Undertreatment of menopausal symptoms and novel options for comprehensive management

Latent Profile Analysis for Classification of Psychosomatic Symptoms in Perimenopausal Women

BACKGROUND

Over 80% of perimenopausal women experience various physical and neuropsychiatric symptoms due to changes in hormones. However, accurate evaluation and treatment of menopausal symptoms are lacking due to limited evidence regarding customized treatment for each symptom type.

OBJECTIVE

This study aimed to identify and cluster psychosomatic symptoms in Korean perimenopausal women and to investigate the characteristics of each cluster type.

METHODS

This Web-based survey assessed 1060 Korean perimenopausal women recruited from nationally representative panels available from a commercial research company. Menopausal symptoms were evaluated using the Menopause Rating Scale, Patient Health Questionnaire-15, Patient Health Questionnaire-9, Insomnia Severity Index, Subjective Memory Complaints Questionnaire, and Overactive Bladder Symptom Score. Data were analyzed using latent profile analysis and multinomial logistic regression.

RESULTS

Latent profile analysis identified 4 latent classes: "all unimpaired (class 1)," "impaired sexual function, while others are unimpaired (class 2)," "unimpaired sexual function, while others are impaired (class 3)," and "all impaired (class 4)." Classes 3 and 4 were significantly more likely to have a family history of perimenopausal syndrome and a history of other mental disorders, postpartum depression, and postpartum psychosis than classes 1 and 2.

CONCLUSIONS

Psychosomatic symptoms appear during perimenopause along with depression, somatic symptoms, insomnia, impaired memory, and overactive bladder symptoms. Individuals with these symptoms are more likely to have a history of postpartum depression, psychosis, and other psychiatric disorders. Therefore, sexual dysfunction must be independently treated. Further studies are needed to develop and verify individualized treatments according to symptom class.

Bis(N-picolinamido)cobalt(II) Complexes Display Antifungal Activity toward Candida albicans and Aspergillus fumigatus

This report highlights the synthesis and characterization of ten new bis(N-picolinamido)cobalt(II) complexes of the type [(L)2 CoX2 ]0/2+ , whereby L=N-picolinamide ligand and X=diisothiocyanato (-NCS), dichlorido (-Cl) or diaqua (-OH2 ) ligands. Single crystal X-ray (SC-XRD) analysis for nine of the structures are reported and confirm the picolinamide ligand is bound to the Co(II) center through a neutral N,O binding mode. With the addition of powder X-ray diffraction (PXRD), we have confirmed the cis and trans ligand arrangements of each complex. All complexes were screened against several fungal species and show increased antifungal activity. Notably, these complexes had significant activity against strains of Candida albicans and Aspergillus fumigatus, with several compounds exhibiting growth inhibition of >80 %, and onecompound inhibiting Aspergillus fumigatus hyphal growth by >90 %. Conversely, no antifungal activity was exhibited toward Cryptococcus neoformans and no cytotoxicity towards mammalian cell lines.

Effect of Mind-Body Approaches on Menopausal Symptoms among Women: A Community-Based Pilot Study

Introduction The process of women aging is characterized by a gradual transition from reproductive to nonreproductive life period. These changes in aging during menopause are accompanied by a wide range of physiological as well as psychological disturbing symptoms. The traditional therapeutic approach toward menopause management is hormone replacement therapy, which increases the risk of breast cancer, stroke, and coronary heart disease. However, the efficacy of complementary and alternative therapies like mind-body approach to troublesome hot flashes, anxiety, and depression is widely proven and it is used by many women. This study aimed to evaluate the effectiveness of the mind-body approach on menopausal symptoms among women.

Methods A quantitative research approach with quasi-experimental pretest–post-test design was adopted in the study. A total of 20 samples between the ages of 48 to 55 years with menopausal symptoms were the participants. The intervention of mind body approach (Mindfulness meditation) was performed for 8 weeks, which includes 35 minutes of session per day.

Results The majority (80%) of the participants were in the age group of 51 to 53 years and 50% of the participants attained menopause between 49 and 50 years. The results showed that the mean post-test menopausal symptom score was 15.60 ± 2.633 which was lower than the mean pretest score 28.420 ± 1.476 and the calculated t-value, t = 10.157 is greater than the table value (p < 0.001) at 0.001 level of significance. Hence, it is evident that the practice of mind-body approach was effective in reducing the intensity of menopausal symptoms among women.

Conclusion The study concludes that the practice of mind-body approach helped in reducing the menopausal symptoms on the domain of psychological and Somato vegetative scale like anxiety, depression, reduction in the intensity of hot flushes, and improved the sleeping pattern. Overall, the practice of Mindfulness meditation helped the participants to have a better quality of life. The study was found to be cost-effective and feasible to be made as a routine intervention for women to manage menopausal symptoms.

Antifungal Activity of Traditional Medicinal Plants from Argentina: Effect of their Combination with Antifungal Drugs

Background and Objective:

The incidence of fungal infections has experienced a marked increase in the last two decades being limited to a few drugs with serious drawbacks. Combination therapy has emerged as an approach to improve the efficacy of currently used antifungal therapy that also may delay the evolution of resistance.

Method:

The objectives of this work are to present a bibliographic search on the plants used in traditional medicine in Argentina for ailments related to fungal infections and to investigate the antifungal activity of currently used antifungal drugs in combination with natural extracts.

Results:

Results of the bibliographic investigation showed that 153 species belonging to 56 families and 120 genera from Argentina are applied to treat signs and symptoms considered to maintain ethnopharmacological uses related to fungal infections, mainly for skin and mucosal conditions.

Conclusion:

Regarding the evaluation of the antifungal activity of combinations between extracts and antifungal drugs, we observed that extracts from plants species belonging to a genera traditionally used for ailments related to fungal infections have more chances of enhancing the activity of amphotericin B, fluconazole and itraconazole. In addition, we observed that there is a greater chance of finding an enhancement in the activity of the commercial antifungals when the combination is performed with extracts that have shown activity in solitary. Nevertheless, inactive extracts that would have been discarded according to the classic strategy displayed activity in combination and they continue being potential candidates in the search for new antifungals.

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometric identification and antifungal susceptibility analysis of Candida species isolated from patients with invasive yeast infections in five university hospitals

In this multicenter study, we compared the performance of the Bruker Biotyper MS system and VITEK 2 YST systems for invasive yeast identification, investigated the distribution of isolated species, and evaluated the antifungal susceptibility profiles of Candida albicans, Candida parapsilosis, and Candida tropicalis. In cases of discrepant results lack of identification with either method, molecular identification techniques were employed. We tested 216 clinical isolates, and concordance between the two methods was observed for 192/216 isolates (88.9%). For five unidentified strains (2.3%), an internal transcribed spacer (ITS) sequencing approach was used. In brief, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-ToF MS) provided short turnaround times and more reliable results than those of Vitek 2 YST. In Wuhan, C. albicans, C. parapsilosis, Candida glabrata, and C. tropicalis were the most common pathogens (93.0%) in patients with candidemia. Cryptococcus neoformans was mainly detected in cerebrospinal fluid samples (88.9%). Trichosporon asahii were all isolated from drainage fluids in the Surgery. Candida albicans was clearly susceptible to azoles, while C. parapsilosis and C. tropicalis displayed differences in susceptibility to azoles. Our findings provide a basis for the practical application of MALDI-ToF MS for identification and for the use of ATB FUNGUS 3 to characterize the susceptibility of Candida spp., thereby providing significant data for therapeutic decisions.

Patterns and severity of menopausal symptoms among Jordanian women

We examined 359 women aged 45-65 years who visited Jordan University Hospital between February and November 2014. The menopausal symptoms were assessed using a validated Arabic version of the menopause rating scale. The mean age at menopause was 49.4 years. Women aged 50-55 years more frequently exhibited hot flushes and vaginal dryness. Although premenopausal women were 1.5 times more likely to experience irritability, perimenopausal women were more likely to experience hot flushes, physical and mental irritability, sexual problems, vaginal dryness, and joint and muscular discomfort. Hence, health care providers should focus on women at all stages of life.

The impact of multimorbidity on quality of life among midlife women: findings from a U.S. nationally representative survey

BACKGROUND

Little is known about the prevalence and cumulative burden of coexisting health conditions including chronic joint and muscular pain, urinary incontinence (UI), depression, osteoporosis risk, moderate/severe vasomotor symptoms, and vulvar/vaginal atrophy (VVA). We surveyed a nationally representative U.S. sample of midlife (age 40-64 years) women to ascertain the prevalence, general health-related quality of life (HRQoL), and health-seeking behaviors associated with these six conditions.

METHODS

This cross-sectional, telephone survey collected data from a sample of English- and Spanish-speaking U.S. women. The survey contained demographic and menopausal status questions, and also five condition-specific symptom/disease risk-screening instruments. The EuroQol 5 dimensions (EQ-5D) questionnaire was used to measure HRQoL. Health-seeking behavior was measured based on clinician discussion of and recent treatment for each condition.

RESULTS

Three thousand fifty eight women (mean age 53.4 years) completed the survey. The majority were white (75.6%), married (60.5%), employed full- or part-time (59.0%), and postmenopausal (69.8%; based on self-report). The prevalence [95% confidence interval] of 0, 1, 2, and ≥3 conditions was 35.2% [33.5-36.9], 34.2% [32.5-35.9], 17.9% [16.6-19.3], and 12.7% [11.5-13.9], respectively. Osteoporosis risk (30.6%) was most prevalent, followed by VVA (27.8%) and UI (26.6%). UI and VVA coexisted most frequently (11.3%), followed by osteoporosis risk and VVA (9.8%). EQ-5D scores decreased with increasing number of illnesses (0, 1, 2, and ≥3 conditions, means: 0.92, 0.87, 0.77, 0.61, respectively; p<0.01). Health-seeking behavior varied by condition.

CONCLUSION

Over 25% of women surveyed had multiple coexisting conditions. Lower HRQoL was associated with multiple conditions and with each added condition.

Prevalence of menopausal symptoms among mid-life women: findings from electronic medical records

BACKGROUND

To assess the prevalence of menopausal symptoms among women prescribed hormone therapy (HT) using electronic medical record data from a regional healthcare organization.

METHODS

Retrospective data from the Reliant Medical Group from 1/1/2006-12/31/2011 were assessed for 102 randomly-selected patients. Study eligibility criteria included: females aged 45 to 65; prescribed oral or transdermal HT; no history of breast cancer, venous thromboembolism, stroke, gynecological cancer, or hysterectomy; continuously enrolled in the health plan for 1 year before and after the first observed HT prescription. Prevalence of menopause-related symptoms was analyzed descriptively at both the patient and visit levels.

RESULTS

Mean age of patients was 54 years. The most common menopausal symptoms were: hot flushes (40%), night sweats (17%), insomnia (16%), vaginal dryness (13%), mood disorders (12%), and weight gain (12%). Among the 102 patients, 163 individual visits listing menopausal symptoms were identified, of which hot flushes (71 visits) were the most common symptom identified.

CONCLUSION

Our findings provide recent data on the types of menopausal symptoms experienced by mid-life women prescribed HT. Electronic medical records may be a rich source of data for future studies of menopausal symptoms in this population.

Synthesis and antimicrobial potential of nitrofuran–triazole congeners

A series of nitrofuran-triazole congeners were synthesized that displayed excellent to appreciable antimicrobial and antibiofilm activities. Compound 9f inhibited CYP51, an enzyme involved in ergosterol biosynthesis in fungi.

Single-center retrospective study of the incidence of, and risk factors for, non-C. albicans invasive candidiasis in hospitalized patients in China

The aims of this study were to establish the incidence of invasive candidiasis (IC) in a Beijing hospital, to identify risk factors associated with IC caused by non-C. albicans Candida (NAC), and to determine risk factors for infection caused by NAC species not susceptible to fluconazole. Clinical data from 141 patients admitted to Beijing Chaoyang Hospital (from 2001-2010) diagnosed with IC were retrospectively analyzed. The incidence of IC increased during the 10-year period, but the proportion due to NAC did not change significantly in that of 141 cases, 55 (39%) were due to NAC and 86 (61%) to C. albicans (CA). The NAC species isolated included C. tropicalis (25 of 141, 18%), C. glabrata (14 of 141, 9.9%), C. parapsilosis (eight of 141, 5.7%), C. krusei (three of 141, 2.1%) and C. lusitaniae (one of 141, 0.71%); other Candida species accounted for four of the 141 cases (2.8%). Twenty-one isolates (38%) of NAC were not susceptible to fluconazole. Total parenteral nutrition (TPN) (OR 4.2; 95% CI 3.5-58; P < 0.001) and previous fluconazole therapy (OR 7.7; 95% CI 2.2-27; P = 0.001) were risk factors for invasive NAC candidiasis, whereas patient age ≥65 years (OR 0.37; CI 0.16-0.88; P = 0.025) and invasive mechanical ventilation (OR 0.22; CI 0.069-0.70; P =0.010) were connected with invasive CA candidiasis. Prior fluconazole therapy was a risk factor (P = 0.007) for infections caused by NAC not susceptible to fluconazole. In conclusion, TPN and prior fluconazole therapy are independent risk factors for NAC infection, while prior fluconazole therapy is a risk factor for infection due to NAC not susceptible to fluconazole.

Safety and efficacy of ospemifene for the treatment of dyspareunia associated with vulvar and vaginal atrophy due to menopause

During the menopausal transition, women experience a number of symptoms due to declining estrogen levels, including vasomotor symptoms and vulvar and vaginal atrophy (VVA). Unlike vasomotor symptoms, vaginal dryness and dyspareunia, the main symptoms of VVA, typically worsen without treatment and can significantly impact the quality of life. Up to 60% of postmenopausal women may be affected by VVA, but many women unfortunately do not seek treatment due to embarrassment or other factors. After 20+ years in development, ospemifene (Osphena™) was approved by the US Food and Drug Administration in 2013 for treatment of moderate-to-severe dyspareunia associated with VVA due to menopause. As the first non-hormonal alternative to estrogen-based products for this indication, the approval of ospemifene represents a significant milestone in postmenopausal women’s health. Ospemifene is a non-steroidal estrogen receptor agonist/antagonist, also known as a selective estrogen receptor modulator (SERM), from the same chemical class as the breast cancer drugs tamoxifen and toremifene. Unlike other selective estrogen receptor modulators, ospemifene exerts a strong, nearly full estrogen agonist effect in the vaginal epithelium, making it well suited for the treatment of dyspareunia in postmenopausal women. Results of Phase III clinical trials showed that ospemifene significantly improved the vaginal maturation index (decreased parabasal cells and increased superficial cells), decreased vaginal pH, and decreased severity of the self-identified most bothersome symptom (dyspareunia or vaginal dryness) compared to placebo. Long-term safety studies revealed that 60 mg ospemifene given daily for 52 weeks was well tolerated and was not associated with any endometrium or breast-related safety concerns. This review discusses the preclinical and clinical data supporting the use of ospemifene for the treatment of dyspareunia associated with VVA due to menopause and provides an overview of its clinical safety.

Conjugated estrogen/bazedoxifene tablets for the treatment of moderate-to-severe vasomotor symptoms associated with menopause

Conjugated estrogen/bazedoxifene (CE/BZA) therapy represents a new, progestin-free treatment in the management of postmenopausal health. CE/BZA pairs CE with the selective estrogen receptor modulator, BZA. The rationale for the development of CE/BZA was that BZA, acting primarily as a selective estrogen receptor degrader in uterine and breast tissue, would sufficiently inhibit the proliferative effects of CE on the endometrium. The absence of a progestin would reduce the incidence of uterine bleeding, breast pain and increased breast density associated with progestin-containing hormone therapy. CE/BZA has been evaluated in five multicenter, randomized, double-blind, placebo-controlled, and active-controlled Phase III trials known as the SMART trials. CE/BZA has been shown to maintain the established benefits of estrogen therapy for treatment of vasomotor symptoms and prevention of a loss in bone mineral density (bone mass), while minimizing certain estrogenic effects, particularly in the uterine endometrium and breast.

Ovarian-cell-like cells from skin stem cells restored estradiol production and estrus cycling in ovariectomized mice

Reduction of estradiol production and high serum concentrations of follicular stimulating hormone (FSH) are endocrine disorders associated with premature ovarian failure. Here, we report that transplantation of ovarian-like cells differentiated from stem cells restored endogenous serum estradiol levels. Stem cells were isolated from postnatal mouse skin and differentiated into ovarian-cell-like cells that are consistent with female germ, and ovarian follicle somatic cells. The ovarian-cell-like cells were transplanted into ovariectomized mice (Cell Trans), whereas control mice were subjected to bilateral ovariectomies without cell transplantation (OVX). Using vaginal cytology analysis, it was revealed that in 13 out of 19 Cell Trans mice, estrus cycles were restored around 8 weeks after cell transplantation and were maintained until 16 weeks post-transplantation, whereas in the OVX group, all mice were arrested at metestrus/diestrus of the estrus cycle. The uterine weight in the Cell Trans group was similar to sham operation mice (Sham OP), while severe uterine atrophy and a decreased uterine weight were observed in the OVX group. Histologically, ectopic follicle-like structures and blood vessels were found within and around the transplants. At 12-14 weeks after cell transplantation, mean serum estradiol level in Cell Trans mice (178.0±35 pg/mL) was comparable to that of the Sham OP group (188.9±29 pg/mL), whereas it was lower in the OVX group (59.0±4 pg/mL). Serum FSH concentration increased in the OVX group (1.62±0.32 ng/mL) compared with the Sham OP group (0.39±0.34 ng/mL). Cell Trans mice had a similar FSH level (0.94±0.23 ng/mL; P<0.05) to Sham OP mice. Our results suggest that ovarian somatic cells differentiated from stem cells are functional in vivo. In addition to providing insights into the function of ovarian somatic cells derived from stem cells, our study may offer potential therapeutic means for patients with hypo-estradiol levels like those encountered in premature ovarian failure.

Bazedoxifene/conjugated estrogens for managing the burden of estrogen deficiency symptoms

The bothersome vasomotor and vaginal symptoms and bone loss that accompany the menopausal transition are associated with significant direct costs due to physician visits and medication, as well as indirect costs from reduced health-related quality of life (HRQoL) and work productivity. With life expectancies increasing, the number of postmenopausal women is also increasing, and more women are remaining in the workforce. These factors have led to an increased burden of menopausal symptoms on healthcare systems. Hormone therapy (HT) has been shown to effectively reduce menopausal symptoms and significantly increase quality-adjusted life years in postmenopausal women, particularly in women experiencing severe symptoms. However, many women discontinue use of HT before their symptoms have dissipated due to safety and tolerability concerns. The tissue selective estrogen complex (TSEC) that pairs bazedoxifene (BZA) with conjugated estrogens (CE) has been developed to provide relief of menopausal symptoms and prevent bone loss without stimulating the breast or endometrium, and to have improved tolerability compared with HT. In this context, BZA 20mg/CE 0.45 and 0.625 mg were shown to prevent bone loss and effectively treat menopausal symptoms in postmenopausal women with an intact uterus, while also demonstrating a favorable safety/tolerability profile. BZA 20mg/CE 0.45 and 0.625 mg were further associated with clinically significant improvements in HRQoL, sleep, and treatment satisfaction. Taken together, the reduction in menopausal symptoms, improvement in HRQoL, and favorable safety/tolerability profile associated with BZA/CE suggest that it is a cost-effective alternative to HT for managing the burden of menopausal symptoms.

Management of osteoporosis and menopausal symptoms: focus on bazedoxifene/conjugated estrogen combination

Loss of estrogen production in women during menopause results in a state of estrogen deficiency which has been associated with multiple problems, including vasomotor symptoms, symptoms of vulvovaginal atrophy, bone loss, and difficulties with sleep, mood, memory, and sexual activity. The only treatment option currently available to address multiple postmenopausal symptoms in women with an intact uterus is estrogen/progestin-containing hormone therapy (HT). Concerns surrounding side effects and published data regarding the association of HT with the increased risk for breast cancer have induced a decrease in the number of women seeking, initiating, and continuing this type of therapy. A combination containing bazedoxifene and conjugated estrogens (BZA/CE) maintains the established benefits of estrogen therapy for treatment of postmenopausal vasomotor symptoms, vulvovaginal atrophy, and osteoporosis, while certain estrogenic effects, such as stimulation of the uterus and breast, are antagonized without the side effects associated with HT. BZA/CE has been evaluated in a series of multicenter, randomized, double-blind, placebo-controlled, and active-controlled Phase III trials known as the Selective estrogens, Menopause, And Response to Therapy (SMART) trials. BZA/CE demonstrated clinically meaningful improvements in vasomotor symptoms, vulvovaginal atrophy, and a protective effect on the skeleton. These clinical benefits were associated with an acceptable safety profile and an improved tolerability compared with HT. BZA/CE showed a favorable safety profile on the breast, endometrium, and ovaries. The incidence of venous thromboembolism was low and the risk does not appear to be any greater than for CE alone or BZA alone or greater than HT. The incidence of coronary heart disease and cerebrovascular accidents were similar to placebo. The overall incidence of cancer (including breast cancer) was low and similar to placebo. The SMART trials demonstrate that BZA/CE is an alternative option for treating non-hysterectomized, symptomatic, postmenopausal women.

Midlife women: symptoms associated with menopausal transition and early postmenopause and quality of life

OBJECTIVE

The objectives of this study were to examine the effects of symptoms associated with the menopausal transition and early postmenopause on quality of life and to determine if there is a clustering of symptoms that has a larger effect on quality of life than individual symptoms.

METHODS

This study used data from a cross-sectional study on women aged 45 to 60 years. Descriptive statistics and regression analyses were used to analyze the data.

RESULTS

More than 60% of the participants reported three or more symptoms. The symptom clusters that had the highest impact on quality of life were sleep disturbances and vaginal dryness, which accounted for 9.7% of the variance in quality-of-life scores. A parsimonious model of individual symptoms, including sleep disturbances, fatigue, and anxiety, accounted for 16.7% of the variance in quality of life. This group of symptoms, not represented by a cluster, had the highest impact on quality of life.

CONCLUSIONS

The symptoms found to most significantly affect quality of life are sleep disturbances, fatigue, and anxiety, suggesting that appropriate management of sleep disorders and anxiety may be beneficial to women undergoing the transition to postmenopause. Unanticipated clusters of symptoms point toward a unique symptom experience influenced by factors other than a decline in ovarian function. In this study, symptoms commonly associated with the menopausal transition and early postmenopause negatively affect quality of life; however, the results indicate that quality of life in midlife women is affected by these symptoms only to a small extent.

The tissue selective estrogen complex: a promising new menopausal therapy

Menopause is associated with health concerns including vasomotor symptoms, vulvar/vaginal atrophy (VVA), and osteoporosis. Estrogen therapy or combined estrogen-progestin therapy (EPT) are primary treatment options for menopausal symptom relief and osteoporosis prevention. Because EPT has been associated with some safety/tolerability concerns relating to undesirable effects of estrogen and progestin, alternative options are needed. The tissue selective estrogen complex (TSEC) is a novel class of agents pairing a selective estrogen receptor modulator (SERM) with 1 or more estrogens. The TSEC combines the established efficacy of estrogens on menopausal symptoms and bone with the protective effects of a SERM on the reproductive tract. The pairing of bazedoxifene (BZA) with conjugated estrogens (CE) has been evaluated in a series of phase 3 clinical trials. BZA 20 mg/CE 0.45 mg and BZA 20 mg/CE 0.625 mg have shown efficacy in reducing the frequency and severity of hot flushes, relieving VVA symptoms, and maintaining bone mass while protecting the endometrium and breast. These BZA/CE doses have been associated with a favorable safety/tolerability profile, with higher rates of cumulative amenorrhea and lower incidences of breast pain than those reported for EPT. Thus, BZA/CE may be a promising alternative to conventional EPT for treating non-hysterectomized, postmenopausal women.

Perceptions, attitudes, and self-management of natural menopausal symptoms in ghanaian women

The use of hormone replacement therapy (HRT) to alleviate menopausal symptoms is associated with risks of cardiovascular and thromboembolic diseases and breast cancer. In this qualitative study, we investigated how women in low-resource settings manage menopausal symptoms without HRT. We interviewed 34 menopausal Ghanaian women about their sources of information, perceptions, attitudes, and self-management methods for alleviating menopausal symptoms. The majority of the women used a combination of nonhormonal medications and complimentary and alternative medicine (CAM), including dietary modifications, exercise, and other lifestyle changes to effectively manage menopausal symptoms. Sources of information about menopause influenced participants' perceptions, attitudes, and self-management choices.

Ospemifene and 4-hydroxyospemifene effectively prevent and treat breast cancer in the MTag.Tg transgenic mouse model

OBJECTIVE

Ospemifene, a new drug indicated for the treatment of vulvovaginal atrophy, has completed phase III clinical trials. A condition affecting millions of women worldwide, vulvovaginal atrophy has long been treated with estrogen therapy. Estrogen treatment carries with it risks of thromboembolism, endometrial proliferative effects, and breast cancer promotion. In this study, we test the effects of three dosing levels of ospemifene in both the prevention and treatment of breast cancer in the MTag.Tg mouse model.

METHODS

The polyomavirus middle-T transgenic mouse model (MTag.Tg), which produces synchronized, multifocal mammary tumors in the immunologically intact C57BL/6 background, was used to examine the impact of ospemifene treatment. First, a cell line derived from an MTag.Tg mouse tumor (MTag 34) was treated in vitro with ospemifene and its major metabolite, 4-hydroxyospemifene (4-OH ospemifene). MTag.Tg mice were treated daily by gavage with three different doses of ospemifene (5, 25, and 50 mg/kg) before or after the development of mammary tumors. Survival and tumor development results were used to determine the effect of ospemifene treatment on mammary tumors in both the preventive and treatment settings.

RESULTS

Tumors and the MTag 34 cell line were positive for estrogen receptor expression. The MTag 34 line was not stimulated by ospemifene or its major, active metabolite 4-OH ospemifene in vitro. Ospemifene increased survival time and exerted an antitumor effect on the development and growth of estrogen receptor-positive mammary tumors in the MTag.Tg mouse model at the 50-mg/kg dose. The levels of ospemifene and 4-OH ospemifene in both the tumors and plasma of mice confirmed the dosing. Ospemifene did not exert an estrogenic effect in the breast tissue at doses equivalent to human dosing.

CONCLUSIONS

Ospemifene prevents and treats estrogen receptor-positive MTag.Tg mammary tumors in this immune-intact mouse model in a dose-dependent fashion. Ospemifene drug levels in the plasma of treated mice were comparable with those found in humans. Combined with our previous data, ospemifene does not seem to pose a breast cancer risk in animals and slows down cancer development and progression in the MTag.Tg model.

Reproductive history and hot flashes in perimenopausal women

BACKGROUND

Hot flashes affect up to 75% of women undergoing the menopausal transition. They are among the most common health problems for perimenopausal women and are associated with a decrease in quality of life. The goal of this study was to examine the associations between reproductive history variables and midlife hot flashes.

METHODS

Data were analyzed from 388 perimenopausal women who participated in the Midlife Health Study, a population-based, cross-sectional study of 639 women aged 45-54 years living in the Baltimore metropolitan region.

RESULTS

The unadjusted analyses showed that none of the reproductive history variables analyzed, including age at menarche, number of live births, ever having been pregnant, age at first birth, age at last pregnancy, and history of oral contraceptive use, were associated with ever experiencing hot flashes. However, after adjusting for race, age group, marital status, education, employment, total family income, smoking and alcohol status, and body mass index (BMI), age at last pregnancy was significantly associated with moderate to severe hot flashes. Specifically, participants who were ≥36 years of age at last pregnancy were less likely to report moderate or severe hot flashes than those ≤35 years of age at last pregnancy (odds ratio 0.36, 95% confidence interval 0.16, 0.84).

CONCLUSIONS

In this study, in general, characteristics of reproductive history were not associated with midlife hot flashes. However, there are a number of potentially modifiable factors that are associated with the occurrence of hot flashes. Thus, alternatives may be available when hormone treatment is contraindicated.

Incorporating bazedoxifene/conjugated estrogens into the current paradigm of menopausal therapy

Many women experience bothersome vasomotor and vaginal symptoms during the menopausal transition. Decreasing levels of estrogens during menopause are also associated with reduced bone density and an increased risk of osteoporosis. Combined estrogen/progestin therapy (hormone therapy) effectively treats menopausal symptoms and prevents bone loss, but has been associated with some safety and tolerability concerns. A novel menopausal therapy is the tissue selective estrogen complex, which pairs a selective estrogen receptor modulator with one or more estrogens. In preclinical studies, the tissue selective estrogen complex partnering bazedoxifene (BZA) with conjugated estrogens (CE) antagonized stimulation of breast and endometrial tissue, reduced vasomotor instability, and preserved bone mass in rat and mouse models. The specific attributes seen with BZA/CE were different from those observed with other selective estrogen receptor modulator/estrogen pairings. BZA/CE has undergone clinical evaluation in the Phase III Selective estrogens, Menopause, And Response to Therapy (SMART) trials in postmenopausal women with an intact uterus. Of the various doses of BZA/CE evaluated, BZA 20 mg/CE 0.45 mg and 0.625 mg were associated with a low incidence of endometrial hyperplasia (<1%) similar to placebo, and showed significant improvements in hot flushes and vulvar/vaginal symptoms and increases in bone mineral density. BZA 20 mg/CE 0.45 mg and 0.625 mg were associated with a low incidence of breast-related adverse events and demonstrated no difference from placebo in age-related changes in mammographic breast density. Both BZA/ CE doses showed a favorable tolerability profile, with no increases in uterine bleeding or breast tenderness, and had positive effects on metabolic parameters and quality of life. BZA/CE may be a promising alternative to hormone therapy for the treatment of menopausal symptoms and prevention of osteoporosis in nonhysterectomized postmenopausal women.

Prevalence of Candida bracarensis and Candida nivariensis in a Spanish collection of yeasts: comparison of results from a reference centre and from a population-based surveillance study of candidemia

Two new species related to Candida glabrata, i.e., Candida nivariensis and Candida bracarensis, have been proposed. The occurrence of these species among isolates collected in a Spanish mycology reference laboratory in 2008-2009 was reviewed. In addition, strains recovered as part of an active population-based surveillance of candidemia conducted in Barcelona between 2002 and 2003 were also analyzed. Among 143 clinical isolates received in 2008-2009, three (2%) were identified as C. bracarensis and none as C. nivariensis through sequencing of their ribosomal DNA. Of the 31 strains initially identified as C. glabrata in the 2002-2003 population-based study (0.38 cases/100,000 population), none were found to belong to these related new species. Results from in vitro susceptibility studies of C. bracarensis isolates were comparable to those found with C. glabrata. Since new and cryptic species have been described, periodic surveillance including the use of molecular identification methods seems to be necessary in order to determine their frequency, geographical distribution and susceptibility profile.

Rapid identification of yeasts from positive blood culture bottles by pyrosequencing

We have developed a rapid protocol for the identification of Candida species from positive blood cultures by combining a simple method for nucleic acid extraction and preparation using microbial storage cardboards with polymerase chain reaction (PCR) and pyrosequencing of a small region of the 18 S rRNA gene. The protocol is robust and easy to implement and can be performed in 4 h. The method was tested against a collection of clinical blood cultures. Agreement of sequence identifications with standard microbiological methods was 100%.

Estrogen actions in the brain and the basis for differential action in men and women: a case for sex-specific medicines

The classic view of estrogen actions in the brain was confined to regulation of ovulation and reproductive behavior in the female of all mammalian species studied, including humans. Burgeoning evidence now documents profound effects of estrogens on learning, memory, and mood as well as neurodevelopmental and neurodegenerative processes. Most data derive from studies in females, but there is mounting recognition that estrogens play important roles in the male brain, where they can be generated from circulating testosterone by local aromatase enzymes or synthesized de novo by neurons and glia. Estrogen-based therapy therefore holds considerable promise for brain disorders that affect both men and women. However, as investigations are beginning to consider the role of estrogens in the male brain more carefully, it emerges that they have different, even opposite, effects as well as similar effects in male and female brains. This review focuses on these differences, including sex dimorphisms in the ability of estradiol to influence synaptic plasticity, neurotransmission, neurodegeneration, and cognition, which, we argue, are due in a large part to sex differences in the organization of the underlying circuitry. There are notable sex differences in the incidence and manifestations of virtually all central nervous system disorders, including neurodegenerative disease (Parkinson's and Alzheimer's), drug abuse, anxiety, and depression. Understanding the cellular and molecular basis of sex differences in brain physiology and responses to estrogen and estrogen mimics is, therefore, vitally important for understanding the nature and origins of sex-specific pathological conditions and for designing novel hormone-based therapeutic agents that will have optimal effectiveness in men or women.

Mind-body therapies for menopausal symptoms: a systematic review

OBJECTIVE

To systematically review the peer-reviewed literature regarding the effects of self-administered mind-body therapies on menopausal symptoms.

METHODS

To identify qualifying studies, we searched 10 scientific databases and scanned bibliographies of relevant review papers and all identified articles. The methodological quality of all studies was assessed systematically using predefined criteria.

RESULTS

Twenty-one papers representing 18 clinical trials from 6 countries met our inclusion criteria, including 12 randomized controlled trials (N=719), 1 non-randomized controlled trial (N=58), and 5 uncontrolled trials (N=105). Interventions included yoga and/or meditation-based programs, tai chi, and other relaxation practices, including muscle relaxation and breath-based techniques, relaxation response training, and low-frequency sound-wave therapy. Eight of the nine studies of yoga, tai chi, and meditation-based programs reported improvement in overall menopausal and vasomotor symptoms; six of seven trials indicated improvement in mood and sleep with yoga-based programs, and four studies reported reduced musculoskeletal pain. Results from the remaining nine trials suggest that breath-based and other relaxation therapies also show promise for alleviating vasomotor and other menopausal symptoms, although intergroup findings were mixed. Most studies reviewed suffered methodological or other limitations, complicating interpretation of findings.

CONCLUSIONS

Collectively, findings of these studies suggest that yoga-based and certain other mind-body therapies may be beneficial for alleviating specific menopausal symptoms. However, the limitations characterizing most studies hinder interpretation of findings and preclude firm conclusions regarding efficacy. Additional large, methodologically sound trials are needed to determine the effects of specific mind-body therapies on menopausal symptoms, examine long-term outcomes, and investigate underlying mechanisms.