Climacteric最新文献

Objective: Ovarian aging significantly impacts women's overall aging, affecting various systems including the musculoskeletal system. This study investigates the correlation between ovarian function and handgrip strength (HGS) across reproductive aging stages and their relation to health-related quality of life (HRQoL).

Method: A cross-sectional study was conducted with female participants spanning all stages of ovarian function. HGS was measured using a dynamometer, and ovarian function was assessed via hormone levels (estradiol [E2], follicle stimulating hormone [FSH], luteinizing hormone [LH], prolactin [PRL], progesterone [P4] and testosterone). HRQoL was evaluated using the Sarcopenia-specific Quality of Life questionnaire (SarQoL). Data analysis involved analysis of variance and Pearson's correlations, adjusted for confounding factors.

Results: The prevalence of possible sarcopenia increased from 3.8% in premenopausal women to 10.3% in postmenopausal women. After adjusting for covariates (age, SarQoL, FSH, LH, FSH/LH ratio, PRL, E2, P4 and testosterone), the negative correlation between HGS and the Kupperman Menopausal Index (KMI) was no longer significant. However, the positive correlation between HGS and the SarQoL remained significant in both the overall population and the postmenopausal group. The negative correlation between HGS and FSH was no longer significant after controlling for age, KMI, LH and E2; however, it persisted after controlling for the SarQoL, FSH/LH ratio, PRL, P4 and testosterone.

Conclusion: HGS is positively correlated with the SarQoL and negatively correlated with age in the overall population. No significant association was found between HGS and testosterone, E2, LH or FSH/LH ratio. Further research is needed to clarify the relationship between HGS and the KMI or FSH.

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.

This invited review is a synthesis of a plenary lecture presented at International Menopause Society Conference in Melbourne 2024. The focus was to set the historic context within which research about women in the workplace must be approached. It is exciting for occupational health researchers to see expansion of the evidence about health and work but we urge menopause and work researchers to collaborate with occupational health colleagues. The growing literature suggests that most women do not experience problems coping with their menopause in the workplace. Most research, however, fails to consider any workplace factors or even the nature of the job women are needing to do. Where studies have focused on occupational groups, they have focused on nurses or other professional/leadership groups. So far, it appears that women's ability to cope is influenced by the number of symptoms, severity of symptoms, and workplace and personal psychosocial factors. However, the problems with coping may be greater for disadvantaged women doing less well-paid work with less flexibility and autonomy. The same women probably have less access to appropriate advice, treatment and support. Researchers must focus on women at highest risk and take a nuanced approach to optimize support without increasing gender-based discrimination.

Objective: Whether blood sex hormone concentrations predict cognitive decline and incident dementia in older women is uncertain. The Sex Hormones in Older Women (SHOW) study is a prospective cohort study of Australian women, aged at least 70 years, without cognitive impairment.

Methods: Sex hormones were measured by liquid chromatography-tandem mass spectrometry, and comprehensive cognitive testing was performed at baseline and 3 years later.

Results: Of the 6358 participants who had sex hormones measured, 4444 women (median age at baseline 74 years [Q1-Q3 71.7-77.5]) provided data for cognitive analyses. The findings were limited to a decline in executive function and verbal fluency was positively associated with the highest quartiles of estrone (odds ratio [OR] = 1.21, 95% confidence interval [CI] 1.01-1.45, p = 0.04) and dehydro-epiandrosterone (DHEA) (OR = 1.21, 95% CI 1.01-1.45, p = 0.04), compared with the lowest quartiles. Estrone and DHEA were not associated with any other cognitive decline. Testosterone was not associated with cognitive decline. In an exploratory analysis, cognitive decline was not different in women who had estradiol below the limit of detection (66% of women) compared with women with measurable estradiol. Over a median 4.1 years of follow-up (22,518 person-years), 121 (2.2%) developed dementia; an incident rate of 5.3 per 1000 person-years. There were no associations between any hormone and incident dementia.

Conclusions: The finding of a greater likelihood of a decline in executive function and verbal fluency in community-dwelling older women with the highest blood concentrations of DHEA and its metabolite estrone need reaffirmation and their clinical significance should be further investigated. These findings do not support use of estrogen or DHEA therapy to prevent cognitive decline in older women.

It was a true honor to be invited as President to deliver the Pieter Van Keep oration at the 2024 International Menopause Society (IMS) Congress in Melbourne, Australia. There was never any doubt that the topic of my lecture would be premature ovarian insufficiency (POI). POI is a condition which has been neglected for far too long given its greater global prevalence than originally estimated and its implications to the sufferers, both in terms of quality of life and long-term well-being. The hope is that we are now entering a new era of awareness given the recent update of the European Society of Human Reproduction (ESHRE) POI guideline, achieved through a partnership of the ESHRE, American Society for Reproductive Medicine (ASRM), Centre for Research Excellence in Women's Health in Reproductive Life (CRE WHiRL) at Monash University and IMS with support from numerous global stakeholder organizations. Whilst as a minimum the update of the guideline is expected to improve clinical management of this condition, the process has also identified key areas of much-needed research, where currently only practical guidance can be given due to the lack of data. The aim of my Pieter Van Keep lecture, and therefore this article, was not to replicate the extensive work already conducted to systematically review the literature for the guideline. The aim was to provide a state-of-the-art commentary highlighting the key controversial topics regarding this distressing condition, and how these are being addressed, or should be addressed in the future, for the sake of sufferers and their families.

Cardiovascular disease (CVD) remains the leading cause of death globally, despite significant public health efforts. The identification and targeting of modifiable risk factors - including hypertension, dyslipidemia, diabetes mellitus, smoking and obesity - have led to significant improvements in patient outcomes over the past 60 years. However, current strategies based on this model have been shown to underestimate CVD risk in women and they are less frequently targeted compared to men. In addition, female-specific biological differences known to contribute to CVD are frequently understudied or excluded from risk stratification efforts. This review explores the unique epidemiological burden, pathobiology and outcomes of CVD in women; the influence of traditional and sex-specific risk factors; and both diagnostic and therapeutic strategies that may improve clinical outcomes in the future.

Objectives: The experiences and needs of women undergoing the menopausal transition vary widely amongst countries in the Asia-Pacific. Thus, practices and challenges amongst clinicians treating perimenopausal and menopausal women in the Asia-Pacific also vary. This study aims to characterize the diverse practices and challenges in managing the menopause across the Asia-Pacific.

Methods: Clinicians in the member organizations of the Asia-Pacific Menopause Federation were invited to participate in a questionnaire seeking information on their usual practices and the challenges faced in managing the menopause.

Results: A total of 39 clinicians from 14 countries in the Asia-Pacific Menopause Federation responded to the questionnaire. While there were similar practices in assessment, clinicians' preferences in prescribing menopausal hormonal therapy varied widely. Challenges they faced included cultural and literacy barriers amongst their patients, a lack of support for menopause care in their healthcare systems and limited availability of novel therapies.

Conclusion: Practices in managing the menopause vary across the Asia-Pacific. Further research and governmental support are needed to establish consensus on managing the menopause and supporting midlife women's health issues in the Asia-Pacific.

Objective: Kisspeptin/neurokinin/dynorphin (KNDy) signaling links reproductive and thermoregulatory systems, and improvements in menopausal flushing are reported with neurokinin 3 receptor (NK3R) antagonists. A rise in brainstem activity preceding a flush has been proposed as its functional origin, with subsequent activity in the insula and prefrontal cortices reflecting individual perception. Using functional magnetic resonance imaging (fMRI), this study investigated the central effect of the NK3R antagonist MLE4901 during a flush, particularly functional connectivity changes in the salience network.

Method: Five postmenopausal women with flushes completed a 1-week flush diary prior to baseline fMRI, during which hot flushes were triggered by heating. Diaries were continued during 7 days of treatment with the NK3R antagonist MLE4901, with repeat fMRI on day 7. Sternal monitors recorded objective flushing before each fMRI. Connectivity changes in the salience network post flush were assessed.

Results: Treatment with MLE4901 reduced the subjective flush frequency (from median 6.9 to 1.1 per day; p = 0.02) without changes in objective flushes. Treatment decreased right anterior insula connectivity, which correlated significantly with decreased subjective flushing.

Conclusion: This pilot study demonstrates decreased connectivity in the salience network during NK3R antagonist treatment. This may indicate areas of interest for further targeted fMRI studies and mechanistic investigation of this novel treatment for flushing.