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Memi E, Pavli P, Papagianni M, Vrachnis N, Mastorakos G. Diagnostic and therapeutic use of oral micronized progesterone in endocrinology. Rev Endocr Metab Disord 2024:10.1007/s11154-024-09882-0. [PMID: 38652231 DOI: 10.1007/s11154-024-09882-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
Progesterone is a natural steroid hormone, while progestins are synthetic molecules. In the female reproductive system, progesterone contributes to the control of luteinizing hormone and follicle-stimulating hormone secretion and their pulsatility, via its receptors on the kisspeptin, neurokinin B, and dynorphin neurons in the hypothalamus. Progesterone together with estradiol controls the cyclic changes of proliferation and decidualization of the endometrium; exerts anti-mitogenic actions on endometrial epithelial cells; regulates normal menstrual bleeding; contributes to fertilization and pregnancy maintenance; participates in the onset of labor. In addition, it exerts numerous effects on other endocrine systems. Micronized progesterone (MP) is natural progesterone with increased bioavailability, due to its pharmacotechnical micronized structure, which makes it an attractive diagnostic and therapeutic tool. This critical literature review aims to summarize and put forward the potential diagnostic and therapeutic uses of MP in the field of endocrinology. During reproductive life, MP is used for diagnostic purposes in the evaluation of primary or secondary amenorrhea as a challenge test. Moreover, it can be prescribed to women presenting with amenorrhea or oligomenorrhea for induction of withdrawal bleeding, in order to time blood-sampling for diagnostic purposes in early follicular phase. Therapeutically, MP, alone or combined with estrogens, is a useful tool in various endocrine disorders including primary amenorrhea, abnormal uterine bleeding due to disordered ovulation, luteal phase deficiency, premenstrual syndrome, polycystic ovary syndrome, secondary amenorrhea [functional hypothalamic amenorrhea, premature ovarian insufficiency], perimenopause and menopause. When administrated per os, acting as a neurosteroid directly or through its metabolites, it exerts beneficial effects on brain function such as alleviation of symptoms of anxiety and depression, asw well as of sleep problems, while it improves working memory in peri- and menopausal women. Micronized progesterone preserves full potential of progesterone activity, without presenting many of the side-effects of progestins. Although it has been associated with more frequent drowsiness and dizziness, it can be well tolerated with nocturnal administration. Because of its better safety profile, especially with regard to metabolic ailments, breast cancer risk and veno-thromboembolism risk, MP is the preferred option for individuals with an increased risk of cardiovascular and metabolic diseases and of all-cause mortality.
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Affiliation(s)
- Eleni Memi
- Unit of Endocrinology, Diabetes mellitus, and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Vas. Sophias Av. 76, 11528, Athens, Greece
| | - Polina Pavli
- Unit of Endocrinology, Diabetes mellitus, and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Vas. Sophias Av. 76, 11528, Athens, Greece
| | - Maria Papagianni
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42100, Trikala, Greece
- Endocrine Unit, 3rd Department of Pediatrics, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54642, Thessaloniki, Greece
| | - Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, Attikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini Str. 1, 12462, Chaidari, Athens, Greece
- St George's NHS Foundation Trust Teaching Hospitals, St George's University of London, London, UK
| | - George Mastorakos
- Unit of Endocrinology, Diabetes mellitus, and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Vas. Sophias Av. 76, 11528, Athens, Greece.
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Inselman AL, Masters EA, Moore JN, Agarwal R, Gassman A, Kuijpers G, Beger RD, Delclos KB, Swift S, Camacho L, Vanlandingham MM, Sloper D, Nakamura N, Gamboa da Costa G, Woodling K, Bryant M, Trbojevich R, Wu Q, McLellen F, Christner D. The effect of black cohosh extract and risedronate coadministration on bone health in an ovariectomized rat model. Front Pharmacol 2024; 15:1365151. [PMID: 38689663 PMCID: PMC11058223 DOI: 10.3389/fphar.2024.1365151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
Preparations of black cohosh extract are sold as dietary supplements marketed to relieve the vasomotor symptoms of menopause, and some studies suggest it may protect against postmenopausal bone loss. Postmenopausal women are also frequently prescribed bisphosphonates, such as risedronate, to prevent osteoporotic bone loss. However, the pharmacodynamic interactions between these compounds when taken together is not known. To investigate possible interactions, 6-month-old, female Sprague-Dawley rats underwent bilateral ovariectomy or sham surgery and were treated for 24 weeks with either vehicle, ethinyl estradiol, risedronate, black cohosh extract or coadministration of risedronate and black cohosh extract, at low or high doses. Bone mineral density (BMD) of the femur, tibia, and lumbar vertebrae was then measured by dual-energy X-ray absorptiometry (DEXA) at weeks 0, 8, 16, and 24. A high dose of risedronate significantly increased BMD of the femur and vertebrae, while black cohosh extract had no significant effect on BMD individually and minimal effects upon coadministration with risedronate. Under these experimental conditions, black cohosh extract alone had no effect on BMD, nor did it negatively impact the BMD-enhancing properties of risedronate.
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Affiliation(s)
- Amy L. Inselman
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Elysia A. Masters
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Jalina N. Moore
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Rajiv Agarwal
- Office of New Drug Products, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Audrey Gassman
- Division of Urology, Obstetrics and Gynecology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Gemma Kuijpers
- Division of Urology, Obstetrics and Gynecology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Richard D. Beger
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Kenneth B. Delclos
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Sybil Swift
- Office of Dietary Supplement Program, Center for Food Safety and Nutrition, U.S. Food and Drug Administration, College Park, MD, United States
| | - Luísa Camacho
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Michelle M. Vanlandingham
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Daniel Sloper
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Noriko Nakamura
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Gonçalo Gamboa da Costa
- Office of the Center Director, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Kellie Woodling
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Matthew Bryant
- Office of Scientific Coordination, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Raul Trbojevich
- Office of Scientific Coordination, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Qiangen Wu
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Florence McLellen
- Office of Scientific Coordination, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Donna Christner
- Office of New Drug Products, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, United States
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Santoro N, Nappi RE, Neal-Perry G, English M, King DD, Yamaguchi Y, Ottery FD. Fezolinetant treatment of moderate-to-severe vasomotor symptoms due to menopause: effect of intrinsic and extrinsic factors in two phase 3 studies (SKYLIGHT 1 and 2). Menopause 2024; 31:247-257. [PMID: 38517210 DOI: 10.1097/gme.0000000000002340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVE This study aimed to assess the efficacy of the neurokinin 3 receptor antagonist, fezolinetant, according to several intrinsic (individual related) and extrinsic (external influence) factors that may influence the frequency and severity of moderate-to-severe vasomotor symptoms (VMS) using pooled 12-week data from SKYLIGHT 1 and 2. METHODS SKYLIGHT 1 and 2 were two phase 3, randomized, double-blind studies conducted from July 2019 to August 2021 (SKYLIGHT 1) or April 2021 (SKYLIGHT 2). Participants were initially randomized to receive daily doses of placebo, fezolinetant 30 mg, or fezolinetant 45 mg. After 12 weeks, placebo participants were rerandomized to receive fezolinetant 30 mg or 45 mg, whereas those receiving fezolinetant continued on the same dose. Change in VMS frequency from baseline to week 12 was used to assess efficacy according to several intrinsic and extrinsic factors. Overall efficacy and safety were also investigated. RESULTS Overall, 1,022 individuals were included. Fezolinetant was efficacious in reducing VMS frequency across all intrinsic and extrinsic factors. Efficacy was most notable for participants who self-identify as Black (least squares mean difference for fezolinetant 45 mg versus placebo, -3.67; 95% CI, -5.32 to -2.01), current smokers (-3.48; -5.19 to -1.77), and current alcohol users (-3.48; -4.42 to -2.54). Overall efficacy was -2.51 (95% CI, -3.20 to -1.82) for fezolinetant 45 mg versus placebo. Similar findings were observed for the fezolinetant 30 mg dose. Comparable incidences of treatment-emergent adverse events were observed for placebo (132 of 342 individuals [38.6%]), fezolinetant 30 mg (132 of 340 individuals [38.8%]), and fezolinetant 45 mg (135 of 340 individuals [39.7%]). CONCLUSIONS None of the intrinsic and extrinsic factors analyzed substantially reduced the efficacy response to fezolinetant in SKYLIGHT 1 and 2. These data provide additional confidence for using fezolinetant in a diverse population of individuals with VMS.
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Affiliation(s)
- Nanette Santoro
- From the Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
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Oh MR, Park JH, Park SK, Park SH. Efficacy of plant-derived dietary supplements in improving overall menopausal symptoms in women: An updated systematic review and meta-analysis. Phytother Res 2024; 38:1294-1309. [PMID: 38189863 DOI: 10.1002/ptr.8112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/06/2023] [Accepted: 12/16/2023] [Indexed: 01/09/2024]
Abstract
This updated systematic review and meta-analysis aims to confirm the effectiveness of plant-based supplements in improving overall menopausal symptoms and vasomotor symptoms. A systematic review of the literature was conducted by searching the PubMed/MEDLINE, Web of Science, EMBASE, and CENTRAL databases up to June 2022. Randomized placebo-controlled clinical trials that evaluated the effects of dietary supplements on menopausal symptoms were included. Outcome measures included daily hot flash frequency, Kupperman's index, Menopause Rating Scale, and Greene Climacteric Scale. Pooled data were analyzed using a fixed-effects model and expressed as a weighted mean difference with a 95% confidence interval for continuous outcomes. For qualitative assessment, 67 studies were selected. For quantitative assessment, 54 reports were obtained from 61 studies. The study participants were peri- or postmenopausal women aged 38-85, most of whom experienced hot flashes as a menopausal symptom. The investigational products included 28 soy-derived, 6 red clover-derived, and 28 other plant-derived supplements. Qualitative assessment revealed that approximately 76% of the studies were generally of fair or good quality, whereas 24% were of low quality. Meta-analysis results indicated significant improvements in all questionnaire scores, including hot flash frequency, in the dietary supplement group compared with the placebo group. Comprehensive evaluation using different questionnaire tools showed that the various plant-derived dietary supplements can significantly alleviate menopausal symptoms. However, further rigorous studies are needed to determine the association of plant-derived dietary supplements with menopausal health because of the general suboptimal quality and heterogeneous nature of current evidence.
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Affiliation(s)
- Mi Ra Oh
- Clinical Trial Center for Functional Foods, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jae Ho Park
- Food Functionality Research Division, Korea Food Research Institute, Wanju, Republic of Korea
| | - Seon Kyeong Park
- Food Functionality Research Division, Korea Food Research Institute, Wanju, Republic of Korea
| | - Soo Hyun Park
- Food Functionality Research Division, Korea Food Research Institute, Wanju, Republic of Korea
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Hedaoo K, Badge AK, Tiwade YR, Bankar NJ, Mishra VH. Exploring the Efficacy and Safety of Black Cohosh ( Cimicifuga racemosa) in Menopausal Symptom Management. J Midlife Health 2024; 15:5-11. [PMID: 38764923 PMCID: PMC11100637 DOI: 10.4103/jmh.jmh_242_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/19/2024] [Accepted: 02/09/2024] [Indexed: 05/21/2024] Open
Abstract
Black cohosh (Cimicifuga racemosa) is a perennial plant used to treat menopause. This plant is known to have a serotonergic rather than estrogenic impact. It has been recommended to treat vasomotor symptoms associated with breast cancer patients. It also relieves symptoms such as night sweats and hot flashes, commonly called vasorelaxation. The variability in the study's results, doses, and assessment methods requires more rigorous research to establish its efficacy and safety. Standardized trials are needed to provide more precise information on the benefits and limitations of menopause treatment, informing women seeking alternatives to hormone therapy. Black cohosh has shown the potential to reduce the frequency and intensity of vasomotor symptoms in breast cancer patients undergoing tamoxifen treatment. In addition to its effectiveness in alleviating night sweats and hot flashes, the vasorelaxation properties contribute to its overall positive impact on menopausal symptoms. Due to discrepancies, varying dosages, and assessment techniques, further comprehensive studies are essential to determine the optimal dosage, long-term safety, and overall efficacy. Only through standardized trials can women make informed decisions about black cohosh as a viable alternative to hormone therapy during menopause.
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Affiliation(s)
- Kritiksha Hedaoo
- Department of Clinical Research, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research (DU), Sawangi, Wardha, Maharashtra, India
| | - Ankit K. Badge
- Department of Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Sawangi, Wardha, Maharashtra, India
| | - Yugeshwari R. Tiwade
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DU), Sawangi, Wardha, Maharashtra, India
| | - Nandkishor J. Bankar
- Department of Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DU), Sawangi, Wardha, Maharashtra, India
| | - Vaishnavi H. Mishra
- Department of Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DU), Sawangi, Wardha, Maharashtra, India
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6
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Karimi SM, Bayat M, Rahimi R. Plant-derived natural medicines for the management of osteoporosis: A comprehensive review of clinical trials. J Tradit Complement Med 2024; 14:1-18. [PMID: 38223808 PMCID: PMC10785263 DOI: 10.1016/j.jtcme.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 01/16/2024] Open
Abstract
Background Osteoporosis is a chronic and systemic skeletal disease that is defined by low bone mineral density (BMD) along with an increase in bone fragility and susceptibility to fracture. This study aimed to overview clinical evidence on the use of herbal medicine for management of osteoporosis. Methods Electronic databases including Pubmed, Medline, Cochrane library, and Scopus were searched until November 2022 for any clinical studies on the efficacy and/or safety of plant-derived medicines in the management of osteoporosis. Results The search yielded 57 results: 19 on single herbs, 16 on multi-component herbal preparations, and 22 on plant-derived secondary metabolites. Risk of fracture, bone alkaline phosphatase, BMD, and specific bone biomarkers are investigated outcomes in these studies. Medicinal plants including Acanthopanax senticosus, Actaea racemosa, Allium cepa, Asparagus racemosus, Camellia sinensis, Cissus quadrangularis, Cornus mas, Nigella sativa, Olea europaea, Opuntia ficus-indica, Pinus pinaster, Trifolium pretense and phytochemicals including isoflavones, ginsenoside, Epimedium prenyl flavonoids, tocotrienols are among plant-derived medicines clinically investigated on osteoporosis. It seems that multi-component herbal preparations were more effective than single-component ones; because of the synergistic effects of their constituents. The investigated herbal medicines demonstrated their promising results in osteoporosis via targeting different pathways in bone metabolism, including balancing osteoblasts and osteoclasts, anti-inflammatory, immunomodulatory, antioxidant, and estrogen-like functions. Conclusion It seems that plant-derived medicines have beneficial effects on bone and may manage osteoporosis by affecting different targets and pathways involved in osteoporosis; However, Future studies are needed to confirm the effectiveness and safety of these preparations.
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Affiliation(s)
- Seyedeh Mahnaz Karimi
- Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Bayat
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roja Rahimi
- Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Schultz NM, Morga A, Siddiqui E, Rhoten SE. Psychometric evaluation of the PROMIS SD-SF-8b instrument in individuals experiencing vasomotor symptoms due to menopause. Health Qual Life Outcomes 2023; 21:126. [PMID: 37990323 PMCID: PMC10662922 DOI: 10.1186/s12955-023-02206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/01/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Women with vasomotor symptoms (VMS) due to menopause frequently experience poor sleep quality. The Patient-Reported Outcomes Measurement Information System Sleep Disturbance - Short Form 8b (PROMIS SD-SF-8b) has been developed to assess sleep disturbance. The study objective was to use data from the fezolinetant SKYLIGHT 1 and 2 studies in individuals with VMS to assess the psychometric properties of the PROMIS SD-SF-8b. METHODS Individuals (aged ≥ 40-≤65 years) with moderate-to-severe VMS (≥ 7 hot flashes/day) were enrolled. Besides PROMIS SD-SF-8b, eight other patient-reported outcome (PRO) measures were used for the psychometric evaluation. All the PRO assessments were completed at weeks 4 and 12 during the treatment period and most were completed at baseline. Psychometric analyses included factor analysis and reliability, construct validity, and sensitivity to change assessments. The within-patient threshold for a clinically meaningful change in sleep disturbance was derived. RESULTS Overall, 1022 individuals were included from the SKYLIGHT 1 and 2 studies. Mean PROMIS SD-SF-8b total score at baseline was 26.80, which decreased to 22.68 at week 12, reflecting improved sleep disturbance. The confirmatory factor analysis supported the proposed PROMIS SD-SF-8b domain structure. Internal consistency was excellent, with Cronbach's alpha values of 0.915 and 0.935 and a McDonald's omega of 0.917. Item-to-item and item-total correlations were sufficient and moderate test-retest reliability was noted. The construct validity assessments showed that moderate Spearman rank correlations (r: 0.608 to 0.651) were observed between PROMIS SD-SF-8b total scores and measures of sleep disturbance and sleep-related impairment, and that significant differences were noted in the total scores across PRO categories. The responsiveness of PROMIS SD-SF-8b total scores was supported by the results from the correlations in change scores and comparisons of mean change scores by PRO categories. Statistically significant differences in mean scores were observed between responder and non-responder PRO groups. A PROMIS SD-SF-8b total score of 8 points was identified as the within-patient threshold to use to confirm a meaningful change in sleep disturbance. CONCLUSIONS The psychometric properties of the PROMIS SD-SF-8b support its use to measure sleep disturbance in women with VMS due to menopause. TRIAL REGISTRATION ClinicalTrials.gov numbers: NCT04003155 and NCT04003142.
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Affiliation(s)
- Neil M Schultz
- Medical Affairs, Astellas Pharma, 1 Astellas Way, Northbrook, IL, 60062, USA.
| | - Antonia Morga
- Medical Affairs, Astellas Pharma Europe Ltd, Addlestone, UK
| | - Emad Siddiqui
- Medical Affairs, Astellas Pharma Europe Ltd, Addlestone, UK
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Davis SR, Pinkerton J, Santoro N, Simoncini T. Menopause-Biology, consequences, supportive care, and therapeutic options. Cell 2023; 186:4038-4058. [PMID: 37678251 DOI: 10.1016/j.cell.2023.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/06/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023]
Abstract
Menopause is the cessation of ovarian function, with loss of reproductive hormone production and irreversible loss of fertility. It is a natural part of reproductive aging. The physiology of the menopause is complex and incompletely understood. Globally, menopause occurs around the age of 49 years, with geographic and ethnic variation. The hormonal changes of the menopause transition may result in both symptoms and long-term systemic effects, predominantly adverse effects on cardiometabolic and musculoskeletal health. The most effective treatment for bothersome menopausal symptoms is evidence-based, menopausal hormone therapy (MHT), which reduces bone loss and may have cardiometabolic benefits. Evidence-based non-hormonal interventions are also available for symptom relief. Treatment should be individualized with shared decision-making. Most MHT regimens are not regulator approved for perimenopausal women. Studies that include perimenopausal women are needed to determine the efficacy and safety of treatment options. Further research is crucial to improve menopause care, along with research to guide policy and clinical practice.
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Affiliation(s)
- Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; Department of Endocrinology and Diabetes, Alfred Health, Commercial Rd., Melbourne, VIC 3004, Australia.
| | - JoAnn Pinkerton
- Department of Obstetrics and Gynecology, Division of Midlife Health, The University of Virginia Health System, Charlottesville, VA, USA
| | | | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Sadahiro R, Matsuoka LN, Zeng BS, Chen KH, Zeng BY, Wang HY, Chu CS, Stubbs B, Su KP, Tu YK, Wu YC, Lin PY, Chen TY, Chen YW, Suen MW, Hopwood M, Yang WC, Sun CK, Cheng YS, Shiue YL, Hung CM, Matsuoka YJ, Tseng PT. Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysis. Menopause 2023; 30:766-773. [PMID: 37192826 DOI: 10.1097/gme.0000000000002196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE Menopausal symptoms are common in midlife women and have broad impacts on their daily functioning and quality of life. Black cohosh extracts have been widely used to relieve menopausal symptoms. However, the comparative benefits of different combined black cohosh regimens remain inconclusive. The aim of the current updated meta-analysis is to address the comparative efficacies of different black cohosh regimens in improving menopausal symptoms. METHODS Random-effect model pairwise meta-analysis of randomized controlled trials was conducted to investigate the treatment effect on menopausal symptoms by the black cohosh extract both alone or combined with other related active ingredients. The outcomes studied were changes in menopausal symptoms after treatment with black cohosh extracts in menopausal women. RESULTS Twenty-two articles including information on 2,310 menopausal women were included in the analyses. Black cohosh extracts were associated with significant improvements in overall menopausal symptoms (Hedges' g = 0.575, 95% CI = 0.283 to 0.867, P < 0.001), as well as in hot flashes (Hedges' g = 0.315, 95% CIs = 0.107 to 0.524, P = 0.003), and somatic symptoms (Hedges' g = 0.418, 95% CI = 0.165 to 0.670, P = 0.001), compared with placebo. However, black cohosh did not significantly improve anxiety (Hedges' g = 0.194, 95% CI = -0.296 to 0.684, P = 0.438) or depressive symptoms (Hedges' g = 0.406, 95% CI = -0.121 to 0.932, P = 0.131). The dropout rate for black cohosh products was similar to that for placebo (odds ratio = 0.911, 95% CI = 0.660 to 1.256, P = 0.568). CONCLUSIONS This study provides updated evidence regarding the potentially beneficial effects of black cohosh extracts for relieving menopausal symptoms in menopausal women.
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Affiliation(s)
- Ryoichi Sadahiro
- From the Department of Immune Medicine, National Cancer Center Research Institute, National Cancer Center Japan, Tokyo, Japan
| | | | | | - Keng-Hsu Chen
- Department of Medical Education, E-Da Hospital, I-Shou University, E-Da Healthcare Group, Kaohsiung, Taiwan
| | - Bing-Yan Zeng
- Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Hung-Yu Wang
- Department of Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | | | | | | | | | - Yi-Cheng Wu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | | | | | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology and Neurology, Kaohsiung City, Taiwan
| | | | | | | | | | | | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | | | - Yutaka J Matsuoka
- Center for Public Health Sciences, National Cancer Center Japan, Japan
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Prior JC, Cameron A, Fung M, Hitchcock CL, Janssen P, Lee T, Singer J. Oral micronized progesterone for perimenopausal night sweats and hot flushes a Phase III Canada-wide randomized placebo-controlled 4 month trial. Sci Rep 2023; 13:9082. [PMID: 37277418 DOI: 10.1038/s41598-023-35826-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/24/2023] [Indexed: 06/07/2023] Open
Abstract
This study tested progesterone for perimenopausal hot flush ± night sweat (vasomotor symptom, VMS) treatment. It was a double-blind, randomized trial of 300 mg oral micronized progesterone@bedtime versus placebo for 3-months (m) after a 1-m untreated baseline during 2012/1-2017/4. We randomized untreated, non-depressed, screen- and baseline-eligible by VMS, perimenopausal women (with flow within 1-year), ages 35-58 (n = 189). Participants aged 50 (± SD = 4.6) were mostly White, educated, minimally overweight with 63% in late perimenopause; 93% participated remotely. The 1° outcome was 3rd-m VMS Score difference. Participants recorded VMS number and intensity (0-4 scale)/24 h on a VMS Calendar. Randomization required VMS (intensity 2-4/4) of sufficient frequency and/or ≥ 2/week night sweat awakenings. Baseline total VMS Score (SD) was 12.2 (11.3) without assignment difference. Third-m VMS Score did not differ by therapy (Rate Difference - 1.51). However, the 95% CI [- 3.97, 0.95] P = 0.222, did not exclude 3, a minimal clinically important difference. Women perceived progesterone caused decreased night sweats (P = 0.023) and improved sleep quality (P = 0.005); it decreased perimenopause-related life interference (P = 0.017) without increased depression. No serious adverse events occurred. Perimenopausal night sweats ± hot flushes are variable; this RCT was underpowered but could not exclude a minimal clinically important VMS benefit. Perceived night sweats and sleep quality significantly improved.
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Affiliation(s)
- Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia (UBC), 2775 Laurel Street, Suite 4111, Vancouver, BC, Canada.
- School of Population and Public Health, UBC, Vancouver, Canada.
- British Columbia Women's Health Research Institute, Vancouver, Canada.
- Endocrinology and Metabolism, Department of Medicine, UBC, Vancouver, BC, Canada.
| | - Andrea Cameron
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia (UBC), 2775 Laurel Street, Suite 4111, Vancouver, BC, Canada
| | - Michelle Fung
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia (UBC), 2775 Laurel Street, Suite 4111, Vancouver, BC, Canada
- Etobicoke General Hospital, William Osler Health System, Etobicoke, ON, Canada
| | - Christine L Hitchcock
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia (UBC), 2775 Laurel Street, Suite 4111, Vancouver, BC, Canada
- Hitchcock Consulting, Oakville, ON, Canada
| | - Patricia Janssen
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia (UBC), 2775 Laurel Street, Suite 4111, Vancouver, BC, Canada
- School of Population and Public Health, UBC, Vancouver, Canada
- British Columbia Women's Health Research Institute, Vancouver, Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Joel Singer
- School of Population and Public Health, UBC, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
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11
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Shon J, Seong Y, Choi Y, Kim Y, Cho MS, Ha E, Kwon O, Kim Y, Park YJ, Kim Y. Meal-Based Intervention on Health Promotion in Middle-Aged Women: A Pilot Study. Nutrients 2023; 15:2108. [PMID: 37432253 DOI: 10.3390/nu15092108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 07/12/2023] Open
Abstract
Middle-aged women belong to a risk group for metabolic dysregulation and menopausal symptoms, mainly due to a dramatic hormonal shift. Supplementation with functional compounds or a single nutrient has been dominantly explored as a nutritional approach for improving aging-related health parameters. However, a meal-based approach might be another strategy for promoting the overall health of the target population. This pilot study aimed to develop a meal-based intervention for middle-aged women and to evaluate its potential health benefits. Considering the nutrient intake status of Korean middle-aged women, diets enriched with four major nutrients (isoflavone, omega-3, fiber, and calcium) were designed and provided to forty-nine women aged 50 to 65 with mild levels of menopausal symptoms for 8 weeks. In the post-intervention phase, they showed reduced body weight and body fat, and improved biochemical metabolic parameters with decreased levels of cholesterol, low-density lipoprotein-cholesterol, ApoB, and fasting insulin. Moreover, bone resorption markers and menopause symptoms were lower in the post-intervention phase. In conclusion, the meal-based intervention might be a prominent strategy for overall health promotion in relatively healthy middle-aged women and further investigation is needed to test its efficacy with a randomized controlled study.
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Affiliation(s)
- Jinyoung Shon
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Republic of Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Yehee Seong
- Graduate School of Clinical Biohealth, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Yeji Choi
- Graduate School of Clinical Biohealth, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Yeri Kim
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Mi Sook Cho
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Eunhee Ha
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Republic of Korea
- Department of Environmental Medicine, Ewha Womans University College of Medicine, Seoul 07804, Republic of Korea
| | - Oran Kwon
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Republic of Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Yuri Kim
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Republic of Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Yoon Jung Park
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Republic of Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Yangha Kim
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Republic of Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Republic of Korea
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12
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Maghalian M, Hasanzadeh R, Mirghafourvand M. The effect of oral vitamin E and omega-3 alone and in combination on menopausal hot flushes: A systematic review and meta-analysis. Post Reprod Health 2022; 28:93-106. [PMID: 35445622 DOI: 10.1177/20533691221083196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This systematic review was conducted to investigate the effects of vitamin E and omega-3 used alone and in combination on the frequency and intensity of hot flushes (primary outcomes) and adverse effects (secondary outcome) in menopausal women. English and Persian databases were searched until March 18, 2021. The quality of the published papers was evaluated using Cochrane Handbook and the meta-analysis was conducted in RevMan 5.3. Heterogeneity was assessed using I2. In cases with substantial heterogeneity, a random effects model was used instead of a fixed effects model. A total of 387 papers were obtained from the databases. Finally, 10 papers with a sample size of 1100 participants entered the systematic review and a meta-analysis was conducted on nine of them. The results of the meta-analysis of two studies indicated that using vitamin E and omega-3 in combination significantly reduced the intensity of hot flushes compared to the placebo (mean difference (MD): -0.35; 95% CI: -0.48 to -0.21). The mean frequency (MD: -0.50; 95% CI: -1.58 to 0.58) and intensity (SMD: -0.61; 95% CI: -1.50 to 0.29) of hot flushes in the omega-3 group and the frequency of hot flushes (SMD: -0.21; 95% CI: -0.47 to 0.04) in the vitamin E group showed no significant differences with the placebo. No serious adverse effects were reported in the studies. Given the low number of RCTs, more clinical trials with larger sample size are required.
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Affiliation(s)
- Mahsa Maghalian
- Student Research Committee, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | - Robab Hasanzadeh
- Department of Midwifery, Bonab Branch, Islamic Azad University, Bonab, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Faculty of Nursing & Midwifery, 48432Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Family Health, Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
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13
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Maffei S, Franchini M, Fortunato L, Guiducci L. Long-term effects of a combination of isoflavones, agnus castus and magnolia extracts on climacteric symptoms and cardiometabolic risk profile in postmenopausal women. Gynecol Endocrinol 2022; 38:339-344. [PMID: 35257639 DOI: 10.1080/09513590.2022.2047171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To evaluate the long-term effects of a combination of isoflavones, agnus castus and magnolia extracts (combined isoflavone compound [CIC]) on climacteric symptoms and cardiometabolic risk in symptomatic postmenopausal women. METHODS This interventional, prospective study evaluated climacteric symptoms, mood and sleep disorders using the 21-item Greene Climacteric Scale (GCS) and 7-item Insomnia Severity Index (ISI) questionnaires; and cardiovascular, metabolic and thrombotic risk markers at baseline (T0) and after 12 months of CIC treatment (T1). RESULTS In healthy postmenopausal women (N = 71), 12-month CIC treatment significantly reduced patient-reported vasomotor symptoms (100% vs. 17%), mood disorders (67% vs. 25%) and sleep disorders (89% vs. 19%%) (all p < .001) compared with baseline; and significantly improved GCS psychological, somatic, and vasomotor domain scores and ISI sleep disturbance scores (all p < .05). CIC significantly reduced systolic (p = .022) and diastolic blood pressure (p < .001), and heart rate (p < .001); glucose concentrations (p = .018), HOMA index (p = .013), and ALT (p = .035), homocysteine (p = .005) and NT-proBNP (p = .003) levels. CONCLUSIONS Long-term CIC therapy improved vasomotor symptoms, mood disorders, sleep disorders, hemodynamic measurements and cardiometabolic risk markers in healthy postmenopausal women. CLINICALTRIALS.GOV IDENTIFIER NCT03699150.
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Affiliation(s)
- Silvia Maffei
- Department of Cardiovascular Endocrinology and Metabolism, Gynecological and Cardiovascular Endocrinology Unit, "Gabriele Monasterio Foundation" and Italian National Research Council (CNR) Pisa, Italy
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14
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Le Y, Li X, Chen S, Ning KG, Guo X, Wu CG, Manjanatha MG, Mei N. Actein contributes to black cohosh extract-induced genotoxicity in human TK6 cells. J Appl Toxicol 2022; 42:1491-1502. [PMID: 35261072 DOI: 10.1002/jat.4313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/27/2022] [Accepted: 02/27/2022] [Indexed: 11/06/2022]
Abstract
Black cohosh extract (BCE) is one of the most popular botanical products for relieving menopausal symptoms. However, recent studies indicate that BCE is not only ineffective for menopausal therapy, but also induces genotoxicity through an aneugenic mode of action (MoA). In this study, the cytotoxicity of five constituents of BCE was evaluated in human lymphoblastoid TK6 cells. Among the five constituents, actein (up to 50 μM) showed the highest cytotoxicity and was thus selected for further genotoxicity evaluations. Actein caused DNA damage proportionally to concentration as evidenced by the phosphorylation of the histone protein H2A.X (γH2A.X) and resulted in chromosomal damage as measured by the increased percentage of micronuclei (MN) in cells. In addition, actein activated DNA damage response (DDR) pathway through induction of p-ATM, p-Chk1, and p-Chk2, which subsequently induced cell cycle changes and apoptosis. Moreover, both BCE and actein increased intracellular reactive oxygen species (ROS) production, decreased glutathione levels, and activated the mitogen-activated protein kinases (MAPK) signaling pathway. N-acetylcysteine, a ROS scavenger, attenuated BCE- and actein-induced ROS production, apoptosis, and DNA damage. These findings indicate that BCE- and actein-induced genotoxicity is mediated through oxidative stress. Taken together, our data show that actein is likely one of the major contributors to BCE-induced genotoxicity.
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Affiliation(s)
- Yuan Le
- Division of Genetic and Molecular Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, USA
| | - Xilin Li
- Division of Genetic and Molecular Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, USA
| | - Si Chen
- Division of Biochemical Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, USA
| | - Kylie G Ning
- Division of Genetic and Molecular Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, USA
| | - Xiaoqing Guo
- Division of Genetic and Molecular Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, USA
| | - Charles G Wu
- Botanical Review Team, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Mugimane G Manjanatha
- Division of Genetic and Molecular Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, USA
| | - Nan Mei
- Division of Genetic and Molecular Toxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, USA
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15
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Mohapatra S, Iqubal A, Ansari MJ, Jan B, Zahiruddin S, Mirza MA, Ahmad S, Iqbal Z. Benefits of Black Cohosh (Cimicifuga racemosa) for Women Health: An Up-Close and In-Depth Review. Pharmaceuticals (Basel) 2022; 15:ph15030278. [PMID: 35337076 PMCID: PMC8953734 DOI: 10.3390/ph15030278] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 12/18/2022] Open
Abstract
Women’s health is an imminent concern worldwide, but it remains an ignored segment of research in most developing countries, and is yet to take the center stage in even developed nations. Some exclusive female health concerns revolve around both pathological and physiological aspects. These gender-specific maladies include breast, cervical, and ovarian cancers, and physiological concerns such as menopause and osteoporosis, which are often coexistent. Recently, women’s health issues, including postmenopausal syndrome, have attracted the attention of researchers and practitioners alike, opening newer pharmaceutical research and clinical avenues. Although not counted as a disease, postmenopausal syndrome (PMS) is a female health phenomenon underpinned by hormonal depletion. Enhanced life expectancy in women has added to their suffering, and pharmacological interventions are needed. Amongst the available treatment modalities, the use of numerous botanicals has emerged as an efficient health management tool for women. Cimicifuga racemosa (CR or Black Cohosh) is a plant/herb which has been traditionally exploited and extensively used by women. This review is an attempt to compile and provide a summary of the importance of CR in complementary and alternative therapies for the improvement of various disorders related to women, such as menopausal syndrome, mammary cancer, and osteoporosis. It aims to systematically highlight the bioactive constituents, pharmacology, pharmacokinetics, therapeutic potentials, quality control processes, chromatographic techniques, and possible mechanisms of action of clinically effective phytomedicine for women’s health. Various clinical trials and patents relating to CR and women’s health have been collated. Furthermore, the plant and its related products have been considered from a regulatory perspective to reveal its commercial feasibility. The present review summarizes the existing data on CR focusing on women’s health, which can help to introduce this traditional phytomedicine to the world and provide some reference for future drug development.
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Affiliation(s)
- Sradhanjali Mohapatra
- Nanotechnology Lab, School of Pharmaceutics Education and Research (SPER), Jamia Hamdard University, New Delhi 110062, India;
- Bioactive Natural Product Laboratory, School of Pharmaceutics Education and Research (SPER), Jamia Hamdard University, New Delhi 110062, India; (B.J.); (S.Z.)
| | - Ashif Iqubal
- Department of Pharmacology, School of Pharmaceutics Education and Research (SPER), Jamia Hamdard University, New Delhi 110062, India;
| | - Mohammad Javed Ansari
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
| | - Bisma Jan
- Bioactive Natural Product Laboratory, School of Pharmaceutics Education and Research (SPER), Jamia Hamdard University, New Delhi 110062, India; (B.J.); (S.Z.)
| | - Sultan Zahiruddin
- Bioactive Natural Product Laboratory, School of Pharmaceutics Education and Research (SPER), Jamia Hamdard University, New Delhi 110062, India; (B.J.); (S.Z.)
| | - Mohd Aamir Mirza
- Nanotechnology Lab, School of Pharmaceutics Education and Research (SPER), Jamia Hamdard University, New Delhi 110062, India;
- Correspondence: (M.A.M.); (S.A.); (Z.I.); Tel.: +98-11-733-016 (Z.I.)
| | - Sayeed Ahmad
- Bioactive Natural Product Laboratory, School of Pharmaceutics Education and Research (SPER), Jamia Hamdard University, New Delhi 110062, India; (B.J.); (S.Z.)
- Correspondence: (M.A.M.); (S.A.); (Z.I.); Tel.: +98-11-733-016 (Z.I.)
| | - Zeenat Iqbal
- Nanotechnology Lab, School of Pharmaceutics Education and Research (SPER), Jamia Hamdard University, New Delhi 110062, India;
- Correspondence: (M.A.M.); (S.A.); (Z.I.); Tel.: +98-11-733-016 (Z.I.)
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16
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Therapeutic Effects of Punica granatum (Pomegranate): An Updated Review of Clinical Trials. J Nutr Metab 2021; 2021:5297162. [PMID: 34796029 PMCID: PMC8595036 DOI: 10.1155/2021/5297162] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/02/2021] [Accepted: 10/11/2021] [Indexed: 12/22/2022] Open
Abstract
Punica granatum L. belongs to the Punicaceae family which is distributed around the world. Different parts of pomegranate like seed, peel, juice, and leaves are rich in potential bioactive compounds. These plants have found application in traditional medicine such as in treatment of gastrointestinal, cardiovascular, and endocrine diseases, among others. The present review aimed to summarize the current research on the traditional and scientific applications of P. granatum with regard to the phytochemical content and clinical applications that may be useful for future drug development. Information about P. granatum was obtained from local classic herbal literature and electronic databases, such as PubMed, Scopus, and ScienceDirect. Several phytochemical constituents including polyphenolics, flavonoids, anthocyanosides, alkaloids, lignans, and triterpenes have been reported from the plant. Randomized clinical trials have provided evidence as to the pharmacological activities of pomegranate in several diseases including diabetes, cardiovascular disease, oral cavity disorders, endocrine disorders, and cancer. The present review has provided an insight into the traditional applications of the plants, and some of them have been validated by scientific evidence, particularly their applications as treatment of cardiovascular and endocrine diseases.
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17
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Naser B, Castelo-Branco C, Meden H, Minkin MJ, Rachoń D, Beer AM, Pickartz S. Weight gain in menopause: systematic review of adverse events in women treated with black cohosh. Climacteric 2021; 25:220-227. [PMID: 34608830 DOI: 10.1080/13697137.2021.1973993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Weight gain is a frequent problem in perimenopausal and postmenopausal women. Cimicifuga racemosa (CR) is a popular treatment option for menopausal symptoms. The aim of this review was to investigate whether there is scientific evidence that CR causes weight gain. We searched our database for medically confirmed, spontaneous adverse events regarding weight gain, literature for case reports and randomized controlled trials. Thirty cases in total were spontaneously reported in 15 years. The causality was not considered certain/likely in any of the cases. A nurse (consumer) assessed the causality as possible. Only one case was published in the literature. However, no change in body fat composition was reported, and the causality seems unlikely. Of the 31 identified studies, 17 were double-blind placebo-controlled, five were double-blind reference-controlled and nine were open reference-controlled. In total, 1839 women were treated with CR for up to 12 months. Two studies reported weight gain as an adverse event; however, no significant differences in weight changes were observed between the groups. One case of weight gain (about 2 kg) was reported, but the authors did not specify in which treatment group. In conclusion, this study provides no scientific evidence that the use of Cimicifuga racemosa causes weight gain in menopausal women.
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Affiliation(s)
- B Naser
- Pharmacovigilance, Schaper & Brümmer GmbH & Co. KG, Salzgitter, Germany
| | - C Castelo-Branco
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine, University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - H Meden
- Swiss Institute for New Concepts and Treatments, Richterswil, Switzerland
| | - M J Minkin
- Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - D Rachoń
- Department of Clinical and Experimental Endocrinology, Medical University of Gdańsk, Gdańsk, Poland
| | - A-M Beer
- Hospital for True Naturopathy, Katholisches Klinikum Bochum, Blankenstein Hospital, Hattingen, Germany
| | - S Pickartz
- Medical Service, Schaper & Brümmer GmbH & Co. KG, Salzgitter, Germany
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18
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Kazemi F, Masoumi SZ, Shayan A, Oshvandi K. The Effect of Evening Primrose Oil Capsule on Hot Flashes and Night Sweats in Postmenopausal Women: A Single-Blind Randomized Controlled Trial. J Menopausal Med 2021; 27:8-14. [PMID: 33942584 PMCID: PMC8102809 DOI: 10.6118/jmm.20033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/11/2021] [Accepted: 03/02/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives Menopause is associated with complications that could decline women's health during this period. Therefore, some of its complications, such as hot flashes and night sweats, must be treated or alleviated. Methods This randomized controlled trial included postmenopausal women who were referred to health centers in Hamadan from May 2018 to April 2019. The hot flash and night sweat questionnaires were completed by the researcher a week before and 8 weeks after the intervention. The intervention group took one capsule (1,000 mg) of evening primrose oil twice daily, while the control group received the same amount of placebo. Finally, the results were analyzed using Stata 13. Results The mean scores of duration, frequency, and severity of hot flashes did not significantly decrease in both groups after the intervention compared with before the intervention, and no statistically significant difference was observed (P > 0.05). However, the intervention group had lower frequency and severity of night sweats after the intervention than the control group, with statistically significant differences (P < 0.05). Conclusion Evening primrose oil effectively decreased the frequency and severity of night sweats.
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Affiliation(s)
- Farideh Kazemi
- Department of Midwifery and Reproductive Health, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyedeh Zahra Masoumi
- Department of Midwifery and Reproductive Health, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Arezoo Shayan
- Department of Midwifery and Reproductive Health, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- Department of Nursing, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
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19
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Salari S, Amiri MS, Ramezani M, Moghadam AT, Elyasi S, Sahebkar A, Emami SA. Ethnobotany, Phytochemistry, Traditional and Modern Uses of Actaea racemosa L. (Black cohosh): A Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1308:403-449. [PMID: 33861455 DOI: 10.1007/978-3-030-64872-5_24] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Actaea racemosa (AR) also known as Cimicifuga racemosa, is a perennial plant from Ranunculaceae family which was used as traditional remedies in treatment of various condition like rheumatoid muscular pain, headache, inflammation and dysmenorrhea. Actaea racemosa was basically native to Canada and the Eastern United State. This chapter proposed the ethnopharmacological uses of Actaea racemosa, and its phytochemical properties. Specifically, in this article we focused on use of Actaea racemose for menopausal and post-menopausal symptoms management. Electronic databases including PubMed and Scopus were searched for studies on Actaea racemose and its administration in management of menopausal symptoms. Chem Office software was also used in order to find chemical structures. The key words used as search terms were Cimicifuga racemose, Actaea racemose, Ranunculaceae, Black cohosh, Menopausal symptoms. We have included all relevant animal and human studies up to the date of publication. The analysis on Actaea racemose showed various indications for different plant's extracts. Approximately 131 chemical compounds have been isolated and identified from Actaea racemosa. According to recently studies, the most important chemicals known of the Actaea racemosa are phenolic compounds, chromones, triterpenoids, nitrogen-containing constituents. In addition, in vivo and in vitro studies reported wide range of pharmacological activities for Black cohosh like attenuating menopausal symptoms. Mechanism of action for some ethnomedicinal indications were made clear while some of its activities are not confirmed by pharmacological studies yet. Further investigations on its pharmacological properties are necessary to expand its clinical effective use. Also, additional large clinical trials are recommended for clarifying the effect of Black cohosh.
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Affiliation(s)
- Sofia Salari
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mahin Ramezani
- Nanotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Tafazoli Moghadam
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Elyasi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. .,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran. .,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran. .,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.
| | - Seyed Ahmad Emami
- Department of Traditional Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Santoro N, Roeca C, Peters BA, Neal-Perry G. The Menopause Transition: Signs, Symptoms, and Management Options. J Clin Endocrinol Metab 2021; 106:1-15. [PMID: 33095879 DOI: 10.1210/clinem/dgaa764] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Indexed: 02/03/2023]
Abstract
CONTEXT Menopause, the permanent cessation of menses, reflects oocyte depletion and loss of gonadal steroids. It is preceded by a transition state, the perimenopause, which is characterized by the gradual loss of oocytes, altered responsiveness to gonadal steroid feedback, wide hormonal fluctuations, and irregular menstrual patterns. The goal of this mini-review is to discuss the basic pathophysiology of the menopausal transition and the hormonal and nonhormonal management of clinicopathology attributed to it. EVIDENCE ACQUISITION A Medline search of epidemiologic, population-based studies, and studies of reproductive physiology was conducted. A total of 758 publications were screened. EVIDENCE SYNTHESIS The reproductive hormonal milieu of the menopausal transition precipitates bothersome vasomotor symptoms, mood disruption, temporary cognitive dysfunction, genitourinary symptoms, and other disease processes that reduce the quality of life of affected women. The endocrine tumult of the menopause transition also exposes racial and socioeconomic disparities in the onset, severity, and frequency of symptoms. Hormone therapy (HT) treatment can be effective for perimenopausal symptoms but its use has been stymied by concerns about health risks observed in postmenopausal HT users who are older than 60 and/or women who have been postmenopausal for greater than 10 years. CONCLUSIONS The menopause transition is a disruptive process that can last for over a decade and causes symptoms in a majority of women. It is important for clinicians to recognize early signs and symptoms of the transition and be prepared to offer treatment to mitigate these symptoms. Many safe and effective options, including HT, are available.
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Affiliation(s)
- Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Cassandra Roeca
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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The effect of Fennel seed powder on estradiol levels, menopausal symptoms, and sexual desire in postmenopausal women. ACTA ACUST UNITED AC 2020; 27:1281-1286. [DOI: 10.1097/gme.0000000000001604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shayan A, Masoumi SZ, Kazemi F, Oshvandi K. Effect of Combined Herbal Capsule Menohelp on Hot Flashes and Night Sweats in Postmenopausal Women: A Single-Blind Randomized Controlled Trial. J Menopausal Med 2020; 26:135-142. [PMID: 32893515 PMCID: PMC7475286 DOI: 10.6118/jmm.20002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/02/2020] [Accepted: 07/04/2020] [Indexed: 11/06/2022] Open
Abstract
Objectives Hot flashes and night sweats are the most common and annoying consequences of menopause. The present study aimed to investigate the effect of a combined herbal capsule (black cohosh, soy, potato, chaste tree, and burdock) on hot flashes and night sweats in postmenopausal women. Methods The present study was a randomized clinical trial conducted on postmenopausal women who were referred to Hamadan health centers in 2018–2019. The patients were distributed randomly in two groups of 85 individuals using the permuted block technique. The intervention group received the Menohelp capsule 550 mg twice daily for eight weeks and those in the control group received placebo. Data was obtained using a demographic questionnaire and a night sweat checklist one week before and eight weeks after the intervention. Data analysis was done using Stata 13. Results Data analysis revealed that means of hot flashes duration, frequency and intensity did not significantly decrease in the postintervention phase as compared to the pre-intervention phase in both the groups (P > 0.05). Comparative analyses of frequency and intensity of night sweats in the two groups revealed that both variables decreased after intervention with the Menohelp capsule (P < 0.05). Conclusions This study revealed that combined herbal medicine (Menohelp) was effective in reducing the frequency and intensity of night sweats. Therefore, it can be used to reduce night sweats in postmenopausal women.
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Affiliation(s)
- Arezoo Shayan
- Department of Midwifery, Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyedeh Zahra Masoumi
- Department of Midwifery, Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Farideh Kazemi
- Department of Midwifery, Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Moghadam FS, Mahmoodi Z, Kabir K, Mirabi P, Yazdkhasti M. Effectiveness of a Multi-Dimensional Group Counseling Program Based on the GATHER Approach on the Quality of Life in Surgically Menopausal Women. J Menopausal Med 2019; 25:130-141. [PMID: 32307938 PMCID: PMC6952707 DOI: 10.6118/jmm.19200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/10/2019] [Accepted: 11/11/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Surgical menopause can influence women's quality of life in many aspects. This study was designed to assess the effectiveness of a multi-dimensional group counseling program based on the great clients, ask clients, tell clients, help clients, explain how to use, return for follow up (GATHER) approach, on quality of life in the surgically menopausal women. METHODS This randomized clinical trial was conducted using two groups. The study comprised 78 women meeting inclusion criteria who had visited 4 healthcare centers in Tehran from December 2017 to September 2018. The participants were selected through simple random sampling (39 in each group). The intervention group underwent 6 consecutive weekly group counseling sessions based on GATHER approach, whereas the control group received no interventions. Data were collected using the Menopause-specific Quality of Life questionnaire at 4 time-points (i.e., baseline, immediately after the intervention, 1 month after the intervention, and 3 months after the intervention). RESULTS The trend of changes at four time-points obtained on the basis of repeated measures test results showed significant betweengroup differences in vasomotor (P = 0.001), psychosocial (P = 0.025), and physical (P = 0.001) domains. Friedman test showed significant between-group differences in the mean score trend of changes at 4 time-points in sexual (P = 0.002) and overall quality of life (P = 0.004) domains. CONCLUSIONS On the basis of the study results, implementation of this approach with less expenditure in healthcare centers aimed at improving quality of life in surgically menopausal women is highly recommended.
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Affiliation(s)
| | - Zohreh Mahmoodi
- Social Determinants of Health Research Center, Department of Midwifery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Kourosh Kabir
- Department of Community Medicine, School of Medicine, Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Parvaneh Mirabi
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mansoureh Yazdkhasti
- Social Determinants of Health Research Center, Department of Midwifery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
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Iliodromiti S, Wang W, Lumsden MA, Hunter MS, Bell R, Mishra G, Hickey M. Variation in menopausal vasomotor symptoms outcomes in clinical trials: a systematic review. BJOG 2019; 127:320-333. [PMID: 31621155 PMCID: PMC6972542 DOI: 10.1111/1471-0528.15990] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is substantial variation in how menopausal vasomotor symptoms are reported and measured among intervention studies. This has prevented meaningful comparisons between treatments and limited data synthesis. OBJECTIVES To review systematically the outcome reporting and measures used to assess menopausal vasomotor symptoms from randomised controlled trials of treatments. SEARCH STRATEGY We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to May 2018. SELECTION CRITERIA Randomised controlled trials with a primary outcome of menopausal vasomotor symptoms in women and a sample size of at least 20 women per study arm. DATA COLLECTION AND ANALYSIS Data about study characteristics, primary vasomotor-related outcomes and methods of measuring them. MAIN RESULTS The search identified 5591 studies, 214 of which were included. Forty-nine different primary reported outcomes were identified for vasomotor symptoms and 16 different tools had been used to measure these outcomes. The most commonly reported outcomes were frequency (97/214), severity (116/214), and intensity (28/114) of vasomotor symptoms or a composite of these outcomes (68/214). There was little consistency in how the frequency and severity/intensity of vasomotor symptoms were defined. CONCLUSIONS There is substantial variation in how menopausal vasomotor symptoms have been reported and measured in treatment trials. Future studies should include standardised outcome measures which reflect the priorities of patients, clinicians, and researchers. This is most effectively achieved through the development of a Core Outcome Set. This systematic review is the first step towards development of a Core Outcome Set for menopausal vasomotor symptoms. TWEETABLE SUMMARY Menopausal hot flushes and night sweats have been reported in 49 different ways in clinical research. A core outcome set is urgently required.
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Affiliation(s)
- S Iliodromiti
- Women's Health Division, Blizard Institute, Queen Mary University London, London, UK.,School of Medicine, University of Glasgow, Glasgow, UK
| | - W Wang
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - M A Lumsden
- School of Medicine, University of Glasgow, Glasgow, UK
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - R Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - G Mishra
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Australia
| | - M Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and The Royal Women's Hospital, Victoria, Australia
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Fernandes ES, Celani MFS, Fistarol M, Geber S. Effectiveness of the short-term use of Cimicifuga racemosa in the endothelial function of postmenopausal women: a double-blind, randomized, controlled trial. Climacteric 2019; 23:245-251. [PMID: 31691621 DOI: 10.1080/13697137.2019.1682542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: This study aimed to assess the effects of daily use of Cimicifuga racemosa on endothelial function through flow-mediated dilation of the brachial artery, when used for 28 days by healthy postmenopausal women.Methods: The double-blind, randomized, placebo-controlled study included two groups of postmenopausal women (n = 31 each). The subjects were clinically assessed and flow-mediated dilation of the brachial artery was measured before and after 28 days of treatment. Patients received dry extract corresponding to 160 mg C. racemosa (extract with 4 mg of triterpene glycosides) or placebo.Results: Mean age, time since menopause, and body mass index in the two groups were similar. The measurements of flow-mediated dilation of the brachial artery, pre and post treatment, respectively, showed a significant increase in patients who used C. racemosa (p = 0.006), unlike patients who used placebo, who did not present changes in the outcome of flow-mediated dilation of the brachial artery after 28 days of use (p ≥ 0.05). When comparing the number of women in both groups who showed an increase in flow-mediated dilation, a significant difference was found in the measurements of the treated group after the use of the medication (p = 0.018).Conclusions: Daily use of 160 mg C. racemosa extract by postmenopausal women for 28 days beneficially influences endothelial function by promoting elasticity of the brachial artery.
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Affiliation(s)
- E S Fernandes
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - M F S Celani
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - M Fistarol
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - S Geber
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Heng Y, Kim MJ, Yang HJ, Kang S, Park S. Lactobacillus intestinalis efficiently produces equol from daidzein and chungkookjang, short-term fermented soybeans. Arch Microbiol 2019; 201:1009-1017. [PMID: 31069407 DOI: 10.1007/s00203-019-01665-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/02/2019] [Accepted: 04/17/2019] [Indexed: 01/25/2023]
Abstract
Equol improves menopausal symptoms and it is synthesized from daidzein, one of the isoflavonoids in soybeans, by the bacteria in the large intestines of some people. The purpose of this study was to isolate equol-producing bacteria using daidzein from the intestinal microflora and to produce equol-containing chungkookjang (short-term fermented soybean). Equol-producing bacteria from the feces of Sprague-Dawley female rats were isolated using media containing daidzein. The isolated bacteria were cultured in thioglycollate media and equol production was identified through thin-layer chromatography and ultraperformance liquid chromatography-mass spectrometry. The bacteria were identified by 16S rRNA sequencing. The rate of equol production in different concentrations of daidzein was assessed. The expression of genes that code for enzymes associated with the production of equol from daidzein was detected through reverse transcription quantitative PCR. The bacterium we isolated was Lactobacillus intestinalis (LC096206.1, 99%). L. intestinalis was found to express daidzein reductase, dihydrodaidzein reductase, and tetrahydrodaidzein reductase, the enzymes involved in producing equol from daidzein. The conversion rate of equol from daidzein was highest (29.5%) using 200 μM daidzein for 48 h of incubation. When chungkookjang fermented with Bacillus amyloquencies SRCM100001 was incubated with L. intestinalis, 0.32 ± 0.04 mg equol/g chungkookjang was produced. In conclusion, L. intestinalis efficiently produces equol from not only daidzein but also in chungkookjang.
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Affiliation(s)
- Yuan Heng
- Department of Food and Nutrition, Obesity/Diabetes Center, Hoseo University, 165 Sechul-Ri, BaeBang-Yup, Asan-Si, Chungnam-Do, 336-795, South Korea
| | - Min Jung Kim
- Food Functional Research Division, Korean Food Research Institutes, Sungnam, South Korea
| | - Hye Jeong Yang
- Food Functional Research Division, Korean Food Research Institutes, Sungnam, South Korea
| | - Suna Kang
- Department of Food and Nutrition, Obesity/Diabetes Center, Hoseo University, 165 Sechul-Ri, BaeBang-Yup, Asan-Si, Chungnam-Do, 336-795, South Korea
| | - Sunmin Park
- Department of Food and Nutrition, Obesity/Diabetes Center, Hoseo University, 165 Sechul-Ri, BaeBang-Yup, Asan-Si, Chungnam-Do, 336-795, South Korea.
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Johnson A, Roberts L, Elkins G. Complementary and Alternative Medicine for Menopause. J Evid Based Integr Med 2019; 24:2515690X19829380. [PMID: 30868921 PMCID: PMC6419242 DOI: 10.1177/2515690x19829380] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Menopause is associated with problematic symptoms, including hot flashes, sleep problems, mood disorders, sexual dysfunction, weight gain, and declines in cognitive functioning. Many women seek complementary and alternative medicine (CAM) for symptom management. This article critically reviews the existing literature on CAM treatments most commonly used for menopausal symptoms. Electronic searches were conducted to identify relevant, English-language literature published through March 2017. Results indicate that mind and body practices may be of benefit in reducing stress and bothersomeness of some menopausal symptoms. In particular, hypnosis is a mind-body intervention that has consistently shown to have a clinically significant effect on reducing hot flashes. Evidence is mixed in regard to the efficacy of natural products and there are some safety concerns. Health care providers should consider the evidence on CAM in providing an integrative health approach to menopausal symptom management.
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De Franciscis P, Colacurci N, Riemma G, Conte A, Pittana E, Guida M, Schiattarella A. A Nutraceutical Approach to Menopausal Complaints. ACTA ACUST UNITED AC 2019; 55:medicina55090544. [PMID: 31466381 PMCID: PMC6780855 DOI: 10.3390/medicina55090544] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 12/21/2022]
Abstract
The menopausal transition, or perimenopause, is characterized by menstrual irregularities, vasomotor symptoms, sleep disturbances, mood symptoms, and urogenital tract atrophy. These changes can also affect the quality of life and one’s self-esteem. Hormone replacement therapy (HRT) is considered the best option to achieve therapeutic relief of different menopausal symptoms but is usually restricted to moderate or severe symptoms. Moreover, many women refuse HRT for a variety of reasons concerning the fear of cancer and other adverse effects. According to these considerations, new topics are emerging: Dissatisfaction with drug costs and conventional healthcare, desire for personalized medicines, and the public perception that “natural is good”. In this context, nonhormonal therapies are mostly evolving, and it is not unusual that women often request a “natural” approach for their symptoms. The aim of this study is to investigate nonhormonal therapies that have been identified to reduce the menopausal symptoms.
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Affiliation(s)
- Pasquale De Franciscis
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Nicola Colacurci
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Gaetano Riemma
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Anna Conte
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Erika Pittana
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Maurizio Guida
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", 80138 Naples, Italy
| | - Antonio Schiattarella
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
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No Author. Chapitre 4 : Symptômes vasomoteurs. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S68-S72. [DOI: 10.1016/j.jogc.2019.02.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gray KE, Katon JG, LeBlanc ES, Woods NF, Bastian LA, Reiber GE, Weitlauf JC, Nelson KM, LaCroix AZ. Vasomotor symptom characteristics: are they risk factors for incident diabetes? Menopause 2018; 25:520-530. [PMID: 29206771 PMCID: PMC5898980 DOI: 10.1097/gme.0000000000001033] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Vasomotor symptoms (VMS), encompassing hot flashes and night sweats, may be associated with diabetes, but evidence is limited. We sought to estimate these associations. METHODS Among 150,007 postmenopausal Women's Health Initiative participants from 1993 to 2014, we prospectively examined associations of incident diabetes with VMS characteristics at enrollment: any VMS, severity (mild/ moderate/severe), type (hot flashes/night sweats), timing (early [premenopausal or perimenopausal]/late [postmenopausal]), and duration. Cox proportional-hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Mean duration of follow-up was 13.1 years. VMS prevalence was 33%. Reporting any VMS was associated with 18% increased diabetes risk (95% CI 1.14, 1.22), which increased with severity (mild: HR 1.13, 95% CI 1.08, 1.17; moderate: HR 1.29, 95% CI 1.22, 1.36; severe: HR 1.48, 95% CI 1.34, 1.62) and duration (4% per 5 years, 95% CI 1.03, 1.05), independent of obesity. Diabetes risk was more pronounced for women reporting any night sweats (night sweats only: HR 1.20, 95% CI 1.13, 1.26; night sweats and hot flashes: HR 1.22, 95% CI 1.17, 1.27) than only hot flashes (HR 1.08, 95% CI 1.02, 1.15) and was restricted to late VMS (late: HR 1.12, 95% CI 1.07, 1.18; early and late: HR 1.16, 95% CI 1.11, 1.22; early: HR 0.99, 95% CI 0.95, 1.04). CONCLUSIONS VMS are associated with elevated diabetes risk, particularly for women reporting night sweats and postmenopausal symptoms. The menopause transition may be an optimal window for clinicians to discuss long-term cardiovascular/metabolic risk with patients and leverage the bother of existing symptoms for behavior change to improve VMS and reduce diabetes risk.
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Affiliation(s)
- Kristen E. Gray
- VA Puget Sound Health Care System, Health Services Research & Development, Seattle, WA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA
| | - Jodie G. Katon
- VA Puget Sound Health Care System, Health Services Research & Development, Seattle, WA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA
| | - Erin S. LeBlanc
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Nancy F. Woods
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA
| | - Lori A. Bastian
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Gayle E. Reiber
- VA Puget Sound Health Care System, Health Services Research & Development, Seattle, WA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Julie C. Weitlauf
- VA Palo Alto Health Care System, Sierra Pacific MIRECC and Center for Implementation to Innovation (Ci2i), Palo Alto, CA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Karin M. Nelson
- VA Puget Sound Health Care System, Health Services Research & Development, Seattle, WA
- VA Puget Sound Health Care System, General Internal Medicine Service, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Andrea Z. LaCroix
- Division of Epidemiology and Department of Family and Preventive Medicine, University of California San Diego, San Diego
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Thompson JJ, Ritenbaugh C, Nichter M. Why women choose compounded bioidentical hormone therapy: lessons from a qualitative study of menopausal decision-making. BMC Womens Health 2017; 17:97. [PMID: 28969624 PMCID: PMC5625649 DOI: 10.1186/s12905-017-0449-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 09/20/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In recent years, compounded bioidentical hormone therapy (CBHT) has emerged as a popular alternative to manufactured, FDA approved hormone therapy (HT)-despite concerns within the medical community and the availability of new FDA approved "bioidentical" products. This study aims to characterize the motivations for using CBHT in a U.S. sample of ordinary midlife women. METHODS We analyze data collected from 21 current and former users of CBHT who participated in a larger qualitative study of menopausal decision-making among U.S. women. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed thematically using an iterative inductive and deductive process. RESULTS Although women's individual motivations varied, two overarching themes emerged: "push motivations" that drove women away from conventional HT and from alternative therapies, and "pull motivations" that attracted women to CBHT. Push motivations focused on (1) fear and uncertainty about the safety of conventional HT, (2) an aversion to conjugated estrogens in particular, and (3) and overarching distrust of a medical system perceived as dismissive of their concerns and overly reliant on pharmaceuticals. Participants also voiced dissatisfaction with the effectiveness of herbal and soy supplements. Participants were attracted to CBHT because they perceive it to be (1) effective in managing menopausal symptoms, (2) safer than conventional HT, (3) tailored to their individual bodies and needs, and (4) accompanied by enhanced clinical care and attention. CONCLUSIONS This study finds that women draw upon a range of "push" and "pull" motivations in their decision to use CBHT. Importantly, we find that women are not only seeking alternatives to conventional pharmaceuticals, but alternatives to conventional care where their menopausal experience is solicited, their treatment goals are heard, and they are engaged as agents in managing their own menopause. The significance of this finding goes beyond understanding why women choose CBHT. Women making menopause treatment decisions of all kinds would benefit from greater shared decision-making in the clinical context in which they are explicitly invited to share their experiences, priorities, and preferences. This would also provide an opportunity for clinicians to discuss the pros and cons of conventional HT, CBHT, and other approaches to managing menopause.
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Affiliation(s)
- Jennifer Jo Thompson
- Department of Crop and Soil Sciences, University of Georgia, 3111 Miller Plant Sciences, Athens, GA 30602 USA
| | - Cheryl Ritenbaugh
- Department of Family and Community Medicine, University of Arizona, 1450 N. Cherry Ave, Tucson, AZ 85719 USA
| | - Mark Nichter
- School of Anthropology, University of Arizona, 1009 E. South Campus Drive, Tucson, AZ 85721 USA
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Abstract
This article addresses the common women's health concerns of menopause-related symptoms, premenstrual syndrome, and chronic pelvic pain. Each can be effectively addressed with an integrative approach that incorporates interventions such as pharmaceuticals, nutraceuticals, mind-body approaches, acupuncture, and lifestyle modification.
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Affiliation(s)
- Delia Chiaramonte
- Department of Family and Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, 520 West Lombard Street, East Hall, Baltimore, MD 21201, USA; Department of Epidemiology and Public Health, Center for Integrative Medicine, University of Maryland School of Medicine, 520 West Lombard Street, East Hall, Baltimore, MD 21201, USA.
| | - Melinda Ring
- Osher Center for Integrative Medicine at Northwestern University, Northwestern University Feinberg School of Medicine, 150 East Huron Avenue, Suite 1100, Chicago, IL 60611, USA
| | - Amy B Locke
- Co-Director Resiliency Center, Office of Wellness and Integrative Health, Department of Family and Preventive Medicine, University of Utah, 555 Foothill Boulevard, Salt Lake City, UT 84112, USA
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The safety and tolerance of phytotherapies in menopausal medicine - a review of the literature. MENOPAUSE REVIEW 2017; 16:8-11. [PMID: 28546801 PMCID: PMC5437054 DOI: 10.5114/pm.2017.67365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/28/2017] [Indexed: 01/26/2023]
Abstract
Phytoestrogens are polyphenol, non-steroidal substances of plant origin, resembling 17β-estradiol in structure. These substances can act as either agonists or antagonists of oestrogen receptors α and β. Phytoestrogens are widely used to alleviate menopausal symptoms, such as hot flushes and night sweats. Most of the currently available products of plant origin registered to soften climacteric symptoms consist of extracts obtained from soy, red clover, or black cohosh. Non-hormonal phytotherapy is a new alternative for patients suffering from menopausal symptoms. Active ingredients such as PI 82-GC FEM extract do not show any direct hormonal mechanisms of action typical for oestrogens and phytoestrogens. There are concerns about the safety and tolerability of phytoestrogens. In this review we summarise the current literature regarding the clinical aspect of safety and tolerance of different phytotherapies used to relieve menopausal symptoms.
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Neuhouser ML, Smith AW, George SM, Gibson JT, Baumgartner KB, Baumgartner R, Duggan C, Bernstein L, McTiernan A, Ballard R. Use of complementary and alternative medicine and breast cancer survival in the Health, Eating, Activity, and Lifestyle Study. Breast Cancer Res Treat 2016; 160:539-546. [PMID: 27766453 DOI: 10.1007/s10549-016-4010-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE Use of complementary and alternative medicine (CAM) is common among breast cancer patients, but less is known about whether CAM influences breast cancer survival. METHODS Health Eating, Activity, and Lifestyle (HEAL) Study participants (n = 707) were diagnosed with stage I-IIIA breast cancer. Participants completed a 30-month post-diagnosis interview including questions on CAM use (natural products such as dietary and botanical supplements, alternative health practices, and alternative medical systems), weight, physical activity, and comorbidities. Outcomes were breast cancer-specific and total mortality, which were ascertained from the Surveillance Epidemiology and End Results registries in Western Washington, Los Angeles County, and New Mexico. Cox proportional hazards regression models were fit to data to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for mortality. Models were adjusted for potential confounding by sociodemographic, health, and cancer-related factors. RESULTS Among 707 participants, 70 breast cancer-specific deaths and 149 total deaths were reported. 60.2 % of participants reported CAM use post-diagnosis. The most common CAM were natural products (51 %) including plant-based estrogenic supplements (42 %). Manipulative and body-based practices and alternative medical systems were used by 27 and 13 % of participants, respectively. No associations were observed between CAM use and breast cancer-specific (HR 1.04, 95 % CI 0.61-1.76) or total mortality (HR 0.91, 95 % CI 0.63-1.29). CONCLUSION Complementary and alternative medicine use was not associated with breast cancer-specific mortality or total mortality. Randomized controlled trials may be needed to definitively test whether there is harm or benefit from the types of CAM assessed in HEAL in relation to mortality outcomes in breast cancer survivors.
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Affiliation(s)
- Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave North, M4B402, Seattle, WA, 98109-1024, USA.
| | - Ashley Wilder Smith
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Stephanie M George
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD, USA
| | - James T Gibson
- Information Management Services, Inc., Calverton, MD, USA
| | - Kathy B Baumgartner
- Department of Epidemiology and Population Health, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Richard Baumgartner
- Department of Epidemiology and Population Health, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave North, M4B402, Seattle, WA, 98109-1024, USA
| | - Leslie Bernstein
- Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute of the City of Hope, Duarte, CA, USA
| | - Anne McTiernan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave North, M4B402, Seattle, WA, 98109-1024, USA
| | - Rachel Ballard
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD, USA
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Trimarco V, Rozza F, Izzo R, De Leo V, Cappelli V, Riccardi C, Di Carlo C. Effects of a new combination of nutraceuticals on postmenopausal symptoms and metabolic profile: a crossover, randomized, double-blind trial. Int J Womens Health 2016; 8:581-587. [PMID: 27785106 PMCID: PMC5066860 DOI: 10.2147/ijwh.s115948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives This study was designed to measure the beneficial effects of a combination of nutraceutics (NUT; AkP04, Morestril®, Akademy Pharma) containing soy isoflavones (80 mg), dry extract of Angelica sinensis (50 mg), dry extract of Morus alba leaf (200 mg) and magnesium (56.25 mg) in the relief of somatic, psychological, and urogenital symptoms in postmenopausal patients, using the validated Menopause Rating Scale (MRS) and cardiovascular risk factors. Materials and methods A total of 43 symptomatic postmenopausal women (MRS ≥20) were enrolled in a crossover trial. After a 2-week run-in period, patients were randomized into two arms. One arm received probiotics plus placebo over 4 weeks, followed by a 4-week treatment with probiotics plus NUT. The second arm received probiotics plus NUT for 4 weeks, followed by a 4-week treatment with probiotics plus placebo. Results After the NUT period, participants showed a significant reduction in MRS score (18.4±5.4) in comparison to baseline (28.4±5) and the placebo period (28±5.2) (P<0.0001 for both comparisons). Furthermore, at the end of the active-treatment period, we observed a significant reduction in triglycerides, total and low-density lipoprotein cholesterol plasma levels and an increase in high-density lipoprotein cholesterol plasma concentration versus baseline and versus placebo (all P<0.04). Moreover, during the NUT period, we detected a significant reduction in diastolic blood pressure in comparison to baseline, but not in comparison to the placebo period. Conclusion This NUT combination was effective for the relief of menopause symptoms in postmenopausal patients and improved their cardiovascular risk profile.
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Affiliation(s)
| | | | - Raffaele Izzo
- Department of Translational Medical Sciences, Federico II University of Naples, Naples
| | - Vincenzo De Leo
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Valentina Cappelli
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Carla Riccardi
- Department of Neuroscience, Reproductive Sciences and Dentistry
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Wong T, Shah NR. Breast Cancer from Oral and Transdermal Estradiol: A Cohort Study of Finnish Women. WOMENS HEALTH 2016; 3:321-4. [DOI: 10.2217/17455057.3.3.321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Evaluation of: Lyytinen H, Pukkala E, Ylikorkala O: Breast cancer risk in postmenopausal women using estrogen-only therapy. Obstet. Gynecol. 108(6), 1354–1360 (2006) [ 1 ]. A cohort study of 84,729 Finnish women over the age of 50 years who used oral or transdermal estradiol for at least 6 months, followed for the incidence of breast cancer using a national cancer registry. The study was conducted to evaluate whether the risk of breast cancer with estrogen-only therapy varies by dose, constituents or route of administration. A total of 2171 women developed breast cancer, with no increased risk observed for less than 5 years of use, and some risk for greater than 5 years of use for both oral and transdermal routes of administration.
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Affiliation(s)
- Tanping Wong
- Division of General Internal Medicine, New York University School of Medicine, VA New York Harbor HCS, 423 E. 23rd Street – 15N, New York, NY 10010, USA, Tel.: +1 212263 4244; Fax: +1 212 263 4240
| | - Nirav R Shah
- Division of General Internal Medicine, New York University School of Medicine, VA New York Harbor HCS, 423 E. 23rd Street – 15N, New York, NY 10010, USA, Tel.: +1 212263 4244; Fax: +1 212 263 4240
- Center for Health Research, Geisinger Health, Danville, PA, USA
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Kuszak AJ, Hopp DC, Williamson JS, Betz JM, Sorkin BC. Approaches by the US National Institutes of Health to support rigorous scientific research on dietary supplements and natural products. Drug Test Anal 2016; 8:413-7. [PMID: 26768111 DOI: 10.1002/dta.1931] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 11/13/2015] [Accepted: 11/14/2015] [Indexed: 11/06/2022]
Abstract
Mechanistic, clinical, and epidemiological research relevant to dietary supplements (DS) is supported by the U.S. National Institutes of Health. The Office of Dietary Supplements and the National Center for Complementary and Integrative Health promote the development and appropriate use of rigorous and comprehensive DS analyses which are critical for research reproducibility, particularly when the investigational DS include chemically complex natural products with unclear mechanisms of action.
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Affiliation(s)
- A J Kuszak
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd., Bethesda, MD, 20892-7517, USA
| | - D C Hopp
- Division of Extramural Research, National Center for Complementary and Integrative Health, National Institutes of Health, 6707 Democracy Blvd., Bethesda, MD, 20892, USA
| | - J S Williamson
- Division of Extramural Research, National Center for Complementary and Integrative Health, National Institutes of Health, 6707 Democracy Blvd., Bethesda, MD, 20892, USA
| | - J M Betz
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd., Bethesda, MD, 20892-7517, USA
| | - B C Sorkin
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd., Bethesda, MD, 20892-7517, USA
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Abstract
Most menopausal women experience vasomotor symptoms with bothersome symptoms often lasting longer than one decade. Hormone therapy (HT) represents the most effective treatment for these symptoms with oral and transdermal estrogen formulations having comparable efficacy. Findings from the Women's Health Initiative and other recent randomized clinical trials have helped to clarify the benefits and risks of combination estrogen-progestin and estrogen-alone therapy. Absolute risks observed with HT tended to be small, especially in younger women. Neither regimen increased all-cause mortality rates. Given the lower rates of adverse events on HT among women close to menopause onset and at lower baseline risk of cardiovascular disease, risk stratification and personalized risk assessment appear to represent a sound strategy for optimizing the benefit-risk profile and safety of HT. Systemic HT should not be arbitrarily stopped at age 65 years; instead treatment duration should be individualized based on patients' risk profiles and personal preferences. Genitourinary syndrome of menopause represents a common condition that adversely affects the quality of life of many menopausal women. Without treatment, symptoms worsen over time. Low-dose vaginal estrogen represents highly effective treatment for this condition. Because custom-compounded hormones have not been tested for efficacy or safety, U.S. Food and Drug Administration (FDA)-approved HT is preferred. A low-dose formulation of paroxetine mesylate currently represents the only nonhormonal medication FDA-approved to treat vasomotor symptoms. Gynecologists and other clinicians who remain abreast of data addressing the benefit-risk profile of hormonal and nonhormonal treatments can help menopausal women make sound choices regarding management of menopausal symptoms.
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Wuttke W, Seidlová-Wuttke D. Black cohosh (Cimicifuga racemosa) is a non-estrogenic alternative to hormone replacement therapy. CLINICAL PHYTOSCIENCE 2015. [DOI: 10.1186/s40816-015-0013-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pooled Analysis of Six Pharmacologic and Nonpharmacologic Interventions for Vasomotor Symptoms. Obstet Gynecol 2015; 126:413-422. [PMID: 26241433 DOI: 10.1097/aog.0000000000000927] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To describe the effects of six interventions for menopausal vasomotor symptoms relative to control in a pooled analysis, facilitating translation of the results for clinicians and symptomatic women. The Menopause Strategies: Finding Lasting Answers for Symptoms and Health network tested these interventions in three randomized clinical trials. METHODS An analysis of pooled individual-level data from three randomized clinical trials is presented. Participants were 899 perimenopausal and postmenopausal women with at least 14 bothersome vasomotor symptoms per week. Interventions included 10-20 mg escitalopram per day, nonaerobic yoga, aerobic exercise, 1.8 g per day omega-3 fatty acid supplementation, 0.5 mg low-dose oral 17-beta-estradiol (E2) per day, and 75 mg low-dose venlafaxine XR per day. The main outcome measures were changes from baseline in mean daily vasomotor symptom frequency and bother during 8-12 weeks of treatment. Linear regression models estimated differences in outcomes between each intervention and corresponding control group adjusted for baseline characteristics. Models included trial-specific intercepts, effects of the baseline outcome measure, and time. RESULTS The 8-week reduction in vasomotor symptom frequency from baseline relative to placebo was similar for escitalopram at -1.4 per day (95% confidence interval [CI] -2.7 to -0.2), low-dose E2 at -2.4 (95% CI -3.4 to -1.3), and venlafaxine at -1.8 (95% CI -2.8 to -0.8); vasomotor symptom bother reduction was minimal and did not vary across these three pharmacologic interventions (mean -0.2 to -0.3 relative to placebo). No effects on vasomotor symptom frequency or bother were seen with aerobic exercise, yoga, or omega-3 supplements. CONCLUSION These analyses suggest that escitalopram, low-dose E2, and venlafaxine provide comparable, modest reductions in vasomotor symptom frequency and bother among women with moderate hot flushes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00894543 (MsFLASH 01), NCT01178892 (MsFLASH 02), and NCT01418209 (MsFLASH 03).
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Abstract
Given the persistent confusion about the risks and benefits of hormone therapy since 2002 and the first publication from the Women's Health Initiative's primary findings, women and health care providers are increasingly motivated to find effective, nonhormonal approaches to treat menopause-related symptoms. Complementary and alternative medicine has grown increasingly popular in the last decade. A wide array of botanic medicines is offered as an alternative approach to hormone therapy for menopause, but data documenting efficacy and safety are limited. None of the available botanicals is as effective as hormone therapy in the management of vasomotor symptoms.
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Affiliation(s)
- Maida Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
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Effects of physical exercise on health-related quality of life and blood lipids in perimenopausal women: a randomized placebo-controlled trial. Menopause 2015; 21:1269-76. [PMID: 24937024 DOI: 10.1097/gme.0000000000000264] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to evaluate the treatment effects of physical exercise on menopausal symptoms in middle-aged female medical staff experiencing perimenopausal syndrome. METHODS A total of 157 female medical staff aged 40 to 55 years and with a Kupperman index score of 15 points or higher were randomized 1:1 into an intervention group (n = 78) or a control group (n = 79). Women in the intervention group were asked to perform aerobic physical exercise (walking with strides) three times a week or more, whereas those in the control group continued as normal. Measurements were taken at baseline and on weeks 4, 8, and 12, with total Kupperman index score, scores on individual elements of the scale, weight, and waist circumference recorded. In addition, fasting blood glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were recorded at baseline and on week 12. The effects of physical exercise therapy on perimenopausal syndrome were evaluated by comparing changes in these parameters between the control group and the intervention group. RESULTS Fifty-four and 57 women completed all three follow-ups in the intervention and control groups, respectively. On week 12, the mean (SD) change in total Kupperman index score (-9.23 [6.23]) from baseline to week 12; the mean (SD) changes in individual scores for paresthesia (-1.08 [1.51]), insomnia (-1.00 [1.46]), irritability (-1.00 [1.34]), joint or muscle pain (-0.75 [0.74]), fatigue (-0.56 [0.75]), headache (-0.54 [0.75]), formication (-0.38 [0.66]), and sexual life (-0.62 [1.71]); and the mean (SD) changes in total cholesterol (-0.76 [0.63] mmol/L) and triglycerides (-0.20 [0.50] mmol/L) were significantly higher in the intervention group than in the control group (P < 0.05). In the intervention group, total Kupperman index score, weight, body mass index, waist circumference, triglycerides, and total cholesterol were significantly lower on week 12 compared with baseline (P < 0.05). CONCLUSIONS Physical exercise can substantially reduce menopausal symptoms and improve blood lipid status and body weight.
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An evidence-based review of commonly used dietary supplements. JAAPA 2015; 28:1-5. [DOI: 10.1097/01.jaa.0000466643.93467.2a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Women generally spend the last third of their lifetime in menopause, after their reproductive years have ended. During menopause, women experience a variety of predictable symptoms and conditions related to changes in sex hormone levels and aging. The menopausal transition precedes menopause by several years and is usually characterized by irregularity of the menstrual cycle and by hot flashes and night sweats. After menopause, genitourinary symptoms predominate, including vulvovaginal atrophy and dryness and lower urinary tract symptoms, including urinary frequency, urgency, and nocturia. Hormonal treatment is effective for vasomotor and genitourinary symptoms, but the understanding of its impact on cardiovascular disease, cognitive dysfunction, and depression continues to evolve.
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Affiliation(s)
- Traci A Takahashi
- Department of Medicine, University of Washington School of Medicine, and VA Puget Sound Health Care System, 1660 South Columbian Way, S-123-PCC, Seattle, WA 98108, USA.
| | - Kay M Johnson
- Department of Medicine, University of Washington School of Medicine, and VA Puget Sound Health Care System, 1660 South Columbian Way, S-111-HSM, Seattle, WA 98108, USA
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Gaowa S, Sun AJ, Jiang Y, He FW, Zheng TP, Wang YP. Ultrasonographic observation of the breast in early postmenopausal women during therapy with Cimicifuga foetida extract and sequential therapy with estrogen and progestin. Chin Med J (Engl) 2015; 128:1000-4. [PMID: 25881590 PMCID: PMC4832936 DOI: 10.4103/0366-6999.155052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: It is now recognized that Cimicifuga foetida (C. foetida) extract is effective in alleviating menopausal symptoms. But the durations reported were usually short. The aim of this study was to investigate the effects of C. foetida extract therapy and different estrogen and progesterone sequential therapies, on the breasts of early postmenopausal women. Methods: This was a prospective randomized trial. Ninety-six early menopausal women were recruited and randomly assigned into three groups treated with different therapies for 2 years. Patients were given C. foetida extract in Group A, estradiol valerate and medroxyprogesterone acetate in Group B, and estradiol valerate and progesterone in Group C. Ultrasonography was used to monitor changes in breast during treatment. Results: In comparing breast glandular section thickness before and after 1 and 2 years of treatment, no significant difference was observed in Group A (11.97 ± 2.84 mm vs. 12.09 ± 2.58 mm and 12.61 ± 3.73 mm, P > 0.05); in Group B glandular section thickness had increased significantly (10.98 ± 2.34 mm vs. 11.84 ± 2.72 mm and 11.90 ± 3.33 mm, P < 0.05) after treatment, the same as Group C (11.56 ± 3.03 mm vs. 12.5 ± 3.57 mm and 12.22 ± 4.39 mm P < 0.05). In comparing breast duct width before and after 1 and 2 years of treatment, no significant difference was seen in Group A (1.07 ± 0.19 mm vs. 1.02 ± 0.18 mm and 0.98 ± 0.21 mm, P > 0.05); in Group B the duct width had a downward trend after treatment (0.99 ± 0.14 mm vs. 0.96 ± 0.22 mm and 0.90 ± 0.18 mm, P < 0.05), the same as Group C (1.07 ± 0.20 mm vs. 1.02 ± 0.17 mm and 0.91 ± 0.19 mm, P < 0.05). The nodules detected before treatment had disappeared after 1-year of treatment or exhibited no distinct changes in the three groups. However, new breast nodules had appeared after 2 years of treatment: There was one case in Group A, two cases in Group B and four cases in Group C, with breast hyperplasia after the molybdenum target check. Conclusions: In early postmenopausal patients, C. foetida extract therapy and estrogen and progesterone therapy at low doses did not increase the incidence of malignant breast tumors
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Affiliation(s)
| | | | - Ying Jiang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Effects of stellate ganglion block on vasomotor symptoms: findings from a randomized controlled clinical trial in postmenopausal women. Menopause 2015; 21:807-14. [PMID: 24496086 DOI: 10.1097/gme.0000000000000194] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Uncontrolled intervention studies, including studies involving breast cancer survivors, have demonstrated improvements in vasomotor symptoms (VMS) after stellate ganglion blockade (SGB) with a local anesthetic. This study presents the first randomized sham-controlled trial of SGB for the treatment of VMS. METHODS Participants included 40 postmenopausal women, aged 30 to 70 years, with moderate to severe VMS. The study was a randomized sham-controlled trial comparing the effects of SGB versus sham injection on the frequencies of total and moderate to severe VMS, as measured by daily diaries. Image-guided SGB was performed with 5 mL of 0.5% bupivacaine. Sham injection of saline was performed in subcutaneous tissues in the neck. VMS were recorded at baseline and for 6 months thereafter. Objective VMS were recorded using ambulatory sternal skin conductance monitoring during a 24-hour period at baseline and on 3-month follow-up. RESULTS There were no significant group differences in overall VMS frequency, but the frequency of moderate to very severe VMS was reduced more in the active group compared with the sham treatment group (event rate ratio, 0.50; 95% CI, 0.35-0.71; P < 0.001). The frequency of objective VMS was also reduced to a greater degree in the SGB group than in the sham group (event rate ratio, 0.71; 95% CI, 0.64-0.99; P < 0.05). There were no study-related serious adverse events. CONCLUSIONS SGB may provide effective treatment of VMS in women who seek nonhormonal treatments because of safety concerns and personal preference. The finding that SGB significantly reduces objectively measured VMS provides further evidence of efficacy. A larger trial is warranted to confirm these findings.
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Abstract
Increasing breast cancer incidence and decreasing mortality have highlighted the importance of survivorship issues related to breast cancer. A consideration of the issues related to menopause is therefore of great importance to both women and clinicians. Menopause/menopausal symptoms, with significant negative effects on quality of life and potential long-term health impacts, may in women with breast cancer be associated with: (1) natural menopause occurring concurrently with a breast cancer diagnosis; (2) recurrence of menopausal symptoms following cessation of hormone replacement therapy; (3) treatment-induced menopause (chemotherapy, ovarian ablation/suppression) and adjuvant endocrine therapy. A variety of non-hormonal pharmacological and non-pharmacological therapies have been investigated as therapeutic options for menopausal symptoms with mixed results, and ongoing research is required. This review presents a summary of the causes, common problematic symptoms of menopause (vasomotor, genitourinary and sexual dysfunction), and longer-term consequences (cardiovascular disease and osteoporosis) related to menopause. It proposes an evidenced-based multidisciplinary approach to the management of menopause/menopausal symptoms in women with breast cancer.
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Affiliation(s)
- A J Vincent
- a Menopause Unit, Monash Medical Centre, Monash Health and Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University , Clayton , Victoria , Australia
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Drewe J, Bucher KA, Zahner C. A systematic review of non-hormonal treatments of vasomotor symptoms in climacteric and cancer patients. SPRINGERPLUS 2015; 4:65. [PMID: 25713759 PMCID: PMC4331402 DOI: 10.1186/s40064-015-0808-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/09/2015] [Indexed: 12/03/2022]
Abstract
The cardinal climacteric symptoms of hot flushes and night sweats affect 24-93% of all women during the physiological transition from reproductive to post-reproductive life. Though efficacious, hormonal therapy and partial oestrogenic compounds are linked to a significant increase in breast cancer. Non-hormonal treatments are thus greatly appreciated. This systematic review of published hormonal and non-hormonal treatments for climacteric, and breast and prostate cancer-associated hot flushes, examines clinical efficacy and therapy-related cancer risk modulation. A PubMed search included literature up to June 19, 2014 without limits for initial dates or language, with the search terms, (hot flush* OR hot flash*) AND (clinical trial* OR clinical stud*) AND (randomi* OR observational) NOT review). Retrieved references identified further papers. The focus was on hot flushes; other symptoms (night sweats, irritability, etc.) were not specifically screened. Included were some 610 clinical studies where a measured effect of the intervention, intensity and severity were documented, and where patients received treatment of pharmaceutical quality. Only 147 of these references described studies with alternative non-hormonal treatments in post-menopausal women and in breast and prostate cancer survivors; these results are presented in Additional file 1. The most effective hot flush treatment is oestrogenic hormones, or a combination of oestrogen and progestins, though benefits are partially outweighed by a significantly increased risk for breast cancer development. This review illustrates that certain non-hormonal treatments, including selective serotonin reuptake inhibitors, gabapentin/pregabalin, and Cimicifuga racemosa extracts, show a positive risk-benefit ratio. Key pointsSeveral non-hormonal alternatives to hormonal therapy have been established and registered for the treatment of vasomotor climacteric symptoms in peri- and post-menopausal women. There are indications that non-hormonal treatments are useful alternatives in patients with a history of breast and prostate cancer. However, confirmation by larger clinical trials is required.
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Affiliation(s)
- Juergen Drewe
- Max Zeller AG, Seeblickstr. 4, 8590 Romanshorn, Switzerland
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