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

Objective: Energy therapies have been suggested as potential treatments for overactive bladder (OAB), yet there are few studies examining their efficacy. This study aimed to compare the effects of fractional microablative radiofrequency (RF) to sham treatment.

Methods: A pilot clinical trial was conducted with 77 women diagnosed with OAB, randomized into two groups: one receiving three monthly sessions of fractional microablative RF and the other receiving sham treatment, both combined with behavioral therapy. Assessments were conducted at baseline and 30 days after therapy using validated questionnaires for urinary symptoms (International Consultation on Incontinence Questionnaire-Short Form, Overactive Bladder, and Quality of Life), as well as vaginal and sexual function, and pelvic floor muscle functionality.

Results: Both treatment groups demonstrated significant improvements in all validated questionnaires assessing urinary and vaginal symptoms ( P < 0.001), with no significant differences between them. The International Consultation on Incontinence Questionnaire-Overactive Bladder scores improved significantly in both the RF group (-4.5 points; P < 0.001) and the sham group (-4.5 points; P < 0.001), with no significant differences between the groups ( P = 0.812). Additionally, there were no improvements noted in sexual function or vaginal trophism in the RF group. However, assessments of endurance, resistance, and fast contractions of the pelvic floor muscles showed improvement only in the RF group, with no changes observed in power or perineometer measurements.

Conclusions: Microablative RF treatment combined with behavioral therapy did not show benefits over sham treatment with behavioral therapy for addressing OAB symptoms.

Objectives: Whereas some work links trauma exposure to poor subjective sleep quality, studies largely rely upon limited trauma measures and self-reported sleep at one time point. It is unknown whether trauma is related to persistent poor sleep, whether associations differ based on childhood versus adulthood trauma, and whether trauma exposure is related to poorer objectively assessed sleep. We tested whether childhood or adult trauma associated with persistent poor objectively and subjectively measured sleep at two time points in midlife women.

Methods: One hundred sixty-seven women aged 40-60 at baseline were assessed twice 5 years apart. At baseline, women reported childhood trauma (Child Trauma Questionnaire), adult trauma (Brief Trauma Questionnaire), demographics, depressive symptoms, apnea symptoms, and medical history, and provided physical measures. At both visits, women completed 3 days of actigraphy (total sleep time [TST], wake after sleep onset [WASO]) and reported sleep quality (Pittsburgh Sleep Quality Index). Relations of childhood and adult trauma exposure, respectively, with persistent poor sleep at both baseline and follow-up visits (TST [<6 hours], WASO [>30 minutes], Pittsburgh Sleep Quality Index [>5]) were assessed in logistic regression models, adjusted for age, race/ethnicity, education, body mass index, sleep medications, nightshift work, apnea, depressive symptoms, vasomotor symptoms, and alcohol use.

Results: Childhood trauma was related to persistent high WASO (odds ratio [95% confidence interval] = 2.16 [1.04-4.50], P = 0.039, multivariable). Adult trauma was related to persistent poor sleep quality (odds ratio [95% confidence interval] = 2.29 [1.07-4.93], P = 0.034, multivariable). Trauma was unrelated to persistent short TST.

Conclusions: Childhood and adult trauma, respectively, were related to persistent poor objective sleep continuity and subjective sleep quality in midlife women, independent of risk factors.

Objective: This study aimed to determine whether exposure to traffic-related air pollution (TRAP) is associated with depressive symptoms while also characterizing the contribution of key explanatory factors related to sociodemographics and health. In addition, it aimed to also explore the role of reproductive health as a pathway through which exposure to TRAP may relate to depressive symptoms.

Methods: Participants were 688 healthy reproductive-age women in the Ovarian Aging Study. TRAP was derived from distance-weighted traffic counts using residential addresses. Depressive symptoms were assessed by the Center for Epidemiological Studies Depression scale. Explanatory factors were assessed by interview and clinic measures, including demographics (age, race/ethnicity), socioeconomic status (SES) (individual SES, neighborhood SES), general health (smoking, body mass index), and reproductive health (menarcheal age, contraceptive use, parity, menstrual cycle characteristics).

Results: In cross-sectional, step-wise multivariate regression analyses, greater exposure to TRAP was related to more depressive symptoms ( b = 0.779, P = 0.015). Lower individual SES, longer menstrual cycle length, and experiencing change (vs no change) in menstrual cycle length were also related to more depressive symptoms ( P 's < 0.05). Examination of each model step showed that variance in depressive symptoms was attributable to TRAP (1.2%, P = 0.004), demographics (1.0%, P = 0.217), SES (1.4%, P = 0.007), general health (0.3%, P = 0.356), and reproductive health (2.0%, P = 0.015). Finally, menstrual cycle length, a marker of reproductive health status, partially mediated effects of TRAP on depressive symptoms (indirect effect: b = 0.064, P = 0.020).

Conclusions: Findings showed that exposure to TRAP is associated with depression, along with SES and reproductive health factors, and that reproductive health may be a pathway through which TRAP relates to depression.

Objective: The key presenting symptom of endometrial cancer is abnormal uterine bleeding, most commonly postmenopausal bleeding (PMB), which facilitates early-stage diagnosis. This study aimed to investigate factors influencing delayed medical consultation for PMB, and particularly its association with social determinants.

Methods: This is a retrospective study that included endometrial cancer patients receiving care in a gynecologic oncology department of a tertiary medical center who presented with PMB. Demographic and oncologic data was collected from the electronic medical charts. Israeli bureau of statistics data was used to assess community socioeconomic index, based on address. Women seeking consultation more than 1 month after experiencing PMB were compared to those seeking earlier care.

Results: Two hundred ninety-five women were included in the study. One hundred seventy-three sought care after less than 1 month of PMB (early presenters) and 122 sought care after more prolonged PMB (late presenters). Late presenters were more likely to be socioeconomically marginalized (odds ratio [OR], 1.8; P = 0.018), higher body mass index (OR, 1.040; P = 0.022), and greater parity (OR, 1.170; P = 0.032). Socioeconomic marginalized patients experienced a 7-day longer delay from diagnosis to surgery compared to their privileged counterparts (59 vs 52 d, P = 0.022).

Conclusions: Among women with endometrial cancer, longer duration of PMB before first seeking medical consultation is associated with socioeconomic marginalization. This highlights the need for targeted interventions to minimize delays in diagnosis and treatment initiation among patients from marginalized communities.

Objective: The aim was to develop and validate a nomogram for evaluating the risk of fatigue in climacteric women and to assess its clinical application value.

Methods: Clinical information was collected from 402 climacteric women who visited a tertiary hospital in Shanghai between November 2023 and April 2024. Network analysis methods were utilized to analyze the core symptom (fatigue). The study participants were then randomly divided into training and validation cohorts in a 7:3 ratio. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for fatigue in climacteric women. A nomogram prediction model was established based on these independent risk factors. The predictive performance of the model was evaluated using the concordance index, area under the curve, receiver operating characteristic curve, Hosmer-Lemeshow test, and calibration curve analysis. Additionally, decision curve analysis was performed to assess the model's performance in clinical applications.

Results: Fatigue is identified as the core symptom in climacteric women. Educational level, chronic diseases, and depression status are independent influencing factors for fatigue in menopausal women. The area under the curve for the training cohort and validation cohort are 0.813 (95% CI, 0.743-0.884) and 0.759 (95% CI, 0.637-0.879), respectively, indicating that the model possesses good discriminative ability. The calibration curve shows good consistency between the predicted probabilities and actual probabilities in both the training and validation cohorts. Additionally, the P values for the Hosmer-Lemeshow test in the training and validation sets are 0.233 and 0.197, respectively, indicating good model calibration. Finally, the decision curve analysis curve demonstrates that the model has good clinical utility.

Conclusions: A simple nomogram based on three independent factors (educational level, chronic diseases, and depression status) can aid in clinically predicting the risk of fatigue in climacteric women.

Objective: The aim of this study was to examine the relationship between night eating syndrome, eating disorders, and menopausal symptoms in climacteric women.

Methods: In this descriptive study, 90 climacteric women who met the inclusion criteria volunteered to participated. The data for the participants were collected via a face-to-face interview method using a sociodemographic and menopause questionnaire, the Eating Disorder Examination Questionnaire, the Night Eating Questionnaire, and the Menopause Rating Scale, and their anthropometric measurements were recorded.

Results: Among all participants, 51.1% had night eating syndrome. However, the night eating syndrome (P = 0.790) and eating disorders (P = 0.634) of the participants did not differ significantly according to the climacteric periods. Menopausal symptoms were found to be higher in perimenopausal and postmenopausal women than in premenopausal women (P = 0.001). There were significant positive correlations between eating disorders and both night eating (r = 0.253 and P < 0.05) and menopausal symptoms (r = 0.291 and P < 0.001). There was no relationship between menopausal symptoms and night eating habits (r = 0.141 and P > 0.05).

Conclusions: Eating disorders were found to be associated with night eating and menopausal symptom severity in climacteric women. There is a need for multidisciplinary studies to measure the risk of occurrence and recurrence of menopausal symptoms and the association with eating disorders experienced by women.

Objective: The physiological changes inherent to the climacteric period can trigger or aggravate overweight/obesity, among several other health disorders. This study aimed to evaluate the effects of time-restricted eating (TRE) on body composition and cardiometabolic parameters in climacteric women with obesity submitted to caloric restriction (CR) through a hypocaloric diet.

Methods: We conducted an analysis of a clinical trial in a pre-post design that included adult climacteric women with obesity. Participants were divided into two groups: hypocaloric diet control group (n = 30) - with hypocaloric diet and free meal times, and hypocaloric diet and time-restricted eating group (HTRE) (n = 27) - with hypocaloric diet and TRE (fasting from 7 pm to 7 am), for 10 weeks. Anthropometric and biochemical parameters were evaluated before and after the intervention period. A significance level of P < 0.05 was considered for all cases.

Results: Both groups showed a reduction in all anthropometric parameters, but without significant difference (P = 0.34) between groups. However, some metabolic parameters were significantly highlighted in the HTRE such as cholesterol level normalization (HTRE, 181.76 ± 34.20 mg/dL) and a decrease in plasma atherogenicity (P = 0.02), glycated hemoglobin (P < 0.001), estimated mean glucose (P = 0.02), and alanine aminotransferase (P = 0.02), unlike the hypocaloric diet control group, which did not show such significance.

Conclusions: In this study, from the perspective of body composition, similar changes were observed between the group subjected to CR alone and the group subjected to CR combined with a 12-hour overnight fast. However, there was an indication of superior improvement in glycemic and lipid parameters in the group subjected to the 12-hour overnight fast. These findings suggest the potential for TRE, as implemented, to have positive effects on reducing cardiovascular risk and other chronic metabolic diseases.

Objective: The aim of this study was to explore women's experience of menopause care after breast cancer in the UK.

Methods: This study is a thematic analysis of free-text comments in an online survey that asked women about their experience of menopause care after breast cancer. A coding framework was used that mapped comments to eight domains of patient experience (deductive analysis). An inductive approach was used to identify subthemes within each of the eight domains.

Results: A total of 1,195 women completed the survey. Two hundred twenty-six women (18.9%) left free-text comments in response to questions about shared decision making and patient experience. Most were White (96.9%), university educated (52.6%), and aged 41 to 60 years at breast cancer diagnosis (81.8%). The menopausal symptom burden was high (96.5%, 87.6%, and 75.7% reported physical, psychological, and genitourinary symptoms, respectively). Lack of involvement in shared decision making was the dominant theme (n = 120, 53%), followed by issues concerning access to menopause care (n = 65, 29%). Lack of information, communication issues, and feeling unsupported were prevalent themes/subthemes. Twenty women (9%) reported a lack of courtesy and respect in their interactions with healthcare professionals.

Conclusions: In this study, women's experience of menopause-related breast cancer aftercare was poor. Larger studies are needed to qualitatively explore the experience, unmet needs, and expectations of all breast cancer survivors including women from more deprived and ethnic minority groups.

Objective: This post hoc analysis evaluated the efficacy of abaloparatide treatment in a subgroup of postmenopausal women from the Abaloparatide Comparator Trial In Vertebral Endpoints (ACTIVE; NCT01343004) study who met high fracture risk criteria (defined in several professional society guidelines).

Methods: Women from ACTIVE meeting ≥1 of the following fracture risk criteria were included: fracture within the past 12 months or prevalent vertebral fracture, baseline T score of <-3.0 at any site, very high fracture risk probability by FRAX (ie, 10-yr major osteoporotic fracture >30% or hip fracture >4.5%), or multiple prior fractures at baseline since age ≥45 years.

Results: A total of 2,026 participants met ≥1 fracture risk criteria defined in clinical guidelines (abaloparatide, n = 664; placebo, n = 677; teriparatide, n = 685). New vertebral fracture risk was reduced in participants receiving abaloparatide (4 [0.72%]) and teriparatide (6 [0.99%]) versus placebo (28 [4.77%]; both P < 0.0001). Estimated Kaplan-Meier cumulative incidence of nonvertebral fracture was 3.0%, 5.3%, and 3.0% in the abaloparatide, placebo, and teriparatide groups, respectively; 4.0%, 9.0%, 4.3% for clinical fracture; 1.6%, 6.8%, 3.0% for major osteoporotic fractures; and 1.1%, 2.1%, 2.1% for wrist fracture. Abaloparatide was associated with bone mineral density gains from baseline at the lumbar spine, total hip, and femoral neck at all time points (6, 12, and 18 mo; P < 0.0001 for all). Common adverse events reported in participants treated with abaloparatide were hypercalciuria (11.5%), dizziness (11.0%), and arthralgia (8.9%).

Conclusions: Abaloparatide reduced fracture incidence and increased bone mineral density in participants at highest fracture risk, consistent with the overall ACTIVE study.