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

Objectives: Understanding the association between hot flashes and sleep disturbance is complicated, given that various dimensions of hot flashes (ie, occurrence, frequency, severity, timing) may have different associations with sleep. We evaluated the associations between various dimensions of momentary hot flashes and sleep disturbance (ie, sleep onset latency, sleep quality). We examined whether daytime, evening, and nocturnal hot flash frequency and/or severity predicted sleep disturbance.

Methods: Participants (N=99) completed self-report measures of hot flashes and sleep for seven consecutive days. Participants retrospectively reported the number and severity of daytime (reported each morning and afternoon), evening (reported each evening), and nocturnal (reported each morning) hot flashes they had, and completed a sleep diary each morning. We conducted a series of linear mixed-effects models regressing both sleep outcomes onto daytime/evening hot flash frequency/severity, and regressing sleep quality onto nocturnal hot flash frequency/severity.

Results: Results indicated that within-person evening hot flash severity was associated with sleep onset latency (Est=5.60, SE=2.48, 95% CI [0.75-10.46], P<0.05), and that within-person nocturnal hot flash frequency was associated with sleep quality (Est=-0.46, SE=0.06, 95% CI [-0.58 to -0.34], P<0.001).

Conclusions: We found that more severe evening hot flashes predicted longer sleep onset latency that night, and that more frequent nocturnal hot flashes were associated with worse sleep quality that night. This may suggest that targeting hot flashes that occur at night-both in the evening before bed and nocturnally during sleep-may be useful in improving sleep in perimenopausal and early postmenopausal women.

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.

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: 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.

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: Hysterectomy is the second most common gynecological surgery performed on reproductive aged women in the United States. It is not known if some groups of women are more susceptible to depression after hysterectomy.

Methods: Participants were scheduled for hysterectomy for benign causes and not undergoing a concomitant urogynecological procedure. Patient Health Questionnaire-9 (PHQ-9) was collected 2 weeks before, and 1, 4, and 6 weeks, and 3, 6, and 12 months post-hysterectomy to understand depressive symptoms associated with surgery. PHQ-9 patterns were identified with latent class analyses. Multivariable multinomial logistic regression was used to estimate relative risk ratios (RRR) and 95% CIs of associations between baseline sociodemographic, clinical, and operative-related characteristics and PHQ-9 class.

Results: Three latent classes (C) were identified from their PHQ-9 score patterns among 455 participants: high and increasing (C1, 15.6%), high and decreasing (C2, 27.7%), and persistently low PHQ-9 trajectory (C3, 56.7%). Insurance type, financial toxicity, pain level, and surgical decision satisfaction before surgery were statistically significantly associated with class membership. At surgery, C1 members were more likely to have public insurance (RRR=2.04, CI: 1.02-4.08), worse finances (0.92, 0.89-0.96), and higher pain (1.22, 1.10-1.35) than members of C3. C2 members were more likely to have worse finances (0.94, 0.91-0.96) than C3 members. C1 members tended to have higher pain (1.14, 1.02-1.26) than C2 members.

Conclusions: Depression symptomology after hysterectomy may be associated with presurgical insurance type, financial toxicity, current pain level, and satisfaction. More research is needed to investigate whether these factors can be incorporated into preoperative counseling and screening tools to guide shared decision-making regarding depression and surgery.

Objective: To develop and validate a nomogram prediction model for deep vein thrombosis (DVT) in epithelial ovarian cancer (EOC).

Methods: Between May 2021 and May 2024, 429 EOC patients admitted to our hospital were retrospectively identified. The patients were randomly divided into a modeling group and a validation group. Based on whether DVT occurred, the modeling group was classified into a DVT group and a non-DVT group. The influencing factors associated with DVT in EOC were analyzed using multivariable logistic regression. R software was used to construct the nomogram model. The receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the nomogram. Moreover, the decision curve analysis (DCA) was used to evaluate the clinical utility of the model.

Results: Of 429 patients, 116 developed DVT, with an incidence rate of 27.04%. In the modeling group of 300 patients, 81 developed DVT, with an incidence rate of 27.00%. Multivariate logistic regression showed that age, BMI, hypertriglyceridemia, tumor staging, tumor grade, CA125 level, platelet count (PLT), and fibrinogen level (FIB) were independent risk factors for developing DVT in EOC ( P <0.05). The area under the ROC curve (AUC) for the modeling group was 0.893, and the AUC of the validation group was 0.973. The Hosmer-Lemeshow (H-L) test of the modeling group showed χ 2 =7.324 ( P= 0.722), and the H-L test of the validation group showed χ 2 =7.043 ( P= 0.711), suggesting good calibration. DCA curve showed that the threshold probability was between 0.08 and 0.97, the clinical value of the DVT nomogram model provided a net clinical benefit.

Conclusion: Age, BMI, hypertriglyceridemia, tumor stage, tumor grade, CA125 level, platelet count (PLT), and fibrinogen level (FIB) are significant independent risk factors for EOC patients developing DVT. The nomogram constructed with these factors demonstrates good predictive performance and clinical utility in predicting the risk of DVT in EOC patients.