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

Objective: To investigate the impact of estrogen deficiency on metabolic dysfunction-associated steatotic liver disease progression and evaluate the therapeutic potential of tirzepatide (Tzp), a dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist, in a murine model of postmenopausal metabolic dysfunction.

Methods: Female C57BL/6J mice were divided into obese-diabetic (Od) and ovariectomized Od groups, along with lean controls (control, CO). After 12 weeks of dietary intervention, mice received daily Tzp (10 nmol/kg) or vehicle for four weeks. Comprehensive assessments included plasma biochemistry, liver histopathology, AMP-activated protein kinase (AMPK)/mechanistic target of rapamycin (mTOR) complex 1 signaling analysis, and hepatic gene expressions.

Results: Od mice developed severe liver pathology, showing 2-3 fold increases in fat accumulation markers, extensive steatosis with hepatocyte ballooning, and 3-4 fold elevated inflammatory markers. Ovariectomy aggravated these effects, increasing fibrosis markers by 2.4-fold and apoptosis signals. Tzp reduced fat deposition by 50%-70%, inflammation by 60%-70%, and fibrosis by 55%. Molecular analyses revealed Tzp restored metabolic balance by: (1) normalizing key energy-sensing pathways (1.5-2 fold AMPK activation; 50% mTOR reduction), (2) reducing fat synthesis signals by 50%-60%, and (3) enhancing fat breakdown pathways (2-2.5 fold increase). Antioxidant defenses were fully restored to normal levels. Principal component analysis demonstrated metabolic improvement, with treated animals showing gene expression patterns closer to healthy controls.

Conclusion: Estrogen deficiency synergizes with metabolic dysfunction to aggravate metabolic dysfunction-associated steatotic liver disease progression through AMPK/mTOR pathway dysregulation. Tzp demonstrates comprehensive hepatoprotective effects, ameliorating steatosis, inflammation, and fibrosis while restoring metabolic homeostasis in this model of postmenopausal liver disease.

Objectives: The present research sought to explore the potential role of masturbation in the relief of symptoms associated with menopause.

Methods: A demographically representative US sample of 1,178 women ages 40-65 completed an online survey about their current symptom management strategies (including masturbation) and their efficacy. Data were analyzed quantitatively using t tests and χ2, and qualitatively with thematic analysis.

Results: Nearly one in five perimenopausal and postmenopausal women had noticed that self-pleasure provided symptom relief. Relative to other symptom management strategies, masturbation was rated among the highest in providing symptom relief, especially with respect to psychological symptoms (ie, mood changes) and sleep disturbances. Nearly half of perimenopausal and postmenopausal women indicated that they would be open to trying masturbation as a symptom relief approach if their doctor recommended it.

Conclusions: Masturbation may play a valuable role in managing menopause symptoms, and it is important that physicians discuss the potential benefits of self-pleasure with their patients.

Objective: Menopause is associated with a range of symptoms, including hot flashes, mood swings, and others that adversely affect the quality of life of women. This study evaluated the effects of a novel nutraceutical combination containing γ-aminobutyric acid (GABA, 50 mg) and EstroG-100 (514 mg) on these symptom clusters using validated questionnaires.

Methods: Eighty women were randomized into active (age: 53.28) or placebo (age: 52.94) groups. During week 1, participants were instructed to take the product whenever they began to experience vasomotor symptoms as pro re nata dosing (PRN dose, "as needed"). For the remainder of the study (weeks 2-5), participants were switched to a daily supplementation phase.

Results: Hot flashes decreased in intensity ( P = 0.001, starting day 1) and number ( P = 0.002, starting day 2) in the active group compared with placebo. Stress response and anxiety also improved as early as day 1, with PRN dosing ( P = 0.042). By day 3, there was significant reduction in stress, mood swings and headaches compared with the placebo group ( P = 0.010, P = 0.024, and P = 0.008, respectively). In the daily supplementation phase from week 2 to week 5, improvements in vasomotor symptoms (day 7, P = 0.010), sleep quality (5 wk, P = 0.030), feelings of depression (3 wk, P = 0.028), tension (5 wk, P = 0.004), and sexual function (day 7, P = 0.029) were observed in those randomized to the active group compared with placebo.

Conclusion: The novel nutraceutical combination of Estro-G100 and GABA may help support women during menopause.

Objectives: Hyperandrogenism, while one of the most common endocrine disorders in women, is relatively uncommon in the postmenopausal population. When present, it may be indicative of an underlying rare androgen-secreting ovarian tumor. Here, we report 2 cases: a 63-year-old woman with 2 years of male-pattern baldness and hirsutism and a 71-year-old female with 2 years of progression to complete scalp alopecia, hirsutism, and libido changes.

Methods: Upon endocrine evaluation, testosterone concentrations were markedly elevated for both patients. In the first case, there was no radiologic evidence of ovarian mass on ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). In the second case, transvaginal ultrasound (TVUS) detected an ovarian lesion, which guided further radiologic workup; however, positron emission tomography (PET) and MRI were unremarkable.

Results: In case 1, surgical pathology upon total hysterectomy with bilateral salpingo-oophorectomy revealed bilateral Leydig cell hyperplasia. For case 2, surgical intervention revealed a right ovarian steroid cell tumor with contralateral stromal and hilus cell hyperplasia.

Conclusion: In both patients, testosterone levels normalized immediately following total hysterectomy with bilateral salpingo-oophorectomy. In conjunction, these 2 cases highlight the importance of having a high clinical suspicion for steroid cell tumors or hyperplasia in postmenopausal women presenting with features of hyperandrogenism and elevated testosterone levels despite unrevealing radiographic findings.

The use of hormone therapy in survivors of breast cancer is complex and contentious. Historically, guidelines have strongly advised against using hormone therapy. Its safety likely depends on many factors. However, long-term oncologic data are lacking, leaving women with unresolved quality-of-life and health concerns and practitioners uncertain about their recommendations. In the short term, there will not be definitive data, and decisions must be made based on the existing imperfect evidence.

Objectives: This multicenter, double-blind, randomized, placebo-controlled trial evaluated the efficacy and safety of Yangyin Shugan (YYSG) capsules in women with premature ovarian insufficiency (POI).

Methods: This study enrolled 548 Chinese women with POI (August 2016-June 2021) from 13 Guangdong hospitals. After screening, 333 participants were randomized (2:1) to receive YYSG capsules or placebo for 12 weeks. Primary outcomes included the modified Kupperman Index (KI) and serum basal follicle-stimulating hormone, basal E2, and anti-Müllerian hormone levels. Secondary outcomes included psychological status scores (Self-Rating Depression Scale, Self-Rating Anxiety Scale) and ovarian markers (antral follicle count, peak systolic velocity).

Results: YYSG demonstrated superior efficacy versus placebo across all endpoints ( P < 0.01), including greater reductions in KI scores (-22.2 vs -6.0) and basal follicle-stimulating hormone levels (-23.7 vs -10.4 IU/L) and greater increases in anti-Müllerian hormone levels (2.5 vs 0.8 ng/mL). The YYSG group exhibited larger antral follicle count gains (4.3 vs 1.1 follicles) and bilateral peak systolic velocity improvements (left: 10.8 vs 4.9 cm/s; right: 10.0 vs 4.4 cm/s) and greater reductions in psychological scores (Self-Rating Depression Scale: -12.9 vs -1.3; Self-Rating Anxiety Scale: -15.7 vs -3.7).

Conclusions: YYSG capsules significantly improved ovarian reserve function and emotional disorders in women with POI, demonstrating good efficacy and safety. These findings support the potential application of YYSG capsules in clinical practice.

Objective: We sought to complete focus groups with postmenopausal women to discuss their past experiences with urinary tract infections and other lower urinary tract symptoms to source input on how to improve patient care.

Methods: We convened 5 focus groups among postmenopausal women with previous experience of treatment for urinary tract infection symptoms. Participants were asked to describe their experiences of urinary symptoms and to make recommendations on how to improve patient education. Three team members read deidentified transcripts of the focus groups, developed a thematic codebook following Conventional Content Analysis guidelines, and coded the data using NVivo software.

Results: Twenty postmenopausal women with previous treatment for at least one patient-reported urinary tract infection participated in five focus groups between February and October 2023. The average age of participants was 69.1 (SD 10.8). Three overarching themes emerged from analysis of focus group discussions: (1) barriers to effective care and treatment for urinary tract infections and/or other lower urinary tract symptoms, (2) finding relief via referral and guideline-concordant care, and (3) the physical and emotional cost of unresolved symptoms. While most participants had not found relief, those who did had been referred to a women's urinary health specialist. Once a correct diagnosis was made, real solutions were implemented, ending the cycle.

Conclusions: The management of older women with urinary tract infection and lower urinary tract symptoms is currently limited by delays in guideline concordant care. All of the information gathered will help us improve the care of these women.

Objectives: To investigate the association between hormone therapy use and severe outcomes due to COVID-19 in perimenopausal and postmenopausal women.

Methods: Using the Rochester Epidemiology Project, we retrospectively searched for the records of women aged 40-65 years who had a documented case of COVID-19 between March 12 and September 29, 2020. We further identified those who were perimenopausal or postmenopausal. The rates of emergency department visits, hospitalizations, and deaths were compared by hormone therapy use. Logistic regression models were used to assess the odds of the combined outcome based on hormone therapy use.

Results: Among the 689 patients included in this study, the median age was 56 years, and 77.5% were White. Compared with patients currently using hormone therapy, those with past/never use of hormone therapy were significantly older, had more risk factors for severe COVID-19, and had a higher incidence of diabetes. A total of 102 emergency department visits/hospitalizations/deaths occurred among both groups. Participants with current hormone therapy use had similar rates and risk of emergency department/hospitalization/death outcomes as those without hormone therapy, even after adjusting for age and severe COVID-19 risk factors.

Conclusions: Severe COVID-19 outcomes were not significantly different between women with current versus past/never use of hormone therapy. Our study adds to the data suggesting no harm with hormone therapy use in women with severe symptoms of COVID-19.

Importance: Isoflavones, natural bioactive compounds with estrogen-like properties, are increasingly used by postmenopausal women to manage menopausal symptoms. However, research on their efficacy has produced inconsistent results, necessitating a comprehensive review to guide clinical practice.

Objective: To evaluate the effects of isoflavone interventions on vaginal atrophy, skin health, and sex-related hormone levels in postmenopausal women through a systematic review and meta-analysis of randomized controlled trials.

Evidence review: A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Library databases from inception to January 2025. Eligible studies were randomized controlled trials investigating isoflavone interventions in postmenopausal women. Effect sizes were summarized as standardized mean differences (SMDs) with 95% CIs using a random-effects model. The risk of bias was assessed using the Risk of Bias 2 tool.

Findings: The analysis included 47 studies comprising 2,657 participants. Isoflavone interventions significantly reduced vaginal dryness (SMD=-1.147; 95% CI, -2.077 to -0.216; P=0.016; I2=95.4%) and increased the vaginal maturation value (SMD=0.605; 95% CI, 0.087 to 1.123; P=0.022; I2​​​​​​=88.7%). Improvements in skin health were observed, including reduced skin roughness measure R2 (SMD=-0.209; 95% CI, -0.389 to -0.029; P=0.028; I²=0.0%) and wrinkle surface (SMD=-0.342; 95% CI, -0.560 to -0.124; P=0.002; I2=0.0%). Isoflavones also significantly increased estradiol levels (SMD=0.247; 95% CI, 0.059 to 0.435; P=0.010; I2=60.5%).

Conclusions and relevance: Isoflavone interventions effectively manage vaginal atrophy in postmenopausal women and show potential for improving skin health and sex-related hormone levels. These findings underscore the therapeutic value of isoflavones while emphasizing the need for further research, particularly regarding their effects on skin health.