Common Menopausal Symptoms Research Articles

CGRP Is Critical for Hot Flushes in Ovariectomized Mice.

Hot flushes are common and troublesome symptoms of menopause. The neuropeptide calcitonin gene-related peptide (CGRP) is increased in plasma during hot flushes but it has not been clear if CGRP is causally involved in the mechanism underpinning the flushes. Here, we examined the effect of interventions with CGRP in a mouse model of hot flushes based on flush-like temperature increases triggered by forced physical activity in ovariectomized mice. Compared to normal mice, ovariectomized mice reacted with an exaggerated, flush-like, temperature increase after physical exercise. This increase was completely blocked by the non-peptide CGRP-antagonist MK-8825 (-0.41 degrees Celsius, 95% CI: -0,83 to 0,012, p < 0.0001) at a dose that had no obvious effects on locomotor activity (50 mg/kg). Further, the flush-like temperature increases were strongly attenuated in ovariectomized mice lacking αCGRP due to a genetic modification. Collectively, our findings suggest that CGRP is an important mediator of experimentally induced hot flushes and they identify CGRP antagonists as promising treatment candidates for women and possibly also men with hot flushes.

Menopausal Hot Flashes: A Concise Review.

Hot flashes (HFs), defined as transient sensations of heat, sweating, flushing, anxiety, and chills lasting for 1–5 min, constitute one of the most common symptoms of menopause among women though only a few seek treatment for these. The basis of HFs lies in abnormal hypothalamic thermoregulatory control resulting in abnormal vasodilatory response to minor elevations of core body temperature. Recent data suggest an important role for calcitonin gene-related peptide, hypothalamic kisspeptin, neurokinin B and dynorphin signal system, serotonin, norepinephrine in causation of HFs in addition to estrogen deficiency which plays a cardinal role. The mainstay of treatment includes hormonal replacement therapy, selective serotonin, and norepinephrine reuptake inhibitors in addition to lifestyle modification. In this review, we address common issues related to menopause HFs and suggest a stepwise approach to their management.

Psychosomatic and vasomotor symptom changes during transition to menopause.

Menopause is the condition in which the gradual decline in ovarian function finally leads to the permanent cessation of menstruation. Oestrogen deficiency may cause early symptoms during the menopausal transition and late symptoms after menopause. Menopause is a normal period of life. During this period, women need adaptation to new biological, social, and psychological parameters. Vasomotor symptoms are among the most common menopausal symptoms. Menopause per se is not correlated with specific psychiatric disorders, but data suggest that perimenopausal women are more likely to develop depressive disorders even without a previous history. Vasomotor symptoms are correlated with mood and sleep disturbances, neuroticism, anxiety, decreased cognitive function, and stress. Personality traits, social, and other factors are also important mediators of vasomotor symptoms during the menopausal transition phase.This is a review based on the existing evidence concerning the correlation between psychosomatic and vasomotor symptoms of menopause during the menopausal transition period. Healthcare providers should take these correlations into consideration when planning the treatment of vasomotor symptoms. Vasomotor symptoms during menopause are associated with significant social costs. There are numerous traditional hormone therapy, and complementary and alternative therapy including over-the-counter treatments and dietary supplements for managing menopause-related vasomotor symptoms. Additional costs include follow-up physician visits, laboratory testing, management of adverse events, and loss of productivity at work. Social support and planning may help women to deal with menopausal symptoms and may reduce overall social costs during this transitional phase.

Dizziness in peri- and postmenopausal women is associated with anxiety: a cross-sectional study

BackgroundAlthough dizziness is one of the most common symptoms of menopause, the underlying mechanism is not precisely known. Therefore, this study aimed to investigate the prevalence of, and the factors associated with, dizziness in peri- and postmenopausal women.MethodsWe conducted a cross-sectional study in which we analyzed the first-visit records of 471 Japanese women aged 40 to 65 years who enrolled in a health and nutrition education program at a menopause clinic. The prevalence of dizziness was estimated according to the participants’ responses to the Menopausal Health-Related Quality of Life Questionnaire. The background characteristics of age, menopause status, body composition, cardiovascular parameters, basal metabolism, and physical fitness; other menopausal symptoms, including vasomotor, insomnia, depression, and anxiety symptoms; and lifestyle characteristics were assessed for their associations with dizziness.ResultsThe percentage of women who suffered from dizziness once a week or more frequently was 35.7%. Compared to the women without dizziness, those with the symptom were younger; had a higher body weight, body mass index, body fat percentage, muscle mass, and waist-to-hip ratio; had higher systolic pressure; were slower in reaction time; had higher physical and psychological symptom scores of menopause; exercised less regularly; and consumed less alcohol. A multivariate logistic regression analysis revealed that the anxiety symptom, which was evaluated by the Hospital Anxiety and Depression Scale, was the sole factor that was independently associated with dizziness (adjusted odds ratio 1.14; 95% confidence interval 1.08–1.20).ConclusionsDizziness is highly prevalent in Japanese peri- and postmenopausal women and it is associated with anxiety. The treatment of anxiety in this population might improve the symptom.

INFLUENCE OF PROBIOTIC SUPPLEMENTATION ON CLIMACTERIC SYMPTOMS IN MENOPAUSAL WOMEN-A MINI REVIEW

Menopause (MP) is a natural physiological event of woman’s life and is defined as the absence of menstrual periods for at least twelve months and loss of function of ovarian. The common symptoms of MP are irregular vaginal bleeding, hot flushes especially in head and chest, night sweats, insomnia, vaginal and urinary symptoms, cognitive dysfunction, increased cancer risk, osteopenia, high blood pressure, diabetes, and cardiovascular diseases. Microbiome has been associated with several health benefits. Probiotic supplementation helps to enhance the quality of microbiome thereby confers the health benefits to the host system. The microbiome, hormone (estrogen) changes, and probiotic intervention are related to the health status of the female reproductive system. The vaginal microbiome (VM) play a critical role in female reproductive health and MP, which can be greatly influenced by probiotics, and other medicine especially antibiotics and hormone therapy. The role of VM in supporting vaginal health is not clear and debatable. Understanding the role of vaginal Lactobacillus could expose the pathogenesis of vaginal dysbiosis, which helps to improve diagnostic and therapeutic strategies for several dysbiosis associated health issues and menopause-related symptoms. Recent studies suggested that the intervention of probiotic preparation with or without nutraceutical formulation (mostly with isoflavones) improve the health status of menopausal women. The mechanism of probiotics mediated health improvement in menopausal women is not yet described clearly. Several controversies are there on the link between probiotic, gut microbiota, vaginal microbiota, and estrogen deficit. The present review summarizes the influence of probiotic supplementation on climacteric symptoms in menopausal women. The literature search was made in Scopus, Google Scholar, PubMed using the keywords “probiotics” and “menopause”. The documents were carefully checked for the relevance to the current manuscript, and the selection was made without any restriction in the year of publication.

Menopause

The female reproductive system matures in a continuous, natural process from menarche to menopause as the finite numbers of oocytes produced during fetal development are gradually lost to ovulation and senescence. Menopause is defined as the permanent cessation of menses; by convention, the diagnosis of menopause is not made until the individual has had 12 months of amenorrhea. Menopause is thus characterized by the menstrual changes that reflect oocyte depletion and subsequent changes in ovarian hormone production. However, hormonal changes, rather than the cessation of menstruation itself, cause the manifestations that occur around the time of menopause. Therefore, a woman who has undergone a hysterectomy but who retains her ovaries can experience normal menopausal symptoms as oocyte depletion leads to changes in estrogen levels, even though cessation of menstruation occurred with surgery. This review covers definitions, natural menopause, menopausal transition and postmenopausal symptom management, and premature ovarian insufficiency. Figures show stages of reproductive aging, serum concentrations of hormones during menopausal transition and postmenopause, hormonal changes associated with reproductive aging, symptoms of menopausal transition and menopause, treatment algorithm(s), and Women’s Health Initiative findings: risks and benefits of estrogen alone and estrogen plus progestin by age group: 50 to 59, 60 to 69, and 70 to 79 years. Tables list target tissues, physical manifestations, and menopausal symptoms; selective estrogen receptor modulators used in postmenopausal women; differential diagnosis and evaluation of common menopausal symptoms; estrogen doses; progestogen dosing for endometrial protection; nonhormonal pharmaceutical hot flash therapies; and pharmacologic therapy for genitourinary atrophy. This review contains 6 highly rendered figures, 7 tables, and 119 references.

Comparing the Pattern of Menopausal Symptoms, Concern and Attitudes in Urban and Rural Postmenopausal Iranian Women.

ObjectivesAlthough hormonal changes during menopause are inevitable in this period, the severity of the menopausal symptoms can be controlled. Accepting menopause and having a positive attitude toward it can also help. Given the results of previous studies, and since environmental factors affect the pattern of menopausal symptoms the present study was conducted to compare the pattern of menopausal symptoms, concern and attitudes in urban and rural postmenopausal women.MethodsThis cross-sectional study was conducted on urban and rural postmenopausal women residing in and around Tabriz, Iran. Cluster sampling was used to select the subjects. The data collection tools used included a demographic questionnaire to assess women's experiences during menopause.ResultsThis study examined 544 urban and rural postmenopausal women between March and September 2015. The women had a mean age of 51.8 ± 3.1. After adjusting the basic variables, the mean scores of menopausal symptoms and their subscales showed significantly higher scores in the physical and psychological subscales in the urban women, while the rural women had significantly higher scores in the concern subscale.ConclusionsRural women were significantly different from urban women in terms of menopausal symptoms, concern and attitudes. Hot flushes, a common menopausal symptom, and decreased sexual desire were more common in the urban women; in contrast, the rural women experienced more concern about menopause and its consequences.

Prevalence of menopausal symptoms among postmenopausal women of urban Belagavi, Karnataka

BACKGROUND: According to the World Health Organization (1981), natural menopause is defined as no menses for 12 consecutive months with no obvious intervening cause. During the menopause, women may experience vasomotor, psychosocial, physical, as well as sexual dysfunction. Studies on menopausal issues and health demand priority in Indian scenario due to the growing population of menopausal women as a result of their increased life expectancy. OBJECTIVE: To know the prevalence of menopausal symptoms in the postmenopausal women aged 40–60 years. METHODOLOGY: A community-based cross-sectional study was conducted between January 1, 2016, and December 31, 2016, using a predesigned, pretested, structured questionnaire based on sociodemographic variables and menopausal symptoms as per the menopause-specific quality of life questionnaire. A total of 345 postmenopausal women aged 40–60 years residing in the field practice area of Urban Health Centre, Ashok Nagar, Belagavi, were selected by systematic random sampling technique and interviewed during house-to-house visit. The outcomes of this study were menopausal symptoms in the postmenopausal women. Data collected in the questionnaire were coded and entered in Microsoft Excel sheet. Values were expressed in the form of frequency and percentages. Tables were prepared. Statistical significance was set at P ≤ 0.05. RESULTS: In this study, the mean age among study participants was 52.04 ± 5.58 years. Majority 200 (58%) were Hindus, while 266 (77.1%) were literates. The most common menopausal symptoms were of physical domain (75.7%–25.5%), followed by psychosocial domain (63.9%–49.3%) to vasomotor domain (63.5%–55.4%) and least common sexual domain (42.3%–36.2%).

THE EFFECT OF LOW-DOSE DROSPIRENONE AND 17β-ESTRADIOL FOR CORRECTION OF THE MANIFESTATIONS OF CLIMACTERIC SYNDROME IN POSTMENOPAUSAL WOMEN

Vasomotor symptoms are the most common symptoms of menopause, requiring treatment with estrogen and/or progestogen. Recent international guidelines recognize the need to use the lowest effective dose of hormone replacement therapy. Drospirenone (DR) in combination with 17β-estradiol (E2) is used as hormone therapy (HT) for relief the symptoms and prevention of postmenopausal osteoporosis.The review presents data of 2 large randomized controlled studies that evaluated the lowest effective dose combination DRSP/ E2, the safety of this dose for endometrium, identified features of its pharmacodynamics and pharmacokinetics, depending on various factors. The minimum effective dose for the relief of hot flushes without causing any significant impact on the endometrium is DRSP of 0,25 mg/E2 of 0,5 mg. According to the results of the pharmacokinetic study a correlation between effectiveness of low dose DRSP/E2 with DRSP and E2 exposure levels was showed, and smoking reduces the effectiveness of hormonal therapy. This drug not only copes with moderate to severe hot flushes, but also reduces the incidence of symptoms of vulvovaginal atrophy, improving quality of life.

Vasomotor Symptoms Resulting From Natural Menopause: A Systematic Review and Network Meta-analysis of Treatment Effects From the National Institute for Health and Care Excellence Guideline on Menopause

(Abstracted from BJOG 2017;124:1514–1523) Vasomotor symptoms (VMSs)—the most common menopausal symptoms—occur in approximately 75% of postmenopausal women in the United Kingdom and are severe in 25%. A large number of treatments, both pharmacological and nonpharmacological, have been used to relieve VMSs during menopause.

Experience of Menopause and Menopausal Transition among Middle aged Women Attending A Periurban Hospital

Objective (s): The objective was to explore frequency of menopause related symptoms among middle aged women and their perception about menopause,Materials and Methods: This was a cross sectional study carried during March to May 2013 among women aged 45-60 years at the out patient Department of Obstetrics and Gynaecology of a tertiary hospital using structured questionnaire. Information was sought regarding menstrual pattern, self reported menopausal symptoms and attitude towards menopausal transition. Data analysis was done using SPSS version 16.Results: Total 106 women were interviewed, The mean age of the respondents was 50.3± 53 years, and 58.5% were post menopausal and 41.5% in menopausal transition. More than half (59.4%) were illiterate, 32% were working. Common menopausal symptoms were insomnia 51.8%, body ache 44.3% and feeling sad 31.3%. Hot flush and night sweats were reported by 50% and 33% respectively. Half of them regard menopause as normal and health seeking for menopausal problems was 42.5%.Conclusion: A significant proportion of women were suffering from vasomotor and psychosomatic symptoms but most of them did not seek treatment. To ensure quality of life health needs of middle aged women should be identified and their views towards menopause incorporated in formulating services for themBangladesh J Obstet Gynaecol, 2016; Vol. 31(1) : 10-15

Menopausal Health Status of the Nepalese Women

Menopause is an unavoidable and sometimes problematic condition in which women may suffer from a number of health problems. Knowledge of the major symptoms associated with menopause helps reduce the burden and stress associated with the condition. In this context, a study was conducted to establish baseline data regarding menopausal health problems among Nepalese women. A descriptive cross-sectional study was conducted among 2000 women aged over 40 years to identify their knowledge, attitude and practice related to menopausal health problems. Data was collected by interviewing the women and doing physical examination. Analysis was done using descriptive statistics and SPSS software was used for data analysis. A cohort of 2073 women (ages 40-60 years) participated in the research, among them 2000 yielded complete response. The study revealed that 820 (41%) women had reached menopause. The average age of menopause was 48.7 years. Majority of the women 1183 (59.2%) in the study did not know about menopausal health problems. Abnormal bleeding 353 (17.65%), sweating 315 (15.75%), hot flushes 299 (14.95%), joint/muscle pain 285 (14.25%) were the most common menopausal symptoms known by the women. Joint pain 736 (36.8%), hot flushes 584 (29.2%), irregular bleeding 582 (29.1%) were the most common experienced symptoms of menopause and only 586 (29.3%) consulted the health workers to alleviate menopausal symptoms. Moreover, most of the women 926 (46.3%) accepted menopause as a part of life. The research has tried to establish the baseline of menopausal health problems in the Nepalese women. The average age of menopause was 48.7 years. Majority did not know about menopausal health problems. Further researches with nationally representative sample are recommended to further explore the menopausal health problems of Nepalese women.

Abstract S5-03: Menopausal symptoms as predictors of long-term adherence in the International breast cancer intervention study (IBIS-1)

Abstract Tamoxifen reduces the risk of breast cancer among women at increased risk of the disease. The effectiveness of the drug is dependent on its appropriate use for the duration of therapy. Adherence for the full course of preventive therapy ranges from 60-80%. Early discontinuation is largely attributed to side-effects, but no studies have validated this using 5-year follow-up data. We assessed the role of menopausal side-effects on long-term adherence in the UK arm of the International Breast Cancer Intervention Study (IBIS-1). In the IBIS-1 trial, 4279 women in the UK were randomised to placebo vs. tamoxifen (20mg/day). A total of 292 were excluded (breast cancer, death, or other cancer), leaving 3987 to be included in the analysis (2000 placebo arm, 1987 tamoxifen arm). Adherence was calculated using data from six monthly clinical visits during the trial. Adherence (&amp;lt;4.5 years, ≥4.5 years) was calculated using the Kaplan-Meier estimator. Our main objective was to investigate the effect of menopausal side effects experienced during the first six months on adherence overall and by treatment arm. All analyses were adjusted for age, Tyrer-Cuzick risk, smoking, hormone replacement therapy use, menopausal status, baseline symptoms, and treatment. Overall, 66.8% of women were adherent for at least 4.5 years (placebo: 71.5% vs. tamoxifen: 62.1%, p&amp;lt;0.001). Highest drop-out rates were found within the first 12 months of follow-up, and a significant difference in adherence between treatment arms was observed thereafter (p&amp;lt;0.05). A low number of women experienced nausea/vomiting (5.0%) and headaches (7.0%), while higher proportions reported gynaecological symptoms (irregular bleeding/vaginal dryness/vaginal discharge, 13.8%) and hot flushes (31.5%). Women reporting nausea/vomiting (OR=1.82 [95% CI, 1.35-2.47], p&amp;lt;0.001) and headaches (OR=1.41 [1.08-1.84], p=0.01) were significantly more likely to be non-adherent at 4.5 years. Long-term adherence was not significantly affected for those who reported hot flushes (OR=1.10 [0.94-1.30], p=0.2) or gynaecological symptoms (OR=1.18 [0.99-1.41], p=0.07) compared with their counterparts. Nausea/vomiting was significantly associated with non-adherence in both the placebo (OR=1.82 [1.16-2.87], p=0.009) and tamoxifen (OR=1.84 [1.22-2.76], p=0.004) arms. Headaches were associated with non-adherence in the placebo arm (OR=1.70 [1.16-2.50], p=0.006), while gynaecological symptoms were only significant in the tamoxifen arm (OR=1.30 [1.05-1.63], p=0.02). The majority of side effects were of mild or moderate severity and we observed significant trends for lower adherence with increasing severity for all symptoms (p&amp;lt;0.05 to &amp;lt;0.001). In the IBIS-I trial, we observed a significant effect of common menopausal symptoms on long-term adherence. These effects were largely similar between tamoxifen and placebo arms, suggesting women are attributing age-related menopausal symptoms to preventive therapy. To ensure women experience the full benefit of preventive therapy, interventions are required to support the management of menopausal symptoms and to promote adherence. The higher rate of drop-out in the early months of the trial suggests early intervention may be an effective way to promote long-term adherence. Citation Format: Smith SG, Sestak I, Forbes J, Howell A, Cuzick JJ. Menopausal symptoms as predictors of long-term adherence in the International breast cancer intervention study (IBIS-1) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S5-03.

The risks of avoiding hormone replacement therapy during menopause

Menopause is associated with several symptoms which, if they reach certain intensity, can severely impair the quality of life. Overall, 90.9% of Latin American women will have at least one climacteric symptom and in 25%, these will be severe. Musculoskeletal pain, physical and mental fatigue and depressed mood are the most common climacteric symptoms. Dyspareunia, mood disorders and irritability can significantly alter female sexuality. Hot flashes are the symptoms most frequently related to menopause by both physicians and patients. However, it is one of the less common menopausal symptoms. This symptom reflects the neurochemical brain disorders caused by estrogen deficiency. The central nervous system (CNS) is also involved in changes of body composition leading to higher adipose tissue accumulation during climacterium, deteriorating quality of life and increasing the risk for chronic non-transmittable diseases. Menopausal discomfort also overloads health systems increasing the demand for medical services and decreasing productivity by labor absenteeism. Hormone therapy of menopause (HTM) decreases menopausal symptoms and improves quality of life. If we do not prescribe HTM to those women who need it, we could deprive them from several potential health benefits.

Study of menopausal symptoms in the nursing staff and female attendants in a rural medical college

Introduction: Menopause is defined as complete cessation of menstruation for 12 months or more. It is characterized by various symptoms such as hot flushes, irritability, sweating, anxiety, and depressive mood. Menopausal symptoms can be assessed by several tools and can be influenced by various sociodemographic factors. The study was planned with the aim to assess the commonly reported menopausal symptoms among women using the Menopause Rating Scale (MRS). Methodology: A cross-sectional study was undertaken at Dr. Rajendra Prasad Government Medical College (DRPGMC) Kangra at Tanda. The study was conducted in the month of November 2013, over a period of 3 weeks. The study population was nursing staff of DRPGMC Tanda and female attendants of patients in the age group 40–60 years. Convenience sampling was used, and the study sample was 200. The psychosomatic, somatic, and urogenital complaints were assessed in this group using the MRS. Results: Two hundred questionnaires were distributed among the nurses and female attendants of whom 180 women responded, a response rate of 90%. 103 of these women had attained menopause. The mean age of study participants was 49.4 ± 4.8 years. The average age of menarche was 14.8 years and mean age of menopause was 45.2 ± 4.7 years. Average MRS score was 11.67 with a maximum score of 31 and minimum score 2. The highest dimensional mean score was 5.48 for the psychosomatic symptoms. Conclusions: Common menopausal symptoms in this study are physical and mental exhaustion, irritability and joint and muscular discomfort.

Severity and Frequency of Menopausal Symptoms in Middle Aged Women, Rasht, Iran.

Menopause is a natural event in women's life. Some studies have shown that, these symptoms can lead to low quality of life. To identify the severity and frequency of menopausal symptoms in different stages of menopause, in a group of middle aged women. This cross-sectional study was conducted on 646 women aged 45-60 years in Rasht, Iran, who were included in the study by convenience sampling method. Menopause Rating Scale (MRS) was used to measure the severity of menopausal symptoms. Descriptive and analytical statistics by SPSS software version 19.0 was used for analysis. Mean age of women was 50.7± 4.65 years. About half of the participants (49.2%) were postmenopausal. The remaining 18.1% (n=117) and 32.7% (n=211) were perimenopausal and premenopausal, respectively. The score of physical domain for menopause symptoms was higher in postmenopausal women. Joint and muscle problems were the most frequent symptoms in post and perimenopausal women. Also, total score for menopausal symptoms was more in postmenopausal group than other groups (p<0.001). Severe symptoms were seen only in three post-menopausal women and 55.2% of them had mild to moderate symptoms. The menopause related symptoms differed based on the stage of menopause. Such studies are useful for creating awareness among women so that they can identify common menopausal symptoms and consequently may improve their quality of life.

Psychological health and menopause-specific quality of life of Malaysian women with type 2 diabetes.

Anxiety and depression are more common among females and those experiencing diabetes and menopause. Menopausal symptoms experienced by women can vary tremendously from population to population; therefore, there is a need to investigate these symptoms and associated risk factors in different communities. This study investigated the differences in psychological health and menopause-specific quality of life (MENQOL) between women with and without diabetes type 2 (T2DM) in Malaysia. Women with T2DM (n=320) were matched by age range to controls without T2DM (n=320). Data were collected from March 2012 to January 2013. Delusions Symptoms States Inventory (DSSI) instrument was used to identify symptoms of depression and anxiety. Women with diabetes had higher depressive (11.8% versus 8.4%) and anxiety (8.4% versus 6.6%) symptoms compared to women without diabetes. In both groups, the most common menopausal symptom was aches (muscles and joints). Women without diabetes had significantly higher scores for the sexual domain compared to women with diabetes (4.20 versus 3.21, p=0.001). The odds that a postmenopausal woman with diabetes was depressed or anxious on the DSSI scale increased significantly when the MENQOL score on the physical, vasomotor, and psychosocial domains increased by one unit. Both diabetes and psychological problems have negative impact on MENQOL. Our findings support the view of screening postmenopausal women with diabetes for depressive and anxiety, to improve overall quality of life.

The REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey in Europe: Country-specific comparisons of postmenopausal women’s perceptions, experiences and needs

ObjectivesTo achieve a better comprehension of the variability of perceptions, experiences and needs in terms of sexual and vaginal health in postmenopausal women (PMW) from four different European countries. MethodsAn internet-based survey was conducted in Italy, Germany, Spain and the United Kingdom with a total surveyed population of 3768 PMW aged between 45 and 75 years. ResultsThe UK sample was significantly older, with almost a quarter of participants over 65 years of age, and had the highest proportion of women experiencing recent vulvar and vaginal atrophy (52.8%). The majority of Italian and Spanish participants were receiving VVA treatment, whereas in the UK only 28% of PMW were on medication. The most common menopausal symptom was vaginal/vulvar dryness, with almost 80% of participants reporting it in all the countries except the UK (48%). On the other hand, vaginal/vulvar irritation was more frequently reported in the UK (41%). The percentage of participants with a partner was lower in the UK (71%), as was the monthly rate of sexual activity (49%). In the UK, the proportion of participants who had seen a healthcare professional for gynaecological reasons in the last year was lower than in other countries (27% vs. ≥50%), as was the proportion who has discussed their VVA symptoms with them (45% vs. ∼67%). In this sense, UK PMW waited for a longer before asking for help (especially for pain with intercourse and dryness). The main issues relating to VVA treatment difficulties expressed by participants were administration route in the UK, efficacy in Germany, and side-effects in Italy. ConclusionsAlthough all European women shared the same expectation of improving the quality of their sex lives, the opportunity for that varied among different countries in relation to the healthcare system and to the effective communication achieved with healthcare professionals when managing VVA.

A Word About Bioidenticals

A Word About Bioidenticals

National consensus on the management of patients in menopause

В документі представлено огляд існуючих методів діагностики і терапії клімактеричних розладів у жінок, запропоновано алгоритми діагностики і лікування даної патології з метою профілактики серцево-судинних захворювань, остеопорозу та покращення якості життя жінок в Україні. Клімактерій – це фізіологічний перехідний період у житті жінки, упродовж якого на фоні вікових змін в організмі домінують інволютивні процеси в репродуктивній системі, що характеризуються зниженням генеративної і менструальної функції внаслідок генетично запрограмованого згасання і припинення функціонування яєчників. Виділяють 4 періоди клімактерію: період менопаузального переходу, менопауза, перименопауза і постменопауза. Діагноз перименопаузи і менопаузи не потребує лабораторних гормональних досліджень для більшості здорових жінок, старших за 45 років, при наступних ознаках: при перименопаузі – наявність вазомоторних симптомів на фоні нерегулярних менструацій; при менопаузі – відсутність менструації протягом останніх 12 місяців або поява клімактеричних симптомів після гістеректомії. Найчастішими симптомами в клімактерії є вазомоторні симптоми: припливи, нічна пітливість, серцебиття, лабільність артеріального тиску; психологічні: емоційна лабільність, депресивні стани, тривога, дратівливість, порушення сну, погіршення пам’яті та концентрації уваги; загальнофізичні симптоми: астенізація, головний біль, біль в м’язах та суглобах, неприємні відчуття на шкірі; урогенітальні і сексуальні: вагінальний свербіж, печія, сухість і диспареунія, часте і ургентне сечовипускання, зниження лібідо. Єдиним патогенетично обгрунтованим і ефективним методом корекції клімактеричних розладів є менопаузальна гормональна терапія. Як таку терапію використовують натуральні естрогени (17β-естрадіол, естрадіолу валерат, естріол) в комбінації з гестагенами (дидрогестерон) або андрогенами. Можливе введення гормонів парентерально (в ін’єкціях), трансдермально, вагінально та перорально. Для корекції клімактеричного синдрому, урогенітальних розладів використовують короткострокові курси менопаузальної гормональної терапії (протягом 1–5 років). Для профілактики та лікування остеопорозу менопаузальна гормональна терапія триває більше 3 років, за необхідності в комбінації з біфосфонатами. This document provides an overview of existing diagnosis and treatment methods of menopausal disorders in women, proposed algorithms for diagnosis and treatment of this disease to prevent heart diseases, osteoporosis and improve the quality of ukrainian women life. Climacteric is a physiological transition period in a woman’s life during which the reproductive system involutive processes against the age-related changes are dominated in the body, and characterized by reduction of menstrual and generative function due to genetically programmed cessation of ovarian function. There are 4 periods of menopause: menopausal transition period, menopause, perimenopause and menopause. No need for hormonal laboratory research to diagnosis of perimenopause and menopause for most healthy women aged over 45 with the following features: vasomotor symptoms on a background of irregular menstruation in perimenopause; absence of menstruation for the last 12 months or appearance of menopausal symptoms after hysterectomy at menopause. The most common symptoms of menopause are vasomotor symptoms (hot flashes, night sweats, palpitations, labile blood pressure); psychological (emotional lability, depression, anxiety, irritability, sleep disturbances, poor memory and concentration); general physical symptoms (asthenia, headache, pain in muscles and joints, skin discomfort); urogenital and sexual (vaginal itching, burning, dryness and dyspareunia, frequent and urgent urination, decreased libido). The only pathogenetically effective method for the correction of menopausal disorders is menopausal hormone therapy. For this therapy are used natural estrogen (17β-estradiol, estradiol valerate, estriol) in combination with progestins (dydrogesterone) or androgens. It is possible parenteral (injections), transdermal, vaginal and oral hormone introduction. To correct the climacteric syndrome, urogenital disorders are used short courses of menopausal hormone therapy (for 1–5 years). For the prevention and treatment of osteoporosis menopausal hormone therapy lasts over 3 years if necessary, in combination with a bisphosphonate. В документе представлен обзор существующих методов диагностики и терапии климактерических расстройств у женщин, предложены алгоритмы диагностики и лечения данной патологии с целью профилактики сердечно-сосудистых заболеваний, остеопороза и улучшения качества жизни женщин в Украине. Климактерий – это физиологический переходный период в жизни женщины, в течение которого на фоне возрастных изменений в организме доминируют инволютивные процессы в репродуктивной системе, характеризующиеся снижением генеративной и менструальной функции вследствие генетически запрограммированного угасания и прекращения функционирования яичников. Выделяют 4 периода климактерия: период менопаузального перехода, менопауза, перименопауза и постменопауза. Диагноз перименопаузы и менопаузы не требует лабораторных гормональных исследований для большинства здоровых женщин старше 45 лет при следующих признаках: при перименопаузе – наличие вазомоторных симптомов на фоне нерегулярных менструаций, при менопаузе – отсутствие менструации в течение последних 12 месяцев или появление климактерических симптомов после гистерэктомии. Наиболее частыми симптомами в климактерии являются вазомоторные симптомы: приливы, ночная потливость, сердцебиение, лабильность артериального давления; психологические: эмоциональная лабильность, депрессивные состояния, тревога, раздражительность, нарушения сна, ухудшение памяти и концентрации внимания; общефизические симптомы: астенизация, головная боль, боль в мышцах и суставах, неприятные ощущения на коже; урогенитальные и сексуальные: вагинальный зуд, жжение, сухость и диспареуния, частое и ургентное мочеиспускание, снижение либидо. Единственным патогенетически обоснованным и эффективным методом коррекции климактерических расстройств является менопаузальная гормональная терапия. В качестве такой терапии используют натуральные эстрогены (17β-эстрадиол, эстрадиола валерат, эстриол) в комбинации с гестагенами (дидрогестерон) или андрогенами. Возможно введение гормонов парентерально (в инъекциях), трансдермально, вагинально и перорально. Для коррекции климактерического синдрома, урогенитальных расстройств используют краткосрочные курсы менопаузальной гормональной терапии (в течение 1–5 лет). Для профилактики и лечения остеопороза менопаузальная гормональная терапия длится более 3 лет, при необходимости в комбинации с бисфосфонатами.