Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy

The neuroplastic brain: current breakthroughs and emerging frontiers

Neuroplasticity, the brain's capacity to reorganize itself by forming new neural connections, is central to modern neuroscience. Once believed to occur only during early development, research now shows that plasticity continues throughout the lifespan, supporting learning, memory, and recovery from injury or disease. Substantial progress has been made in understanding the mechanisms underlying neuroplasticity and their therapeutic applications. This overview article examines synaptic plasticity, structural remodeling, neurogenesis, and functional reorganization, highlighting both adaptive (beneficial) and maladaptive (harmful) processes across different life stages. Recent strategies to harness neuroplasticity, ranging from pharmacological agents and lifestyle interventions to cutting-edge technologies like brain-computer interfaces (BCIs) and targeted neuromodulation are evaluated in light of current empirical evidence. Contradictory findings in the literature are addressed, and methodological limitations that hamper widespread clinical adoption are discussed. The ethical and societal implications of deploying novel neuroplasticity-based interventions, including issues of equitable access, data privacy, and the blurred line between treatment and enhancement, are then explored in a structured manner. By integrating mechanistic insights, empirical data, and ethical considerations, the aim is to provide a comprehensive and balanced perspective for researchers, clinicians, and policymakers working to optimize brain health across diverse populations.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Unraveling sleep quality in menopausal women: objective assessments and self-reported experiences - a mini-review

Sleep is a cornerstone of health, playing an integral role in both physiological and psychological functions. However, it is vulnerable to a variety of factors including menopause. According to available research, the onset of the menopause transition may not necessarily worsen sleep architecture and could even enhance it, leading to conflict between assessment of subjective and objective sleep complaints. This discrepancy highlights the complex relationship between subjective and objective sleep quality. Understanding this relationship remains challenging due to the limited number of longitudinal studies and small sample sizes. This review explores findings from both subjective and objective sleep assessments in menopausal women and examines the impact of menopausal hormone therapy on sleep quality.

The sleep quality in women with surgical menopause compared to natural menopause based on Ardakan Cohort Study on Aging (ACSA)

OBJECTIVE

Menopause is a significant period in a woman's life that can be natural or surgical. We aimed to assess the association between the type of menopause and sleep quality, especially in elderly women.

METHOD

This was a cross-sectional study using data from the first phase of the Ardakan Cohort Study on Ageing (ACSA) of 50 and above years of menopausal women, distributed into two groups of natural and surgical menopause. Three questionnaires were used to assess sleep quality, including Pittsburgh Sleep Quality Index (PSQI), Berlin questionnaire, and Epworth Sleepiness Scale. Multiple regression models were used to assess the association between the type of menopause and sleep quality. P-value less than 0.05 was considered significant.

RESULTS

In total, 2,532 menopausal and postmenopausal women were included in the study, of which 669 (26.4%) had surgical menopause. The mean of the PSQI score for participants with surgical menopause was 9.29±4.30 compared to 8.78±4.10 for participants with natural menopause (P-value = 0.001). 37.1% of participants with natural menopause had sleep-disordered breathing according to the Berlin questionnaire despite 43.9% among participants with surgical menopause (P-value = 0.007). The multivariable regression models showed that surgical menopause was not significantly associated with the PSQI score differences, Epworth score, or Berlin score compared to natural menopause (OR:0.89, 1.13, and 0.85; CI 95%: 0.13-1.19, 0.68-1.86, and 0.68-1.07 respectively).

CONCLUSION

The findings suggest that the type of menopause is not associated with sleep quality. However, further studies employing objective sleep assessments are necessary to validate these results and guide clinicians and individuals in refraining from prioritizing the type of menopause as a significant risk factor for poor sleep quality.

Acute effects of high-intensity interval exercise plus whole-body vibration on bone turnover markers, BDNF, irisin, and neurocognitive performance in postmenopausal women

The acute effects of exercise can elucidate the molecular and psychophysiological mechanisms underlying exercise's benefits in several systems (e.g., the brain, muscle, and bone). In this study, a single 30-minute session of high-intensity interval aerobic exercise (HIIAE) administered in conjunction with isometric resistance exercise on a whole-body vibration (WBV) platform (HIIAE+WBV) was compared with HIIAE alone in their effects on molecular and neurocognitive indices among 63 sedentary, healthy postmenopausal women who were randomly assigned to HIIAE (n = 20), HIIAE+WBV (n = 20), and Control (n = 23) groups. The assessed molecular indices were serum levels of osteocalcin (OC), uncarboxylated OC (ucOC), carboxylated OC (cOC), brain-derived neurotrophic factor (BDNF), and irisin, and the assessed neurocognitive indices were the accuracy rate (AR), reaction time (RT), and electroencephalography event-related potentials (ERPs) of P2 and P3 components in a visuospatial working memory task. Data on these indices before versus after an acute bout of HIIAE or HIIAE+WBV or after a resting session were compared. An HIIAE or HIIAE+WBV intervention yielded no significant change in ERP P2 latency/amplitude and P3 latency but yielded significantly higher ARs, shorter RTs, larger ERP P3 amplitudes, and higher OC, cOC, BDNF, and irisin levels in the postmenopausal women. HIIAE+WBV outperformed HIIAE alone in AR, ucOC, and BDNF. However, the changes in these molecular and neurocognitive indices induced by the two exercise modes did not show any significant correlations in the present study. The present findings suggest that HIIAE and HIIAE+WBV have the potential to acutely influence markers of bone and brain health, with HIIAE+WBV showing greater effectiveness than HIIAE alone. These interventions should be further investigated in future randomized controlled trials involving postmenopausal women.

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

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

A single session of slow-paced breathing improved cognitive functions and postural control among middle-aged women: a randomized single blinded controlled trial

OBJECTIVE

The aim of the study was to explore the immediate effects of slow-paced breathing (SPB) on cognitive performance and postural control in middle-aged postmenopausal women.

METHODS

Thirty-four middle-aged women were recruited and assigned to either an experimental group (EG), who practiced SPB, or a control group (CG), who watched an educational video. Both groups had their cognitive functions and postural control assessed using validated tools during both pre-intervention and post-intervention sessions.

RESULTS

Simple reaction time, congruent reaction time, incongruent reaction time, and incongruent reaction accuracy improved ( P ≤ 0.01) in the EG in the post-intervention compared to the pre-intervention. The incongruent reaction time improved ( P ≤ 0.05) among the EG compared to the CG in the post-intervention session. Postural control improved ( P ≤ 0.05) post-intervention compared to pre-intervention in the EG, on a firm surface in the eyes closed condition. On the foam surface, postural control improved ( P ≤ 0.001) in the post-intervention compared to pre-intervention in the EG irrespective of the vision conditions.

CONCLUSIONS

Our findings highlight the potential benefits of SPB as a nonpharmacological, cost-effective, and easily accessible intervention to improve cognitive performance and postural control among postmenopausal women. Hence, this technique should be taken into consideration when designing preventive and therapeutic strategies for these women. Additionally, women are encouraged to incorporate this exercise into their daily activities to enhance their quality of life.

Effectiveness of Low Doses of Semaglutide on Weight Loss and Body Composition Among Women in Their Menopause

Background and Aims: Menopause is a complex period in women's life, when weight gain and predisposition to obesity are frequent. Moreover, even during menopause transition, women begin to lose lean mass up to 0.5% and, therefore, an increase in the percentage of fat mass with central distribution and an increased risk of metabolic syndrome. Despite lifestyle habits remain the cornerstone in this period, their long-term effectiveness is a challenge. In this sense, GLP-1 analogs have shown their efficacy in improving weight loss and other cardiovascular risk factors. Methods: To assess the effectiveness of low doses of semaglutide on body weight and composition for 4 months during menopause compared with premenopausal women. Results: Baseline weight and body mass index were significantly greater among postmenopausal women (95 ± 23.4 vs. 86.4 ± 12.8 kg and 35.9 ± 7.3 vs. 32.9 ± 4.7 kg/m2; P = 0.02 and P = 0.03, respectively). Fat mass was higher among postmenopausal women (45.2 ± 17.1 vs. 38.2 ± 9.8 kg; P = 0.03). The percentage of fat mass and lean mass were comparable between the two groups (43.2 ± 8.1% vs. 40.9 ± 7.1% and 29.6 ± 5.5 vs. 32.4 ± 8.4 kg; P = 0.2 and P = 0.08, respectively). After 4 months of semaglutide 1 mg, either weight loss (5.9 ± 5.2 vs. 4.5 ± 3.5 kg; P = 0.1) or percentage of weight loss (5.8 ± 4.7% vs. 5.1 ± 3.2%; P = 0.4) were comparable. Furthermore, both fat mass loss in kilos (4.1 ± 4.5 vs. 3.1 ± 3.7 kg; P = 0.3) and lean mass loss (-0.4 ± 1.7 vs. -1.1 ± 3.7 kg; P = 0.1) were similar between the two groups. Conclusions: Despite a greater initial weight and fat mass among postmenopausal women, after 4 months of treatment with semaglutide 1 mg, either fat mass loss or weight loss were similar to premenopausal women.

Influence of sedentary behavior on sleep quality in postmenopausal women in high-altitude regions of China: a cross-sectional study

Objective

This study investigates the association between sedentary behavior and sleep quality among postmenopausal women residing in China's plateau regions. Particular attention is given to moderating effects of age, body mass index (BMI), and sleep environment. This study aims to identify modifiable risk factors influencing sleep quality in this high-altitude population.

Methods

This cross-sectional study focused on postmenopausal women (aged ≥50 years, ≥12 months post-menopause) across four primary plateau regions in China: Qinghai-Tibet, Yunnan-Guizhou, Inner Mongolia, and the Loess Plateau. Sedentary behavior was evaluated with the Older Adults Sedentary Behavior Questionnaire, and sleep quality was assessed with the Pittsburgh Sleep Quality Index. Data analysis encompassed descriptive statistics, correlation analysis, multiple linear regression, and subgroup analyses.

Results

Among the 151 participants (mean age 58.5 years), sedentary behavior was positively correlated with poorer sleep quality (r = 0.36, p < 0.001). Improvements in the sleep environment were similarly associated with better sleep quality (r = 0.29, p < 0.001). Multiple linear regression identified sedentary behavior and sleep environment as significant predictors of sleep quality, while other variables showed no significant associations. Subgroup analysis revealed age-specific effects: sedentary behavior had a strong influence on sleep quality in women under 60 years (r = 0.36, p < 0.01) but demonstrated a weaker, non-significant association in those aged 60 years or older (p = 0.062).

Conclusion

Prolonged sedentary behavior is an independent risk factor for reduced sleep quality among postmenopausal women residing in high-altitude regions, while improvements in the sleep environment are positively associated with better sleep quality. The influence of sedentary behavior on sleep quality varies by age groups. These findings highlight the importance of tailored interventions and health policies to improving sleep quality in postmenopausal women living at high altitudes.

Cognitive function with changing hormonal milieu across menopausal transition stages and related symptoms in midlife and beyond

The menopausal transition is regarded as the critical window where midlife women experience various health challenges having debilitating impact on their wellbeing. The present cross-sectional study intends to assess cognitive outcome with changing hormonal milieu during menopausal transition and related symptoms in midlife and beyond. For this purpose, cognitive performance of women and menopausal symptoms were studied on the sample of 320 women ranging in age from 45 to 60 years. Data collection was carried out by purposive sampling method from rural areas of Haryana from March 2021 to January 2023. Findings of the study demonstrated a successive downward trend in the mean scores of orientation to time and place, registration, attention, recall, as well as language and visual spatial skills cognitive domain from premenopause to late postmenopause stage. Multivariate logistic regression analysis (adjusted for age and educational status) identified severe menopausal symptoms, i.e. heart beating quickly or strongly, difficulty in sleeping, feeling tired, feeling unhappy or depressed, and sexual dysfunction as the potential determinants of poor functioning of different cognitive domains among women transitioning menopause and beyond. Hence, it was observed that cognitive decline during menopause transition and beyond is sensitive to severe menopausal symptoms.

Neurological, psychological, psychosocial complications of long-COVID and their management

Since it first appeared, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has had a significant and lasting negative impact on the health and economies of millions of individuals all over the globe. At the level of individual health too, many patients are not recovering fully and experiencing a long-term condition now commonly termed 'long-COVID'. Long-COVID is a collection of symptoms which must last more than 12 weeks following initial COVID infection, and which cannot be adequately explained by alternate diagnoses. The neurological and psychosocial impact of long-COVID is itself now a global health crisis and therefore preventing, diagnosing, and managing these patients is of paramount importance. This review focuses primarily on: neurological functioning deficits; mental health impacts; long-term mood problems; and associated psychosocial issues, among patients suffering from long-COVID with an eye towards the neurological basis of these symptoms. A concise account of the clinical relevance of the neurological and psychosocial impacts of long-COVID, the effects on long-term morbidity, and varied approaches in managing patients with significant chronic neurological symptoms and conditions was extracted from the literature, analysed and reported. A comprehensive account of plausible pathophysiological mechanisms involved in the development of long-COVID, its management, and future research needs have been discussed.

Cognitive and physical fatigue-the experience and consequences of 'brain fog' after spontaneous coronary artery dissection: a qualitative study

AIMS

Brain fog and fatigue are common issues after acute coronary syndrome. However, little is known about the nature and impact of these experiences in spontaneous coronary artery dissection (SCAD) survivors. The aim of this study was to understand the experiences of brain fog and the coping strategies used after SCAD.

METHODS AND RESULTS

Participants were recruited from the Victor Chang Cardiac Research Institute Genetics Study database and considered eligible if their event occurred within 12 months. Seven semi-structured online focus groups were conducted between December and January 2021-22, with this study reporting findings related to brain fog and fatigue. Interviews were transcribed and thematically analysed using an iterative approach. Participants (n = 30) had a mean age of 52.2 (±9.5) and were mostly female (n = 27, 90%). The overarching theme of brain fog after SCAD included four main themes: how brain fog is experienced, perceived causes, impacts, and how people cope. Experiences included memory lapses, difficulty concentrating and impaired judgement, and perceived causes, including medication, fatigue and tiredness, and menopause and hormonal changes. Impacts of brain fog included rumination, changes in self-perception, disruption to hobbies/pastimes, and limitations at work. Coping mechanisms included setting reminders and expectations, being one's own advocate, lifestyle and self-determined medication adjustments, and support from peers.

CONCLUSION

Brain fog is experienced by SCAD survivors, and the impacts are varied and numerous, including the capacity to work. Spontaneous coronary artery dissection survivors reported difficulty understanding causes and found their own path to coping. Recommendations for clinicians are provided.

Menopause and Traumatic Brain Injury: A NIDILRR Collaborative Traumatic Brain Injury Model Systems Study

OBJECTIVE

To examine the experience of menopause symptoms in women with traumatic brain injury (TBI).

DESIGN

Cross-sectional descriptive study.

SETTING

Five sites of the TBI Model Systems (TBIMS) program.

PARTICIPANTS

Participants were 210 women, aged 40-60 years, who were not taking systemic hormones and did not have both ovaries removed: 61 participants were enrolled in the TBIMS, who were at least 2 years post-TBI and living in the community. One hundred forty-nine participants without TBI were recruited from a research registry and the metropolitan Detroit community.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

A checklist comprised of 21 menopause symptoms assessing 4 symptom clusters (vasomotor, somatic, psychological, and cognitive).

RESULTS

TBI and non-TBI groups did not significantly differ and showed small effect sizes on vasomotor symptoms. On the remaining symptom clusters, women with TBI showed greater presence and severity of symptoms than women without TBI, as well as fewer differences between premenopausal and postmenopausal women on those symptoms. A profile indicating an additive or potentiating effect of TBI on menopause symptoms was not observed.

CONCLUSIONS

Findings support a conceptual model of menopause and TBI indicating that symptoms most closely associated with estrogen decline are similar for women with and without TBI, whereas symptoms that overlap with common TBI sequelae are generally more frequent and severe among these women. Likely because of lower baseline of symptoms premenopause, postmenopausal women without TBI reported more numerous and severe symptoms relative to their premenopausal counterparts without TBI. Overall, it may be that women without TBI experience menopause as more of a "change" of life, whereas women with TBI chronically face significantly more of these symptoms than women without TBI.

Integrated analysis of metabolome and microbiome in a rat model of perimenopausal syndrome

The objectives of this study are to examine the disparities in serum and intestinal tissue metabolites between a perimenopausal rat model and control rats and to analyze the diversity and functionality of intestinal microorganisms to determine the potential correlation between intestinal flora and metabolites. We established a rat model of perimenopausal syndrome (PMS) and performed an integrated analysis of metabolome and microbiome. Orthogonal partial least-squares discriminant analysis scores and replacement tests indicated distinct separations of anion and cation levels between serum and intestinal samples of the model and control groups. Furthermore, lipids and lipid-like molecules constituted the largest percentage of HMDB compounds in both serum and intestinal tissues, followed by organic acids and derivatives, and organoheterocyclic compounds, with other compounds showing significant variability. Moreover, analysis of diversity and functional enrichment of the intestinal microflora and correlation analysis with metabolites revealed significant variability in the composition of the intestinal flora between the normal control and perimenopausal groups, with these differentially expressed intestinal flora strongly correlated with their metabolites. The findings of this study are expected to contribute to understanding the indications and contraindications for estrogen application in perimenopausal women and to aid in the development of appropriate therapeutic agents.

IMPORTANCE

In this work, we employed 16S ribosomal RNA gene sequencing to analyze the gut microbes in stool samples. In addition, we conducted an ultra-high-performance liquid chromatography-tandem mass spectrometry-based metabolomics approach on gut tissue and serum obtained from rats with perimenopausal syndrome (PMS) and healthy controls. By characterizing the composition and metabolomic properties of gut microbes in PMS rats, we aim to enhance our understanding of their role in women's health, emphasizing the significance of regulating gut microbes in the context of menopausal women's well-being. We aim to provide a theoretical basis for the prevention and treatment of PMS in terms of gut microflora as well as metabolism.

Sex-specific changes in sleep quality with aging: Insights from wearable device analysis

Prior studies evaluating sleep quality have found that women often have better polysomnography-defined sleep quality than men, but women subjectively report a greater frequency of sleep disturbances. Although these studies can be partially attributed to study design, it is currently unclear what may be causing these discrepancies. In this study, we aim to identify potential differences in objectively assessed sleep quality between men and women with further emphasis on subgroup analysis based on age. We hypothesize that women's sleep worsens after menopause. Sleep quality was assessed by comparing the Sleep Quality Index, Arousal Index, sleep efficiency and apnea-hypopnea index, as provided by the SleepImage Ring@ 2.3.0, between men and women, with a sub-group analysis performed by age (18-40 years, 41-50 years, 51-60 years, 61-70 years, and > 70 years), run separately for women and men. In total, 1444 subjects (704 women and 740 men) with a mean age of 53.6 ± 14.71 years were enrolled in this analysis. In women, a significant drop in Sleep Quality Index was noted after age 51 years. Regression analysis demonstrated that age, Arousal Index, sleep efficiency and apnea-hypopnea index correlated significantly with Sleep Quality Index - with age, Arousal Index and apnea-hypopnea index negatively correlated, and sleep efficiency positively correlated. The highest correlation coefficient was obtained for Arousal Index in both women and men. In women, age older than 50 years was associated with a more rapid decrease of sleep quality than men, as defined by an increase in Arousal Index and apnea-hypopnea index with a concurrent decrease in Sleep Quality Index.

Real-world evaluation of treatment utilization by women experiencing vasomotor symptoms associated with menopause in the United States and Europe: Findings from the REALISE study

OBJECTIVES

Despite the profound impact of menopausal symptoms on women, treatment utilization is low, and many seek alternative therapies. The REALISE study aimed to evaluate the treatment landscape - that is, pharmacological treatment, lifestyle changes (LC), and use of over-the-counter (OTC) products - for women from six high-income countries experiencing vasomotor symptoms (VMS) and receiving healthcare.

STUDY DESIGN

Analysis of a secondary dataset, the Adelphi Real World Disease Specific Programme™, a large, cross-sectional, point-in-time survey conducted in the United States and five European countries (February-October 2020). Physicians provided demographic, clinical, and treatment data; women were stratified by VMS severity (mild; moderate-severe) and presence of concomitant sleep/mood symptoms. Women completed forms on VMS severity, concomitant symptoms, LC, and OTC product use. Two subgroups were identified: VMS-only and VMS + sleep/mood.

MAIN OUTCOME MEASURES

Prescription treatment, LC, and OTC product utilization.

RESULTS

Physicians (n = 233) provided data on 1767 women; 825 (46.7 %) completed a self-completion form. Physicians rated 60 % of women with moderate-severe VMS, of whom 709 (66.8 %) were currently prescribed pharmacological treatment; 27.1 % had never been prescribed. Hormone therapy was most frequently prescribed in the moderate-severe group (overall, 49.8 %; VMS-only, 57.4 %; VMS + sleep/mood, 47.3 %), followed by serotonergic antidepressants (15.7 %; 9.7 %; 17.6 %, respectively). Most women (78.3 %) with moderate-severe VMS adopted LC, and 57.6 % used at least one OTC product for VMS relief.

CONCLUSIONS

Nearly a third of women with moderate-severe VMS had never received treatment despite access to healthcare. This, combined with the prevalent use of LC/OTC products, suggests an unmet need for new treatment options to manage VMS and concomitant sleep/mood symptoms.

The association between HIV infection and perimenopausal syndrome: A matched cross-sectional study of women living with HIV/ AIDS and their uninfected counterparts in rural areas of Anhui, China

The study compared the level of perimenopausal syndrome (PS) among women age 40 or older living with HIV/AIDS (WLWH) and their HIV-negative counterparts in rural areas of Anhui, China and it analyzed the association between HIV infection and PS. From March 2018 to February 2019, WLWH ≥ the age of 40 and their aged-matched HIV-negative female neighbors in 8 townships in the cities of Fuyang and Bozhou in Anhui Province, China were selected by cluster random sampling to respond to a questionnaire survey. Multivariable logistic regression analysis was performed. Responses from a total of 464 participants were analyzed, including 220 HIV-positive women and 244 HIV-negative female neighbors. The average score for PS was 18.02 and the prevalence of PS was 85.0% in the HIV-positive group, both of which were higher than those in the control group (p < 0.05). The most common PS symptoms among WLWH were irritability (83.2%), followed by fatigue (79.5%) and arthralgia myalgia (68.2%). The risk of developing moderate to severe PS in HIV-uninfected women was 0.605 times that in WLWH. Other significant risk factors included being older, a history of chronic diseases, poor sleep quality, and poor appetite. In the future, more attention should be paid to the prevention of PS in WLWH while actively providing antiretroviral therapy and follow-up.

A clinical trial of the effects of cocoa rich chocolate on depression and sleep quality in menopausal women

In this triple-blind, randomized clinical trial, 60 menopausal women between the ages of 45 and 65 were randomized to receive 78% dark chocolate (12 g/day) or milk chocolate (12 g/day) for eight weeks. The primary outcome was depression scores. Secondary outcomes included sleep quality and anthropometric indices. ANCOVA with baseline adjustment showed that the mean depression score after the intervention in the group receiving dark chocolate was significantly reduced compared to the milk chocolate group (mean difference: -2.3; 95% confidence interval: -3.9 to -0.8; p = 0.003; Cohen's d = -0.54). However, no statistically significant difference in the overall sleep quality score and its subdomains was observed between the two groups after the intervention (p > 0.05). Furthermore, after the intervention, there was no statistically significant difference between the two groups in terms of anthropometric indices, including weight (p = 0.075), BMI (p = 0.137), waist circumference (p = 0.463), and hip circumference (p = 0.114). The study suggests that consuming 78% dark chocolate for eight weeks may contribute to improvements in depression scores, but it does not appear to improve sleep quality or anthropometric indices.Trial registration: IRCT20220926056046N1; December 2022.

General self-efficacy as a moderator between severity of menopausal symptoms and satisfaction with life in menopausal women

The study aimed to determine whether self-efficacy acts as a moderator between the severity of menopausal symptoms and life satisfaction. The research tools were: The Generalized Self-Efficacy Scale (GSES), The Satisfaction with Life Scale (SWLS) The Menopause - Specific Quality of Life (MENQOL), and a standardized questionnaire comprising questions on the participants' characteristics. 516 women using health care services who had menopausal symptoms took part in the study. Self-efficacy (GSES) (r = -0.176; p < 0.001) and life satisfaction (SWLS) (r = -0.106; p = 0.016) were negatively correlated with the severity of menopausal symptoms (MENQOL). The self-efficacy correlated positively with satisfaction with life (r = 0.278; p < 0.001). A low level of self-efficacy was associated with a significant and negative relationship between the severity of menopausal symptoms and satisfaction with life (p = 0.005), while at a high and moderate level of self-efficacy, the severity of menopausal symptoms was not associated with life satisfaction (p > 0.05). Self-efficacy moderates the relationship between the severity of menopausal symptoms and life satisfaction in menopausal women. The moderating function of self-efficacy is that, at its low level, an increase in the severity of menopausal symptoms reduces life satisfaction, while at medium and high levels, an increase in the severity of menopausal symptoms does not reduce life satisfaction.

Sleep disturbance associated with the menopause

IMPORTANCE AND OBJECTIVES

Sleep disturbance is one of the most common and debilitating symptoms experienced by women during the menopause transition. However, there are currently no therapies specifically approved for sleep disturbance associated with the menopause. Here, we consider how to characterize sleep disturbance associated with the menopause and discuss its etiology, including the latest advances in our understanding of the neuronal circuits that regulate reproduction, body temperature, sleep, and mood; and reflect on its impact on women's health and well-being. We also examine the current treatment landscape and look to the future of treatment for this condition.

METHODS

We conducted a review of the literature and combined this with discussion with experts in the fields of sleep and menopause as well as experiences from our own clinical practices.

DISCUSSION AND CONCLUSIONS

Sleep disturbance associated with the menopause is characterized by frequent night-time awakenings and increased awake time after sleep onset. Its impacts are wide-ranging, negatively affecting health as well as personal and social relationships, productivity, and work performance. There is currently an unmet need for effective, safe, and well-tolerated treatments to address this important symptom, and wider recognition of the association between sleep disturbances and the menopause is needed. Sleep disturbances associated with the menopause can result from hormone changes as well as vasomotor and mood symptoms. Growing research has contributed to our knowledge of the role of hypothalamic estrogen-sensitive kisspeptin/neurokinin B/dynorphin neurons. These neurons are thought to integrate the gonadotropin-releasing hormone pathway and the pathways responsible for the homeostatic control of body temperature and the circadian regulation of sleep-wake cycles. Understanding these neurons offers the potential to create treatments that target a key cause of sleep disturbance associated with the menopause. Further research to understand their etiology and characterize the neuronal circuits responsible could benefit the development of these targeted treatment approaches.

The risk of depression in the menopausal stages: A systematic review and meta-analysis

INTRODUCTION

For many women, menopause transition can be a period of emotional and physical changes, with different menopausal stages associated with varied risk for depressive symptoms and diagnosis. This review aimed to conduct a systematic review and meta-analyses to provide an estimate for the risk of developing a) clinical depression and b) depressive symptoms at different menopausal stages.

METHODS

We searched Medline, PsycInfo, Embase and Web of Science from inception to July 2023. Seventeen prospective cohort studies with a total of 16061 women were included in the review, and risk of bias was assessed using the Quality in Prognosis Studies tool (QUIPS). Seven papers with a total of 9141 participants were included in meta-analyses, using random effects models and pooled odds ratios (OR) calculated for depressive symptoms and diagnoses.

RESULTS

Perimenopausal women were found to be at a significantly higher risk for depressive symptoms and diagnoses, compared to premenopausal women (OR = 1.40; 95 % CI: 1.21; 1.61, p < .001). We did not find a significantly increased risk for depressive symptoms or diagnoses in post-menopausal, compared to pre-menopausal women.

LIMITATIONS

Studies used different criteria to classify the menopausal stages and different measures for depression, which may have contributed to the heterogeneity seen in some models. We were unable to include a model that compared peri to post-menopause, due to a lack of longitudinal studies comparing the two stages.

CONCLUSIONS

The risk of depression in perimenopause, shown in an ethnically diverse sample; highlights the clinical need for screening and support in this potentially vulnerable group.

Interrogating the estrogen-mediated regulation of adrenocortical Klotho expression using ovariectomized albino rat model exposed to repeated restraint stress

Reproductive aging is associated with altered stress response and many other menopausal symptoms. Little is known about the adrenal expression of the anti-aging protein Klotho or how it is modulated by estrogen in ovariectomized stressed rats. Fifty-six Wistar female rats were assigned into seven equal groups. Sham-operated (Sham), sham stressed (Sham/STS), ovariectomized (OVR), ovariectomized stressed (OVR/STS), ovariectomized stressed rosiglitazone-treated (OVR/STS/R), ovariectomized stressed estrogen-treated (OVR/STS/E), and ovariectomized stressed estrogen/GW9662 co-treated (OVR/STS/E/GW) groups. All stressed rats were subjected daily to a one-hour restraint stress test for 19 days. At the end of the experiment, blood was collected for serum corticosterone (CORT) analysis. Adrenal tissues were obtained and prepared for polymerase chain reaction (PCR) assay, hematoxylin and eosin (H&E), immunohistochemistry-based identification of Klotho and PPAR-γ, and Oil Red O (ORO) staining. The rise in serum CORT was negligible in the OVR/STS group, in contrast to the Sham/STS group. The limited CORT response in the former group was restored by estrogen and rosiglitazone and blocked by estrogen/GW9226 co-administration. ORO-staining revealed a more evident reduction in the adrenal fat in the OVR/STS group, which was reversed by estrogen and counteracted by GW. Also, there was a comparable expression pattern of Klotho and PPAR-γ in the adrenals. The adrenal Klotho decreased in the OVR/STS group, but was reversed by estrogen treatment. GW9226/estrogen co-treatment interfered with the regulatory effect of estrogen on Klotho. The study suggested modulation of the adrenal Kotho expression by estrogen, in the ovariectomized rats subjected to a restraint stress test. This estrogen-provided adrenal protection might be mediated by PPAR-γ activation.

Sleep, Mood, and Nutrition Patterns of Postmenopausal Women Diagnosed with Major Depressive Disorder by Menopause Periods

Menopausal women experience changes in ovarian activity and fluctuating hormone levels. The aim of this study was to detect ongoing sleep and nutritional problems in postmenopausal women. This study was conducted with 62 postmenopausal women who had been diagnosed with major depressive disorder, were aged 42-64, were not dieting for at least 1 month, and had been using antidepressants for at least 6 months. The Pittsburgh Sleep Quality Index and Depression Anxiety Stress Scale-42 were used. Anthropometric measurements were taken and body composition analysis was performed. The prevalence of obesity and overweight were 12.9% and 71%, respectively. Hot flashes, night sweats, and mood swing were more common in those who had been through menopause for <5 years. Also, the PSQI, Depression, and Stress scores of those women were higher. Women who had been menopausal for ≥5 years had a higher BMI, waist/hip ratio, and fat mass and better sleep quality and lower daytime dysfunction according to the PSQI. Energy and fat intake were higher, while protein, vitamin C, and calcium intakes were lower in women who had been menopausal for ≥5 years. It is crucial for healthcare professionals to review approaches for early and late menopausal periods and to individualize treatment options, especially in patients whose symptoms persist.

The Effect of Yoga on Menopause Symptoms: A Randomized Controlled Trial

The research was conducted as a randomized controlled study with the aim of determining the effect of yoga on menopause symptoms. Menopausal women between the ages of 40 and 60 years were included in the research. There were 31 menopausal women in each of 2 groups, making a total of 62. A Descriptive Characteristics Form and the Menopause Rating Scale (MRS) were used to collect data. In the research, the yoga group practiced yoga for 60 minutes twice a week for 10 weeks. In the final lesson of the 10 weeks of yoga training, the women were again given the MRS. No intervention was performed on the control group. The median score on the MRS of the women in the yoga group was 16 (11-21) in the pretest, and 5 (3-9) in the posttest (P < .05). The median score on the subscale of psychological complaints of the women in the yoga group was 6 (3-8) in the pretest, and 1 (1-2) in the posttest (P < .05). The median score on the subscale of urogenital complaints of the women in the yoga group was 3 (3-5) in the pretest, and 1 (0-2) in the posttest (P < .05). The median score on the subscale of somatic complaints of the women in the yoga group was 7 (4-10) in the pretest, and 1 (1-3) in the posttest (P < .05). It was concluded from the research that 60 minutes of yoga 2 days a week for 10 weeks may reduce the psychological, somatic, and urogenital symptoms experienced in menopause.

Relationship between sleep quality and marital satisfaction of working women during the premenopausal period

Sleep disorders can adversely affect physical, sexual, and marital health, particularly among middle-aged women. This study aimed to determine the relationship between sleep quality and marital satisfaction of working women during the premenopausal period. In this cross-sectional study, we selected 150 women working at Shiraz University of Medical Sciences in Iran was selected using random cluster sampling. A demographic information form, the Pittsburgh Sleep Quality Index (PSQI), and the Evaluation and Nurturing Relationship Issues, Communication, and Happiness (ENRICH) marital satisfaction scale were used for data collection. The Data were analyzed using SPSS.22 software at a significance level of P < 0.05. Multiple linear regression analysis was employed to predict sleep quality based on marital satisfaction. Our results showed that 79 (52.7%) of the participants had undesirable sleep quality, 87 (58%) had high marital satisfaction, and 32 (21.3%) had very high marital satisfaction. Regression analysis revealed that the total marital satisfaction score could not predict the sleep quality score of the participants. However, as dimensions of marital satisfaction, personality issues negatively (β = 0.327, P < 0.05) and ideological orientation positively (β = 0.336, P < 0.01) predicted the sleep quality score. Based on the prediction of the sleep quality score by personality issues and ideological orientations among the dimensions of marital satisfaction, it seems that life skills training, especially in these two dimensions, may improve the quality of sleep and, as a result, the physical and mental health of working women.

The Role of Silymarin in Mitigating Inflammation and Cognitive Impairment Induced by Ovariectomy in Wistar Rats

Background. Silymarin, a polyphenolic flavonoid found in milk thistle, has been used to treat liver and brain injuries in humans and animals. The study aims to investigate the protective effects of silymarin on spatial and passive avoidance memory, oxidative stress, and inflammatory factors in the brain and liver tissues of ovariectomized (OVX) Wistar rats. Methods. The study involved 30 female Wistar rats divided into control, sham, and three silymarin-treated groups. After ovariectomy, rats underwent CT scan, and some of them were administered silymarin via gavage for 2 months. Memory and learning were assessed using Morris water maze and shuttle box tests. Brain and liver tissues were analyzed for inflammatory factors (IL-1β, TNFα, and IL-6) and oxidative stress markers (CAT, SOD, and MDA) after sacrifice. Results. Silymarin improved spatial memory and fear learning compared to the sham group ($P\le 0.05$ to $P\le 0.001$). It also significantly reduced IL-1β, TNF-α, and IL-6 levels in the cortex, hippocampus, and liver ($P\le 0.05$ to $P\le 0.0001$) and increased CAT and SOD while decreasing MDA levels ($P\le 0.05$ to $P\le 0.001$) compared to control and sham groups. Conclusion. Long-term administration of silymarin extract can improve learning and memory, reverse cognitive impairment caused by ovariectomy, and reduce oxidative stress and inflammatory factors induced by ovariectomy in the liver and brain of Wistar rats. This is due to the reduction in MDA levels and an increase in CAT activity, although silymarin has some effect on SOD at high doses.

Statin Use and the Risk of Venous Thromboembolism in Women Taking Hormone Therapy

Importance

Although hormone therapy (HT) in perimenopausal women is associated with increased risk for venous thromboembolism (VTE), it is unclear to what extent statins may mitigate this HT-associated risk.

Objective

To estimate VTE risk in women aged 50 to 64 years taking HT with or without statins.

Design, Setting, and Participants

This nested case-control study analyzed data from a commercially insured claims database in the US. Eligible participants included women aged 50 to 64 years with at least 1 year of continuous enrollment between 2008 and 2019. Data analysis occurred from January 2022 to August 2023.

Exposure

Filled prescriptions for estrogens, progestogens, and statins were recorded in the 12 months prior to index. Recent HT was defined as any estrogen or progestogen exposure within 60 days before the index date. Current statin exposure was defined as 90 or more days of continuous exposure prior to and including the index date. Statin intensity was defined by the statin exposure 30 days prior to index.

Main Outcomes and Measures

Cases were identified with VTE diagnoses (diagnostic codes) preceded by at least 12 months without VTE and followed within 30 days by anticoagulation, an inferior vena cava filter placement, or death. Controls were matched to cases (10:1) on date and age. Conditional logistic regression models estimated risk for HT and statin exposures with odds ratios (OR), adjusted for comorbidities. Conditional logistic regression models were used to estimate VTE risk for HT and statin exposures with odds ratios (ORs), adjusted for comorbidities. Intensity of statin therapy was measured as a subgroup analysis.

Results

The total sample of 223 949 individuals (mean [SD] age, 57.5 [4.4] years) included 20 359 cases and 203 590 matched controls. Of the entire sample, 19 558 individuals (8.73%) had recent HT exposure and 36 238 individuals (16.18%) had current statin exposure. In adjusted models, individuals with any recent HT exposure had greater odds of VTE compared with those with no recent HT exposure (OR, 1.51; 95% CI, 1.43-1.60). Individuals receiving current statin therapy had lower odds of VTE compared with those with no current statin exposure (OR, 0.88; 95% CI, 0.84-0.93). When compared with those not recently taking HT or statins, the odds of VTE were greater for those taking HT without statins (OR, 1.53; 95% CI, 1.44-1.63) and for those taking HT with statins (OR, 1.25; 95% CI, 1.10-1.43), but were lower for those taking statins without HT (OR, 0.89; 95% CI, 0.85-0.94). Individuals taking HT with statin therapy had 18% lower odds of VTE than those taking HT without statins (OR, 0.82; 95% CI, 0.71-0.94) and there was greater risk reduction with higher intensity statins.

Conclusions and Relevance

In this case-control study, statin therapy was associated with reduced risk of VTE in women taking HT, with greater risk reduction with high-intensity statins. These findings suggest that statins may reduce risk of VTE in women exposed to HT and that HT may not be contraindicated in women taking statins.

Impact of the new coronavirus (SARS-CoV-2) pandemic on climacteric women's health: Websurvey

OBJECTIVE

The menopausal transition is an important milestone in female reproductive life. Many studies have been conducted to assess the impact of the COVID-19 pandemic on women, but few of them focus on the climacteric population. This study aimed to investigate changes in the health and health care of climacteric women aged 40-70 years residing in Brazil during the pandemic period.

METHOD

A cross-sectional study was carried out using an electronic form with questions related to sociodemographic, clinical and gynecological data, treatments, access to health services and changes in behavior.

RESULTS

A total of 419 women answered the questionnaire. Sixty percent reported weight gain and 50.8% reported reduced physical activity practice. More than 80% reported worsening mental health and 66.1% had a change in their sleep pattern. More than half reported having difficulty accessing gynecological consultations and routine examinations. Women living in capital cities reported a greater change in alcohol consumption (p = 0.002). Income change was associated with a higher prevalence of weight gain (p = 0.033) and changes in sleep quality (p = 0.018).

CONCLUSION

We observed an important reduction in the health care of climacteric women during the pandemic period, such as a decrease in medical consultations and preventive examinations, worsening of life habits and deterioration in mental health.

Effects of Omega-3 Polyunsaturated Fatty Acids Intake on Vasomotor Symptoms, Sleep Quality and Depression in Postmenopausal Women: A Systematic Review

The menopausal transition is often accompanied with distressing manifestations, such as vasomotor symptoms, sleep disruptions, and depressive syndrome. Omega-3 polyunsaturated fatty acids (n-3 PUFAs) have emerged as a potential intervention to alleviate these symptoms. This review aimed to comprehensively assess the impact of n-3 PUFAs supplementation on vasomotor symptoms, sleep quality, and depression among postmenopausal women. We conducted a systematic literature search of randomized controlled trials across the Cochrane Library, Web of Science, PubMed, CINAHL, EMBASE, and SCOPUS databases from inception to August 2023. Among the initial pool of 163 identified studies, nine studies met the inclusion criteria and were incorporated into this systematic review. Notably, four studies detected potential benefits of n-3 PUFAs in improving hot flashes and night sweats. On the contrary, sleep quality outcomes displayed heterogeneity across the studies. Incorporating diverse scales, such as the Hamilton Depression Rating Scale-21, the Patient Health Questionnaire depression scale, and Generalized Anxiety Disorder-7 for depression outcomes, we found inconclusive evidence of n-3 PUFA's impact on depression. Overall, the combined analysis of these studies did not provide substantial evidence to support the efficacy of n-3 PUFAs in improving vasomotor symptoms, sleep quality, and depression. Further well-designed randomized clinical trials with larger participant groups are crucial to validate and generalize these results. Review Registration: PROSPERO registration no: CRD42023421922.

Perioperative sleep disorders in gynaecological daycase surgery patients and analysis of risk factors: protocol for a cross-sectional study

INTRODUCTION

Sleep disorders are clinical syndromes of disturbed sleep-wake rhythms and abnormal sleep quality. They have various causes, but their main manifestations are difficulty falling asleep, sleep disruption and daytime fatigue. These are common clinical symptoms in perioperative patients, especially in gynaecological patients. There is a lack of research on the factors influencing perioperative sleep disorders in gynaecological patients. The aim of this study is to assess the prevalence of sleep disorders in gynaecological surgery patients and to analyse the possible factors influencing them to provide new ideas for improving sleep disorders in this patient population.

METHODS AND ANALYSIS

This cross-sectional, descriptive and observational survey is planned to include 480 gynaecological day surgery patients. All patients who meet the inclusion criteria are eligible to join the study. The study will record preoperative diagnosis, surgical procedure, duration of surgery, type of anaesthesia, anaesthetic drugs, sleep quality, anxiety and depression levels and pain indices 30 days before and 1, 2, 3 and 30 days after surgery.

ETHICS AND DISSEMINATION

The study was approved by the Ethics Committee of Beijing Shijitan Hospital Affiliated with Capital Medical University (Approval Number: sjtkyll-lx-2022(109)) before the start of recruitment. The results of the study will be disseminated through peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

ChiCTR2200064533.

Impact of COVID-19 on health of menopausal women: A scoping review

OBJECTIVE

This scoping review aims to map and summarize the direct impact of contracting COVID-19, and the indirect consequences of the pandemic on the health of peri- and postmenopausal women.

METHODS

Searches for published studies were conducted in CINAHL, Cochrane, EMBASE, PubMed, Scopus, Web of Science, PsycINFO and ProQuest from inception to 26 Oct, 2022. Grey literature and reference lists of included studies were searched. Results are presented as a narrative synthesis and tables.

RESULTS

Thirty-eight studies were selected in this review. Overall, a majority of studies (n = 31) suggest that menopausal women were negatively impacted, while lesser studies (n = 21) concluded that they were not and some studies (n = 14) produced both negative and neutral results. Twenty-three studies presented on the direct health impact of COVID-19 infections on menopausal women. Eleven studies focused on the indirect impact of COVID-19 in terms of contact restriction measures on menopausal health during the pandemic compared to before the pandemic. Six studies described the different indirect impact of COVID-19 on health of menopausal women with various characteristics or lifestyles.

CONCLUSION

The direct and indirect impacts of COVID-19 on menopausal women on physical, mental health and social wellbeing are largely negative.

Acupuncture-adjuvant therapies for treating perimenopausal depression: A network meta-analysis

BACKGROUND

The issues related to the treatment of perimenopausal depression (PMD) are the side effects of antidepressants and hormone replacement therapy. The aim of this study was to assess the efficiency and safety of acupuncture and moxibustion in PMD patients.

METHODS

Databases, namely PubMed, Cochrane Library, Web of Science, EMBASE, CNKI, CBM, VIP, and WanFang, were reviewed for related randomized controlled trials dated between database inception and November 22, 2022. The primary outcomes were the efficacy rate and the Hamilton Depression Scale score. The secondary outcomes were the levels of follicle-stimulating hormone, luteinizing hormone, and estradiol and the Kupperman score. Odds ratios (ORs) were generated as the effect size for dichotomous outcomes, while the standard mean difference (SMD) ± standard deviation was used for continuous outcomes. Matrices were developed to demonstrate pairwise comparisons of regimens related to each endpoint. Utilizing Review Manager (RevMan) 5.3, Stata 16.0 and SPSS 21, data were analyzed.

RESULTS

In total, 27 studies involving 2269 PMD patients and 8 therapeutic measures were incorporated into the network meta-analysis (NMA). The NMA showed that warm acupuncture (OR = 1.55, 95% CI: 1.00-2.44), electroacupuncture (OR = 1.34, 95% CI: 1.00-1.8), abdominal acupuncture (OR = 1.19, 95% CI: 0.73-1.96), and common acupuncture (OR = 1.4, 95% CI: 0.9-2.17) were more effective than fluoxetine + menopausal hormone treatment in the treatment of PMD. The NMA also showed that, based on the Hamilton Depression Scale score, warm acupuncture was more effective than the other 4 acupuncture-related treatments, i.e., electroacupuncture (SMD = -1.22, 95% CI: -2.34 to -0.09), thread embedding (SMD = -1.31, 95% CI: -2.21 to -0.40), abdominal acupuncture (SMD = -1.33, 95% CI: -2.42 to -0.24), and common acupuncture (SMD = -1.46, 95% CI: -2.26 to -0.66). The cumulative ranking probability (SUCRA) showed that warm acupuncture (99.6%) was the best treatment method.

CONCLUSIONS

The findings of this network meta-analysis may help patients and therapists choose the best acupuncture therapy for treating perimenopausal depression patients and furnish reliable evidence for guidelines.

Buckwheat tartary regulates the Gsk-3β/β-catenin pathway to prevent neurobehavioral impairments in a rat model of surgical menopause

Menopause is a natural aging process characterized by decreased levels of sex hormones in females. Deprivation of estrogen following menopause results in alterations of dendritic arborization of the neuron that leads to neurobehavioral complications. Hormone replacement therapy is in practice to manage postmenopausal conditions but is associated with a lot of adverse effects. In the present study, the efficacy of buckwheat tartary (Fagopyrum tataricum) whole seed extract was investigated against the neurobehavioral complication in middle-aged ovariectomized rats, which mimic the clinical postmenopausal condition. Hydroalcoholic extraction (80% ethanol) was done, and quantification of major marker compounds in the extract was performed using HPLC. Oral treatment of the extract following the critical window period rescued the reconsolidation process of spatial and recognition memory, as well as depression-like behavior. Gene expression analysis disclosed elevated oxidative stress and neuroinflammation that largely disturb the integrity of the blood-brain barrier in ovariectomized rats. Gfap and Pparγ expression also showed reactive astrogliosis in the rats subjected to ovariectomy. The extract treatment reverted the elevated oxidative stress, neuroinflammation and expression of the studied genes. Furthermore, protein expression analysis revealed that Gsk-3β was activated differentially in the brain, as suggested by β-catenin protein expression, which was normalized following the treatment with extract and rescued the altered neurobehavioral process. The results of the current study concluded that Fagopyrum tataricum seed extract is better option to overcome the neurobehavioral complications associated with the menopause.

Association of lifespan reproductive duration with depression in Swedish twins: The role of hormone replacement therapy

OBJECTIVE

To examine the association between reproductive duration and postmenopausal depression (taking the use of hormone replacement therapy [HRT] into account).

METHODS

In this population-based cohort study, 11 320 postmenopausal women (mean age 63.6 years) were followed for up to 18 years. Reproductive duration was categorized into three groups: short (≤34 years), average (35-39 years), and long (≥40 years). Depression was ascertained from the Sweden National Patient Registry.

RESULTS

During the follow up, 593 (5.24%) women developed depression. In the multi-adjusted generalized estimating equation model, the odds ratios (ORs) of depression were 1.28 (95% confidence interval [CI] 1.05-1.55) and 1.25 (95% CI 1.01-1.55) for women with short and long reproductive durations, respectively, compared with those women with average reproductive duration. Women with a non-typical reproductive duration (≤34 or ≥40 years) who received HRT were at a higher risk of depression (OR 1.82, 95% CI 1.42-2.33). There was a significant additive interaction between non-typical reproductive duration and the use of HRT on depression (attributable proportion 0.26, 95% CI 0.03-0.50).

CONCLUSION

Women with a short or long reproductive duration, especially those with a history of HRT use, have a higher risk of depression after menopause compared with those with an average reproductive duration.

Sex differences in cognitive function among Chinese older adults using data from the Chinese longitudinal healthy longevity survey: a cross-sectional study

Objective

To compare the sex differences in cognitive function and its influencing factors among Chinese older adults.

Method

We conducted a cross-sectional study by using data from the China Longitudinal Healthy Longevity Survey (CLHLS). According to the 32 provinces and 4 municipalities directly under the Central Government of China, 3-5 counties or districts were randomly selected in each province or city (except Tibet), and then 1-3 villages or streets were randomly selected in each county or district, from which the target population was sampled. Mini Mental State Examination (MMSE) was used to assess the cognitive function of 9,262 older adults aged 65 and above in China. Descriptive analysis was applied to demonstrate the participants' demographic characteristics, health-related behaviors, social and non-social activity, disease status, mental and sleep condition. And then, univariate and multifactor analyses were performed to validate different risk factors for cognitive function, respectively in the general population, male older adults and female older adults.

Result

The older adults with cognitive impairment accounted for 10.4% of the total population. There are significant differences in cognitive function between male and female older adults. The odds of cognitive impairment in older adult women was 1.291 times that of older adult men (OR = 1.291, 95%CI: 1.084-1.538). Among the male older adults, those who were older, highly educated, spouseless, had depressive symptoms, and lacked social activities were more likely to have cognitive impairment, whereas among the female older adults, those who were older, highly educated, and lacked social activities were more likely to have cognitive impairment.

Conclusion

Overall, there are subtle differences in potential influencing factors for cognitive function between the male older adults and female older adults. Attention should be paid to the different cognitive protection measures for the older adults with different sexes.

The COVID-19 Pandemic Impact on the Psychophysical Health of Post-Menopausal Women: A Cross-Sectional Study

Background and Objectives: The aim of this study was to investigate lifestyle, menopausal symptoms, depression, post-traumatic stress disorder (PTSD) and sleep disorders in post-menopausal women throughout the first wave of the COVID-19 pandemic, including the impact of menopause hormonal therapy (HT). Materials and Methods: Post-menopausal women were given the following questionnaires: socio-demographic characteristics; lifestyle; history of COVID-19; menopause-specific quality of life (MENQOL), the first part of which refers to the pre-pandemic period ("pre COVID-19") and the second refers to the current period ("during COVID-19"); Beck's depression inventory (BDI); the impact of event scale-revised (IES-R); and the Pittsburgh sleep quality index (PSQI). Results: One hundred and twenty-six women completed all questionnaires, with a mean age of 55.5 ± 6.0 years. The mean menopause duration was 5.7 ± 5.6 years. Twenty-four women were taking HT. A significant mean weight gain, a reduction in physical activity (respectively p < 0.001) and worsened quality of romantic relationships (p = 0.001) were reported during the pandemic. Menopausal symptoms did not vary significantly throughout the pandemic; however, women taking menopausal HT had lower physical (p = 0.003) and sexual (p = 0.049) MENQOL domain scores, lower depressive symptoms (p = 0.039) and better romantic relationships (p = 0.008). Conclusions: The COVID-19 pandemic caused reduced physical activity, worsened food habits and weight gain in post-menopausal women. They also reported a high rate of severe-moderate PTSD and a negative influence on their romantic relationships. Menopausal HT seems to be a potential protective factor for sexual and physical status and for symptoms of depression.

TFOS Lifestyle: Impact of lifestyle challenges on the ocular surface

Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.

Cognitive Dysfunction, an Increasingly Valued Long-Term Impairment in Acromegaly

Acromegaly is a chronic disease caused by the overproduction of growth hormone (GH) and accompanying insulin-like growth factor-1 (IGF-1), which is often caused by GH-secreting pituitary adenomas. In addition to its somatic burden, a growing number of studies have found that patients suffering from acromegaly exhibit psychosocial and personality changes. Over the past 70 years, there has been increasing interest in the cognitive impairment and neuropsychological issues of patients with acromegaly, and a variety of neuropsychological and neurophysiological tests have been used to measure cognitive changes in patients. The impact of disease progression status, treatment modalities, and various comorbidities on cognitive function and the mechanisms of cognitive impairment in patients with acromegaly are therefore outlined in this review. Multidisciplinary assessment has important implications for the management of acromegaly, particularly in relation to cognitive function. Here, we summarize the relevant literature concerning cognitive-behavioral research on acromegaly to demonstrate the impact of long-term impairment caused by GH and IGF-1 on the cognitive behavior of patients.

[Cognitive and psychoemotional changes in menopausal transition: The possibility of medical correction]

The increasing of older age group in the population determines studying of age related diseases and emergence of new investigations in this area. In Female body, entering the menopausal transition is the start of «aging» of reproductive function and linked with decreasing of sex hormons levels. A direct connection between changes of estrogen, progesterone, androgen ratios and cognitive function of women was revealed. The anatomical localization of sex hormone receptors, the mechanisms of interaction of hormones with these receptors determine the ways of implementing biological effects of steroids on the CNS. Modern theories of «healthy nerve cells» and «eu-estrogenemia» explains the role of additional criteria, such as the absence of neurological diseases history and the duration of hypoestrogenia, to the outcome of menopausal hormone therapy. Additional factors that can affect to MHT action include: the composition of hormone therapy, administration methods, regimens (cyclic, continuous), duration of treatment, history of endocrine diseases, diabetes mellitus, gynecological history (parity, menarche age, COC use), heredity. The sections present the effect of menopausal transition on the development of depression, mood changes, sleep disturbances and mental disabilities. The explanation of negative effects of menopausal hormone therapy to cognitive health is also described by modern point of view. The ambivalent opinions of researchers, the potential of new reading of the results of earlier studies, confirms the necessity of continuing study of this topic.

Nutritional and lifestyle management of the aging journey: A narrative review

With age, the physiological responses to occasional or regular stressors from a broad range of functions tend to change and adjust at a different pace and restoring these functions in the normal healthy range becomes increasingly challenging. Even if this natural decline is somehow unavoidable, opportunities exist to slow down and attenuate the impact of advancing age on major physiological processes which, when weakened, constitute the hallmarks of aging. This narrative review revisits the current knowledge related to the aging process and its impact on key metabolic functions including immune, digestive, nervous, musculoskeletal, and cardiovascular functions; and revisits insights into the important biological targets that could inspire effective strategies to promote healthy aging.

The risk of depressive and anxiety symptoms in women with premature ovarian insufficiency: a systematic review and meta-analysis

Premature ovarian insufficiency (POI) appears to be associated with depressive and anxiety symptoms. However, there is a lack of high-quality evidence relating to the risk of patients with POI developing depression or anxiety. Therefore, we conducted a systematic review and meta-analysis to quantify the risk of depressive and anxiety symptoms in women with POI. We searched English and Chinese databases to evaluate the risk of depression and anxiety disorders in patients with POI. The final search date was November 2021. The risk was quantified using meta-analysis, with an estimation of pooled odds ratio (OR) and 95% confidence interval (CI). Sources of heterogeneity were explored by subgroup analysis. A total of seven primary studies with 1316 individuals were included, five of which were related to depression and six to anxiety disorders. All included articles were case-control studies of high quality. Patients with POI were associated with a higher odds of depression and anxiety (depression: OR = 3.33, 95% CI = 2.31-4.81, P < 0.001; anxiety: OR = 4.89, 95% CI = 3.28-7.30, P < 0.001). Subgroup analysis also indicated that patients with POI are at a higher risk of anxiety and depression. POI appears to be associated with a high risk of depression and anxiety. Early psychosocial assessment and regular screening of patients with POI are also necessary. In addition, it is important to consider the mental health of patients with POI.

The Interplay Among Natural Menopause, Insomnia, and Cognitive Health: A Population-Based Study

PURPOSE

The interrelationships among age at menopause, sleep, and brain health have been insufficiently studied. This study sought to examine the influence of age at natural menopause and insomnia symptoms on long-term cognitive function among US women.

PATIENTS AND METHODS

Our study included a nationally representative cohort of US adults age 50+ from the Health and Retirement Study (2008-2018). We restricted this cohort to 5880 women age 50+, from a diverse racial and ethnic groups. Age at menopause was retrieved from baseline (2008) for women having natural menopause. Five questions were used to identify women with insomnia symptoms (2010 and 2012): trouble falling asleep, nighttime awakenings, early morning awakenings, feelings of nonrestorative sleep, and use of sleep aids. A battery of four neuropsychological tests was conducted biennially (years) to evaluate cognitive function. Longitudinal associations between age at natural menopause and cognitive function were estimated with mixed effects models with a random intercept. Insomnia symptoms were examined as potential mediators or modifiers in the pathway between age at menopause and cognition.

RESULTS

One year earlier in age at menopause was associated with a 0.49 lower mean in composite cognitive score, in any given survey year (adjusted p = 0.002). Earlier age at menopause was associated with higher risk of developing insomnia symptoms (eg, trouble falling asleep OR = 0.97; 95% CI: 0.96, 0.99), and insomnia symptoms were associated with worse cognitive performance (eg, trouble falling asleep, beta = -0.5, p-value = 0.02). Therefore, insomnia symptoms could potentially mediate the association between age at natural menopause and cognition.

CONCLUSION

Earlier age at menopause is associated with a lower score in cognitive performance. This association may be mediated by insomnia symptoms. Our findings spotlight that among women who experience early menopause, there is the need for studies of sleep-based interventions to mitigate cognitive decline.

Functional state of glutathione system in menopausal women of the Buryat ethnic group with insomnia

   The aim of the study was to assess the functional state of glutathione system in menopausal women of the Buryat ethnic group with insomnia.   Methods. The study involved 94 women aged 45 to 60 years who were divided into perimenopause (n = 44) and postmenopause (n = 50) groups. In each period, a control group and an insomniac group were identified. The reduced (GSH) and oxidized (GSSG) glutathione levels in erythrocyte lysate, the glutathione-S-transferase π concentration and glutathione reductase activity in blood serum were determined.   Results. An increase of the GSH level (p < 0.05) and GSH/GSSG ratio (p < 0.05) both in perimenopausal and postmenopausal women with insomnia were found as compared to controls. There were no differences in the glutathione-depends enzymes parameters. Comparative analysis of the main groups showed an increase GSH/GSSG ratio (p < 0.05) in the postmenopausal period compared with perimenopause.   Conclusion. The study results demonstrate the glutathione link activation in Buryat menopausal women with insomnia. In this regard, the appointment of glutathione preparations for the correction of free radical homeostasis in these groups of women cannot be recommended.

Management of Menopause Symptoms and Quality of Life during the Menopause Transition

Some women experience bothersome symptoms around the time of menopause that may have a negative impact on their quality of life and prompt them to seek treatments. Menopausal hormone therapy was historically the treatment of choice. However, medical contraindications and personal preference for nonhormonal therapy have prompted the evaluation of a range of nonhormonal pharmacologic and non-pharmacologic therapies. This review provides an update focusing on the latest evidence-based approach for the management of bothersome symptoms of menopause.

The effect of mindfulness training on stress and sleep quality of postmenopausal women: A systematic review and meta-analysis

INTRODUCTION

Mindfulness is an effective method for empowering women to cope with menopausal changes. This study aimed to determine the effect of mindfulness training on stress and sleep quality in postmenopausal women.

MATERIALS AND METHODS

English (PubMed, Cochrane Library, Google Scholar, Scopus, Web of Science, and CINHAL) and Persian (SID, Magiran) databases were searched until 25 June 2022, using the free and MeSH keywords included Mindfulness and Menopause. The quality of the published papers was evaluated using Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0. The meta-analysis was conducted in RevMan 5.3 and the results were reported with mean difference (95% confidence interval). The quality of evidence was assessed using the GRADE approach.

RESULTS

A total of 1206 records were obtained. After removing duplicate and non-eligible records, finally five articles were included in the systematic review and meta-analysis. The results indicated that sleep quality score (SMD = -1.44; 95% CI = -2.44 to -0.46; p = 0.004) and perceived stress score (MD = -4.21; 95% CI = -6.41 to -2.00; p = 0.0002) were significantly reduced in the mindfulness training group compared to control group.

CONCLUSION

Mindfulness training is associated with improving sleep quality and perceived stress (with a low quality of evidence) in postmenopausal women. Mental health and quality of life in postmenopausal women impressively affect the community health. Given the low quality of evidence of the studies in this field, randomized controlled trials with better methodologies are suggested.

Adjuvant aromatase inhibitor treatment worsens depressive symptoms and sleep quality in postmenopausal women with localized breast cancer: A one-year follow-up study

First-line treatment in postmenopausal women with estrogen- and/or progesterone-positive breast cancer consists of aromatase inhibitors (AROi). The ability of AROi to promote or worsen cognitive function, depressive symptoms, sleep quality and performance in basic activities of daily life as primary and concomitant outcomes in long longitudinal studies in post-menopausal women has been seldom investigated. This study is a cohort trial which aimed to determine if there were differences in cognitive function assessment, depressive symptoms, and sleep quality after 1 year under AROi treatment and to determine the interrelations between these symptoms.

METHODS

A prospective 1-year longitudinal study was performed in a representative sample of tertiary hospital. Women with localized breast cancer newly treated with AROi therapy were evaluated for cognitive functions, depressive symptoms, sleep problems and ability to perform basic activities of the daily life at baseline and after 6 months and 12 months under adjuvant AROi treatment.

RESULTS

Analysis of cognitive functions by the Mini-Mental State Examination (MMSE) scores did not show significantly worsening under AROi treatment after 6 months and 12 months of treatment compared to the baseline. Analysis of depressive symptoms with the Geriatric Depression Scale and sleep quality with the Athens Insomnia Scale (AIS) scores showed significant (p < 0.05) changes after 6 and 12 months of treatment with AROi, with women describing more depressive symptoms and more sleep disturbances.

CONCLUSIONS

Our study found impairments in sleep quality and an increase in depressive symptoms, which has important implications for clinicians as they impair quality of life and adherence to treatment.

Effect of rosuvastatin on spatial learning, memory, and anxiety-like behaviour in ovariectomized rats

The effect of rosuvastatin (Ros) on cognitive function and anxiety-like behaviour in ovariectomized rats were evaluated. Eighteen female Wistar rats (218-310 g, 6-8 months old) were allocated into sham (n = 6), ovariectomy (Ovx, n = 6) or Ovx + Ros (up to eighth week n = 6, then n = 4) groups. Ros was administered at 20 mg/kg/day by oral gavage for 12 weeks. Behavioural tests were performed at 4, 8 and 12 weeks following Ovx. At 12 weeks, Ovx group had significantly longer escape latency than the sham group at the first day of the four-day training period of the Morris Water Maze test (p < .01). In the Elevated Plus Maze test, Ovx group spent significantly more time in the closed arms than the sham group (p < .01), and this anxiety-like behavioural effect of Ovx was prevented by 12-weeks Ros treatment (p < .05). In conclusion, Ros prevents memory deficit and anxiety-like behaviour in the ovariectomized rats, a model for human surgical menopause. Impact StatementWhat is already known on this subject? Reduced levels of oestrogen in surgical postmenopausal period has been linked to an increased risk of cognitive dysfunction. Although statins have been shown to improve cognitive function in experimental and clinical studies, there are limited studies evaluating the effect of statins on the cognitive decline and anxiety-like behaviour associated with surgical menopause.What do the results of this study add? Rosuvastatin, a long-acting statin, prevents learning and memory deficit and anxiety-like behaviour in the ovariectomized rat model.What are the implications of these findings for future clinical practice and/or future clinical research? These findings will form the basis for further experimental and clinical research on the effects of statins on cognitive functions and anxiety-like behaviour in the surgical menopause.

Deep multilayer brain omics identifies the potential involvement of menopause molecular networks in Gliomas' disease progression

The risk of high-grade gliomas is lower in young females, however, its incidence enhances after menopause, suggesting potential protective roles of female sex hormones. Hormone oscillations after menopause have received attention as a possible risk factor. Little is known about risk factors for adult gliomas. We examined the association of the aging brain after menopause, determining the risk of gliomas with proteomics and the MALDI-MSI experiment. Menopause caused low neurotransmitter levels such as GABA and ACH, high inflammatory factor levels like il-1β, and increased lipid metabolism-related levels like triglycerides in the brain. Upregulated and downregulated proteins after menopause were correlated with differentially expressed glioma genes, such as ACTA2, CAMK2D, FNBPIL, ARL1, HEBP1, CAST, CLIC1, LPCAT4, MAST3, and DOCK9. Furthermore, differential gene expression analysis of monocytes showed that the downregulated gene LPCAT4 could be used as a marker to prevent menopausal gliomas in women. Our findings regarding the association of menopause with the risk of gliomas are consistent with several extensive cohort studies. In view of the available evidence, postmenopausal status is likely to represent a significant risk factor for gliomas.

Effect of Aromatherapy with Essential oil of Lavandula Angustifolia Mill- Citrus Bergamia and Mindfulness-Based Intervention on Sexual Function, Anxiety, and Depression in Postmenopausal Women: A Randomized Controlled Trial with Factorial Design

BACKGROUND

Due to the importance of psychological support for women during menopause as a period with a high prevalence of mental health problems, this study aimed to evaluate the effect of the essential oil of lavender-Bergamot (La-Ber) and Mindfulness-Based Intervention (MBI) on sexual function, anxiety (primary outcome), and depression score (secondary outcome) in postmenopausal women with sexual dysfunction.

MATERIALS AND METHODS

This controlled randomized trial with a factorial design was performed on 132 postmenopausal women. Participants were randomly allocated into four equal groups: Aromatherapy-Routine Care (Aroma-RC), MBI-Placebo (MBI-P), Aromatherapy-MBI (Aroma-MBI), or Routine Care-Placebo (RC-P). Two to three drops of La-Ber or a similar placebo were inhaled three times a day for 8 weeks. Eight sessions of MBI intervention were conducted. At the end of the intervention and eight weeks afterward, the outcomes were assessed.

RESULTS

The sexual function score improved significantly in Aroma-MBI (adjusted Mean Difference [aMD]: 2.4, 95% CI: 0.01 to 4.80) and MBI-P (aMD: 2.6, 95% CI: 0.2 to 5.1) groups compared to the RC-P group. The anxiety score was reduced in the Aroma-RC group at the end of the intervention (aMD: -4.12, 95% CI: -7.41 to -0.72; p = 0.020) and eight weeks later as well as in the Aroma-MBI group. In terms of depression, the mean score of depression was significantly lower than the RC-P group in the Aroma-RC group at the end of the intervention (p = 0.011).

CONCLUSIONS

MBI and aromatherapy seem effective on sexual function and menopausal anxiety. MBI improves sexual function, while aromatherapy ameliorated anxiety and depression.