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Grub J, Willi J, Süss H, Ehlert U. The role of estrogen receptor gene polymorphisms in menopausal symptoms and estradiol levels in perimenopausal women - Findings from the Swiss Perimenopause Study. Maturitas 2024; 183:107942. [PMID: 38412592 DOI: 10.1016/j.maturitas.2024.107942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/15/2024] [Accepted: 02/10/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES Fluctuating estradiol (E2) levels seem to be associated with menopausal symptoms, though not all women suffer from these symptoms to the same extent despite experiencing these hormonal changes. This suggests underlying, interindividual mechanisms, such as single-nucleotide polymorphisms (SNPs) influencing estrogen receptors α and β, and the g-protein-coupled estrogen receptor (GPER). As research is scarce, we aimed to address this research gap by assessing genetic traits, E2 levels, and menopausal symptoms longitudinally. STUDY DESIGN 129 perimenopausal women (aged 40-56 years) participated in the 13-month longitudinal Swiss Perimenopause Study. MAIN OUTCOME MEASURES Menopausal symptoms were assessed fortnightly using the Menopause Rating Scale (MRS II). Salivary E2 levels were assessed 14 times over two non-consecutive months. Blood samples were collected using the dried blood spot (DBS) technique to analyze ESR1 rs2234693, ESR1 rs9340799, ESR2 rs1256049, ESR2 rs4906938, and GPER rs3808350. Group-based trajectory modeling was performed to identify interindividual trajectories of menopausal symptoms. Multinomial logistic regression models were employed to identify factors associated with these trajectories. RESULTS Four distinct trajectory groups of menopausal symptoms were identified (increase, moderate, rebound, decrease). ER gene polymorphisms and E2 fluctuation were significantly associated with group membership. Furthermore, ER gene polymorphisms modulated the effect of E2 fluctuations on menopausal symptom trajectory. CONCLUSIONS This study illuminates the multifaceted factors contributing to the individuality of the perimenopausal experience. ER gene polymorphisms emerged as integral factors by modulating the effect of E2 fluctuations on menopausal symptom trajectory. This underscores the intricate interplay of genetic factors, E2 fluctuations, and menopausal symptoms during perimenopause.
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Affiliation(s)
- Jessica Grub
- Clinical Psychology and Psychotherapy, University of Zurich, Switzerland; University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Jasmine Willi
- Clinical Psychology and Psychotherapy, University of Zurich, Switzerland; University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Hannah Süss
- Clinical Psychology and Psychotherapy, University of Zurich, Switzerland; University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, University of Zurich, Switzerland; University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland.
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Walther A, Grub J, Tsar S, Ehlert U, Heald A, Perrin R, Ogrodniczuk JS, Seidler ZE, Rice SM, Kealy D, Oliffe JL, Eggenberger L. Status loss due to COVID-19, traditional masculinity, and their association with recent suicide attempts and suicidal ideation. Psychology of Men & Masculinities 2022. [DOI: 10.1037/men0000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Eggenberger L, Komlenac N, Ehlert U, Grub J, Walther A. Association between psychotherapy use, sexual orientation, and traditional masculinity among psychologically distressed men. Psychology of Men & Masculinities 2022. [DOI: 10.1037/men0000402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Walther A, Eggenberger L, Grub J, Ogrodniczuk JS, Seidler ZE, Rice SM, Kealy D, Oliffe JL, Ehlert U. Examining the Role of Traditional Masculinity and Depression in Men's Risk for Contracting COVID-19. Behav Sci (Basel) 2022; 12:80. [PMID: 35323399 PMCID: PMC8945728 DOI: 10.3390/bs12030080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
In the light of the COVID-19 pandemic and claims that traditional masculinity may put some men at increased risk for infection, research reporting men's health behaviors is critically important. Traditional masculine norms such as self-reliance and toughness are associated with a lower likelihood to vaccinate or follow safety restrictions. Furthermore, infection risk and traditional masculinity should be investigated in a differentiated manner including gender role orientation, underlying traditional masculine ideologies and male gender role conflict. In this pre-registered online survey conducted during March/April 2021 in German-speaking countries in Europe, 490 men completed questionnaires regarding contracting COVID-19 as confirmed by a validated test, fear of COVID-19 (FCV-19S), and experience of psychological burden due to COVID-19. In addition, depression symptomatology was assessed by using prototypical internalizing and male-typical externalizing depression symptoms. Furthermore, self-identified masculine gender orientation, endorsement of traditional masculinity ideologies, and gender role conflict were measured. A total of 6.9% of men (n = 34) reported having contracted COVID-19 since the beginning of the pandemic. Group comparisons revealed that men who had contracted COVID-19 exhibited higher overall traditional masculine ideology and gender role conflict. Logistic regression controlling for confounders (age, income, education, and sexual orientation) indicated that only depression symptoms are independently associated with the risk of having contracted COVID-19. While prototypical depression symptoms were negatively associated with the risk of having contracted COVID-19, male-typical externalizing depression symptoms were positively associated with the risk of contracting COVID-19. For traditional masculinity, no robust association for an increased risk of contracting COVID-19 could be established, while higher male-typical externalizing depression symptoms were associated with an increased risk of contracting COVID-19.
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Affiliation(s)
- Andreas Walther
- Department of Clinical Psychology and Psychotherapy, University of Zurich, 8050 Zurich, Switzerland; (L.E.); (J.G.); (U.E.)
| | - Lukas Eggenberger
- Department of Clinical Psychology and Psychotherapy, University of Zurich, 8050 Zurich, Switzerland; (L.E.); (J.G.); (U.E.)
| | - Jessica Grub
- Department of Clinical Psychology and Psychotherapy, University of Zurich, 8050 Zurich, Switzerland; (L.E.); (J.G.); (U.E.)
| | - John S. Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (J.S.O.); (D.K.)
| | - Zac E. Seidler
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia; (Z.E.S.); (S.M.R.)
- Orygen, Melbourne, VIC 3052, Australia
| | - Simon M. Rice
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia; (Z.E.S.); (S.M.R.)
- Orygen, Melbourne, VIC 3052, Australia
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (J.S.O.); (D.K.)
| | - John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
- Department of Nursing, University of Melbourne, Parkville, VIC 3010, Australia
| | - Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, University of Zurich, 8050 Zurich, Switzerland; (L.E.); (J.G.); (U.E.)
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Grub J, Süss H, Willi J, Ehlert U. Steroid Hormone Secretion Over the Course of the Perimenopause: Findings From the Swiss Perimenopause Study. Front Glob Womens Health 2022; 2:774308. [PMID: 34970652 PMCID: PMC8712488 DOI: 10.3389/fgwh.2021.774308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Perimenopause is characterized by a decline in the steroid hormones, estradiol, and progesterone. By contrast, the steroid hormone cortisol, a marker of the hypothalamic–pituitary–adrenal (HPA) axis, increases. Recent longitudinal studies reported fluctuations in steroid hormone levels during perimenopause, and even increases in estradiol levels. To understand these confounding results, it is necessary to conduct a longitudinal, highly standardized assessment of steroid hormone secretion patterns in perimenopausal women. Methods: This longitudinal study investigated 127 perimenopausal women aged 40–56 years for 13 months. Estradiol, progesterone, and cortisol were assessed using saliva samples, which were collected for two (during months 2 and 12 for estradiol and progesterone) or three (during months 2, 7, and 12 for cortisol) non-consecutive months over the course of the study. A total of 14 saliva samples per participant were analyzed to investigate the courses of estradiol and progesterone. Cortisol awakening response and fluctuations of cortisol throughout the day were measured using a total of 11 saliva samples per participant (on awakening, +30 min, +60 min, at 12:00 p.m., and before going to bed) for months 2, 7, and 12. Results: Multilevel analyses revealed variance in intercept and slope across participants for estradiol [intercept: SD = 5.16 (95% CI: 4.28, 6.21), slope: SD = 0.50 (95% CI: 0.39, 0.64)], progesterone [intercept: SD = 34.77 (95% CI: 25.55, 47.31), slope: SD = 4.17 (95% CI: 2.91, 5.99)], and cortisol (intercept: SD = 0.18 (95% CI: 0.14, 0.23), slope: SD = 0.02 (95% CI: 0.01, 0.02)]. Time predicted cortisol levels [b = −0.02, t(979) = −6.63, p < 0.0001]. Perimenopausal status (early vs. late) did not predict estradiol [b = −0.36, t(1608) = −0.84, p = 0.400], progesterone [b = −4.55, t(1723) = −0.87, p = 0.385], or cortisol [b = 0.01, t(1124) = 0.61, p = 0.542] scores over time. Discussion: Our results are consistent with previous findings emphasizing highly individual fluctuations of estradiol and progesterone levels during perimenopause. However, our findings do not suggest a continuous decline during the observed transition phase, implying relatively stable periods of fluctuating hormone levels. Furthermore, given the lack of significant group differences, it may not be necessary to differentiate between early and late perimenopause from the standpoint of hormonal progression.
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Affiliation(s)
- Jessica Grub
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Hannah Süss
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Jasmine Willi
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
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Süss H, Willi J, Grub J, Ehlert U. Estradiol and progesterone as resilience markers? - Findings from the Swiss Perimenopause Study. Psychoneuroendocrinology 2021; 127:105177. [PMID: 33676150 DOI: 10.1016/j.psyneuen.2021.105177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/12/2021] [Accepted: 02/24/2021] [Indexed: 12/13/2022]
Abstract
While resilience seems to be associated with a variety of biological markers, studies assessing such correlates in women during the perimenopause are lacking. The perimenopause constitutes a phase of major biopsychosocial changes, during which the sex hormones estradiol (E2) and progesterone (P4) eventually decrease significantly. The aim of this study was to examine the extent to which the declining levels of E2 and P4 serve as resilience markers in perimenopausal women. In 129 healthy perimenopausal women aged 40-56 years, saliva samples were collected on every fourth day over a period of four weeks in order to investigate E2 and P4 levels. All participants completed psychosocial questionnaires including variables related to resilience, well-being, and mental health. Perimenopausal status was determined using the Stages of Reproductive Aging Workshop (STRAW) criteria. The results indicate that P4 is linked to psychosocial resilience. More precisely, women with higher P4 levels seem to be more resilient than women with lower P4 levels, irrespective of the perimenopausal status. No such relation was found for E2 levels. Further analyses revealed that women with higher P4 levels experience significantly higher life satisfaction, lower perceived stress, and lower depressive symptoms than women with lower P4 levels. Accordingly, P4 can be considered as a biological marker of resilience in perimenopause.
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Affiliation(s)
- Hannah Süss
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Jasmine Willi
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Jessica Grub
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland.
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Willi J, Süss H, Grub J, Ehlert U. Corrigendum to "Prior depression affects the experience of the perimenopause - findings from the Swiss Perimenopause Study". [Journal of Affective Disorders, 277C, 603-611]. J Affect Disord 2021; 281:1004-1005. [PMID: 33190854 DOI: 10.1016/j.jad.2020.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jasmine Willi
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Hannah Süss
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Jessica Grub
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland.
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Abstract
Despite significant biological, psychological, and social challenges in the perimenopause, most women report an overall positive well-being and appear to be resilient to potentially negative effects of this life phase. The objective of this study was to detect psychosocial variables which contribute to resilience in a sample of perimenopausal women. A total of 135 healthy perimenopausal women aged 40-56 years completed a battery of validated psychosocial questionnaires including variables related to resilience, well-being, and mental health. First, using exploratory factor analysis, we examined which of the assessed variables related to resilience can be assigned to a common factor. Second, linear regression analyses were performed to investigate whether a common resilience factor predicts well-being and mental health in the examined sample of women. Optimism (LOT-R-O), emotional stability (BFI-K-N), emotion regulation (ERQ), self-compassion (SCS-D), and self-esteem (RSES) in perimenopausal women can be allocated to a single resilience-associated factor. Regression analyses revealed that this factor is related to higher life satisfaction (SWLS; β = .39, p < .001, adj. R2 = .20), lower perceived stress (PSS-10; β = - .55, p < .001, adj. R2 = .30), lower psychological distress (BSI-18; β = - .49, p < .001, adj. R2 = .22), better general psychological health (GHQ-12; β = - .49, p < .001, adj. R2 = .22), milder menopausal complaints (MRS II; β = - .41, p < .001, adj. R2 = .18), and lower depressive symptoms (ADS-L; β = - .32, p < .001, adj. R2 = .26). The α levels were adjusted for multiple testing. Our findings confirm that several psychosocial variables (optimism, emotional stability, emotion regulation, self-compassion, and self-esteem) can be allocated to one common resilience-associated factor. This resilience factor is strongly related to women's well-being as well as mental health in perimenopause.
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Affiliation(s)
- Hannah Süss
- Clinical Psychology and Psychotherapy, University of Zurich, Binzmühlestrasse 14, 8050 Zurich, Switzerland ,URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Jasmine Willi
- Clinical Psychology and Psychotherapy, University of Zurich, Binzmühlestrasse 14, 8050 Zurich, Switzerland ,URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Jessica Grub
- Clinical Psychology and Psychotherapy, University of Zurich, Binzmühlestrasse 14, 8050 Zurich, Switzerland ,URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, University of Zurich, Binzmühlestrasse 14, 8050, Zurich, Switzerland. .,URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland.
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Willi J, Süss H, Grub J, Ehlert U. Prior depression affects the experience of the perimenopause - findings from the Swiss Perimenopause Study. J Affect Disord 2020; 277:603-611. [PMID: 32905912 DOI: 10.1016/j.jad.2020.08.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/07/2020] [Accepted: 08/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is a prevalence peak of depression in the perimenopause, with this reproductive phase being considered a window of vulnerability due to major biopsychosocial changes. Depression has been associated with physical and psychosocial impairment. Prior depression has been shown to be a risk factor for the development of several somatic and mental diseases. We assume that women with prior depression will exhibit increased burdensome symptoms in the perimenopause compared to women without prior depression. METHODS A total of 135 perimenopausal women aged 40-56 years participated in the longitudinal Swiss Perimenopause Study. For the purpose of this investigation, a cross-sectional design was chosen. A wide range of validated psychosocial questionnaires were used to compare women with and without prior depression regarding their experience of the perimenopause. Findings were statistically adjusted for multiple testing. RESULTS Women with prior depression showed significantly more depressive symptoms (U = 1215.5, p < .01), more menopausal symptoms (U = 1395.0, p < .01), and more sleep disturbances (U = 1583.5, p < .05) than women without prior depression. Moreover, women with a history of depression reported lower subjective mental health (U = 1573.0, p < 05) and felt more isolated (U = 1524.0, p < .05) than those without prior depression. LIMITATIONS Self-report data may affect the results. Furthermore, due to the cross-sectional design, causality cannot be inferred. CONCLUSIONS Prior depression affects women's experience of the perimenopause. Women with prior depression exhibit significantly more negative health outcomes in the perimenopause than those without prior depression.
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Affiliation(s)
- Jasmine Willi
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Hannah Süss
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Jessica Grub
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland.
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