Climacteric最新文献

Objective: Premenopausal women (PreM) have a cardioprotective advantage over postmenopausal women (PostM) due to estrogen. The interaction of estrogen with the mineralocorticoid receptor (MR) pathway remains unexplored. This study aimed to identify changes in aldosterone, renin and sexual steroid levels and MR surrogate biomarkers in PostM that may explain changes in blood pressure and renal damage.

Methods: A cross-sectional study was carried out with 47 normotensive and hypertensive Chilean women distributed between PreM and PostM. Clinical, anthropometric and biochemical parameters, including aldosterone, plasma renin activity (PRA) and surrogate markers of MR activity, were assessed.

Results: PostM had greater systolic blood pressure (SBP) (p < 0.001) than PreM. A negative correlation was observed between estradiol and fractional excretion of potassium (FEK) (ρ = -0.29; p = 0.023), adjusted for age and SBP. Compared with hypertensive PreM, hypertensive PostM (PostM-HT) showed reduced PRA (p = 0.045) and greater FEK (p = 0.04). Normotensive PostM (Post-NT) exhibited greater SBP (p = 0.03), neutrophil gelatinase-associated lipocalin (NGAL) levels (p = 0.04) and FEK (p = 0.03) than normotensive PreM.

Conclusion: Our results suggest enhanced MR sensitivity not only in PostM-HT, as evidenced by lower PRA and elevated FEK, but also in PostM-NT, who exhibited greater FEK and NGAL levels, surrogate markers of MR activation. These results support a novel role of MR activation and cardiovascular risk in PostM women.

Objective: Menopause is a significant and natural phase in a woman's life, representing a transition that requires early understanding to manage its effects and promote overall well-being. This study aimed to evaluate the awareness, understanding and perceptions of menopause and menopausal hormone therapy (MHT) among premenopausal women in southern China.

Methods: A cross-sectional design was employed to enroll women aged 18-40 years (n = 1631) from August 2022 to January 2023 at a public hospital in Fujian, China. A structured questionnaire, developed from existing research and the Climacteric Scale, was used to assess women's menopausal symptoms and MHT knowledge. Face-to-face interviews were conducted to identify factors correlated with menopausal knowledge levels.

Results: More than 50% of women demonstrated a comprehensive understanding of menopause. Education level was a significant predictor of menopause knowledge (p < 0.001), with women holding higher education (college degree or above) demonstrating greater knowledge than those with lower education (high school or below). High awareness of common menopausal symptoms, including irritability, sleep disturbances, fatigue, difficulty concentrating and hot flashes, was observed. Although most participants lacked detailed knowledge of MHT, they agreed on the importance of managing menopausal symptoms and recognized the usefulness of MHT for symptom management.

Conclusions: Premenopausal women in southern China possess a basic understanding of menopause but lack sufficient knowledge about MHT. This highlights the need for educational initiatives and targeted counseling to increase awareness of menopause and MHT, especially regarding its implications and treatment options.

Objective: The real-world PatiEnt satisfactiON studY (PEONY) involves postmenopausal women already treated or starting local estrogen therapy (LET) or ospemifene. The aim of the present analysis was to assess treatment satisfaction and persistence, effectiveness and patient-reported outcomes (PROs) in sexual function and quality of life after 6 months of therapy with LET or ospemifene to treat vulvovaginal atrophy (VVA).

Methods: PEONY is an ongoing prospective, observational study conducted in 17 gynecology centers. Participants complete questionnaires at baseline (T0) and after 3 months (T3) and 6 months (T6). The main outcome measures were treatment satisfaction, severity of symptoms, Day-to-Day Impact of Vaginal Aging (DIVA), Female Sexual Function Index (FSFI), Female Sexual Distress Scale - Revised (FSDS-R) and SF-12 Health Survey.

Results: Overall, 385 women were included, of whom 145 started (87.6%) or continued (12.4%) ospemifene and 240 started (66.7%) or continued (33.3%) LET at T0. The likelihood of moderate/severe VVA symptoms decreased by 70-90% and the mean treatment satisfaction score increased overall from 7.3 (95% confidence interval [CI]: 7.0; 7.5) at T3 to 7.7 (95% CI: 7.4; 7.9) at T6 (p = 0.003). DIVA and FSDS-R scores significantly improved in both groups.

Conclusions: PEONY underlines the importance of proactively treating VVA with LET or ospemifene to alleviate the burden associated with the disease.

After a long and challenging history, there have finally been major breakthroughs in the development of effective obesity medications. Agents that act at receptors of one or more gut hormones are achieving unprecedented weight reductions and improvements in cardiovascular risk factors, comparable to some bariatric surgical procedures. Importantly, there is evidence of beneficial effects on a growing range of conditions, including type 2 diabetes, fatty liver, chronic kidney disease, obstructive sleep apnea and cardiovascular disease. Barriers to access need to be overcome to allow the standard of care for obesity to match that of other chronic diseases.

Objective: This study aimed to evaluate the effect of vaginal oxygen and hyaluronic acid on lower urinary tract symptoms (LUTS) in breast cancer survivors.

Method: A prospective trial was conducted at a university hospital's Menopause Outpatient Clinic. Breast cancer patients experiencing LUTS received intravaginal natural oxygen for 15 min, coupled with a 2% hyaluronic acid solution during the last 5 min. This treatment was performed five times at 15-day intervals. Assessments were repeated at each application and 60 days after the last application. Scores on the Urogenital Distress Inventory-6 (UDI-6) short form and its single items assessing different LUTS aspects were determined.

Results: Treatment in 85 breast cancer patients decreased the UDI-6 total score (from 24.8 ± 19.9 to 17.5 ± 16.2; p < 0.001) and subscales evaluating irritative (p = 0.001), stress (p = 0.006) and obstructive discomfort (p = 0.001) symptoms. In multivariate analysis, aromatase inhibitors were independently associated with a greater improvement of LUTS (coefficient of regression [CR] - 8.05, 95% confidence interval [CI] -13.41, -2.64; p = 0.004)). The use of a gonadotrophin-releasing hormone (GnRH) analog was associated with a greater improvement of irritative symptoms (CR -2.42, 95% CI -4.75, -0.08; p = 0.042), while tamoxifen reduced the improvement of stress symptoms (CR 2.49, 95% CI 0.10, 4.90; p = 0.041).

Conclusion: Short-term treatment with vaginal oxygen and hyaluronic acid appeared to improve LUTS of breast cancer patients.

Objective: This study aimed to investigate the association between four insulin resistance (IR) surrogates and bone mineral density (BMD) and whether IR surrogates could be risk factors for osteoporosis (OP) in Chinese non-diabetic postmenopausal individuals.

Methods: Four non-insulin-based surrogates including triglyceride glucose (TyG), triglyceride glucose with body mass index (TyG-BMI), triglycerides (TG)/high-density lipoprotein cholesterol (HDL-C) and the metabolic score for insulin resistance (METS-IR) index were calculated. All individuals underwent dual-energy X-ray absorptiometry for measurement of BMD. Pearson correlation analysis was employed to evaluate the correlations between IR indices and BMD. Subsequently, logistic regression analysis was performed to investigate the relationship between these indices and OP while the receiver-operating characteristic curve was used to assess the predictive values for OP.

Results: Both TyG-BMI and the METS-IR index were significantly positively associated with BMD. As TyG-BMI and the METS-IR index increased, the prevalence of OP decreased. After adjusting confounding factors, the fourth quartile of TyG-BMI and the METS-IR index showed significantly decreased odds ratio of 0.304 and 0.352, respectively, for OP with respect to its first quartile value. The area under the curve of TyG-BMI and the METS-IR index was 0.616 and 0.605, respectively.

Conclusions: IR surrogates TyG-BMI and the METS-IR index were positively associated with BMD and may be protective factors for OP in Chinese non-diabetic postmenopausal women.

The menopause experience is unique to people with ovaries who attain an age at which functioning follicles are depleted. Unlike male reproductive aging, menopause is accompanied by a definable reproductive milestone in that menstrual periods cease and the failure of follicle growth results in a large drop in circulating estrogen and no further ovarian production of progesterone. While the focus on menopause has largely been centered on this absence of hormone production, the most dynamic changes in symptoms and health markers begin before the final menstrual period, and merit attention. Vasomotor symptoms, the most common symptom of menopause and the primary symptom that drives women to seek treatment, peak in frequency and prevalence in the late menopause transition, when women are still having menstrual periods. Body composition and adverse lipoprotein and lipid changes also worsen most acutely in the late transition, and then assume a slower, age-related trajectory of change. Multiple processes that worsen across the transition restabilize after it is over. The notion that the menopause transition is an adaptive process for women has scientific merit and suggests that facilitating this adaptation and recognizing its implications may represent the next phase of progress in the field.

Objective: This study aimed to investigate the effects of menopause on ocular health and visual function.

Method: Sixty-two women (31 premenopausal and 31 postmenopausal) who visited Rasht Health Center were selected and matched based on their ages and compared in terms of their hormonal status, central corneal thickness (CCT), contrast sensitivity (CS), binocular vision variables and refractive error.

Results: CCT and corneal curvature were significantly thinner in postmenopausal women. However, menopause had no significant impact on CS, binocular vision or refractive error.

Conclusion: Age-related hormonal abnormalities play a significant role in corneal thinning, highlighting the intricate relationship between systemic hormonal changes and ocular health. In contrast, binocular vision functions remain unaffected by menopause.

Objective: Subjective cognitive complaints have been reported in women during perimenopause and the Everyday Memory Questionnaire - Revised (EMQ-R) has been recently evaluated as a standardized instrument to measure subjective cognitive changes. The purpose of this study was to identify potential cut-off points for the EMQ-R retrieval subscale and attentional subscale, and to assess the validity of these cut-off points in detecting objective cognitive changes associated with reported subjective cognitive complaints.

Method: After screening, 232 perimenopausal women were included in the analyses. The supervised classification and regression tree was applied to identify optimal cut-off points. Its performance was evaluated by the value of the receiver operating characteristics curve, sensitivity and specificity.

Results: Findings revealed that the optimal cut-off point for the attentional subscale was 7, and for the retrieval subscale was 13. Both cut-off points presented acceptable discrimination performance. An independent t-test indicated that both cut-off points were associated with significant differences in scores on neuropsychological measures of retrieval (episodic memory and verbal fluency) as well as neuropsychological measures of higher-level attention (working memory).

Conclusion: The identified cut-off points may be helpful for women to track or quantify their subjective experiences of brain fog or cognitive symptoms during the menopause transition.