Postmenopausal Research Articles

Owners’ Experience and Satisfaction with Radioiodine Treatment in Hyperthyroid Cats—A Prospective Questionnaire Study

Radioiodine (RAI) treatment (RAIT) is considered the gold standard for treatment of feline hyperthyroidism. This study aimed to assess owners’ motivation, concerns and satisfaction with RAIT and health-related quality of life (HRQoL) changes in RAI-treated cats. Two surveys (before and six months post-RAIT) were sent to owners of cats scheduled for RAIT between April 2023 and March 2024. The owners of 78 and 68 cats completed the first and the second surveys, respectively. The main reasons for choosing RAIT were that RAIT was considered the gold standard treatment (n = 27/78; 35%) and difficulties administering antithyroid drugs (n = 18/78; 23%). The primary care veterinarian (n = 50/78; 64%) and the internet (n = 33/78; 42%) were the main information sources about RAIT at the referral clinic. Owners were mostly concerned about the anaesthetic risk and hospitalisation, with the cat missing the owner and vice versa being the main worries. Most owners were satisfied with the outcome and their decision for RAIT. The HRQoL score improved within the first six months after RAIT (p < 0.01), with no difference between euthyroid and hypothyroid cats (p = 0.609). This study emphasises the role of the primary care veterinarian and the internet as primary sources of information regarding RAIT. The findings help to better understand owner concerns, improve owner counselling, and educate primary care veterinarians about RAIT.

Quality of life changes after electrochemotherapy: a prospective single-center analysis

The rising prevalence of cutaneous and subcutaneous tumors has driven interest in electrochemotherapy (ECT) as a potential treatment. However, patient-reported outcomes remain underexplored. This study aims to assess the short-term impact of ECT on the quality of life (QoL) of patients, addressing a gap in the current literature. A prospective study evaluated 62 patients treated with ECT between 2015 and 2022. QoL was measured using the EQ-5D-3L questionnaire, calculating EQ-5D-index and assessing health state (EQ-VAS) and pain (pain-VAS). Subgroup analysis was conducted based on tumor histology, previous radiotherapy, and tumor size. Statistical analysis was performed using SPSS 29.0.0. The median age was 70 years, with a median follow-up of 47 days. Pre-treatment, 38.7% of patients reported pain/discomfort, and 24% had anxiety/depression. Post-treatment, these decreased to 32.2% and 19%, respectively. While the EQ-VAS and EQ-5D-3L scores showed a non-significant increase, pain-VAS decreased. Significant improvements were seen in patients with previous radiotherapy (EQ-VAS, p = 0.047; EQ-5D-index, p = 0.012) and smaller tumors (EQ-VAS, p = 0.035; pain-VAS, p = 0.029). ECT demonstrates a significant short-term benefit in maintaining or improving QoL in patients with cutaneous malignancies.

Effects of Interactive Health Education Combined With Evidence-based Pain Management Nursing on Disease Cognition, Postoperative Pain and Post-traumatic Growth in Patients Undergoing Laparoscopic Salpingectomy

AIM: Laparoscopic salpingectomy has been widely used in the clinical treatment of benign tubal lesions. This study aims to explore the effects of interactive health education combined with evidence-based pain management nursing on disease cognition, postoperative pain and post-traumatic growth in patients undergoing laparoscopic salpingectomy, in order to provide new insights into clinical nursing for these patients. METHODS: In this retrospective study, 360 patients who underwent laparoscopic salpingectomy in our hospital from January 2022 to December 2023 were included. Patients receiving routine care were included in the control group (n = 213) and patients receiving interactive health education combined with evidence-based pain care were classified under the study group (n = 147). General data, disease cognition, postoperative pain and post-traumatic growth of the two groups were collected and compared. RESULTS: The awareness rate regarding pathogenesis, cardinal symptom, surgical and postoperative precautions, prevention of complications, medication management, diet management, sleep management, and review time and project in the study group were all significantly higher than those in the control group (p < 0.05). The numerical rating scale (NRS) scores of the study group were lower than those of the control group at 6 h, 12 h, 24 h and 48 h post-surgery (p < 0.001). Before discharge, all dimensions of the post-traumatic growth inventory (PTGI) scores like relating to others, new possibilities, personal strength, spiritual change, and appreciation of life of the study group patients were significantly higher than those of the control group (p < 0.05). The time to get out of bed, exhaust time, and hospitalization stay of the study group patients were significantly shorter than those of the control group (p < 0.05). The total incidence of complications in the study group was significantly lower than that in the control group (p < 0.05). CONCLUSIONS: Interactive health education combined with evidence-based pain management nursing is conducive to improving disease cognition, reducing postoperative pain, enhancing post-traumatic growth, and promoting postoperative recovery in patients undergoing laparoscopic salpingectomy.

A randomized controlled trial adding behavioral counseling to supervised physical activity in people living with and beyond cancer (BOOST-UP-): a study protocol for a live remotely-delivered behavior change intervention

BackgroundFor many people living with and beyond cancer (LWBC), physical activity (PA) declines significantly after supervised PA interventions. The effect of short-term, supervised PA interventions on motivational outcomes and longer-term PA in people LWBC is limited, especially theoretically-based approaches to identify key motivational outcomes for behavior change. The purpose of this study is to compare the effects of a 6-month virtual supervised PA group plus standard exercise counseling (PA + EC) versus a virtual supervised PA plus motivationally-enhanced behavioral counseling (PA + BC) group on moderate-to-vigorous intensity PA (MVPA) in people LWBC.MethodsThis study is a two-armed, multi-site randomized controlled trial (RCT). People LWBC will be recruited and randomized to a 6-month virtual supervised PA intervention plus standard exercise counseling (PA + EC group; n = 118) or a 6-month virtual supervised PA plus behavioral counseling based on the Multi-Process Action Control (M-PAC) framework (PA + BC group; n = 118). Supervised PA will be delivered via synchronous Zoom classes that tapers to a home-based protocol at the end of the study. The goal of both groups is to gradually increase PA to the cancer PA guidelines (e.g., 90 min of MVPA/week). The PA + BC group will receive twelve behavioral counseling sessions with a qualified exercise professional (QEP), and the corresponding counseling session will be delivered bi-weekly. The behavioral counseling sessions will be based on the M-PAC’s reflective, regulatory, and reflexive processes. In addition to the supervised PA classes, the PA + EC (i.e., attention control group) will receive twelve standard PA counseling sessions based on PA training principles. People LWBC will complete measures at baseline, midpoint, post-intervention (6-months), at 6-months follow-up, and 1-year follow-up. Self-reported measures include quality of life (QoL), motivational outcomes, health economics, and patient satisfaction. Objective measures include PA via accelerometry. Multilevel modelling will examine change in the primary (i.e., PA) and secondary outcomes (i.e., motivational outcomes from the M-PAC, physical function, QoL) at the five time points.DiscussionThis study will create greater understanding on efficacious programming to support PA maintenance that can be used by clinical and community-based organizations as a low-cost, supportive care tool to improve health outcomes for people LWBC.Trial registrationClinicaltrials.gov ID NCT06624930.

Is laccase from medicinal mushroom Cerrena unicolor cytotoxic to colon cancer cell line CT-26?

Colorectal cancer takes an increasing toll every year. Despite the dynamic development of pharmacology, there is still no drug that would be strong enough to cause apoptosis of cancer cells, but at the same time would be free from numerous side effects. Taking traditional Eastern medicine into account, studies were carried out using an extract - laccase (LAC) from a medical mushroom called Cerrena unicolor- on CT-26 colon cancer cells. Preliminary cytotoxicity tests have already confirmed that the examined extract affects cancer cells and at the same time has no significant effect on L929 cells. The Electric Cell-substrate Impedance Sensing system (ECIS) and standard methods were used in this work. ECIS used in this study is an advanced in vitro impedance measuring system. The CT-26 and L929 cells were treated by five different concentrations of the LAC preparation ranging from 0.025 to 250 μg/mL. Concentrations selected for the ECIS system assay were: 0.25;2.5 and 250 μg/mL. The default optimal frequencies in the ECIS system for Resistance (R) 4000Hz, Impedance (Z) 16000Hz, Capacitance (C) 64000Hz were used. ECIS results demonstrate the potential anti-cancer activity of the laccase preparation against CT-26 cancer cells, and affect theL929 cells in to a lesser extent. Thanks to the use of the ECIS research technique, it was possible to monitor live changes in cell morphology and physiology, which translates into accurate conclusions about the action of the tested preparation.

Retirees from Europe migrating to Thailand: A study of two co-occurring occupational transitions

ABSTRACT Background Retirement migration has increased in Global North societies. However, little is known about how migration affects individuals’ transition into retirement and their occupational engagement. This study explored the experience of co-occurring occupational transitions of retirement and migration. Methods A constructivist grounded theory approach was used. Data were collected through in-depth interviews with 21 retiree migrants from Europe living in Thailand. Results The co-occurring transitions of retirement and migration are a dynamic process where retirees go back and forth between both transitions. The process is described in four periods: (i) beach period, (ii) real-life period, (iii) becoming established and connected, and (iv) thoughts on health and future. In the early part of the process, the migration transition is more dominant. Once it plateaus, the retirement transition is more dominant. After this period, retirees have thoughts of possible migration back to their country of origin in the future. Conclusion When migration and retirement transitions co-occur, they intertwine in a process where each alternately takes prominence until both achieve a stable phase of establishment over time. This study shows how retirement and migration influence each other, shaping retirees’ occupations, identity, and well-being, and provides insights into how people adapt to major life changes.

Changes in left ventricular diastolic flow dynamics in the neonatal transition period and beyond.

Significant hemodynamic changes occur within the neonatal transition period including a sudden increase in pulmonary blood flow, disappearance of fetal shunts and increase in systemic vascular resistance. How this affects left ventricular (LV) physiology and intraventricular flow dynamics is still poorly understood. Blood speckle tracking is a novel high frame rate echocardiographic technique that allows to visualize two-dimensional intraventricular flow dynamics. In this study longitudinal changes in LV diastolic flow dynamics were explored in a prospective single-center design analyzing a total of 176 echocardiographic examinations in 36 healthy newborns from birth until six months of age. Kinetic energy, energy loss, vorticity and intraventricular pressure difference increased significantly from birth until six-eight weeks of age (p < 0.001 for all parameters). The increase in IVPD continued until six months of age while no further significant changes in the other quantitative LV flow parameters could be observed beyond six-to-eight weeks. Early after birth, diastolic vorticity was predominantly located at the anterior mitral valve leaflet while at six months of age, vorticity was similar at the anterior compared to the posterior mitral valve leaflet. Overall, these results indicate that LV diastolic physiology and flow dynamics undergo substantial changes in early life. The observed changes in diastolic LV properties are likely associated with increased LV filling in the presence of increased pulmonary blood flow.

Medical cost inflation and its drivers in Indonesian employer-sponsored health insurance for retiree families

Rising life expectancy and changes in disease patterns have led to an increase in retiree medical costs. Understanding these trends is essential for ensuring the financial sustainability of retiree healthcare programs. The aim of this study was to analyze medical cost inflation and its drivers in Indonesia's employer-sponsored retiree health insurance program from 2020 to 2023. A retrospective cohort study using total sampling included 29,695 retirees, analyzing medical records and insurance claims to examine demographic transition, cost analysis and relative risk of cost drivers. The study found that the retiree population is aging, characterized by longer life expectancy and a growing proportion of individuals aged above 71 years. Medical cost inflation among retirees is higher compared to the general population, driven by aging, high-cost diseases, increased healthcare utilization, and rising treatment costs. Cardiovascular diseases, diabetes, and chronic kidney disease are major drivers of high medical costs. Inpatient care is the most significant cost component, with a cost risk 14.39 times higher than clinic visits. Medicine and medical treatment are leading cost contributors in the retired population. The rising cost of retiree healthcare necessitates sustainable financing strategies. The study highlights that medical cost inflation in retirees was higher than in the general population, driven by aging, high-cost diseases, increased utilization, and rising treatment costs. Strengthening preventive care, optimizing primary care, and diversifying funding sources are recommended to ensure long-term financial stability.

Predictors of psychosocial adaptation in haemodialysis patients according to haemodialysis vintage: a quantitative study

Background: Haemodialysis (HD) patients face difficulties adapting to the drastic life changes associated with their treatment, emphasising the crucial role of psychosocial adaptation in improving long-term health outcomes. The level of psychosocial adaptation and its predictors are different according to the duration of HD therapy. Aim: The objective was to compare the predictors of psychosocial adaptation in HD patients based on the duration of haemodialysis, with a reference point of one year since initiating HD. Design: A comparative cross-sectional survey design was used. Methods: Patients from one outpatient and four community-based haemodialysis centres in South Korea completed a paper-based survey during their dialysis admission. The survey included self-report questionnaires on psychosocial adaptation, depression, perceived social support, dialysis-related symptoms, and self-management. Results: The adaptation score of short-term patients was below the average and lower than that of long-term patients. The predictors of adaptation were dialysis symptoms, social support, depression, and self-management for short-term patients, and depression and self-management for long-term patients. Conclusions: The findings highlight the need for interventions that address depression and promote self-management in HD patients, regardless of the duration of HD. Strategies aimed at increasing social support and effectively managing dialysis-related symptoms should also be considered, particularly for short-term patients within one year of initiating HD. Based on the identified predictors of adaptation in this study, tailored nursing interventions that effectively promote adaptation, consideringthe duration of the patient’s HD, should be developed, and implemented in clinical practice.

THE ANTIOSTEOPOROTIC POTENTIAL OF HESPERIDIN AND ADVANCED DELIVERY SYSTEMS

This study explores Hesperidin (HP) and its bone-protective effect against Osteoporosis (OP), summarizing its healing mechanisms supported by in vitro and in vivo evidence and insights into its ethnobotanical significance and advanced drug delivery systems. To gather information on the antiosteoporotic potential of HP, we thoroughly searched many scientific databases, including Science Direct, Google Scholar, PubMed, and Scopus, for articles published between 1990 and 2025. Data were collected using the keywords HP, traditional uses, phytochemistry, anti-OP, and drug delivery systems. Only studies published in English are considered for this review. It has gained attention for potential health benefits, especially the osteoprotective effect. In vitro studies found that HP reverses dexamethasone-induced inhibition of osteogenic differentiation by suppressing the p53 (Protein 53) pathway. In rat models of Postmenopausal (PM), senile, and disuse OP, HP showed bone-protective benefits. Clinical trials revealed a 15% increase in serum calcium and a 25% increase in osteocalcin levels, indicating enhanced bone formation. Comparative analysis showed that HP's efficacy in increasing bone mineral density is similar to that of bisphosphonates. The findings demonstrate that HP is an excellent therapeutic candidate that protects the skeleton through various mechanisms. Future research should focus on developing HP-based nutraceuticals or pharmaceuticals, integrating traditional knowledge with modern pharmacological approaches to enhance bone health. Despite its potential, the efficacy of HP formulations in treating OP has not yet been investigated.

Practical Application of Evidence-Based Dietary Therapy in Inflammatory Bowel Disease: The DELECTABLE Program.

Exclusive Enteral Nutrition (EEN) and the Crohn's Disease Exclusion Diet (CDED) have been shown to induce remission in Crohn's disease. Low-sulphur, plant-based diets are being explored for ulcerative colitis, and wholefood, low-additive approaches are emerging as significant. Although Inflammatory Bowel Disease (IBD) patients modify their diet, evidence for tolerability and benefit outside clinical trials is limited. The DELECTABLE program aimed to assess satisfaction, adherence, and efficacy of dietary therapies as part of IBD care. In this dietitian-led, open-label, prospective study, patients with Crohn's disease were offered the CDED or a whole-food, additive-free diet (WFD), and patients with ulcerative colitis were offered a low-sulphur, plant-based diet (UCD) or WFD. Primary outcomes were 12-week diet satisfaction (modified DSAT-28) and diet adherence, including food additive intake. Secondary outcomes were quality of life (QoL) (IBDQ-9), disease activity (CDAI for Crohn's disease, partial Mayo score for ulcerative colitis), and biochemical markers (CRP, faecal calprotectin). Analyses were conducted within, rather than between, diet arms due to the non-random nature of the study. Diet adherence and disease activity change across time points (baseline, week 6, week 12) were assessed using repeated measures ANOVA or Friedman's test, with pairwise paired t-test or Wilcoxon Signed-Rank test. Diet satisfaction and quality of life changes across time (baseline/week 1, week 12) were assessed using a paired t-test or Wilcoxon Signed-Rank test. Of 165 referrals, 76 patients enrolled, with 64 completing the 12-week program (CDED: n = 15, WFD: n = 42, UCD: n = 7). Diet satisfaction was initially high and remained stable over time on CDED (p = 0.212) and improved on WFD (p = 0.03). Patient- and dietitian-rated adherence was high at baseline and did not significantly decrease on any diet arm (p > 0.349). Food additive intake decreased on WFD (p = 0.009). QoL improved on CDED and WFD (p < 0.001). CRP, calprotectin, and CDAI were reduced on CDED (p < 0.045), and CDAI and partial Mayo were reduced on WFD (p < 0.027). Well-balanced therapeutic diets are feasible and well-accepted by patients with IBD, with a promising impact on disease activity.

A critical review on restoration of grassland ecosystems: Challenges, strategies and future directions

Grasslands, covering 40 % of global biomes, are crucial for maintaining biological and human life, food security, tourism and climate change mitigation. However, these ecosystems face significant threat from climate change, overgrazing and unsustainable practices like land-use change, leading to declines in biodiversity, productivity and ecosystem resilience. This review aims to identify factors promoting grassland degradation, analyze patterns of degradation and the assessment methods, with a focus on remote sensing and GIS (Geographical Information System) application and evaluate restoration practices and technologies using mechanical, biological and chemical approaches incorporating climate change resilience techniques. Key socio-economic and policy issues challenges include inadequate funding incentives and disjointed governance systems, necessitating stakeholder engagement and sustainable funding. To combat degradation, this study emphasizes the importance of integrating native knowledge from local communities with modern methods and adopting transdisciplinary and climate-resilient approaches for enhanced grassland restoration successes. This study emphasizes on effectively restoring grasslands, improve ecosystem robustness and advance the sustainable development agenda.

Evoluation of Stress and Its Management through Homoeopathy

Stress is a fundamental aspect of human existence and is commonly viewed as a reaction to outside influences. Stress is characterized as the body’s physical and mental response to circumstances. Those can create a challenge or risk to a person’s overall well-being. It is worth noting that certain stress levels are essential for human survival and productivity. It can include the mental stage as well as physical well-being. This essay explores the concept of stress, its measurement, and the importance of adopting a Homoeopathic approach to manage stress. Life would be simple indeed if all of our needs are automatically satisfied. In reality, however many obstacles both personal and environmental, prevent this ideal situation. Such obstacles demands to adjust with situation and it can lead to stress. Dictionary Meaning: • The word Stress has Latin origin. This word has been derived from the word Strictus that indicates to draw together. • A force exerted upon a body that tends to strain or deform its shape. • Mental or physical tension or strain. Definition: • Stress is a normal physical response to events that make you feel threatened or upset your balance in some way. • According to Neufeld stress is a by-product of poor or inadequate coping. Historical Evolution of Stress: • Walter B Canon used the term stress in both a Physiologic and a Psychological sense as early as 1914. • He applied the engineering concept of stress and strain in a physiological context. He believed that emotional stimuli were also capable of causing stress. • Hans Selye in 1946 popularized these same findings, viewing stress as a biological phenomenon. • In 1950 it was investigated that stress might be influence the immunity and resistance to disease. • In the study of 1970 it was founded that life changes or emotions resulting from life changes were associated with decreased immune function. • More recently we have seen the interactions among social, Psychological and biological factors in causing and prolonging or shortening the course of disease. • This will give rise to a more holistic and complex model of molecular biology, immunology, neurology endocrinology and behavioral science. Responsible Factors For Stress: • Factors, which are responsible for the production or giving rise to Stress, are known as Stressors. • Anything that puts high demands on you or forces you to adjust can be stressful. • The root sources of Stressors are Frustration, Conflicts and Pressure. • Not all stress is caused by external factors. Stress can also be self-generated, for example, when you worry excessively about something that may or may not happen, or have irrational, pessimistic thoughts about life can also generate stress. Situation Our Perception Stress

Sexual dysfunction and body image in BRCA mutation carriers before and after risk-reducing salpingo-oophorectomy: a cross-sectional study

Sexual dysfunction and body image in BRCA mutation carriers before and after risk-reducing salpingo-oophorectomy: a cross-sectional study

Family Members' Experiences of a Person-Centered Information and Communication Technology-Supported Intervention for Stroke Rehabilitation (F@ce 2.0): Qualitative Analysis.

Stroke often leads to long-term effects on daily activities and participation. Consequences impact not only stroke survivors but also their close networks, and capturing their experiences is crucial for the development of effective interventions. F@ce 2.0 is a person-centered, information and communication technology (ICT)-supported stroke rehabilitation intervention currently being evaluated. This study aims to describe family members' experiences of the F@ce 2.0 intervention from the perspective of being a caregiver to a stroke survivor. Participants were family members (n=7) of stroke survivors participating in the intervention. Semistructured interviews were conducted at 2 time points, postintervention and 6 months postbaseline, resulting in a total of 13 interviews. Data was analyzed using qualitative inductive content analysis. An overarching theme was developed from 4 categories. The main theme was the potential of F@ce 2.0 as a support for family members of stroke survivors in the sudden change of life. The categories were: dialogue and partnership with the F@ce 2.0 team, resuming daily activities lowers the demand for family support, support and involvement through the ICT component of F@ce 2.0, and engagement in F@ce 2.0, leading to suggestions for development. This study aligns with previous research delineating the effects of stroke on family members of stroke survivors. Participants highlighted the positive impact of the focus on daily activities within the intervention. Furthermore, the ICT component was perceived as a support in structuring rehabilitation. Participants, however, suggested further development, both in terms of content and technology.

Physiological alterations around the menopause transition-A 2-year follow-up in PRE, PERI, and POST menopause females.

The menopause transition is a critical period marked by significant physiological adaptations. Data on the dynamic changes in body composition and metabolism during this transition are limited. The purpose was to determine body composition and metabolic changes over a 2-year follow-up in a cross-sectional sample of premenopausal (PRE), perimenopausal (PERI), and postmenopausal (POST) females. Twenty-three females who previously participated in a cross-sectional study returned for a 2-year follow-up visit were classified as PRE, PERI, or POST based on menstrual history and a Menopause Health Questionnaire. Muscle size [muscle cross-sectional area (mCSA)] and muscle quality [echo intensity, (EI)] were evaluated in the vastus lateralis with ultrasound. Bone mass and body composition were assessed using dual-energy X-ray absorptiometry, and metabolic flexibility through submax exercise with indirect calorimetry. At the 2-year follow-up, POST females had an increase in EI (change: 26.93 ± 12.82 a.u., group×time p-adjusted = 0.001) with no change in mCSA (change: -2.03 ± 2.40 cm², group×time p = 0.980). PERI compared to PRE females had lower total bone mass (group×time p-adjusted = 0.029) with an even lower bone mass in POST compared to PERI females (group×time p-adjusted = 0.023). No differences in metabolic flexibility at any exercise intensity were observed between groups over time (group×time p = ≥ 0.05). This study highlights a decline in muscle quality and total bone mass despite stable muscle size, emphasizing the need for targeted exercise and nutrition interventions to support muscle and bone health in females around the menopause transition.

Rates of Primary Ovarian Insufficiency and Surgical Menopause in Patients With Endometriosis

Rates of Primary Ovarian Insufficiency and Surgical Menopause in Patients With Endometriosis

Inbound logistics optimization for fresh oranges with waste management

Inbound logistics optimization for fresh oranges with waste management

Health consequences of graded, full, and no sickness absence among workers with musculoskeletal disorders: health profiles and six-months symptom changes of patients referred to Norwegian outpatient clinics for chronic neck and back pain

ObjectiveIt is generally assumed that graded sickness absence results in favourable health effects due to observed positive consequences of maintaining work participation. To date, however, the direct health benefits of graded sick leave have not been widely explored. Musculoskeletal disorders are among the most prominent health issues resulting in work incapacities. This study examined baseline characteristics and six-months pain-related disability and health-related life quality progression of working age adults who attended a neck and back pain outpatient clinic. Patients prescribed graded sick leave were compared to patients prescribed full sick leave and those working without sick leave.MethodsDemographic, health, and treatment information of patients were assessed using clinician and patient self-report questionnaire data collected at neck and back pain outpatient clinics between 2016 and 2022. Data were obtained from the Norwegian Neck and Back Registry and the Norwegian Labour and Welfare Administration. Patient characteristics in the two weeks leading up to clinic intake were described. General linear models for repeated measures were employed to observe six-months changes in pain-related disability and health-related life quality.ResultsA total of 5143 (54% female, M = 44.70 years, SD = 11.50) patients were prescribed full (n = 1411, 27%), graded (n = 1164, 23%), and no (n = 2568, 50%) sickness absence. Patients prescribed graded sick leave reported lower baseline levels of pain-related disability compared to those on full sick leave but higher pain-related disability than patients without sick leave. There were significant main and interaction effects of time and sickness absence, whereby reductions in pain-related disability were greatest among patients prescribed full sick leave, however, this group reported the highest levels of pain-related disability and lowest life quality prior to their clinic intake and six months later.ConclusionPatients who were prescribed full, graded, or no sick leave exhibited significant, albeit not clinically meaningful, reductions in pain-related disability over a six-months period. Symptom reductions may be due to clinician support or remission trends in line with regression towards the mean. While no superior health effects of graded sick leave were noted, work participation did not appear to have detrimental health effects.

Association between endometriosis and type and age of menopause: a pooled analysis of 279948 women from five cohort studies.

What is the association between endometriosis and the type and age of menopause? Women with endometriosis had a 7-fold increased risk of undergoing surgical menopause rather than natural menopause and were more likely to experience premature or early menopause, both surgically and naturally. Endometriosis is associated with reduced ovarian reserve, but evidence on its relationship with the type of menopause (surgical vs natural) and timing (especially premature and early menopause) is limited. Women with endometriosis are more likely to undergo hysterectomy and/or oophorectomy (either unilateral or bilateral), but the average age of these surgeries remains unclear. The study analysed individual-level data from 279948 women in five cohort studies conducted in the UK, Australia, Sweden, and Japan between 1996 and 2022. Women whose menopause type and age could not be determined due to premenopausal hysterectomy with ovarian preservation or use of menopausal hormone therapy were excluded. Endometriosis was identified through self-reports and administrative data. Surgical menopause was defined as premenopausal bilateral oophorectomy. Fine-Gray subdistribution hazard models estimated hazard ratios (HRs) for surgical and natural menopause. Age at menopause was determined by the ages at the final menstrual period or bilateral oophorectomy. Linear regression assessed mean differences in menopause age, while multinomial logistic regression estimated odds ratios (ORs) for categorical menopause age: <40 (premature), 40-44 (early), 45-49, 50-51 (reference), 52-54, and ≥55 years. Spontaneous premature ovarian insufficiency (POI) was defined as natural menopause before age 40years. Endometriosis was identified in 3.7% of women. By the end of follow-up, 7.9% had surgical menopause and 58.2% experienced natural menopause. Using a competing risk model, women with endometriosis had a 7-fold increased risk of surgical menopause (HR: 7.54, 95% CI 6.84, 8.32) and were less likely to experience natural menopause (HR: 0.40, 95% CI 0.33, 0.49). On average, surgical menopause occurred 1.6 years (19 months) earlier (β: -1.59, 95% CI -1.77, -1.42) in women with endometriosis. Among women who experienced natural menopause, it was 0.4 years (5 months) earlier (β: -0.37, 95% CI -0.46, -0.28) for those with endometriosis. Women with endometriosis were twice as likely to experience premature surgical menopause (<40 years) (OR: 2.11, 95% CI 2.02, 2.20) or 1.4 times more likely to develop spontaneous POI (OR: 1.36, 95% CI 1.17, 1.59). They were also at increased odds of early surgical and natural menopause (40-44 years). This study could not differentiate between subtypes and stages of endometriosis or assess treatments for ovarian endometrioma, which may impact ovarian reserve. Self-reported menopause type and age could introduce recall bias. Given the consistent findings across individual studies, our results are likely to be generalizable to different populations, highlighting the need for tailored management of endometriosis to prevent medically induced or premature menopause. Long-term monitoring of women with endometriosis is recommended, given their elevated risk of surgical menopause and premature or early menopause, which are associated with adverse health outcomes in later life. The InterLACE Consortium is funded by the Australian National Health and Medical Research Council project grant (APP1027196) and Centres of Research Excellence (APP1153420). G.D.M. is funded by the Australian National Health and Medical Research Council Leadership Fellowship (APP2009577). This research is funded in part by the Japan Society for the Promotion of Science (JSPS KAKENHI: 19KK0235, 23KK0167). The authors have no conflict of interest. Where authors are identified as personnel of the International Agency for Research on Cancer or WHO, the authors alone are responsible for the views expressed in this article, and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer or WHO. N/A.