilton, ON, Canada
| | - Peter Faris
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Data & Analytics, Alberta Health Services, Calgary, AB, Canada
| | - Erin A. Brennand
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada
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Douglass A, Dattilo M, Feola AJ. Evidence for Menopause as a Sex-Specific Risk Factor for Glaucoma. Cell Mol Neurobiol 2023; 43:79-97. [PMID: 34981287 PMCID: PMC9250947 DOI: 10.1007/s10571-021-01179-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/03/2021] [Indexed: 01/07/2023]
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide and is characterized by progressive loss of visual function and retinal ganglion cells (RGC). Current epidemiological, clinical, and basic science evidence suggest that estrogen plays a role in the aging of the optic nerve. Menopause, a major biological life event affecting all women, coincides with a decrease in circulating sex hormones, such as estrogen. While 59% of the glaucomatous population are females, sex is not considered a risk factor for developing glaucoma. In this review, we explore whether menopause is a sex-specific risk factor for glaucoma. First, we investigate how menopause is defined as a sex-specific risk factor for other pathologies, including cardiovascular disease, osteoarthritis, and bone health. Next, we discuss clinical evidence that highlights the potential role of menopause in glaucoma. We also highlight preclinical studies that demonstrate larger vision and RGC loss following surgical menopause and how estrogen is protective in models of RGC injury. Lastly, we explore how surgical menopause and estrogen signaling are related to risk factors associated with developing glaucoma (e.g., intraocular pressure, aqueous outflow resistance, and ocular biomechanics). We hypothesize that menopause potentially sets the stage to develop glaucoma and therefore is a sex-specific risk factor for this disease.
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Affiliation(s)
- Amber Douglass
- grid.484294.7Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA USA
| | - Michael Dattilo
- grid.189967.80000 0001 0941 6502Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, B2503, Clinic B Building, 1365B Clifton Road NE, Atlanta, GA 30322 USA ,grid.414026.50000 0004 0419 4084Department of Ophthalmology, Atlanta Veterans Affairs Medical Center, Atlanta, GA USA ,grid.213917.f0000 0001 2097 4943Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA USA
| | - Andrew J. Feola
- grid.484294.7Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA USA ,grid.189967.80000 0001 0941 6502Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, B2503, Clinic B Building, 1365B Clifton Road NE, Atlanta, GA 30322 USA ,grid.213917.f0000 0001 2097 4943Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA USA
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Iwamoto SJ, Defreyne J, Kaoutzanis C, Davies RD, Moreau KL, Rothman MS. Gender-affirming hormone therapy, mental health, and surgical considerations for aging transgender and gender diverse adults. Ther Adv Endocrinol Metab 2023; 14:20420188231166494. [PMID: 37113210 PMCID: PMC10126651 DOI: 10.1177/20420188231166494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 03/13/2023] [Indexed: 04/29/2023] Open
Abstract
As the transgender and gender diverse (TGD) population ages, more transfeminine and transmasculine individuals present to clinic to initiate or continue their gender-affirming care at older ages. Currently available guidelines on gender-affirming care are excellent resources for the provision of gender-affirming hormone therapy (GAHT), primary care, surgery, and mental health care but are limited in their scope as to whether recommendations require tailoring to older TGD adults. Data that inform guideline-recommended management considerations, while informative and increasingly evidence-based, mainly come from studies of younger TGD populations. Whether results from these studies, and therefore recommendations, can or should be extrapolated to aging TGD adults remains to be determined. In this perspective review, we acknowledge the lack of data in older TGD adults and discuss considerations for evaluating cardiovascular disease, hormone-sensitive cancers, bone health and cognitive health, gender-affirming surgery, and mental health in the older TGD population on GAHT.
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Affiliation(s)
| | - Justine Defreyne
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Christodoulos Kaoutzanis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- UCHealth Integrated Transgender Program – Anschutz Medical Campus, Aurora, CO, USA
| | - Robert D. Davies
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- CUMedicine LGBTQ Mental Health Clinic, University of Colorado Hospital, Aurora, CO, USA
- UCHealth Integrated Transgender Program – Anschutz Medical Campus, Aurora, CO, USA
| | - Kerrie L. Moreau
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Micol S. Rothman
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- UCHealth Integrated Transgender Program – Anschutz Medical Campus, Aurora, CO, USA
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Langton CR, Whitcomb BW, Purdue-Smithe AC, Harmon QE, Hankinson SE, Manson JE, Rosner BA, Bertone-Johnson ER. Association of adverse pregnancy outcomes and multiple gestation with natural menopause: A population-based cohort study. Maturitas 2023; 167:82-89. [PMID: 36308975 PMCID: PMC9712230 DOI: 10.1016/j.maturitas.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/02/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Adverse pregnancy outcomes (APOs) and early menopause are each associated with increased risk of cardiovascular disease (CVD); whether APOs are associated with age at menopause is unclear. We examined the association of gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), preterm birth, and multiple gestation with age at natural menopause. STUDY DESIGN Observational, prospective study within the Nurses' Health Study II cohort (1989-2019). MAIN OUTCOMES MEASURES Risk of early natural menopause, defined as occurring before the age of 45 years, and age at onset of natural menopause (hazard ratio (HR) >1 indicates younger age at menopause). RESULTS The mean [SD] baseline age of 69,880 parous participants was 34.5 [4.7] years. Compared with participants who had a term singleton first birth, those with a term multiple-gestation first birth had higher risk of early menopause (HR: 1.65, 95% CI: 1.05, 2.60) and younger age at natural menopause (HR: 1.46, 95% CI: 1.31, 1.63). Estimates for preterm multiple gestation were of similar magnitude. Menopause occurred at a younger age for those with a preterm birth with spontaneous labor (HR: 1.08, 95% CI: 1.03, 1.14) compared to those with a term birth with spontaneous labor. Conversely, estimates for GDM (HR: 0.95, 95% CI: 0.89, 1.02) and HDP (preeclampsia, HR: 0.93, 95% CI: 0.89, 0.97) suggested an association with older age at menopause. CONCLUSIONS In this large cohort study, several statistically significant associations between APOs and age at natural menopause were observed. A deeper understanding of the relationships among APOs, menopause, and CVD is needed to help identify people at higher risk for early menopause and later CVD.
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Affiliation(s)
- Christine R Langton
- Women's Health Group, Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, USA; Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA.
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA
| | - Alexandra C Purdue-Smithe
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Quaker E Harmon
- Women's Health Group, Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, USA
| | - Susan E Hankinson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA
| | - JoAnn E Manson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Bernard A Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA; Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA
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Ovarian Reserve Disorders, Can We Prevent Them? A Review. Int J Mol Sci 2022; 23:ijms232315426. [PMID: 36499748 PMCID: PMC9737352 DOI: 10.3390/ijms232315426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
The ovarian reserve is finite and begins declining from its peak at mid-gestation until only residual follicles remain as women approach menopause. Reduced ovarian reserve, or its extreme form, premature ovarian insufficiency, stems from multiple factors, including developmental, genetic, environmental exposures, autoimmune disease, or medical/surgical treatment. In many cases, the cause remains unknown and resulting infertility is not ultimately addressed by assisted reproductive technologies. Deciphering the mechanisms that underlie disorders of ovarian reserve could improve the outcomes for patients struggling with infertility, but these disorders are diverse and can be categorized in multiple ways. In this review, we will explore the topic from a perspective that emphasizes the prevention or mitigation of ovarian damage. The most desirable mode of fertoprotection is primary prevention (intervening before ablative influence occurs), as identifying toxic influences and deciphering the mechanisms by which they exert their effect can reduce or eliminate exposure and damage. Secondary prevention in the form of screening is not recommended broadly. Nevertheless, in some instances where a known genetic background exists in discrete families, screening is advised. As part of prenatal care, screening panels include some genetic diseases that can lead to infertility or subfertility. In these patients, early diagnosis could enable fertility preservation or changes in family-building plans. Finally, Tertiary Prevention (managing disease post-diagnosis) is critical. Reduced ovarian reserve has a major influence on physiology beyond fertility, including delayed/absent puberty or premature menopause. In these instances, proper diagnosis and medical therapy can reduce adverse effects. Here, we elaborate on these modes of prevention as well as proposed mechanisms that underlie ovarian reserve disorders.
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Macpherson BE, Quinton ND. Menopause and healthcare professional education: A scoping review. Maturitas 2022; 166:89-95. [PMID: 36095904 DOI: 10.1016/j.maturitas.2022.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There has been a growing discourse regarding menopause, but despite this growth there is little education on this important topic across health professions. This scoping review provides a comprehensive synthesis of how menopause is represented in health professions' education literature, to inform future pedagogy and practice. DESIGN A scoping review using the framework developed by Arksey and O'Malley (2005). METHODS In the scoping review, only empirical studies were considered and only those published in the English language were included. Four databases were interrogated using a variety of search terms, including menopause, healthcare, medical and education. RESULTS Twelve studies were included and mapped independently by the authors onto the internally developed data-extraction tool. Insights into how menopause is understood in educational terms and how it is taught within health professions' education were gained, specifically in relation to knowledge, language used, and learning and educational gaps. CONCLUSION The review establishes how menopause is understood in educational terms and how it is taught within health professions' education, and develops an understanding of the pedagogy of menopause. There is an urgent need for menopause to be included in mainstream curricula and for an appropriate pedagogy that acknowledges the complexity of the topic, to achieve excellence in education across health professions' education. There is a broader perspective in addressing the challenges for health professions' education in terms of the prioritisation and pedagogy of women's health.
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Affiliation(s)
- Barbara E Macpherson
- Leeds Institute of Medical Education, School of Medicine, University of Leeds, Leeds LS2 9NL, UK.
| | - Naomi D Quinton
- Leeds Institute of Medical Education, School of Medicine, University of Leeds, Leeds LS2 9NL, UK. https://twitter.com/drna
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Guo C, Yu T, Chen J, Chang LY, Lin C, Yu Z, Chan SHT, Dong G, Tam T, Huang B, Lau AK, Lao XQ. Associations between long-term exposure to multiple air pollutants and age at menopause: a longitudinal cohort study. Ann Epidemiol 2022; 76:68-76. [DOI: 10.1016/j.annepidem.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/15/2022]
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Han Q, Chen ZJ, Du Y. Dietary supplementation for female infertility: Recent advances in the nutritional therapy for premature ovarian insufficiency. Front Microbiol 2022; 13:1001209. [PMID: 36466679 PMCID: PMC9712792 DOI: 10.3389/fmicb.2022.1001209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/01/2022] [Indexed: 08/27/2023] Open
Abstract
Premature ovarian insufficiency (POI) ranks top in the reproductive disorders that may impair multiple functioning systems, reduce the quality of life and ultimately deprive patients of their fertility among women. Symptoms can be partially alleviated by present hormone replacement therapy that cannot improve conception or decrease occurrence rates of systemic complication. Nutritional dietary supplements are attracting more and more attention because of their safety, bioavailability, and efficacy for well-being. Nutrients in the daily food are composed of carbohydrates, fat and lipoprotein, protein and polypeptide, vitamins, and vegetable or fruits containing phytoestrogens. These are functional nutrients due to the proliferative, anti-inflammatory, anti-oxidant, and mitochondria-protective potential during the course of menopause. Apart from dietary nutrients, microbe-related nutritional substances, including probiotics, prebiotics and the combination-synbiotics, display high potential as well in supporting estrous cycle, ovarian viability and modulating other vital reproductive functions. The present review will discuss dietary and microbial nutrients and their roles and applications in the living body based upon animal or human research, evaluate possible effect mechanisms from molecular, cellular and tissue levels, and provide insights into nutritional therapy for prolonging reproductive lifespan in female patients.
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Affiliation(s)
- Qixin Han
- Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
| | - Yanzhi Du
- Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
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48
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Madjedi KM, Stuart KV, Chua SYL, Foster PJ, Strouthidis NG, Luben RN, Warwick AN, Kang JH, Wiggs JL, Pasquale LR, Khawaja AP. The Association of Female Reproductive Factors with Glaucoma and Related Traits: A Systematic Review. Ophthalmol Glaucoma 2022; 5:628-647. [PMID: 35691565 PMCID: PMC10051419 DOI: 10.1016/j.ogla.2022.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 05/20/2022] [Accepted: 06/03/2022] [Indexed: 11/25/2022]
Abstract
TOPIC This systematic review summarizes evidence for associations between female reproductive factors (age at menarche, parity, oral contraceptive [OC] use, age at menopause, and postmenopausal hormone [PMH] use) and intraocular pressure (IOP) or open-angle glaucoma (OAG). CLINICAL RELEVANCE Understanding the associations between female reproductive factors and glaucoma may shed light on the disease pathogenesis and aid clinical prediction and personalized treatment strategies. Importantly, some factors are modifiable, which may lead to new therapies. METHODS Two reviewers independently extracted articles in MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials databases to identify relevant studies. Eligibility criteria included studies with human subjects aged > 18 years; a measured outcome of either IOP or OAG; a cohort, case-control, cross-sectional, or randomized controlled trial design; a reported measure of association, such as the hazard ratio, relative risk, odds ratio, or mean difference, with an associated confidence interval; and a measured exposure of at least 1 of the following variables: age at menarche, parity, OC use, age at menopause, or PMH use. RESULTS We included a total of 27 studies. Substantial differences in study designs, exposure and treatment levels, treatment durations, and variable reporting precluded a meaningful quantitative synthesis of the identified studies. Overall, relatively consistent associations between PMH use and a lower IOP were identified. Estrogen-only PMH use may be associated with lower OAG risk, which may be modified by race. No significant associations were found with combined estrogen-and-progesterone PMH use. No strong associations between parity or age at menarche and glaucoma were found, but a younger age at menopause was associated with an increased glaucoma risk, and adverse associations were identified with a longer duration of OC use, though no overall association with OC use was found. CONCLUSIONS The association between PMH use and lower IOP or OAG risk is a potentially clinically relevant and modifiable risk factor and should be investigated further, although this needs to be interpreted in the context of a high risk of bias across included studies. Future research should examine associations with IOP specifically and how the relationship between genetic factors and OAG risks may be influenced by female reproductive factors.
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Affiliation(s)
- Kian M Madjedi
- National Institute for Health Research, Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & University College London, Institute of Ophthalmology, London, United Kingdom; Department of Ophthalmology, University of Calgary, Alberta, Canada.
| | - Kelsey V Stuart
- National Institute for Health Research, Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & University College London, Institute of Ophthalmology, London, United Kingdom
| | - Sharon Y L Chua
- National Institute for Health Research, Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & University College London, Institute of Ophthalmology, London, United Kingdom
| | - Paul J Foster
- National Institute for Health Research, Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & University College London, Institute of Ophthalmology, London, United Kingdom
| | - Nicholas G Strouthidis
- National Institute for Health Research, Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & University College London, Institute of Ophthalmology, London, United Kingdom
| | - Robert N Luben
- National Institute for Health Research, Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & University College London, Institute of Ophthalmology, London, United Kingdom; Medical Research Council, Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | | | - Jae H Kang
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Janey L Wiggs
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, Massachusetts
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anthony P Khawaja
- National Institute for Health Research, Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & University College London, Institute of Ophthalmology, London, United Kingdom
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49
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Li SR, Reitz KM, Kennedy J, Gabriel L, Phillips AR, Shireman PK, Eslami MH, Tzeng E. Epidemiology of age-, sex-, and race-specific hospitalizations for abdominal aortic aneurysms highlights gaps in current screening recommendations. J Vasc Surg 2022; 76:1216-1226.e4. [PMID: 35278654 PMCID: PMC9458770 DOI: 10.1016/j.jvs.2022.02.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/24/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND The detection and elective repair of abdominal aortic aneurysms (AAA) guided by known risk-factor specific screening decrease AAA-related mortality. However, minimal epidemiologic data exist for AAA in female persons and racial minority groups. We established the contemporary risk of US AAA hospitalization across age, sex, and race. METHODS National Inpatient Sample and US Census (2012-2018) data were used to quantify age-, sex-, and race-specific incidences and adjusted odds ratios (aOR) of AAA hospitalizations (≥18 years), associated risk factors, and in-hospital mortality. Interaction terms evaluated subgroups. RESULTS Among 1,728,374,183 US residents during the study period (51.3% female; 78.4% White, 12.7% Black, 5.7% Asian), 211,501,703 were hospitalized (aged 57.56 ± 0.04 years; 58.4% female; 64.9% White, 14.3% Black, 2.5% Asian) of which 291,850 were for AAA (aged 73.17 ± 0.04 years; 22.6% female; 81.8% White, 5.6% Black, 1.6% Asian). An estimated 15.2 (95% CI, 15.1-15.3) and 1.7 (95% CI, 1.7-1.7) hospitalizations per 100,000 residents were for intact AAA (iAAA) and ruptured AAA (rAAA) AAA, respectively. In addition, 16.2% of iAAA (83.8% male; 79.1% White) and 18.4% of rAAA (86.4% male; 75.0% White) hospitalizations occurred in patients less than 65 years of age. For iAAA, female sex (aOR, 0.27; 95% CI, 0.27-0.28) compared with male sex and both Black (0.47; 95% CI, 0.45-0.49) and Asian (0.86; 95% CI, 0.83-0.93) persons compared with White persons had a reduced aOR for hospitalization. For rAAA, the reduced aOR persisted for female sex (0.33; 95% CI, 0.32-0.36) and for Black persons (0.52; 95% CI, 0.46-0.58). Although female sex demonstrated an overall decreased odds of AAA hospitalization, female persons who were older, Black, or had peripheral vascular disease (Pinteractions < .001) had a relative increase in AAA hospitalization aOR. Female sex (aOR, 1.54; 95% CI, 1.38-1.70), but not Black or Asian race, was associated with increased mortality which was more pronounced for iAAA (1.93; 95% CI, 1.66-2.25) than rAAA (1.29; 95% CI, 1.13-1.48]; Pinteraction < .001). CONCLUSIONS We confirmed a substantially decreased adjusted risk of AAA hospitalization for females and racial minority groups; however, aging and comorbid peripheral vascular disease decreased these differences. The disparate risk of AAA hospitalization by sex and race highlights the importance of inclusivity in future AAA studies.
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Affiliation(s)
- Shimena R Li
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Katherine M Reitz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
| | - Jason Kennedy
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA; Department of Critical Care and Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Lucine Gabriel
- School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Amanda R Phillips
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Paula K Shireman
- Department of Surgery, University of Texas Health San Antonio, San Antonio, TX; South Texas Veterans Health Care System, San Antonio, TX; University Health, San Antonio, TX
| | - Mohammad H Eslami
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Edith Tzeng
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
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50
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Williams M, Richard-Davis G, Williams PL, Christensen L, Ward E, Schrager S. A review of African American women's experiences in menopause. Menopause 2022; 29:1331-1337. [PMID: 36126249 DOI: 10.1097/gme.0000000000002060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE AND OBJECTIVE Little is known and reported about the experiences of African American women as they transition to and experience menopause. Accepted norms are based on the experience of a predominantly White population. The aim of this study is to review available data about the distinct experiences of African American women during the menopause transition and menopause. METHODS A literature search was developed and executed by the review team in collaboration with a health sciences librarian. The search combined controlled vocabulary and title/abstract terms related to the health status disparities of African Americans in the menopause transition and menopause. The following databases were searched from inception through April 28, 2022: PubMed, Scopus (Elsevier), and Web of Science Core Collection (Clarivate). DISCUSSION AND CONCLUSION African American women experience distinct differences in physical, psychological, social, and quality of life measures during menopause. Increasing awareness about the unique menopause experiences of African American women is critically important to improve the health of this underserved population.
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Affiliation(s)
- Makeba Williams
- From the Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Gloria Richard-Davis
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Leslie Christensen
- Department of Library Science, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Earlise Ward
- Department of Nursing, University of Wisconsin-Madison, WI
| | - Sarina Schrager
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
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