Greene Climacteric Scale Score Research Articles

Efficacy and safety of fezolinetant, a neurokinin-3 antagonist, in treating vasomotor symptoms in postmenopausal women: A systematic review and meta-analysis.

Menopause causes a variety of symptoms such as hot flashes and night sweats. While menopausal hormonal therapy has been used for managing postmenopausal vasomotor symptoms (VMS) for quite a while, it has a considerably poor safety profile. To review and analyze existing data to evaluate the efficacy of the neurokinin-3 antagonist, fezolinetant, in treating postmenopausal VMS and to assess its safety profile. A thorough literature search was performed on PubMed, Cochrane Library, and Google Scholar in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020, to find publications on the efficacy of fezolinetant for postmenopausal VMS. Changes in the frequency and severity scores of moderate/severe VMS and changes in the Hot Flash-Related Daily Interference Scale (HFRDIS), Greene Climacteric Scale (GCS), and Menopause-Specific Quality of Life (MENQoL) were the efficacy outcomes. Adverse events, drug-related treatment-emergent adverse effects (TEAEs), drug-related dropouts, hepatotoxicity, endometrial hyperplasia or tumor, and uterine bleeding were all safety outcomes. We used Review Manager 5.4 for pooling risk ratios (RRs) and mean differences (MDs) for dichotomous and continuous outcomes, respectively. A P value of < .05 was considered significant. There was a significant reduction in mean daily VMS frequency at weeks 4 and 12 (MD, -2.36; 95% confidence interval [CI], -2.85 to -1.87; P < .00001, for week 12) and also a significant decrease in VMS severity scores in the treatment group. Furthermore, improvements in MENQoL, HFRDIS, and GCS scores were observed. There was no significant difference in adverse events while drug-related TEAEs (RR, 1.21; 95% CI, 0.90-1.63; P = .21) showed a slight increase with fezolinetant. Drug-related dropouts were again similar across the 2 groups. Uterine bleeding had a lower incidence while endometrial events and hepatotoxicity showed a statistically insignificant, increasing trend in the fezolinetant group. Fezolinetant can be a treatment option for postmenopausal VMS but warns of a risk increase in endometrial hyperplasia or tumors. The heterogeneity in the data being analyzed, short follow-up period, and small sample size in most of the included randomized controlled trials were the greatest limitations, which must be considered in further research and safety profile exploration.

Hormone replacement therapy subcutaneous implants for refractory menopause symptoms; the patient's perspective.

For women with menopause symptoms refractory to standard hormone replacement therapy (HRT) preparations, HRT implants offer an alternative. The primary objective of this study was to evaluate women's perceptions regarding efficacy, tolerability, satisfaction and safety of implant therapy. A single centre service evaluation study performed at Birmingham Women's & Children's Foundation Hospital Trust. An anonymised semi-structured survey link was posted to all women (n = 397) recorded to have received HRT implant(s) at a tertiary Menopause clinic (May 1982 and Dec 2018). Women attending clinic (June 2020 to Sept 2020) were opportunistically invited to complete a written version of the survey. Data collected included demographics, medical and surgical history, therapy duration, type, indication and complications. Climacteric symptoms were assessed using the Greene Climacteric Scale. Data was obtained for 119 women. The written survey yielded higher response rates (n = 73, 61.3%). Most respondents were 51-60years old (n = 51 42.9%) and 87.4% (n = 104) were 'White British'. 70 women used estradiol only implants. 30.1%% (n = 34) of patients reported a low Greene Climacteric Scale score (0-5). Subgroup analysis showed prevalence of sexual dysfunction and vasomotor symptoms across ages. There was a lower prevalence of psychological symptoms amongst ≥51 year olds. High satisfaction rates were reported. Data from a large cohort is presented. Good symptom control, satisfaction and long-term efficacy was demonstrated. This study supports the value of HRT implants for refractory menopause symptoms. A national database of implant users would be a useful tool to record satisfaction scores and adverse events.

A Clinical Trial on the Effect of Guduci (Tinospora Cordifolia (Willd) Miers) Satva along with Ksheera in Perimenopausal Symptoms

Perimenopause refers to the period around menopause. In Ayurveda it is considered as Rajakshaya, the transition period of body from predominance of Pitta dosha to Vatadosha which is characterized by aggravation of Vata, alteration of Pitta and Kaphadosha. It is included as a Swabhavikavyadhi in Ayurveda. Management of Dhatukshaya, Rasayana, Balya and Rasa- Raktha Prasadana treatments are seen beneficial in this condition. Guduci is one among Rasayana drugs mentioned in Ayurveda. The drug Guducisatva taken for the study is from the classic Yogaratnakara and has Dhatukrith and Vayastapana property. The objective of the study was to evaluate the effect of 1g Guduci Satva along with Ksheera (25ml boiled and lukewarm) in perimenopausal symptoms. Females in the age group 40-50 years with perimenopausal symptoms were selected for the study from the OPD of Prasutitantra-striroga, GAVC Hospital, Tripunithura as per the inclusion criteria. Study tools are clinical case proforma and Greene Climacteric scale score above 30. Drug was given orally in the dose of 1g twice along with 25ml Ksheera one hour before food. Duration of administration was 30 days and assessment was taken on 0th day, 31st day and 60th day. Results were analysed statistically by Wilcoxon's signed rank test and Friedman’s test. The study result is highly significant after treatment with P value &lt;0.001 during treatment and during follow up and is found effective in reducing the symptoms in perimenopause.

Treatment of menopausal symptoms: concomitant modification of cortisol.

To evaluate whether change in menopausal symptoms is related to modification of 24-hour urinary cortisol. Sixty-nine postmenopausal women were treated for their menopausal symptoms with either estrogen progestin therapy (0.3 mg conjugate equine estrogens and 1.5 mg medroxyprogesterone acetate; n = 25), phytoestrogens (75 mg isoflavones, twice daily; n = 21) or acupuncture (once a week; n = 23). Baseline and treatment-induced changes of total and subscale scores (vasomotor, depression, anxiety, somatization, sexuality) of the Greene's Climacteric Scale and of 24-hour urinary cortisol were evaluated. At baseline, 24-hour urinary cortisol was related to Greene's Climacteric Scale score (P < 0.0001). Independent determinants (R2 = 0.319) were the Greene's subscales scores of depression (with a mean difference of 24-h cortisol for score unit expressed as beta coefficient of regression (b) of 4.91, 95% CI 2.14-7.7; P = 0.0007), and of somatization (b 3.04 95% CI 0.69-5.4; P = 0.012). The Greene's Climacteric Scale score (-5.67 ± 6.8; P = 0.0001) and 24-hour cortisol (-23.6 ± 45.7 μg/24 h; P = 0.0001) declined after 3 months of treatment. Changes of 24-hour cortisol values were linearly related to changes of total Greene's Climacteric Scale score with a mean change for unit score (b) of 2.10, 95% CI 0.47-3.73; P = 0.012). Present data indicate that greater reduction in menopausal symptoms is associated with a larger decrease in cortisol levels. Possible implication of this finding on the long-term consequences for women's health needs to be explored.

Menopausal symptoms in the Southwest United States: A cross-sectional survey of women from areas with different socioeconomic resources

ObjectiveMenopausal symptoms may differ by geography and ethnicity, but the impact of socioeconomic factors is less clear. The purpose of this study was to compare menopausal symptoms in women from areas of Arizona with different socioeconomic resources. Study designWomen aged 40–65 years in two cohorts were surveyed: (1) Phoenix women attending either a clinic for patients who are uninsured or a clinic for people experiencing homelessness; and (2) Scottsdale women living in zip codes with higher average income and neighborhood advantage (surveyed by mail). Surveys included the Greene Climacteric Scale (GCS) and demographic questions. Main outcome measuresGCS score by domain and subdomain, corrected for age, race, menopause stage and menopausal hormone therapy (HT). ResultsPhoenix participants (N = 104) were 51.2 years old (SD 6.45), Hispanic (54.4%), White (28.2%) or African American (8.7%), and uninsured (53.0%). Scottsdale participants (N = 151) were 52.6 years old (SD 5.52), mostly White (94.7%) and insured (100%). Three percent of Phoenix women were on HT vs. 23.3% in Scottsdale (p < 0.001). Multivariate analysis revealed higher total GCS scores in the Phoenix vs. Scottsdale cohort (39.13 vs 30.14, p < 0.001), which was also seen in the psychological and somatic domains, as well as the anxiety and depression subdomains. No statistically significant differences were seen in the vasomotor or sexual dysfunction domains. ConclusionIn a group of women living in Arizona from distinct socioeconomic areas, significant differences were demonstrated in menopausal symptom bother specifically with higher psychological and somatic symptoms in women who were uninsured or experiencing homelessness independent of age, race, menopause stage and HT use. Future studies controlling for co-morbidities associated with lower socioeconomic status such as depression would provide further insight into this population of midlife women.

Menopausal Symptoms in Underserved and Homeless Women Living in Extreme Temperatures in the Southwest.

Background: Little is known about menopausal symptoms in underserved women.Aim: To better understand self-reported menopausal symptoms in underserved and homeless women living in extreme heat during different seasons.Methods: A cross-sectional study, including the Greene Climacteric Scale (GCS), climate-related questions, and demographics was administered June to August of 2017 and December to February 2018 to women 40–65 years of age.Results: In 104 predominantly Hispanic (56%), uninsured (53%), menopausal (56%), and mid-aged (50 ± 9.5) women, 57% reported any bother, while 20% of these women reported “quite a bit” or “extreme” bother from hot flushes. The total GCS score was a mean of 41 ± 15.0; out of 63 indicating significant symptoms, the psychological and somatic clusters were highest. Women did not think temperature outside influenced their menopausal symptoms at either time point (69% in winter vs. 57% in summer, p = 0.23). In multivariable analyses after adjusting for race, body mass index, and living situation neither season nor temperature was associated with self-reported hot flush bother. While one-third of women reported becoming ill from the heat, 90% of women reported not seeking care from a doctor for their illness.Conclusion: Menopausal, underserved, homeless women living in Arizona reported few vasomotor symptoms regardless of season, and endorsed psychological and somatic complaints. Socioeconomic factors may influence types of bothersome menopausal symptoms in this population of women.

Comparative safety and efficacy of tibolone and escitalopram in postmenopausal women.

Background:A high prevalence of psychiatric disorders, particularly depressive and anxiety disorders among women is observed through the postmenopausal stage.Aim:The aim of this study is to compare the safety and efficacy of tibolone (TIB) and escitalopram (ESCIT) in postmenopausal women (PMW).Materials and Methods:It was an interventional, open-label, hospital-based, follow-up study conducted on 60 PMW with the diagnosis of depression as per the Diagnostic and Statistical Manual of Mental Disorder-5 criteria. Patients were divided into two groups of 30 each, i.e. Group I (TIB-2.5 mg/day) and Group II (ESCIT-10–20 mg/day). The primary outcome was assessed for change in climacteric symptom scores on Greene's Climacteric Scale (GCS), severity of depression and anxiety on Hamilton Rating Scale for Depression (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A), and sexual functioning on Arizona Sexual Experience Scale (ASEX). The secondary outcome of well-being was assessed on World Health Organization Quality of life (QOL)-BREF. All the observations were carried out from baseline and at 2, 4, 8, and 12 weeks.Results:Both the groups showed significant improvement in climacteric and depressive symptoms. However, at the 8th and 12th weeks, mean ± standard deviation scores were significantly lower in Group I (GCS score - 24.80 ± 4.92, 20.30 ± 3.56; HAM-D score - 16.57 ± 5.83, 10.2 ± 5.67) compared to Group II (GCS score - 27.27 ± 5.83 and 23.33 ± 5.70, HAM-D score - 19.97 ± 7.98 and 16.17 ± 10.11). No significant difference between the groups was seen for anxiety on HAM-A scores. Only in Group I, there was significant improvement in ASEX scores. QoL in Group I had shown significant improvement in physical and psychological domain compared to Group II at different time interval, i.e. 4th and 8th week onward. In Group I, Alternative Dispute Resolution was reported to be 23.3%, whereas it was 56.7% in Group II. However, none were serious to warrant discontinuation.Conclusion:TIB was better than ESCIT in improving depression, climacteric symptoms, and physical and psychological domain of QoL with an additional benefit of restoring sexual functioning.

Relationship between number of menopausal symptoms and work performance in Japanese working women.

The presence of various menopausal symptoms could decrease work performance because symptom management strategies differ, and it is difficult to control all symptoms at work. The aim of this study was to examine the relationship between the number of menopausal symptoms experienced and work performance in working women. An online cross-sectional study was conducted with 599 working Japanese women aged 45 to 65 years. To represent work performance, absolute presenteeism was measured using the Japanese version of the World Health Organization and Work Performance Questionnaire short form, and menopausal symptoms were measured using the Greene Climacteric Scale. The total number of subscales on which a participant scored more than one point represented the number of menopausal symptoms. Participants' mean age was 54.2 years, and 60.6% were postmenopausal. Their mean Greene Climacteric Scale score and mean absolute presenteeism score were 10.5 ± 10.6 and 61.7 ± 17.9, respectively. The proportions of participants who provided care for a family member, who had chronic disease, and who undertook regular exercise were significantly different among the four groups. After adjusting for other factors, absolute presenteeism was negatively correlated with the number of menopausal symptoms experienced (β = -0.13, P < 0.001). Higher numbers of menopausal symptoms were correlated with lower work performance. The maintenance of health and the provision of appropriate working environments would help working women and improve work performance by reducing menopausal symptoms.

Mindfulness-Based Stress Reduction (MBSR) or Psychoeducation for the Reduction of Menopausal Symptoms: A Randomized, Controlled Clinical Trial

Psychological and behavioural interventions may be effective in reducing menopause-related symptoms. This randomized controlled trial aimed to evaluate the effectiveness of Mindfulness-based Stress Reduction (MBSR) in reducing menopause-related symptoms by comparing with an active control group, the menopause education control (MEC). Symptomatic peri-menopausal and post-menopausal women with mild to moderate symptoms were recruited. The primary outcome was overall menopausal symptoms measured by modified Greene Climacteric Scale (GCS). Secondary outcomes include subscales of the GCS perceived stress, mindfulness and health related Quality of Life. All outcome measures were collected at baseline, 2 months (immediately post intervention), 5 and 8 months (3 and 6 months post intervention respectively). Both MBSR (n = 98) and MEC (n = 99) groups reported a reduction in total GCS score at 8 months. Between group analysis show significant symptom score reduction in MBSR group on Anxiety and Depression subscales of GCS. No differences were found between groups on other GCS subscales and majority of the secondary outcome measures. The findings show that menopausal symptoms in both MBSR and MEC significantly reduced over the study period. MBSR show a greater reduction of psychological symptoms of depression and anxiety above active controls but do not reduce other somatic, urogenital and vasomotor symptoms.

Association between urinary incontinence and climacteric symptoms in postmenopausal women.

The aim of the study was to evaluate whether climacteric symptoms are related to urinary incontinence (UI) in postmenopausal women. A cross-sectional investigation was performed on 1,502 postmenopausal women attending the outpatient service for menopause at a University Hospital. Data regarding climacteric symptoms, evaluated by the Greene Climacteric Scale, objective pelvic floor defects, and UI of any type, were retrieved from an electronic database. Additional information retrieved were age, anthropometric measures, personal and reproductive history, use of medication or drugs, smoking, state of anxiety (State-Trait Anxiety Inventory scale score), and depression (Zung's scale score). The score of the Greene Climacteric Scale was higher (P = 0.0001) in women with (n = 534) than without (n = 902) UI (32.3 ± 13.1 vs 26.5 ± 12.5; P < 0.0011). The same was true when considering stress (n = 370) (31.4 ± 13.4; P = 0.0007), urge (n = 84) (34.5 ± 13.5; P = 0.005), or mixed (n = 89) (34.3 ± 11.4; P = 0.006) UI. In multiple logistic regression models, the Greene climacteric score was independently related to UI (odds ratio [OR] 1.05; 95% CI, 1.03-1.07), along with the presence of a bladder prolapse (OR 3.72; 95% CI, 2.59-5.34), age at menopause (OR 1.05; 95% CI, 1.01-1.09), and previous hysterectomy (OR 1.80; 95% CI, 1.08-3.01). Women in the fourth quartile of the Greene Climacteric Scale score had an OR of UI of 2.09 (95% CI, 1.5-2.9). In postmenopausal women, higher symptom burden, as captured by the Greene Climacteric Scale, relates to UI. Underlying mechanisms were not assessed, and deserve further investigation.

Efficacy of black cohosh (Cimicifuga racemosa L.) in treating early symptoms of menopause: a randomized clinical trial

BackgroundThis study aims to evaluate the efficacy of Black cohosh (Cimicifuga racemosa L.) in treating early menopausal symptoms.MethodsThis randomized, double-blind, placebo-controlled clinical trial was conducted on 84 early post-menopausal participants with Greene climacteric scale (GCS) scores of 15 to 42, who were referred to two public health care centers in Tehran, Iran, in 2011–2012. The participants were randomly allocated into treatment (6.5 mg of dried extract of Black cohosh roots daily) and control (placebo) groups with a ratio of 1:1. The participants took one tablet per day for 8 weeks. The GCS scores were recorded at baseline, and after 4 and 8 weeks of treatment. Data analysis was carried out using a general linear model with repeated measures with SPSS software. The level of significance was set at P < 0.05.ResultsThere was no loss to follow-up during the 8 weeks of treatment. The GCS total score (primary outcome) in the treatment group was significantly lower than that in the control group at both week 4 [adjusted mean difference: -7.8 (95% confidence interval: -11.1 to -4.4)] and week 8 [-12.9 (-16.2 to -9.3)]. The treatment group showed significantly more improvement than the control group in all GCS subscale scores (vasomotor, psychiatric, physical, and sexual symptoms; secondary outcomes). The differences between the treatment and control groups at week 8 were significantly higher (P < 0.001) than those at week 4 in terms of the total scores and the vasomotor and psychiatric subscale scores. No side effects were reported.ConclusionsBlack cohosh reduced the GCS total score and all GCS subscale scores (vasomotor, psychiatric, physical, and sexual symptoms) during 4 and 8 weeks of treatment.Clinical trial registrationThis study was approved (Code 9061) by the Ethics Committee of Tabriz University of Medical Sciences and registered at the Iranian Registry of Clinical Trials with IRCT201107186709N4 on 15 January 2012.

English

Every woman who lives beyond 50 years goes through a period of transition from reproductive to non-reproductive stages of life. Menopause is considered as a clinical marker of declining ovarian function. The common climacteric symptoms experienced by women during this period can be group into: vasomotor, somatic, psychological and sexual complaints. The aim of the study was to compare the climacteric symptoms among rural women who attained menopause and those who did not attained menopause in the age group of 43-55 years. METHODS AND MATERIALS: A cross-sectional study design was conducted in a rural area in Kerala. Data were collected from 320 women by interviewing with the help of a structured questionnaire consisting of a socio-demographic data, and the Greene's Climacteric Scale. The Statistical Package for the Social Sciences software Version 16.0 was used for statistical analyses. Mann Whitney U test was used to compare the total score of climacteric symptoms and each sub-scale symptom scores (psychological, somatic, and sexual scores) among women who attained and not attained menopause. The X² test was applied to compare the proportion of the different grades of symptoms between the different menopausal statuses. The level P < 0.05 was considered as the cut-off value for significance RESULTS: The total Greene's climacteric scale score (p: 0.001), the psychological subscale scores (p: 0.007), the somatic subscale scores (p : 0.022) , the vasomotor subscale scores (p: 0.011) and the sexual subscale scores (p: 0.001) were significantly higher in women who attained menopause compared to those who did not. CONCLUSION: The climacteric symptoms vary significantly between women who attained menopause and women who did not attained menopause. INTRODUCTION: All women who live beyond 50 years go through a period of transition from reproductive to non-reproductive stages of life. Menopause is considered as a clinical marker of declining ovarian function. It implies the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. The vasomotor symptoms of hot flushes and night sweats are the characteristic symptoms of menopause. These symptoms are directly resulted from depletion of estrogen level as women approaches menopausal stage and some of these women begin to experiences these menopausal symptoms before attaining menopause. The quality of life of women varies significantly on the menopausal status. Symptoms experienced during menopause affect the quality of life in postmenopausal women. The common climacteric symptoms experienced by them can be grouped into: vasomotor, somatic, psychological or sexual complaints. The prevalence and severity of climacteric symptoms varies widely from individual to individual in the same population and also from population to population.

A randomized, double-blind, multiple-dose escalation study of a Chinese herbal medicine preparation (Dang Gui Buxue Tang) for moderate to severe menopausal symptoms and quality of life in postmenopausal women

This study is a phase II clinical trial that aims to investigate the dose-response relationship of a Chinese herbal medicine preparation, Dang Gui Buxue Tang (DBT), with short-term menopausal symptoms and quality of life in local postmenopausal women. A randomized, double-blind, multiple-dose escalation trial was performed in 60 postmenopausal women experiencing severe hot flashes and night sweats. The participants were randomized to receive DBT preparations at 1.5, 3.0, or 6.0 g/day for 12 weeks. The primary outcomes were vasomotor symptoms, Greene Climacteric Scale (GCS) score, and Menopause-Specific Quality of Life (MENQOL) score. Secondary outcomes included serum hormones and lipids. There were between-group differences in psychological/psychosocial (P = 0.015, GCS; P = 0.013, MENQOL) and somatic/physical (P = 0.019, GCS; P = 0.037, MENQOL) domains, and improvement was significantly greatest (P < 0.05) in the 6.0 g/day dose group. The frequency and severity of hot flashes and night sweats were significantly reduced in the 3.0 g/day (14.5%-21.2%, P < 0.05, hot flashes; 28.6%-39.6%, P < 0.05, night sweats) and 6.0 g/day (34.9%-37.4.0%, P < 0.01, hot flashes; 10.1%-12.8%, P < 0.01, night sweats) dose groups. The female hormones follicle-stimulating hormone, luteinizing hormone, and 17β-estradiol, as well as the lipids total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, were not significantly different within groups and between groups. DBT preparations at 6.0 g/day significantly improve physical and psychological scores and significantly reduce vasomotor symptoms from baseline. The treatment was well tolerated, with no serious adverse events noted during the 12-week intervention period. The changes do not affect hormones and lipid profiles.

The impact of menopausal symptoms on work ability

Menopause is an important life event that may have a negative influence on quality of life. Work ability, a concept widely used in occupational health, can predict both future impairment and duration of sickness absence. The aim of this study was to examine the impact of menopausal symptoms on work ability. This was a cross-sectional study that used a sample of healthy working Dutch women aged 44 to 60 years. Work ability was measured using the Work Ability Index, and menopausal symptoms were measured using the Greene Climacteric Scale. Stepwise multiple linear regression models were used to examine the relationship between menopausal symptoms and work ability. A total of 208 women were included in this study. There was a significant negative correlation between total Greene Climacteric Scale score and Work Ability Index score. Total Greene Climacteric Scale score predicted 33.8% of the total variance in the Work Ability Index score. Only the psychological and somatic subscales of the Greene Climacteric Scale were significant predictors in multiple linear regression analysis. Together, they accounted for 36.5% of total variance in Work Ability Index score. Menopausal symptoms are negatively associated with work ability and may increase the risk of sickness absence.

Menopausal symptoms and risk factors for cardiovascular disease in postmenopause

ABSTRACTObjectives Conflicting evidence indicates an increased risk for cardiovascular disease in postmenopausal women suffering from hot flushes. In this study, we tested whether, beyond hot flushes, menopausal symptoms are associated with biochemical and biophysical risk factors for cardiovascular disease.Methods Retrospective cross-sectional analysis on 951 women in surgical or physiological postmenopause, recruited at the menopause outpatient service of our university hospital between April 2002 and December 2009. The Greene Climacteric Scale and its subscales for anxiety, depression, somatic symptoms, vasomotor symptoms and sexuality were used to evaluate menopausal complaints. Blood pressure, fasting glucose and lipids levels were evaluated as risk factors for cardiovascular disease. Anthropometric parameters and those derived by remote and reproductive medical history were used as possible confounders. All data were anonymously retrieved from an electronic database.Results By multiple regression analysis, high density lipoprotein (HDL) cholesterol was inversely related to body mass index, the Greene Climacteric Scale score and years since menopause (R = 0.390; p = 0.0001). The total cholesterol/HDL cholesterol ratio was positively related to waist circumference and the Greene Climacteric Scale score (R = 0.356; p = 0.0001). Triglycerides (R = 0.353; p = 0.0001) and triglyceride/HDL cholesterol (R = 0.425; p = 0.0001) were positively related to waist circumference, the Greene Climacteric Scale score and the Greene vasomotor subscore. Glucose was positively related to waist circumference, years since menopause and the Greene Climacteric Scale score (R = 0.390; p = 0.0001). Blood pressure was not related to menopausal symptoms. The 10-year risk for cardiovascular disease calculated by the Framingham formula was related independently and directly to body mass index and the Greene Climacteric Scale score (R = 0.183; p = 0.0001).Conclusions Menopausal symptoms evaluated by a validated climacteric scale are associated with a worsening of biochemical risk factors for atherosclerosis and cardiovascular disease.

The symptomatology of climacteric syndrome: whether associated with the physical factors or psychological disorder in perimenopausal/postmenopausal patients with anxiety–depression disorder

PurposeTo explore whether the symptoms of climacteric syndrome associated with its physical factors or psychological disorder in perimenopausal/postmenopausal patients with anxiety–depression disorder.MethodsWe recruited 78 climacteric patients with anxiety–depression disorder and 72 control participants in perimenopausal/postmenopausal without anxiety–depression disorder for this study. We measured symptoms using the Greene Climacteric Symptom Scale in all cases. We also collected demographic data and tested sexual hormone, blood pressure, bone density, cognitive, estrogen receptor-alpha (ERα) gene polymorphism as physiological factors, using HARS-14 and CHDS assessed psychological disorder degree.ResultsC-MMSE scores as well as Estradiol and progesterone levels in the anxiety–depression disorder group were significantly lower compared to the control group (P < 0.01). In addition, the anxiety–depression disorder group had significantly higher Greene Climacteric Scale scores, as well as somatic symptoms compared to controls (P < 0.01). Moreover, the anxiety, depression and somatic symptoms of the Greene Climacteric Scale were positively correlated with HARS-14 and CHDS scores (P < 0.001) and negatively with estrogen level and C-MMSE scores (P < 0.05) in the anxiety–depression disorder group. Greene Climacteric Scale Symptoms were not significantly correlated with blood pressure, bone density or other factors (P > 0.05). There was no significant change in the allele frequency or the estrogen receptor-alpha gene polymorphisms, between the two groups (P > 0.05); however, the Pp genotype was negatively associated with C-MMSE scores (r = appraises, P = 0.033).LimitationsThe sample size was relatively small.ConclusionsThe symptoms of somatic symptoms in patients with climacteric syndrome and anxiety–depression disorder are associated with the emotional disorder but not with a physical disease. The Pp ERα polymorphism Pvu II is associated with a cognitive decrease.

High-order maternity may be a more significant determinant of quality of midlife than some of the climacteric symptoms

The aim of this study was to assess the impact of menopause, age, and women's symptoms and characteristics on quality of midlife. This was a cross-sectional study of 151 healthy women aged 45 to 55 years attending university-affiliated menopause clinics. To obtain the data, a questionnaire designed by the investigators and based on the Greene Climacteric Scale and the Utian Menopause-Specific Quality of Life scale was self-completed by the participants. A significant gradual increase in the total Greene Climacteric Scale score was observed from premenopausal to perimenopausal and postmenopausal women (P = 0.02), specifically in the vasomotor and sexual subscores (P < 0.0001 and P = 0.001, respectively). In contrast, the total quality-of-life score remained stable in every specific aspect (occupation, health, emotion, and sex) throughout the menopausal transition (P = 0.8). A significant correlation was found between the psychological, somatic, and sexual Greene Climacteric Scale subscores and the Utian quality-of-life score (r = -0.46, P < 0.001; r = -0.29, P < 0.05; r = -0.28, P < 0.05, respectively), whereas the vasomotor subscore had no impact on midlife quality. The number of children was the only demographic factor that had a significant impact on the Utian score (P < 0.05) and to a higher extent than the climacteric syndrome. Hormone therapy equalizes the climacteric symptom profile of users to that of nonusers, yet both users and nonusers reported similar scores of midlife quality. Menopause-specific quality of life may be affected by both demographic and climacteric parameters. Menopausal symptoms, but not vasomotor symptoms, have a negative impact on midlife quality, yet to a lesser degree than does the number of children.

Increased cortisol level

Vasomotor symptoms may increase the risk for cardiovascular diseases through still elusive mechanisms. Increased cortisol release may favor atherosclerosis. In this study, we tested whether vasomotor and psychological symptoms are associated with an increase in cortisol levels. A cross-sectional investigation on women in early menopause enrolled consecutively between January and June 2009 was conducted. This study was set at a menopause outpatient service at University Hospital. Participants included 85 healthy women who were 6 months to 5 years postmenopause. The 24-hour urinary cortisol level and Greene Climacteric Scale scores were evaluated. Anthropometric parameters and fasting blood samples for the determination of high-density lipoprotein (HDL) cholesterol, total cholesterol, triglycerides, glucose, and insulin levels were measured. Body mass index, waist-to-hip ratio, and homeostatic model assessment of insulin resistance were calculated. The relation between Greene Climacteric Scale scores and 24-hour urinary cortisol level and between 24-hour urinary cortisol level and lipid levels or insulin resistance was determined. The Greene Climacteric Scale score for climacteric symptoms (coefficient of regression [CR], 1.343; 95% CI, 0.441-2.246) and body mass index (CR, 4.469; 95% CI, 1.259-7.678) explained 32.5% and 10.3%, respectively, of the variance in 24-hour urinary cortisol level (r = 0.428; P = 0.0003). Twenty-four-hour urinary cortisol level was inversely related to HDL-cholesterol level (CR, -0.065; 95% CI, -0.114 to -0.017; r = 0.283; P = 0.009) and was related to waist girth (CR, 0.685; 95% CI, 0.306-1.063) and homeostatic model assessment of insulin resistance (CR, 0.097; 95% CI, 0.032-0.162; r = 0.510; P = 0.0001). In early postmenopausal women, the Greene Climacteric Scale score is associated with increased 24-hour urinary cortisol level. Increased cortisol level is associated with known risk factors for cardiovascular disease, such as insulin resistance and decreased HDL-cholesterol level.

The effect of synthetic genistein on menopause symptom management in healthy postmenopausal women: A multi-center, randomized, placebo-controlled study

Objective To evaluate the efficacy of synthetic genistein for reducing the frequency and severity of hot flushes. Study design A 12 week randomized double-blind, placebo-controlled study in which 84 postmenopausal women received placebo or a single 30 mg dose of synthetic genistein. Outcome measures primary: percentage change in the number of daily hot flushes from pre-treatment to week 12. Secondary: duration and severity of daily hot flushes, Greene Climacteric Scale score, serum follicle stimulating hormone (FSH), 17β-estradiol and endometrial thickness. Results Genistein supplemented subjects completing at least 4 weeks on trial ( n = 40) demonstrated a 51% reduction (9.4–4.7/day) in the number of hot flushes by week 12 compared to a 27% reduction in the placebo group (9.9–7.1/day) ( p = 0.026). Subjects in the genistein group also reported significantly fewer hot flushes per day ( p = 0.010) and a decrease in total duration of hot flushes per day ( p = 0.009) at week 12 versus placebo. Subjects on genistein ( n = 32) completing 12 weeks on trial demonstrated a 51% reduction (9.7–4.7/day) in the number of hot flushes by week 12 ( p = 0.049) compared to 30% reduction in the placebo group (9.8–7.0/day) and had fewer hot flushes per day and a decrease in total duration of hot flushes per day at week 12 compared to placebo ( p = 0.020 and p = 0.017, respectively). There were no differences between groups in Greene Climacteric Scale, FSH, 17β-estradiol, endometrial thickness or adverse events. Conclusions The current study provides the first evidence that a single daily dose of 30 mg of synthetic genistein reduces hot flush frequency and duration.

Paroxetine increases brain-derived neurotrophic factor in postmenopausal women

Menopause is marked by a decline in ovarian function resulting in one or more climacteric symptoms. In the last few years, attention has been focused on the use of selective serotonin reuptake inhibitors (SSRIs) in the treatment of vasomotor symptoms associated with the menopausal transition. Thanks to the recent findings on the interaction between the serotoninergic system and neurotrophins, it has been suggested that brain-derived neurotrophic factor (BDNF) could contribute to the activity of SSRIs. Moreover, because endogenous gonadal hormones modulate both BDNF expression and serotonin biosynthesis and bioavailability and regulate brain functions like affective and cognitive functions, we proposed to evaluate the effects of a treatment with paroxetine, an SSRI, in a group of postmenopausal women and to clarify the possible relationship between paroxetine, plasma BDNF levels, and climacteric symptoms. A total of 119 postmenopausal women (age, 46-60 y; menopause age, 1-20 y) were included; 89 took paroxetine 10 mg/day for 6 months and 30 took estrogen + progestogen therapy (EPT) for 6 months. Blood samples were taken before the beginning of the therapy and at 3 and 6 months. The Green Climacteric Scale questionnaire was used to follow up women's clinical conditions. Plasma BDNF levels significantly increased after 3 and 6 months of therapy (P < 0.001), although a negative correlation between plasma BDNF level and both age and menopause age persisted throughout the treatment. Moreover, a significant reduction in the Greene Climacteric Scale score was observed. In the EPT group, the plasma BDNF level significantly increased after 6 months of therapy. The plasma BDNF levels after 6 months of paroxetine were significantly lower than those after 6 months of EPT. The present data suggest that a low dose of paroxetine is effective in enhancing plasma BDNF levels, and this increase might have a role in improving climacteric symptoms, highlighting the possible role of BDNF in endocrinological and cognitive functions.