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

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.

Importance: Menopause is defined as the permanent cessation of menstruation that occurs due to the loss of ovarian follicular activity. It is often associated with various symptoms resulting from fluctuations in estrogen levels, such as psychogenic symptoms and sleep-related discomfort, which affect daily functioning and overall quality of life. Hormone therapy can be used to manage these symptoms effectively, but its adverse effects restrict its long-term use. There are various nonhormone options available to manage these symptoms, and exercise is one of them. However, research findings regarding the effectiveness of various forms of exercise in managing these symptoms need to be more consistent, highlighting the significance of this systematic review of the effects of exercise on sleep quality and psychological well-being of women during menopause transition.

Objective: The primary objective of this systematic review is to determine the effectiveness of different forms of exercise in improving sleep quality and psychological well-being among perimenopausal and postmenopausal women.

Evidence review: An extensive and systematic literature search was performed across 5 electronic databases-EMBASE, Pubmed, SCOPUS, Google Scholar, and ResearchGate-to retrieve all the randomized controlled trials that provide information on the effectiveness of exercise in managing psychological and sleep-related discomforts in perimenopausal and postmenopausal women. The quality of included studies was evaluated using the Cochrane Bias Risk assessment tool.

Findings: A total of 13 randomized controlled trials involving 1,470 perimenopausal and postmenopausal women across the globe that evaluated the effectiveness of various forms of exercise in improving sleep quality and psychological well-being were included in this systematic review. The findings of this review suggest that exercises, such as aerobic, yoga, Pilates, resistance, stretching, and relaxation, are significantly effective in improving the quality of sleep and psychological status of perimenopausal and postmenopausal women.

Conclusion and relevance: The findings of this systematic review reveal that exercise positively influences sleep quality and psychological well-being among perimenopausal and postmenopausal women.

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.

Objective: The present work was designed to explore women's experiences of going through the menopause while working, using Playmobil as a tool for eliciting discussion. A growing body of evidence shows the value of using playful approaches in research; however, very little research has explored the use of Playmobil as a research method.

Methods: Research was carried out with 12 co-researchers (aged 31-60) working at a UK university, who were perimenopausal and postmenopausal women. Women attended a workshop and were encouraged to discuss and reflect on their experience of menopause in the workplace using playmobil to facilitate group discussion. The session was audio-recorded.

Results: Three themes were developed using Reflexive Thematic Analysis regarding menopause experiences in the workplace: (1) menopause symptoms fundamentally changing experiences of work, (2) symptoms leading to doubts about the ability to work effectively, and (3) ideas for moving forward and improving experiences of menopause in the workplace.

Conclusions: Playmobil was a useful method for stimulating discussion. Physical and psychological symptoms of the menopause can have a substantial impact on a person's working life. Workplace settings need to ensure sufficient support is available for employees who are experiencing menopause.

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.