Possible association of early menopause with worse physical function: a systematic review

Possible association between subclinical hypothyroidism and age at menopause in Colombian women

OBJECTIVE

To evaluate the association between subclinical hypothyroidism with early menopause, premature menopause, and last menstrual bleeding before the natural age of menopause.

METHODS

This was a cross-sectional study conducted in 643 postmenopausal women aged 40-69 years. Groups were formed according to last menstrual episode: ≥45 [Natural age at menopause], 40-44 and [Early menopause], <40 [Premature menopause], and <45 [last menstrual episode before the natural age of menopause]. The Zulewski scale was applied to identify manifestations related to hypothyroidism and subclinical hypothyroidism, diagnosed with a serum TSH > 4.5 µIU/mL plus T4-free between 0.7 and 1.9 ng/dL.

RESULTS

It was found that 24.4% had the last menstrual episode before the natural age of menopause, 18.6% had early menopause, and 5.7% had premature menopause. Subclinical hypothyroidism was diagnosed in 4.5% of patients. Among women with subclinical hypothyroidism, there was a higher frequency of early menopause, premature menopause, and last menstrual episode before the natural age of menopause, than in women without subclinical hypothyroidism (p < 0.05). Paresthesia (50%) and dry skin (40.7%) were the most reported hypothyroidism-related manifestations. Early menopause, premature menopause, and last menstrual episode before the natural age of menopause were associated with subclinical hypothyroidism, OR: 3.37 [95% CI: 1.40-8.10], OR: 4.31 [95% CI: 1.24-14.97], and OR: 3.57 [95% CI: 1.57-8.10], respectively.

CONCLUSIONS

The last menstrual episode before the natural age of menopause, early menopause, and premature menopause were significantly associated with a higher chance of subclinical hypothyroidism.

Menopause hormone therapy and physical performance: The Canadian Longitudinal Study on Aging

OBJECTIVE

To examine the association between menopause hormone therapy (MHT) and physical performance among women from the Canadian Longitudinal Study on Aging.

STUDY DESIGN

Cross-sectional study of 12,506 postmenopausal Canadian women.

MAIN OUTCOME MEASURES

Grip strength (kg), gait speed (m/s), timed up and go (s), chair rise (s), and balance (s) were assessed following standard procedures. The association between MHT and physical performance was evaluated using linear regression models adjusted for age, education, study site, smoking, alcohol consumption, body mass index, diabetes, hypertension, and hysterectomy. Sensitivity analyses were conducted according to age at study visit (<65 vs. ≥65 years), body mass index (<25 kg/m2 vs. ≥25 kg/m2), physical activity level (less vs. more active), duration and type of MHT, and time of starting MHT after menopause.

RESULTS

Compared with those who never used MHT, prior or current use was associated with better performance on the timed up and go test (β: -0.19; 95%CI: -0.28; -0.11) and faster gait speed (β = 0.01, 95%CI = 0.00; 0.02). No association was found for grip strength, balance, and chair rise. Results did not change by body mass index, physical activity, or duration of MHT use. When stratified by age at study visit, the effect remained significant only in among those aged 65 years or more. Starting MHT <5 years after menopause was associated with better physical performance.

CONCLUSIONS

MHT was associated with better physical performance in gait speed and timed up and go tests. The cross-sectional design of the study limits causal interpretation. Prospective studies are needed to confirm our results.

Estimation of Sarcopenia Indices in Women from Saudi Arabia in Relation to Menopause and Obesity: Cross-Sectional Comparative Study

Sarcopenia prevalence depends on the definition, and ethnicity must be considered when setting reference values. However, there is no specific cut-off for sarcopenia in Saudi women. Accordingly, we aimed to establish a cut-off value for sarcopenia in Saudi women. We determined the prevalence of sarcopenia in terms of low handgrip strength (HGS) in postmenopausal women using the EWGSOP2 value, redefined a specific cut-off for low HGS derived from Saudi premenopausal women, re-determined the prevalence of low HGS using the new cut-off, and analyzed the proportion of low HGS in women with obesity compared to those without obesity. Following EWGSOP2 guidelines, we defined probable sarcopenia and set new HGS values. We assessed HGS and body composition in 134 pre/postmenopausal women. Probable sarcopenia prevalence was calculated using EWGSOP2's HGS of 16 kg and new cut-offs from young premenopausal women without obesity. HGS 10 and 8 kg cut-offs were calculated from premenopausal Saudi women's mean -2 SDs and mean -2.5 SDs. Using the HGS 16 kg cut-off, sarcopenia prevalence was 44% in postmenopausal and 33.89% in premenopausal women. Applying the new HGS 10 kg and 8 kg cut-offs, the prevalence was 9.33% and 4%, respectively, in postmenopausal and 5% and 3.40%, respectively, in premenopausal women. Women with obesity had a higher proportion of low HGS across all cut-offs. We suggest that EWGSOP2 cut-offs may not be adaptable for Saudi women. Considering body composition differences between Saudis and Caucasians, our proposed HGS cut-offs appear more relevant.

Early menopause and premature ovarian insufficiency may increase the risk of sarcopenia: A systematic review and meta-analysis

PURPOSE

Menopausal transition, resulting from a decline in estrogen concentrations, may compromise musculoskeletal health. However, it is unclear if early menopause (defined as age at menopause <45 years) and premature ovarian insufficiency (defined as age at menopause <40 years) are associated with increased risk of sarcopenia. The aim of this systematic review and meta-analysis was to synthesize studies evaluating the association between age at menopause and risk of sarcopenia.

METHODS

A comprehensive search was conducted in PubMed, CENTRAL and Scopus, up to 31 December 2022. Data were expressed as standardized mean difference with 95 % confidence intervals. The I² index was employed to evaluate heterogeneity.

RESULTS

Six studies were included in the qualitative and quantitative analysis, with a total of 18,291 post-menopausal women. Compared with women of normal age at menopause (>45 years), women with early menopause demonstrated lower muscle mass, assessed by appendicular skeletal muscle mass/body mass index [standardized mean difference (SMD) -0.14, 95 % confidence interval (CI) -0.20 to -0.07, p < 0.001; I² 0%]. However, no differences in muscle strength, assessed by handgrip strength (SMD -0.15, 95 % CI -0.31 to 0.01, p = 0.071; I² 72%), and muscle performance, assessed by gait speed (SMD -0.11, 95 % CI -0.29 to 0.05, p = 0.18; I² 79%), were found. Women with premature ovarian insufficiency had lower handgrip strength (SMD -0.3, 95 % CI -0.58 to -0.01, p = 0.04; I² 74.6 %) and gait speed (SMD -0.13, 95 % CI -0.23 to -0.04, p = 0.004; I² 0%) compared with women of normal age at menopause.

CONCLUSION

Early menopause is associated with reduced muscle mass and premature ovarian insufficiency with reduced muscle strength and performance compared with normal age at menopause.

Cognitive Decline in Early and Premature Menopause

Early and premature menopause, or premature ovarian insufficiency (POI), affects 1% of women under the age of 40 years. This paper reviews the main aspects of early and premature menopause and their impact on cognitive decline. Based on the literature, cognitive complaints are more common near menopause: a phase marked by a decrease in hormone levels, especially estrogen. A premature reduction in estrogen puts women at a higher risk for cardiovascular disease, parkinsonism, depression, osteoporosis, hypertension, weight gain, midlife diabetes, as well as cognitive disorders and dementia, such as Alzheimer's disease (AD). Experimental and epidemiological studies suggest that female sex hormones have long-lasting neuroprotective and anti-aging properties. Estrogens seem to prevent cognitive disorders arising from a cholinergic deficit in women and female animals in middle age premature menopause that affects the central nervous system (CNS) directly and indirectly, both transiently and in the long term, leads to cognitive impairment or even dementia, mainly due to the decrease in estrogen levels and comorbidity with cardiovascular risk factors, autoimmune diseases, and aging. Menopausal hormone therapy from menopause to the age of 60 years may provide a "window of opportunity" to reduce the risk of mild cognitive impairment (MCI) and AD in later life. Women with earlier menopause should be taken care of by various specialists such as gynecologists, endocrinologists, neurologists, and psychiatrists in order to maintain their mental health at the highest possible level.

Association between menopausal status and physical function: A systematic review protocol

INTRODUCTION

Physical function is considered an important marker of adverse health outcomes. Postmenopausal women seem to have worse physical function, but conflicting results have been reported in the literature. The aim of this systematic review is to assess the association between menopausal status and physical function in community-dwelling women.

METHODS

Cross-sectional and/or longitudinal studies which objectively or subjectively assess physical function at different menopausal stages will be included. Studies conducted in institutionalized populations or with any specific medical condition that may have induced menopause (i.e. cancer or degenerative diseases) will be excluded. This systematic review protocol follows the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The searches will be carried out in the Pubmed, Embase, SciELO (Scientific Electronic Library Online), LILACS (Latin American and Caribbean Literature on Health Sciences), VHL (Virtual Health Library), Scopus and Web of Science databases, using the search equation "Menopause AND (Physical Performance OR Function)". The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies will be considered to assess the methodological quality of the included studies. The selection and evaluation of the methodological quality of the studies will be carried out by independent researchers and the discrepancies will be resolved by a separate researcher.

ETHICS AND DISCLOSURE

Ethical approval is not required as this is a study using secondary data. The results will be published in a scientific journal. We intend to contribute to the expansion of knowledge regarding physical function of women according to the menopause status, thus helping in the perspective of improving health and functioning. This systematic review started in January 2022 and all steps are expected to be finished by October 2022.

PROSPERO REGISTRATION NUMBER

CRD42021289899.

Hand grip strength, standing balance, and rapid foot tapping in relation to the menopausal transition in Campeche, Mexico

OBJECTIVES

This cross-sectional study investigated menopause status in relation to hand grip strength, standing balance, and rapid foot tapping. A secondary aim was to examine the relationship between physical performance and urban/rural residence with a focus on habitual daily tasks.

METHODS

Maya and non-Maya women (40-60 years) were drawn from urban and rural sites in Campeche, Mexico (n = 543). Demographic, reproductive, and lifestyle information was collected in face-to-face interviews along with anthropometric and physical function measures. Linear regression was used to evaluate menopause status in relation to strength, balance, and foot tapping speed while adjusting for residence, ethnicity, and other variables.

RESULTS

Hand grip strength was 22.5, 21.6, and 20.0 kg in pre-, peri-, and postmenopausal women, respectively, but menopause status was not significantly related to grip strength in models adjusted for age. Grip strength was negatively associated with age and socioeconomic index, and positively associated with height and weight, self-reported health, and hours/week spent grinding corn/making tortillas. Postural stability was 9.4, 6.9, and 5.6 s across menopause categories; and menopause status remained significant in adjusted models. The number of foot taps in 10 s was 35.7, 33.4, and 33.9 taps in pre-, peri-, and postmenopausal women. Parity was negatively associated with foot tapping in adjusted models.

CONCLUSIONS

While age is a key predictor of physical function in women aged 40-60 years, menopausal status appears to have additional influences on postural control beyond age alone. Hours spent grinding corn/making tortillas were significantly associated with grip strength among rural women.

Earlier menopause is associated with higher risk of incident frailty in community-dwelling older women in England

BACKGROUND

Although it is well known that women have higher risk of frailty, mechanisms are not clear. Reproductive history may be related to the sex difference in frailty.

METHODS

A total of 1249 community-dwelling women aged ≥60 in England were examined for associations between age at menopause and risk of developing frailty. Frailty defined by the frailty phenotype was measured at baseline and 4 years later. Age at menopause was used as a continuous variable and categorical groups: premature/early (10-45 years), normal (46-55 years), and late (56 years or older). Men with comparable conditions from the same cohort were also used as a comparison.

RESULTS

Earlier age at menopause was significantly associated with higher risk of incident frailty. One year later menopause age was associated with a 3% decrease in incident frailty risk (Odds ratio [OR] = 0.97, 95%CI = 0.95-1.00, p = 0.02). Women with premature or early menopause had a significantly higher risk of developing frailty compared with those with normal menopause (OR = 1.90, 95%CI = 1.28-2.81, p = 0.001), while those with late menopause did not. In a supplementary analysis with older men, older women with premature or early menopause were more likely to develop frailty compared with older men (OR = 2.29, 95%CI = 151-3.48, p < 0.001), however, there was no significant difference between women with normal or late menopause.

CONCLUSIONS

Earlier menopause was significantly associated with higher risk of developing frailty. Our findings suggest that menopause or its related factors, such as decline in estrogen after menopause, potentially play an important role in the sex difference in frailty.

Heterogeneity in resistance training-induced muscle strength responses is associated with training frequency and insulin resistance in postmenopausal women

BACKGROUND

In older adults, muscle strength (MS), a key component of sarcopenia, is essential to maintaining independence and physical capacity. The rate of muscle strength decline typically accelerates during the menopausal transition. Although MS has been shown to increase with resistance training (RT), the response to training is quite heterogeneous. Thus, if contributing factors to RT non-responsiveness to MS gains are identified, it may be possible to develop more effective and personalized ways to improve MS or identify individuals who may benefit from RT interventions. This study assessed potential factors that may contribute to MS response heterogeneity in postmenopausal women: training frequency, serum FSH and estrogen levels, adiposity, inflammation marker, and insulin resistance.

METHODS

One hundred and thirteen individuals participated in a 16-week program of supervised RT (3 sets, 8-12 repetitions, and 2-3 times/week). A control group (CTL, n = 63 - no performed the RT) was used as the comparator arm. Body composition (skinfold) and blood samples (metabolic and inflammatory indicators and hormones) were measured at baseline. Knee extensor strength (1RM) was measured at baseline, 8 weeks, and 16 weeks.

RESULTS

Only the RT group increased 1RM after 8 weeks (RT = 14 ± 12% vs. CTL = 6 ± 15%). Both groups increased 1RM after 16 weeks, with the RT group showing a greater increase than the CTL group (RT = 31 ± 23% vs CTL = 13 ± 25%). After 8 weeks of RT, 41 (36% of total) individuals were considered non-responders (based on control group responses) and 27 (24% of total) individuals after 16 weeks. At week 8, lower RT frequency (2 times/week vs. 3 times/week) was associated with higher odds of being non-responder (3 times, P = 0.048). At week 16, lower RT frequency (13 times, P = 0.009) and higher HOMA-IR (for every unit increase, odds increase by 40%, P = 0.022) were associated with higher odds of being non-responder. Higher QUICKI was associated with lower odds of being non-responder (for every unit increase, odds decrease by 16%, P = 0.039). Moreover, higher RT frequency (17 times, P = 0.028) and higher QUICKI (for every unit increase, odds increase by 41%, P = 0.017) were associated with higher odds of becoming a responder at week 16, being a non-responder at week 8.

CONCLUSION

Heterogeneity in RT-induced MS responses is associated with training frequency and insulin resistance in postmenopausal women.