The menopause transition and women's health at midlife: a progress report from the Study of Women's Health Across the Nation (SWAN)

Pulmonary V̇O2 on-kinetics and walking net V̇O2 associate with fatigue and mood disturbance in postmenopausal women

Postmenopausal women often experience fatigue and mood disturbance both of which interfere with quality-of-life. Since greater physical function aids psychosocial well-being, we hypothesized the acute cardiopulmonary responses during walking may reveal important factors linked to fatigue and mood disturbance. In this cross-sectional study, women of similar body mass index (BMI) aged 55-75 y were dichotomized to mid-life (55-65 y; 83.4 ± 8.4 kg/m2; n = 14) or older (≥65 y; 81.8 ± 10.4 kg/m2; n = 11) groups. A 6-minute walk test was used to estimate peak aerobic capacity (V̇O2peak). A treadmill task coupled with indirect calorimetry measured mean response time (MRT) - representing the duration to reach 63 % of steady-state net oxygen uptake (V̇O2). Average daily fatigue and fatigue interference were measured with the Fatigue Symptom Inventory. General mood disturbance was measured with the Profile of Mood States (POMS) questionnaire. Age-group differences were not detected in fatigue ratings, MRT, or walking net V̇O2. However, older women had lower aerobic capacity (p = 0.002, ES = 1.39) and greater disturbance in the POMS Depression-Dejection subscale (p = 0.042, ES = 0.41). Among all participants, and independent of V̇O2peak, MRT correlated with average daily fatigue (r = 0.500, p = 0.015), fatigue interference (r = 0.421, p = 0.046), and POMS total mood disturbance (rs = 0.437, p = 0.037). Regression modeling revealed MRT and walking net V̇O2 jointly explained 55 % (R = 0.744, p < 0.001) of the variance in average daily fatigue. In conclusion, MRT and walking net V̇O2 may serve as important points of intervention to alleviate fatigue and mood disturbance in postmenopausal women.

Disordered eating and body dissatisfaction in women with non-natural menopause

OBJECTIVE

Research on menopause and eating behavior has mostly focused on women with premenopausal, perimenopausal, and natural postmenopausal stages. The aim of this study was to investigate eating behavior and body image in women with non-natural menopause.

METHODS

The sample included 330 postmenopausal women, classified as non-natural menopause (NNMP) (N = 103) due to gynecological surgery (oophorectomy/hysterectomy) and natural menopause (NMP) (N = 227) who completed an anonymous questionnaire on current health, weight history, eating behavior including eating disorder symptoms (EDS) and body image. We compared women with NNMP and NMP and in a subanalysis, women with oophorectomy and hysterectomy using various logistic regression models.

RESULTS

NNMP women were similar in most demographic characteristics to NMP women except younger age, higher maximum BMI, more mental illnesses, restrictive dieting, and EDS. The group difference in EDS disappeared after adjustment for confounders. Our subanalysis of oophorectomized women showed a significantly higher prevalence of EDS (29%) compared to hysterectomized women (11%) (p = 0.017), even after adjustment for confounders, and a significantly more pronounced body weight dependence of their self-esteem. Body satisfaction was below 50% in all groups.

CONCLUSION

Women who have undergone oophorectomy appear to be highly susceptible for EDS compared to those with natural menopause, unlike hysterectomized women, whose menopausal transition is less abrupt. While body image was generally moderate to negative across all groups, oophorectomized women showed a stronger focus on weight-related self-esteem. Incorporating eating behavior into clinical care is crucial, especially for women post-oophorectomy.

Comparison of Symptoms Between Midlife Women in Perimenopause and Postmenopause Using Network Comparison Test

INTRODUCTION

Midlife women in perimenopause and postmenopause experience a complex array of symptoms. However, there is conflicting evidence on how their symptom experiences differ by menopausal stage. Current studies have not examined the interconnected relationship among menopausal symptoms and understood how this relationship may differ based on the menopausal stage.

METHODS

This is a secondary data analysis using cross-sectional data (visit 5) from the Study of Women's Health Across the Nation. Network analysis was used to visualize the network structure and to identify key symptoms. Then, a network comparison test was conducted to compare the symptom network properties. Propensity score matching was used to match participants in terms of their covariates.

RESULTS

In midlife women in perimenopause, frequent mood change was the key symptom with the highest strength (1.59), closeness (1.27), and expected influence (1.62). In midlife women in postmenopause, anxiety was the key symptom with the highest closeness (0.95) and expected influence (1.48). The symptom networks were not significantly different between the 2 groups in terms of global strength (global strength = 0.01, P = .974), network structure (network structure = 0.10, P = .461), and specific centrality measure (centrality = -0.10, P = .083). While the symptom networks were not invariant, the key symptoms were different between the 2 groups.

CONCLUSION

Our study findings indicate a potential need for different symptom management approaches for midlife women in perimenopause and postmenopause. With this new knowledge, clinicians should offer targeted key symptom assessment and management.

17β-estradiol status alters NMDAR function and antipsychotic-like activity in female rats

Low 17β-estradiol (E2) in females of reproductive age, and marked E2 decline with menopause, contributes to heightened symptom severity in schizophrenia (i.e. cognitive dysfunction) and diminished response to antipsychotic medications. However, the underlying mechanisms are unknown. N-methyl-D-aspartate receptor (NMDAR) hypofunction contributes to the pathophysiology of schizophrenia, yet impact of E2 depletion on NMDAR function is not well characterized. Quantitative electroencephalography (qEEG), specifically gamma power, is a well-established functional readout of cortical activity that is elevated in patients with schizophrenia and is sensitive to alterations in NMDAR function. Using qEEG and touchscreen cognitive assessments, present studies investigated the effects of E2 on NMDAR function by administering MK-801 (NMDAR antagonist) to ovariectomized rats with or without E2 implants (Ovx+E and Ovx, respectively). Ovx rats were more sensitive to MK-801-induced elevations in gamma power and attentional impairments compared to Ovx+E rats. Further investigation revealed these effects were mediated by reduced synaptic GluN2A expression. Consistent with clinical reports, olanzapine (second-generation antipsychotic) was less effective in mitigating MK-801-induced elevations in gamma power in Ovx rats. Lastly, we examined antipsychotic-like activity of a Group II metabotropic glutamate receptor (mGlu2/3) positive allosteric modulator (PAM), SBI-0646535, as a novel therapeutic in E2-deprived conditions. SBI-0646535 reversed MK-801-induced elevations in gamma power regardless of E2 status. Collectively, these studies established a relationship between E2 deprivation and NMDAR function that is in part GluN2A-dependent, supporting the notion that E2 deprivation increases susceptibility to NMDAR hypofunction. This highlights the need to examine age/hormone-specific factors when considering antipsychotic response and designing novel pharmacotherapies.

Prevalence of menopausal symptoms around the time of the final menstrual period in Japanese women: Data from the Japan Nurses' Health Study

OBJECTIVE

To characterize various menopausal symptoms by examining their prevalence around the time of the final menstrual period (FMP).

STUDY DESIGN

The Japan Nurses' Health Study is a prospective cohort study on women's health. All participants, regardless of their age at the initial survey, were mailed a 4-year follow-up questionnaire that included questions on 21 climacteric symptoms. We analyzed 5189 Japanese women who completed the questionnaire 6 years before to 10 years after their FMP.

MAIN OUTCOME MEASURES

The prevalence of severe climacteric symptoms in the years before and after the time of the FMP (YFMP).

RESULTS

Four distinct patterns were identified in the distribution of age-adjusted prevalence ratios by YFMP categories during menopausal transition. The prevalence of Group 1A symptoms (hot flashes, sweats, and poor memory or forgetfulness) was highest at the FMP and this continued through to the postmenopausal period. The prevalence of Group 1B symptoms was highest around the FMP but declined in the postmenopausal period. The independent effect of age was negatively significantly associated with most symptoms in Groups 1A and 1B, which suggested that younger women were more likely to have symptoms if they were in the same YFMP. In Group 2, the prevalence of symptoms did not increase. In Group 3, severe symptoms were rare.

CONCLUSIONS

Climacteric symptoms can be characterized according to their prevalence in the YFMP. The improved understanding of symptoms based on when they appear relative to the FMP could enable more detailed management of menopausal disorders and facilitate the prediction of changes in symptoms in Japanese women.

Workplace physical activity, sitting time, and menopause symptoms

OBJECTIVE

Increasing numbers of women are in employment during the menopause; however, menopause symptoms can negatively impact capacity to work. Aspects of the work environment, such as the amount of time spent in physical activity (PA) and sitting, may influence symptoms, yet this is unexplored. This study aimed to explore relationships between workplace PA and sitting, and menopause symptom severity.

METHODS

Using a cross-sectional study design, 264 perimenopausal or postmenopausal women were recruited to complete an online questionnaire assessing their self-reported workplace PA and sitting time, and their menopause symptom severity (menopause quality of life, hot flash interference, symptom severity). Multiple linear regression analyses examined the associations between menopause symptom severity and the time spent in PA (standing, walking, and physically demanding tasks) and sitting during work hours. Binomial logistical regression was used to assess if menopause symptom severity predicts whether women meet workplace activity guidelines.

RESULTS

No significant associations were observed between the time spent in PA or sitting while at work and menopause symptom severity ( P > 0.05). Menopause symptom severity did not significantly predict whether women met workplace activity guidelines ( P > 0.05).

CONCLUSIONS

In a cohort of perimenopausal and postmenopausal women, self-reported time spent in PA and sitting while at work is not associated with menopause symptom severity. Further research is needed using device-based methods to assess PA and sitting time, to explore in more detail the influence of the time spent in these behaviors while at work on menopause symptoms.

Development and validation of a menopause-specific health literacy scale for middle-aged women

OBJECTIVE

This study aimed to develop and validate the Menopause-Specific Health Literacy Scale (Men-HLS) for middle-aged women aged 45-64 years, utilizing an Item Response Theory (IRT) framework and traditional factor analysis.

METHODS

Based on the four subdomains (access, understand, appraise, and apply) of the integrated health literacy conceptual model proposed by the European Health Literacy Consortium, we developed 73 preliminary items, combining self-reported (subjective) and performance-based (objective) measures. Content validity was assessed by an expert panel (n = 14) and face validity was evaluated by the target population (n = 15). Validity and reliability were evaluated using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), internal consistency, and item analysis based on classical test theory and IRT.

RESULTS

The scale was refined to 45 items following content and face validity assessments and reduced to 35 items through classical test theory-based item analysis and inter-item correlation. EFA removed seven cross-loaded items, resulting in three distinct factors: accessing (ACS), appraising (APR), and utilizing (UTL). The IRT analysis demonstrated high item discrimination, with four items in the UTL subdomain showing moderate discrimination. CFA confirmed a good model fit. The final Men-HLS comprised 28 items (6 for ACS, 9 for APR, and 13 for UTL) and achieved a Cronbach's alpha of 0.91.

CONCLUSIONS

The Men-HLS is a valid and reliable instrument for identifying health literacy challenges in middle-aged women. Further research is needed to establish its predictive validity through longitudinal data and confirm its measurement invariance across diverse sociodemographic groups.

PRACTICE IMPLICATIONS

The Men-HLS provides healthcare professionals with a practical tool for assessing the health literacy levels required to manage menopausal symptoms and chronic conditions, facilitating the development of targeted educational resources and interventions for improved health management.

Psychological and cultural correlates of illness conception and menopausal symptoms: a cross-sectional and longitudinal comparative study of Mosuo, Yi, and Han women

Objective

This study explores the differences in menopausal symptoms, illness conception, and health-seeking behaviors among Mosuo, Yi, and Han women in China, analyzes the key factors behind these differences, and conducts a longitudinal comparison.

Methods

This study collected data from Mosuo, Yi, and Han women in Yongning Township, Ninglang County, Yunnan Province, through a questionnaire survey. The instruments included the Kupperman Menopause Index (KMI), Depression-Anxiety-Stress Scale (DASS), Self-Rating Scale of Illness Conception and Health Seeking Behavior (SSICHSB) and General Self-Efficacy Scale (GSES). First, descriptive statistical analysis was conducted on the demographic characteristics and various indicators of the sample. Chi-square tests and one-way ANOVA were used to examine the differences in KMI and SSICHSB among the different ethnic groups. The KMI was used to assess menopausal symptoms, and multiple linear regression analysis was employed to identify the main factors influencing menopausal symptoms. A longitudinal comparison of data from 2012 and 2020 was performed to analyze the dynamic changes in KMI and SSICHSB of Mosuo and Han women.

Results

The regression analysis identified stress, anxiety, and dysmenorrhea experience as risk factors, while self-efficacy served as a protective factor influencing menopausal symptoms. Both the menopausal symptoms and the scores for concerns and fears about illness among Mosuo women significantly decreased in 2020 compared to 2012 (p = 0.040, p = 0.010).

Conclusion

The results provide an important basis for the development of culturally sensitive health interventions. Future public health strategies should consider cultural, social, and physiological factors to provide more effective health support and interventions for women from different ethnic groups.

Recent Developments in Women's Health Research at the US National Institutes of Health

Importance

This article highlights key National Institutes of Health (NIH) programs, policies, and scientific advances that have informed and improved the health of women and describe the promise and potential of harnessing cutting-edge science and integrative approaches to advance women's health research. Policy updates combined with recent scientific and programmatic initiatives are intended to expand understanding of women's health, deliver diagnostics, and develop preventive approaches and novel therapies to meet critical health needs of contemporary women.

Observations

To benefit all people through the work funded and conducted by the NIH biomedical research enterprise, NIH has implemented policies that broadly expanded the knowledge of human health and disease from the laboratory to the clinic. Historically, women's health research initially focused on reproductive health and female-specific conditions. It has since expanded to encompass all aspects of the health of women. As new knowledge is generated, novel insights are uncovered about how diseases and conditions affect women uniquely, differently, or disproportionately and how sex and gender, as biological and social factors, respectively, influence health and disease at multiple levels. Although cutting-edge research has generated scientific advances leading to lifesaving vaccines, diagnostics, and treatments for women, many still do not have access to them. Thus, the White House announced an initiative that catalyzes innovative, integrative women's health research and propels translation from basic science to practical benefits, improving outcomes for all women across the lifespan.

Conclusions and Relevance

NIH's policies, programs, and research funding fill gaps in knowledge about the health of women. Their synergistic results generate evidence for data-driven decision-making and targeted interventions that will improve the health not just of women, but of all people.

The Mechanism by Which Estrogen Level Affects Knee Osteoarthritis Pain in Perimenopause and Non-Pharmacological Measures

Perimenopausal women have fluctuating estrogen levels, which often trigger a range of symptoms of perimenopausal syndromes as estrogen levels decrease. Changes in perimenopausal estrogen levels are closely related to pain in knee osteoarthritis (KOA), which has long been a research area of great interest in perimenopausal women. In recent years, it has been found that perimenopausal estrogen levels have an important role in KOA pain, namely, that estrogen can affect KOA pain through the regulation of inflammatory responses, inhibition of cellular senescence and apoptosis, and modulation of neurotransmitters, which may provide new ideas for KOA treatment. This study aims to describe the mechanism of estrogen level on knee osteoarthritis pain in perimenopause and related non-pharmacological measures, such as physical therapy, physical factor therapy, traditional Chinese medicine, and diet, which can provide a reference for the study and treatment of pain in perimenopausal women with KOA.

The association between depressive symptoms and ischemic heart disease in postmenopausal women: a cross-sectional study

Background

The negative impact of depression on cardiovascular health has drawn much attention. However, the relationship between depressive symptoms and ischemic heart disease (IHD) in postmenopausal women has not been previously reported.

Methods

This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005 to 2018, including 6,538 postmenopausal women. Weighted multivariable logistic regression analyses were conducted to examine the independent association between depressive symptoms and IHD.

Results

The fully adjusted model revealed a significant association between depressive symptoms and IHD (OR 1.97, 95% CI [1.24, 3.13]). Subgroup and interaction analyses revealed that depressive symptoms were more strongly linked to IHD risk among younger women, those with lower annual household incomes, non-Hispanic Black women, and individuals with comorbidities such as diabetes and hypercholesterolemia. Moreover, the presence of hypertension moderated the relationship between depressive symptoms and IHD.

Conclusion

Our findings indicate a significant association between depressive symptoms and increased IHD prevalence among postmenopausal women in the United States, with hypertension acting as a moderating factor. These results offer new insights and potential targets for improving cardiovascular health in this population.

Women's Health Study (WENDY)-a protocol of a population-based study assessing gynecological and metabolic health in women in their mid-30s

The Women's Health Study (WENDY) was conducted to improve insights into women's health and health burden. It provides a unique, comprehensive data source that can be broadly utilized to understand gynecological symptoms, diseases, and their relation to metabolic and overall health more deeply in a population-based setting. The study was conducted in Finland from May 2020 to October 2022. It included 1918 women (33-37 years old) who were born in northern Finland between July 1985 and December 1987. Data collection comprised one 3- to 4-hour study visit that included clinical measurements, biological samples, ultrasound examinations and an extensive questionnaire on gynecological and reproductive history, physical and mental health, quality of life, lifestyles, current life situations, health awareness, and opinions. The study also included a menstrual cycle follow-up and cognitive testing up to 3 months via a mobile application. Given that all participants' data can be linked to all Finnish national registers, and the Northern Finland Birth Cohort participants' data can be linked to the birth cohort data set collected from gestational week 24 onward, WENDY study forms one of the largest data sets worldwide to investigate gynecological and metabolic health burden in women.

Effects of physical exercise on the lipid profile of perimenopausal and postmenopausal women: a systematic review and meta-analysis

During the climacteric period, the decline in ovarian hormones leads to changes in the lipid profile. Physical exercise is the main non-pharmacological recommendation for controlling lipid levels. However, the effects on the lipid profile in perimenopausal and postmenopausal women are incipient and inconclusive. In this context, we searched the Embase, PubMed, Scopus, and Web of Science databases for randomized clinical trials on the effects of exercise on the lipid profile of these women. We excluded studies that did not specify criteria for classifying the climacteric phase, that involved women undergoing hormone replacement therapy, or that examined combined treatments or acute effects of physical exercise. The meta-analysis indicated that general physical exercise increased high-density lipoprotein cholesterol (HDL-C) levels (mean difference [MD]=4.89; 95% confidence interval [95%CI]=0.97 to 8.81) in perimenopausal women. For obese postmenopausal women, 16 weeks of aerobic training increased HDL-C levels (MD=3.88; 95%CI=0.56 to 7.20) and reduced total cholesterol (MD=-22.36; 95%CI=-29.67 to -15.05) and low-density lipoprotein cholesterol (LDL-C) levels (MD=-17.86; 95%CI=-25.97 to -9.75), whereas 12 weeks of resistance training increased HDL-C levels (MD=4.20; 95%CI=1.16 to 7.23) and decreased triglycerides (MD=-14.86; 95%CI=-26.62 to -3.09) and LDL-C levels (MD=-16.36; 95%CI=-28.05 to -4.67). Overall, the results showed that physical exercise regulated lipid profiles in perimenopausal and postmenopausal women. Specifically, 12 weeks of resistance exercise and 16 weeks of aerobic exercise improved the lipid profile of obese postmenopausal women.

Racial/ethnic differences in social support for dementia caregiving: Midlife women family caregivers of people with Alzheimer's disease

This study explored racial/ethnic differences in social support among racial/ethnic minority midlife women who are family caregivers of people with Alzheimer's disease (MWPLAD) in the US. This secondary analysis used data from a cross-sectional online survey conducted among 136 MWPLAD. Structured questionnaires were used to assess the demographic and caregiving-related characteristics, perceived social support, and sociocultural factors. Moreover, the relative contributions of demographic and sociocultural factors to social support were evaluated by hierarchical linear regression analysis while controlling for race/ethnicity. Cultural justification for duty (β = .338, p < .001) and discrimination during caregiving (β = -.215, p = .014) were significant sociocultural influencing factors, and advanced age (β = -.188, p = .015) was significantly associated with low social support. Therefore, interventions based on social determinants of health are necessary to enhance social support among racial/ethnic MWPLAD.

Hypertension Management in Women With a Multidisciplinary Approach

Current clinical practice guidelines were established by several organizations to guide the diagnosis and treatment of hypertension in men and women in a similar manner despite data demonstrating differences in underlying mechanisms. Few publications have provided a contemporary and comprehensive review focused on characteristics of hypertension that are unique to women across their life spectrum. We performed a computerized search using PubMed, OVID, EMBASE, and Cochrane library databases between 1995 and 2023 that highlighted relevant clinical studies, challenges to the management of hypertension in women, and multidisciplinary approaches to hypertension control in women, including issues unique to racial and ethnic minority groups. Despite our current understanding of underlying mechanisms and strategies to manage hypertension in women, numerous challenges remain. Here, we discuss potential factors contributing to hypertension in women, differences related to effects of lifestyle modifications and drug therapy between men and women, the impact of sleep, and the importance of recognizing disparities in socioeconomic conditions and access to care. This review outlines several opportunities for future studies to fill gaps in knowledge to achieve optimal control of hypertension in women using a multidisciplinary approach, particularly related to sex-specific treatment approaches while considering socioeconomic conditions and life stages from premenopause through the transition to menopause.

17β-estradiol status alters NMDAR function and antipsychotic-like activity in female rats

Low 17β-estradiol (E2) in females of reproductive age, and marked E2 decline with menopause, contributes to heightened symptom severity in schizophrenia (i.e. cognitive dysfunction) and diminished response to antipsychotic medications. However, the underlying mechanisms are unknown. N-methyl-D-aspartate receptor (NMDAR) hypofunction contributes to the pathophysiology of schizophrenia, yet impact of E2 depletion on NMDAR function is not well characterized. Quantitative electroencephalography (qEEG), specifically gamma power, is a well-established functional readout of cortical activity that is elevated in patients with schizophrenia and is sensitive to alterations in NMDAR function. Using qEEG and touchscreen cognitive assessments, present studies investigated the effects of E2 on NMDAR function by administering MK-801 (NMDAR antagonist) to ovariectomized rats with or without E2 implants (Ovx+E and Ovx, respectively). Ovx rats were more sensitive to MK-801-induced elevations in gamma power and attentional impairments compared to Ovx+E rats. Further investigation revealed these effects were mediated by reduced synaptic GluN2A expression. Consistent with clinical reports, olanzapine (second-generation antipsychotic) was less effective in mitigating MK-801-induced elevations in gamma power in Ovx rats. Lastly, we examined antipsychotic-like activity of a Group II metabotropic glutamate receptor (mGlu2/3) positive allosteric modulator (PAM), SBI-0646535, as a novel therapeutic in E2-deprived conditions. SBI-0646535 reversed MK-801-induced elevations in gamma power equally regardless of E2 status. Collectively, these studies established a relationship between E2 deprivation and NMDAR function that is in part GluN2A-dependent, supporting the notion that E2 deprivation increases susceptibility to NMDAR hypofunction. This highlights the need to examine age/hormone-specific factors when considering antipsychotic response and designing novel pharmacotherapies.

Aesthetic Gynecology and Mental Health: What Does It Really Mean for Women?

Body image, a complex interplay of perceptions, thoughts, and feelings about one’s physical appearance, has been a subject of extensive research. It is a dynamic construct that evolves throughout a woman’s lifespan, influenced by a multitude of biological, psychological, and sociocultural factors. From adolescence, marked by the onset of puberty and societal pressures to conform to specific beauty standards, to adulthood and the physical changes associated with aging, women’s body image undergoes significant transformations. Aging is a universal process that affects all organs, including the female genitalia. The vaginal tract undergoes significant atrophy due to declining estrogen levels, particularly during and after menopause. Aesthetic gynecology offers a range of procedures to address both functional and aesthetic concerns related to aging genitalia. Aesthetic gynecology, a burgeoning field within women’s health, provides various procedures aimed at enhancing genital appearance and function. It also helps balance the hormonal and anatomical changes that every woman experiences over time. The goal is to strengthen each patient’s intimate well-being and self-esteem, enabling them to experience intimacy peacefully. While often driven by concerns about physical attractiveness and sexual satisfaction, the psychological implications of these procedures are complex and multifaceted. It is crucial to recognize the interplay between psychological factors and the decision to undergo these procedures. Collaboration between surgeons and mental health professionals can ensure that candidates are psychologically prepared and have realistic expectations. By adopting a patient-centered approach and conducting rigorous research, healthcare providers can ensure that aesthetic gynecology is used as a tool for empowerment rather than exploitation. This article explores the intricate relationship between psychological well-being and aesthetic gynecology, examining how these procedures can impact body image, self-esteem, and overall quality of life.

Understanding the menopause journey

The menopause experience is unique to people with ovaries who attain an age at which functioning follicles are depleted. Unlike male reproductive aging, menopause is accompanied by a definable reproductive milestone in that menstrual periods cease and the failure of follicle growth results in a large drop in circulating estrogen and no further ovarian production of progesterone. While the focus on menopause has largely been centered on this absence of hormone production, the most dynamic changes in symptoms and health markers begin before the final menstrual period, and merit attention. Vasomotor symptoms, the most common symptom of menopause and the primary symptom that drives women to seek treatment, peak in frequency and prevalence in the late menopause transition, when women are still having menstrual periods. Body composition and adverse lipoprotein and lipid changes also worsen most acutely in the late transition, and then assume a slower, age-related trajectory of change. Multiple processes that worsen across the transition restabilize after it is over. The notion that the menopause transition is an adaptive process for women has scientific merit and suggests that facilitating this adaptation and recognizing its implications may represent the next phase of progress in the field.

Accelerated ovarian failure results in brain alterations related to Alzheimer's disease that are not recovered by high-intensity interval training in mice

INTRODUCTION

The menopausal decline in ovarian estrogen production is thought to increase the risk of Alzheimer's disease; however, this link requires further investigation. The chronological development of this connection is not well defined because of the lack of animal models that recapitulate the time course of menopause. This study characterized the cognitive and neuronal effects of the 4-vinylcyclohexene diepoxide (VCD) model of ovarian failure in female mice and assessed whether high-intensity interval training (HIIT) would attenuate impairments.

METHODS

Female mice were injected with VCD for 15 days. Novel object recognition tests (NORT) were conducted during (perimenopause) and after (menopause) ovarian failure (n = 7). HIIT was initiated in menopause and mice underwent NORT testing after 2 and 8 weeks of HIIT (n = 5).

RESULTS

VCD mice had a lower discrimination index, and lower SNAP25 and NeuN expression in perimenopause. HIIT did not recover memory in VCD mice.

DISCUSSION

Neuronal changes arise early in the perimenopausal transition and HIIT did not improve recognition memory when initiated in menopause.

HIGHLIGHTS

The menopausal decline in ovarian estrogen production increases the risk of Alzheimer's disease (AD). The chronological development of this connection is not well defined because of the lack of animal models that recapitulate the time course of menopause. 4-vinylcyclohexene diepoxide (VCD)-induced ovarian failure provides a model that simulates the average human experience in the transition from perimenopause to menopause. We demonstrate that cognitive and biochemical effects related to AD pathology are present from the earliest available timepoint in perimenopause in VCD mice. This work highlights the importance of examining the time course in the progression to menopause and the use of VCD as a model to investigate changes in the brain.

Cut-off point development for the Everyday Memory Questionnaire - Revised in perimenopausal women

OBJECTIVE

Subjective cognitive complaints have been reported in women during perimenopause and the Everyday Memory Questionnaire - Revised (EMQ-R) has been recently evaluated as a standardized instrument to measure subjective cognitive changes. The purpose of this study was to identify potential cut-off points for the EMQ-R retrieval subscale and attentional subscale, and to assess the validity of these cut-off points in detecting objective cognitive changes associated with reported subjective cognitive complaints.

METHOD

After screening, 232 perimenopausal women were included in the analyses. The supervised classification and regression tree was applied to identify optimal cut-off points. Its performance was evaluated by the value of the receiver operating characteristics curve, sensitivity and specificity.

RESULTS

Findings revealed that the optimal cut-off point for the attentional subscale was 7, and for the retrieval subscale was 13. Both cut-off points presented acceptable discrimination performance. An independent t-test indicated that both cut-off points were associated with significant differences in scores on neuropsychological measures of retrieval (episodic memory and verbal fluency) as well as neuropsychological measures of higher-level attention (working memory).

CONCLUSION

The identified cut-off points may be helpful for women to track or quantify their subjective experiences of brain fog or cognitive symptoms during the menopause transition.

Evolutionary Perspectives, Comparative Approaches, and the Lived Experience of Menopause

The purpose of this synthesis is to review age at menopause, symptom experience at midlife, and the evolution of menopause in a way that is helpful for biological anthropologists who are interested in the study of this challenging time of life. The synthesis begins with the biology of menopause, then shifts to the evolution of menopause with an emphasis on phylogenetic and adaptationist perspectives. Discussion of the biology and evolution of menopause incorporates a cross-species perspective, with particular attention to whales and primates. The synthesis continues with a cross-population review of variation in age at menopause. The final section is about symptom experience across populations with attention to the medical context of midlife, a focus on hot flashes, and consideration of the strengths and limitations of ethnographic and questionnaire-based research. The review ends with suggestions for where biological anthropology can make important contributions to the research of midlife and menopause.

Different temporal relationship between sex hormones and sleep status in midlife women: a longitudinal cohort study

Background

Fluctuation in sex hormones and the occurrence of sleep disturbance are 2 major health challenges among midlife women. However, the temporal relationship between them remains unclear.

Methods

This study included 2488 females (mean ± SD age, 49.0 ± 2.70 years) with an average follow-up of 6.95 years. We constructed a composite score by summing items related to sleep problems to reflect the comprehensive sleep status of the participants in the Study of Women's Health Across the Nation. Cross-lagged path analysis was used to examine the temporal relationship between sex hormones and sleep status. Sensitivity analyses were conducted in nonoverweight and overweight groups and adjusted for vasomotor symptoms in the main model.

Aim

In this study, we aimed to examine the temporal relationship between sex hormones and sleep status in midlife women using cross-lagged path analysis.

Outcomes

The primary outcomes included results of the cross-lagged path analysis between sex hormones and sleep status.

Results

After adjusting for age, race, income, menopausal status, body mass index, hormone therapy use, smoking, and drinking, the cross-lagged path coefficients from baseline follicle-stimulating hormone (FSH) and estradiol (E2) to follow-up sleep status were 0.054 (P = .017) and -0.054 (P = .016), respectively. The path coefficient from baseline sleep to follow-up dehydroepiandrosterone sulfate (DHAS) was 0.042 (P = .017). The path coefficients between testosterone and sleep were not statistically significant. In the nonoverweight group, the patterns of the temporal relationship between sex hormones and sleep were the same as the total sample, and the point estimates were larger. However, the temporal relationships in the overweight group were nonsignificant. After adjustment for vasomotor symptoms in the main model, results were basically consistent.

Clinical Implications

Given the temporal relationship between sex hormones and sleep, our findings will provide scientific perspectives to benefit health management in the transition of menopause.

Strengths and Limitations

This study used a longitudinal theoretical model to distinguish the temporal relationship between sex hormones and sleep status in midlife women. Limitations include limited causal evidence in observational studies, unknown confounders, and careful extrapolation.

Conclusion

There were distinct patterns in the unidirectional temporal relationship between (1) FSH, E2, and DHAS and (2) sleep. Changes in FSH and E2 occurred earlier than the change of sleep, while the change of DHAS was later. In contrast, there was no temporal relationship between testosterone and sleep.

Exploring weight management beliefs during the menopausal transition (ME-WEL project): A qualitative comparative study based on Health Belief Model

OBJECTIVES

While most women experience weight gain during the menopausal transition, a subset successfully maintains a healthy weight. This study explores the determinants influencing different weight experiences during the menopausal transition, using the Health Belief Model (HBM).

DESIGN

Qualitative design.

METHODS

Semi-structured individual interviews with 62 Portuguese post-menopausal women were performed. Among them, 31 women maintained a normal weight from pre-menopause to post-menopause, with a variation not exceeding 5% of pre-menopausal weight, while another 31 women transitioned from normal weight in pre-menopause to overweight or obesity in post-menopause, with an increase above 7% of pre-menopausal weight. Deductive-dominant content analysis and multiple correspondence analysis were performed.

RESULTS

Prominent differences exist between the Unhealthy Weight Gain Group (UWG-G) and the Healthy Weight Maintenance Group (HWM-G). The UWG-G lacks perceived susceptibility in pre-menopause and perceives obesity as stigmatizing. They prioritize immediate changes as benefits, while the HWM-G focuses on self-concept. Both groups face barriers like food cravings and weight loss challenges in middle-aged. For cues to action, the UWG-G emphasizes social support and self-care resources, while the HWM-G emphasizes age progression and healthy behaviour adherence. The HWM-G presents higher self-efficacy.

CONCLUSION

This study confirms the suitability of the HBM in understanding weight management beliefs among post-menopausal women, highlighting differences between women who maintain a healthy weight and those who experience weight gain during this life phase. This facilitates identifying key determinants (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy) crucial for future interventions in weight management.

Health care concerns in women at midlife: differences by race, ethnicity, and neighborhood socioeconomic status

OBJECTIVES

The aims of the study were to identify conditions diagnosed in at least 10% of midlife women living in the US upper midwest and to assess prevalence by age, race, ethnicity, and sociodemographic status.

METHODS

The Rochester Epidemiology Project was used to conduct a cross-sectional prevalence study of 86,946 women between 40 and 59 years residing in a 27-county region of the United States on January 1, 2020. Diagnostic billing codes were extracted and grouped into broader condition categories using the Clinical Classification System Refined. The prevalence of 424 conditions was calculated by age, race, ethnicity, and area deprivation index quartiles. Logistic regression was used to examine associations between participant characteristics and conditions that affected 10% or more of the study population.

RESULTS

Twenty-eight conditions affected ≥10% of women, and eight conditions increased by ≥45% between the ages of 40 and 59 (disorders of lipid metabolism, hypertension, sleep/wake disorders, thyroid disorders, esophageal disorders, osteoarthritis, tendon and synovial disorders, and menopausal disorders; all test for trend P < 0.01). Black women had a significantly higher prevalence of hypertension and esophageal disorders at all ages (adjusted P values <0.05). Women living in more deprived areas had a significantly higher prevalence of hyperlipidemia, hypertension, sleep/wake disorders, and esophageal disorders (adjusted P values <0.05). Women living in less deprived areas had a significantly higher prevalence of thyroid disorders at age 40 to 44 and menopausal disorders at ages 50 to 59 (adjusted P values <0.05).

CONCLUSIONS

These data suggest that additional attention should focus on Black women and women with a lower socioeconomic status to ensure that common midlife conditions are diagnosed and treated.

Menopausal hormone therapy use among active duty service women

OBJECTIVE

Menopausal hormone therapy (HT) has been shown to be effective in alleviating symptoms of menopause. While previous literature has described the frequency of HT use for the relief of menopausal symptoms in both the general and veteran female populations, there is currently no literature describing this frequency within the female active duty population. This study aims to address this gap in knowledge by conducting a retrospective cross-sectional study of HT receipt in active duty service women (ADSW) ages 45 to 64 during fiscal years (FYs) 2018 to 2022.

METHODS

We used the Military Health System (MHS) Data Repository (MDR) to conduct a retrospective study of ADSW ages 45 to 64 in the US Army, Air Force, Navy, and Marine Corps during FY 2018 to 2022. Study analyses included descriptive statistics on participant demographics and HT type. Logistic regressions were performed to assess for significant associations between participant demographics and receipt of HT.

RESULTS

We identified a total of 13,629 women aged 45 to 64 on active duty service in the US Army, Air Force, Navy, and Marine Corps during FY 2018 to 2022, of whom 1,290 (9.5%) received HT. Significantly lower odds for receipt of HT was observed among ADSW ages 45 to 49, 60 to 64, of Asian/Pacific Islander race, and all ranks below Senior Officer. No significant associations were observed by Service branch.

CONCLUSIONS

The prevalence of HT use among ADSW ages 45 to 65 is lower than HT use among the US veteran population age 45 and older but higher than among the US general population age 45 and older.

Fatigue in living kidney donors compared to a German general population sample: an exploratory study

Background

Clinical studies have not conclusively clarified whether fatigue scores in living kidney donors after donation are fundamentally different from general population samples. Moreover, the association between sociodemographic and donor specific factors and fatigue in donors is not well understood.

Patients and methods

Fatigue scores of 358 living kidney donors on average 7.67 years post-donation were compared with 1896 subjects from the German general population in five strata of age and sex. Fatigue was measured with the Multidimensional Fatigue Inventory (MFI-20). Relationships between the five MFI-20 subscales and the sociodemographic variables sex, age, education, and in the donor sample also years since donation were calculated. Additionally, the association between donor specific variables and fatigue levels were analyzed.

Results

Overall, donors had lower fatigue scores than the population sample. Particularly the age group 65-74 and above reported significantly lower fatigue scores. A significant exception was found in women aged 45-54 years, where donors showed significant higher general fatigue scores than the corresponding subgroup of the general population sample. Multiple regression analyses in the general population sample revealed associations between female sex and higher age with higher values in most MFI-20 subscales, whereas subjects with higher education showed mostly lower fatigue scores. In the donor group, these associations were of little importance. Also, years since donation, partnership, and recipient group were not strongly related to fatigue. However, higher fatigue in donors was associated with more donation regret, a more negative relationship with the recipient, a more negatively perceived recipient health, less perceived family support, and more financial burden.

Conclusion

Fatigue is less prevalent particularly in older donors and predictors of fatigue presented in the general population sample seem to have little importance in the donors. However, middle-aged female donors might be more prone to develop fatigue. This group may require more intense exploration before and after donation to detect and treat the underlying factors timely.

Self-harm in women in midlife: rates, precipitating problems and outcomes following hospital presentations in the multicentre study of self-harm in England

BACKGROUND

Suicide in women in the UK is highest among those in midlife. Given the unique changes in biological, social and economic risk factors experienced by women in midlife, more information is needed to inform care.

AIM

To investigate rates, characteristics and outcomes of self-harm in women in midlife compared to younger women and identify differences within the midlife age-group.

METHOD

Data on women aged 40-59 years from the Multicentre Study of Self-harm in England from 2003 to 2016 were used, including mortality follow-up to 2019, collected via specialist assessments and/or emergency department records. Trends were assessed using negative binomial regression models. Comparative analysis used chi-square tests of association. Self-harm repetition and suicide mortality analyses used Cox proportional hazards models.

RESULTS

The self-harm rate in midlife women was 435 per 100 000 population and relatively stable over time (incident rate ratio (IRR) 0.99, p < 0.01). Midlife women reported more problems with finances, alcohol and physical and mental health. Suicide was more common in the oldest midlife women (hazard ratio 2.20, p < 0.01), while psychosocial assessment and psychiatric inpatient admission also increased with age.

CONCLUSION

Addressing issues relating to finances, mental health and alcohol misuse, alongside known social and biological transitions, may help reduce self-harm in women in midlife. Alcohol use was important across midlife while physical health problems and bereavement increased with age. Despite receiving more intensive follow-up care, suicide risk in the oldest women was elevated. Awareness of these vulnerabilities may help inform clinicians' risk formulation and safety planning.

Menopause symptom burden and management across rural, suburban, and urban settings in a US population

OBJECTIVE

The aim of this study was to compare menopause experience in rural, suburban, and urban-residing women.

METHODS

A 2019 online survey of US females queried respondents on menopause symptoms, resources, and treatments. Those ≥45 years of age and in late menopause transition or postmenopause were included in the analysis. Late menopause transition and postmenopause subgroups were stratified by rural, suburban, and urban residence, and age-weighted proportions for menopause symptoms and treatments were calculated and compared using chi-square tests.

RESULTS

A total of 1,531 respondents, 45% (n = 686) late menopause transition, mean age of 50.7 (SD 3.9) and 55% (n = 845) postmenopause, and mean age of 65.1 (SD 8.5) were included. More prevalent symptoms in late menopause transition rural residents were as follows: muscle aches and pains (urban: 49%, suburban: 49%, rural: 65%, P = 0.003), and panic attacks (urban: 18%, suburban: 24%, rural: 30%, P = 0.04). More prevalent symptoms in postmenopause rural residents were as follows: mood swings (urban: 18%, suburban: 14%, rural: 23%, P = 0.02), urinary incontinence (urban: 19%, suburban: 14%, rural: 23%, P = 0.02), and vaginal dryness (urban: 22%, suburban: 29%, rural: 37%, P = 0.004). Vasomotor symptom prevalence was high (71% late menopause transition, 20% postmeopause), but current menopause hormone therapy use was low (11% late menopause transition, 11% postmenopause) and did not differ by residence, despite differences in menopausal resources used.

CONCLUSIONS

Rural women may experience greater burden of psychological and somatic menopause symptoms but not vasomotor symptoms. Overall low rates of menopause hormone therapy use suggest a need for education regarding hormone therapy, tailored to residential groups who rely on different resources on healthy aging.

Health Disparities in Vasomotor Symptom Prevalence and Treatment Discontinuation in Women of Menopausal Age: A Commercial Claims Analysis

Objective: To estimate the prevalence of diagnosed vasomotor symptoms (VMS) due to menopause among US women aged 40-64 years and assess sociodemographic differences in VMS prevalence and risk of discontinuing VMS-related treatment. Materials and Methods: This retrospective study evaluated merged data from IQVIA's PharMetrics Plus medical claims and consumer attributes databases for 2017-2020. VMS diagnosis was identified using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. Continuous enrollment was required ≥6 months before and 12 months after diagnosis date. Treatment discontinuation was measured for VMS-related treatments initiated at diagnosis or during the 12 months after diagnosis. Treatment duration was measured from diagnosis to the first day of a ≥90-day treatment gap. A Cox proportional hazards model was used to determine factors associated with risk of treatment discontinuation. Results: Among 7,386,206 eligible women, the 4-year prevalence of diagnosed VMS in 2017-2020 was 79.1 per 1,000 and was highest among non-Hispanic White women (82.5 per 1,000), followed by Hispanic (77.3), Black (71.6), and Asian women (64.5). Rates were higher among women living in urban areas and those with higher education and income. Among women newly diagnosed with VMS (n = 226,262), median treatment duration was 297 days. Black, Asian, and Hispanic women had higher risks of discontinuing treatment than non-Hispanic White women. Lower income was also associated with higher risk of discontinuation than higher income. Conclusion: Lower prevalence of diagnosed VMS and higher risk of treatment discontinuation were observed among racial/ethnic minorities and women with less education and income, suggesting possible underdiagnosis and unmet needs.

Health Disparities and Hormone Therapy Prescribing for Early, Peri-, and Postmenopausal Women: A Scoping Review

OBJECTIVES

Menopause hormone therapy has improved the quality of life for perimenopausal and early postmenopausal women, yet women may not be prescribed or use this treatment option. The purpose of this study was to conduct a scoping review to assess whether health disparities existed in hormone therapy prescription rates and use for peri- and postmenopausal care based on demographic and clinical characteristics in real-world, observational studies conducted in the USA.

METHODS

A chief librarian conducted a search strategy from 1940 to 10/31/2023 in five bibliographic databases. One hundred eighty-four articles were found through database and handsearching. After removing duplicates and excluding articles that did not meet study criteria, 14 articles were included in this review. Data were independently extracted and charted using a data extraction form, which was developed based on the study aims. Reviewers met to confirm agreement and discuss disagreements.

RESULTS

Sixteen health disparities, in menopause hormone therapy prescribing or use, were found in this scoping review. Differences between ethnic groups were found in 9 of 14 articles. Education level, menopause route, medical conditions, and practitioner specialization were in 4 of the 14 articles. The remaining 11 health disparities were categorized under chronic medical conditions and social constructs.

CONCLUSIONS

Health disparities have existed for decades in menopause hormone therapy prescribing and use for peri- and postmenopausal women. Identification of health disparities for underserved groups can help reshape educational initiatives for practitioners in all relevant disciplines.

Evolutionary Perspectives, Comparative Approaches, and the Lived Experience of Menopause

The purpose of this synthesis is to review age at menopause, symptom experience at midlife, and the evolution of menopause in a way that is helpful for biological anthropologists who are interested in the study of this challenging time of life. The synthesis begins with the biology of menopause, then shifts to the evolution of menopause with an emphasis on phylogenetic and adaptationist perspectives. Discussion of the biology and evolution of menopause incorporates a cross-species perspective, with particular attention to whales and primates. The synthesis continues with a cross-population review of variation in age at menopause. The final section is about symptom experience across populations with attention to the medical context of midlife, a focus on hot flashes, and consideration of the strengths and limitations of ethnographic and questionnaire-based research. The review ends with suggestions for where biological anthropology can make important contributions to the research of midlife and menopause.

Rural residence and health-related quality of life in a sample of Spain perimenopausal women

BACKGROUND

The prevalence and severity of perimenopausal symptoms are typically associated with multiple factors, including demographic characteristics. The sociodemographic characteristics of women living in rural areas differ from those residing in urban areas, and it has been suggested that these differences could potentially influence the prevalence of symptoms experienced during perimenopause.

OBJECTIVES

To evaluate if perimenopausal women living in Spanish rural areas have a higher prevalence of perimenopausal symptoms and assess their influence on health-related quality of life.

METHODS

A cross-sectional study was conducted in a sample of 270 perimenopausal women residing in rural and urban areas. The participants completed the Cervantes Scale Short Version and Beck Depression Inventory 2.

RESULTS

Perimenopausal women in rural areas reported a higher incidence of perimenopausal symptoms and a lower perception of health-related quality of life compared to those in urban areas, as evidenced by higher scores on the total Cervantes Scale Short Version scale (33.2 (±16.2) vs. 26.4 (±18.1), p = .001). No differences in the Beck Depression Inventory 2 score were detected.

CONCLUSIONS

Perimenopausal women residing in rural areas of Spain reported a higher prevalence of perimenopausal symptoms and experienced a poorer Health-Related Quality of Life compared to those living in urban areas of Spain.

Women's expectations for system support for a healthy menopausal transition: A pilot study

BACKGROUND

This pilot study contributes to the knowledge on healthy menopause by adopting a person-centric, lifelong approach to support a healthy menopausal transition. It focuses on women's expectations of system support for this transition.

METHOD

Twenty-two online in-depth interviews were conducted with women of various ages, experiences, and backgrounds in the United Kingdom, ensuring representation across the menopausal transition journey - before, during and after menopause. The interviews explored perceptions and expectations of healthy menopause and the required support. User journey and systems frameworks guided data collection and analysis. The pilot aimed to verify the feasibility of the developed study approach and protocol.

RESULTS

A healthy menopausal transition is seen as preserving essential capacities to maintain normal daily activities despite bodily changes, a crucial aspect of ageing. Participants outlined a journey of awareness, contemplation of lifestyle adjustments, experimentation with new behaviours, and habit formation. These findings underscore the importance of fostering awareness and support for menopausal transition early in life. Participants also stressed the impact of the broader environment across the ageing journey, including education, research, health services, workplace dynamics, built environment, food industry, technology and innovation, media, advertising, and social networks.

CONCLUSIONS

This work highlights person-centric perceptions of healthy menopause, complementing existing biology-centred perspectives. By introducing a co-creation approach at the system level, it offers opportunities to define holistic support for the menopausal transition. The findings informed a knowledge exchange and ideation workshop with forty relevant system stakeholders to advance solution co-creation.

Menopausal stages and overactive bladder symptoms in middle-aged women: A cross-sectional study

OBJECTIVE

To examine the prevalence of overactive bladder (OAB) according to menopausal stages in middle-aged women.

DESIGN

Cross-sectional study.

SETTING

Total Healthcare Center in South Korea.

POPULATION

Middle-aged Korean women (n=3469, mean age, 49.5 ± 2.9 years).

METHODS

Menopausal stages were defined according to the Stages of Reproductive Aging Workshop +10 criteria, and menopausal symptoms were assessed using the Korean version of Menopause-Specific Quality of Life (MENQOL). Logistic regression models were used to estimate prevalence ratios with 95% confidence intervals for OAB according to menopausal stage and to assess the associations with menopausal symptoms.

MAIN OUTCOME MEASURES

OAB symptoms were evaluated using the Overactive Bladder Symptom Score (OABSS).

RESULTS

The prevalence of OAB increased with menopausal stage; however, the multivariable-adjusted prevalence ratios for women in menopausal transition and postmenopausal stage were insignificant (ptrend = 0.160) compared to those for premenopausal women. Among individual OAB symptoms, the multivariable-adjusted prevalence ratios for nocturia increased with menopausal stage in a dose-response manner (ptrend = 0.005 for 1 time/day; ptrend < 0.001 for ≥2 times/day). The association between menopausal stages and nocturia occurring ≥2 times/day was evident in women without OAB and with relatively high MENQOL scores, vasomotor symptoms and difficulty sleeping.

CONCLUSIONS

The prevalence of OAB, particularly nocturia, increased with menopausal stage, and the association was obvious in women with other menopausal symptoms. This finding underscores the importance of addressing nocturia as a potential menopausal symptom in middle-aged women. Further studies are required to understand the mechanisms linking OAB with menopausal symptoms in middle-aged women.

Sarcopenic Obesity: A Comprehensive Approach for Postmenopausal Women

Sarcopenic obesity, characterized by the concurrent presence of muscle loss and obesity, poses significant health challenges, especially in the elderly. This review explores the impact of sarcopenic obesity on disability, metabolic health, comorbidities, and potential management strategies. With the aging global population, the prevalence of sarcopenic obesity is expected to increase, necessitating a comprehensive management approach. Early screening, prevention, and ongoing research on its underlying mechanisms and therapeutic options are crucial for promoting healthy aging.

Exploring the effects of estrogen deficiency and aging on organismal homeostasis during menopause

Sex hormone signaling declines during aging, from early midlife through menopause, as a consequence of reduced circulating estrogens and decreased receptiveness to these hormones in target tissues. Estrogens preserve energy homeostasis and promote metabolic health via coordinated and simultaneous effects throughout the brain and body. Age-associated loss of estrogen production during menopause has been implicated in a higher risk for metabolic diseases and increased mortality. However, it remains unclear whether age-associated changes in homeostasis are dependent on reduced estrogen signaling during menopause. Although menopausal hormone therapies containing estrogens can alleviate symptoms, concerns about the risks involved have contributed to a broad decline in the use of these approaches. Non-hormonal therapies have emerged that target tissues or pathways with varying levels of selectivity, reducing risk. We summarize here the broad effects of estrogen loss on homeostasis during menopause, current and emerging therapies and opportunities for understanding homeostatic disruptions associated with menopause.

The role of menopausal symptoms on future health and longevity: A systematic scoping review of longitudinal evidence

Women live longer than men but spend more years in poor health. Menopausal symptoms are not generally associated with adverse health outcomes. However, increasingly, evidence suggests they can significantly impact future health and longevity. Understanding the long-term effects of menopausal symptoms will enable clinicians to identify risk factors and intervene with modifications to support healthy aging. This review examined the scope of research investigating the association between menopausal symptoms and future health outcomes. We searched for longitudinal cohort studies. Date and geographical restrictions were not applied. Articles were screened and data extracted using standardised methods. Included studies examined the role of menopausal symptoms on future health developments using a sample who had experienced menopause and were deemed healthy at baseline, with clear reporting of their menopausal status at symptom assessment. We identified 53 eligible studies with data from over 450,000 women enrolled in 28 longitudinal cohorts. Cardiovascular disease, psychiatric disorders, diabetes, and reduced bone mineral density were positively associated with menopausal symptoms. Breast cancer was associated with an asymptomatic menopause. Psychological menopausal symptoms and cognitive decline improved after menopause, except among women from low socioeconomic backgrounds. These findings demonstrate that menopausal symptoms are important indicators for future health risks. Future work should investigate the impact of underexplored menopausal symptoms on future health, such as sleeping problems and urogenital issues, and evaluate whether treating menopausal symptoms could lead to improvements in future health outcomes. Should future research continue to support these findings, clinical guidelines should be updated to support clinical decision-making in menopause care.

Perceived lack of behavioral control is a barrier to a healthy lifestyle in post-menopause: a qualitative study

INTRODUCTION

Menopause is a natural phase in a woman's life, but the quality of life and health of postmenopausal women are often compromised by unhealthy lifestyles. Therefore, it is crucial to identify the factors that influence their well-being. The main objective of this study is to explore the barriers to a healthy lifestyle among Iranian postmenopausal women.

METHODS

Qualitative exploratory research was conducted among postmenopausal women aged 45-65 years in three different health centers located in urban areas with varying economic level in a central city of Iran. These areas represented upscale, downtown, and downscale areas with different economic statuses (wealthy, relatively wealthy, and less wealthy). Nine focus group discussions were held, focusing on managing menopausal symptoms, physical activity, and healthy nutrition. Each topic was discussed separately in a different health center, with 10 women participating in each session. Data analysis was conducted using Graneheim and Lundman's method.

RESULTS

The study revealed a prominent theme, "perceived lack of behavioral control as a barrier to a healthy lifestyle in post-menopause." Two categories, "False attitudes" and "Perceived inability to engage in behavior," were derived from 26 codes related to managing menopausal symptoms. Furthermore, a category, "Perceived inability to engage in behavior," was formed from 11 to 13 codes related to physical activity and healthy nutrition, respectively. The theme highlighted that the perceived lack of behavioral control prevented the women from adopting a healthy lifestyle.

CONCLUSION

Improving perceived behavioral control through the modification of attitudes and abilities is essential for maintaining a healthy postmenopausal lifestyle.

Ovarian tissue cryopreservation and transplantation as a natural means to delay menopause

Ovarian tissue cryopreservation and transplantation (OTCT) offers hope for preserving fertility and endocrine functions in patients undergoing gonadotoxic treatments. Advancements in techniques for the procedure have transformed OTCT from an experimental procedure into a viable option. There is a growing interest in utilizing OTCT to delay menopause and alleviate associated health issues. Menopausal transition affects women globally, leading to symptoms and long- term health risks. OTCT has the potential to restore endocrine functions, reducing menopause-related symptoms while mitigating health consequences such as osteoporosis and cardiovascular diseases. Although the use of OTCT for delaying menopause is not clinically proven, the discussion around shows potential for future utilization. In essence, the remarkable advancements in OTCT have bestowed upon us the ability to safeguard fertility and sustain the delicate endocrine functions of the ovaries. However, it is the tantalizing prospect of utilizing this technique to postpone menopause and alleviate its associated symptoms that truly captivates the imagination. Further research is imperative to substantiate the clinical efficacy of OTCT; nonetheless, its potential in menopausal therapy is both promising and warrants comprehensive exploration. This review highlights advancements and the feasibility of OTCT to postpone menopause as an alternative approach to currently used conventional menopause therapy methods.

Tipping the scale: Effects of physical activity and body composition on cardiac parameters in postmenopausal females

The risk of cardiovascular disease increases significantly after menopause. We sought to assess the impact of different activity levels on cardiac structure and function in postmenopausal women. We grouped age-similar, postmenopausal women by self-reported physical activity levels over two decades. The study involved 34 women (age 61 ± 1 years; 11 ± 2 postmenopausal years; body mass index 23 ± 3 kg/m2) categorized into three activity tiers: sedentary (SED; ≤1 h exercise weekly; n = 9); moderately active (MOD; ≥2 ≤6 h low/moderate intensity exercise weekly; n = 11) and highly active (HIGH; >4 h of moderate/high intensity exercise weekly; n = 14). Maximum oxygen uptake (VO2max) differed significantly (p < 0.05) between the groups (24.9 ± 5.8; 30.5 ± 5.8; 38.4 ± 4.4 mL O2/kg/min; SED, MOD and HIGH respectively). Conversely, there were no differences (p > 0.05) in height, Total fat-free mass, body surface area or in echocardiographic measures of left ventricular (LV) morphology, systolic function, diastolic function and right ventricular function. Contrary to our hypothesis, these findings reveal that marked differences in activity level and VO2max are not reflected in measures of LV morphology or echocardiographic indicators of cardiac diastolic or systolic function in postmenopausal women of similar body size.

The Effectiveness of Cognitive Behavioral Therapy on Insomnia Severity Among Menopausal Women: A Scoping Review

This review explores the impact of cognitive behavioral therapy for insomnia (CBT-I) on menopausal women suffering from insomnia. The transition to menopause is often accompanies by sleep disturbances, which significantly affect women's quality of life. This review applies a scoping approach to evaluate randomized controlled trials (RCTs) focused on CBT-I interventions for insomnia among menopausal women. The included studies examined variations in the number of CBT-I sessions, the duration of interventions, and their delivery methods (face-to-face, online, or telephone-based). The results consistently showed that CBT-I significantly improves sleep quality and reduces insomnia severity in menopausal women. CBT-I was particularly effective compared to other interventions such as sleep restriction therapy and sleep hygiene education. Sleep quality improvements were observed to persist for up to six months after treatment. These findings support the use of CBT-I as a first-line intervention for insomnia in menopausal women, offering a sustainable solution with fewer side effects compared to pharmacological treatments. However, the review also highlights the need for further research on CBT-I's efficacy in diverse populations, as most studies focused on predominantly white and well-educated women.

Hormone replacement therapy for menopausal mood swings and sleep quality: The current evidence

Marked alterations in the normal female hormonal milieu in the perimenopausal period significantly affect women’s health, leading to decreased well-being, psychological distress, and impaired quality of life. Common menopausal symptoms include hot flashes, sleep and mood changes, fatigue, weight gain, and urogenital disturbances. Clinicians often neglect mood swings and disrupted sleep, although those can significantly limit the productivity of women and impair their cognitive function and mental health. Evidence-based management should include a personalized, holistic approach to alleviate symptoms and careful consideration of the risks vs benefits of hormone replacement therapy (HRT), with due consideration of personal preferences. A research paper in the recent issue of the World Journal of Psychiatry by Liu et al investigated the role of HRT in altering mood changes and impaired sleep quality in menopausal women, which helps us to understand the benefits of this treatment approach.

Intention to Use a Mental Health App for Menopause: Health Belief Model Approach

BACKGROUND

Menopause presents a period of heightened vulnerability for mental health issues. Despite this, mental health screening is not consistently integrated into menopausal health care, and access to psychological interventions is limited. Digital technologies, such as web and smartphone apps, may offer a way to facilitate and improve mental health care provision throughout menopause. However, little is known about potential users' intention to use such technologies during this critical phase of life.

OBJECTIVE

To examine the factors that impact the intention of potential users to use a mental health app during menopause, we used the Health Belief Model (HBM), a psychological framework widely used to understand and predict individuals' health-related behaviors.

METHODS

An online survey was generated. Convenience sampling was used, with participants recruited via social media and email, through relevant foundations and support groups, and by word of mouth. Structural equation modeling with maximum likelihood estimation was conducted to explore whether the factor structure of the HBM is a good fit for predicting the intention to use a mental health app for menopause. A Cronbach α value of .05 was used for determining statistical significance.

RESULTS

A total of 1154 participants commenced the survey, of which 82.49% (n=952) completed at least 97% of the survey. Of these, 86.76% (n=826) expressed that their menopausal symptoms had negatively affected their mental health, and went on to answer questions regarding their experiences and interest in using a web or smartphone app for mental health symptoms related to menopause. Data from this subgroup (N=826) were analyzed. In total, 74.09% (n=612) of respondents sought online help for mental health symptoms related to menopause. The most common topics searched for were symptom characteristics (n=435, 52.66%) and treatment or therapy options (n=210, 25.42%). Psychoeducation (n=514, 62.23%) was the most desired mental health app feature, followed by symptom tracking (n=499, 60.41%) and self-help tips (n=469, 56.78%). In terms of the intention to use a mental health app, the Satorra-Bentler-scaled fit statistics indicated a good fit for the model (χ2278=790.44, P<.001; comparative fit index=0.933, root mean square error of approximation=0.047, standardized root mean square residual=0.056), with cues to action emerging as the most significant predictor of intention (β=.48, P<.001). This was followed by perceived barriers (β=-.25, P<.001), perceived susceptibility (β=.15, P<.001), and perceived benefits (β=.13, P<.001). Perceived severity (β=.01, P=.869) and self-efficacy (β=.03, P=.286) were not significantly associated with behavioral intention.

CONCLUSIONS

This study reveals important factors that influence the intention to use a mental health app during menopause. It emphasizes the need to address barriers to app usage, while highlighting the impact of credible endorsements and psychoeducation. Furthermore, the study underscores the significance of improving accessibility for users with lower digital literacy or limited resources.

Exercise intensity and reliability during recreational team handball training for 50-77-year-old unexperienced women

This study analyzed the physiological and physical demands of recreational team handball (RTH) and the training sessions' (matches) intensity variability in 50-77-year-old postmenopausal women (n = 20) without prior experience with the sport. Heart rate (HR), blood lactate, rating of perceived exertion (RPE), distance covered, time spent in different locomotor categories, accelerations, decelerations, Player Load (PL), game actions and fun levels were evaluated in 245 matches, played indoor (n = 130) or outdoor (n = 115), as small-sided games (3 × 15-min periods). Mean and peak HRs were 79 and 88% of maximal HR (%HRmax), showing reliable values across the training sessions, with time spent in the HR zones showing excellent relative reliability, though poor absolute reliability. Time spent > 80 and > 90%HRmax was 48% and 14% of total match time, respectively. Mean and peak blood lactate values were 2.6 ± 0.8 and 2.9 ± 0.9 mmol · l-1, respectively. RPE was 5.5 ± 1.5, showing good relative though poor absolute reliability, and fun levels were 8.4 ± 1.1 (0-10 scale). Total distance covered was 1878 ± 333 m and the participants spent 54%, 3% and < 1% of total match time walking, fast running and sprinting, respectively. Total PL was 224 ± 41 (AU), with 67% of total match time being spent in low-intensity zones. Participants performed a total of 38 specific high-demanding actions per match, mainly throws (10.6 ± 5.8) and stops (11.0 ± 3.6). RTH training, played as small-sided games, is a high-intensity exercise training mode with high aerobic and anaerobic demands, low RPE and high fun levels for 50-77-year-old women without prior experience with the sport. Average cardiovascular demands were consistent across the training sessions.

Longitudinal Exposure to Neighborhood Concentrated Poverty Contributes to Differences in Adiposity in Midlife Women

Background: Neighborhood poverty is associated with adiposity in women, though longitudinal designs, annually collected residential histories, objectively collected anthropometric measures, and geographically diverse samples of midlife women remain limited. Objective: To investigate whether longitudinal exposure to neighborhood concentrated poverty is associated with differences in body mass index (BMI) and waist circumference (WC) among 2,328 midlife women (age 42-52 years at baseline) from 6 U.S. cities enrolled in the Study of Women's Health Across the Nation (SWAN) from 1996 to 2007. Methods: Residential addresses and adiposity measures were collected at approximately annual intervals from the baseline visit through a 10-year follow-up. We used census poverty data and local spatial statistics to identify hot-spots of high concentrated poverty areas and cold-spots of low concentrated poverty located within each SWAN site region, and used linear mixed-effect models to estimate percentage differences (95% confidence interval [CI]) in average BMI and WC levels between neighborhood concentrated poverty categories. Results: After adjusting for individual-level sociodemographics, health-related factors, and residential mobility, compared to residents of moderate concentrated poverty communities, women living in site-specific hot-spots of high concentrated poverty had 1.5% higher (95% CI: 0.6, 2.3) BMI and 1.3% higher (95% CI: 0.5, 2.0) WC levels, whereas women living in cold-spots of low concentrated poverty had 0.7% lower (95% CI: -1.2, -0.1) BMI and 0.3% lower (95% CI: -0.8, 0.2) WC. Site-stratified results remained in largely similar directions to overall estimates, despite wide CIs and small sample sizes. Conclusions: Longitudinal exposure to neighborhood concentrated poverty is associated with slightly higher BMI and WC among women across midlife.

Comparison of arterial stiffness index predictors in perimenopausal and postmenopausal women

The present cross-sectional study aimed to compare climacteric symptoms and arterial stiffness indices between perimenopausal and postmenopausal women. The study sample comprised 70 healthy female participants, including 27 perimenopausal (49.8 ± 3.8 years) and 43 postmenopausal (55.7 ± 4 years) individuals. Validated methods were used to assess physical activity level, quality of life, climacteric symptoms, and anthropometric data. Arterial stiffness parameters were measured using Mobil-O-Graph. Pulse wave velocity (PWV) had a higher mean in the postmenopausal group than in the perimenopause group [8.04 m/s (SD 0.79) vs 7.01 m/s (SD 0.78), p < .001). PWV was strongly correlated with peripheral (r = 0.619) and central (r = 0.632) Systolic Blood Pressure (SBP) in postmenopausal group and an even stronger correlation was observed in perimenopausal group (r = 0.779 pSBP and 0.782 cSBP). BMI was a risk predictor in the perimenopausal group contributing positively to increase Pulse Pressure Amplification (PPA) (0.458, p < .05). In postmenopausal women, heart rate (HR) was a stronger predictor for central SBP, cardiac output, and total vascular resistance, whereas perimenopausal women HR influenced central diastolic blood pressure and PPA. Vascular changes initiating during perimenopause may contribute to the development of cardiovascular pathologies in the postmenopausal period. Further research with larger, representative samples is warranted to corroborate these findings.