Climacteric最新文献

After a long and challenging history, there have finally been major breakthroughs in the development of effective obesity medications. Agents that act at receptors of one or more gut hormones are achieving unprecedented weight reductions and improvements in cardiovascular risk factors, comparable to some bariatric surgical procedures. Importantly, there is evidence of beneficial effects on a growing range of conditions, including type 2 diabetes, fatty liver, chronic kidney disease, obstructive sleep apnea and cardiovascular disease. Barriers to access need to be overcome to allow the standard of care for obesity to match that of other chronic diseases.

Energy-based treatments, including the fractional CO₂ laser, have been widely used for treatment of genitourinary symptoms associated with menopause. With the availability of data from seven double-blind sham-controlled randomized trials, the evidence does not support the fractional CO₂ laser as an efficacious treatment for genitourinary syndrome of menopause (GSM). A 2024 meta-analysis of these trials demonstrated that the symptom with greatest absolute improvement was dyspareunia at 16.3%, although not statistically significant. This improvement is far less than previously anticipated based on prospective data that suggested promising improvements of more than 90% satisfaction following laser treatment. Other data, including those from unblinded studies which are subject to a placebo effect, and outcomes that are not participant-reported including the appearance of the vagina on examination and histology, are not reliable in determining efficacy of laser treatment for GSM. While there may be a clinical effect of laser over sham treatments for GSM, the effect is unlikely to be clinically meaningful. Until we define and demonstrate a minimal clinically important difference in a robust and appropriately powered study, the laser should not be used in a clinical context for GSM.

Objective: The concurrent presence of multiple chronic diseases, termed multimorbidity, is increasingly prevalent among patients with chronic illnesses. This phenomenon is particularly pronounced in middle-aged women, yet has not received adequate attention. The objective of this study was to investigate the pattern of multimorbidity and its changes over time in perimenopausal women.

Methods: A longitudinal study was conducted on the coexistence of chronic diseases in 3990 middle-aged women aged 40-65 years. The primary analytical tools were association rule mining and cross-lagged panel modeling, applied to the comprehensive medical examination data of the cohort.

Result: At the first medical examination, 77.72% of participants were diagnosed with two or more chronic diseases, a figure that rose to 86.98% by the last examination. The most frequently observed multimorbidity combination pair under strong association rules is obesity and dyslipidemia. Additionally, the findings indicated that central obesity significantly influences lipid composition.

Conclusion: This study highlights the elevated prevalence of multimorbidity in perimenopausal women and the added complexity of endocrine-related disorders at this life stage. There is an urgent need to develop personalized health management strategies for this demographic and to monitor and intervene in their health status in order to achieve healthy aging for perimenopausal women.

About 50% of postmenopausal women experience symptoms of vulvovaginal atrophy (VVA) including vulvovaginal dryness, burning, itching and dyspareunia as a natural physiological consequence of hypoestrogenism. These symptoms can have a major impact on quality of life and sexual function. VVA is a component of genitourinary syndrome of menopause, also associated with urinary tract problems such as frequent urination, urge incontinence and recurrent urinary tract infections. Vaginal low-dose estrogen is an effective treatment for symptoms of VVA, overactive bladder and urge incontinence, and prevents recurrent urinary tract infections. In contrast, systemic menopausal hormone therapy seems to worsen urinary incontinence. Women with breast cancer treated with aromatase inhibitors often have severe symptoms of VVA and urinary tract problems. Non-hormonal lubricants and moisturizers should be the first-line treatment in these patients. However, there is no evidence of increased cancer recurrence by low-dose vaginal estrogen in breast cancer survivors. When non-hormonal products are ineffective, low-dose vaginal estrogen could be considered in collaboration with the woman's oncologist. An individualized approach is required for the management of VVA and urinary tract symptoms. As VVA is a chronic condition, women should not be denied long-term use of vaginal estrogens if the treatment is of benefit to them.

The menopause experience is unique to people with ovaries who attain an age at which functioning follicles are depleted. Unlike male reproductive aging, menopause is accompanied by a definable reproductive milestone in that menstrual periods cease and the failure of follicle growth results in a large drop in circulating estrogen and no further ovarian production of progesterone. While the focus on menopause has largely been centered on this absence of hormone production, the most dynamic changes in symptoms and health markers begin before the final menstrual period, and merit attention. Vasomotor symptoms, the most common symptom of menopause and the primary symptom that drives women to seek treatment, peak in frequency and prevalence in the late menopause transition, when women are still having menstrual periods. Body composition and adverse lipoprotein and lipid changes also worsen most acutely in the late transition, and then assume a slower, age-related trajectory of change. Multiple processes that worsen across the transition restabilize after it is over. The notion that the menopause transition is an adaptive process for women has scientific merit and suggests that facilitating this adaptation and recognizing its implications may represent the next phase of progress in the field.

Objectives: This study aimed to describe treatment patterns among naturally menopausal women from the USA, the UK and Germany.

Methods: Using health claims (the USA) and electronic health records (the UK and Germany), women aged 40-65 years with a first record of natural menopause (index date) from 2009 to 2022 were identified. Women with a history of bilateral oophorectomy, total hysterectomy, endocrine therapy for breast cancer or hormone/non-hormone therapy for menopausal symptoms were excluded. Treatments evaluated following the index date were hormone therapy, benzodiazepines, antidepressants, anticonvulsants and the antihypertensive clonidine.

Results: In total, 1,260,742 (the USA), 214,374 (the UK) and 124,542 (Germany) women were included, and treatments were recorded in 38.8%, 33.4% and 28.8%, respectively. Among these, the majority received one treatment class, mostly hormone therapy (44.2% for the USA, 41.1% for the UK, 92.6% for Germany), benzodiazepines (25.3% for the USA, 6.8% for the UK, 2.2% for Germany) and antidepressants (18.6% for the USA, 33.5% for the UK, 4.1% for Germany). Discontinuation rates at 6 months from starting initial treatment were 75.0-88.0% for hormone therapy, 65.0-85.0% for antidepressants and ≥98% for benzodiazepines. Treatment switches occurred in 25.4% (the USA), 21.8% (the UK) and 1.7% (Germany).

Conclusions: Continuation rates with current treatments for women experiencing natural menopausal symptoms are low, indicating an unmet need for effective and acceptable therapies.

Objective: This study aimed to investigate socio-demographic, reproductive, lifestyle and health factors associated with the age of natural menopause in the Brazilian context.

Method: The cross-sectional study was conducted with data from 3538 women who reported natural menopause from the baseline (2008-2010) to the date of the second visit (2012-2014) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The outcome of the study was the age of natural menopause. The association between socio-demographic, reproductive, lifestyle and health characteristics and the age of menopause were investigated using multiple linear regression.

Results: The mean age of natural menopause was 49.5 years. The following conditions were associated with a younger age at onset of menopause: lower education level, historically marginalized races/skin colors and smoking. By contrast, multiparity and contraceptive use for less than 3 years were associated with a higher mean age at the onset of menopause, related to no previous pregnancies and no contraceptive use.

Conclusion: The study findings provide relevant support for the development of public policies aimed at preventing early menopause and promoting comprehensive and continuous care for women's health.

The decline in bone mineral density (BMD) is common among older adults, especially due to reduced sex hormone production in women (menopause). Understanding the impact of resistance training on bone tissue is essential for developing effective strategies for the prevention and treatment of this condition. This study investigated the effects of resistance training on BMD in rodent models of osteopenia induced by ovariectomy. The protocol was registered on PROSPERO (CRD42024549460). Inclusion criteria focused on ovariectomized (OVX) female rats and mice engaged in resistance training, with no restrictions on duration, frequency or intensity. A comprehensive search across six databases (and grey literature) identified 314 articles, of which 18 were selected. Resistance training, compared to control groups, significantly increased BMD, particularly in the femur and tibia. The included studies employed various training protocols, such as climbing, jumping and squatting, with variations in training duration and intensity. The meta-analysis demonstrated standardized mean differences of 3.02 (95% confidence interval 1.81-4.24) for climbing and 1.27 (95% confidence interval 0.72-1.82) for jumping protocols, quantifying the extent of improvement in BMD - particularly in the femur and tibia - observed in OVX rodents subjected to resistance training, as compared to sedentary controls. These findings suggest that resistance training positively impacts bone remodeling and may help restore bone microarchitecture in postmenopausal conditions.

Objective: Premature ovarian insufficiency (POI) is associated with reduced quality of life and increased health risks. While hormone therapy (HT) is standard treatment, some women seek other options to treat its sequelae. This review explores the role of complementary therapies for POI.

Method: A systematic search of four databases up to January 2024 identified randomized controlled trials, systematic reviews, meta-analyses and umbrella reviews that examined the use of complementary therapies by women with POI. Outcomes included menopausal symptoms, gonadotropins, antral follicle count, ovarian volume and quality of life. Study quality was evaluated using Cochrane Risk of Bias and A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2).

Results: The search identified 1869 citations, with nine studies meeting the inclusion criteria. Findings suggest that Chinese herbal medicine and acupuncture may alleviate menopausal symptoms and regulate gonadotropins in women with POI, although evidence is very limited. There is insufficient evidence for other complementary therapies for POI.

Conclusion: While Chinese herbal medicine may improve menopausal symptoms, there is insufficient evidence specific to POI. There is a clear need for additional and rigorous research on the efficacy and safety of complementary therapies for POI. Evidence does not support complementary medicines as replacements for HT.