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Li W, Wang Z, Li X, Luo R, Huang J, Liu B, Zhou X. Associations Between Serum Estrogen Levels and Urinary Incontinence in Women: A Cross-sectional Analysis of NHANES 2013 to 2016. Urology 2024; 188:63-69. [PMID: 38670273 DOI: 10.1016/j.urology.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To explore the relationship between serum estrogen levels and urinary incontinence in a nationally representative female population. MATERIALS AND METHODS We included women who had serum estradiol measurements and self-reported urinary incontinence problems in the 2013-2016 National Health and Nutrition Examination Survey cycles. A weighted multivariable logistic regression model was used to determine the association between urinary incontinence and serum estrogen levels after adjusting for age, race, Body Mass Index, diabetes, venipuncture, hypertension, poverty-to-income ratio, smoking, marital status, alcohol use, education, and menopause. RESULT A total of 4114 individuals were ultimately included in our study. Of these women, 1200 (29.17%) complained of urge urinary incontinence (UUI), 1674 (40.69%) complained of stress urinary incontinence (SUI), 730 (17.74%) complained of mixed urinary incontinence (MUI). Women in the lowest quartile of serum estrogen were more likely to complain of UUI compared to those in the highest quartile (OR=1.885; 95% CI=1.042-3.412, P = .039). No association was noted between serum estrogen levels and SUI or MUI. CONCLUSION Our study shows a significant association between low serum estrogen level and the increased likelihood of UUI in women. Further research is required to validate our findings, elucidate the physiological mechanisms that underlie them, and assess potential therapeutic implications.
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Affiliation(s)
- Wenshuang Li
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Ziqiao Wang
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Xiaoyang Li
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Ruixiang Luo
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Junlong Huang
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Bolong Liu
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Xiangfu Zhou
- Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China.
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Clark AL, Goetsch MF. Genitourinary Syndrome of Menopause: Pathophysiology, Clinical Presentation, and Differential Diagnosis. Clin Obstet Gynecol 2024; 67:13-26. [PMID: 38281168 DOI: 10.1097/grf.0000000000000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Scientific information is incomplete regarding the genitourinary syndrome of menopause. Both the lower genital and urinary tracts are rich in receptors for reproductive hormones and are highly susceptible to waning ovarian hormones at menopause. Symptoms of dryness and pain emerge in late perimenopause, but they can also result earlier from cancer therapies or bilateral oophorectomy. Lower urinary tract symptoms rise in prevalence at midlife and increase further with advancing age. Because ovarian senescence is typically followed by years of aging, some postmenopausal complaints may be attributable to increasing longevity.
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Affiliation(s)
- Amanda L Clark
- Department of Obstetrics and Gynecology, Division of Urogynecology
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Martha F Goetsch
- Department of Obstetrics and Gynecology, Oregon Health and Science University
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Woods NF, Shaver JF, Berg JA. Genitourinary Syndrome of Menopause: Prevalence and Predictors. Clin Obstet Gynecol 2024; 67:27-42. [PMID: 38126336 DOI: 10.1097/grf.0000000000000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The genitourinary syndrome of menopause (GSM) has been proposed as a diagnosis by a consensus of clinicians and investigators. Our purpose for this paper is to review extant evidence about: 1) the breadth of symptoms and symptom clusters as related to the syndrome; 2) the prevalence of GSM (includes vulvar and vaginal atrophy); 3) factors that are associated with, predict, or explain the syndrome; and 4) what should be pursued for expanding meaningful evidence. Within recent literature, we found a wide range of prevalence estimates, likely a function of the differing populations studied, study design, and methods of data collection. Factors related to the prevalence of GSM included age and aging; reproductive aging stage; hormones, especially estrogen; and culture and language. We recommend further specification of diagnostic criteria for GSM; clarification of urinary symptoms in GSM; use of longitudinal study designs; validation of GSM-related measures; exploration of cultural equivalence of GSM measures; and assessing biases in completed research.
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Affiliation(s)
- Nancy F Woods
- University of Washington School of Nursing, Seattle, Washington
| | - Joan F Shaver
- The University of Arizona College of Nursing, Tucson, Arizona
| | - Judith A Berg
- The University of Arizona College of Nursing, Tucson, Arizona
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Huang H, Ding G, Li M, Deng Y, Cheng Y, Jin H. Menopause and stress urinary incontinence: The risk factors of stress urinary incontinence in perimenopausal and postmenopausal women. J Obstet Gynaecol Res 2023; 49:2509-2518. [PMID: 37443520 DOI: 10.1111/jog.15742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE The prevalence of stress urinary incontinence (SUI) increases around menopause. The quality of life of perimenopausal and postmenopausal women with SUI is significantly affected. This study aimed to investigate the prevalence of SUI and the associated risk factors in a population of Chinese perimenopausal and postmenopausal women. METHODS A total of 273 perimenopausal and postmenopausal women were enrolled, and a cross-sectional study was conducted. SUI was defined as an involuntary loss of urine with increases in abdominal pressure. Data including personal characteristics, menopause information, estrogen levels, and pelvic floor muscle strength levels were statistically analyzed. RESULTS The study enrolled 158 (57.9%) perimenopausal and 115 (42.1%) postmenopausal women. Sixty-six (41.8%) perimenopausal women and 56 (48.7%) postmenopausal women complained of SUI. The mean age was 49.42 ± 5.58 years. Body mass index over 24 kg/m2 (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.07-3.81), vaginal delivery (OR 2.47, 95% CI 1.33-4.58), and diabetes (OR 4.65, 95% CI 1.23-17.62) were high-risk factors for SUI. Climacteric symptoms (evaluated by Kupperman index scores) were statistically related to SUI, and among the 13 symptoms, insomnia, nervousness, weakness and fatigue, arthralgia and myalgia, headache, palpitation, and sexual complaints were all correlated with SUI in perimenopausal and postmenopausal women. CONCLUSIONS Several factors are associated with SUI in Chinese perimenopausal and postmenopausal women. Obesity, vaginal delivery, climacteric symptoms, and diabetes were identified as the most notable risk factors. The management strategy could focus on the prevention and management of risk factors.
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Affiliation(s)
- He Huang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Guowei Ding
- Division of HCV and STD Prevention and Treatment National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mei Li
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Yu Deng
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Yan Cheng
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Hongyan Jin
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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Abstract
OBJECTIVE Vasomotor symptoms (VMS), the most frequently reported symptoms during the menopausal transition, have been associated with inflammation. Whether inflammation is a risk factor for or a consequence of VMS remains unclear. The objectives of these analyses were to determine if elevated proinflammatory marker levels were associated with increased incident VMS in women without VMS at baseline and whether these associations varied by menopause transition stage or race/ethnicity. METHODS We used longitudinal data on incident VMS, high-sensitivity C-reactive protein (hs-CRP; n = 1,922) and interleukin-6 (IL-6; n = 203) from 13 follow-up visits in the Study of Women's Health Across the Nation, which included five racial/ethnic groups of midlife women. We performed multivariable discrete-time survival analyses to determine adjusted hazard ratios (aHRs) for the association of these proinflammatory markers with incident VMS in women without VMS at baseline. RESULTS We found no significant associations of incident VMS with dichotomized hs-CRP (>3 vs ≤3 mg/L) at baseline, concurrent or prior visit (aHRs, 1.04-2.03) or IL-6 (>1.44 vs ≤1.44 pg/mL) at visit 1, concurrent or prior visit (aHRs, 0.67-1.62), or continuous hs-CRP or IL-6 values over 13 follow-up visits (with nonsignificant adjusted increased hazards ranging from 0% to 2%). CONCLUSIONS Our results showed no significant association of the proinflammatory biomarkers, hs-CRP or IL-6, either concurrently or with subsequent incident VMS, indicating that inflammation was unlikely to be a risk factor for VMS. Thus, clinical treatments directed at reducing inflammation would be unlikely to reduce the occurrence of VMS.
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Woods R, Hess R, Biddington C, Federico M. Association of lean body mass to menopausal symptoms: The Study of Women's Health Across the Nation. Womens Midlife Health 2020; 6:10. [PMID: 32944260 PMCID: PMC7490966 DOI: 10.1186/s40695-020-00058-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 08/17/2020] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study was to examine the association of lean body mass (LBM) to the development of vasomotor symptoms (VMS) as women transition through menopause. Methods This study is a secondary use of data available for public use from follow up visits six through 10 for participants in the Study of Women’s Health Across the Nation. The study examined 2533 women, between the ages 42–52 years, each year over a10-year period. Data was modeled for associations of lean body mass and VMS. Changes in LBM since prior visit and since baseline were also modeled along with differences in means using binary logistic regression, adjusting for covariates. Results LBM was significantly associated to concurrent VMS (p = .036), percent change in LBM since prior visit (p = .003), percent change since baseline (p < .001), and overall means associations (p = .023). LBM was not significant for VMS at individual visit measures. In mixed regression modeling, time was significant (p < .0001) at all visits. The estimated probability of developing VMS decreases significantly as LBM increases. Conclusions Lean body mass is negatively associated with incident VMS. Our data suggests that maintaining higher levels of LBM during the menopausal transition may be protective against the development of VMS. Every woman will experience menopause in her life and the ability to potentially prevent the onset of specific symptoms through basic interventions, such as resistance training to increase lean body mass, may positively impact this large population.
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Affiliation(s)
- Rosanne Woods
- Department of Exercise Science and Sport Studies, California University of Pennsylvania, 50 University Ave, California, PA 15419 USA
| | - Rebecca Hess
- Department of Exercise Science and Sport Studies, California University of Pennsylvania, 50 University Ave, California, PA 15419 USA
| | - Carol Biddington
- Department of Exercise Science and Sport Studies, California University of Pennsylvania, 50 University Ave, California, PA 15419 USA
| | - Marc Federico
- Department of Exercise Science and Sport Studies, California University of Pennsylvania, 50 University Ave, California, PA 15419 USA
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El Khoudary SR, Greendale G, Crawford SL, Avis NE, Brooks MM, Thurston RC, Karvonen-Gutierrez C, Waetjen LE, Matthews K. The menopause transition and women's health at midlife: a progress report from the Study of Women's Health Across the Nation (SWAN). Menopause 2019; 26:1213-1227. [PMID: 31568098 PMCID: PMC6784846 DOI: 10.1097/gme.0000000000001424] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Our initial understanding of the menopause transition (MT) has been framed by clinical samples of women seeking treatment rather than by population-based studies. The Study of Women's Health Across the Nation (SWAN) initiated in 1996 with an overall goal to define the MT, to characterize its biological and psychosocial antecedents and sequelae in an ethnically and racially diverse sample of midlife women. METHODS This review summarizes the central findings of SWAN to date that can inform women and their healthcare providers about the impact of the MT and midlife aging on overall health and well-being. RESULTS SWAN characterized changes in reproductive axis and menstrual cycle patterns that informed the development of the reproductive aging staging system Staging of Reproductive Aging Workshop+10; MT-related symptoms and mental health (vasomotor symptoms, sleep complaints, psychological symptoms, cognitive performance, and urogenital and sexual health); and physiological systems and functions (cardiovascular and cardiometabolic health, bone health, physical function performance) that are influenced by the MT. SWAN demonstrated substantial interrelations among these changes and significant racial/ethnic differences in the rate and magnitude of change in multiple health indictors in midlife women. The findings point to midlife as a critical stage for adopting healthy behavior and preventive strategies. CONCLUSIONS Over the past 23 years, SWAN has advanced our understanding of the impact of the MT and midlife aging on health and well-being in women. SWAN will be instrumental to determine whether MT-related changes during midlife are related to unfavorable health and well-being in early old age.
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Affiliation(s)
- Samar R. El Khoudary
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA
| | - Gail Greendale
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sybil L. Crawford
- University of Massachusetts Medical School, Graduate School of Nursing, Worcester, MA
| | - Nancy E. Avis
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Maria M. Brooks
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA
| | - Rebecca C. Thurston
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | | | - L. Elaine Waetjen
- Department of Obstetrics and Gynecology, University of California Davis School of Medicine, Sacramento, CA
| | - Karen Matthews
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
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Govender Y, Gabriel I, Minassian V, Fichorova R. The Current Evidence on the Association Between the Urinary Microbiome and Urinary Incontinence in Women. Front Cell Infect Microbiol 2019; 9:133. [PMID: 31119104 PMCID: PMC6504689 DOI: 10.3389/fcimb.2019.00133] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/12/2019] [Indexed: 01/26/2023] Open
Abstract
Urinary incontinence (UI) is a burdensome condition with high prevalence in middle-aged to older women and an unclear etiology. Advances in our understanding of host-microbe interactions in the urogenital tract have stimulated interest in the urinary microbiome. DNA sequencing and enhanced urine culture suggest that similarly to other mucosal sites, the urinary bladder of healthy individuals harbors resident microbial communities that may play distinct roles in bladder function. This review focused on the urobiome (expanded quantitative urine culture-based or genomic sequencing-based urinary microbiome) associated with different subtypes of UI, including stress, urgency and mixed urinary incontinence, and related syndromes, such as interstitial cystitis and overactive bladder in women, contrasted to urinary tract infections. Furthermore, we examined clinical evidence for the association of the urinary microbiome with responses to pharmacotherapy for amelioration of UI symptoms. Although published studies are still relatively limited in number, study design and sample size, cumulative evidence suggests that certain Lactobacillus species may play a role in maintaining a healthy bladder milieu. Higher bacterial diversity in the absence of Lactobacillus dominance was associated with urgency UI and resistance to anticholinergic treatment for this condition. UI may also facilitate the persistence of uropathogens following antibiotic treatment, which in turn can alter the commensal/potentially beneficial microbial communities. Risk factors of UI, including age, menopausal status, sex steroid hormones, and body mass index may also impact the urinary microbiome. However, it is yet unclear whether the effects of these risks factors on UI are mediated by urinary host-microbe interactions and a mechanistic link with the female urogenital microbiome is still to be established. Strategies for future research are suggested.
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Affiliation(s)
- Yashini Govender
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Iwona Gabriel
- Division of Urogynecology, Brigham and Women's Hospital, Boston, MA, United States
| | - Vatche Minassian
- Division of Urogynecology, Brigham and Women's Hospital, Boston, MA, United States
| | - Raina Fichorova
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
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10
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Longitudinal analysis of changes in weight and waist circumference in relation to incident vasomotor symptoms: the Study of Women's Health Across the Nation (SWAN). Menopause 2018; 24:9-26. [PMID: 27749738 DOI: 10.1097/gme.0000000000000723] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Greater body mass index (BMI) and body fat are associated with vasomotor symptoms (VMS). Thus, weight loss may prevent VMS. We analyzed whether concurrent BMI or waist circumference and/or changes in weight or waist circumference predicted incident VMS and whether these relations differed by menopause stage or race/ethnicity. METHODS Data from 10 follow-up visits for 1,546 participants in the Study of Women's Health Across the Nation who reported no VMS at baseline were modeled for time to first symptomatic visit in relation to concurrent BMI and waist circumference and change in weight and waist circumference during early and late menopause using discrete survival analyses, adjusting for covariates. RESULTS Greater concurrent BMI and waist circumference were significantly related to greater any and frequent (≥6 d in the last 2 wk) incident VMS in early menopause and lower VMS risk in late menopause. Percentage weight change since baseline and since the prior visit was unrelated to incident any VMS in either menopause stage. Percentage weight change since baseline had a significant shallow U-shaped association with incident frequent VMS in early menopause (P = 0.02), a shallow inverse U-shape in late menopause (P = 0.02), and a significant interaction with menopause stage (P = 0.004) but not with race/ethnicity. Recent weight change was unassociated with incident VMS in either menopause stage. Results were similar for waist change. CONCLUSIONS Concurrent BMI and waist circumference were positively related to incident VMS in early menopause and negatively related in late menopause. Maintaining healthy weight in early menopause may help prevent VMS.
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Changes of Bladder Function Related to the Effects of Menopause. WOMEN’S HEALTH BULLETIN 2017. [DOI: 10.5812/whb.14390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Cruz Y, Lucio RA, Palacios JL. Neural and Endocrine Factors Contribute to the Comorbidity of Urinary and Sexual Dysfunctions. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0129-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Association between urinary incontinence and climacteric symptoms in postmenopausal women. Menopause 2017; 24:77-84. [DOI: 10.1097/gme.0000000000000727] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jackson EA, El Khoudary SR, Crawford SL, Matthews K, Joffe H, Chae C, Thurston RC. Hot Flash Frequency and Blood Pressure: Data from the Study of Women's Health Across the Nation. J Womens Health (Larchmt) 2016; 25:1204-1209. [PMID: 27404767 PMCID: PMC5175429 DOI: 10.1089/jwh.2015.5670] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Vasomotor symptoms (VMS) are highly prevalent among midlife women and have been associated with subclinical cardiovascular disease (CVD). However, the association between VMS frequency and risk factors such as hypertension (HTN) remains unclear. MATERIALS AND METHODS We examined VMS frequency and blood pressure (BP) among 2839 participants of the Study of Women's Health Across the Nation (SWAN), a multiethnic, prospective, study of women enrolled from seven U.S. sites between November 1995 and October 1997. Women were age 42-52, with no history of CVD, and not postmenopausal at baseline. VMS was defined by the number of days a woman reported VMS over the 2-week period before each annual visit. Frequent VMS was defined as ≥6 days of VMS; less frequent VMS was defined 1-5 days of symptoms with asymptomatic women the reference group. BP was measured at each visit in addition to demographic and clinic factors. RESULTS At baseline, 298 women reported frequent VMS, 794 less frequent VMS and 1747 no VMS. More frequent baseline VMS was associated with higher BP. Compared to no VMS, baseline VMS was associated with HTN (odds ratio [OR] 1.47, 95% confidence interval [CI]; 1.14-1.88 for infrequent VMS, and OR 1.40, (95% CI; 0.97-2.02 for frequent VMS). Risk for incident pre-HTN or HTN during follow-up was increased among women with frequent VMS (hazard ratio of 1.39, 95% CI; 1.09-1.79) after adjustment for multiple covariates. CONCLUSION Women with VMS may be more likely to develop HTN compared to women without VMS. Further research related to VMS including frequency of symptoms is warranted.
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Affiliation(s)
| | | | - Sybil L. Crawford
- Division of Preventive and Behavioral Medicine, University of Massachusetts, Worcester, Massachusetts
| | - Karen Matthews
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hadine Joffe
- Department of Psychiatry, Brigham and Women's Hospital, and Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Claudia Chae
- Department of Internal Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rebecca C. Thurston
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Quintana FA, Johnson WO, Waetjen E, Gold E. Bayesian Nonparametric Longitudinal Data Analysis. J Am Stat Assoc 2016; 111:1168-1181. [PMID: 28366967 DOI: 10.1080/01621459.2015.1076725] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Practical Bayesian nonparametric methods have been developed across a wide variety of contexts. Here, we develop a novel statistical model that generalizes standard mixed models for longitudinal data that include flexible mean functions as well as combined compound symmetry (CS) and autoregressive (AR) covariance structures. AR structure is often specified through the use of a Gaussian process (GP) with covariance functions that allow longitudinal data to be more correlated if they are observed closer in time than if they are observed farther apart. We allow for AR structure by considering a broader class of models that incorporates a Dirichlet Process Mixture (DPM) over the covariance parameters of the GP. We are able to take advantage of modern Bayesian statistical methods in making full predictive inferences and about characteristics of longitudinal profiles and their differences across covariate combinations. We also take advantage of the generality of our model, which provides for estimation of a variety of covariance structures. We observe that models that fail to incorporate CS or AR structure can result in very poor estimation of a covariance or correlation matrix. In our illustration using hormone data observed on women through the menopausal transition, biology dictates the use of a generalized family of sigmoid functions as a model for time trends across subpopulation categories.
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Koch M, Mitulovic G, Hanzal E, Umek W, Seyfert S, Mohr T, Koelbl H, Laterza RM. Urinary proteomic pattern in female stress urinary incontinence: a pilot study. Int Urogynecol J 2016; 27:1729-1734. [PMID: 27193112 PMCID: PMC5065895 DOI: 10.1007/s00192-016-3033-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/19/2016] [Indexed: 01/05/2023]
Abstract
Introduction and hypothesis Previous studies aiming to identify specific pre-defined urine protein biomarkers for stress urinary incontinence (SUI) have not identified clinically important differences. The hypothesis of our study was that the global distribution of urinary proteins, the proteome, differs between women with and those without SUI. Methods In this age-matched case–control study, we compared the urinary proteome of 20 women with SUI and 20 controls. Proteins were identified by applying high-performance liquid chromatography separation and tandem mass spectrometry detection. Data analysis was performed using Mascot 2.4.1 embedded in ProteinScape 3.1. Results We identified 828 different proteins. The concentration of six of those showed a significant difference between urine samples of SUI patients and those of controls (q value < 0.25). Four proteins showed a higher abundance in SUI samples compared with controls: plasma serine protease inhibitor (logFC 1.11), leucine-rich alpha-2-glycoprotein (logFC 3.91), lysosomal alpha-glucosidase (logFC 1.24), and peptidyl-prolyl cis- trans isomerase A (logFC 1.96). We identified two proteins in lower abundance in SUI samples compared with controls: uromodulin (logFC −4.87) and TALPID3 (logFC −1.99). Conclusions Overexpression of plasma serine protease inhibitor, leucine-rich alpha-2-glycoprotein, lysosomal alpha-glucosidase, and peptidyl-prolyl cis- trans isomerase A, and lower expression of uromodulin and TALPID3, in urine may be associated with female SUI. Electronic supplementary material The online version of this article (doi:10.1007/s00192-016-3033-5) contains supplementary material, which is available to authorized users
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Affiliation(s)
- Marianne Koch
- Clinical Division of General Gynecology and Gynecological Oncology, Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Goran Mitulovic
- Core Facility Proteomics, Clinical Institute of Laboratory Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Engelbert Hanzal
- Clinical Division of General Gynecology and Gynecological Oncology, Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Wolfgang Umek
- Clinical Division of General Gynecology and Gynecological Oncology, Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Sonja Seyfert
- Core Facility Proteomics, Clinical Institute of Laboratory Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Thomas Mohr
- Science Consult Thomas Mohr KG, Guntramsdorf, Austria
| | - Heinz Koelbl
- Clinical Division of General Gynecology and Gynecological Oncology, Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Rosa Maria Laterza
- Clinical Division of General Gynecology and Gynecological Oncology, Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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Augoulea A, Sioutis D, Rizos D, Panoulis C, Triantafyllou N, Armeni E, Deligeoroglou E, Chrelias C, Creatsa M, Liapis A, Lambrinoudaki I. Stress urinary incontinence and endogenous sex steroids in postmenopausal women. Neurourol Urodyn 2015; 36:121-125. [PMID: 26380958 DOI: 10.1002/nau.22885] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/28/2015] [Indexed: 11/09/2022]
Abstract
AIMS Urinary incontinence in general is a major cause of quality of life impairment, morbidity and hospitalization. Its onset is strongly linked to the menopause. Our study aimed to elucidate the possible relationship between endogenous circulating estrogens and the onset and development of stress urinary incontinence (SUI). METHODS One hundred and thirty eight peri- and postmenopausal women with SUI were matched 1:1 with continent women based on age and BMI. Morning fasting blood samples were drawn from all subjects for assessment of estradiol (E2), FSH, LH, Testosterone, Δ4-Androstendione (Δ4Α), DHEAS, prolactin, SBHG as well as a biochemical profile (glucose, insulin, triglycerides, cholesterol, HDL, LDL, ApoA1, ApoB). Hormone and biochemical parameters were compared between continent and incontinent women. RESULTS Incontinent women had significantly lower serum estradiol levels compared to those in the control group (17.30 ± 8.16 vs. 24.22 ± 8.99, P < 0.001). Furthermore, the same association was observed for serum Δ4Α (146.07 ± 52.63 vs. 159.99 ± 42.62, P = 0.017). These associations remained significant after controlling for age, menopausal age, BMI, and number of deliveries. CONCLUSIONS These results may indicate that within the postmenopausal range, endogenous sex hormones may be associated with the presence of SUI in women not on menopausal hormone therapy. Neurourol. Urodynam. 36:121-125, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Areti Augoulea
- Second Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, Athens, Greece
| | - Dimos Sioutis
- Second Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, Athens, Greece
| | - Demetrios Rizos
- Hormonal Laboratory, University of Athens, Aretaieio Hospital, Athens, Greece
| | - Constantinos Panoulis
- Second Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, Athens, Greece
| | - Nikolaos Triantafyllou
- First Department of Neurology, University of Athens, Aiginiteio Hospital, Athens, Greece
| | - Eleni Armeni
- Second Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, Athens, Greece
| | - Efthymios Deligeoroglou
- Second Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, Athens, Greece
| | - Charalambos Chrelias
- Third Department of Obstetrics and Gynecology, University of Athens, Attico Hospital, Athens, Greece
| | - Maria Creatsa
- Second Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, Athens, Greece
| | - Angelos Liapis
- Second Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, Athens, Greece
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, Athens, Greece
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Otunctemur A, Dursun M, Ozbek E, Sahin S, Besiroglu H, Koklu I, Erkoc M, Danis E, Bozkurt M. Impact of metabolic syndrome on stress urinary incontinence in pre- and postmenopausal women. Int Urol Nephrol 2014; 46:1501-5. [DOI: 10.1007/s11255-014-0680-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/19/2014] [Indexed: 10/25/2022]
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Mitchell ES, Woods NF. Correlates of urinary incontinence during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study. Climacteric 2013; 16:653-62. [PMID: 23560943 DOI: 10.3109/13697137.2013.777038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Urinary incontinence (UI) becomes more prevalent as women age, but little is known about UI in midlife, including stress incontinence (SUI) and urge incontinence (UUI) and their relationship to reproductive aging, reproductive history, health-related factors, and personal and social factors associated with midlife. OBJECTIVES To determine the influence of age and reproductive aging factors (menopausal transition stages, follicle stimulating hormone (FSH), estrone glucoronide), reproductive history (number of live births), health-related factors (perceived health, body mass index (BMI), exercise, diabetes) and personal and social factors (race/ethnicity, education) on the experience of UI among midlife women during the menopausal transition and early postmenopause. METHODS A subset of the Seattle Midlife Women's Health Study participants (n = 298 with up to 2249 observations) provided data during the late reproductive, early and late menopausal transition stages and early postmenopause, including menstrual calendars, annual health questionnaire and provided health diaries since 1990. Generalized estimating equation analysis was used to test models accounting for SUI and UUI that included age as a measure of time with predictors. RESULTS Stress urinary incontinence was associated significantly with individual predictors of: worse perceived health (odds ratio (OR) 0.89, p = 0.025), history of ≥ three live births (OR 3.00, p = 0.002), being in the early menopausal transition stage (OR 1.53, p = 0.06), having less formal education (OR 0.33, p = 0.02), and being White/not Black (OR 0.32, p = 0.04). The most parsimonious model for SUI included: worse perceived health, ≥ three live births, and being White. Urge incontinence was associated significantly with individual predictors of: increasing age (OR 1.06, p = 0.001), worse perceived health (OR 0.78, p < 0.001), BMI ≥ 30 kg/m(2) (OR 2.96, p = 0.001), history of ≥ three live births (OR 2.81, p = 0.01), and lower FSH levels (OR 0.59, p = 0.08). The most parsimonious model for UUI included: being older, having worse perceived health, and having a high BMI. CONCLUSIONS SUI risk was a function of reproductive history, poor health, and being White. UUI risk was a function of aging, having worse health, and higher BMI. Further exploration of UI during the menopausal transition is needed to articulate a lifespan view of UI and its typology.
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Menopause, hormone treatment and urinary incontinence at midlife. Maturitas 2013; 74:26-30. [DOI: 10.1016/j.maturitas.2012.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 10/12/2012] [Indexed: 11/18/2022]
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Cody JD, Jacobs ML, Richardson K, Moehrer B, Hextall A. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev 2012; 10:CD001405. [PMID: 23076892 PMCID: PMC7086391 DOI: 10.1002/14651858.cd001405.pub3] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND It is possible that oestrogen deficiency may be an aetiological factor in the development of urinary incontinence in women. This is an update of a Cochrane review first published in 2003 and subsequently updated in 2009. OBJECTIVES To assess the effects of local and systemic oestrogens used for the treatment of urinary incontinence. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register of trials (searched 21 June 2012) which includes searches of MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) and handsearching of journals and conference proceedings, and the reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials that included oestrogens in at least one arm in women with symptomatic or urodynamic diagnoses of stress, urgency or mixed urinary incontinence or other urinary symptoms post-menopause. DATA COLLECTION AND ANALYSIS Trials were evaluated for risk of bias and appropriateness for inclusion by the review authors. Data were extracted by at least two authors and cross checked. Subgroup analyses were performed by grouping participants under local or systemic administration. Where appropriate, meta-analysis was undertaken. MAIN RESULTS Thirty-four trials were identified which included approximately 19,676 incontinent women of whom 9599 received oestrogen therapy (1464 involved in trials of local vaginal oestrogen administration). Sample sizes of the studies ranged from 16 to 16,117 women. The trials used varying combinations of type of oestrogen, dose, duration of treatment and length of follow up. Outcome data were not reported consistently and were available for only a minority of outcomes.The combined result of six trials of systemic administration (of oral systemic oestrogens) resulted in worse incontinence than on placebo (risk ratio (RR) 1.32, 95% CI 1.17 to 1.48). This result was heavily weighted by a subgroup of women from the Hendrix trial, which had large numbers of participants and a longer follow up of one year. All of the women had had a hysterectomy and the treatment used was conjugated equine oestrogen. The result for women with an intact uterus where oestrogen and progestogen were combined also showed a statistically significant worsening of incontinence (RR 1.11, 95% CI 1.04 to 1.18).There was some evidence that oestrogens used locally (for example vaginal creams or pessaries) may improve incontinence (RR 0.74, 95% CI 0.64 to 0.86). Overall, there were around one to two fewer voids in 24 hours amongst women treated with local oestrogen, and there was less frequency and urgency. No serious adverse events were reported although some women experienced vaginal spotting, breast tenderness or nausea.Women who were continent and received systemic oestrogen replacement, with or without progestogens, for reasons other than urinary incontinence were more likely to report the development of new urinary incontinence in one large study.One small trial showed that women were more likely to have an improvement in incontinence after pelvic floor muscle training (PFMT) than with local oestrogen therapy (RR 2.30, 95% CI 1.50 to 3.52).The data were too few to address questions about oestrogens compared with or in combination with other treatments, different types of oestrogen or different modes of delivery. AUTHORS' CONCLUSIONS Urinary incontinence may be improved with the use of local oestrogen treatment. However, there was little evidence from the trials on the period after oestrogen treatment had finished and no information about the long-term effects of this therapy was given. Conversely, systemic hormone replacement therapy using conjugated equine oestrogen may worsen incontinence. There were too few data to reliably address other aspects of oestrogen therapy, such as oestrogen type and dose, and no direct evidence comparing routes of administration. The risk of endometrial and breast cancer after long-term use of systemic oestrogen suggests that treatment should be for limited periods, especially in those women with an intact uterus.
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Affiliation(s)
- June D Cody
- Cochrane Incontinence Review Group, University of Aberdeen, Foresterhill, UK.
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Pérez-López FR, Cuadros JL, Fernández-Alonso AM, Chedraui P, Sánchez-Borrego R, Monterrosa-Castro A. Urinary incontinence, related factors and menopause-related quality of life in mid-aged women assessed with the Cervantes Scale. Maturitas 2012; 73:369-72. [PMID: 23041251 DOI: 10.1016/j.maturitas.2012.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 09/03/2012] [Accepted: 09/04/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine urinary incontinence (UI) prevalence, related factors and menopause-related quality of life (QoL) in mid-aged Colombian women. METHODS A total of 1739 women aged 40-59 were surveyed with the 31 item Cervantes Scale (CS) and a socio-demographic questionnaire. Item 18 of the scale was used to categorize the degree of UI. Remaining 30 items (Adjusted global score) were used to assess global menopause-related QoL. RESULTS Median age of the sample was 46 years. A 26.0% of women presented some degree of UI, rated as moderate to severe in 16.4% of cases. Adjusted global CS scores (excluding item 18) significantly increased with the severity of UI. Mean scores for item 18 were found to be significantly higher in relation to age, menopausal status, body mass index values, lower education and unemployment status. Multiple linear regression analysis determined that age, postmenopausal status and ethnicity (Mestizo) were significantly related to higher item 18 scores, and thus more severe UI. CONCLUSION This is the first study to report UI prevalence in a large mid-aged Latin American female population in which age, menopausal status and ethnicity were related factors.
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Affiliation(s)
- Faustino R Pérez-López
- Department of Obstetrics and Gynecology, Lozano Blesa University Hospital, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain.
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Legendre G, Fritel X, Ringa V, Lesavre M, Fernandez H. Incontinence urinaire et ménopause. Prog Urol 2012; 22:615-21. [DOI: 10.1016/j.purol.2012.08.267] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 08/07/2012] [Accepted: 08/09/2012] [Indexed: 11/25/2022]
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Nappi RE, Davis SR. The use of hormone therapy for the maintenance of urogynecological and sexual health post WHI. Climacteric 2012; 15:267-74. [DOI: 10.3109/13697137.2012.657589] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Brito LGO, Brito LMO, Chein MBDC, Malheiros ESDA, Duarte TB, Pinto-Neto AM. Stress urinary incontinence in climacteric women in a northeastern Brazilian municipality: a household survey. Int Urogynecol J 2012; 23:639-45. [DOI: 10.1007/s00192-012-1697-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 02/09/2012] [Indexed: 11/30/2022]
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