Climacteric最新文献

Objective: Frailty is a dynamic condition, but the influence of female reproductive factors on its long-term trajectories remains unclear. This study aimed to examine whether age at menarche (AAM), age at menopause (AMP) and reproductive span (RS) predict long-term frailty trajectories in middle-aged and older women.

Method: Data were analyzed from four waves (2011-2018) of the China Health and Retirement Longitudinal Study (CHARLS). Frailty was measured using the frailty index (FI), and trajectories were identified via latent category growth modeling (LCGM). Logistic regression and restricted cubic spline analyses assessed the associations of reproductive factors with FI trajectories.

Results: Among 2775 women, FI trajectories were classified into two groups: 'low-stable' (N = 1961) and 'high-rising' (N = 814). Compared with women who had menopause at ages 46-54 years, those with AMP ≤45 years (odds ratio [OR] = 1.377, 95% confidence interval [CI]: 1.073-1.766) or AMP ≥55 years (OR = 1.558, 95% CI: 1.113-2.181) had higher odds of following the 'high-rising' frailty trajectory. Similarly, RS < 26 years (OR = 1.810, 95% CI: 1.277-2.566) or RS ≥40 years (OR = 1.734, 95% CI: 1.123-2.678) were associated with increased odds of the 'high-rising' trajectory. AAM was not significantly associated with frailty trajectories.

Conclusions: Early or late menopause and extreme RS are associated with worsening frailty trajectories.

Objective: Menopausal hormone therapy is standard treatment, but some women use complementary therapies. This review examines complementary therapies for menopause to inform International Menopause Society (IMS) recommendations.

Method: A systematic search of six databases (January 2022-December 2024) identified randomized controlled trials (RCTs) and systematic reviews on complementary therapies for menopause. Outcomes included menopausal, vasomotor, genitourinary, cardiometabolic, sleep symptoms, bone health and safety. The study quality and certainty of evidence were evaluated using Cochrane Risk of Bias (RoB2), A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2) and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

Results: From 3187 citations, 158 studies were included: one overview, 36 meta-analyses, seven systematic reviews and 114 RCTs. While promising evidence was found for acupuncture, Chinese herbal medicine (CHM), herbs, nutrients, mind-body/touch therapies for a variety of symptoms, most was of low/very low certainty. High-certainty evidence supports vitamin D safety; and moderate-certainty evidence supports black cohosh (vasomotor/menopausal symptoms), CHM (menopausal symptoms, sleep, blood pressure), acupuncture + CHM (sleep) and vitamin D (fracture risk). Most complementary therapies are safe.

Conclusion: Vitamin D, black cohosh, CHM and acupuncture + CHM may improve some menopausal symptoms, but overall evidence remains limited. More rigorous research is needed on the efficacy and safety of complementary therapies for menopause.

Objective: Postmenopause is characterized by changes in reproductive hormones and body composition. Preclinical evidence suggests that follicle stimulating hormone (FSH) may increase adiposity, but epidemiologic research is limited. This study examined whether postmenopausal FSH and luteinizing hormone (LH) are related to adiposity changes.

Method: The sample included 675 postmenopausal women enrolled in the Women's Health Initiative (WHI) Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) study with dual-energy X-ray absorptiometry measures. Adiposity measures included visceral adipose tissue (VAT), subcutaneous adipose tissue, body mass index, and total and percent body fat. Group-based trajectory models and generalized estimating equation models estimated associations of baseline FSH and LH with 17-year adipose trajectories and longitudinal measures of adiposity, respectively.

Results: The study estimated three trajectories for adiposity measures, corresponding to low, medium and high levels of adiposity over time. Higher baseline concentration of FSH and LH was associated with reductions in adiposity measures over time. An increase of 1 mIU/ml in FSH was associated with a 0.55 cm² reduction in VAT (95% confidence interval [CI]: -0.69, -0.40); and an increase of 1 mIU/ml in LH was associated with a 0.81 cm² reduction in VAT (95% CI: -1.09, -0.52).

Conclusion: Higher circulating FSH and LH were associated with lower adipose trajectories and lower adiposity levels in older postmenopausal women, counter to our hypothesis. Future research is needed on the relationship between gonadotropins and adiposity during the postmenopausal period.

Objective: There are many menopauses; bilateral oophorectomy is associated with the worst cognitive outcomes. Compared to females with intact ovaries, females with bilateral oophorectomy experience early, abrupt ovarian hormone loss and are at increased risk for later-life Alzheimer's disease. They also have double the odds of developing later-life sleep disordered breathing (SDB) - a modifiable Alzheimer's risk factor. With respect to bilateral oophorectomy, it is unknown when respiratory disturbances occur or whether estradiol therapy (ET) ameliorates them. Also unknown is whether SDB influences cognition in this group.

Method: Females with risk-reducing bilateral salpingo-oophorectomy (BSO) taking ET (BSO+ET, n = 19) or not (BSO, n = 16) and premenopausal age-matched controls (AMC, n = 17) were assessed for SDB markers using take-home polysomnography and for working memory performance.

Results: The BSO group showed signs of respiratory disturbance compared to the AMC group. Memory performance was uncorrelated with respiratory metrics. While the BSO+ET group showed an intermediate sleep phenotype, estrone glucuronide levels correlated with improved respiratory metrics.

Conclusion: The results suggest that respiratory disturbances manifest as early as 5 years post-BSO in younger females; ET offers some amelioration. The close relationship between sleep disruption and Alzheimer's risk emphasizes the importance of SDB screening post-BSO for early intervention.

Objective: Genitourinary syndrome of menopause (GSM) has a negative impact on quality of life. Treatments for GSM are largely hormonal, yet some patients remain symptomatic after recommended treatments. Photobiomodulation therapy (PBMT) is a promising non-hormonal technique.

Method: In this prospective, first-in-human, medical device safety study, postmenopausal patients with pelvic pain due to vaginal atrophy after failure of non-invasive therapies for >3 months were recruited. Exclusion criteria included pelvic pain of physical and/or psychological origin, treatment for cancer or immunosuppression. Patients received six weekly PBMT sessions using the MILTA GYNECO vaginal probe (PHYSIOQUANTA). The primary outcome was device safety, according to patient-reported adverse events. Secondary outcomes were vaginal mucosal health (vaginal health index [VHI]), pain (0-10 visual analog scale), vaginal flora and patient satisfaction (Patient Global Impression of Change [PGI-C]).

Results: Twenty-five patients were recruited and analyzed, with an average age of 58.7 years. In total, 148 adverse events were declared, of which 146 were minor (grade I) and most were for heat sensation (89.2%). Significant improvements were found in pain during intercourse (7.65 [±1.95] before versus 3.89 [±2.44] after, p > 0.0001) and in vaginal health according to the VHI score (12.68 [±4.20] before versus 17.63 [±4.35] after, p > 0.0001). According to the PGI-C score, most patients rated their condition as improved.

Conclusion: Even when applying a broad definition for adverse events, these preliminary data suggested that PBMT using the MILTA GYNECO vaginal probe was safe, with high patient satisfaction. The next step is to assess the efficacity of the medical device in a randomized trial.

Objective: This study aimed to report the prevalence of menopausal hormone therapy (MHT) usage in symptomatic postmenopausal women in Australia.

Method: The Australian Midlife Years Study is a nationally representative, cross-sectional questionnaire-based study of women aged 40-69 years that included current MHT usage and menopausal symptoms. Data were collected during October 2023-March 2024.

Results: Of 8086 participants, 10.8% of postmenopausal respondents reported MHT use. Further analysis was limited to 2503 potential MHT users (postmenopausal with vasomotor symptoms; 77.5%, n = 1941) or current users (22.5%; n = 562). The absolute number of MHT users was greatest amongst those aged 50-59 years (n = 309/1304, 24%), but the greatest proportion of use was amongst those aged 40-49 years (96/319, 30%). MHT use was less likely for participants who had body mass index (BMI) of 18.5 kg/m² or ≥30 kg/m² versus BMI of 18.5-29.9 kg/m² (p < 0.05 for all), were smokers (p < 0.001), were unemployed but seeking work versus in paid employment (p = 0.003) or were of non-European ancestry (p < 0.05). Education beyond high school (p = 0.002) and past hysterectomy and/or oophorectomy were associated with greater likelihoods of MHT use (p < 0.001).

Conclusions: Fewer than one-quarter of symptomatic postmenopausal Australian women were using MHT, with socio-demographic variables predicting use. The overall use remains similar to that reported a decade ago.

Objective: Osteoporosis is a prevalent multifactorial disease. Single nucleotide variants (SNVs) have been studied as a potential tool for estimating disease risk. These findings suggest that the GG genotype of rs2282679 in the vitamin D-binding protein (GC) gene may confer a protective effect against osteoporosis in postmenopausal Mexican women, whereas no significant association was found for rs4516035 in the vitamin D receptor (VDR). This highlights the potential of integrating genetic screening, particularly of GC-related variants, into osteoporosis risk assessment and prevention strategies.

Method: A total of 535 women were included. Genotyping was performed through TaqMan assays, and association analyses, including the chi-squared test and logistic regression, were conducted considering different inheritance models.

Results: The allelic frequencies from both SNVs did not show a statistically significant difference between the groups of cases and controls. However, through logistic regression analyses for rs2282679, the GG genotype of the rs2282679 was associated with a protective effect under both recessive and additive inheritance models in unadjusted (odds ratio [OR] 0.27, confidence interval [CI] 0.11-0.63, p = 0.003; OR 0.26, CI 0.11-0.63, p = 0.003, respectively) and adjusted (OR 0.13, CI 0.03-0.55, p = 0.006; OR 0.13, CI 0.03-0.57, p = 0.007, respectively) models.

Conclusion: The GG genotype of rs2282679 seems to confer protection against osteoporosis. Further research, including functional validation and studies in larger and diverse cohorts, is warranted to elucidate the underlying biological mechanisms and confirm these results.

Objective: This study aimed to explore the pharmacological mechanism of Chai-shen powder (CSP) in the treatment of perimenopausal syndrome (PMS) and to evaluate its clinical efficacy via clinical data mining, network pharmacology, bioinformatics and experimental verification.

Method: A single-group before-after control study analyzed CSP efficacy in 100 PMS cases using data mining. PMS datasets were retrieved from the GEO database to screen for differentially expressed microRNAs (miRNAs). Their mRNA targets were predicted using miRDB and miRWalk. These targets were considered therapeutic targets for PMS. CSP targets were screened from databases. The active components and key targets were identified by network pharmacology. The most important targets were confirmed by molecular docking. The prediction results of network pharmacology were verified by experiment.

Results: Data mining showed that the effective rate of CSP was 87.33%. Through bioinformatics and network pharmacology, 10 targets and nine chemical components were screened. CSP regulates hormone levels and inhibits ovarian injury of PMS through PI3K-Akt and cAMP signaling pathways and three key targets (SRC, PIK3CA and PRKACA).

Conclusion: The clinical effective rate of CSP in this study was 87.33%. CSP may alleviate PMS by regulating hormone levels, mitigating ovarian injury and acting through multi-pathway, multi-target mechanisms.

Objective: This study aimed to report the first successful live births following ovarian tissue transplantation (OTT) in patients with cancer treatment-induced premature ovarian insufficiency (POI) in Japan and evaluate a novel non-fixation technique, the Circular String Arrangement.

Method: Two patients who developed POI following treatment for Ewing sarcoma underwent OTT using our novel non-fixation technique. The Circular String Arrangement technique involves placing ovarian tissue fragments in a bead-like formation within peritoneal pockets. Both patients underwent assisted reproductive technology treatment following restoration of ovarian function. Histological examination was performed to assess minimal residual disease in the transplanted tissue.

Results: Both patients experienced successful restoration of ovarian function post transplantation. Following multiple oocyte retrievals, both women achieved pregnancy through vitrified-warmed embryo transfer, resulting in healthy live births at term. The Case 1 patient delivered vaginally at 40 weeks (birth weight 3462 g), whereas the Case 2 patient underwent cesarean section at 38 weeks due to pre-eclampsia (birth weight 2930 g). Laparoscopic examination confirmed successful tissue engraftment with visible follicular development.

Conclusion: This study presents the first live births following OTT in cancer survivors with chemotherapy-induced POI in Japan. The Circular String Arrangement technique showed feasibility for OTT, with successful engraftment and ovarian function restoration in both cases.

Objective: Menopause increases the risk of insulin resistance and cardiometabolic diseases. This study summarizes the effects of hormone therapy (HT) on insulin resistance in non-diabetic postmenopausal women.

Method: The study analyzed randomized controlled trials (1998-2024) that assessed the impact of HT on insulin resistance using homeostasis model assessment of insulin resistance (HOMA-IR) in non-diabetic postmenopausal women. Raw mean differences (RMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analysis compared estrogen alone (E alone) and estrogen plus progestogen (E + P) to placebo.

Results: Seventeen randomized controlled trials with 5772 women (3644 on HT: E alone [n = 1259] or E + P [n = 2385]; 2128 on placebo) were included. The weighted mean (standard deviation) age was 56.91 (5.95) years, with treatment lasting 8 weeks to 3 years. HT significantly reduced HOMA-IR (RMD = -0.24 [-0.32 to -0.16], p < 0.001, I² = 60.3%). Subgroup analysis showed reductions in both E alone (RMD = -0.42 [-0.55 to -0.29], p < 0.001, I² = 35%) and E + P (RMD= -0.14 [-0.23 to -0.04], p = 0.005, I² = 13.7%) compared to placebo.

Conclusion: HT significantly lowers insulin resistance in healthy, non-diabetic postmenopausal women, with E alone yielding greater reductions than combination therapy.