Maturitas最新文献

Sexual minority women (lesbian/gay, bisexual, and queer-identified cisgender women) as well as non-binary people have unique experiences in menopause but remain underrepresented in the scientific literature as compared with cisgender, heterosexual women. This review provides an overview of their experiences with menopause, including menstrual cessation, menopause symptoms, experiences with healthcare systems, and sexual health. The end of menstruation comes with mixed emotions for many sexual minority women, including sadness, grief, relief, and a sense of freedom. Sexual and gender minority individuals often experience discrimination and bias in healthcare encounters. So, too, do sexual minority women and non-binary people report negative experiences with the healthcare system while navigating menopause. In particular, this includes challenges locating inclusive menopause resources and culturally competent clinicians who create safe, trusting healthcare environments. In contrast to heterosexual women, sexual minority women have more open communication with partners regarding sexual function during menopause, and often have greater sexual satisfaction due to more expansive definitions of sex and pleasure. Non-binary individuals can experience distress, isolation, and gender dysphoria during the menopause transition, though research on their experiences remains extremely limited. To better care for sexual and gender minorities, more inclusive menopause education resources and healthcare environments are sorely needed, as are culturally competent healthcare clinicians. Increasing representation of sexual and gender minorities in the scientific literature on menopause is also crucial to improve understanding and clinical care.

Objectives

This study examined the associations between pulse pressure, hypertension, and the decline in physical function in a prospective framework.

Study design

The Healthy Aging Longitudinal Study tracked a group of Taiwanese adults aged 55 or more over an average of 6.19 years to assess pulse pressure and decline in physical function, including in handgrip strength, gait speed, and 6-min walking distance, at baseline (2009–2013) and in the second phase of assessments (2013−2020).

Main outcome measures

Pulse pressure was calculated as the difference between systolic and diastolic blood pressure values. Weakness, slowness, and low endurance were defined as decreases of ≥0.23 m/s (one standard deviation) in gait speed, ≥5.08 kg in handgrip strength, and ≥ 57.73 m in a 6-min walk, as determined from baseline to the second phase of assessment. Linear and logistic regressions were employed to evaluate the associations between pulse pressure, hypertension, and decline in physical function.

Results

Baseline pulse pressure was associated with future handgrip strength (beta = −0.017, p = 0.0362), gait speed (beta = −0.001, p < 0.0001), and 6-min walking distance (beta = −0.470, p < 0001). In multivariable models, only handgrip strength (beta = −0.016, p = 0.0135) and walking speed (beta = −0.001, p = 0.0042) remained significantly associated with future pulse pressure. Older adults with high systolic blood pressure (≥140 mmHg) and elevated pulse pressure (≥60 mmHg) exhibited a significantly increased risk of weakness (odds ratio: 1.30, 95 % confidence interval: 1.08–1.58), slowness (1.29, 1.04–1.59), and diminished endurance (1.25, 1.04–1.50) compared with the reference group, who exhibited systolic blood pressure of <140 mmHg and pulse pressure of <60 mmHg.

Conclusions

Among older adults, pulse pressure is associated with a decline in physical function, especially in terms of strength and locomotion.

Objectives

This study assessed the uptake of hormone replacement therapy (HRT) in cervical cancer patients with iatrogenic menopause. Survival in relation to HRT use was assessed via a retrospective chart study, and the severity of menopausal symptoms, motivations and barriers to starting HRT were examined via questionnaires.

Study design

In total, 293 women under the age of 51 and treated with radiotherapy for cervical cancer between 2010 and 2020 were identified. Medical records were searched for information on HRT use. If still living, women were sent digital questionnaires addressing menopausal symptoms, quality of life (QoL) and potential barriers and motivations concerning HRT use. Univariable data were analysed using Mann-Whitney U, chi-square, and Fisher's exact test, while logistical regression was used to analyse relationships between certain variables and use of HRT and survival.

Results

Overall HRT uptake was 78.1 %, which was related to age and Charlson Comorbidity Index, but independent of the duration of radiotherapy or FIGO stage. Overall survival was higher for HRT users (χ²(1) = 4.3, p = 0.038). Questionnaires were sent to 193 patients and 100 completed it (response rate 51.8 %). Main reasons for HRT use were relief of hot flushes and improvement in QoL. For women below age 51, QoL was indeed higher for current HRT users than for non-HRT users (EQ-index 0.8 vs. 0.7, p = 0.008).

Conclusions

HRT prescription rate was inversely correlated with age. Survival was not negatively affected by HRT use. It is important to stress the benefits of HRT and address women's fears regarding its use.

Objectives

The aim of the study was to evaluate the change in menopause symptoms and work impairment among a cohort of UK working women who utilised an employer-provided digital menopause health application offering education and personalised support.

Study design

We adopted a retrospective, single-arm, longitudinal approach by analysing data from 11,870 users of the Peppy Health menopause application. Users reported their menopause symptoms and work impairment on day 0 and after 90 and 180 days of application use.

Main outcome measures

Menopause symptoms were measured by the Menopause Rating Scale, while work impairment was measured by a single question.

Results

A significant decrease in the severity of menopause symptoms was observed in users across menopause stages, except for premenopausal users who saw lower severity and no change over time. Improvement in menopause symptoms was positively associated with the degree of application engagement. Work impairment also significantly reduced over time for menopausal users, and a significant association was observed between a reduction in menopause symptoms and a decline in work impairment.

Conclusions

Our findings show that engaging with a digital menopause application is associated with an improvement in menopause symptoms, which lends initial support for the use of personalised digital solutions to help working women through the menopause transition.

Background

Studies of the associations of polypharmacy and frailty with adverse health outcomes in middle-aged adults are limited. Furthermore, a potentially stronger association of polypharmacy with adverse health outcomes in frail than in non-frail adults is of interest.

Objective

To evaluate associations of frailty (assessed using a frailty index) and polypharmacy (defined as taking five or more drugs) with major cardiovascular events, cancer incidence, all-cause, cardiovascular disease-specific, and cancer-specific mortality.

Methods

Cox proportional hazards regression models were used to analyze 501,548 participants of the UK Biobank cohort study aged 40–69 years who were followed up for an average of 12 years.

Results

The prevalence of pre-frailty and frailty were 43.2 % and 2.3 %, respectively, and that of polypharmacy was 18.3 %. Although strongly associated with each other, frailty and polypharmacy were independently, statistically significantly associated with major cardiovascular events, cardiovascular disease-specific, and all-cause mortality. In addition, the hazard ratios of polypharmacy were stronger among (pre-)frail than non-frail study participants. No profound associations with cancer incidence and cancer mortality were observed. No sex and age differences were observed.

Conclusions

This large cohort study showed that polypharmacy and frailty are independent risk factors for major cardiovascular events, cardiovascular disease-specific and all-cause mortality in both middle-aged (40–64 years) and older people (≥ 65 years). In addition, the hazard ratios of polypharmacy were stronger among (pre-)frail than non-frail study participants. This underlines the need to avoid polypharmacy as far as possible not only in older but also in middle-aged subjects (40–64 years), especially if they are pre-frail or frail.

The Georgia Centenarian Study is one of the earliest comprehensive studies on centenarians. Based on the Georgia model of adaptation, the primary purpose of this study was to assess the health and well-being of our oldest population, with a focus on several primary adaptation areas: genetics and family longevity, environmental support, individual characteristics, cognitive and behavioral skills, health behaviors, and physical and mental health, including overall life satisfaction. The results of the three Georgia Centenarian sub-studies indicate that genetic and environmental variables play an important role in determining different levels of healthy aging, but they also highlight relevant mediating and moderating effects in a network of interrelating adaptation components.

The experience of menopause is not “one size fits all.” Instead, biologic, physiologic, and sociocultural factors strongly affect women's experiences of menopause symptoms and the ways in which they would like to manage their care. By providing culturally sensitive and patient-centered care, clinicians may be able to improve menopause experiences for all of their patients. However, a literature review revealed a lack of information about culturally responsive care for menopause. The first objective of this review is to discuss the ways in which sociocultural identity influences menopause care-seeking and management. The second objective is to introduce a framework of culturally responsive care for menopause.

The rates of prescription for menopause hormone therapy have been low in the U.S. since the 2002 Women's Health Initiative study, but no recent studies have assessed the prescribing of hormone therapy in the U.S. Using the National Ambulatory Medical Care Survey data from 2018 to 2019, we found that hormone therapy was prescribed in 3.8 % of U.S. visits by midlife and older women, with 60 % of these visits including estradiol-only prescriptions. Older age and Hispanic/Latina ethnicity were associated with decreased odds of prescribing, while White race and depression were associated with increased odds, indicating possible disparities in menopause care.

Objective

The effects on the brain of hormone therapy after the onset of menopause remain uncertain. The effects may be beneficial, neutral, or harmful. We provide a conceptual review of the evidence.

Methods

We 1) provide a brief history of the evidence, 2) discuss some of the interpretations of the evidence, 3) discuss the importance of age at menopause, type of menopause, and presence of vasomotor symptoms, and 4) provide some clinical recommendations.

Results

The evidence and the beliefs about hormone therapy and dementia have changed over the last 30 years or more. Five recent observation studies suggested that hormone therapy is associated with an increased risk of dementia, and the association appears not to change with the timing of initiation of therapy. These harmful associations may be explained by a causal effect of hormone therapy on the brain or by several confounding mechanisms. We suggest that the use of hormone therapy should be customized for different subgroups of women. It may be important to subgroup women based on age at onset of menopause, type of menopause, and presence or absence of vasomotor symptoms. In addition, the effects may vary by type, dose, route, and duration of administration of estrogens and by the concurrent use of progestogens.

Discussion

The relation of hormone therapy with the risk of dementia is complex. Hormone therapy may have beneficial, neutral, or harmful effects on the brain. Hormone therapy should be guided by the clinical characteristics of the women being treated.

Premature ovarian insufficiency (POI) is a rare condition characterized by loss of ovarian function before the age of 40. POI seems associated with mood disorders and sexual dysfunction. However, there is a lack of high-quality evidence relating to the impact of POI on sexual function. Therefore, we conducted a systematic review and meta-analysis to evaluate sexual function in women with POI compared to women without the condition. The following online databases were systematically searched up to January 2023: EMBASE, Medline (Ovid), Web of Science, Cochrane, PsychInfo, and Google Scholar. Random effects models were used for analyses, with data reported as Hedges' g and 95 % confidence interval, and the risk of heterogeneity was evaluated. The protocol of this study was registered with PROSPERO (CRD42023437203). A total of 10 studies were included in the systematic review and 5 studies involving 352 women with POI were included in the meta-analysis. Eight of the ten studies concluded that women with POI have reduced sexual function. An overall medium Hedges' g effect size of −0.72 was found (ranging between −0.20 and −1.29) in favor of control women, with moderate heterogeneity (I² = 64 %). Stratified studies of women on systemic hormone replacement therapy (HRT) showed an even higher Hedges' g effect size, of −0.82 (95 % CI −1.18, −0.47). In conclusion, sexual function in women with POI is reduced compared with control women. Sexual function should be discussed with women with POI and they should be offered psychosexual counseling.