Does metabolic syndrome or its components differ in naturally and surgically menopausal women?

Metabolic Syndrome and Survival Outcomes in Endometrial Cancer

Menopause, through attributable estrogen level decline and the corresponding increase in circulating androgens, significantly elevates a woman's risk for cardiometabolic diseases, including metabolic syndrome (MetS), type 2 diabetes, and cardiovascular disease. Metabolic syndrome itself is a cluster of interconnected risk factors, and among them, central obesity is a well-established factor for the development of endometrial cancer (EC), the most common gynecologic malignancy. This research investigates the impact of metabolic syndrome on survival rates among patients with endometrial cancer. The goal is to assess whether having metabolic syndrome or its individual components influences disease-free survival (DFS), overall survival (OS), cancer-specific survival, and recurrence rates. Understanding this link is crucial for determining risk levels and could help tailor treatment approaches for better long-term outcomes in endometrial cancer care.

The association between arterial hypertension and menarcheal age

OBJECTIVE

Menarche, as a milestone of puberty, may have a long-term effect on health. The present study investigated the association of age at menarche with the incidence of arterial hypertension.

STUDY DESIGN

A total of 4747 post-menarcheal participants of the Tehran Lipid and Glucose Study who met the eligibility criteria were selected. Demographic, lifestyle, reproductive, and anthropometric data, as well as risk factors for cardiovascular diseases, were collected. Participants were classified according to their age at menarche: group I: ≤11 years, group II: 12-15 years, and group III: ≥16 years.

MAIN OUTCOME MEASURES

A Cox proportional hazards regression model was used to estimate the associations between age at menarche and arterial hypertension outcomes. The generalized estimating equation models were used to compare the trend of changes in systolic and diastolic blood pressure between the three groups.

RESULTS

The mean age of participants at baseline was 33.9 (13.0). At the end of the study, 1261 (26.6 %) participants had arterial hypertension. Women in group III had a 2.04-fold higher risk of arterial hypertension than those in group II. The mean changes in systolic and diastolic blood pressure were 29 % (95 % CI: 0.02-0.57) and 16 % (95 % CI: 0.00-0.38) higher for women in group III compared with group II.

CONCLUSIONS

Late menarche could be a risk factor for arterial hypertension, so it is necessary to pay more attention to age at menarche in cardiovascular risk assessment programs.

Reproductive factors and metabolic syndrome among Chinese women aged 40 years and older

BACKGROUND

The aim of this study is to explore the relationship between reproductive variables and the prevalence of metabolic syndrome (MetS) and its components among Chinese women aged 40 years and older.

METHODS

A cross-sectional study was conducted among 4453 women aged 40 years and older in Guangxi, China. The associations between women's reproductive factors and MetS were analyzed using a logistic regression model.

RESULTS

The prevalence of MetS was 23.9% in this population. Women with MetS were mostly older, more likely to be postmenopausal, and had higher parity. Compared to women with one prior live birth, those with three or more live births had the highest odds of having MetS (odds ratio [OR] = 1.56; 95% CI, 1.23-1.99). Similarly, compared to premenopausal women, postmenopausal participants had higher odds of having MetS (OR = 1.86; 95% CI, 1.49-2.31). No associations were observed between MetS and abortion or with age at menarche.

CONCLUSIONS

Our study suggests that multiparity and menopausal status may be associated with the development of MetS. The inconsistency seen in epidemiological research to date calls for further investigation.

Metabolic Disorders in Menopause

Menopause is an aging process and an important time equivalent to one-third of a woman's lifetime. Menopause significantly increases the risk of cardiometabolic diseases, such as obesity, type 2 diabetes, cardiovascular diseases, non-alcoholic liver disease (NAFLD)/metabolic associated fatty liver disease (MFFLD), and metabolic syndrome (MetS). Women experience a variety of symptoms in the perimenopausal period, and these symptoms are distressing for most women. Many factors worsen a woman's menopausal experience, and controlling these factors may be a strategy to improve postmenopausal women's health. This review aimed to confirm the association between menopause and metabolic diseases (especially MetS), including pathophysiology, definition, prevalence, diagnosis, management, and prevention.

Effects of prebiotic-rich yogurt on menopausal symptoms and metabolic indices in menopausal women: a triple-blind randomised controlled trial

This study aimed to investigate the effects of prebiotics on metabolic indices and menopausal symptoms. This triple-blind randomised controlled trial was conducted on 60 menopausal women. The participants were assigned to two groups based on block randomisation. Over 6 weeks, the experimental group received 100 g of prebiotic-rich yogurt daily after lunch and the control group received regular yogurt. Menopausal symptoms and metabolic indices were assessed before and after the treatment. The mean total score of menopausal symptoms (p < 0.001), anxiety (p < 0.001), depression (p = 0.003), vasomotor (p < 0.001), and low-density lipoprotein (p = 0.028) was statistically lower in the experimental group than the control group. Moreover, the serum insulin level was statistically higher among those in the experimental group (p = 0.011). The study results demonstrated the positive effects of prebiotic-rich yogurt on menopausal symptoms and some metabolic indices. Trial registration: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N52; Date of registration: 12/4/2019. URL: https://en.irct.ir/user/trial/41105/view; Date of first registration: 12/5/2019.

Aging and changes in adiposity indices: the impact of menopause

PURPOSE

Aging is associated with significant changes in fat distribution and menopause may alter this process. This study aimed to investigate the longitudinal effect of menopause on changes in adiposity indices (AI).

METHODS

A total number of 3876 non-menopausal women, aged > 20 years, who participated in the Tehran Lipid and Glucose study, were selected for the present study. They were followed from 1998 to 2018 at a 3-year interval and their adiposity indices were measured. Throughout the study, participants were categorized into two groups according to their menopausal status as group 1): women who reached menopause and group 2): women who did not reach menopause. The generalized estimation equation (GEE) models were used to compare the trend of changes in AIs between these two groups.

RESULTS

At the end of the study, a total number of 1479 (38.2%) participants reached menopause. The odds of general obesity decreased by 5% (OR: 0.95, 95% CI: 0.90-0.99), and the odds of central obesity increased by 6% in group1 compared to group2 (OR: 1.06, 95% CI: 1.01-1.12).

CONCLUSIONS

Menopause alters the impact of aging on central fat distribution. Increasing awareness of the related risk in menopausal women and their healthcare professional may prevent adverse related outcomes.

Anthropometric Indices and Age at Natural Menopause: A 15-Year Follow-up Population-Based Study

BACKGROUND

Following menopause, the risk of many diseases is increased, and this situation may be due to changes in anthropometric indices (AI), while the association between adiposity and age at natural menopause (ANM) is not clear yet.

OBJECTIVES

This longitudinal study was conducted to investigate the ability of AI in predicting ANM.

METHODS

For this purpose, a total of 3,876 women aged > 20 years old from participants of the Tehran lipid and glucose study (TLGS) met our eligibility criteria. The association between ANM and various AIs was assessed using the Accelerated Failure Time (AFT) model, and time ratio (TR) with 95% confidence intervals was reported in this longitudinal study.

RESULTS

The median [interquartile range (IQR) 25 - 75] of the survival time was 12.5 (7.9 - 15.8) years. At the end of the follow-up, 1,479 (38.2%) of the participants reached menopause. The median time to natural menopause was decreased by about 2% with one standard deviation (SD) increase of both a body shape index (ABSI) (time ratio (TR): 0.98, 95% CI: 0.97, 0.99) and lipid accumulation product (LAP) (TR: 0.98, 95% CI: 0.98, 0.99) z-scores; and this time was increased by about 1% (TR: 1.01, 95% CI: 1.00, 1.02) with one SD increase in body mass index (BMI) z-score.

CONCLUSIONS

The ABSI, LAP, and BMI were the most useful AIs for identification of the time to menopause onset, and ABSI and LAP were inversely associated with the ANM. Also, the BMI was directly associated with the ANM.

Ovariectomized rodents as a menopausal metabolic syndrome model. A minireview

Bilateral ovariectomy is the best characterized and the most reported animal model of human menopause. Ovariectomized rodents develop insulin resistance (IR) and visceral obesity, the main risk factors in the pathophysiology of metabolic syndrome (MS). These alterations are a consequence of hypoestrogenic status, which produces an augment of visceral fat, high testosterone levels (hyperandrogenism), as well as inflammation, oxidative stress, and metabolic complications, such as dyslipidemia, hepatic steatosis, and endothelial dysfunction, among others. Clinical trials have reported that menopause per se increases the severity and incidence of MS, and causes the highest mortality due to cardiovascular disease in women. Despite all the evidence, there are no reports that clarify the influence of estrogenic deficiency as a cause of MS. In this review, we provide evidence that ovariectomized rodents can be used as a menopausal metabolic syndrome model for evaluating and discovering new, safe, and effective therapeutic approaches in the treatment of cardiometabolic complications associated to MS during menopause.

Association between duration of endogenous estrogen exposure and cardiovascular outcomes: A population - based cohort study

AIMS

Duration of endogenous estrogen exposure is apparently associated with risk of cardiovascular disease, the longer durations being more cardiovascular disease protective in women. We aimed to investigate the association of cumulative duration of endogenous estrogen exposure over women's reproductive lifespans with cardiovascular disease outcomes.

MAIN METHODS

For the purpose of the present study, of 10,192 female participants, after excluding those using HRT (n = 84), 3656 women, aged ≥30 years, who met eligibility criteria were selected and divided into three groups based on tertiles (T1, T2, T3) of exposure durations to endogenous estrogen. Cox proportional hazards regression model was used to estimate associations between exposure durations and cardiovascular disease outcomes.

KEY FINDINGS

Cardiovascular events occurred in 352 participants over a median follow-up of 14.2 (13.5, 14.6) years (7.7 per 1000 person years; 95% CI: 6.9-8.5). Incidence of outcome was 10.9 per 1000 person years (CI, 9.4-12.8) in T₁, 7.2 per 1000 person years (CI, 6.0-8.7) in T₂, and 5.1 per 1000 person years (CI, 4.1-6.4) in T₃. The hazard ratio of cardiovascular events in T₁ was significantly higher than that inT₃, before and after adjustment for confounding variables. Before adjustment, women in T₂ had a 40% higher risk of CVD, compared to T₃; after adjustment however the risk was similar to that of women in T₃.

SIGNIFICANCE

Shorter durations of exposure to endogenous estrogen may increase the risk of cardiovascular diseases among these women later in life. Future studies should target women with short duration of exposure for timely screening and implementation of preventative interventions.

The prevalence of metabolic syndrome in postmenopausal women: A systematic review and meta-analysis in Iran

Metabolic syndrome is a set of cardiovascular risk factors that increase the risk of cardiovascular disease, diabetes and mortality. Women are at risk of developing metabolic syndrome as they enter the postmenopausal period. The present systematic review and meta-analysis was conducted to estimate the prevalence of metabolic syndrome in Iranian postmenopausal women. In this systematic review and meta-analysis, 16 national articles published in Persian and English were gathered without time limit. National databases such as SIDs, IranMedex and MagIran, and international databases such as Web of Science, Google Scholar, PubMed and Scopus were used to search the relevant studies. We searched for articles using the keywords "menopause", "postmenopausal", "metabolic syndrome", "MetSyn", and their combinations. Data were analyzed using the meta-analysis method and the random effects model. Analysis of 16 selected articles with a sample size of 5893 people showed that the prevalence of metabolic syndrome in Iranian postmenopausal women was 51.6% (95% CI: 43-60). The prevalence of metabolic syndrome based on ATP III and IDF criteria was 54% (95% CI: 59-63) and 50% (95% CI: 45-56), respectively. Based on the results of univariate meta-regression analysis, the increase in the mean age of postmenopausal women (p = 0.001) and sample size (p = 0.029), the prevalence of metabolic syndrome increased significantly. More than half of postmenopausal women in Iran suffer from metabolic syndrome. Providing training programs for postmenopausal women to prevent and control cardiovascular disease and its complications seems to be necessary.

Metabolic syndrome in menopause and associated factors: a meta-analysis

OBJECTIVE

Metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease and diabetes. Menopause is associated with an increased risk for MetS. The purpose of this meta-analysis is to better understand the relationship between MetS and menopause.

METHODS

MEDLINE and EMBASE were searched for all the associated articles on (1) MetS components in postmenopausal women vs. premenopausal women, (2) comparison of MetS incidence between surgical menopause and natural menopause, (3) the effect of hormone therapy (HT) with 17β-estradiol (E2) compared to conjugated equine estrogen (CEE) on MetS components among postmenopausal women. A meta-analysis was applied by Review Manager 5.3 software.

RESULTS

All comparable indicators were significantly unfavorably changed in postmenopausal women compared to premenopausal women except for high density lipoprotein cholesterol. Women who underwent surgical menopause suffered a 1.51-fold higher risk for MetS compared to those with natural menopause. HT with E2 provided more benefits for levels of triglyceride and diastolic blood, while CEE showed a better effect on both high and low density lipoprotein cholesterol levels.

CONCLUSIONS

Menopause nearly adversely affects all components of MetS, and surgical menopause may lead to a higher incidence of MetS compared to natural menopause. HT with various preparations may have different effects on MetS components. These results may clarify the management of menopause-related MetS in clinical practice.

Metabolic Syndrome and Menopause: Pathophysiology, Clinical and Diagnostic Significance

Menopause is a risk factor for cardiometabolic diseases, including metabolic syndrome (MetS), type 2 diabetes, and cardiovascular diseases. MetS is a constellation of interdependent factors such as insulin resistance, abdominal obesity, dyslipidemia, and hypertension. The prevalence of MetS in postmenopause is due to loss of the protective role of estrogens and increased circulating androgens resulting in changes to body fat distribution and development of abdominal obesity. Excessive visceral adipose tissue plays an important role due to synthesis and secretion of bioactive substances such as adipocytokines, proinflammatory cytokines, reactive oxygen species, prothrombotic, and vasoconstrictor factors. MetS may also impact risk assessment of breast cancer, osteoporosis and chronic kidney disease, and quality of life during the menopausal transition. Increased MetS has stimulated the exploration of new laboratory tests for early detection and therapies.

Surgical menopause versus natural menopause and cardio-metabolic disturbances: A 12-year population-based cohort study

PURPOSE

Menopausal status exposes women to increased risk of cardiovascular disease. This study was performed to compare the effect of menopausal types, including surgical and natural, on metabolic syndrome and other metabolic disorders 3 years before and after menopause.

METHODS

Of 437 postmenopausal women, who participated in the Tehran Lipid and Glucose Study, 13 women with surgical menopause and 39 age-matched controls with natural menopause were selected. During the follow-up period, changes in metabolic and biochemical profiles were compared between surgical and natural menopause women.

RESULTS

Odds of incidence of metabolic syndrome in surgical menopause women, compared to natural menopause women, was 9.7 (95 % CI 1.8-51.8).

CONCLUSIONS

Metabolic disturbances after menopause are highly influenced by type of menopause and are more prevalent in those undergoing surgical menopause.