Climacteric最新文献

Age alone should not be an absolute contraindication for any contraceptive methods. However, medical eligibility criteria for combined hormonal contraception (CHC) use must be taken into consideration when choosing an appropriate contraceptive method. Women should be counseled on the benefits and risks of CHC while in their 40s. If there are no contraindications, women may use CHC for contraception up until the age of 50 years. Loss of libido is a common symptom during the late 40s. While women associate this with hormone levels, libido is multifactorial and is influenced by family and work stress, tiredness, self-image, medications and the physical changes in their partner. During this stage, women might experience urogenital issues such as vaginal dryness, dyspareunia and bladder problems, which can further affect the woman's sexual function. Before attributing the cause of sexual dysfunction to CHC use, a complete gynecologic examination and a full biopsychosocial assessment of the woman and her partner should be conducted to define other potential causes. When CHC-related female sexual dysfunction is suspected, using an oral CHC with a higher estrogen dose, a vaginal contraceptive ring or a transdermal contraceptive patch, or switching to a progesterone-only pill or non-hormonal method, might be suggested.

Objective: Menopause can impact women's physical and mental well-being, including sexual function. The present study aims to evaluate the effect of sexual counseling based on the PLISSIT model on improving the sexual function of postmenopausal women.

Methods: The randomized trial focused on postmenopausal married women who did not have any pre-existing health conditions. The intervention group were provided with personalized sexual counseling grounded in the PLISSIT model, whereas the control group were given educational pamphlets. Participants filled out the Female Sexual Function Index (FSFI) questionnaire and were categorized into two groups through randomized blocking, utilizing blocks of four and six. The main outcome measure was the average sexual function score assessed at the start of the study, as well as at 4 and 8 weeks following the intervention.

Results: A total of 60 eligible participants were included in the study. The mean ± standard deviation participant age was 58.7 ± 3.5 years. At week 4 following the intervention, statistically significant differences were observed between the study groups in the mean scores of sexual desire (p = 0.023), arousal (p = 0.002), orgasm (p = 0.0001), lubrication (p = 0.001) and satisfaction (p = 0.004). At week 8 following the intervention, significant differences were noted in the mean scores for sexual arousal (p = 0.001), orgasm (p = 0.000), lubrication (p = 0.031) and satisfaction (p = 0.004) between the study groups.

Conclusion: The sexual counseling based on the PLISSIT model can significantly improve sexual function in postmenopausal women, making it a valuable intervention for healthcare providers to consider in their practice.

Objective: This study aimed to examine factors associated with seogeulpeum (a feeling of loneliness and solitude) - including aging anxiety, menopausal symptoms, social support and self-efficacy - in middle-aged women to provide fundamental data for future research endeavors.

Methods: One hundred and fifty-nine women aged 40-60 years were recruited from two cities in Gyeongnam Province and Busan City. Gu and Eun's Seogeulpeum Scale was employed to evaluate seogeulpeum, alongside questionnaires to assess menopause status and symptoms, self-efficacy, social support and aging anxiety. To determine factors influencing seogeulpeum, a multiple stepwise regression analysis was conducted.

Results: The average seogeulpeum score was 2.4 ± 0.44, indicating a moderate level of seogeulpeum experienced by the participants. Seogeulpeum was positively correlated with aging anxiety and menopausal symptoms, and negatively with self-efficacy and social support, among which aging anxiety most significantly influenced seogeulpeum. Aging anxiety, menopausal symptoms and social support combined accounted for 60.9% of the variation observed in seogeulpeum.

Conclusions: The findings indicate the importance of health interventions aimed at reducing aging anxiety and menopausal symptoms and enhancing social support for promoting well-being and facilitating a healthy menopausal transition among middle-aged women. Additionally, seogeulpeum can serve as a valuable process indicator during this stage of multiple transitions for women.

Objective: This study aimed to evaluate the effect of the vaginal erbium laser (VEL) in association with vaginal hyaluronic acid (HA) in postmenopausal women suffering from genitourinary syndrome of menopause (GSM).

Methods: One hundred sexually active postmenopausal women were selected and divided into three groups using a block randomization method; 10 women declined to participate. The remaining women received three laser applications at 30-day intervals; 22 women dropped out for personal reasons or protocol violations. Group 1 (n = 25) received VEL treatment (XS Fotona Smooth^®; Fotona, Slovenia) alone; Group 2 (n = 22) received daily vaginal HA tablets for 10 days after VEL treatment, followed by a twice a week administration during the follow-up period; and Group 3 (n = 21) received daily HA tablets for 10 days before the first VEL treatment and for 10 days after each laser application, followed by a twice a week administration for the follow-up period. Vaginal dryness and dyspareunia were assessed at the screening visit, before VEL treatment, after 1 and 3 months from the last laser treatment, using the visual analog scale. Data were analyzed using one-way analysis of variance and a linear mixed model for repeated measures. The post-hoc test for the interaction between time and treatment was performed using Bonferroni correction.

Results: A significant (p < 0.001) improvement in both vaginal dryness and superficial dyspareunia was evident, with greater (p < 0.001) improvement in Group 2 and Group 3.

Conclusions: The results suggest that vaginal HA administration can improve the VEL effects on GSM in postmenopausal women.

Excessive androgen levels in women after menopause often result from an imbalance in ovarian steroid secretion: a rapid decline in estrogen secretion associated with a slow decrease in androgen secretion, compounded by a physiological decrease in sex hormone-binding globulin. Hyperandrogenism is associated with a higher risk of cardiovascular events and gynecological neoplasms, also impacting the emotional well-being of affected women. Therefore, the aim of these guidelines is to guide the clinical physician in the appropriate clinical and biochemical evaluation of hyperandrogenism after menopause, thus optimizing therapeutic outcomes. The most frequent consultation in this stage of life is facial hirsutism associated with hair loss. If the onset of signs is abrupt, severe, associated with virilization and accompanied by serum testosterone levels in the male range, it is necessary to rule out a tumoral origin. A thorough medical history guides the diagnosis. Determination of total testosterone using reliable methods and imaging studies are valid tools to assist when doubts arise in the differential diagnosis.

Objective: This study aimed to evaluate the effects of a therapeutic lifestyle modification (TLM) intervention on health-related quality of life, sexual functioning and cardiometabolic health in perimenopausal Chinese women.

Method: The study was a randomized controlled trial (registration number: ChiCTR2300070648). Ninety-four perimenopausal women aged between 40 and 55 years were randomly assigned in a 1:1 ratio to receive the TLM intervention or usual care for 12 weeks. Menopause-specific Quality of Life (MENQOL), Female Sexual Function Index (FSFI), pelvic floor muscle strength (PFMS) and composite cardiometabolic indicators were evaluated at baseline and post intervention.

Results: After 12 weeks, linear mixed-effects models showed that the TLM intervention led to a statistically significant improvement in MENQOL (-0.60, 95% confidence interval [CI] - 0.80 to -0.41), FSFI (3.82, 95% CI 2.03 to 5.61), resting heart rate (-5.44, 95% CI -10.40 to -0.48), waist circumference(-3.14, 95% CI -4.15 to -2.13) and body fat percentage (-4.25, 95% CI -6.92 to -1.58) compared to the control group. There were also statistically significant differences between the intervention (TLM) group and the control group in the proportions of PFMS (p = 0.006).

Conclusion: The TLM intervention effectively improved menopause-specific quality of life in midlife women, supported by enhancements in female sexual functioning and cardiometabolic health status.

Objective: Oral, low-dose and ultra-low-dose continuous combined 17β-estradiol (E) plus dydrogesterone (D) reduce vasomotor symptoms (VMS) in postmenopausal women.

Methods: Two phase 3, double-blind studies were included. In the European study, postmenopausal women were randomized 2:1:2 to receive E0.5 mg/D2.5 mg (ultra-low dose), E1 mg/D5 mg (low dose) or placebo for 13 weeks. In the Chinese study, women were randomized 1:1 to receive E0.5 mg/D2.5 mg or placebo for 12 weeks. Post-hoc endpoints assessed in body mass index (BMI) subgroups (<25 kg/m²; ≥25 kg/m²) included number of hot flushes and moderate-to-severe hot flushes per day, and the proportion of women with amenorrhea.

Results: A total of 640 women were included. At the end of treatment, the mean (95% confidence interval) numbers of daily hot flushes were significantly lower (p ≤ 0.05) for all treatment groups versus placebo, with E0.5 mg/D2.5 mg (BMI < 25 kg/m²: 2.5 [1.9, 3.1]; BMI ≥ 25 kg/m²: 3.2 [2.5, 3.8]) and E1 mg/D5 mg versus placebo (BMI < 25 kg/m²: 2.7 [1.2, 4.2]; BMI ≥ 25 kg/m²: 2.3 [1.1, 3.5]) than with placebo (BMI < 25 kg/m²: 4.4 [3.8, 50]; BMI ≥ 25 kg/m²: 4.2 [3.6, 4.9]). A similar pattern was seen for moderate-to-severe hot flushes. The amenorrhea rate was high (79-98%) across both studies and BMI subgroups.

Conclusion: Oral, ultra-low-dose continuous combined E0.5 mg/D2.5 mg and low-dose continuous combined E1 mg/D5 mg alleviated postmenopausal VMS compared with placebo, irrespective of BMI.

The specific Italian Group of Study of the Menopause formulated a consensus opinion on the use of estrogen therapy (ET) or combined estro-progestin hormone therapy (HT) after breast and gynecological cancers. This consensus is based on the risk of recurrence of the specific cancer during ET/HT, the presence of steroid receptors in cancer cells, the use of adjuvant hormone therapies and data on the use of ET/HT after cancer. The following positions were reached. ET/HT can be used after vulvar cancers and melanoma, but with great caution after the rare adenocarcinomas. ET/HT can be used after cervical cancer, but ET should be used with caution after adenocarcinomas. ET/HT can be used after International Federation of Obstetrics and Gynecology (FIGO) stage I-II estrogen-dependent endometrial cancers, except in Black women, and can probably be used after estrogen-independent endometrial cancers. ET/HT cannot be administered or should be used with great caution after most uterine sarcomas. ET/HT can probably be used after ovarian neoplasms except for granulosa cell tumors, and with great caution after low-grade serous ovarian carcinoma and serous borderline ovarian tumors. ET/HT can be used with great caution in women after estrogen receptor (ER)/progesterone receptor (PR)-positive breast cancer and is probably allowed after ER/PR-negative breast cancer.

Objective: This retrospective study aims to assess the association of the triglyceride-glucose index (TyG index) with postmenopausal osteoporosis and investigate longitudinal changes in TyG index levels in relation to osteoporosis risk.

Methods: Out of 704 women, after excluding those with osteopenia, a total of 517 patients who met the inclusion criteria were included. Participants were categorized based on T-scores derived from lumbar spine dual-energy X-ray absorptiometry scans. Demographic data, biochemical parameters and TyG index levels were analyzed. Logistic regression, correlation analysis and receiver operating characteristic (ROC) curve analysis were employed for statistical evaluation.

Results: The osteoporosis group (n = 254) exhibited significantly higher TyG index and triglyceride levels compared to controls (n = 263). Longitudinal analysis revealed significant increases in TyG index levels among women developing osteoporosis over time. ROC analysis demonstrated the TyG index's accuracy for osteoporosis (first TyG area under the curve [AUC]: 0.767, second TyG AUC: 0.818, p < 0.001). Regression analyses identified the TyG index as a significant factor associated with osteoporosis (odds ratio: 39.468, 95% confidence interval: 12.884-120.903, p < 0.001).

Conclusions: The TyG index emerges as a valuable indicator for postmenopausal osteoporosis. These results emphasize the need for integrating metabolic health indicators into osteoporosis management strategies, warranting further research into targeted interventions.