Climacteric最新文献

Objective: This research aimed to determine the prevalence of depressive symptoms during the menopausal transition (MT) among women in Türkiye and to examine the effects of menopausal symptom severity, aging anxiety, health-related quality of life (HRQoL) and sociodemographic factors on these symptoms.

Methods: The cross-sectional study included 1146 women aged 45-55 years in the MT phase who voluntarily agreed to participate. The data were collected via a link containing survey questions on Google Forms, including sociodemographic information, health status, gynecological/obstetric history, menopause questions and the following scales: Perimenopausal Depression Scale, Menopause Rating Scale (MRS), Aging Anxiety Scale and Short Form Health Survey.

Results: The prevalence of depressive symptoms during the MT (≥20 points) was found to be 27.1% (95% confidence interval: 24.6-29.8), with 3.8% experiencing severe depression, 12.7% moderate depression and 10.6% mild depression. Binary multiple logistic regression analysis identified residence in the Eastern and Southeastern Anatolia regions, alcohol consumption, higher MRS scores and lower mental component levels as significant predictors of depressive symptoms during the MT.

Conclusions: This study provides valuable data on the prevalence of depressive symptoms during the MT among perimenopausal women in Türkiye, offering insights for developing targeted strategies for at-risk groups.

Objective: This study aimed to investigate the potential causal relationship between 731 immune cell traits and age at natural menopause (ANM), a measurable endpoint for ovarian aging.

Methods: Based on variant ANM data from the ReproGen Consortium, two-sample Mendelian randomization (MR) analyses were conducted in a European population to identify significant immune cell traits associated with menopausal timing using inverse variance weighting (IVW) methods as the primary strategy. The study performed additional scrutiny to test the robustness of the significant associations via weighted median and MR-Egger as complementary methods, heterogeneity and pleiotropy analyses, the Steiger test and reverse MR for testing directionality, and leave-one-out analysis for biased and dominant variants. Replication analyses were also carried out using an independent dataset for ANM from UK Biobank.

Results: After false discovery rate (FDR) correction, 10 significant immune cell traits were identified, suggesting putative causal associations with menopausal timing. Six immunophenotypes were associated with earlier ANM including CD39⁺ activated regulatory T cell (Treg) %activated Treg, NK% CD3^- lymphocyte and CD27 on four B cell types (IgD^-CD38^dim B cell, memory B cell, unswitched memory B cell, switched memory B cell). Four immunophenotypes were associated with later ANM: CD39⁺ resting Treg absolute count, HLA DR⁺ CD4⁺ %lymphocyte, CD24 on IgD^-CD38^dim memory B cell and HVEM (Herpesvirus Entry Mediator, also named as TNFRSF14) on CD4⁺ T cell. These results were validated in the replication dataset from UK Biobank. No reverse causation was found.

Conclusion: This study demonstrates a causal relationship between 10 immune cell traits and menopausal timing, thereby expanding our knowledge about reproductive aging from the perspectives of inflammaging.

Objective: This study aimed to analyze the effects of jazz dance or concurrent training on the cardiorespiratory fitness (CRF), muscle strength and sleep quality of postmenopausal women.

Method: A randomized clinical trial with 6-month and 12-month follow-up was conducted including 70 postmenopausal women (mean age 53.19 ± 3.39 years). Participants were randomized into the jazz dance intervention (JD) group, concurrent training intervention (CT) group and control group (CG). CRF was assessed using the 6-min walk test, muscle strength using the isokinetic dynamometer and sleep quality using the Pittsburgh Sleep Quality Index questionnaire. Generalized estimating equations with post-hoc minimum significant difference were used, and intention-to-treat and protocol adherence analyses were performed.

Results: CRF showed changes between groups, times and interactions, but the CT group achieved greater gains compared to the JD group. Isokinetic strength showed long-term intragroup improvement for both intervention groups, at peak extension and flexion. Intergroup differences were observed, with the JD group presenting higher means in peak extension at all times compared to the CG post intervention; however, the CT group achieved higher means compared to the JD group; and at peak flexion, the JD group presented with higher averages compared to the CG post intervention. The JD group showed an improvement in sleep duration in the short term, while the CT group did so at the 6-month follow-up. There were intergroup changes in the reduction in sleep medication in both intervention groups compared to the CG.

Conclusion: Both modalities are effective for improving CRF, muscle strength and sleep quality.

Objective: Androgens have been prescribed to alleviate symptoms in midlife women, but evidence regarding benefits and risks remains limited, with no clearly established indications for Testosterone therapy. In many Latin American countries, Testosterone is prescribed without specific guidelines, making it difficult to identify patients who might benefit. This position statement aims to summarize evidence and provide a Latin American perspective on androgen therapy in midlife and older women.

Method: Data were collected from Cochrane reviews, placebo-controlled studies, meta-analyses, international guidelines, consensus statements, and government regulations published between 2000 and the present. Analyses focused on efficacy, safety, and clinical recommendations for androgen therapy in midlife and older women.

Results: Testosterone therapy for postmenopausal women should be limited to those with hypoactive sexual desire disorder (HSDD) confirmed through a formal biopsychosocial evaluation (Grade A: High). Routine serum measurements of Testosterone or other androgens are not recommended for diagnosis (Grade A: High), but baseline levels should be checked before therapy to exclude elevated concentrations (Grade C: Low). Treatment monitoring should occur within 3-6 weeks, maintaining Testosterone within the premenopausal physiological range (Grade C: Low). Transdermal formulations are preferred. Subcutaneous pellets and compounded "bioidentical" Testosterone are not recommended due to risks of supraphysiological dosing and insufficient evidence (Grade C: Low). Oral dehydroepiandrosterone (DHEA) is not advised systemically (Grade A: High). Vaginal DHEA is approved only for genitourinary syndrome of menopause.

Conclusion: Women should receive counseling aligned with current clinical guidelines. Prior to initiating Testosterone therapy, patients must be informed that its use is off-label. Evidence to date does not support systemic DHEA as an effective treatment for sexual symptoms.

While the biological processes of menopause are universal, individual experiences vary widely, shaped by psychological, social and cultural factors. Recent perspectives advocate for an empowerment-based model, emphasizing the importance of incorporating both medical and psychological dimensions into menopause management. This contribution builds upon previous models and integrates a psychological framework that considers menopause as not only a time of loss but also a period of growth, self-realization and transformation. From a psychological perspective, menopause invites a redefinition of identity, with key psychological changes structured around two central dimensions: body-space and time perception. The transition away from the cyclical rhythms of fertility to a more stable bodily and temporal experience provides women with a grounding sense of self and fosters a deeper engagement with long-term goals. These changes, although potentially disorienting, represent a developmental opportunity for stabilization and growth. By embracing this broader understanding, clinicians and researchers can support women in thriving during and beyond this stage, moving beyond solely symptoms management and fostering a collaborative relationship with women navigating this transition. Implications for clinical practice of this approach are discussed, offering guidance on how clinicians can integrate psychological well-being into menopause care.

Objective: Bone loss is common with aging, particularly due to reduced sex hormones, as seen in menopause. While physical training is a known non-pharmacological therapy for osteopenia and sarcopenia, few studies compare resistance and aerobic protocols, especially with systemic inflammatory markers. This study evaluated the effects of aerobic and resistance training on physical performance, femoral trabecular bone quality (micro-computed tomography), serum inflammatory markers (IL-1β, IL-6, TNF-α, IL-10) and gastrocnemius muscle area in ovariectomized (OVX) female mice.

Method: Sixty-four c57bl/6 mice were divided into OVX and SHAM groups and subjected to sedentary, resistance (climbing) or aerobic (treadmill) protocols for 8 weeks.

Results: Training reduced body mass (p < 0.001) in trained animals compared to sedentary. Bone quality was higher in trained groups versus sedentary. OVX increased TNF-α, but training did not alter it. IL-1β levels were higher in climbing than treadmill groups, and IL-6 increased with OVX and aerobic training (p < 0.001). IL-10 was elevated in the SHAM and climbing groups (p < 0.01). Gastrocnemius muscle area increased in both trained groups (p < 0.001) with no differences between modalities.

Conclusion: Aerobic and resistance training improved bone quality and muscle area in OVX mice, with climbing training uniquely linked to increased IL-10 levels.

Objective: Menopause, typically occurring between ages 45 and 55 years, is a natural life stage marked by hormonal changes that can affect the symptom burden, quality of life and chronic disease risk. While not a disease, the transition often requires individualized, holistic care. Lifestyle medicine - encompassing healthy eating, physical activity, mental well-being, avoidance of risky substances, restorative sleep and healthy relationships - offers a promising non-pharmacological strategy to optimize health during this period.

Method: A systematic literature search was conducted in PubMed, Embase, Scopus and Web of Science (January 2000-December 2024) using the following keywords and combinations: 'menopause', 'lifestyle medicine', 'healthy eating', 'physical activity', 'mental wellbeing', 'avoidance of risky substances', 'restorative sleep', 'healthy relationships', 'weight management', 'chronic disease prevention', 'health equity and access' and 'general health frameworks'. Peer-reviewed human studies in perimenopausal, menopausal or postmenopausal women evaluating one or more lifestyle medicine pillars were included. Data were extracted on study design, population, interventions, outcomes and main findings.

Results: Lifestyle medicine interventions were associated with reductions in vasomotor symptoms, improved sleep quality, enhanced mental well-being, healthier weight regulation, and reduced cardiometabolic and osteoporosis risk. Multidisciplinary, person-centered approaches improved adherence and patient-reported outcomes. Strategies were cost-effective, adaptable and beneficial for long-term disease prevention across diverse populations.

Conclusion: Lifestyle medicine offers a foundational, evidence-based framework for equitable menopause care. Integrating these strategies into clinical guidelines and public health policy can improve quality of care, empower women to manage their health and reduce disparities in access. Collaborative action among healthcare providers, policymakers and communities is essential to maximize impact.

Objective: Sexual dysfunction and sexual dysfunctional beliefs are common problems in postmenopausal women. The purpose of this study was to evaluate the effect of sexual counseling based on the BETTER (Bring up, Explain, Tell, Time, Educate, Record) model in these women.

Methods: The randomized controlled trial study was conducted with 106 postmenopausal women in 2023. Eligible women were assigned randomly to the intervention and control groups. Accordingly, the intervention group received two individual counseling sessions based on the BETTER model. The Female Sexual Function Index (FSFI) and the Sexual Dysfunctional Beliefs Questionnaire (SDBQ) were used for collecting data at baseline and 4 weeks after the intervention.

Results: The sexual function score in the intervention group increased from 15.97 to 18.51 (p = 0.001), and the score of sexual dysfunctional beliefs decreased from 33.80 to 24.86 (p = 0.001). In the control group, the sexual function score decreased from 19.09 to 18.59 (p = 0.032) and the sexual dysfunctional beliefs score increased from 31.83 to 32.18 (p = 0.111).

Conclusion: Sexual counseling based on the BETTER model has demonstrated efficacy in promoting sexual function and diminishing sexual dysfunctional beliefs. Consequently, the use of this model in the sexual health counseling of postmenopausal women can be considered.

Trial registration: IRCT20150128020854N12; October 12, 2023. Iranian Registry of Clinical Trials: https://irct.behdasht.gov.ir/user/trial/71128/view.

Objective: This study aimed to assess the risk factors associated with sarcopenia and identify risk profiles through cluster analysis in postmenopausal women treated at specialized outpatient clinics.

Methods: A retrospective cross-sectional study evaluated data from 287 postmenopausal women. Sarcopenia was determined by handgrip and gait speed testing. Cluster analysis was applied to identify risk subgroups, and logistic regression to identify factors associated with sarcopenia.

Results: Sarcopenia was identified in 18.50% of women. Advanced age (odds ratio [OR] = 1.12; 95% confidence interval [CI]: 1.07-1.16; p < 0.01), number of pregnancies (OR = 1.14; 95% CI: 1.00-1.29; p = 0.04), hip Fracture Risk Assessment Tool (FRAX) (OR = 1.29; 95% CI: 1.12-1.49; p < 0.01), systemic arterial hypertension (OR = 3.20; 95% CI: 1.66-6.17; p < 0.01) and multiple comorbidities (OR = 2.46; 95% CI: 1.19-5.09, p = 0.01) were associated with higher risk for sarcopenia. Cluster analysis revealed an increased risk profile for women who were aged over 70 years, multiparous, hypertensive, with hip FRAX greater than 3% and with major fractures greater than 6%.

Conclusion: Postmenopausal women with sarcopenia are more likely to have fragility fractures at 10 years, to be older, multiparous and hypertensive, and to have multiple comorbidities.