Maturitas最新文献

Objectives: Vasomotor symptoms (VMS) are a burden for women in menopause. Despite the availability of hormone therapy (HT), many cannot or do not wish to utilise it. The efficacy of the neurokinin receptor antagonists fezolinetant and elinzanetant has been established in clinical trials. Matching-adjusted indirect comparison (MAIC), which controls for the differences in treatment effect modifiers between trials and provides robust estimates of relative treatment effects, was used here to compare the efficacy of fezolinetant and elinzanetant in individuals with VMS associated with menopause.

Study design: Patient-level data from the fezolinetant SKYLIGHT-1/2 trials were used to match the population and study design of elinzanetant OASIS-1/2 trials. Treatment effect modifiers were identified and MAIC analyses were performed.

Main outcome measures: VMS frequency and severity, Patient-Reported Outcomes Measurement Information System Sleep Disturbance - Short Form 8b (PROMIS SD SF 8b), Menopause Specific Quality of Life Questionnaire (MENQOL).

Results: The OASIS-1/2 trial populations had higher mean VMS frequency/severity and greater sleep disturbance at baseline. Fezolinetant and elinzanetant had comparable efficacy in reducing VMS frequency and severity. Sleep disturbance improved with both drugs but more with elinzanetant. Improvement in sleep disturbance did not translate into a significant difference in overall QoL, as measured by MENQOL.

Conclusions: MAIC analysis found that fezolinetant and elinzanetant had a similar efficacy profile for reduction of VMS frequency and severity. Differences in reduction of sleep disturbances did not result in differences in QoL. Neurokinin receptor antagonists provide an alternative to HT and other non-HT options for the treatment of VMS associated with menopause.

Objectives: To examine women's perspectives on what constitutes a women's health-friendly work culture, and to assess whether perceiving one's organisation as women's health-friendly is associated with menopausal symptom experience and work-related outcomes.

Methods: A cross-sectional mixed-methods online survey collected self-reported quantitative and qualitative data from working menopausal women. Primary outcome measures included presence of menopausal symptoms (past four weeks), vasomotor symptom problem rating, job stress, and whether participants perceived their organisation as supportive of women's health (dependent variable). Two open-ended questions explored participants' views on what makes a work culture friendly or unfriendly to women's health.

Results: From the responses of 300 participants, over two-thirds (65.7%) perceived their organisation as supportive of women's health. These participants reported significantly lower job stress and less problematic vasomotor symptoms than those who did not. No significant association was found between menopausal symptom presence. Thematic analysis of qualitative responses revealed two overarching themes capturing shared perceptions of women's health-friendly and unfriendly work cultures. Theme 1 focused on the people at work: awareness and understanding of women's health, attitudes towards women and work, and their talking about women's health at work. Theme 2 addressed more structural factors of organisational arrangements and provisions: flexibility in work arrangements, resources and support, and the physical work environment.

Conclusions: This study provides novel insights into how women perceive a health-friendly work culture and the potential relevance to menopausal experiences and work. The findings have clear implications for policy and practice, warranting further attention and investigation.

Background: Hearing loss is an emerging public health concern, with women typically experiencing deterioration during menopause; however, longitudinal studies across this transition are limited. This study examined hearing changes across the menopausal transition in order to identify distinct patterns of hearing decline from 11 years before to 9 years after the final menstrual period, with the goal of informing strategies for early detection and intervention.

Materials and methods: We followed 4448 women aged 42-52 years who underwent regular health exams at the Kangbuk Samsung Hospital Total Healthcare Centers (2014-2018) through 2023. Hearing changes were analyzed using linear mixed-effects models across the menopausal transition. Group-based trajectory modeling was applied to assess heterogeneity in hearing deterioration relative to the final menstrual period.

Results: A significant change in average bilateral hearing thresholds was observed across menopausal transition. Hearing change during the menopausal transition varied by obesity, with minimal change in those with obesity and slight improvement in those without during early transition. Group-based trajectory modeling identified two patterns: Group 1 (71.7 %) had stable hearing until the final menstrual period, then declined; Group 2 (28.3 %) showed poorer baseline hearing with a steeper, persistent decline. At baseline, Group 2 exhibited a significantly higher prevalence of overweight/obesity and hyperglycemia than Group 1.

Conclusions: Postmenopausal stages were associated with significant hearing decline in middle-aged women. Furthermore, subgroups with metabolically unhealthy profiles exhibited poorer baseline hearing and a steeper decline in hearing, highlighting the need for appropriate screening and management during the menopausal transition.

Objectives: The associations between female reproductive milestones, use of menopausal hormone therapy (MHT), and the risk of hearing loss remain unclear. This study explored these associations and the potential mediating pathways.

Methods: This longitudinal study used data from the UK Biobank. The sample comprised 214,327 women aged 40-69 years without hearing loss at baseline and without diagnosis of the condition in the first five years of follow-up. Adjusted Cox proportional hazard models were used, along with sensitivity analyses, assessments of dose-response relationships, and joint effect analyses. The mediating roles of cardiovascular disease (CVD) and diabetes were also investigated.

Results: Over a mean follow-up of 13.42 years, 5106 women developed hearing loss. Higher parity (≥4 children; HR 1.29, 95 % CI 1.14-1.46), premature menopause (<40 years; 1.27, 1.14-1.41), both shorter (≤30 years; 1.12, 1.02-1.22) and longer (≥45 years; 1.16, 1.01-1.32) reproductive lifespans were associated with an increased risk of hearing loss. Surgical menopause (2.71, 2.39-3.07) and natural menopause (2.49, 2.25-2.75) showed higher risk compared with pre-menopause. MHT use was associated with increased risk of hearing loss in women with typical-age natural menopause, but not in those with premature or late menopause (although point estimates were above 1 the 95 % CI included 1). CVD mediated 46.07 % of the association between parity and hearing loss, and 19.61 % of the association between early menopause and hearing loss.

Conclusion: Reproductive factors (such as parity and age at menopause) may influence the risk of hearing loss in women. These findings suggest that reproductive history should be incorporated into hearing health assessments, and integrated health strategies addressing both reproductive and metabolic health may help mitigate the risk of hearing loss in women.

Objective: To explore the associations between spirometric patterns and cardiometabolic diseases progression in middle-aged and older adults, and examine the mediating effects of levels of C-reactive protein and score on the atherogenic index of plasma.

Methods: Based on 320,795 participants from the UK Biobank, five spirometric patterns were defined using baseline measurements of forced expiratory volume in one second and forced vital capacity. The cardiometabolic diseases included type 2 diabetes, coronary heart disease, and stroke. Multistate model and mediation analysis were used for statistical analyses.

Results: During a median follow-up of 13.68 years, 37,053 participants developed at least one cardiometabolic disease, 3746 developed cardiometabolic multimorbidity, and 22,204 died. In the transition from baseline to first cardiometabolic diagnosis, the hazard ratios (95 % confidence intervals) compared with normal lung function were 1.14 (1.11, 1.17) for airflow obstruction, 1.17 (1.10, 1.23) for preserved ratio impaired spirometry alone, 1.21 (1.10, 1.32) for restrictive spirometric pattern alone, and 1.38 (1.33, 1.43) for the combined preserved ratio impaired spirometry with restrictive spirometric pattern. Combined preserved ratio impaired spirometry with restrictive spirometric pattern was also associated with a higher risk of progressing from first cardiometabolic disease to multimorbidity (hazard ratio: 1.21; 95 % confidence interval: 1.10, 1.33). The levels of C-reactive protein and score on the atherogenic index of plasma mediated 6.56 % to 15.74 % of the associations between spirometric patterns and cardiometabolic diseases.

Conclusions: Spirometric patterns exhibit differential effects throughout the progression of cardiometabolic diseases, and C-reactive protein and atherogenic index of plasma play a partial role in mediating these effects.

Objectives: To evaluate the long-term efficacy and safety of a single injection session of cross-linked hyaluronic acid for postmenopausal vulvovaginal atrophy.

Study design: 12-week, randomised, placebo-controlled, single-blind phase followed by 40-week open-label phase. At study start, patients received hyaluronic acid or placebo injection. At 12 weeks, patients who initially received placebo received hyaluronic acid.

Main outcome measures: Mean change from baseline in the severity score of the most bothersome symptom, scores for vulvovaginal atrophy individual symptoms, score on the Female Sexual Function Index and vaginal pH after hyaluronic acid injection. Patients receiving hyaluronic acid were followed to 36 weeks or 52 weeks if treated at study start.

Results: 115 patients receiving hyaluronic acid were analysed. The mean score for most bothersome symptom and all individual symptom scores were significantly reduced from baseline at all time points (p < 0.001). The initial decrease in most bothersome symptom was observed at 4 weeks, with a mean (SD) decrease of -1.05 (1.05) to 1.69 (1.11), and maintained up to 52 weeks. Mean full-scale score on the Female Sexual Function Index was significantly increased from baseline at all time points (p < 0.001). The initial increase was observed at 4 weeks, with a mean increase of 4.50 (6.51) to 20.54 (8.60), and maintained up to 52 weeks. Improvement was observed across all domains of the Female Sexual Function Index. There was a general trend for improvement in vaginal pH.

Conclusions: A single injection session of hyaluronic acid is effective in reducing vulvovaginal symptomatology and in improving sexual function for up to 52 weeks, making it a suitable management option for moderate to severe vulvovaginal atrophy symptoms.

Clinical trials: gov identifier NCT04219722.

Introduction: Several studies indicate that regular physical activity can reduce systolic and diastolic blood pressure, improve endothelial function, and enhance overall cardiovascular fitness in postmenopausal women. To gain a deeper understanding, we conducted a narrative review of systematic reviews to assess the impact of exercise on cardiovascular parameters in postmenopausal women.

Method: The literature search was conducted using the Excerpta Medica, Medical Literature Analysis and Retrieval System Online, Scopus, and Web of Science databases. We included systematic reviews investigating the effects of exercise on cardiovascular parameters in postmenopausal women, with publications considered up until December 2024.

Results: Following the exclusion of 187 publications, three systematic reviews were selected. These reported significant exercise-induced improvements in vasomotor symptoms, systolic blood pressure, diastolic blood pressure and heart rate.

Conclusion: This narrative review revealed that exercise benefits cardiovascular health in postmenopausal women. Still, methodological limitations emphasize the need for better systematic reviews. Clinicians ought to interpret findings carefully when recommending physical exercise.