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

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.

Objectives: We aimed to characterize cardiovascular health status as measured by Life's Essential 8 (LE8) in midlife women and to test the associations between baseline and change since baseline in LE8 with subclinical measures of vascular health, cardiovascular disease (CVD) events, and all-cause mortality.

Methods: Baseline and follow-up LE8 metrics (diet, physical activity, nicotine exposure, sleep, body mass index, lipids, glucose, and blood pressure) were calculated as total and component scores. Changes in LE8 were calculated as differences between follow-up and baseline scores. Subclinical measures of vascular health included carotid intima-media thickness, pulse wave velocity, and carotid plaque presence. CVD events (n = 213) included myocardial infarction, stroke, heart failure, and revascularization. Deaths (n = 161) were recorded from death certificates/family reports. Linear, logistic, and Cox proportional hazards regression models were used.

Results: Among 2,924 midlife women (mean age: 46 ± 3 y), 21% consistently showed ideal total LE8 scores (≥80) across visits. Higher baseline and greater increases in total LE8 scores were associated with more favorable measures of all outcomes. Among the components, more favorable baseline/greater increases in glucose, blood pressure, and nicotine exposure scores were generally associated with lower risks for all outcomes. Sleep quality was associated with events; with more favorable baseline and/or greater increases in sleep score associated with lower risks of CVD events and/or mortality.

Conclusions: The prevalence of ideal total LE8 scores remained below 25% among midlife women. Glucose, blood pressure, and nicotine exposure are critical components of associated risks with lower LE8 scores. Midlife sleep quality may uniquely contribute to future event risk.

Objective: To evaluate the association of hormone therapy (HT) and oral contraceptives (OC) with the risk of knee osteoarthritis (KOA).

Methods: Using data from the UK Biobank, we included 211,345 women (mean 56.5 y) who were free of KOA and had self-reported data on the use of HT and OC at baseline. The outcome was an incident KOA during the follow-up. Cox regression models were used to evaluate the association of the status (never, former, current) and duration of HT and OC use with the risk of KOA. We also assessed the association between specific exogenous sex hormones and the risk of KOA.

Results: During a median follow-up of 13.6 years, 14,878 (7.0%) women developed KOA. Compared with women who had never used HT, both former and current users had an increased risk of KOA [former: hazard ratio (HR)=1.25, 95% CI: 1.20-1.31; current: HR=1.46, 95% CI: 1.35-1.58; Ptrend <0.001). There was a dose-responsive association between the duration of HT use and the risk of KOA (HR=1.20-1.43, Ptrend <0.001). Former use of OC increased KOA risk only in women <60 years (HR=1.15, 95% CI: 1.04-1.27). In addition, both estrogen and progestogen and their combination were associated with an increased risk of KOA (HR=1.33-1.47).

Conclusions: There is a dose-responsive association between the duration of HT use and the risk of KOA among middle-aged and older women. History of OC use may increase the risk of KOA in women younger than 60 years.

Importance: Most Australian women will experience menopause while in paid employment, and many workplaces are introducing menopause-related policies. However, the quality of the evidence for the impact of menopause on women's work outcomes is unclear.

Objective: To systematically review the published literature that has examined the impact of menopausal status and symptoms on work ability and productivity.

Evidence review: A systematic review of English-language peer-reviewed literature. Data sources included Ovid MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus databases searched from inception to 14 November 2024, Google Scholar, and reference lists of included articles. Eligible studies included a formal process to identify menopausal status; a robust questionnaire or validated tool for assessing menopausal symptoms; a comparator group by menopausal status, symptom presence or severity; assessment of work outcomes by a validated tool; and a sample size of at least 100 women. Two authors selected the articles for inclusion and extracted the data from the included studies. The risk of bias was assessed using the modified Joanna Briggs Institute critical appraisal checklist for cohort studies and the modified Hoy tool for cross-sectional studies.

Findings: Of the 40 articles retrieved for full-text review, 10 met the inclusion criteria. Nine studies were cross-sectional and one was longitudinal. Menopausal status was not consistently related to work ability. The presence and severity of VMS and other menopause-related symptoms may impact work outcomes, but findings were mixed. A number of adverse employment, socioeconomic, and personal factors were independently associated with lower self-reported work ability in studies that examined such factors. Each included study was limited by a high risk of bias in at least one assessed domain, and only 6 of the studies adjusted for confounders. Heterogeneity in study design and analysis precluded a meta-analysis.

Conclusions and relevance: Menopausal status alone was not consistently associated with work outcomes. Evidence for an adverse impact of menopausal symptoms on work ability is mixed and may be confounded by other factors impacting on women's work outcomes at midlife. Rigorously designed studies that assess the potential factors impacting work ability in midlife women are needed to ensure robust evidence underpins menopause-related workplace policies.

Importance: The climacteric period, particularly the postmenopausal phase, presents significant risks to women's cardiovascular and mental health due to hormonal changes. Effective interventions are needed to address these challenges and improve clinical outcomes.

Objective: To evaluate the effects of aerobic exercise on cardiovascular parameters (systolic blood pressure, diastolic blood pressure, lipid profile, and triglycerides) and psychological outcomes (depression and anxiety) in postmenopausal women.

Evidence review: In this systematic review with meta-analysis, four databases (PubMed, Embase, SportDiscus, and PsycINFO) were searched from inception to December 18, 2024. Randomized controlled trials (RCTs) assessing aerobic exercise interventions in postmenopausal women were included. Study selection, data extraction, and risk-of-bias assessments (using RoB 2) were performed by two independent reviewers, with discrepancies resolved by a third. Certainty of evidence was evaluated using GRADE.

Findings: The review included 61 RCTs with 4,100 women (2,356 exercise and 1,744 control). Aerobic exercise reduced systolic blood pressure by 4.5 mm Hg (95% CI: -6.5 to -2.4) and diastolic blood pressure by 2.4 mm Hg (95% CI: -3.8 to -1.1). high-density lipoproteincholesterol increased by 2.4 mg/dL (95% CI: 1.0 to 3.8), while low-density lipoprotein cholesterol and triglycerides decreased by 3.6 mg/dL (95% CI: -6.1 to -1.1) and 7.7 mg/dL (95% CI: -11.9 to -3.5), respectively. No significant effect was found for total cholesterol. Aerobic exercise reduced anxiety scores by 0.2 SDs (95% CI: -0.3 to -0.03), but the effects on depression were not statistically significant.

Conclusion and relevance: Aerobic exercise significantly improves cardiovascular health by reducing blood pressure, low-density lipoprotein cholesterol, and triglycerides, while increasing high-density lipoprotein cholesterol in postmenopausal women. Its positive effects on anxiety highlight its role in addressing mental health. These findings support aerobic exercise as a recommended intervention to mitigate health risks in this population and emphasize the need for further research on long-term, hard outcomes.

Objective: This preliminary study aimed to conduct initial, exploratory analyses of the association between hyperinsulinemia and biomarkers of metabolic syndrome in reproductive-aged women with abnormal uterine bleeding (AUB), with the goal of motivating future hypothesis-driven research.

Methods: A cross-sectional study was conducted from June 2019 to August 2023 at a single institution's outpatient gynecology clinics. A total of 205 premenopausal women aged 18-54 were enrolled, including 116 with AUB and 89 with normal menstrual cycles. Participants underwent fasting insulin assessment with additional markers of metabolic syndrome, including body mass index (BMI), high-density lipoprotein, and waist-to-hip ratio. Logistic regression was used to examine the association between hyperinsulinemia and AUB, adjusting for confounders such as age, race, and low-density lipoprotein. Model selection prioritized low Akaike Information Criterion and model parsimony.

Results: Hyperinsulinemia was a significant predictor of AUB (OR=3.009, 95% CI: 1.372-6.832; P =0.0085). Including BMI in the model diminished the significance of hyperinsulinemia, suggesting overlapping or mediating pathways. The final model which included age, race, low-density lipoprotein, and waist-to-hip ratio achieved 73% concordance and improved model fit.

Conclusion: This study highlights an association between hyperinsulinemia and AUB, with BMI playing a unique role in this relationship. These exploratory findings underscore the need for larger, longitudinal studies to clarify causal mechanisms and evaluate the potential of addressing hyperinsulinemia and BMI as part of AUB prevention and treatment strategies. Limitations, including small sample size and cross-sectional design, should be considered when interpreting these results.