Climacteric最新文献

The effectiveness of various exercise types in improving sleep quality in menopausal women remains controversial. This network meta-analysis was designed to evaluate and rank the efficacy of five exercise modalities on sleep quality in peri-postmenopausal women. Five English databases and three Chinese databases were searched for randomized controlled trials (RCTs) published from inception to July 2024. Pairwise meta-analysis and frequentist network meta-analyses were performed based on the random effects model. The analysis revealed that younger menopausal women (age ≤55 years) (standardized mean difference [SMD] = -2.00; 95% confidence interval [CI] [-2.70, -1.31]), those with sleep disorders (SMD = -2.29; 95% CI [-2.79, -1.78]) and those from Asia (SMD = -2.50, 95% CI [-3.62, -1.38]) were able to derive greater health benefits. Flexibility exercise (low certainty) and aerobic exercise (low certainty), combined exercise (moderate certainty) and mind-body exercise (moderate certainty) significantly improved sleep quality. Combined exercise showed the highest efficacy (surface under the cumulative ranking curve [SUCRA] = 93.5%), followed by flexibility exercise (SUCRA = 76%), and these exercises also showed a positive effect on women's quality of life (SMD = 0.49; 95% CI [0.13, 0.84]; p = 0.007). Future research should develop more acceptable exercise intervention models and use combined and flexibility exercises to explore the optimal parameters of exercise for menopausal women.

Objective: This study aimed to characterize menopause timing, type (natural or surgical) and symptoms in US-based South Asian women.

Method: The study included 405 women of South Asian descent aged between 43 and 78 years who participated in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Menopause experiences were assessed with structured questionnaires. The study described sociodemographic, health and lifestyle characteristics and menopause symptoms by menopause stage, type (natural or surgical) and timing, and tested for differences using chi-square and Fisher's exact tests.

Results: Most women (92%) were postmenopausal, and 7% reported surgical menopause. The mean recalled age at natural menopause was 48 years, and the median recalled age was 49 years. Nearly a third of women experienced premature/early menopause (age ≤45 years). Overall, women reported hot flashes of any intensity (from mild to extremely bothersome) in the past month (30%), urinary incontinence in the past 12 months (37%) and depressive symptoms (15%). Menopause symptoms varied by menopause timing and type (natural vs. surgical). Particularly, the point prevalence of bothersome hot flashes of any intensity in the past month, urinary leakage in the past 12 months and depressive symptoms in the past week was 28%, 37% and 14%, respectively, for women who had natural menopause, and 40%, 48% and 20%, respectively, for surgical menopause.

Conclusion: Women of South Asian ancestry reported an earlier recalled age at natural menopause than the average age of 52 years reported in the USA. The burden of hot flashes of any intensity, urinary and mood disturbances suggested distinct postmenopause experiences.

Objective: Postmenopausal hypoestrogenism may cause significant changes in the oral cavity, interfering with inflammatory mechanisms such as salivary secretion. This study aimed to compare the salivary flow, pH levels and prevalence of dry mouth in postmenopausal women treated with hormone replacement therapy (HRT), those treated with selective serotonin reuptake inhibitors (SSRIs) and those without treatment.

Methods: Ninety postmenopausal women participated in the study. Of these, 30 used HRT, 30 used SSRIs and 30 did not receive any treatment (control). Salivary flow was measured using stimulated sialometry, while the pH level was measured using pH strips. Meanwhile, a questionnaire was used to assess for xerostomia.

Results: The salivary flow measurements were 1.66 ± 0.49 ml/min for the HRT group, 1.23 ± 0.50 ml/min for the SSRI group and 1.68 ± 0.65 ml/min for the control group (p = 0.005 for comparison). The pH values were 7.13 ± 0.43, 7.0 ± 0.26 and 6.97 ± 0.41 for the HRT, SSRI and control groups, respectively. Xerostomia was reported in 60% of women receiving HRT, 46.7% receiving SSRIs and 26.7% of the controls (p = 0.033).

Conclusion: Women using SSRIs had lower salivary flow than the HRT or control group. However, xerostomia was more prevalent in women receiving HRT.

Objective: Environmental consciousness and the role of plastic waste are increasing. Topical vaginal estrogen prescription can be prescribed with one reusable plastic applicator or multiple single-use plastic applicators. User preference about the role of plastic in personal healthcare is not fully understood. This study aimed to explore patients' perspectives on the applicator and environmental considerations.

Method: A mixed-methods questionnaire was employed to assess users' experience with topical vaginal estrogen applicators and their views on the environment.

Results: Ninety-two respondents had previously used estriol 0.1% cream and 77 had used estradiol 10 μg vaginal inserts. The mean age of participants was 67.3 years. The mean duration of use was 36.5 months, and the discontinuation rate was 26.1% and 29.9% for estriol 0.1% cream and estradiol 10 μg vaginal insert users, respectively. Satisfaction with applicators and ease of use were similar in both groups. There was a higher report of the product being 'messy' (38.0% vs. 18.2%; p = 0.026) and 'not hygienic' (48.9% vs. 18.2%; p < 0.001) by estriol 0.1% cream users compared to estradiol 10 μg vaginal insert users. Women aged <65 years demonstrated a greater concern about plastic use and the impact on the environment compared to women aged over 65 years (81.0% vs. 56.9%; p = 0.002). The younger cohort showed a preference for reusable applicators (66.2%) compared to single-use applicators (33.8%) (p = 0.005). There was no statistically significant difference in preference for women aged over 65 years.

Conclusion: This study demonstrates that younger postmenopausal women showed greater concern for plastic waste and its impact on the environment, with a preference for reusable products. Manufacturers of health products and prescribers should be aware of this growing trend. With similar overall satisfaction and side-effect profiles, users should be made aware of the different types of applicators available to help support an informed decision.

The characteristics of menopause symptoms exhibit considerable variation across different countries and regions. Understanding these variations is crucial for developing strategies to manage the menopausal symptoms specific to each region. A comparative analysis of menopausal symptoms between the East and the West is presented, based on a review of the epidemiological literature and data. In the East, the age of menopause and the onset of the menopausal symptoms were observed to occur slightly earlier than in the West. The two most commonly reported menopausal symptoms in western countries are hot flushes and sleeplessness, whereas Asian women mostly report somatic symptoms. The reported prevalence of menopausal symptoms varies considerably and differs substantially between the studies. These variations may be related to research methods, sample size, ethnicity, culture, socioeconomic differences, menopausal status and other factors.

Objective: This study aimed to evaluate the association between obesity and cognitive impairment.

Methods: This study is a sub-analysis of an observational, cross-sectional study in nine Latin American counties. Sociodemographic, clinical and anthropometric data were collected, and cognition was assessed using the Montreal Cognitive Assessment (MoCA) tool in 722 postmenopausal women.

Results: The mean age, body mass index (BMI) and years of education of the cohort were 56.9 years, 26.8 kg/m² and 13.6 years, respectively. Women with cognitive impairment, compared to those without, had a higher BMI (27.8 ± 5.9 vs. 26.6 ± 4.9 kg/m², p = 0.037), had more children (3.1 ± 2.4 vs. 2.5 ± 1.7, p = 0.023), experienced more severe menopausal symptoms (56.3% vs. 31.9%, p < 0.001) and presented more comorbidities (60.0% vs. 43.8%, p = 0.006). They also had fewer years of study (10.8 ± 5.1 vs. 13.9 ± 4.9 years, p = 0.001), were less physically active (35.0% vs. 49.1%, p = 0.018) and were less likely to use menopausal hormone therapy (MHT) (11.3% vs. 28.8%, p = 0.001). In binary logistic regression analysis, BMI ≥ 35.0 kg/m² (odds ratio [OR] 2.27, 95% confidence interval [CI] 1.08-4.76) and severe menopausal symptoms (OR 2.10, 95% CI 1.29-3.43) were associated with cognitive impairment. In the model, factors related to lower risk were ever use of MHT (OR 0.44, 95% CI 0.21-0.92) and having more years of education (OR 0.38, 95% CI 0.20-0.64).

Conclusion: Severe obesity and severe menopausal symptoms increased the risk of cognitive impairment in postmenopausal women, while higher education and ever use of MHT were protective factors.

Objective: Menopause has a significant effect on a woman's quality of life, which leads to physical illnesses and mental stresses. Social media listening (SML) studies reveal the experiences of users, sources of information on disease experiences and health dynamics in populations. The aim of this study was to assess the overview of portraits, complaints, symptom distribution and treatment methods of menopausal women through SML.

Methods: An info-surveillance study was conducted wherein the search was performed in the question and answer (Q&A) search and online consultation forums. Using the Python + Scrapy crawl technology tool, the search involved single or combined keywords related to menopause, including population, diagnosis, symptom, treatment and treatment comparison.

Results: Data were extracted from three menopause-related Q&A search platforms and 15 online consultation forums. Menstrual disorders, menopausal symptoms, and menopausal examination and treatment were the high-frequency keywords while irritability, insomnia and hot flashes were the most commonly mentioned symptoms. A total of 76.62% of menopausal women had a willingness for tier 3 hospitals, with gynecology being the most preferred department chosen by the majority. Among the 359 women reporting hormone treatment to be effective, 90.96% women showed an improvement in symptoms, and the rest had improvement in emotions, various improvements and overall improvement.

Conclusion: The results of this SML study indicate that menopausal women in China have a strong urge for menopause-related knowledge but are not well informed. Thus, there is a need for science popularization to sensitize menopausal women to choose the right department, and explore the long-term management of menopause and menopausal hormone therapy.

Objective: Studies have shown that oral estrogen with or without progestogen increases the risk of venous thromboembolism (VTE). Recent data suggest that transdermal estrogen confers little to no increased risk of VTE. There is no systematic review that examines menopause hormone therapy (MHT) use in women with risk factors for VTE. This systematic review therefore aims to summarize the evidence in this population.

Method: The OVID Medline, Embase, PubMed and CENTRAL online databases were searched. A total of 762 studies were screened and 10 were included in the study.

Results: Six studies were case-control studies, two were randomized controlled trials (RCTs), one was an RCT that contained a nested case-control study and one was a cohort study. Studies were heterogeneous in their definition of menopause, dose, form and route of administration of MHT, and the underlying VTE risk factor being assessed. In women with risk factors for VTE, transdermal estrogen conferred no increased risk of VTE. Oral estrogen alone has the next safest profile, and oral estrogen plus a progestogen conferred the highest increased risk of VTE.

Conclusion: Transdermal MHT appears safe in women with risk factors for VTE. Oral MHT, notably oral estrogen plus a synthetic progestogen, does increase relative risk. More contemporary data are required to confirm these findings.

Objective: Menopausal hormone therapy (MHT) is the most effective treatment for relieving menopausal symptoms. However, many women avoid this therapy due to fear, and in Brazil numerous cities lack access to this treatment in the public health system. This study aimed to investigate prescribing habits regarding MHT among gynecologist-obstetricians in the Brazilian public versus private health systems, and to identify the main barriers to its use.

Method: This descriptive cross-sectional study utilized a quantitative approach. Gynecologist-obstetricians from across Brazil were invited to complete a structured electronic questionnaire assessing their prescribing practices in both the public and private health sectors.

Result: A total of 433 valid responses were analyzed. Among them, 51.5% of participants reported providing care to climacteric patients in the public health system, with 46.2% working in both sectors. Among physicians practicing in both settings, 76.5% reported prescribing MHT more frequently in the private sector. The main barriers to MHT prescription in the public system were treatment cost (68.2%) and lack of availability of free medication (61.4%), while in the private system the predominant barriers were fear of therapy-related risks (93.6%), especially cancer. Only 27.8% reported free access to MHT in their cities.

Conclusion: The findings indicate that MHT prescribing practices in Brazil are still significantly influenced by structural barriers in the public sector and by negative perceptions in the private sector. Interventions aimed at expanding access and educating both physicians and patients are essential to ensure safe and equitable use of MHT.