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

Objectives: The aims of the study are to explore the range and variation in serum estradiol concentration, and to estimate the prevalence of "poor absorption" (women using licensed estradiol doses with subtherapeutic levels), in perimenopausal and postmenopausal women using transdermal estradiol in the real world.

Methods: This is a cross-sectional analysis in a specialist menopause clinic in the UK.

Results: Serum samples were obtained from 1,508 perimenopausal and postmenopausal women. A total of 61.87% were using licensed doses. The median estradiol concentration was 355.26 pmol/L (interquartile range 198.44-646.15 pmol/L). A reference interval for the whole cohort was defined as 54.62-2,050.55 pmol/L. There was substantial interindividual variation across the dose range. Variance was greater in younger women ( P = 0.002) and gel users ( P = 0.002). There was a trend toward greater variance in women using higher doses, but the association failed to reach statistical significance ( P = 0.074). One in four women (24.84%) using the highest licensed dose had subtherapeutic levels (<200 pmol/L). Older women (≥50 y) and patch users were more likely to have low levels (odds ratio 1.77, 95% confidence interval 1.22-2.62, P = 0.003; and odds ratio 1.51, 95% confidence interval 1.18-1.95, P = 0.001, respectively).

Conclusions: The reference interval for perimenopausal and postmenopausal women using on-label and off-label doses of transdermal estradiol in the real world is wide, and there is considerable interindividual variation. The number of estradiol users with low estradiol levels (<200 pmol/L) is higher than previously recognized. Measurement of serum estradiol can be helpful to identify women who may benefit from an off-label dose. Dose customization is key to ensure that all women can reap the benefits of HT.

Objective: Menopausal symptoms are a reproductive health issue for women. Some studies have suggested that the use of probiotics may alleviate the severity of menopausal symptoms and mental health status. This study aimed to evaluate the effect of probiotic administration on the severity of menopausal symptoms and improve mental health in postmenopausal women in Hamadan, Western Iran.

Methods: A triple-blind randomized controlled trial was conducted from February 20, 2023, to August 23, 2023, at the Comprehensive Health Service Centers in Hamadan City, Western Iran. Participants were randomized to intervention and control groups. The participants in the intervention group were administered probiotic supplements in 200 mg daily capsules for 6 weeks, and those in the control group received 200 mg daily capsules containing starch powder for 6 weeks. The primary outcomes were measured using the Menopausal Rating Scale and Depression Anxiety and Stress Scale questionnaires at baseline, week 3, and week 6.

Results: A total of 84 women took part in the study, with 42 individuals assigned to each of the intervention and control groups, respectively. The findings indicated no significant differences in baseline characteristics between the study groups ( P > 0.05). The results indicated that the study outcomes changed differently over time between the two groups. The participants in the intervention group exhibited greater improvements in depressive symptoms, anxiety, and stress symptoms, as well as in physical, psychological, and urogenital symptoms at both week 3 and week 6, compared with the control group ( P < 0.05).

Conclusions: This study provides evidence regarding potential treatment effects of probiotics consumption in alleviating physical and mental symptoms related to menopause. Further multicenter and large-scale clinical trials with longer follow-up are recommended.

Objective: Menopausal hormone therapy (HT) has been shown to be effective in alleviating symptoms of menopause. While previous literature has described the frequency of HT use for the relief of menopausal symptoms in both the general and veteran female populations, there is currently no literature describing this frequency within the female active duty population. This study aims to address this gap in knowledge by conducting a retrospective cross-sectional study of HT receipt in active duty service women (ADSW) ages 45 to 64 during fiscal years (FYs) 2018 to 2022.

Methods: We used the Military Health System (MHS) Data Repository (MDR) to conduct a retrospective study of ADSW ages 45 to 64 in the US Army, Air Force, Navy, and Marine Corps during FY 2018 to 2022. Study analyses included descriptive statistics on participant demographics and HT type. Logistic regressions were performed to assess for significant associations between participant demographics and receipt of HT.

Results: We identified a total of 13,629 women aged 45 to 64 on active duty service in the US Army, Air Force, Navy, and Marine Corps during FY 2018 to 2022, of whom 1,290 (9.5%) received HT. Significantly lower odds for receipt of HT was observed among ADSW ages 45 to 49, 60 to 64, of Asian/Pacific Islander race, and all ranks below Senior Officer. No significant associations were observed by Service branch.

Conclusions: The prevalence of HT use among ADSW ages 45 to 65 is lower than HT use among the US veteran population age 45 and older but higher than among the US general population age 45 and older.

Importance: Hormone treatments for genitourinary syndrome of menopause (GSM) symptoms have limitations. There is interest in nonhormone therapies, including energy-based interventions. Benefits and harms of energy-based interventions are not currently well known.

Objective: The aim of this study was to assess the benefits and harms of energy-based therapies (eg, CO 2 laser, Er:YAG laser, and radiofrequency) for GSM. Outcomes of interest are the eight "Core Outcomes in Menopause" and include the following: dyspareunia, vulvovaginal dryness, vulvovaginal discomfort/irritation, dysuria, change in most bothersome symptom, quality of life, treatment satisfaction, and treatment adverse effects.

Evidence review: Eligible studies included English language randomized controlled trials (RCT) or prospective observational studies of energy-based treatments with ≥8 weeks follow-up in postmenopausal women with ≥1 GSM symptom and studies of any design reporting adverse effects ≥12 months postintervention. Ovid/MEDLINE, Embase, and CINAHL were searched from inception to December 11, 2023 using vocabulary and natural language terms, along with free-text words. Two authors extracted data and assessed the quality of included studies.

Findings: We identified 32 unique studies (16 RCT; 1 quasi-RCT; 15 nonrandomized). Ten RCT and the quasi-RCT were rated low to moderate risk of bias (RoB) and underwent data extraction. Included studies evaluated CO 2 laser (k = 7), Er:YAG laser (k = 3), or radiofrequency and CO 2 laser (k = 1). CO 2 laser compared with sham (k = 4) may result in little to no difference in dysuria, dyspareunia, or quality of life (low certainty of evidence [COE]). CO 2 laser compared with vaginal conjugated estrogens cream (k = 2) may result in little to no difference in dyspareunia, dryness, discomfort/irritation, dysuria, or quality of life (low COE). Treatment effects on all other outcomes and effects of Er:YAG laser or radiofrequency on any outcome are very uncertain (very low COE). Studies noted few adverse events and no serious adverse events.

Conclusions and relevance: CO 2 laser resulted in little to no difference in outcomes compared with sham or vaginal estrogen; the evidence is very uncertain on the effect of energy-based interventions versus all other comparators for all other outcomes. Adverse event reporting was limited. There is a need for further evidence assessing energy-based interventions.

Objective: The main aim was to evaluate the relationships between menopausal symptoms, endogenous hormones, and stress-related factors.

Methods: Participants were recruited through online advertisements at Vilnius University and social networks. Sixty-three White Lithuanian women aged 50.2 ± 2.9 years without any known diseases or conditions that could affect menopausal symptoms, hormone levels, or mental health were selected to participate in the cross-sectional study. The Menopause-Specific Quality of Life Questionnaire was used to assess the intensity of menopausal symptoms in four domains (vasomotor, psychosocial, physical, and sexual). The levels of reproductive hormones were measured in blood serum. To evaluate the level of chronic stress, we used the Perceived Stress Scale 10 (PSS-10) and the assessment of hair glucocorticoids (cortisol, cortisone). Multiple linear regression analysis was performed to estimate the associations between menopausal symptoms severity, endogenous hormones, and stress-related factors.

Results: Age (the unstandardized β [ B ] = 0.12), follicle-stimulating hormone concentration ( B = 0.9), and PSS-10 score ( B = 0.08) were associated with the total Menopause-Specific Quality of Life Questionnaire score (all P < 0.05). The vasomotor domain was related to age ( B = 0.19), follicle-stimulating hormone ( B = 1.24), and dehydroepiandrosterone sulfate concentration ( B = -2.8) (all P < 0.05). The psychosocial domain was associated with the PSS-10 score ( B = 0.13, P < 0.001). The physical domain was associated with the number of sleep hours ( B = -0.35, P = 0.02). The sexual domain was negatively related to testosterone concentration ( B = -3.5, P = 0.01).

Conclusions: The results of the present study show that not only hormonal changes but also other factors, such as age, hours of sleep, and experienced stress, are associated with the intensity of menopausal symptoms.

Objective: To examine the association between serum thyroid-stimulating hormone (TSH) levels with handgrip strength (HGS) and dynapenia in euthyroid postmenopausal women.

Methods: This was an exploratory cross-sectional study among 385 participants from the Department of Obstetrics, Gynecology, and Reproduction of the Dexeus Women's University Hospital, Barcelona, Spain. Age, age at menopause, adiposity, alcohol consumption, body mass index (BMI), and smoking status were recorded. TSH was determined by electrochemiluminescence immunoassay. HGS was measured using a digital dynamometer, and physical activity was assessed by the International Physical Activity Questionnaire. Dynapenia was considered when HGS was <20 kg. A directed acyclic graph was designed to identify confounding variables. Multivariable linear and logistic regression models were adjusted by age, age at menopause, adiposity, BMI, glomerular filtration rate, glycated hemoglobin, physical activity, and smoking status.

Results: Multivariable linear regression model showed that age ( β = -0.22; 95% CI, -0.28 to -0.16), adiposity ( β = -0.15; 95% CI, -0.22 to -0.07), BMI ( β = 0.15; 95% CI, 0.04-0.25), glomerular filtration rate ( β = -0.04; 95% CI, -0.07 to -0.01), and physical activity ( β = 0.79; 95% CI, 0.07-1.5) were significantly associated with HGS. Instead, serum TSH levels were not significantly associated ( β = 0.21; 95% CI, -0.10 to 0.51). Multivariable logistic regression model showed that dynapenia was associated with age (OR, 1.20; 95% CI, 1.12-1.31) and glomerular filtration rate (OR, 1.03; 95% CI, 1.00-1.05). No significant association between TSH and dynapenia was observed (OR, 0.98; 95% CI, 0.78-1.23).

Conclusions: In this study of postmenopausal women, normal TSH levels were not associated with low HGS or dynapenia.

Objectives: We examined the health-related quality of life (HRQoL) during menopause transition (MT) among middle-aged Korean women.

Methods: This cross-sectional study comprised 2,290 middle-aged women who completed web-based questionnaires between 2020 and 2022. Based on self-reported menstrual cycle patterns, menopause status was classified as premenopausal, early or late transition, or postmenopausal. HRQoL was assessed using the Patient-Reported Outcomes Measurement Information system, with all 29 items scored using a T-score metric. Multiple linear regression analyses were performed to investigate whether HRQoL varied based on MT stages. Antimüllerian hormone levels were used as an objective measure instead of self-reported menstrual status in the sensitivity analysis. Logistic regression models were used to estimate the prevalence ratios for moderate or severe HRQoL symptoms across menopausal stages.

Results: The mean T-scores for anxiety, depression, and pain interference and intensity were significantly higher with advancing menopausal stage. Anxiety, depression, sleep disturbances, pain interference, and intensity were significantly and linearly positively correlated with MT stages after adjusting for potential confounders. Physical function significantly worsened in the late transition stage compared with premenopausal status ( β = -1.51 [95% CI, -2.72 to -0.31] in late MT and β = -1.92 [95% CI, -3.46 to -0.37] in postmenopause, P for trend = 0.007). However, no significant trends were observed in the sensitivity analysis using antimüllerian hormone levels. Women with moderate or severe symptoms in all domains except physical function had significantly higher prevalence ratios according to MT.

Conclusions: Overall HRQoL was lower with advancing menopausal stages. All symptoms should be monitored to control early transition symptoms. Thus, women undergoing MT should consistently assess and manage not only menopausal symptoms but also the overall quality of their health to prevent both menopause-specific and nonspecific conditions and their consequences.