Menopause: The Journal of The North American Menopause Society最新文献

Objective: To evaluate the efficacy of nonablative capacitive-resistive monopolar radiofrequency on sexual function and vaginal health in postmenopausal women with genitourinary syndrome of menopause.

Methods: This was a single-blind, randomized, controlled clinical trial. The participants were randomly assigned to receive six weekly sessions of capacitive-resistive monopolar radiofrequency (n=32) or sham treatment (n=30). Sexual function was assessed using the Female Sexual Function Index (FSFI) and vaginal health was assessed using the Vaginal Health Index (VHI). The estrogenic status was determined by vaginal cytology, which involves calculating the proportions of basal, intermediate, and superficial cells. Assessments were conducted at baseline, post-treatment, and 12-week follow-up.

Results: Compared with the control group, the intervention group showed significantly greater improvements in the Female Sexual Function Index and Vaginal Health Index at post-treatment and at the 12-week follow-up. FSFI mean changes were 5.86 versus 1.33 at posttreatment (P<0.001) and 4.41 versus -0.41 at 12-week follow-up (P=0.011). VHI mean changes were 4.75 versus -0.03 at post-treatment (P<0.001) and 6.90 versus -0.66 at follow-up (P<0.001). The effect sizes were moderate to large for the FSFI (Cohen's d >0.77, 95% CI, 0.25-1.29) and large for the VHI (d >3.49, 95% CI, 2.68-4.28). No significant changes were observed in estrogenic status, and no adverse events were reported.

Conclusion: Capacitive-resistive monopolar radiofrequency significantly improved sexual function and vaginal health in women with genitourinary syndrome of menopause, thereby supporting its use as a safe, nonhormone treatment option.

Objectives: Early-onset menopause has been increasingly observed among women living with HIV (WLWH). However, limited data exist on its prevalence and determinants in sub-Saharan Africa. This study aimed to determine the prevalence and predictors of self-reported early-onset menopause among WLWH in Botswana.

Methods: This cross-sectional analysis was conducted as a substudy within the InterCARE cluster-randomized controlled trial among women with HIV and hypertension aged ≥18 years, at 14 HIV clinics in Botswana. Data were collected between January and September 2023 and included sociodemographic, clinical, reproductive history, and HIV parameters. Early-onset menopause was defined as self-reported cessation of menstruation for at least 12 months before the age of 45, unrelated to surgery or pregnancy. A generalized estimating equation model was used to identify independent predictors of early menopause.

Results: The mean age (SD) of the 1,088 women enrolled was 59.1 (7.2) years, with 23.7% (n=258) having experienced early-onset menopause. The mean age (SD) at menopause overall was 47.4 (5.5) years and that for early-onset menopause was 40.3 (4.6) years. In adjusted analysis, the only predictor of early-onset menopause was HIV diagnosis before age 35 years (aRR=1.46; 95% CI: 1.06-2.01; P=0.020). CD4 count was inversely associated with the risk of early-onset menopause (aRR 0.98; 95% CI: 0.96-1.00; P=0.045).

Conclusions: Early-onset menopause is relatively common among WLWH in Botswana and is associated with a younger age at HIV diagnosis. These findings highlight the need for integrated reproductive and HIV care, including screening and management of early-onset menopause to prevent menopause-related complications.

Objective: This study aimed to evaluate the effect of Emotional Freedom Techniques (EFT) on menopausal symptoms, quality of life, and depression.

Methods: The study was designed as a three-arm randomized controlled trial with a pretest-posttest design, conducted among women in menopause. The sample included 35 participants in the EFT group, 35 in the sham group, and 35 in the control group, totaling 105 participants. The intervention was administered to the EFT and sham groups once weekly for four weeks. Data were collected using the Personal Information Form, Menopause Symptoms Rating Scale (MSRS), Menopause-Specific Quality of Life Scale (MSQLS), and Perimenopausal Depression Scale (Meno-D). Data analysis was performed using χ2 tests, paired-samples t-tests, one-way ANOVA, and two-way mixed ANOVA for repeated measures.

Results: After the intervention, statistically significant differences were observed in the mean posttest scores of the MSRS (EFT: 10.14±5.96; sham: 16.80±7.21; control: 17.74±5.79), MSQOL (EFT: 50.31±24.69; sham: 57.91±24.43; control: 75.51±24.87), and Meno-D (EFT: 7.69±5.02; sham: 13.31±7.60; control: 15.40±6.17) among the EFT, sham, and control groups (P<0.05). The EFT group had the lowest MSRS and Meno-D scores, with significant differences observed between the EFT group and both the sham and control groups (P<0.05). The EFT group also had the lowest MSQOL score, with significant differences identified between the control group and both the sham and EFT groups (P<0.05). Repeated measures analyses revealed that the time-dependent changes between groups were statistically significant (P<0.05).

Conclusion: EFT can be considered an effective complementary intervention for reducing menopausal symptoms, alleviating depression, and improving quality of life in women. Incorporating low-cost and feasible techniques such as EFT into women's health services is recommended.

Objective: Menopausal hormone therapy (HT) is effective for alleviating vasomotor symptoms but remains controversial regarding long-term safety, particularly in women over 65. Despite guidelines recommending initiation before age 60, a notable proportion of older women continue or begin HT later in life. The health outcomes of HT in women aged 65 and older, especially those initiating therapy after 65, compared with younger users and nonusers were evaluated.

Methods: This retrospective cohort study included 83,147 women aged 50 years or older enrolled in Clalit Health Services (2000-2022). Women were categorized by age at HT initiation: never-users, initiators at 50-65 years, initiators 65 years or older, or initiators after 50 continuing beyond 65. Outcomes included malignancies, cardiovascular events, osteoporosis, and dementia. Group differences were evaluated using χ2 tests, and time-to-event associations were examined using Cox proportional hazards models with age as the underlying time scale. To evaluate the health outcomes of HT in women aged 65 and older, especially those initiating therapy after 65, compared with younger users and nonusers.

Results: HT use was associated with increased risks of several malignancies, including both hormone-sensitive and non-hormone-sensitive cancers. In crude analyses, women initiating HT at 50-65 years had lower ischemic heart disease/myocardial infarction prevalence (3.6% vs. 9.2%) but higher hypertension (11.0% vs. 6.2%). In adjusted Cox models, initiation at 65 years or older was associated with increased hazards of any cancer (hazard ratio [HR]: 2.216, 95% confidence interval [CI]: 1.833-2.677) and cerebrovascular accident (HR: 2.695, 95% CI: 2.358-3.079). Among women initiating HT at 50-65 years, hazards were markedly elevated for cerebrovascular accident (HR: 16.692, 95% CI: 15.571-17.893), cancer (HR: 8.490, 95% CI: 7.281-9.900), and ischemic heart disease/myocardial infarction (HR: 9.169, 95% CI: 8.321-10.102); the crude cardiovascular advantage was not observed after adjustment.

Conclusions: Initiation of HT after age 65 is linked to significantly increased risks of cancer and vascular events, supporting current guidelines discouraging late initiation. While HT may offer some cardiovascular benefits when started earlier, use in older women should involve individualized risk-benefit assessment and close monitoring. These findings underscore the need to align clinical practice with evolving evidence and guideline recommendations. Given the retrospective design, incomplete pre-2000 medical history, and potential residual confounding, findings should be interpreted with caution.

Objectives: To evaluate the feasibility and acceptability of a multicomponent intervention to reduce cardiovascular disease (CVD) risk in perimenopausal Latinas.

Methods: Forty-nine perimenopausal Latinas (age 40-60 y) who spoke Spanish or English were randomized to a multicomponent intervention or waitlist control group. The intervention consisted of 12 weekly sessions (diet education, exercise, and stress management), followed by 3 months of continued support, and 6 months of independent skill maintenance. The primary outcomes were feasibility and acceptability measures, including enrollment and retention rates, intervention attendance, and intervention fidelity. Secondary outcomes included changes in CVD risk factors (eg, anthropometric measures, health behaviors, perceived stress, lipids, glucose, and arterial stiffness) from baseline to 6- and 12-month follow-up. Descriptive statistics, t tests, and χ2 were used to examine participant characteristics and changes in CVD risk factors.

Results: Twenty-six women were randomly assigned to the intervention group and 23 to the waitlist control, who received the intervention after study completion. The mean age of the participants (n=49) was 47.1 ± 4.5 years, 98% were born outside of the United States, and 61% reported financial strain. Women attended an average of eight (53.3%) intervention sessions, with seven participants (26.7%) attending ≥80% of the intervention sessions. Forty-three participants (87.8%) completed the 6-month assessment, and 79.6% returned for 12-month data collection. At 12 months, 94.6% of participants would recommend the study to a friend or relative.

Conclusions: This pilot study found that a culturally tailored intervention consisting of diet education, exercise, and stress management may be feasible and acceptable to reduce CVD risk in perimenopausal Latinas.

Objectives: Perimenopause is associated with increased anxiety symptoms. However, data is lacking regarding the experiences of women with perimenopausal anxiety. We explored the experiences of women with new onset or worsening of anxiety symptoms during perimenopause to better understand lived experiences and contributing factors.

Methods: Twenty women (aged 43-53 y) who reported new or worsening anxiety symptoms during perimenopause were recruited from online perimenopausal support groups to participate in individual interviews to explore experiences of perimenopausal anxiety in the context of daily lives and perimenopausal symptoms. Inductive thematic analysis was used to develop themes from transcribed data. Analysis was done using MAXQDA software. Codes were developed verbatim from repeating words, ideas, or concepts. Themes were developed from coded data.

Results: Six themes were identified to contribute to anxiety symptoms during perimenopause, including uncertainty, anxiety related to health status, mid-life stressors, past medical history, and perimenopausal hormonal and physical changes. Social support and lifestyle interventions were reported as protective against anxiety symptoms.

Conclusions: Women reported a general lack of awareness of perimenopause. This further exacerbated uncertainty, anxiety, and the loss of a sense of control women felt as they experienced perimenopausal changes. This research highlights the potential impact of perimenopausal anxiety on women's quality of life and the complex interaction of physical, psychological, and social factors contributing to perceived worsening anxiety during perimenopause. This exploratory study illustrates the need for further research to identify the contributing factors to perimenopausal anxiety and the development of multifaceted interventions for anxiety during perimenopause.

Objectives: This study examines the employment trajectories of women experiencing early and surgical menopause over a 10-year period bracketing their final menstruation or surgery, representing for most women the menopause transition. It also investigates the potential mediating role of hormone therapy in early postmenopause in these relationships.

Methods: We used data from 1,386 women in the English Longitudinal Study of Aging (ELSA) who had undergone natural menopause, premenopausal bilateral oophorectomy or hysterectomy. We used sequence analysis of employment histories to define 3 different 10-year employment trajectories. We then carried out regression analysis to assess associations between timing and type of menopause on employment, followed by mediation analysis. Sensitivity analysis was conducted by excluding cases with hysterectomy with preserved ovaries.

Results: Women with early menopause, compared with those who undergo menopause at 45 or older, are less likely to have flexible working arrangements (part-time work or self-employment) compared with full-time work during this sensitive period (relative risk ratio [RRR], 0.70; 95% CI: 0.51-0.97). However, the likelihood of leaving the labor market compared with working full-time is similar in women with early and later menopause (RRR, 0.95; 95% CI: 0.62-1.41). Surgical menopause, compared with natural menopause, is associated with an increased risk of labor market exit (RRR, 1.45; 95% CI: 1.01-2.32), particularly for women aged 45 or older at the time of surgery (RRR, 1.50; 95% CI: 0.94-2.38). Hormone therapy use may help reduce the risk of labor market exit for women with both early (RRR NATURAL INDIRECT EFFECT [NIE] , 0.79; 95% CI BIAS-CORRECTED [BC] , 0.58-1.04) and surgical menopause (RRR NIE , 0.73; 95% CI BC , 0.53-1.01). Sensitivity analysis suggests that the potential reduction in labor market exit risk via hormone therapy for early menopausal women holds true only when women with hysterectomy with preserved ovaries are included.

Conclusions: Our study highlights that early menopause and surgical menopause, including hysterectomy with preserved ovaries, impact women's labor market trajectories and suggests that hormone therapy within the early years of the final menstruation may help women remain employed. We advocate for further research on the impact of the timing and type of menopause on women's labor market circumstances and for workplace policies that consider their diverse experiences.

Objective: To determine associations between central adiposity, cognitive function, and randomized menopausal hormone therapy (MHT) in a reanalysis of the Kronos Early Estrogen Prevention Study-Cognitive and Affective (KEEPS-Cog) sub-study participants.

Methods: KEEPS randomized 727 women (ages 42-58) who were <36 months postnatural menopause to oral conjugated equine estrogens (o-CEE), transdermal 17-β-estradiol (t-E2), or placebo for 48 months. Participants with diabetes, body mass index >35 kg/m 2 , coronary artery calcium score >50 Agatston Units, and other cardiometabolic disease risk indicators were excluded from enrollment. In the ancillary KEEPS-Cog study, cognitive tests were completed at baseline, 18-, 36-, and 48-month post-randomization. In these analyses, cognitive variables were summarized as four cognitive domain-specific factor scores: verbal learning and memory, auditory attention and working memory, visual attention and executive function, and speeded language and mental flexibility. Waist-hip-ratio (WHR), an indicator of central adiposity, was measured at screening (baseline) and modeled as a covariate in linear latent growth models assessing associations of MHT with cognitive functions at baseline and over time.

Results: Higher baseline WHR was associated with poorer performance on all domain-specific cognitive outcomes at baseline and with changes in visual attention and executive function across time. Models including interaction effects were not significant for either o-CEE x WHR or t-E2 x WHR.

Conclusion: Central adiposity is a risk factor for domain-specific cognitive decline, and thus, cognitive health effects should be investigated in early postmenopausal women, even in women with low cardiovascular risk statuses.