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

Objective: This study aims to differentiate hot flashes (HF) and night sweats (NS) as distinct vasomotor symptoms (VMS) by integrating physiological, self-reported, and qualitative data. Specifically, we investigate (1) whether participants distinguish between HF and NS, (2) how subjective reports of NS correspond to objective physiological measures, and (3) whether HF and NS exhibit different associations with stress, depression, and sleep.

Methods: Data were drawn from a study on brown adipose tissue and HF (n = 274, ages 45-55). Participants answered questions regarding lifestyle, well-being, and menopause experiences, and wore skin conductance (to detect HF and NS) and activity monitors overnight. Questions about HF and NS experience were analyzed with thematic analysis. Objective NS scores were compared with subjective reports. Logistic regression analyses were used to compare subjective and objective VMS to stress, depression, and sleep variables.

Results: Qualitative responses revealed that participants perceived NS as distinct from HF, describing NS as prolonged, full-body sweating events, often without the intense heat or anxiety typical of HF. Objectively, NS were significantly longer than HF (mean: 60.5 vs 3.4 min) and occurred earlier in the night (P = 0.02). Self-reported NS corresponded with objective NS counts (P = 0.04). Only subjective VMS were significantly associated with stress (NS: 1.04, 1.00-1.09), depression (HF: 1.11, 1.02-1.20; NS: 1.12, 1.04-1.20) and sleep (HF: 1.28, 1.09-1.50).

Conclusions: Findings suggest that NS and HF represent distinct phenomena rather than variations of the same symptom. The results underscore the need for separate criteria for NS in research and clinical practice, as NS may have unique health implications beyond those of HF.

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.

Objective: To explore the association between the severity of menopausal symptoms and work-related outcomes and performance.

Methods: This cross-sectional study involved 3,523 women aged 40-60 from 30 health care centres across 12 Latin American countries. The severity of menopausal symptoms was assessed with the Menopause Rating Scale (MRS). Work-related outcomes were surveyed, including absenteeism, medical visits, perceived reduced work performance, impact of menopause on work performance, and job loss. Comparisons employed suitable tests based on data distribution, and logistic regression was used to assess associations, adjusting for covariates such as menopausal symptoms, comorbidities, age, and education.

Results: Women with severe menopausal symptoms (total MRS score ≥14 points) were significantly older (51.1 ± 5.1 vs 49.7 ± 5.6y), had a higher body mass index (27.4 ± 4.8 vs 26.7 ± 4.6 kg/m2), were postmenopausal in a higher proportion (69.9% vs 52.2%), had more comorbidities (42.8% vs 27.6%), higher smoking prevalence, and lower educational attainment. In addition, these women significantly reported more medical leaves (42.4% vs 29.5%), more medical visits (mean: 3.9 vs 2.5 visits), and a more significant perceived reduction of work performance (82.1% vs 56.7%). They also were more likely to believe that menopause significantly reduced their work capacity (67.0% vs 24.0%), had a higher prevalence of job dismissals (6.9% vs 2.0%), and more voluntary resignations or early retirements (8.1% vs 4.7%). Binary logistic regression determined that severe menopausal symptoms, subsequently adjusted for covariates, were primarily associated with more work absenteeism (aOR: 1.64; 95% CI: 1.41-1.90), more medical visits (aOR: 2.45; 95% CI: 1.97-3.05), decreased work performance (aOR: 3.13; CI 95%: 2.65-3.69), the perception of menopause negatively impacting their work performance (aOR: 5.84; 95% CI: 5.01-6.80), more job dismissals (aOR: 3.23; 95% CI: 2.21-4.72), and more voluntary resignations or early retirements (aOR: 1.44; 95% CI: 1.08-1.93).

Conclusion: In this large sample of midlife Latin American women, severe menopausal symptoms were associated with reduced work capacity and adverse work-related outcomes.

Objective: This mixed-methods study aimed to describe the prevalence and impact of menopausal symptoms on midlife women in a US workplace.

Methods: An online survey was disseminated to all US-based employees of a US-headquartered pharmaceutical company. Eligible respondents were aged 40-65 years and self-identified as having (or expecting to have) personal experience of menopause. Descriptive statistics were generated. Survey respondents were sampled for in-depth interviews, on which thematic analysis was performed.

Results: Eligible survey responses were received from 1,642 employees, of which 18 participated in in-depth interviews. The mean respondent age was 51 years, and a range of job roles were represented. The majority of respondents (83%) reported that they had current or prior experience of menopause. Menopause symptoms most commonly impacting workplace performance included changes to sleep patterns, changes to memory, hot flashes and anxiety, although interviews highlighted a diversity of symptom presentations. Menopause symptoms were reported to affect stress levels, confidence in abilities, patience with others, and ability to concentrate at work; 7% of menopausal respondents took time off work due to menopause symptoms. Although half of the respondents disclosed that they would feel extremely or somewhat comfortable discussing menopause with colleagues, only 9% of those with current symptoms reported that they had received support with their menopause symptoms at work.

Conclusions: This study found that menopause impacts women's perceptions of their own performance at work, and that many are unsure how to approach conversations about menopause in the workplace. A substantial gap in knowledge about menopause was identified, highlighting the need for further education and support.

Objectives: Although investigators have devoted significant effort to understanding women's experiences of depressed mood and clinical depression during the menopausal transition and early postmenopause, they have focused less on women's perimenopausal experiences of emotional arousal, including anger. The purpose of these analyses was to examine the influence of aging and reproductive aging stages on women's reports of anger.

Methods: Participants aged 35-55 years from the Seattle Midlife Women's Health Study population-based cohort (N=501 at baseline) completed an annual health report. Participants completed the State-Trait Anger Inventory (STAXI) (State Anger, Trait Anger, Anger Temperament, Anger Reaction, Anger-in, and Anger Control subscales) and the SCL90 Hostility scale on up to five occasions during the course of the study. Reproductive aging stages were assessed using menstrual calendars and questionnaire data. Menstrual calendars were used to identify menopausal transition stages using the Mitchell (2000) criteria for stages of reproductive aging: late reproductive stages (LRS1 and LRS2), early menopausal transition stage (EMT), late menopausal transition stage (LMT), and postmenopause (PM). Multilevel modeling with Mixed Models Analysis of Linear Models (SPSS 28) was used to examine the effects of age and reproductive aging stages on the repeated measures of anger and hostility using the STAXI Scales and SCL-90 Hostility Subscale.

Results: Age was significantly related to most anger measures, with State and Trait Anger and Anger Control increasing with age. Anger Temperament, Anger Reaction, Anger Expressed Aggressively, and Hostility each decreased significantly with age. Only Anger Suppressed was not related to age. When accounting for age effects, Reproductive Aging Stages significantly affected State and Trait Anger and Anger Temperament: each decreased after the late reproductive stages with women's progression through further reproductive aging stages.

Conclusions: Aging was significantly related to anger, with anger expression indicators decreasing with age, suggesting emotion regulation may occur during midlife. When aging was taken into account, reproductive aging was associated with decreasing levels of State and Trait Anger and Anger Temperament Scale scores. Both chronological aging and reproductive aging had important effects on dimensions of anger, warranting further attention during midlife and the menopausal transition and early postmenopause.

Objectives: Investigate associations between stress, cortisol, menopause symptoms, and depression in a sample of midlife women. Because stress has been associated with greater menopause symptoms, we examined this as a mediator for the association between stress and depressive symptoms.

Methods: Data from a cross-sectional study of 118 women (40-64 y old) were analyzed. Participants completed in-person visits and self-reported questionnaires, including the Menopause-Specific Quality of Life questionnaire, the Perceived Stress Scale, and the Center for Epidemiological Studies Depression Scale. Saliva samples were collected at 4 intervals upon waking (wake, 30 min, 45 min, and 60 min after waking), and one sample before bed, as a measure of cortisol. Both the diurnal cortisol slope and the cortisol area under the curve with respect to ground (AUCg) were used to characterize cortisol secretion and exposure. A multivariate analysis of variance determined differences in menopause symptoms and depression outcomes. Mediation models examined the indirect effects of menopause symptoms on associations between perceived stress and depressive symptoms.

Results: Women with moderate stress had significantly lower cortisol awakening responses ( P = 0.047), poorer psychosocial ( P < 0.001), physical ( P < 0.001), and sexual ( P <0.001) menopause symptoms, and depression symptoms ( P < 0.001) compared to women with low stress. Mediation analyses (95% CI) between stress and depression demonstrated significant positive indirect effects of psychological (B = 0.247; 0.117, 0.355), physical (B = 0.120; 0.049, 0.210), and sexual menopause symptoms (B = 0.042; 0.006, 0.106).

Conclusions: Cross-sectional data revealed that greater stress was associated with poorer outcomes of menopause symptoms, depressive symptoms, and a lower cortisol awakening response. The association between stress and depression was mediated by the psychosocial, physical, and sexual menopause symptoms, and future longitudinal studies should seek to confirm these findings.

Objective: To discuss the potential for adverse consequences that could arise from the quest to prolong the functional life span of the human ovary.

Methods: A series of arguments are presented that: (a) question the dogma that monthly ovulatory menstrual cycles are critical for women's health; (b) review adverse consequences of decades of menstrual cyclicity; (c) review the evidence for a longevity benefit of ovarian steroid hormone treatment after the age at natural menopause has been achieved; and (d) utilize a mathematical model of ovarian follicle loss over time to raise the possibility that current strategies directed at delaying menopause might well backfire and in fact cause a woman to have a prolonged menopause transition.

Results: Regular, monthly menstrual cycles have not been the reality for women for most of history. Rather, when not pregnant, lactational amenorrhea and nutritionally based hypothalamic amenorrhea were the norm for reproductive-aged women. Moreover, monthly menstrual cycles cause substantial morbidity for women during their reproductive years. Providing steroid hormones after menopause has failed to demonstrate an increase in the female life span. Restoring ovarian follicles either surgically or medically has a high probability of causing women to spend more years of life in the menopause transition.

Conclusions: Strategies to prevent or delay menopause would benefit from careful consideration of unintended consequences as they are implemented. Directing treatment trials to those with the greatest chance for benefit should be undertaken before adopting this type of treatment for a broader population.