Menopausal transition and metabolic syndrome risk: insights from the Chinese PALM longitudinal cohort

Menopausal hormone therapy and menopausal symptoms

ABSTRACTObjective The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW +10 reviewed advances in understanding of the critical changes in hypothalamic–pituitary–ovarian function that occur before and after the final menstrual period.Methods Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus.Results STRAW +10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage −3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage −1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics.Conclusions STRAW +10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW +10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.

The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW + 10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period. Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus. STRAW + 10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics. STRAW + 10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW + 10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.

Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging

National Institutes of Health State-of-the-Science Conference Statement: Management of Menopause-Related Symptoms

The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW + 10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period.Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus.STRAW + 10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics.STRAW + 10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW + 10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.

Vasomotor symptoms (VMS) are the most common symptoms among menopausal women; these include hot flashes and night sweats, and palpitations often occur along with hot flashes. Some studies in Mexico reported that around 50% of women presented with VMS mainly in the menopausal transition. It has been proven that VMS are not only triggered by an estrogen deficiency, but also by nutritional risk factors. Evidence of an association between nutritional risk factors and VMS is limited in Mexican women. The aim of this study is to identify nutritional risk factors associated with VMS in women aged 40–65 years. This is a comparative cross-sectional study, undertaken in a retrospective way. A sample group (n = 406 women) was divided into four stages according to STRAW+10 (Stages of Reproductive Aging Workshop): late reproductive, menopausal transition, early postmenopause, and late postmenopause. Hot flashes were present mainly in the early postmenopause stage (38.1%, p ≤ 0.001). Two or more VMS were reported in 23.2% of women in the menopausal transition stage and 29.3% in the early postmenopause stage (p < 0.001). The presence of VMS was associated with different nutritional risk factors (weight, fasting glucose levels, cardiorespiratory fitness, and tobacco use) in women living in the northeast of Mexico.

The aims of this cross-sectional study were to determine if cognitive function differs across stages of reproductive aging and to evaluate whether hormones or menopausal symptoms predict cognition in perimenopause. We hypothesized that women in late menopausal transition and early postmenopause would perform more poorly than those in the late reproductive stage on attention and verbal memory tasks, and that estradiol, depressive symptoms, anxiety symptoms, hot flashes, and sleep disturbance would predict cognitive performance on those tasks. One hundred seventeen middle-aged women enrolled in the Rochester Investigation of Cognition Across Menopause were categorized into late reproductive stage (n = 34), early menopausal transition stage (n = 28), late menopausal transition stage (n = 41), or early postmenopause stage (n = 14) according to criteria from the Stages of Reproductive Aging Workshop +10. We administered a neuropsychological battery assessing six domains of cognition, assessed menopausal symptoms, and measured serum levels of estradiol and follicle-stimulating hormone. Multivariate regressions were conducted to determine the impact of menopausal stage and symptoms on cognition. Women in the first year of postmenopause performed significantly worse than women in the late reproductive and late menopausal transition stages on measures of verbal learning, verbal memory, and motor function. They also performed significantly worse than women in the late menopausal transition stage on attention/working memory tasks. Cognitive function does not change linearly across perimenopause. Decreases in attention/working memory, verbal learning, verbal memory, and fine motor speed may be most evident in the first year after the final menstrual period.

Perimenopausal Depression

Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative.

Executive summary: stages of reproductive aging workshop (STRAW)

This study aims to describe changes in follicle-stimulating hormone (FSH), estradiol (E2), ovarian volume (OV), and antral follicle count (AFC), and to examine their relationships at the same menopause stage, based on the Stages of Reproductive Aging Workshop (STRAW) system, among Chinese women in community settings. Prospective longitudinal study design was used to analyze the sex hormone levels, OV, and AFC of 327 community women aged 30 to 65 years. They were followed up at 1 year. Significant differences in FSH, E2, and OV were observed at baseline and on follow-up (all P<0.001). Significant differences in E2 were observed between baseline and follow-up for women in premenopause (-2.743, P=0.006) and late postmenopause (-5.213, P<0.001). There were significant differences in FSH between baseline and follow-up in early menopausal transition (MT) (-2.430, P=0.015) and late MT (-3.737, P<0.001). There were significant differences in OV between baseline and follow-up in late MT (-3.805, P<0.001) and early postmenopause (-4.341, P<0.001). There were significant differences in AFC between baseline and follow-up in premenopause (-2.046, P=0.041). These results suggest the existence of significant associations between FSH, E2, OV, AFC, and menopause status, supporting the use of the STRAW system among community-based women in China. Further study of the MT is recommended to confirm the appropriateness of the STRAW system for Chinese women.

Obesity and Atherogenic Dyslipidemia

Background: The menopausal transition (MT) marks the end of a woman’s reproductive years, characterized by hormonal changes, irregular menstrual cycles, and various symptoms impacting health and quality of life. Objective: To understand the hormonal fluctuations during MT and the clinical implications for managing symptoms. Method and Materials: The article synthesizes findings from various studies and consensus workshops, particularly the Stages of Reproductive Aging Workshop (STRAW), detailing hormonal changes and clinical presentations during early and late MT. Results: MT involves erratic estradiol levels, decreased progesterone, and increased follicle-stimulating hormone (FSH), leading to irregular cycles, with notable events like luteal out-of-phase (LOOP) cycles. Symptoms often include abnormal uterine bleeding, hot flashes, sleep disturbances, and mood disorders. Hormonal therapies, including estrogen and selective serotonin reuptake inhibitors (SSRIs), are effective but should be administered cautiously due to associated risks. Discussion: The hormonal chaos of MT complicates infertility and symptom management. Non-hormonal therapies and lifestyle modifications are beneficial but often less effective than hormone therapy. Conclusion: A personalized approach to managing MT is crucial, integrating hormonal and non-hormonal strategies, lifestyle changes, and mental health support. Continuous research aims to optimize these interventions for better outcomes in women during MT.

Purpose This study aimed to find the associations between vasomotor symptoms (VMS) and metabolic syndrome (MetS) in Chinese middle-aged women in a cross-sectional study. Methods A total of 675 participants were recruited from an urban Chinese community. MetS was defined by the 2009 criteria of the Joint Interim Statement. VMS including hot flashes and sweats, blood pressure, weight, height, waist circumference (WC), serum glucose, triglycerides, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), estradiol, and follicle-stimulating hormone (FSH) were collected. Results The presence of hot flashes was independently associated with the risk of MetS after adjusting for age, menopausal status, FSHlog, estradiollog, and physical activity (odds ratio: 1.98, 95% confidence interval: 1.21–3.24, p = 0.006). Both hot flashes and sweats were also independently associated with WC (for hot flashes, p = 0.016; and for sweats, p = 0.007) and triglycerides (for hot flashes, p = 0.041; and for sweats, p = 0.014) significantly. However, VMS were not significantly associated with blood pressure, glucose, HDL, and LDL. Conclusion Women with hot flashes had a higher risk of MetS. Both hot flashes and sweats were related to a higher amount of central fat indicated by WC and higher triglycerides, but were not related to blood pressure, glucose, and HDL in Chinese women.