Conditions In Postmenopausal Women Research Articles

The Paradoxical Relationship Among Diabetes Mellitus, Osteoporosis and Sarcopenia: The PARADOS Study.

Type 2 diabetes mellitus (DM), osteoporosis (OP) and sarcopenia are major public health problems related with higher fall/fracture risks, morbidity and mortality. Due to the lack of a comprehensive analysis among OP, sarcopenia and DM; we aimed to explore the relationships between DM and the aforementioned conditions in postmenopausal women. This cross-sectional study included postmenopausal women who consecutively admitted to the Departments of Physical & Rehabilitation Medicine, and Endocrinology and Metabolism. Demographic data, nutrition/cognition status and frailty scores of the participants were recorded. Sarcopenia-related parameters including, anterior thigh muscle thickness, handgrip strength, chair stand test, gait speed, and one-leg stand test (OLST) were measured. ISarcoPRM algorithm was used for the diagnosis of sarcopenia. A total of 444 postmenopausal women were consecutively enrolled. DM patients (N=158) had higher frequency of sarcopenia (23.4% vs. 12.9%), but lower frequency of OP (33.5% vs. 50.7%) than controls (both p<0.01). As regards regression analyses; menopause duration was positively (OR: 1.054, 95% CI 1.030-1.077), but weight (OR: 0.957, 95% CI 0.940-0.975) and DM (OR: 0.477, 95% CI 0.310-0.733) were negatively related with OP (all p<0.001). On the other hand, age (OR: 1.094, 95% CI 1.056-1.133), body mass index (OR: 1.131, 95% CI 1.067-1.198), and DM (OR: 1.887, 95% CI 1.107-3.218) were positively related with sarcopenia (all p<0.05). In addition, age (β=-0.355, p<0.001), body mass index (β=-0.108, p=0.021) and DM (β=-0.209, p<0.001) were negatively related with OLST values. DM has paradoxical associations with bone mass and muscle mass/function. Although it has negative relationship with OP (about two times lower odds), it has positive relationship with sarcopenia (about two times higher odds).

A review of the role for pelvic floor physiotherapy in postmenopausal women with urinary incontinence.

Urinary incontinence is a prevalent condition affecting women. Pelvic floor physiotherapy is a specialized field of physiotherapy dedicated to assessing and treating pelvic floor muscles. This therapy has demonstrated benefits in addressing stress urinary incontinence in premenopausal women, with numerous studies supporting its efficacy in this population. However, pelvic floor physiotherapy in the treatment of postmenopausal women is less well-established, and furthermore, the types of urinary incontinence in postmenopausal women are much broader. We provide a comprehensive review of recent literature investigating the effectiveness of pelvic floor physiotherapy therapy for various conditions in postmenopausal women, including urinary incontinence, urgency urinary incontinence, pelvic organ prolapse, genitourinary syndrome of menopause, sexual dysfunction, and urinary incontinence in the context of obesity, frailty, mobility, and dementia. After evaluating the current literature, it is evident that there is insufficient data to definitively endorse or dismiss the utilization of Pelvic floor physiotherapy for treating urinary incontinence in postmenopausal women. Nevertheless, considering the low associated risks of pelvic floor physiotherapy, we advocate for the initiation of comprehensive, large-scale randomized studies aimed at evaluating its effectiveness in addressing urinary incontinence in postmenopausal women with special attention to vulnerable subgroups, including individuals who are obese, frail or experiencing cognitive impairment.

Combined treatment of postmenopausal patients with pelvic organ prolapse and genitourinary syndrome

Background. Colpoptosis combined with stress urinary incontinence is one of the most common conditions in postmenopausal women. Menopause is also associated with the risk of genitourinary syndrome due to estrogen deficiency. Despite the variety of options for surgical correction of genital prolapse and urinary incontinence, there is no universal technique. The use of vaginal approach in pelvic floor surgery is associated with several controversies regarding the rates of recurrence and mesh-associated complications. Studies of the state of the endothelium in menopause have demonstrated a close relationship between age-related features and the frequency of adverse clinical outcomes, which requires an optimal intervention not only on the hormonal status but also on the microcirculatory system. Aim. To improve the principles of complex treatment of pelvic organ prolapse and genitourinary syndrome in postmenopausal patients. Materials and methods. The study included 48 postmenopausal patients with genital prolapse of stage II and above according to the POP-Q classification. All patients received continuous menopausal hormone therapy (MHT) with a combined estrogen-progestogen agent. The patients in group 1 (n=24) received MHT according to clinical guidelines for managing patients with genitourinary syndrome. The patients in group 2 (n=24), in addition to MHT, received sulodexide containing glucurono-2-amino-2-deoxyglucoglucan sulfate before the intended surgical treatment and for 30 days after surgery. Correction of colpocystocele, proctocele and stress urinary incontinence was performed using anterior and posterior colporrhaphy, perineoplasty, and urethral sling placement in case of stress urinary incontinence. Results. Six months after surgical treatment, signs of genital prolapse recurrence were detected in 3 patients (12.5%) in group 1, and 1 patient (4.2%) showed signs of mesh-associated complications (implant extrusion) after urethral sling placement. In group 2, only 4.2% of patients (n=1) showed signs of recurrence of stage II cystocele. All patients who underwent urethral sling surgery reported improved urinary incontinence (n=10). During complex therapy, 3 months after surgery, a more significant improvement of endothelial dysfunction markers was noted in group 2 patients (homocysteine level in group 1 after treatment was 12.27±0.34, in group 2 – 8.34±0.24). Conclusions. Combination therapy of genitourinary syndrome and genital prolapse using MHT, endotheliotropic drugs and vaginal surgical approach in postmenopausal patients contributes to effective and safe treatment associated with minimal risk of complications and recurrence rate. Endothelial dysfunction correction is an essential step in planning surgical intervention in menopausal patients, which contributes to improving tissue repair in the postoperative period.

Identification of the Risk Factors Associated with Low Bone Density in Peri- and Early Postmenopausal Women

Evidence has shown that one of the most prevalent chronic conditions in postmenopausal women is osteoporosis. Despite the development of some medications, there are still safety and adherence concerns, and, thus, attention has been placed on understanding modifiable risk factors for bone loss. This study aimed to examine the differences in various sociodemographic and body composition factors, physical activity components, and nutrient and food group intake levels among peri- and early postmenopausal women with whole-body bone mineral density (BMD) Z-scores greater than and less than zero. This cross-sectional study utilized baseline data obtained from 45 peri- and early postmenopausal women aged 45–60 years old who participated in a 6-month three-arm, randomized, double-blind, placebo-controlled clinical trial that evaluated the effects of blackcurrant supplementation on bone metabolism. Anthropometric data, BMD values obtained via DXA scans, and self-reported demographic, health, dietary, and physical activity data were collected at baseline. Overall, participants with whole-body BMD Z-scores greater than zero had higher body mass indexes (BMIs), lean mass, fat mass, android fat percentages, ratios of trunk fat mass to limb fat mass, resting metabolic rates, relative skeletal muscle indexes, total and occupational physical activity, alcohol intakes, trans fatty acid intakes, and adequacy of potassium intake, but lower adequacy of vitamin E (p &lt; 0.05). In addition, total calorie intake was positively correlated with added sugar, vitamin E, potassium, alcohol, trans fatty acids, calcium, and vitamin D intakes (p &lt; 0.05); whole-body BMD was positively correlated with added sugars (p &lt; 0.05); vitamin D intake was positively correlated with vitamin E, potassium, trans fatty acid, and calcium intakes (p &lt; 0.05); and calcium intake was positively correlated with added sugar, vitamin E, potassium, and trans fatty acid intakes (p &lt; 0.05). These findings suggest that numerous body composition factors, components of physical activity, and dietary factors are related to bone health in adult women in the menopause transition.

Pilates versus Zumba training effects on postural control under conflicting sensory conditions in postmenopausal women

The current study aimed to compare the effects of Pilates versus Zumba training on postural performance in middle-aged postmenopausal women. Fifty-seven eligible women, aged between 50 and 60years, were randomized into three groups: Zumba (ZG) group, Pilates (PG) group or control (CG) group. Postural control was assessed using a force platform under 4 sensory manipulation conditions: on firm and foam surfaces with eyes opened (EO) and closed (EC). Our results showed more marked adaptations in favor of ZG concerning postural performance compared to PG. For the PG, postural control was significantly improved only in simple postural conditions on the firm surface with EO (p<0.1) and EC (p<0.05) conditions. However, postural control of the ZG significantly improved in both the simple and complex postural conditions, even under conflicting sensory situations (firm surface/EO (p<0.001; 95% CI: [1.34, 4.46]), EC (p<0.001; 95% CI: [2.13, 5.24])); foam surface/EO (p<0.01; 95% CI: [0.70, 8.57]), EC (p<0.01; 95% CI: [0.65, 8.52])). In conclusion, Zumba training seems to be more effective and a better strategy to promote postural control in daily living activities and autonomy in postmenopausal women than Pilates training. These findings are useful for public health practitioners in designing physical interventions for balance disorders.

Impact of Osteoporosis in Postmenopausal Women With Primary Knee Osteoarthritis.

Although knee osteoarthritis (OA) and osteoporosis (OP) are common age-related bone disorders, the association between the two conditions remains indefinable. The aim of the present study is to investigate a possible relationship between the two conditions in post-menopausal women. A cross-sectional study was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia, after obtaining IRB approval. The study included all post-menopausal female patients above 50 years of age, who underwent dual-energy X-ray absorptiometry (DXA) scans between January 2019 and July 2021 and have clear radiological data regarding knee OA. For our study, 487 ladies satisfied our inclusion criteria with an age range of 50-94 years (mean 64.67 ±8.4). The severity of knee OA was determined according to theKellgren and Lawrence (KL) grading system. The mean age and weight of all patients showed a significant association withknee OA. There was no significant association between bone quality and all parameters of bone mineral density (BMD) and T-scorewith the presence of knee OA. The mean age, height, weight, and BMI have a significant relationship with OP. Grade 3 of the KL classification system for knee OA is the only grade that showed a significant relationship with the presence of OP. The status of bone quality, BMD, and T-score parameters have no significant relationship with the severity subgrouping of knee OA. The BMD and the T-score of the right femoral neck have a significant correlation with BMI, which is linked to the presence of knee OA. We didn't find a clear relationship between OP or BMD and the presence of knee OA. However, our findings demonstrated that BMD, T-score of the right femoral neck, and BMI can all be utilized as predictors for the development and progression of knee OA. We recommendconsidering the many potential confounding variations when describing a relationship between OP and OA.

Birthweight and subsequent risk for thyroid and autoimmune conditions in postmenopausal women.

The objective of this study was to determine the association between birthweight and risk of thyroid and autoimmune conditions in a large sample of postmenopausal women. Baseline data from the Women's Health Initiative (n = 80,806) were used to examine the associations between birthweight category (<6 lbs., 6-7 lbs. 15 oz, 8-9 lbs. 15 oz, and ≥10 lbs.) and prevalent thyroid (underactive and overactive thyroid and goiter) and autoimmune (lupus, rheumatoid arthritis (RA), multiple sclerosis, ulcerative colitis/Crohn's disease) conditions. Follow-up questionnaire data were used to examine the associations between birthweight and incident underactive and overactive thyroid, lupus, and RA. Logistic and Cox proportional hazards regression models were used to estimate crude and adjusted odds (OR) and hazards ratios (HR), respectively. Overall, women born weighing ≥10 lbs. had an increased risk for underactive thyroid [OR 1.14 (95% CI 1.02, 1.28)] and incident lupus [HR 1.51 (95% CI 1.12, 2.03)] and a decreased risk for overactive thyroid [OR 0.67 (95% CI 0.50, 0.92)] compared to women born weighing 6-7.99 lbs., after adjustment for adult BMI, demographic variables, and lifestyle factors. Further, women born weighing <6 lbs. were at increased risk for underactive thyroid [OR 1.13 (95% CI 1.04, 1.22)]. Birthweight was not associated with other thyroid or autoimmune disorders. High birthweight was associated with later-life thyroid and autoimmune conditions while low birthweight was associated with underactive thyroid. Preconception and prenatal interventions aimed at reducing the risk of both high and low birthweights may reduce the burden of later-life thyroid and autoimmune conditions.

What are the benefits and risks of hormone replacement therapy for primary prevention of chronic conditions in postmenopausal women?

Evidence-Based Practice: October 2021 - Volume 24 - Issue 10 - p 52-54 doi: 10.1097/EBP.0000000000001297

Oral Analgesic Use in Postmenopausal Women After Curative Breast Cancer Treatment: Post Hoc Analysis of the ATAC Trial

Aim: To evaluate analgesic use and associated conditions in postmenopausal women who had undergone curative breast cancer treatment. Materials &amp; methods: This post hoc analysis used the Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial database, which included patient reports of concomitant medications and associated indications during follow-up. Results: Of 3434 women with eligible concomitant medication data, 71.8% reported oral analgesic use. Of 2321 patients using analgesics ≥30 days, 47.9% reported opioid use. Musculoskeletal pain was the most common indication for oral analgesic use. Of patients using opioids, 28.1% reported concomitant laxative use. Conclusion: Approximately half of the patients reported opioid use, most commonly for noncancer (musculoskeletal) pain, suggesting that breast cancer survivors experience chronic pain that should be appropriately managed.

Guideline: USPSTF recommends against menopausal estrogen for primary prevention of chronic conditions.

Source Citation US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Hormone therapy for the primary prevention of chronic conditions in postmenopausal women: US Preventive Services Task Force recommendation statement. JAMA. 2017;318:2224-33. 29234814

Reproductive endocrinology: Postmenopausal hormone therapy to prevent chronic conditions.

The US Preventive Services Task Force recently produced their recommendation statement on hormone therapy for primary prevention of chronic conditions in postmenopausal women. Here, I outline the changes from the 2013 recommendations and discuss clinical questions providers continue to ponder daily as they care for women during the menopausal period.

HT for Preventing Chronic Conditions in Postmenopausal Women: USPSTF Weighs in Again

Sponsoring Organization: U.S. Preventive Services Task Force (USPSTF)Target Population: OB/GYN and primary care providersBackground and ObjectiveIn

Del Editor sobre la Terapia hormonal de reemplazo para la prevención primaria de enfermedades crónicas – Borrador del documento de recomendación del Grupo de Trabajo de los Servicios de Prevención de los EE UU

En 16 de mayo de 2017, el Grupo de Trabajo de Servicios de Prevención de los EE UU solicitó comentarios a una declaración de recomendación y revisión de la evidencia sobre la terapia hormonal para la menopausia en la prevención primaria de enfermedades crónicas. Basado en la revisión de la evidencia, el Grupo de Trabajo hace la recomendación contra el uso combinado de estrógeno y progestágeno para la prevención de condiciones crónicas en las mujeres posmenopáusicas. A partir de este documento, se realiza una breve consideración sobre la fisiología hormonal estrogénica durante la menopausia y las recomendaciones subsecuentes por instituciones especializadas sobre la terapia hormonal con estrógenos y progestágenos para la prevención de la sintomatología crónica cardiovascular, vasomotora, neurológica y osteoporótica.

Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women: Evidence Report and Systematic Review for the US Preventive Services Task Force

Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women: Evidence Report and Systematic Review for the US Preventive Services Task Force

Analysis of the Ki-67 index in the vaginal epithelium of castrated rats treated with tamoxifen

OBJECTIVES:Vaginal atrophy and breast cancer are common conditions in postmenopausal women and tamoxifen is the standard endocrine treatment for hormone-sensitive tumors. The present study aimed to assess the effect of tamoxifen on Ki-67 protein expression in the vaginal epithelium of castrated rats.MATERIAL AND METHODS:Forty Wistar-Hannover adult, virgin, castrated rats were randomly divided into two groups, group I (control, n=20) and group II (tamoxifen, n=20), receiving 0.5 ml of propylene glycol and 250 µg of tamoxifen diluted in 0.5 ml of propylene glycol, respectively, daily by gavage for 30 days. On the 31st day, the rats were euthanized and their vaginas were removed and fixed in 10% buffered formalin for the immunohistochemical study of Ki-67 protein expression. Data were analyzed by the Levene and Student's t tests (p<0.05).RESULTS:The mean index of Ki-67 expression in the rat vagina of groups I and II was 4.04±0.96 and 26.86±2.19, respectively (p<0.001).CONCLUSIONS:According to the results of the present study, tamoxifen, at the dose and treatment length used, induced a significant increase in the cell proliferation of the vaginal mucosa in castrated rats, as evaluated by Ki-67 protein expression.

The risk of using intrauterine devices to benign reproductive system conditions in postmenopausal women: A case control study.

Background:To investigate the effect of using intrauterine devices (IUDs) during the fertile window on women's reproductive system health.Materials and Methods:2,744 postmenopausal women in the Minhang District, Shanghai, China were enrolled. In the IUDs group there were 2,253 women; in the tubal ligation group there were 202 women and there were 289 women in the control group. We selected subjects according to the cases number in different hospital by using step sampling, and, in addition, collected the sociological data and information of the previously used contraceptives by the subjects, which included whether the contraceptives were used appropriately and the effect they had. Kolmogorov-Smirnov test, Levene's test, and logistic regression analysis were used to analyze the data.Results:The prevalence rate of benign reproductive system conditions was significantly different among them (P < 0.05). Further comparison revealed, the rate in Group 1 was significantly lower than that in Group 2 and Group 3 (P < 0.05, respectively). Results of logistic regression analysis show that the risk factors for development of such conditions lie in the women's pregnancy history [odds ratio (OR) = 3.85], reproductive history (OR = 0.5), the use of IUD in fertile window (OR = 0.4), tubal ligation (OR = 1.74), birth control time (OR = 0.9), contraceptive failure history (OR = 1.7), and history of family planning procedures (OR = 1.73).Conclusion:IUDs, maybe, can effectively reduce the risk of getting benign reproductive conditions in postmenopausal females.

Fecal bacterial community changes associated with isoflavone metabolites in postmenopausal women after soy bar consumption.

Soy isoflavones and their metabolism by intestinal microbiota have gained attention because of potential health benefits, such as the alleviation of estrogen/hormone-related conditions in postmenopausal women, associated with some of these compounds. However, overall changes in gut bacterial community structure and composition in response to addition of soy isoflavones to diets and their association with excreted isoflavone metabolites in postmenopausal women has not been studied. The aim of this study was to determine fecal bacterial community changes in 17 postmenopausal women after a week of diet supplementation with soy bars containing isoflavones, and to determine correlations between microbial community changes and excreted isoflavone metabolites. Using DGGE profiles of PCR amplified 16S rRNA genes (V3 region) to compare microbial communities in fecal samples collected one week before and one week during soy supplementation revealed significant differences (ANOSIM p<0.03) before and after soy supplementation in all subjects. However, between subjects comparisons showed high inter-individual variation that resulted in clustering of profiles by subjects. Urinary excretion of isoflavone (daidzein) metabolites indicated four subjects were equol producers and all subjects produced O-desmethylangolensin (ODMA). Comparison of relative proportions of 16S rRNA genes from 454 pyrosequencing of the last fecal samples of each treatment session revealed significant increases in average proportions of Bifidobacterium after soy consumption, and Bifidobacterium and Eubacterium were significantly greater in equol vs non-S-(-)equol producers. This is the first in vivo study using pyrosequencing to characterize significant differences in fecal community structure and composition in postmenopausal women after a week of soy diet-supplementation, and relate these changes to differences in soy isoflavones and isoflavone metabolites.Trial RegistrationClinicaltrials.gov NCT00244907

Importance of Vitamin D to Postmenopausal Women’s Health

<h2>Abstract</h2> Postmenopausal women have a significantly higher incidence and rate of breast cancer, cardiovascular disease, and osteoporosis compared with the general population. Current scientific evidence has shown that, in addition to calcium homeostasis, vitamin D has protective properties against breast neoplasms and cardiovascular risks and promotes bone health. Acknowledging these attributes of vitamin D will help not only to expand the understanding of pathophysiology of chronic conditions but also encourage primary care clinicians to provide vitamin D screening, supplementation, and education to prevent debilitating conditions in postmenopausal women.

Panel: Hormone Therapy Isn't for Chronic Conditions

Combined estrogen and progestin should not be used for the prevention of osteoporosis or other chronic conditions in postmenopausal women, according to recommendations issued by the U.S. Preventive Services Task Force. Hormone therapy currently has Food and Drug Administration approval for use in the prevention of osteoporosis in postmenopausal women. The task force, an independent body of volunteers that advises the Department of Health and Human Services, issued the recommendations as an update of its 2005 statement on hormone therapy for prevention of disease in postmenopausal women. Using the most recent scientific evidence available, including long-term follow-up data from the Women's Health Initiative (WHI) studies of hormone therapy use in postmenopausal women, the task force reached the same conclusions as it had in 2005, advising against combined estrogen and progestin for prevention of chronic conditions, and also against the use of estrogen alone for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. The task force emphasized that hormone therapy was still indicated for the management of menopausal symptoms, such as hot flashes or vaginal dryness. It additionally made clear that its recommendation against hormone therapy for disease prevention does not apply to women younger than 50 years of age who have undergone surgical menopause. Prior to the WHI studies, a series of government-funded trials that began in the 1990s, with follow-up ending in 2010, showed that hormones had been widely used for the prevention of bone disease in postmenopausal women. Both estrogen and combined estrogen and progestin are known to reduce fracture risk. However, both forms of hormone therapy were shown during the WHI studies to also increase the risk of serious adverse events, to the point where the trials were stopped early. In one randomized, placebo-controlled trial, estrogen alone was associated with a significantly higher risk of stroke, deep vein thrombosis, and gallbladder disease, while combined therapy was associated with an increased risk of stroke, invasive breast cancer, dementia, gallbladder disease, deep vein thrombosis, and pulmonary embolism. Reproductive endocrinologist Jan L. Shifren of the department of obstetrics and gynecology and reproductive biology at Harvard Medical School and director of the menopause program at Massachusetts General Hospital, both in Boston, said in an interview that the task force's updated position largely reflected the current consensus of the Ob/Gyn community, “which is that HT should not be used to prevent the diseases of aging.” The task force was “very careful to point out that they are not saying HT should not be used for the treatment of vasomotor symptoms or vaginal atrophy. It's not that hormones aren't indicated; they're just not indicated for prevention. They remain an appropriate treatment for otherwise healthy, very symptomatic women at the menopause transition,” said Dr. Shifren, who is not a task force member. FDA-approved indications for hormone therapy in postmenopausal women include treatment of menopausal symptoms and prevention of osteoporosis. A black box warning indicates that estrogen with or without progestin should be prescribed at the lowest effective dose and for the shortest time possible. The task force's findings were based on the dosages and formulations used in the WHI trials: oral conjugated equine estrogen (0.625 mg/day plus medroxyprogesterone acetate, 2.5 mg/day) or estrogen 0.625 mg/day alone. Dr. Shifren said that there are some practitioners “who believe that hormone therapy could still be appropriate for the prevention of osteoporosis in people who absolutely cannot tolerate any other therapy. But what I would argue is that it is incredibly rare that there is a patient who can't tolerate one of the very many other FDA-approved treatments for the prevention of osteoporosis.” The task force members declared no relevant financial conflict of interest.

Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2005 U.S. Preventive Services Task Force (USPSTF) recommendation statement on hormone therapy for the prevention of chronic conditions in postmenopausal women. The USPSTF commissioned a review of the literature to update evidence about the benefits and harms of using menopausal hormone therapy to prevent chronic conditions, as well as whether the benefits and harms of hormone therapy differ by population subgroups defined by age; the presence of comorbid medical conditions; and the type, dose, and method of hormonal delivery. This recommendation applies to postmenopausal women who are considering hormone therapy for the primary prevention of chronic medical conditions. It does not apply to women who are considering hormone therapy for the management of menopausal symptoms, such as hot flashes or vaginal dryness. It also does not apply to women younger than 50 years who have had surgical menopause. The USPSTF recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women. (Grade D recommendation).The USPSTF recommends against the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. (Grade D recommendation).