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

Objectives: Vaginal estrogenization plays a crucial role in alleviating pain during sexual activity while low-dose vaginal estrogen therapy provides benefit often with no increase in systemic estrogen levels after use. This study aimed to compare the effects of estriol applied to the distal or proximal thirds of the vagina on dyspareunia in postmenopausal women, evaluate serum estriol levels, and assess sexual function.

Methods: This prospective, randomized clinical trial included a total of 116 sexually active postmenopausal women with dyspareunia who were randomized to receive vaginal estriol (1.0 mg/application, every other day) for 12 weeks in the proximal estriol group (PEG) or distal estriol group (DEG), or a vaginal lubricant gel (VLG) before intercourse. Plasma estriol levels, coital pain (McGill Pain Questionnaire), sexual function (FSFI), and emotional status (HADS) were assessed at baseline and after 12 weeks. Statistical analyses included the Shapiro-Wilk test for normality, one-way ANOVA with Tukey's post-hoc test, χ 2 test, and Pearson correlation as appropriate.

Results: No significant changes in serum estriol levels were observed in any group after the intervention. PEG and DEG showed significant increases in FSFI total scores and all domains. The VLG group showed improvements in FSFI total scores and the domains of desire, arousal, lubrication, satisfaction, and pain. Intergroup analysis revealed that the PEG group showed significantly greater improvement in the lubrication domain compared with DEG (mean difference=0.70; 95% CI: 0.05-1.37; P =0.04) and VLG (mean difference=1.22; 95% CI: 0.58-1.86; P <0.01). All other domains showed no statistically significant differences between groups.

Conclusions: Vaginal estriol, applied distally or proximally, improved dyspareunia and sexual function without increasing systemic estriol levels. Lubricant use also enhanced sexual function (except orgasm) and reduced pain comparably to estriol.

Objectives: Hormone therapy is recommended in women with premature ovarian insufficiency to mitigate long-term risks associated with estrogen deficiency, such as loss of bone mineral density. However, data on the optimal route of administration are scarce. This study aimed to compare the effect of transdermal and oral hormone therapies on the T-scores of the femur and the hip in women with premature ovarian insufficiency.

Methods: This retrospective, single-center cohort study included 55 women with spontaneous premature ovarian insufficiency who were regularly monitored at the Clinical Division of Gynecological Endocrinology and Reproductive Medicine of the Medical University of Vienna. For hormone therapy, participants received either oral or transdermal estrogen therapy. The main outcome parameters were the T-scores of the femur and hip assessed by dual-energy x-ray absorptiometry scans.

Results: Among the 55 women included [median age: 34 y, interquartile range (IQR): 27-36], 65.5% showed reduced bone mineral density in the dual-energy x-ray absorptiometry scan results (osteopenia: n= 27, 49.1%; osteoporosis: n= 9, 16.4%). Participants were treated with transdermal and oral estradiol in 27 (49.1%) and 28 cases (50.9%), respectively. There were no significant differences in the T-scores of the femur and the hip, neither at baseline ( P =0.586, P =0.400) nor at follow-up assessment ( P =0.618, P =0.471) between the two treatment groups.

Conclusions: Both oral and transdermal hormone therapies effectively help maintain bone mineral density in women with premature ovarian insufficiency, indicating that either option is a suitable treatment choice for this population.

Objective: To describe treatment patterns for menopausal symptoms in women taking endocrine therapy for breast cancer treatment/prevention from the United States (US), United Kingdom (UK), and Germany.

Methods: We undertook a retrospective cohort study using data from the US Market Scan Commercial Claims and Encounters Data database, and electronic health records from the UK's Clinical Practice Research Database Aurum and the German Disease Analyzer. Women aged 18-65 years with a first prescription/dispensation for endocrine therapy for breast cancer treatment or prevention (index date) from 2010 to 2022 were followed up, and the following treatment classes were evaluated: antidepressants, benzodiazepines, anticonvulsants, antihypertensives, and hormone therapy.

Results: Treatments were recorded in 32.7% (39,137/119,717) US women, 20.4% (8,350/40,956) UK women, and 8.3% (1,031/12,388) German women. Among these, ~80% in the US and UK, and all in Germany, received one treatment class; switches occurred in 20.5% (US) and 16.5% (UK). The most frequent initial treatment classes were antidepressants (31.7% US, 45.3% UK, 38.1% Germany); the second most frequent were benzodiazepines (30.3% US), anticonvulsants (24.3% UK), and hormone therapy (27.2% Germany). Among antidepressants, the most common were venlafaxine (US and Germany), and amitriptyline, sertraline, and citalopram (UK). Six-month continuation rates for antidepressants were 42% (US), 12% (UK), and 7% (Germany); continuation rates for other treatments were even lower.

Conclusions: Continuation rates with available treatments for menopausal symptoms in women receiving endocrine therapy for breast cancer treatment/prevention are very low. This indicates a clear unmet need for safe, effective, and well-tolerated treatments in this patient population.

Objective: We aimed to assess the relationship between hysterectomy and/or bilateral oophorectomy and the risk of stroke-a topic of ongoing debate in current research.

Methods: We utilized data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 to estimate both crude and multivariable-adjusted hazard ratios (HRs) and 95% CIs, applying survey-weighted Cox proportional hazards regression model. The modeling incorporated sampling weights and design variables to address NHANES's multistage probability sampling framework. In addition, a meta-analysis was conducted, incorporating findings from NHANES with those from other cohort studies identified through database search.

Results: This unweighted NHANES cohort included 21,240 women with 8.3 median follow-up years, documenting 193 stroke-related deaths. Compared with no hysterectomy, hysterectomy was not significantly associated with stroke mortality (HR: 1.28, 95% CI: 0.89-1.85). However, a meta-analysis of 2,065,490 participants from NHANES and 15 other studies demonstrated hysterectomy was linked to a 9% higher stroke risk (HR: 1.09, 95% CI: 1.04-1.15) compared with no hysterectomy. Similar finding was identified for bilateral oophorectomy (HR: 1.13, 95% CI: 1.09-1.17) compared with no bilateral oophorectomy. Subgroup analyses stratified by surgical indication, ovarian conservation status, and reference population consistently demonstrated elevated risks.

Conclusions: In summary, the data from NHANES and other studies indicate women with hysterectomy and/or bilateral oophorectomy may be associated with an increased stroke risk. Additional prospective studies are needed to confirm the association between hysterectomy and/or bilateral oophorectomy and stroke risk.

Objective: To compare the prevalence of female sexual dysfunction (FSD) and distress between sexually active midlife women (50-64 y) and older women (65+ y) presenting for care at women's health clinics at a tertiary care center.

Methods: This cross-sectional study included women aged 50 and above who received care at Mayo Clinic women's health clinics in Rochester, MN; Scottsdale, AZ; and Jacksonville, FL, between May 1, 2015, and August 31, 2022. Sexual function and distress were compared between midlife and older women using the Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), and self-reported sexual health concerns.

Results: Among 3,465 sexually active women, older women were less likely to report loss of sexual desire (33.4% vs. 47.6%; P<0.001) and reduced genital sensation (13.0% vs. 16.9%; P=0.024) compared with midlife women. There were no significant differences for vaginal dryness, painful intercourse, or arousal/orgasm difficulties. FSFI scores were higher in older women for desire (3.0 vs. 2.4; P<0.001) and lubrication (3.9 vs. 3.6; P<0.001). While total FSFI scores were similar between older and midlife women (21.2 vs. 22.2; P=0.11), sexually related distress was lower in older women compared with midlife women (13.0 vs. 15.0; P=0.015). The prevalence of FSD (defined as FSFI score ≤26.55 and FSDS-R score ≥11) was similar between groups (51.8% vs. 56.2%; P=0.056).

Conclusions: Older women experienced FSD at similar rates as midlife women but reported less sexual distress, potentially reflecting lower expectations regarding sexual function. Addressing sexual health concerns in older women may enhance quality of life.

Objectives: To assess the prevalence of genitourinary syndrome of menopause (GSM) and its association with female sexual dysfunction, the partner's knowledge, and repercussions on the couple's sexual life.

Methods: A cross-sectional study was conducted on 266 couples (532 individuals) aged 50-70 years. Women and their partners were selected utilizing the "snowball" technique, formed from the "ego" couples who answered the interview regarding general health, genitourinary symptoms, sexual function, and partner knowledge information via telephone by trained interviewers.

Results: The prevalence rate of GSM was 74.44%. Low sexual function was significantly more frequent in women (46.15%) than in their partners (15.77%) ( P <0.001). Vaginal dryness present in 44.15% and dyspareunia (58.67%) were associated with female sexual dysfunction ( P <0.01), decreased satisfaction with sex, and avoidance of sex for fear of pain or lack of desire. Urinary incontinence, nocturia, and urgency were reported by 17.29%, 35.34%, and 24.81% of women, respectively. and were not associated with sexual dysfunction. Approximately 49% of partners knew about their partner's GSM symptoms. Vaginal discomfort led to the loss of men's desire, and women avoided intercourse because they were concerned about pain.

Conclusions: The prevalence of GSM is high and related to low female sexual function. Half of the partners knew about problems with GSM, and the women's symptoms interfered with the couple's sexual desire and satisfaction, which could impact the affective and sexual aspects of the couple's relationship.