Climacteric最新文献

Objective: Women experience menopause around the age of 45-55 years. Cognitive dysfunction is one of the most prevalent menopausal complaints. This focus group study aimed to explore cognitive experiences and management during the menopause transition.

Methods: Eighteen participants, including 15 women in menopause transition from multi-ethnic backgrounds and three healthcare professionals, were recruited to five focus groups conducted between June and August 2024.

Results: Thematic analysis yielded three overarching themes: cognitive changes relevant to the menopause transition; multidimensional impacts of cognitive changes; and holistic management of cognitive changes. From participants' narratives, 12 cognitive domains were affected in the menopause transition. These in turn had psychological, social and behavioral impact, resulting in the need to use various coping strategies.

Conclusion: The findings of this study identified cognitive challenges in the menopause transition. Women's current coping with cognitive dysfunction addressed the multidimensionality of menopausal management and highlighted unmet needs regarding cognitive health. The research identified cognitive challenges beyond memory and concentration in the menopause transition. Associations of menopause-related factors, culture and ethnicity with cognitive function warrant further investigation for potential intervention development.

Objective: This study aimed to investigate the association between the severity of vasomotor symptoms (VMS) and the burden of the condition in the real-world setting within Japan.

Methods: The cross-sectional survey study was administered as a web-based questionnaire involving perimenopausal and postmenopausal women. Respondents were female at birth, 40-64 years old and had ≥1 episode of VMS in the prior 12 months. The primary objective was to understand the treatment landscape related to mild to severe VMS. Secondary objectives were to understand attitudes to VMS, opinions on available treatments and impact of VMS on quality of life (QoL).

Results: The target population included 2188 respondents. Only 219 (10.0%) respondents visited a medical facility for VMS, and 123 (5.6%) women consulted a doctor when visiting for other treatment. Being able to cope with symptoms was the most common reason for not attending a medical institution. More than half who received treatment were prescribed traditional Chinese medicine (181/325 [55.7%] respondents) and one-third received hormone therapy (108 [33.2%] respondents). Severe VMS were associated with lower QoL, worse sleep quality and reduced work productivity.

Conclusions: Women in Japan with VMS do not typically visit medical institutions or receive appropriate medical intervention even when they are aware of VMS and feel some burden.

Objective: This study aimed to investigate the characteristics of bone mineral density (BMD) in patients with premature ovarian insufficiency (POI), compare BMD between iatrogenic POI and idiopathic POI patients, and investigate the factors affecting BMD in POI patients.

Method: This cross-sectional study recruited a total of 88 iatrogenic POI patients, 45 idiopathic POI patients and 45 normal reproductive-age women, all of whom met the study criteria and were treated at the Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University from 1 January 2023 to 30 June 2024. Medical history was collected for all patients, and follicle stimulating hormone (FSH), estradiol (E2), total testosterone (TT), free testosterone (FT), biologically active testosterone (BioT), dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) were measured. Height and weight were measured, and the body mass index (BMI) was calculated. BMD of the lumbar spine and left femur was measured in POI patients. Multiple linear regression analyses were performed to determine the correlation between characteristics and BMD.

Results: The incidence of osteoporosis was significantly higher in iatrogenic POI patients than in idiopathic POI patients (40.9% vs. 20.0%, p < 0.05). The femoral shaft BMD, greater trochanter BMD t-score, total femoral BMD and total femoral BMD t-score were significantly lower in iatrogenic POI patients compared to idiopathic POI patients (all p < 0.05). Multiple linear regression analysis revealed that delay in diagnosis negatively affected the lumbar BMD t-score (p < 0.05) and the BMI and DHEAS positively affected the total femur BMD t-score in iatrogenic POI patients (p < 0.05). No significant correlations were found in idiopathic POI patients.

Conclusion: The incidence of osteopenia and osteoporosis in POI patients is high, especially in iatrogenic POI patients, who experience more severe bone loss and a higher incidence of osteoporosis. BMI and a delay in diagnosis significantly affected BMD in iatrogenic POI patients. This, to our knowledge, is the first study showing that DHEAS positively affects BMD in iatrogenic POI patients, which, however, needs further studies for confirmation.

Objective: Diet significantly modulates immunological responses and can impact climacteric symptoms. This study evaluated the association between Dietary Inflammatory Index (DII) scores and climacteric symptoms in postmenopausal women.

Method: The study was conducted with postmenopausal women between May and July 2024. A face-to-face questionnaire including demographic characteristics, the Menopause Rating Scale (MRS) and the Kupperman Menopausal Index (KMI) was administered. The DII score was computed based on dietary data. Anthropometric measurements were based on participants' self-reports. The data were analyzed using SPSS 24.0.

Result: s: In total, 193 postmenopausal women were recruited. Participants in T3, who had the highest DII scores and thus followed the most pro-inflammatory diets, had higher MRS and KMI scores, with significant differences between the groups (p < 0.001 and p = 0.033, respectively). T3 had higher intakes of energy and total fat (p = 0.018 and p = 0.030, respectively) but lower intakes of n-3 fatty acids (p = 0.038). Multivariate linear regression analysis revealed that moderate to high DII scores correlated with elevated MRS scores (odds ratio 1.100, p < 0.001 and 1.106, p < 0.001, respectively). After adjusting for age, marital status, education, employment, physical activity, year of menopause, supplement use and socioeconomic status, the results remained consistent.

Conclusion: A pro-inflammatory diet might be associated with higher symptoms. Further studies are needed to confirm these findings.

Objective: This study aimed to summarize available evidence on the efficacy of vulvovaginal topical estrogen therapy on lower urinary tract symptoms (LUTS) of genitourinary syndrome of menopause.

Method: Multiple databases were systematically searched from inception to October 2024 to identify all studies providing pretreatment and post-treatment data for menopausal women with LUTS who received vulvovaginal estrogen therapy. A random effect meta-analysis was conducted (PROSPERO registration number: CRD42024517516).

Results: Seventeen studies were included for a total of 2111 patients. The pooled odds ratio for the occurrence of considered outcomes after versus before treatment was 0.14 (95% confidence interval [CI] 0.05-0.36; I² = 73%) for recurrent urinary tract infections, 0.12 (95% CI 0.05-0.29; I² = 62%) for stress urinary incontinence, 0.22 (95% CI 0.16-0.32; I² = 0%) for urge incontinence, 0.11 (95% CI 0.06-0.18; I² = 23%) for urgency, 0.22 (95% CI 0.16-0.23; I² = 0%) for frequency and 0.24 (95% CI 0.17-0.34; I² = 0%) for nocturia. The pooled mean difference for vaginal pH was -1.29 (95% CI -1.66 to -0.91; I² = 96%).

Conclusions: Vulvovaginal topical estrogen therapy appears to improve all analyzed LUTS in menopausal women. Available evidence supports current guidelines recommending vulvovaginal topical estrogen therapy for the management of these symptoms in menopausal women.

Objective: This study aims to explore the prevalence and related factors of genitourinary syndrome of menopause (GSM) in a Chinese longitudinal cohort.

Method: A total of 616 women in the menopausal transition or postmenopausal stage from an urban Chinese community were included in this study. The study assessed the prevalence, degree and factors associated with different types of GSM.

Results: The prevalence of moderate/severe GSM rose from 23.9% in the early menopausal transition to 36.8% in the late menopausal transition, to 56.1% in postmenopause stage +1 and 71.4% in postmenopause stage +2. More than half of the postmenopausal women reported loss of libido (68.7%), vaginal dryness (60.2%), stress urinary incontinence (59.8%) and low sexual pleasure (58.8%). Multivariable analysis revealed that Stages of Reproductive Aging Workshop +10 (STRAW +10) stages (p = 0.009), marital status (p < 0.001) and anxiety (p = 0.005) were independently associated with GSM.

Conclusion: This study shows that as women progress through the menopausal transition, GSM symptoms become increasingly common and severe. In particular, postmenopausal women experience a higher burden of these symptoms. Additionally, menopausal stage, marital status and anxiety were identified as independent factors associated with GSM. These findings provide a comprehensive insight of GSM among middle-aged Chinese women, underlining the importance of diagnosis and treatment for GSM.

Objective: This study aimed to investigate the prevalence and characteristics of genitourinary syndrome of menopause (GSM) in midlife women.

Methods: The cross-sectional study from the Indian Midlife Registry included women aged >40 years attending outpatient clinics at multiple centers across India. Real-world data were collected on an Electronic Health Record platform. GSM was diagnosed in the presence of either two genitourinary or sexual symptoms or one symptom and a Vaginal Health Index (VHI) score of ≤15.

Results: A total of 1781 women, 826 perimenopausal and 955 postmenopausal, were included. The prevalence of GSM was 48.5%, and the most prevalent symptoms were lower urinary tract symptoms (LUTS) (38.2%) and vaginal dryness (26.4%). The VHI score was ≤15 in 42.1% of women. Based on logistic regression analysis, age ≥70 years, late postmenopause, low education, insomnia and other sleep problems were associated with higher odds of GSM.

Conclusion: GSM is highly prevalent in Indian women. GSM remains under-recognized and undertreated. Sleep problems, advanced age, late postmenopause and low education significantly increase the odds. This study underscores the importance of routine screening for GSM, especially in those with sleep disturbances or LUTS in order to improve quality of life (QoL).

Objective: Menopause-related changes in body composition and physical function are unclear in Southern Africa, particularly in the context of a generalized HIV epidemic with high antiretroviral therapy (ART) coverage.

Method: A total of 263 Zimbabwean women (53% women living with HIV [WLH]) aged 40-60 years provided data on menopause, ART use, anthropometry, body composition (appendicular lean mass [ALM], muscle area, fat mass), handgrip strength (HGS) and gait speed. Linear regression determined relationships between body composition and physical function, unadjusted and age-menopause-adjusted, stratified by HIV status. Univariate logistic regression investigated associations between body composition and self-reported falls.

Results: WLH (96% ART established) were a median (interquartile range) 10.4 (6.4-14.5) years since diagnosis, with lower weight, body mass index, ALM, fat mass and HGS than women living without HIV (WLWOH). With menopause transition, WLH lost weight, ALM, gynoid mass and muscle area (all p-trend <0.05); however, WLWOH did not. Both WLH and WLWOH lost HGS (p-trend <0.05). ALM was positively associated with HGS in all women. In WLH, greater percentage body fat, particularly gynoid fat, was associated with increased odds of falls (1.69 [1.00-2.89], p = 0.049 and 1.72 [1.08-2.75], p = 0.023, respectively).

Conclusion: Women living with HIV were more likely to experience adverse changes in body composition through menopause; fat mass gains were associated with risk of falls.

Objective: This study was a dual-module approach that aimed to evaluate knowledge and concerns of healthcare providers (HCPs) about menopause hormone therapy (MHT) in under-resourced communities, and to understand the awareness and sources of information on menopause and MHT in these communities.

Methods: The cross-sectional survey study consisted of two modules: the population module was administered offline and followed the computer-aided personal interview methodology; and the HCP module was an online, self-administered survey.

Results: Out of 32,518 women surveyed from underprivileged communities, 50% were unaware of the effects of menopause, and 62% were unaware of the available treatment; if offered by the HCP, 48% were willing to take treatment. Responses from 1261 HCPs showed that systemic MHT was prescribed by 62.4% of HCPs and vaginal estrogen therapy by 86.0%. Although 95% of HCPs were aware of the indications, risks and benefits of MHT, 57% used alternative therapies as first-line therapy and 71% used them as an adjunct to MHT.

Conclusions: There is a lack of awareness regarding the impact of menopause on health and on the use of MHT, and educational programs may encourage women to seek help. While HCPs are knowledgeable, hesitancy in the use of systemic MHT indicates the need for professional training programs to increase confidence in prescription writing.

Objective: Menopause experiences are diverse and vary by social and cultural contexts. This study explored midlife women's experiences and views about menopause in urban settings in Zimbabwe and South Africa to inform co-production of supportive interventions.

Method: Forty semi-structured interviews were conducted with women aged 40-60 years. Purposive sampling identified women, considering their age, comorbidities, HIV status and socioeconomic background. Data were audio-recorded, transcribed and analyzed thematically.

Results: Three inter-related themes were identified: loss and decline; uncertainty; and acceptance and growth. For some women, fertility was integral to their identity, without which they felt 'incomplete'. Several women described shock and confusion at their unanticipated experiences of bodily changes. Difficulties arose distinguishing menopause symptoms from other conditions, and women highlighted absence of information about symptom management. To gauge what was 'normal', women compared their experiences with those of trusted women. Some women in South Africa welcomed menopause as their transition to a respected elder; menopause meant freedom from menstruation and childbirth. Acceptance related to women's sense of whether they experienced menopause at 'the right time'.

Conclusion: The study highlights similarities in women's menopausal experiences across Africa, as well as affirming the existence of wide and varied local views.