Climacteric最新文献

Testosterone is unquestionably a normal female hormone that exerts important physiological effects in multiple tissues. Clinical trials have consistently demonstrated benefits of testosterone therapy on several domains of sexual function for postmenopausal women with low sexual desire causing substantial personal concern. Whether other benefits can be attributed to testosterone therapy for postmenopausal women remains uncertain. This article summarizes the available data for the use of testosterone therapy beyond the treatment of low sexual desire with distress. The article is not a systematic review of the entire published literature in the field. Rather, it includes recent systematic reviews and meta-analyses the author highlighted in their plenary lecture at the 2024 World Congress on the Menopause. The aim was to provide an overview of the published data for clinicians and researchers in this field.

Objective: For patients with contraindications to hormone therapy, the absence of effective treatments for ovarian dysfunction post chemotherapy represents a critical issue requiring resolution. Local administration of mitochondria may enhance ovarian function in premature ovarian insufficiency (POI) by ameliorating diminished mitochondrial activity. Nevertheless, there is a paucity of literature on the efficacy of mitochondrial transplantation through intravenous injection, a less invasive and more convenient method than local injection, for the improvement of ovarian function in POI following chemotherapy.

Method: Mitochondria were isolated from mouse livers, their activity and integrity were validated with MitoTracker Red and their localization was examined via confocal microscopy, real-time quantitative PCR and enzyme-linked immunosorbent assay post tail vein injection. An ovarian insufficiency animal model induced by chemotherapy was developed, and ovarian function was assessed through ovarian diameter, vaginal smear, body weight, sex hormone levels and histological analysis. The impact of mitochondrial transplantation on an ovarian cell model was examined through the assessment of mitochondrial function, apoptosis and levels of reactive oxygen species.

Conclusion: Tail vein injection of isolated mitochondria has the potential to enhance ovarian functions in an animal model of POI induced by cyclophosphamide, increase mitochondrial activity in impaired ovarian cells and decrease the rate of apoptosis.

Objective: This study aimed to examine the association between concentrations of sex hormone binding globulin (SHBG) and fracture risk in community-dwelling older women and explore whether this was explained by the genetic regulation of SHBG.

Methods: This prospective cohort study examined 4871 women aged ≥70 years who were not taking medications influencing SHBG concentrations. A genome-wide association study was undertaken to identify single nucleotide polymorphisms (SNPs) associated with SHBG concentrations. Incident fracture was confirmed by medical imaging and adjudicated by expert review committee.

Results: The median age of participants was 74.0 years. Over 3.9 (standard deviation 1.4) years of follow-up, 484 participants had an incident fracture. There was a linear trend for a positive association between SHBG concentrations and fracture risk (p = 0.001), with the highest SHBG quartile associated with a significantly greater fracture risk compared with the lowest quartile (hazard ratio 1.54, 95% confidence interval 1.16-2.04, p = 0.003), adjusting for age, body mass index, alcohol consumption, smoking, diabetes, impaired renal function, treatment allocation, medications affecting bone and high-density lipoprotein cholesterol. Two independent SNPs were associated with SHBG concentrations, rs10822163 and rs727428, but neither was associated with fracture risk.

Conclusion: SHBG concentrations were positively associated with a greater fracture risk in community-dwelling women aged ≥70 years, which was not explained by genetic variants associated with SHBG regulation.

Objective: This study aimed to examine the association of serum uric acid levels with handgrip strength (HGS) and dynapenia in postmenopausal women.

Methods: A cross-sectional study among 422 participants collected data on age, age at menopause, adiposity, alcohol consumption, body mass index, current smoking status, HGS (measured using a digital dynamometer) and physical activity. Serum levels of creatinine, glucose, glycated hemoglobin, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, thyroid-stimulating hormone and uric acid were evaluated. Women were categorized into quartiles. A directed acyclic graph was designed to identify confounding variables. Multivariable regression analysis was used to assess associations between uric acid with HGS or dynapenia.

Results: Women with hyperuricemia presented significant association with lower HGS (p = 0.00028). After adjusting for potential confounders, the multivariable linear regression to analyze the association between uric acid and HGS showed an inverted U-shaped curve, with quartile 1 (β = -0.54; 95% confidence interval [CI]: -1.50, 0.40), quartile 3 (β = -0.21; 95% CI: -1.20, 0.74) and quartile 4 (β = -1.3; 95% CI: -2.3, -0.37) compared with quartile 2. Serum uric acid levels were significantly associated with HGS (p = 0.036).

Conclusions: The association between uric acid quartiles with HGS or dynapenia displayed an inverted U-shaped curve. These findings suggest that specific serum uric acid levels within the normal range are associated with better HGS.

Objective: This study aimed to evaluate physician-patient alignment on menopausal symptom burden and impact for women experiencing natural vasomotor symptoms (nVMS) or VMS induced by endocrine therapy for breast cancer (iVMS).

Methods: For this real-world, cross-sectional survey, physicians from the USA and five European countries provided data for consulting patients experiencing nVMS/iVMS; patients optionally self-reported their experiences. Alignment between physician and patient responses was assessed using weighted Cohen's κ analysis.

Results: Physicians and patients completed 1029 pairs of surveys (846 nVMS; 183 iVMS). In 28.1% of cases for nVMS and 29.6% for iVMS, patients reported more severe vasomotor symptoms (VMS) than physicians; alignment of responses was slight (nVMS, κ = 0.1364, p ≤ 0.0001; iVMS, κ = 0.1014, p = 0.039). For the non-VMS symptoms surveyed, 18.5-34.9% of patients with nVMS and iVMS reported symptoms without a corresponding physician report; sleep disturbances, cognitive difficulties and mood changes were among the symptoms most under-reported by physicians. Alignment regarding the impact of nVMS and iVMS on sleep, mood and overall quality of life was moderate.

Conclusions: Only slight to moderate physician-patient alignment was found across all areas surveyed. These findings suggest that physicians often underestimate the severity of VMS and the presence of other menopausal symptoms, highlighting a need to improve physician-patient communication.

Objective: Knowing the important repercussions of menopause for women's health and that female longevity can be better understood through studies based on aging biomarkers, studies on the relationship between menopause and telomere shortening may help to better understand this stage of life. This study aimed to analyze what research has been produced regarding the relationship between menopause and telomere length.

Methods: This integrative literature review included searches in PubMed, CINAHL, LILACS, Web of Science and Scopus databases. Four studies were selected for the final sample.

Results: The findings of these studies indicate that older age for menopause and longer reproductive life (difference between age at menopause and menarche) are associated with longer telomeres, that is, with longevity.

Conclusion: The relationship between menopause and telomere length is uncertain. The small number of studies included in this review, and the fact that the results indicate that the relationship between menopause and telomere length may be dependent on the stage of the menopause and race/ethnicity, suggest that additional research focusing on these variables should be carried out.

Objective: This study aimed to assess the efficacy of randomly started oral dienogest/ethinylestradiol (DNG/EE) for swift endometrial preparation prior to outpatient hysteroscopic polypectomy in perimenopausal women.

Method: A multicenter, prospective, randomized controlled trial was conducted in university hospitals. Eighty perimenopausal women scheduled for outpatient hysteroscopic polypectomy between January 2023 and March 2024 were randomly assigned to either intervention (n = 40) or control (n = 40) groups. Exclusion criteria included concomitant endometrial pathologies, recent therapy and adnexal diseases. The intervention group received oral DNG/EE 2 mg/0.03 mg/day started on any day of the menstrual cycle for 14 days. The control group underwent polypectomy between menstrual cycle days 8 and 11 without pharmacological treatment.

Results: Pre-procedure (p < 0.001) and post-procedure (p < 0.001) endometrial thickness were significantly reduced in the intervention group, along with a higher incidence of hypotrophic/atrophic endometrial patterns (p < 0.001). Surgical parameters also differed significantly between groups.

Conclusion: DNG/EE treatment offers rapid, cost-effective endometrial preparation, enhancing surgical outcomes and patient satisfaction during outpatient polypectomy.

Trial registration: ClinicalTrials.gov NCT06316206.

Objective: Findings concerning the effects of hormone therapy (HT) on cognition and dementia are mixed, with some trials suggesting increased harm at older ages. Personality, like cognition, changes with dementia, but no clinical trials to date have examined the effects of HT on personality traits. This study aimed to determine the effects of HT on personality traits in older men and women.

Method: Secondary data analysis was performed from randomized, double-blind, placebo-controlled cross-over studies of menopausal HT in women and testosterone therapy (TT) in men. Participants were community-dwelling cognitively normal adults (mean age = 75.2 years), including 29 men and 22 women. Three months of hormone intervention (for women, 0.625 mg/day conjugated equine estrogen with or without 2.5 mg/day medroxyprogesterone acetate; for men, 200 mg intramuscular testosterone enanthate every 2 weeks) were crossed over with 3 months of identical placebo with a 3-month washout between intervention phases. The main outcome measure was neuroticism and conscientiousness personality domains and facets assessed with the Revised NEO Personality Inventory (NEO-PI-R) after the active and placebo intervention phases.

Results: In linear mixed-effect models, HT in women decreased conscientiousness (p < 0.01) and the conscientiousness facet of achievement striving (p < 0.01), and increased vulnerability, a facet of neuroticism (p < 0.05). Testosterone in men decreased conscientiousness (p < 0.05) and the conscientiousness facet of dutifulness (p < 0.05), and increased vulnerability (p < 0.05).

Conclusion: In a preliminary study of healthy older adults, HT and TT formulations produced adverse changes in vulnerability and conscientiousness facets that parallel personality changes in dementia.