Maturitas最新文献

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.

An increasing number of women of menopausal age, many of whom experience menopausal symptoms, are participating in the workforce. Understanding the factors that influence work productivity in this life stage can inform the development of targeted interventions. This systematic review explores which health-related, lifestyle, work-related, and socio-demographic factors are associated with work productivity among menopausal women. A systematic search was conducted for observational studies in PubMed, PsycINFO, and Embase up to July 2024. The risk of bias was assessed using an adapted Newcastle-Ottawa scale. The GRADE framework for prognostic research was applied to evaluate the quality of evidence. A total of 29 studies were included. Menopausal symptoms in general, as well as psychological and vasomotor symptoms, and lower sleep quality were associated with lower at-work productivity, with moderate to high quality of evidence. Additionally, there was moderate quality of evidence that better (perceived) health was associated with higher at-work productivity. Regarding absenteeism, moderate evidence was found for an association with vasomotor symptoms. Inconclusive evidence was found for socio-demographic, work-related factors and remaining health-related and lifestyle factors in relation to both at-work productivity and absenteeism. This review highlights the association of menopausal symptoms and poor sleep quality with decreased work productivity in menopausal women. The evidence for other associations was limited due to the low quality of available evidence or a lack of studies. Further research on modifiable lifestyle and work-related factors is needed to improve the work functioning of women during menopause.

Objectives: To describe the translabial ultrasound findings in patients with stress urinary incontinence (SUI) who underwent single-incision sling (SIS) insertion and to determine the correlation between these findings and results after surgery.

Study design: Retrospective and analytical study of patients with SUI who underwent SIS. Translabial ultrasound was performed 12 months after surgery. Success was assessed using the cough test. Satisfaction was assessed using the Treatment Benefit Scale (TBS). The presence of de novo urgency and de novo voiding dysfunction were assessed by anamnesis and questionnaires.

Main outcome measures: Objective resolution of incontinence, patient satisfaction, de novo urgency and voiding dysfunction.

Results: 111 patients were analyzed. Among the patients with resolution of SUI (92 patients, 82,9 %), 93,5 % (86 patients) had the mesh in the middle third of the urethra, reducing to 78,9 % (15 patients) in patients with SUI unresolved (p = 0,04). In the group of SUI cured, 78,3 % of these patients showed a mean reduction of 17,4 ± 20 % of mesh-pubis distance in Valsalva compared with rest and in the group of SUI unresolved this distance showed an increase of 1,6 ± 16 % (p = 0,02). Mesh-urethral lumen distance was significantly shorter in patients who experienced de novo voiding dysfunction compared with patients without voiding dysfunction (4(3-4,9)mm vs 5(4-7)mm, p = 0,03). The prevalence of voiding dysfunction was 19 % (13 patients) when the mesh-urethral lumen distance was <5 mm, reducing to 2 % (1 patient) in patients with a larger distance (p = 0,01). Urgency was not correlated with any of the variables evaluated.

Conclusions: Translabial ultrasound findings after SIS are correlated to objective resolution of SUI and de novo voiding dysfunction.