Symptom reports from a cohort of African American and white women in the late reproductive years

Melatonin: Current evidence on protective and therapeutic roles in gynecological diseases

Melatonin, a potent antioxidant and free radical scavenger, has been demonstrated to be effective in gynecological conditions and female reproductive cancers. This review consolidates the accumulating evidence on melatonin's multifaceted protective effects in different pathological contexts. In gynecological conditions such as endometriosis, polycystic ovary syndrome (PCOS), and uterine leiomyoma, melatonin has shown promising effects in reducing oxidative stress, inflammation, and hormonal imbalances. It inhibits adhesion molecules' production, and potentially mitigates leukocyte adherence and inflammatory responses. Melatonin's regulatory effects on hormone production and insulin sensitivity in PCOS individuals make it a promising candidate for improving oocyte quality and menstrual irregularities. Moreover, melatonin exhibits significant antitumor effects by modulating various signaling pathways, promoting apoptosis, and suppressing metastasis in breast cancers and gynecological cancers, including ovarian, endometrial, and cervical cancers. Furthermore, melatonin's protective effects are suggested to be mediated by interactions with its receptors, estrogen receptors and other nuclear receptors. The regulation of clock-related genes and circadian clock systems may also contribute to its inhibitory effects on cancer cell growth. However, more comprehensive research is warranted to fully elucidate the underlying molecular mechanisms and establish melatonin as a potential therapeutic agent for these conditions.

Level of Psychological and Somatic Symptoms Predict Perimenopausal Syndrome Severity Better Than Obstetric and Psychiatric History Do Among Korean Women

OBJECTIVE

Menopause symptoms can vary in type, duration, and severity. The purpose of this study was to investigate the key factors predicting severe symptoms among Korean perimenopausal women with various demographic data, obstetric and psychiatric histories, and menopausal symptoms screening scale scores.

METHODS

Data were collected from 1,060 women, and 4 latent classes were identified using latent profile analysis, with 6 major categories of menopausal complaints. Among the 4 classes, we selectively used data from the "all unimpaired" and "all impaired" groups. Menopause rating scale (MRS), sociodemographic, obstetric, and psychiatric factors were assessed, and hierarchical logistic regression analyses were conducted with the "all impaired" group as a dependent variable.

RESULTS

Marital status and scores on the psychological and somatic subscales of the MRS were statistically related to being in the "all impaired" group. Otherwise, family history of menopausal symptoms, menarche age, and history of other psychiatric disorders were not statistically significant predictors of being in the "all impaired" group.

CONCLUSION

The psychological and somatic subscales of the MRS predict the severity of perimenopausal syndrome better than obstetric and psychiatric history do among Korean perimenopausal women. Psychological and somatic symptoms as well as genitourinary symptoms in menopausal patients should be closely evaluated.

Perimenopause meets life: observations from the Women Living Better Survey

OBJECTIVE

The purpose of these analyses was to test a predictive quantitative model relating personal characteristics, reproductive aging stages, health behaviors, roles, stressors, and satisfaction with life roles to bothersome symptoms experienced during the late reproductive stage and the menopausal transition (MT).

METHODS

Participants (N = 2,406) aged 35 to 55 years completed the Women Living Better Survey online between March to August 2020, and 1,529 met the inclusion criteria and provided menstrual cycle data for staging reproductive aging. They were recruited from the Women Living Better newsletter and from other online groups of midlife women. Hierarchical regression analysis using a two-stage model tested the effect of several factors on each of five bothersome symptom groups: brain fog, volatile mood, fatigue/pain, vasomotor/sleep disruption, and anxiety/vigilance symptoms. In stage I, personal characteristics, reproductive aging stage, and health behaviors were examined, and in stage II roles (ie, caregiver, partner, employment-related), satisfaction with life roles and stressors associated with roles were added.

RESULTS

More bothersome brain fog symptoms were associated with less education, MT (vs late reproductive stage), low satisfaction with life roles, and greater health-related and overcommitment stress (all P < 0.005). More bothersome volatile mood symptoms were associated with health-related, partner relationship, and other relationship stress. More bothersome fatigue/pain symptoms were associated with less education and greater difficulty paying for basics and health-related and other relationship stress. Vasomotor/sleep-onset symptoms were associated with less education, MT, and health-related and work stress. More bothersome anxiety/vigilance symptoms were associated with less education, more difficulty paying for basics, and health and work stress.

CONCLUSIONS

Recognizing that midlife stress comes from many role- and relationship-related sources and that several of these stressors are associated with greater symptom bother supports the importance of proactive identification and management of sources of stress.

Psychological well-being of midlife women: a structural equation modeling approach

OBJECTIVE

Women experience menopause at approximately 50 to 52 years of age, when reproductive aging causes various somatic, psychological, and urogenital symptoms. Women's changing lifestyles and increasing lifespan make it difficult to pinpoint the factors affecting their well-being during menopause, warranting continuous research in this field. Therefore, this study developed a structural equation model, based on the transactional model of stress and coping, to test the significance of positive and negative factors associated with psychological health during menopause.

METHODS

This study validated a structural equation model based on the empirical data collected using a crosssectional study. We analyzed 300 questionnaire responses completed between May 15 and July 10, 2020, by South Korean middle-aged women (aged 45-60 y) who agreed to participate. The study's structural equation model used self-efficacy as an exogenous variable and perceived stress, menopausal management, self-compassion, menopausal symptoms, and psychological well-being as endogenous variables. Educational and economic levels were set as control variables.

RESULTS

We observed statistical support for 9 out of 10 hypotheses; the predictor variables had an explanatory power of 79.5% for psychological well-being. Self-efficacy was positively associated with the psychological wellbeing of middle-aged menopausal women and appeared to be mediated by perceived stress, menopausal management, menopausal symptoms, and self-compassion.

CONCLUSIONS

To improve the psychological well-being of middle-aged women, it is important to increase their self-efficacy and minimize stress. Moreover, managing menopausal symptoms and increasing self-compassion through effective coping may maximize psychological well-being.

VIDEO SUMMARY

http://links.lww.com/MENO/A933.

Effect of acceptance and commitment therapy on mood, sleep quality and quality of life in menopausal women: a randomized controlled trial

BACKGROUND

One of the most critical periods in a woman's life is menopause. During menopause, depression and anxiety are among the most common mood changes. Sleep disorders also increase during menopause, which leads to quality of life disorders. Different methods such as medication, psychotherapy, or a combination of them are used to treat these disorders. Acceptance and commitment-based therapy is one of the newest methods in psychotherapy that recently has been used a lot. Therefore, this study was conducted to determine the effect of acceptance and commitment therapy (ACT) on mood (primary outcome), sleep quality, and quality of life (secondary outcomes) of menopausal women.

METHODS

This randomized controlled trial was performed on 86 menopausal women in Tabriz, Iran in 2021. Using the blocking method, participants were randomly assigned into the intervention and control groups. The intervention group received counseling based on ACT approach in 8 sessions of 60 to 90 min. The control group received only routine health care. Depression, Anxiety, Stress Scale-21 (DASS 21), Menopause Quality of Life (MENQOL), and Pittsburgh Sleep Quality Index (PSQI) questionnaires were completed before intervention and immediately after the intervention. Independent t-test and Mann-Whitney U test were used to compare the outcomes between the two groups.

RESULTS

In terms of sociodemographic characteristics and baseline values of the studied variables, there was no statistically significant difference between the study groups before the intervention. At the end of the intervention, the mean (SD: standard deviation) scores of anxiety, stress, and depression in the counseling group were 2.66 (1.28), 2.91 (1.62), and 1.98 (1.59) and in the control group were 4.19 (1.85), 5.61 (1.49) and 3.59 (1.91). In the intervention group, the mean score of all three variables was significantly lower than the control group (P < 0.001). After the intervention, the mean (SD) of the total sleep quality score was 4.04 (2.52) in the counseling group and 4.13 (2.63) in the control group. In addition, the mean (SD) of the total quality of life score was 23.47 (20.13) in the counseling group and 23.14 (17.76) in the control group. Between the study groups, there were no statistically significant differences in the mean of the overall score of sleep quality (P = 0.867) and the overall score of quality of life (P = 0.759).

CONCLUSION

Using ACT-based counseling can improve the mood of menopausal women. However, further randomized clinical trials are needed before making a definitive conclusions.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N65. Date of registration: 2/19/2021. Date of first registration: 2/19/2021. URL: https://en.irct.ir/user/trial/53544/view; Date of recruitment start date: 2/22/2021.

Menopause and Brain Health: Hormonal Changes Are Only Part of the Story

Most studies of menopause and brain aging have focused on the role of the sex steroid hormone, estradiol, as a key mechanisms contributing to cognitive and brain aging in women. An emerging literature demonstrates that beyond endogenous estradiol levels, menopausal symptoms, particularly vasomotor symptoms (VMS), are also key determinants of menopause-related changes in cognition and brain function. Critically, that literature shows the importance of using objective techniques to identify associations of VMS with memory performance, brain structure, and brain function. While self-report measures are important patient-centered outcomes in women's health research, objective measures of VMS typically relate more strongly to indices of cognitive and brain health. Currently, it is premature to make a causal claim about VMS and memory dysfunction, but initial findings raise the possibility that women with VMS might experience an improvement in cognition with VMS treatment. More generally, these findings underscore the utility of investigating female-specific risk factors for cognitive decline.

Women's views about physical activity as a treatment for vasomotor menopausal symptoms: a qualitative study

Background

Women commonly seek medical advice about menopausal symptoms. Although menopausal hormone therapy is the most effective treatment, many women prefer non-pharmacological treatments, such as physical activity. The effectiveness of physical activity has been inconclusive when assessed by randomised controlled trials, and it remains unclear how women feel about it as a possible treatment approach. The aim of the study was to explore symptomatic menopausal women’s views and experiences of physical activity as a treatment for vasomotor and other menopausal symptoms.

Methods

An in-depth qualitative study was embedded within a randomised controlled trial that assessed the effectiveness of physical activity as a treatment for vasomotor menopausal symptoms in previously inactive vasomotor symptomatic women. Participants were randomised to one of two physical activity interventions or a usual care group. Both physical activity interventions involved two one-to-one consultations, plus either supporting materials or access to physical activity support groups, over 6 months. Semi-structured interviews were conducted with 17 purposively selected participants from all three trial groups after they had completed trial follow-up. Interviews were audio recorded, transcribed verbatim, and analysed by constant comparison.

Results

All participants talked positively about physical activity as a treatment for their menopausal symptoms, with most reporting participation had improved their hot flushes and night sweats. They reported that they had experienced improved sleep, physical health and psychological well-being. Those who received the physical activity plus social-support intervention reported their ability to cope with their menopausal symptoms had improved. Many participants commented that they would prefer doctors to discuss physical activity as a possible treatment for their hot flushes and night sweats, before offering medication.

Conclusions

Based on the views and experiences of the women who participated in this study, healthcare professionals should continue discussing physical activity as a potential first treatment option with menopausal women. Furthermore, healthcare professionals should ensure they prepare, support, and encourage these women both physically and emotionally.

Trial registration

ISRCTN ISRCTN06495625 Registered 10/11/2010

Computerized hybrid decision-making system for hormone replacement therapy in menopausal women

BACKGROUND

The diversity of the results of different hormone replacement therapy (HRT) protocols and the fuzziness of the conclusions have caused problems in routine clinical practice.

OBJECTIVE

To develop an intelligent decision-making system for HRT specifically is appropriate as we use the abbrevation HRT in the background section in menopausal women in order to assist physicians.

METHODS

This study consisted of 179 peri- and post-menopausal patients who were admitted to Hacettepe University Hospital (between 1996 and 2001) with various menopausal complaints. Database variables used in this study were age, height, weight, menopause duration, clinical condition, HRT duration, and the laboratory test results. Our newly developed multiple-centered fuzzy clustering (MCFC) algorithm was applied to the medical data set to differentiate patient groups. Finally, a hybrid intelligent decision-making system was developed by combining knowledge-based algorithms and the MCFC algorithm results.

RESULTS

We have used Fuzzy C-means, K-means, Hard C-means, similarity based clustering, and MCFC algorithms on the medical data set and have determined that the MCFC algorithm is the most appropriate algorithm for our medical model. We have defined 5 clusters and 16 cluster centers. A diagnostic phrase was assigned to each cluster center by the physician and these clusters together with knowledge-based algorithms were used for the decision-making system.

CONCLUSIONS

We have developed a computerized hybrid decision-making system recommending HRT to peri- and post-menopausal women in order to assist and protect physicians.

Predictors of decreased libido in women during the late reproductive years

OBJECTIVE

To identify risk factors for decreased libido among women in the late reproductive years.

DESIGN

Prospective cohort. Women aged 35 to 47 years identified through random digit dialing were prospectively followed for 4 years with serial hormone assays and standardized questionnaires. Mean hormone values, hormone trends over 4 years, and fluctuation in hormone levels were compared among women with and without a decrease in libido at the last assessment period. Total testosterone, dihydroepiandrosterone sulfate, estradiol, follicle-stimulating hormone, luteinizing hormone, body mass index, psychosocial, and socioeconomic variables were evaluated using multivariable logistic regression.

RESULTS

Of 326 women, 87 (27%) reported a decreased libido, whereas 239 (73%) did not. Participant-specific means for all hormone levels over the study period were similar among both groups. However, total testosterone fluctuation over the study was significantly different between groups. Women whose testosterone levels fluctuated from 3.8 to 21.5 ng/dL around a mean value of 9 ng/dL were four times more likely to report decreased libido compared with women with little fluctuation in testosterone [odds ratio (OR) 4.0; 95% CI, 1.6-10.0]. Depression (OR 3.4; 95%CI, 1.9-6.1), vaginal dryness (OR 3.5; 95%CI, 1.8-6.6), and children living at home (OR 1.4; 95%CI, 1.1-1.7) were also independently associated with decreased libido.

CONCLUSIONS

Decreased libido in the late reproductive years is associated with a pronounced fluctuation in total testosterone over time. Other independent risk factors for decreased libido include vaginal dryness, depression, and living with children. Sexual dysfunction is a complex disorder, related to physiological and psychosocial factors, requiring further investigation.

The association of an alpha2C adrenoreceptor gene polymorphism with vasomotor symptoms in African American women

OBJECTIVE

The alpha2C adrenoreceptor deletion 322-325 (ADRA2C del 322-325) polymorphism has been associated with autonomic activity and thermoregulation, which are implicated in the vasomotor symptom (VMS) mechanism. The ADRA2C del (322-325) has higher prevalence in African American women, a group known to experience more frequent and bothersome VMS. We assessed whether the ADRA2C del (322-325) genotype is associated with increased frequency of VMS in African American women.

METHODS

DNA samples from African American (N = 400) women participating in the Study of Women's Health Across the Nation (SWAN) were genotyped for the ADRA2C del (322-325) polymorphism. Longitudinal data on VMS were obtained from the SWAN repository. The relation of ADRA2C del (322-325) genotypes (deletion/deletion [D/D]; insertion/deletion [I/D]; insertion/insertion [I/I]) with VMS over the menopausal transition for up to 12 years of follow-up was examined using generalized estimating equations. Primary models considered the outcome of frequent VMS (6 or more days in the prior 2 wk vs VMS <6 d in the prior 2 wk) by stage of menopause.

RESULTS

Four hundred DNA samples from African American women were included. Seventy-five women (18.8%) were found to carry the homozygous variant allele (D/D). There was no significant difference in the trajectory of frequent VMS over the menopausal transition between women with D/D and I/I + I/D genotypes (P = 0.39).

CONCLUSIONS

In this preliminary study among African American women in SWAN, ADRA2C del (322-325) was not significantly related to self-reported VMS. Further studies are warranted to help us understand the role of the adrenergic system in the physiology of VMS to tailor medical therapy to patient needs.

The challenges of midlife women: themes from the Seattle midlife Women's health study

Background

Midlife, the period of the lifespan between younger and older adulthood, has been described as a period of transition in women’s lives. Investigators studying midlife have focused on women 40 to 65 years of age, who typically experience multiple social, psychological and biological challenges, among them the menopausal transition. Investigators have reported a diverse array of stressful events, for example, health concerns, family problems, work-related issues, deaths, frustrated goal attainment, and financial worries; however, none have identified which life events midlife women experience as the most salient. The purpose of this study was to understand the meaning behind the experiences that midlife women identify as the most challenging.

Methods

Participants were enrolled in The Seattle Midlife Women’s Health Study, a longitudinal study spanning up to 23 years. Summative content analysis, incorporating manifest and latent analysis approaches, was used to identify life experiences that women described as the most challenging looking back over 15 years of being in the study. Eighty-one women responded to the question, “Since you have been in our study (since 1990 or 1991), what has been the most challenging part of life for you?”

Results

Women identified the most challenging aspects of midlife as changing family relationships, re-balancing work/personal life, re-discovering self, securing enough resources, and coping with multiple co-occurring stressors. Within these themes the most frequently reported challenges were: multiple co-occurring stressors, divorce/breaking up with a partner, health problems of self, and death of parents. Few women mentioned menopause as the most challenging aspect of their lives.

Conclusion

Women found themselves searching for balance in the midst of multiple co-occurring stressors while coping with losses and transitions, for some in a context of limited resources. Menopause was infrequently mentioned. Future research to identify the challenges experienced by more diverse populations of women and further understanding of the dynamics among multiple co-occurring stressors is needed to provide individualized health care appropriately to midlife women.

Menopausal symptoms and cardiovascular disease mortality in the Women's Ischemia Syndrome Evaluation (WISE)

OBJECTIVE

Studies have linked vasomotor symptoms (VMS) to markers of cardiovascular disease (CVD) risk, yet few have considered clinical cardiovascular events. Data suggest that associations may depend upon the age that symptoms occur. We examined associations between VMS and cardiovascular events and endothelial function, considering age of symptom onset.

METHODS

The Women's Ischemia Syndrome Evaluation enrolled women referred for coronary angiography for suspected myocardial ischemia. A total of 254 women aged more than 50 years, postmenopausal, with both ovaries, not taking hormone therapy underwent a baseline evaluation, were followed annually (median = 6.0 y), and the National Death Index was searched to ascertain CVD mortality (median = 9.3 y). A subset of participants underwent brachial artery ultrasound for flow-mediated dilation (FMD). Receiver-operating curve analysis was used to determine vasomotor symptom groups (symptoms beginning < age 42 [early onset], beginning ≥42 [later onset], never) which were examined in relation to cardiovascular events and FMD in Cox proportional hazard and linear regression models.

RESULTS

Women reporting early onset VMS (HR = 3.35, 95% CI = 1.23-7.86, P = 0.005) and women who never had VMS (HR = 2.17, 95% CI = 1.02-4.62, P = 0.05) had higher CVD mortality than women with later onset symptoms (multivariable models). Women with early onset VMS had lower FMD than women with later onset symptoms (b = -4.31, SE = 2.10, P = 0.04, multivariable).

CONCLUSIONS

Women with signs and symptoms of ischemia who had VMS beginning early in midlife had higher CVD mortality and reduced endothelial function relative to women with later onset symptoms. Future research should evaluate the vascular phenotype of women with early midlife VMS.

Assessment of hot flushes and vaginal dryness among obese women undergoing bariatric surgery

OBJECTIVE

Menopausal symptoms are associated with a negative impact on the quality of life, leading women to seek medical treatment. Obesity has been linked to higher levels of menopausal symptoms such as hot flushes. This assessment will explore whether the prevalence and bother of hot flushes and vaginal dryness change from pre- to post-bariatric surgery among obese midlife women.

METHODS

This study is a longitudinal analysis of data from 69 women (ages 35-72 years) undergoing bariatric surgery with reported reproductive histories and menopausal symptoms at preoperative and 6-month postoperative visits. Prevalence of and degree of bother of hot flushes and vaginal dryness at pre- and post-surgery were compared using McNemar's test and Wilcoxon signed-rank test.

RESULTS

The reported degree of bother of symptoms associated with hot flushes decreased from pre- to post-surgery (p < 0.01). There was no significant change in the prevalence of hot flushes or vaginal dryness in the overall study sample.

CONCLUSIONS

The degree of bother of symptoms associated with hot flushes among midlife women may decrease after bariatric surgery. These results highlight important secondary gains, including less bothersome menopausal symptoms, for women who choose bariatric surgery for weight loss.

The Psychometric Properties of the Midlife Women's Symptom Index

OBJECTIVE

To evaluate the psychometric properties of the Midlife Women's Symptom Index (MSI) among four racial/ethnic groups of midlife women in the United States.

DESIGN

A secondary data analysis.

SETTING

Internet communities/groups.

PARTICIPANTS

A total of 494 midlife women with symptoms of menopause who self-reported using an Internet survey and completed all sections of the MSI questionnaire.

METHODS

Data were collected from January 1, 2008 to December 31, 2010. The psychometric properties of the MSI were evaluated using measures of internal consistency, item-total correlation coefficients, and discriminant validity.

RESULTS

There were statistically significant differences in marital status, employment, income, religion, country of birth, level of education, diagnosed disease, and self-reported health status across the four racial/ethnic groups. The Kuder-Richardson Formula 20 (KR-20) coefficients for the three subscales of the MSI prevalence section (i.e., physical, psychological, and psychosomatic) ranged from 0.58 (psychosomatic symptoms in Whites) to 0.91 (psychological symptoms in Asian Americans). The Cronbach's alpha coefficients for the three subscale scores ranged from 0.60 (psychosomatic symptoms in Whites) to 0.93 (psychological symptoms in Asian Americans). The mean scores of the MSI differed significantly by race/ethnicity among midlife women of each menopausal status, except for the prevalence section of the psychosocial symptoms.

CONCLUSION

The MSI has demonstrated an acceptable reliability and appropriate discriminant validity across the four racial/ethnic groups, except in the domain of psychosomatic symptoms. Health care providers as well as researchers could use the MSI to assess the symptoms of menopause of midlife women from diverse racial/ethnic backgrounds.

Cigarettes, genetic background, and menopausal timing: the presence of single nucleotide polymorphisms in cytochrome P450 genes is associated with increased risk of natural menopause in European-American smokers

OBJECTIVE

This study aims to evaluate associations between variations in genes involved in the metabolism of environmental chemicals and steroid hormones and risk of menopause in smokers.

METHODS

Survival analysis was performed on 410 eligible participants from the Penn Ovarian Aging study (ongoing for 14 years), a cohort study of late-reproductive-age women. Single nucleotide polymorphisms at the following loci were studied: COMT Val158Met, CYP1B1*4 Asn452Ser, CYP1B1*3 Leu432Val, and CYP3A4*1B.

RESULTS

Significant interactions between smoking and single nucleotide polymorphisms were observed in European-American carriers of CYP3A4*1B and CYP1B1*3, supporting a greater risk of menopause entry compared with those not carrying these alleles. Among CYP1B1*3 carriers, smokers had a greater risk of menopause entry than nonsmokers (adjusted hazard ratio [HR], 2.26; 95% CI, 1.4-3.67; median time to menopause, 10.42 and 11.07 y, respectively). No association between smoking and menopause was identified in CYP1B1 wild types. Among CYP3A4*1B carriers, smokers were at greater risk for menopause entry than nonsmokers (adjusted HR, 15.1; 95% CI, 3.31-69.2; median time to menopause, 11.36 and 13.91 y, respectively). Risk of menopause entry in CYP3A4 wild types who smoked was far lower (adjusted HR, 1.59; 95% CI, 1.03-2.44). Heavily smoking CYP1B1*3 carriers (adjusted HR, 3.0; 95% CI, 1.54-5.84; median time to menopause, 10.41 y) and heavily smoking CYP3A4*1B carriers (adjusted HR, 17.79; 95% CI, 3.21-98.65; median time to menopause, 5.09 y) had the greatest risk of menopause entry.

CONCLUSIONS

Our finding that the risk of menopause entry in European-American smokers varies depending on genetic background represents a novel gene-environment interaction in reproductive aging.

How well do different measurement modalities estimate the number of vasomotor symptoms? Findings from the Study of Women's Health Across the Nation FLASHES Study

OBJECTIVE

Studies of vasomotor symptoms (VMS) typically measure VMS via daily diaries completed at the end of the day. VMS can also be measured via diaries completed throughout the day or via physiological monitors-modalities with lower recall demands. We examined the degree of correspondence between three VMS measurement modalities: retrospective end-of-day/morning diaries, prospective reporting, and physiological monitoring. We determined whether discrepancies between measurement modalities varied by participant characteristics.

METHODS

Twenty-five African-American women and 27 white women from the Pittsburgh site of the Study of Women's Health Across the Nation who were experiencing VMS, had intact uterus and ovaries, and were free of medications affecting VMS underwent 4 days of ambulatory VMS and Actiwatch monitoring. VMS were recalled in end-of-day and morning diaries, reported prospectively during the day, and measured physiologically via a hot flash monitor. Associations between anxiety, sleep, or race/ethnicity and VMS measurement modality difference scores were examined using generalized estimating equations.

RESULTS

Women underestimated the number of daytime VMS at the end of the day as compared with VMS that were prospectively reported or physiologically measured throughout the day. This pattern was particularly pronounced among African-American women (b [SE] = -3.01 [0.93], P = 0.001) and women with higher anxiety (b [SE] = -3.13 [1.53], P = 0.04). For nighttime VMS, women overestimated the number of VMS in the morning upon waking as compared with prospective measures, particularly if they had poorer sleep (higher wakening after sleep onset: b [SE] = 0.03 [0.008], P = 0.001).

CONCLUSIONS

Different measurement modalities yield different VMS estimates. Negative affect, sleep, and race/ethnicity may affect the recall of VMS.

ACOG Practice Bulletin No. 141: management of menopausal symptoms

Vasomotor and vaginal symptoms are cardinal symptoms of menopause. Vasomotor symptoms can be particularly troubling to women and are the most commonly reported menopausal symptoms, with a reported prevalence of 50-82% among U.S. women who experience natural menopause (1, 2). The occurrence of vasomotor symptoms increases during the transition to menopause and peaks approximately 1 year after the final menstrual period (3-5). The purpose of this document is to provide evidence-based guidelines for the treatment of vasomotor and vaginal symptoms related to natural and surgical menopause. (Treatment of menopausal symptoms in cancer survivors is discussed in the American College of Obstetricians and Gynecologists' Practice Bulletin Number 126, Management of Gynecologic Issues in Women With Breast Cancer.).

Diagnosis and office-based treatment of urinary incontinence in adults. Part one: diagnosis and testing

Urinary incontinence is a common problem in both men and women. This review article addresses its prevalence, risk factors, cost, the various types of incontinence, as well as how to diagnose them. The US Preventive Services Task Force, the Cochrane Database of Systematic Reviews, and PubMed were reviewed for articles focusing on urinary incontinence. Incontinence is a common problem with a high societal cost. It is frequently underreported by patients so it is appropriate for primary-care providers to screen all women and older men during visits. A thorough history and physical examination combined with easy office-based tests can often yield a clear diagnosis and rule out other transient illnesses contributing to the incontinence. Specialist referral is occasionally needed in specific situations before embarking on a treatment plan.

Arterial stiffness and related variables across menopausal status: an epidemiologic study

OBJECTIVES

To determine if postmenopausal women have different arterial stiffness, blood pressure (BP) values, or metabolic patterns in comparison to fertile women and to men at a population level.

METHODS

This is a population-based epidemiologic study of 1853 representative men and women aged 18-95 years. Clinostatic humeral BP was measured using Omron 705CP. Aortic BP, augmentation index (AI), and pulse wave velocity (PWV) were determined using applanation tonometry. Body mass index (BMI) and subscapular skinfold thickness were used as measures of adiposity. Fasting and postload blood glucose, homeostasis model assessment (HOMA), low-density and high-density lipoprotein serum cholesterol (LDL-C and HDL-C) and triglycerides were assessed.

RESULTS

Age was higher in postmenopausal women than in fertile women (68.8 ± 9.5 vs. 35.7 ± 10.2 years, p<0.001), and BMI was 16% higher (p<0.01) in the postmenopausal women after age adjustment. Humeral and aortic BP, carotid and radial AI, carotid-femoral PWV, BMI, LDL-C, LDL-C/HDL ratio, triglycerides, glucose tolerance, HOMA, and skinfold thickness were apparently higher in postmenopausal than in fertile women. Using multivariate analysis, however, all these differences were abolished after adjusting for confounders (age and, when appropriate, BMI), except for LDL-C, which remained 19% higher (p<0.01) in postmenopausal women than in fertile women after adjusting for many confounders (age, BMI, cholesterol, ethanol intake, caloric intake, and triiodothyronine).

CONCLUSIONS

Only LDL-C increases in postmenopausal women, whereas other differences attributed to menopause, including BP and arterial stiffness, seem to be confounding effects of age and BMI.

Factors that may influence the experience of hot flushes by healthy middle-aged women

BACKGROUND

Interest in menopausal symptoms in general and hot flushes (HFs) in particular has grown in recent years. This is mostly due to increased awareness and the vast impact these symptoms have on women's lives. Despite the high prevalence of women who experience HFs, a definitive etiology for HFs is yet to be found. Our objective was to review the current literature dealing with associated factors for experiencing HFs and to provide a synthesized overview on this common and often debilitating condition.

METHODS

We systematically searched the English-language literature in the PubMed database using relevant key words and included only those articles that contained information on associated factors for HFs in generally healthy midlife women.

RESULTS

Both conflicting scientific results between studies documenting factors that influence HFs and the lack of validated measuring tools make it difficult to truly pinpoint associated factors for HFs. Nonetheless, we identified the following clusters of associated factors: the menopausal stages, sex steroid hormones, other endocrine agents, genetic polymorphisms, race/ethnicity, body mass index (BMI) and obesity, mood disorders, smoking, soy isoflavones and phytoestrogens, alcohol consumption, and physical activity.

CONCLUSIONS

No single associated factor was consistently identified as having a major role in experiencing HFs. More resources should be directed to develop a unified study system along with multivariable analyses to get a better understanding of this condition, which often imposes a tremendous social and personal toll on the women who experience it.

Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging

OBJECTIVE

The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW + 10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period.

METHODS

Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus.

RESULTS

STRAW + 10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics.

CONCLUSIONS

STRAW + 10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW + 10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.

Physical, psychological, and menopause-related symptoms and minor psychiatric disorders in a community-based sample of Brazilian premenopausal, perimenopausal, and postmenopausal women

OBJECTIVE

The aim of this study was to identify the prevalence of physical, psychological, and menopause-related symptoms and their association with minor psychiatric disorders in premenopausal, perimenopausal, and postmenopausal women.

METHODS

This was a nested cross-sectional study. Demographic characteristics, education, and climacteric symptoms were investigated. The 20-item Self-Reporting Questionnaire was used to screen for minor psychiatric disorders, with a score of 8 or higher indicating positive screening.

RESULTS

We studied 324 Brazilian women aged 36 to 62 years (86 premenopausal women, 156 perimenopausal women, and 82 postmenopausal women). Mean (SD) age was 44.8 (3.6), 46.3 (4.6), and 53.3 (3.8) years, respectively (P < 0.001); 52.4% had 8 years or less of schooling (whereas 22.8% had 4 years or less). Forty-five (28.8%) perimenopausal women and 32 (39%) postmenopausal women were users of hormone therapy; 15 (17.4%) and 21 (13.5%) premenopausal and perimenopausal participants, respectively, were users of oral contraceptives. Hormone therapy and oral contraceptive users were excluded from the analysis of symptom prevalence. Hot flashes, night sweats, and vaginal dryness were more prevalent among perimenopausal women (P < 0.001). Fatigue was the most frequent complaint in all groups (61%, 81%, and 88% in premenopausal, perimenopausal, and postmenopausal women, respectively). The variables most frequently associated with positive findings during the screening for minor psychiatric disorders were very low education level and memory loss and irritability. Classic vasomotor complaints were weakly associated with nonpsychotic disease. In turn, perimenopausal women, but not postmenopausal women, were at greater risk of minor psychiatric disorders.

CONCLUSIONS

Low education level, memory loss, irritability, and the menopausal transition represent risk factors for positive findings in a screening for minor psychiatric disorders.

Joint effects of smoking and gene variants involved in sex steroid metabolism on hot flashes in late reproductive-age women

BACKGROUND

Although smoking has a known association with hot flashes, the factors distinguishing smokers at greatest risk for menopausal symptoms have not been well delineated. Recent evidence supports a relationship between menopausal symptoms and variants in several genes encoding enzymes that metabolize substrates such as sex steriods, xenobiotics, and catechols. It is currently not known whether the impact of smoking on hot flashes is modified by the presence of such variants.

OBJECTIVE

The objective of the study was to investigate the relationship between smoking and hot flash occurrence as a function of genetic variation in sex steroid-metabolizing enzymes.

METHODS

A cross-sectional analysis of data from the Penn Ovarian Aging study, an ongoing population-based cohort of late reproductive-aged women, was performed. Smoking behavior was characterized. Single-nucleotide polymorphisms in five genes were investigated: COMT Val158Met (rs4680), CYP1A2*1F (rs762551), CYP1B1*4 (Asn452Ser, rs1800440), CYP1B1*3 (Leu432Val, rs1056836), and CYP3A4*1B (rs2740574).

RESULTS

Compared with nonsmokers, European-American COMT Val158Met double-variant carriers who smoked had increased odds of hot flashes [adjusted odds ratio (AOR) 6.15, 95% confidence interval (CI) 1.32-28.78)]; European-American COMT Val158Met double-variant carriers who smoked heavily had more frequent moderate or severe hot flashes than nonsmokers (AOR 13.7, 95% CI 1.2-154.9). European-American CYP 1B1*3 double-variant carriers who smoked described more frequent moderate or severe hot flashes than nonsmoking (AOR 20.6, 95% CI 1.64-257.93) and never-smoking (AOR 20.59, 95% CI 1.39-304.68) carriers, respectively. African-American single-variant CYP 1A2 carriers who smoked were more likely to report hot flashes than the nonsmoking carriers (AOR 6.16, 95% CI 1.11-33.91).

CONCLUSION

This is the first report demonstrating the effects of smoking within the strata of gene variants involved in sex steroid metabolism on hot flashes in late reproductive-age women. The identification of individuals with a genetic susceptibility to smoking-related menopausal symptoms could contribute to interventions targeted at reducing reproductive morbidity both in the menopause and across the reproductive life course.

Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging

OBJECTIVE

The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW + 10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period.

METHODS

Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus.

RESULTS

STRAW + 10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics.

CONCLUSIONS

STRAW + 10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW + 10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.

Menopausal Symptoms according to Sasang Constitution and Menopausal Status among Perimenopause Women

PURPOSE

The purpose of this study was to address the difference menopausal symptoms according to sasang constitution and menopausal status among perimenopausal women.

METHODS

Data for this cross-sectional study was collected by administering questionnaires that elicited general information. The menopause rating scale (MRS) and Questionnaire for the Sasang Constitution Classification II (QSCC II) was given to 284 perimenopausal women who met the eligibility criteria and agreed to participate in the study.

RESULTS

The study subjects were composed of 27.5% so-yangin, 24.6% so-eumin, 18.7% tae-eumin, and 29.6% undefined category. The total MRS and all subscales were significantly higher for postmenopausal women in comparison to premenopausal women. Especially, so-eumin and tae-eumin displayed significantly higher scores in urogenital symptoms. The MRS score in postmenopausal women who belonged to the group of tae-eumin and so-eumin was significantly higher than those for premenopausal women. However, so-yangin displayed higher scores in psychological and urogenital symptoms than tae-eumin for premenopausal women. So-eumin presented significantly higher scores in urogenital symptoms in comparison to the undefined category for postmenopausal women.

CONCLUSION

These findings suggest that sasang constitution could be an important factor in understanding the woman's menopausal symptoms and identify the best treatment.

Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation

Vasomotor symptoms (VMS), or hot flashes and night sweats, are often considered the cardinal symptoms of menopause. SWAN, one of the largest and most ethnically diverse longitudinal studies of the menopausal transition, has allowed unique insights into VMS. Specifically, SWAN has helped yield important information about the prevalence of, racial/ethnic differences in, risk factors for, and implications of VMS for midlife women's mental and physical health. We have reviewed the literature on VMS, emphasizing findings that have emerged from SWAN and new areas of inquiry in the area of VMS.

Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging

OBJECTIVE

The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW + 10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period.

METHOD(S)

Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus.

RESULT(S)

STRAW + 10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics.

CONCLUSION(S)

STRAW + 10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW + 10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.

Executive summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging

OBJECTIVE

The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW +10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period.

METHODS

Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus.

RESULTS

STRAW +10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics.

CONCLUSIONS

STRAW +10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW +10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.

Menopausal symptoms among healthy, middle-aged Omani women as assessed with the Menopause Rating Scale

OBJECTIVE

The aim of this study was to analyze the prevalence and severity of climacteric symptoms and associated risk factors among a cohort of healthy, middle-aged Omani women.

METHODS

In this cross-sectional study, 472 healthy Omani women between 40 and 60 years old from the representative regions of Omani society were surveyed using the Menopause Rating Scale. The scores obtained were plotted against their demographic data and menopausal stage.

RESULTS

Overall, 39.6% of the participants were premenopausal, 15.2% were perimenopausal, and 43.6% were postmenopausal. The Menopause Rating Scale scoring showed that somatic and psychological symptoms occurred more frequently than did urogenital symptoms in all three stages. Muscle and joint pain was the most common symptom (73.3%), followed by mental and physical exhaustion (47.2%) and anxiety (46.6%). An increase in the mean scores for both somatic and psychological symptoms and their severity was observed when the following factors were present: progression of menopausal stage (mean ± SD, 22.5 ± 2.6, 3.6 ± 2.9, 4.5 ± 3.2), old age (4.2 ± 3.2) versus young age (2.9 ± 2.6), single (4.3 ± 3.3) versus married (3.3 ± 2.9), illiterate (3.9 ± 3.1) versus educated (2.7 ± 2.6), and sexually inactive (4.4 ± 3.4) versus sexually active (3.1 ± 2.7).

CONCLUSIONS

Omani women were found to exhibit highly atypical symptoms of menopause. Increased severity of symptoms was found to be related to age, advanced stage of menopause, and lower educational level.

Effects of reproductive history on symptoms of menopause: a brief report

OBJECTIVE

The aim of this study was to examine the relationship between reproductive history and menopausal symptoms among urban women.

METHODS

This was a cohort study of women aged 35 to 47 years recruited in Philadelphia, PA. Two hundred ninety-one premenopausal women meeting the study eligibility criteria and contributing reproductive health history and infertility information completed the assessments of occurrence and severity of several menopausal symptoms over a 14-year period. Reproductive history included the number of pregnancies, live births, preterm deliveries, and miscarriages. Trying to get pregnant for more than 1 year was used as an assessment of infertility. The occurrence of severe hot flashes, vaginal dryness, and decreased libido was evaluated.

RESULTS

Women scoring positive on the infertility index were significantly more likely to report severe decreased libido (odds ratio [OR], 1.86; 95% CI, 1.05-3.31) and were more than twice as likely to report severe vaginal dryness (OR, 2.79; 95% CI, 1.19-6.94) in multivariable models. None of the other reproductive health indices were related to the report of severe hot flashes, vaginal dryness, or decreased libido. The race-specific models continued to find a significant increased risk of severe vaginal dryness (OR, 2.79; 95% CI, 1.22-6.36) and decreased libido (OR, 1.87; 95% CI, 1.04-3.34) among white women scoring positive on the infertility index; however, the relationship did not remain significant among African American women.

CONCLUSIONS

Severe vaginal dryness and decreased libido are common and important considerations of the menopausal transition, and the experience of infertility problems may influence the report of severe vaginal dryness and decreased libido particularly among white women.

Reported symptoms before and one year after hysterectomy in African American and white women

PURPOSE

Although African American women are more likely than white women to undergo hysterectomy, there are few data describing their symptoms before and after surgery. This report compares reported symptoms in white and African American women before and 1-year after having a hysterectomy with at least one ovary retained.

METHODS

Using data from a prospective cohort study, we compared self-reported symptoms at baseline and 1-year follow-up among 382 women undergoing hysterectomy without bilateral oophorectomy (197 African American and 185 white) and 448 controls (199 African American and 249 white). Symptoms were assessed using an 11-item scale with questions on somatic, psychologic, and urogenital symptoms.

RESULTS

Women undergoing hysterectomy had more severe symptom scores before surgery than controls, but no significant racial differences were found. At follow-up, total scores for women with hysterectomies were comparable to those of control women, but some differences were observed within individual domains. Urogenital scores were worse for women with hysterectomies for both African American and white women. African American women with hysterectomies had better scores in the psychologic domain than either controls or white women with hysterectomies.

CONCLUSIONS

African American women, despite having such characteristics as larger uterine weight and lower hemoglobin that might suggest they would have more severe symptoms, had scores that were no worse than white women both before and after hysterectomy.

First time proof of sage's tolerability and efficacy in menopausal women with hot flushes

BACKGROUND

This trial aimed to assess the tolerability and efficacy of a fresh sage preparation in treating hot flushes and other menopausal complaints. Sage (Salvia officinalis) has been traditionally used to treat sweating and menopausal hot flushes, as well as to alleviate associated menopausal symptoms and as a general tonic. However, no clinical studies substantiating the use of sage in menopause have been published previously.

METHODS

In an open, multicenter clinical trial conducted in eight practices in Switzerland, 71 patients (intent-to-treat population [ITT], n=69; with a mean age of 56.4±4.7 years, menopausal for at least 12 months, and with at least five flushes daily) were recruited and treated with a once-daily tablet of fresh sage leaves for 8 weeks after an introductory baseline week. Parameters for the evaluation of efficacy were the change in intensity and frequency of hot flushes, and total score of the mean number of intensity-rated hot flushes (TSIRHF) as determined by diary protocol over the 2-month treatment period. Other variables included assessment of the Menopause Rating Scale (MRS) by the treating physician at baseline and after 2 months of therapy.

RESULTS

In the ITT population there was a significant decrease in the TSIRHF by 50% within 4 weeks and by 64% within 8 weeks (P<0.0001). The mean total number of hot flushes per day decreased significantly each week from week 1 to 8. The mean number of mild, moderate, severe, and very severe flushes decreased by 46%, 62%, 79%, and 100% over 8 weeks, respectively. The MRS and its somato-vegetative, psychological, and urogenital subscales decreased significantly by 43%, 43%, 47%, and 20% respectively. The treatment was very well tolerated.

CONCLUSION

A fresh sage preparation demonstrated clinical value in the treatment of hot flushes and associated menopausal symptoms.

Effect of hormone metabolism genotypes on steroid hormone levels and menopausal symptoms in a prospective population-based cohort of women experiencing the menopausal transition

OBJECTIVE

This study evaluated whether genes involved in the metabolism of steroid hormones are associated with hormone levels or menopausal symptoms.

METHODS

We used a population-based prospective sample of 436 African American (AA) and European American (EA) women who were premenopausal at enrollment and were followed longitudinally through menopause. We evaluated the relationship between steroid hormone metabolism genotypes at COMT, CYP1A2, CYP1B1, CYP3A4, CYP19, SULT1A1, and SULT1E1 with hormone levels and menopausal features.

RESULTS

In EA women, SULT1E1 variant carriers had lower levels of dehydroepiandrosterone sulfate, and SULT1A1 variant carriers had lower levels of estradiol, dehydroepiandrosterone sulfate, and testosterone compared with women who did not carry these variant alleles. In AA women, CYP1B1*3 genotypes were associated with hot flashes (odds ratio [OR], 0.62; 95% CI, 0.40-0.95). Interactions of CYP1A2 genotypes were associated with hot flashes across menopausal stage (P = 0.006). Interactions of CYP1B1*3 (P = 0.02) and CYP1B1*4 (P = 0.03) with menopausal stage were associated with depressive symptoms. In EA women, SULT1A1*3 was associated with depressive symptoms (OR, 0.53; 95% CI, 0.41-0.68) and hot flashes (OR, 2.08; 95% CI, 1.64-2.63). There were significant interactions between SULT1A1*3 and hot flashes (P < 0.001) and between SULT1A1*2 and depressive symptoms (P = 0.007) on menopausal stage, and there were race-specific effects of SULT1A1*2, SULT1A1*3, CYP1B1*3, and CYP3A4*1B on menopause.

CONCLUSIONS

Our results suggest that genotypes are associated with the occurrence of menopause-related symptoms or the timing of the menopausal transition.

Menopausal symptom experience of Hispanic midlife women in the United States

Using a feminist approach, we examined the menopausal symptom experience of Hispanic midlife women in the United States This was a qualitative online forum study among 27 Hispanic midlife women in the United States. Seven topics related to menopausal symptom experience were used to administer the 6-month online forum. The data were analyzed using thematic analysis. Four themes were identified: (a) "Cambio de vida (change of life)," (b) "being silent about menopause," (c) "trying to be optimistic," and (d) "getting support." More in-depth studies with diverse groups of Hispanic women are needed while considering family as a contextual factor.

Acupuncture for vasomotor menopausal symptoms: a systematic review

OBJECTIVE

The aim of this study was to critically assess whether acupuncture therapy reduces vasomotor menopausal symptoms and to evaluate the adverse effects of acupuncture therapy on the basis of the results of randomized controlled trials (RCTs).

METHODS

Nineteen electronic databases, including English, Korean, Japanese, and Chinese databases, were systematically searched for RCTs in which acupuncture was used to reduce vasomotor menopausal symptoms before July 2008. There were no language restrictions. The methodological quality of the eligible studies was assessed using the categories provided by the Menstrual Disorders and Subfertility Review Group.

RESULTS

Eleven studies, which included a total of 764 individual cases, were systematically reviewed. The methodological quality of the trials varied substantially. Six trials compared acupuncture treatment to sham or placebo acupuncture. Only one study using a nonpenetrating placebo needle found a significant difference in the severity outcomes of hot flashes between groups (mean difference, 0.48; 95% CI, 0.05-0.91). Five studies reported a reduced frequency of hot flashes within groups; however, none found a significant difference between groups. An analysis of the outcomes of the trials that compared acupuncture with hormone therapy or oryzanol for reducing vasomotor symptoms showed that acupuncture was superior. Three RCTs reported minimal acupuncture-related adverse events.

CONCLUSIONS

There is no evidence from RCTs that acupuncture is an effective treatment in comparison to sham acupuncture for reducing menopausal hot flashes. Some studies have shown that acupuncture therapies are better than hormone therapy for reducing vasomotor symptoms. However, the number of RCTs compared with a nonpenetrating placebo control needle or hormone therapy was too small, and the methodological quality of some of the RCTs was poor. Further evaluation of the effects of acupuncture on vasomotor menopausal symptoms based on a well-controlled placebo trial is therefore warranted.

Racial and ethnic differences in reproductive potential across the life cycle

OBJECTIVE

To review variations in specific reproductive health outcomes by race and ethnicity. A growing number of reports have explored potential gaps in the quality of reproductive health and healthcare across racial and ethnic groups. Diverse results from numerous investigations have made it challenging for practitioners to confirm the significance of these disparities.

METHOD(S)

Three specific areas of the reproductive life cycle were examined: pubertal onset, outcomes from treatment with assisted reproductive technologies (ART), and the menopausal transition. These areas were selected as they encompass a continuum of events across the reproductive life span of women. Outcomes were compared in black, white, Asian, and Hispanic women. Medline searches querying on keywords puberty, IVF, ART, menopause, menopausal symptoms, racial disparity, race, Asian, Japanese, Chinese, African American, black, Hispanic, and Latino were performed to isolate relevant publications for review.

RESULT(S)

Differences across race and ethnicity were noted in each clinical endpoint. The most notable findings included earlier puberty in blacks and Hispanics compared with whites, significantly lower live birth rates after ART in all racial and ethnic groups compared with whites, and differences in perimenopausal symptomatology and possibly timing in various racial/ethnic groups compared with whites. Additional research is needed to completely unravel the full significance and basic underpinnings of these disparities. Some of the limitations of the current state of the literature in drawing conclusions about the independent effect of race/ethnicity on reproductive disparities include small samples sizes in some studies, inconsistencies in the characterization of racial/ethnic groups, and incomplete control of potential confounding.

CONCLUSION(S)

Race and ethnicity appear to be important correlates of outcomes from the initiation of reproduction functioning through to its conclusion. The ultimate goal of identifying racial disparities in reproduction is to isolate the basic determinants of disparities and formulate strategies to improve outcomes for women at risk. The differences demonstrated in this review of the literature could represent environmental, sociocultural, and/or genetic correlates of race that influence these important milestones.

Effects of hepatitis C virus infection on menopause status and symptoms

OBJECTIVE

To examine the relationship between hepatitis C virus (HCV) infection with menopause status and vasomotor symptoms among middle-aged, impoverished women.

METHODS

The baseline interview and laboratory data from a study on menopause were used for a cross-sectional analysis of HCV antibody and HCV-RNA levels and their relationship to menopause status and symptoms, using logistic regression. For HCV-infected and HCV-uninfected women, menopause status was defined according to the World Health Organization criteria.

RESULTS

Of 559 participants, 48% were black, 38.6% were Hispanic, and 267 (47.8%) were HCV seropositive; of these, 189 (72.1%) had detectable HCV-RNA levels. The median age was 43 years [interquartile range (IQR), 40-46 years]; 50.2% of the women were premenopausal, 31.8% were perimenopausal, and 18% were postmenopausal. Median age at natural menopause was 46 years (IQR, 42.25-49 years) in HCV-infected women compared with 47 years (IQR, 40.25-48 years) in uninfected controls. Women infected with HCV were more likely to be postmenopausal than were uninfected women (adjusted odds ratio [ORadj], 1.68; 95% CI, 1.02-2.77). Human immunodeficiency virus status (ORadj, 1.69; 95% CI, 1.04-2.75), drug use (ORadj, 2.34; 95% CI, 1.42-3.86), and nulliparity (ORadj, 2.74; 95% CI, 1.42-5.29) were independently associated with natural menopause, whereas being more physically active (ORadj, 0.90; 95% CI, 0.85-0.95) was inversely associated with menopause. Women infected with HCV were more likely than uninfected women to report vasomotor symptoms (ORadj, 1.52; 95% CI, 1.06-2.18).

CONCLUSIONS

Hepatitis C virus infection is independently associated with natural menopause, controlling for age. In addition, HCV was associated with vasomotor symptoms. Further studies are warranted to better understand the menopausal transition in HCV-infected women.

Effects of ethyl-eicosapentaenoic acid omega-3 fatty acid supplementation on hot flashes and quality of life among middle-aged women: a double-blind, placebo-controlled, randomized clinical trial

OBJECTIVE

To compare the effects of enriched ethyl-eicosapentaenoic acid (E-EPA) omega-3 fatty acid supplementation with those of placebo on hot flashes (HFs) and quality of life among middle-aged women.

METHODS

Women were considered for participation if they were between 40 and 55 years of age and had moderate to severe psychological distress. A total of 120 women were randomly assigned to E-EPA or placebo for 8 weeks. Only women with HFs were included in this analysis (E-EPA, n = 45; placebo, n = 46). Outcomes were changes from baseline to week 8 postintervention regarding hot flash (HF) frequency (number of HFs per day), intensity and score (frequency x intensity), and Menopause-specific Quality of Life questionnaire scores.

RESULTS

At baseline, the average number of HFs was 2.8 per day. After 8 weeks, HF frequency and score decreased significantly in the E-EPA group compared with the placebo group. There was no difference in the change in HF intensity between groups. Frequency of HFs declined by a mean of 1.58 per day (95% CI, -2.18 to -0.98) in the E-EPA group and by 0.50 per day (95% CI, -1.20 to 0.20) in the placebo group. The odds of being a responder among those taking E-EPA were about three times greater than among those taking placebo (odds ratio, 2.70; 95% CI, 1.03-7.03; P = 0.04). Menopause-Specific Quality of Life scores improved significantly over time in both groups but no significant differences were noted between them.

CONCLUSIONS

Supplementation with E-EPA omega-3 fatty acid reduced HF frequency and improved the HF score relative to placebo. These results need to be confirmed by a clinical trial specifically designed to evaluate HFs in more symptomatic women.

Experience of menopausal symptoms by women in an urban community in Ibadan, Nigeria

OBJECTIVE

The aim of this study was to determine the prevalence and distribution of menopausal symptoms among women in Ibadan in the 4-week period preceding the survey and factors associated with these symptoms.

METHODS

A descriptive cross-sectional, community-based study was carried out on Nigerian women aged 40 to 60 years, using the multistage sampling technique. Quantitative data were collected on sociodemographic, obstetric, and gynecological variables as well as symptom experience in the preceding 4 weeks using a structured questionnaire that included a standardized Menopause Rating Scale (MRS). Eleven symptom groups were scored for each respondent on a scale of 0-4, with increasing severity for each score and a maximal total score of 44. The MRS is made of three subscales (somatovegetative, psychological, and urogenital) with maximal scores of 16, 16, and 12, respectively. Scores for each subscale and the overall total score were calculated for each respondent, and these served as the main outcome measures. The higher the composite score, the greater the severity of menopausal symptoms.

RESULTS

In all, 1,189 women with a mean age of 48.1 +/- 5.9 years were interviewed. Prevalence of any menopausal symptom was 84.5% during the 4-week period studied. Joint and muscular discomfort was the most common reported symptom among all women in this study (59.0%), followed by physical and mental exhaustion (43.0%), sexual problems (40.4%), and hot flashes (39.0%). Factors predicting the total score on the MRS were age of respondent (P = 0.01; 95% CI, 0.02-0.17), menopause status (P = 0.001; 95% CI, 0.33-1.24), and occupational group (P = 0.02; 95% CI, 0.10-1.42). Age of respondent and menopause status also predicted scores on the somatovegetative and urogenital subscales, but not on the psychological subscale. Occupation was the only predictor on the psychological subscale (P = 0.002; 95% CI, 0.16-0.75).

CONCLUSIONS

Prevalence of menopausal symptoms was high among women in this study. Although any woman could face challenges associated with menopausal symptoms, those who were older, perimenopausal, and postmenopausal and who had routine or manual occupations had the highest total MRS scores. All women, especially those in these categories, should receive health information and guidance on possible lifestyle adjustments to ease the disruptions that menopausal symptoms can cause.

Ethyl-eicosapentaenoic acid for the treatment of psychological distress and depressive symptoms in middle-aged women: a double-blind, placebo-controlled, randomized clinical trial

BACKGROUND

Psychological distress (PD) and depressive symptoms are commonly observed during menopausal transition. Studies suggest that omega-3 (n-3) fatty acids may help alleviate depression.

OBJECTIVE

The objective was to compare enriched ethyl-eicosapentaenoic acid (E-EPA) supplementation with placebo for the treatment of PD and depressive symptoms in middle-aged women.

DESIGN

Women with moderate-to-severe PD (n = 120) were randomly assigned to receive 1.05 g E-EPA/d plus 0.15 g ethyl-docosahexaenoic acid/d (n = 59) or placebo (n = 61) for 8 wk. The main outcomes were 8-wk changes in PD scores [Psychological General Well-Being Schedule (PGWB)] and depressive scales [20-item Hopkins Symptom Checklist Depression Scale (HSCL-D-20) and the 21-item Hamilton Depression Rating Scale (HAM-D-21)].

RESULTS

At baseline, women with PD were mildly to moderately depressed, and 24% met the major depressive episode (MDE) criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. After 8 wk, outcomes improved in both groups, but no significant differences were noted between them. Stratification analyses for MDE diagnosis at baseline indicated that differences in adjusted 8-wk changes between the E-EPA group without MDE (n = 46) and the placebo group (n = 45) were 8.0 (95% CI: 0.6, 15.3; P = 0.034) for the PGWB, -0.2 (95% CI: -0.01, -0.4; P = 0.040) for the HSCL-D-20, and -2.7 (95% CI: -0.3, -5.1; P = 0.030) for the HAM-D-21. Differences in adjusted 8-wk changes between the E-EPA group with MDE (n = 13) and the placebo group (n = 16) were not significant.

CONCLUSIONS

To our knowledge, this is the first trial of n-3 supplementation in the treatment of PD and depressive symptoms in middle-aged women. In women with PD without MDE at baseline, the 8-wk changes in PD and depressive scales improved significantly more with E-EPA than with placebo. This trial was registered at http://www.controlled-trials.com as ISRCTN69617477.

Menopause does not affect blood pressure and risk profile, and menopausal women do not become similar to men

OBJECTIVE

Menopause is considered to be a cardiovascular risk factor, but this belief is based on opinions rather than on evidence. Confounding effects of age are often neglected.

DESIGN

Population-based study with further subanalysis of case-to-case age-matched cohorts of men and fertile and menopausal women.

SETTING

Epidemiology in primary, public, institutional frame.

PARTICIPANTS

Nine thousand three hundred and sixty-four men and women aged 18-70 years representative of Italian general population followed-up for 18.8 +/- 7.7 years.

MAIN OUTCOME MEASURES

Blood pressure (BP), prevalence and incidence of hypertension, serum total, high-density lipoprotein and low-density lipoprotein cholesterol, glucose tolerance, body adiposity, vascular reactivity, target organ damage, overall and cardiovascular mortality and morbidity, by gender and by menopausal status.

RESULTS

Cross-sectional: crude BP, pressor response to cold, orthostatic BP decrease, BMI, skinfold thickness, fasting and postload blood glucose and insulin, serum lipids, left ventricular mass, serum creatinine, microalbuminuria and augmetantion index were higher in menopausal than in fertile women, and comparable in menopausal women and men, a difference that was no longer present when adjusting for age or considering age-matched cohorts. Longitudinal: BP increase during follow-up, cardiovascular mortality and morbidity were greater in menopausal than in fertile women, and comparable in menopausal women and men, a difference no longer present in age-matched cohorts. Menopausal status was rejected from multivariate Cox analysis also including age.

CONCLUSION

The cardiovascular effects usually attributed to menopause seem to be a mere consequence of the older age of menopausal women.

Attribution of menopause symptoms in human immunodeficiency virus-infected or at-risk drug-using women

OBJECTIVE

To examine the relationship of human immunodeficiency virus (HIV) and attribution of menopausal symptoms.

DESIGN

Peri- and postmenopausal women participating in a prospective study of HIV-infected and at-risk midlife women (the Ms. Study) were interviewed to determine whether they experienced hot flashes and/or vaginal dryness and to what they attributed these symptoms.

RESULTS

Of 278 women, 70% were perimenopausal; 54% were HIV-infected; and 52% had used crack, cocaine, heroin, and/or methadone within the past 5 years. Hot flashes were reported by 189 women and vaginal dryness was reported by 101 women. Overall, 69.8% attributed hot flashes to menopause and 28.7% attributed vaginal dryness to menopause. In bivariate analyses, age 45 years and older was associated with attributing hot flashes and vaginal dryness to menopause, and postmenopausal status and at least 12 years of education were associated with attributing vaginal dryness to menopause, but HIV status was not associated with attribution to menopause. In multivariate analysis, significant interactions between age and menopause status were found for both attribution of hot flashes (P=0.019) and vaginal dryness (P=0.029). Among perimenopausal women, older age was independently associated with attribution to menopause for hot flashes (adjusted odds ratio=1.2, 95% CI: 1.1-1.4, P=0.001) and vaginal dryness (adjusted odds ratio=1.3, 95% CI: 1.1-1.6, P=0.011). None of the tested factors were independently associated with attribution to menopause among postmenopausal women.

CONCLUSION

Tailored health education programs may be beneficial in increasing the knowledge about menopause among HIV-infected and drug-using women, particularly those who are perimenopausal.