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

Objectives: This study examined the relationship of anxiety and depression with menopausal symptoms in postmenopausal women.

Methods: This descriptive, cross-sectional study was conducted with 236 postmenopausal women aged 45-65 years. Data were collected using the Personal Information Form, the Beck Anxiety Inventory, the Beck Depression Inventory, and the Menopause Symptom Assessment Scale. Descriptive statistics, Pearson correlation analysis, and multivariable-adjusted linear analysis were employed for the statistical evaluation of the data. The models were adjusted for the following covariates: age, educational status, income status, marital status, number of living children, presence of chronic disease, body mass index, duration of menopause, and perception of the menopausal period.

Results: A statistically significant positive correlation was found between anxiety and menopausal symptoms (r=0.623, P<0.001). Multivariable-adjusted linear regression analysis indicated that a one-unit increase in anxiety was associated with a 0.424-unit increase in menopausal symptom scores (B=0.424, P<0.001). Similarly, a statistically significant positive correlation was observed between depression and menopausal symptoms (r=0.442, P<0.001). A one-unit increase in depression was associated with a 0.416-unit increase in menopausal symptom scores (B=0.416, P<0.001).

Conclusions: In conclusion, a significant relationship was found between anxiety and depression and menopausal symptoms. This finding highlights the importance of not overlooking psychological factors such as anxiety and depression when evaluating menopausal symptoms in postmenopausal women.

Objective: Attention to women's perimenopausal experiences of anxiety has been limited. The purpose of these analyses was to examine the influence of chronological aging and reproductive aging stages on midlife women's reports of anxiety.

Methods: Participants aged 35-55 years from the Seattle Midlife Women's Health Study population-based study (N = 508 at baseline) completed an annual health questionnaire and menstrual calendars. In addition, they completed the Symptom Checklist-90 Revised Scales, including anxiety, phobic anxiety, and interpersonal sensitivity, on up to four occasions during the course of the study. Reproductive aging stages were assessed using menstrual calendars and questionnaire data applying Mitchell's (2000) criteria for stages of reproductive aging: late reproductive stages (late reproductive stage 1 [LRS1] and late reproductive stage 2), early menopausal transition stage, late menopausal transition (LMT) stage, and postmenopause (PM). Multilevel modeling using mixed models analysis of linear models (SPSS 28) was employed to examine the effects of age and reproductive aging stages on repeated measures of anxiety, phobic anxiety, and interpersonal sensitivity.

Results: Age was significantly and negatively related to each of the measures: anxiety (beta = -0.015), phobic anxiety (beta = -0.008), and interpersonal sensitivity (beta = -0.016), each decreased significantly with age (P < 0.001). When accounting for age effects, anxiety scale scores increased as women progressed through reproductive aging stages from LRS1 to the LMT, then decreased from late stage to PM, but changes were not significant. When accounting for age effects, phobic anxiety increased significantly from LRS1 to PM stages (LRS1 vs PM betas -0.139, -0.057, -0.052, -0.010 for LRS1 to LMT, P = 0.018). Interpersonal sensitivity increased from LRS1 to LMT, but changes were not significant.

Conclusion: Aging was significantly and negatively related to anxiety, phobic anxiety, and interpersonal sensitivity, suggesting emotion regulation effects during midlife. When chronological aging was taken into account, reproductive aging was associated significantly with increasing levels of phobic anxiety from the late reproductive stages to PM. Anxiety and interpersonal sensitivity both increased with progression from LRS1 through LMT before decreasing PM, but the changes were not significant.

Objective: To identify metabolic syndrome (MetS) clustering patterns, examine transitions between classes from perimenopausal to postmenopausal stages, and identify factors associated with these transitions.

Methods: This secondary analysis used data from 1,104 women in the Korean Genome Epidemiology Study, a population-based longitudinal cohort. Latent class analysis was conducted for perimenopausal and postmenopausal stages, and latent transition analysis class changes. Age at menopause, white blood cell count, and homeostasis model assessment of insulin resistance (HOMA-IR) were examined as predictors.

Results: Four classes were identified in the perimenopausal stage: metabolic-diabetic, metabolic-hypertensive, low high-density lipoprotein cholesterol (HDL-c), and non-MetS. Five classes were identified in the postmenopausal stage: treated-hypertensive, metabolic-hypertensive, high-risk, low HDL-c, and non-MetS. Approximately 40% of women changed their classes during the menopause transition. The metabolic-diabetic group showed a markedly higher likelihood of progression to the high-risk group (88.3%). In the metabolic-hypertensive group at the perimenopausal stage, higher HOMA-IR was associated with increased transitions to low the HDL-c (odds ratio [OR]: 51.37, 95% CI: 15.27-172.78) and high-risk (OR: 78.10, 95% CI: 19.16-318.30) classes. Later menopause reduced the likelihood of remaining in (OR: 0.10, 95% CI: 0.02-0.50) or progressing to high-risk (OR: 0.05, 95% CI: 0.01-0.43) in the metabolic-hypertensive group but increased the probability of transitioning to treated-hypertensive in women in the non-MetS group (OR: 1.48, 95% CI: 1.13-1.94).

Conclusions: Metabolic risk profiles shift substantially during menopause. Targeted interventions, especially for high-risk groups before menopause, and the inclusion of simple insulin resistance markers such as HOMA-IR in screening may improve prevention and management.

Objectives: To estimate the short-term vocal outcomes of semioccluded vocal tract exercise in postmenopausal teachers.

Methods: Twenty-three postmenopausal teachers meeting the inclusion and exclusion criteria were recruited for the study, out of which three were lost to follow-up. The participants underwent baseline voice assessment using acoustic measures, aerodynamic measures, and perceptual measures. The participants completed eight face-to-face semioccluded vocal tract exercise sessions during the first month, comprising humming, lip and tongue trills, and straw phonation with and without water resistance. Daily home practice was also carried out over 3 months. Follow-up assessments were conducted at the end of 1 month and 3 months from the baseline assessment to estimate the changes in parameters over the intervention duration of 3 months.

Results: Postintervention assessment indicated improvement in all the parameters with statistically significant changes in jitter, shimmer, mean pitch, mean intensity, and harmonics-to-noise ratio (P<0.05), all showing strong effect sizes. There was also a notable improvement in the Acoustic Voice Quality Index (P=0.050) and maximum phonation duration (P=0.053). Cepstral peak prominence and s/z ratio showed no significant changes. Grade in GRBAS (grade, roughness, breathiness, asthenia, strain) rating showed a significant difference (P=0.039). Further, the Voice-Related Quality of Life scores improved significantly from pretherapy to post-therapy.

Conclusion: The findings suggest that semioccluded vocal tract exercise, supported by structured sessions and consistent home practice, is effective in improving vocal outcomes in postmenopausal teachers. It serves as an effective therapeutic approach for addressing postmenopausal vocal changes in teachers who are not under hormone therapy.

Objective: Generative artificial intelligence is rapidly evolving and is now being explored in health care to support patient and clinician education. This study evaluated the accuracy, completeness, and readability of four large language models (LLMs): ChatGPT 3.5, Gemini, ChatGPT 4.0, and OpenEvidence in answering questions about menopause and hormone therapy.

Methods: A total of 35 questions (20 patient-level, 15 clinician-level) were entered into each LLM. OpenEvidence was only used for clinician-level questions. Four blinded expert reviewers rated responses as accurate and complete, accurate but incomplete, or inaccurate. Readability of patient-level responses was assessed using the Flesch Reading Ease Score (FRES) and word count. Analysis used ANOVA for readability, odds ratios for accuracy comparisons.

Results: For patient-level questions, ChatGPT 3.5 achieved the highest accuracy (70%), followed by ChatGPT 4.0 (60%) and Gemini (30%); Gemini had significantly lower odds of accuracy compared with ChatGPT 3.5 (OR=0.18, 95% CI=0.05-0.71; P=0.014). FRES scores differed significantly (P<0.001): Gemini scored 38.9±7.3 ("difficult"), ChatGPT 3.5 scored 31.0±11.2, and ChatGPT 4.0 scored 26.5±8.6 (both "very difficult"). For clinician-level questions, ChatGPT 4.0 achieved the highest accuracy (67%), followed by ChatGPT 3.5 and OpenEvidence (60% each) and Gemini (47%); no significant differences were observed among models (all P>0.05).

Conclusion: LLMs demonstrated limited accuracy and frequent incorrect or incomplete responses to menopause-related queries, highlighting the need to improve model performance to ensure accurate and reliable information for both patients and clinicians.

Objectives: To determine the risk of developing de novo carpal tunnel syndrome (CTS), arthritis, or rheumatoid arthritis in women who underwent hysterectomy with bilateral ovarian conservation (H-OC) before reaching spontaneous menopause.

Methods: We identified 1,573 women undergoing H-OC for a benign indication at age 18 to 44 years between 1980 and 2002 in Olmsted County, Minnesota. Each woman was age-matched (±1 y) to a referent woman who had not undergone hysterectomy or oophorectomy before the matching date (index date). Diagnostic codes for CTS and arthritis were extracted from the Rochester Epidemiology Project medical records-linkage system through 2019. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models and the two cohorts were balanced for 19 chronic conditions and for several potential confounders present at index date.

Results: Over a median 25.8-year follow-up, women undergoing H-OC had an increased risk of developing CTS (HR: 1.33; 95% CI: 1.13-1.56) compared with referent women. The risk was similar in strata by age at H-OC and was higher for women with endometriosis and menstrual disorders indications. Women undergoing H-OC also had an increased risk of developing arthritis (HR: 1.34; 95% CI: 1.23-1.47). The risk was similar in strata by age at H-OC and by indication. Rheumatoid arthritis considered separately was also associated with H-OC (HR: 1.55; 95% CI: 1.05-2.30).

Conclusions: H-OC was associated with an increased risk of de novo CTS, arthritis (all types), and rheumatoid arthritis. Further studies are needed to confirm these associations and to explore potential biological mechanisms.

Objective: The present study compared changes in body temperature during sleep, sleep quality (eg, subjective and objective sleep parameters) between middle-aged women and young women.

Methods: Nineteen middle-aged women and 14 young women with normal menstrual cycles were recruited. Over 7 consecutive days, skin temperature and sleep parameters (subjectively and objectively analyzed using the Pittsburgh Sleep Quality Index [PSQI] and actigraphy, respectively) were assessed. For the PSQI, higher score means decreased quality of sleep.

Results: The skin temperature during sleep was significantly higher in middle-aged women (35.0 ± 0.4℃) than young women (34.6 ± 0.5℃, P < 0.05). In young women, skin temperature increased immediately after bedtime and then gradually decreased, whereas skin temperature did not decrease in middle-aged women (P < 0.05 between groups). In addition, skin temperature remained significantly higher in middle-aged women than young women during the 30%-80% phase for the entire night (P < 0.05). Middle-aged women had a significantly higher PSQI score (5.4 ± 0.4) than young women (3.9 ± 0.4, P < 0.05), indicating that sleep quality was impaired in middle-aged women. However, no significant difference was found in objective sleep parameters between middle-aged women and young women.

Conclusion: Middle-aged women had significantly higher body temperatures during sleep than younger women. A sustained higher body temperature during sleep may be associated with decreased sleep quality, as evaluated by the PSQI.

Objective: To develop and evaluate the acceptability and effectiveness of an extended reality (XR) avatar-based menopause education simulation module for the clinical training of OB/GYN residents.

Methods: This menopause education pilot recruited 57 OB/GYN residents from nine institutions via listservs and snowball sampling. Participants completed a menopause-focused XR avatar simulation module developed using Kern's curriculum design framework and guided by APGO/CREOG objectives and national guidelines. Learners completed an 11-item preintervention and postintervention assessment measuring usability and satisfaction (Kirkpatrick Level 1: reaction outcomes) and knowledge and self-reported confidence (Level 2: learning outcomes). Descriptive statistics summarized additional outcomes, and paired t tests were used to evaluate changes in knowledge. We also conducted a brief descriptive review of voluntary free-text comments.

Results: From preintervention to postintervention, mean knowledge scores improved from 79.8% to 82.8% (P=0.028). Participants reported improved preparedness and confidence across multiple domains: 59% improvement in overall readiness to manage menopause, 50% in comfort managing hormone therapy, and 39% in managing nonhormone therapy. No learners reported feeling "not at all prepared" postintervention. Most rated the module as effective (63%) and more engaging than lectures (60%); 96% would recommend it. Narrative feedback endorsed the module as valuable while suggesting improvements in interactivity, content depth, and avatar responsiveness.

Conclusions: The XR simulation module demonstrated acceptability and effectiveness in enhancing clinical menopause training. Results support its potential as a scalable educational tool to address gaps in clinical menopause education.

Objective: Menopause is accompanied by decreased circulating estrogen for all people; however, only some develop genitourinary syndrome of menopause, the cause of which is unknown. In this pilot study, we measured vaginal blood vessel and nerve fiber density, as well as vaginal fluid immune markers to identify a potential cause of vaginal symptoms.

Methods: This is a secondary analysis of samples from a randomized trial of vaginal estradiol or moisturizer versus placebo for moderate-severe postmenopausal vaginal discomfort. Fourteen participants were selected from the placebo tablet/vaginal moisturizer or dual placebo arms of the original study: eight with a ≥2-point reduction in most bothersome symptom severity (responders) and six with a <2-point reduction in symptom severity (nonresponders). At 0, 4, and 12 weeks, we characterized vaginal protein gene product 9.5-positive nerve fiber and CD31+ vessel length and density from vaginal wall biopsies (immunofluorescent staining) and vaginal fluid immune markers (MesoScale Discovery). We compared responders versus nonresponders at baseline and across visits using linear mixed models to evaluate associations between symptoms, nerve/vessel length and density, and immune markers.

Results: There were no significant differences in baseline characteristics between responders and nonresponders. Mean CD31+ vessel length at 12 weeks was higher in responders than nonresponders (P = 0.034), while all other measurements were similar between the two groups. No clear patterns were observed across proinflammatory or chemoattractant cytokine concentrations with biopsy measures.

Conclusions: Vaginal blood supply and extent of vascularization may contribute to vaginal discomfort symptoms in postmenopausal people; however, the results of this small study need to be confirmed with a larger sample size.

Objectives: While there has been increasing interest in older adults' sexuality, the literature to date has largely ignored sex toy use. This study investigated sex toy use in partnered sex and masturbation among older adult women.

Methods: A survey was fielded in October 2023 among a national demographically representative sample (N = 3,001). Participants had to be at least 60 years old, identify as a woman, and be living in the United States.

Results: Most of the survey participants were 60-69 years old (67.1%). Participants reported much greater use of sex toys during masturbation than during sex with a partner. Of the women who reported masturbating at least once in the last year, 46.4% used toys almost always or always during masturbation, compared with 5.1% who used sex toys almost always or always during partnered sex. Those who reported almost always or always using sex toys during masturbation were significantly more likely to report always or almost always having an orgasm compared with the lower frequency sex toy users. Of those who had partnered sex, 38.7% reported using sex toys during partnered sex at least rarely. Those who reported almost always or always using sex toys during partnered sex were more likely to report always or almost always having an orgasm compared with the lower frequency sex toy users.

Conclusions: Given the prevalence of masturbation and sex toy use as well as their relationships to orgasm, older women could benefit from information from health care professionals on these topics.