This study aimed to examine the effects of tele-Pilates exercise on menopausal symptoms, quality of life, depression, and anxiety levels in postmenopausal women. Forty postmenopausal women were separated into two groups: as tele-Pilates and the control group. Pilates exercises were performed 2 days a week for 6weeks via online. Participants were assessed with the Menopause Rating Scale, Menopausal Quality of Life Scale, Beck Depression Scale, and State and Trait Anxiety Inventory. From baseline to week 6, the tele-Pilates group improved more than the control group. Menopausal symptoms decreased, including MRS somatic (Δtele - Δcontrol -3.30; 95% CI -4.23 to -2.38; p < 0.001), MRS psychological (-2.52; 95% CI -3.78 to -1.27; p = 0.0009) and MRS total (-6.09; 95% CI -8.29 to -3.89; p < 0.001), while MRS urogenital did not differ between groups (0.00; p = 1.000). Quality of life improved more with tele-Pilates, including MENQOL vasomotor (-2.52; 95% CI -3.11 to -1.93; p < 0.001), MENQOL psychosocial (-1.52; 95% CI -2.34 to -0.71; p = 0.0018), MENQOL physical (-9.15; 95% CI -11.82 to -6.47; p < 0.001), and MENQOL total (-13.29; 95% CI -17.02 to -9.57; p < 0.001); MENQOL sexual showed no between-group difference (-0.11; p = 0.151). Tele-Pilates also reduced state anxiety (STAI-I -2.79; 95% CI -3.74 to -1.84; p < 0.001) and depressive symptoms (BDS -2.89; 95% CI -5.17 to -0.62; p = 0.023), whereas trait anxiety did not differ (STAI-II -1.32; p = 0.077). Tele-Pilates exercises improved somatic and psychological menopausal symptoms, overall quality of life, depression and state anxiety in postmenopausal women, but had no significant effect on urogenital symptoms or sexual quality of life.

Associations of reproductive history with serum and intratumoral sex steroid hormone levels among postmenopausal women with breast cancer: Analysis of paired serum and tumor tissue samples.

The protective effect of physical activity on breast cancer recurrence may be mediated changes in by sex hormone levels. In this study, we examined the association between habitual physical activity and estrogen and androgen plasma levels in postmenopausal women with localised breast cancer. We conducted a cross-sectional study among 47 postmenopausal women who were breast cancer survivors with estrogen receptor-positive tumours (enrolled at the Medical Oncology Department of University Hospital Dr. Peset, Valencia, Spain). Habitual physical activity was assessed using the International Physical Activity Questionnaire (IPAQ), and a weighted estimate of total physical activity per week (MET∙min∙wk−1) was calculated. Total plasma levels of estrone, 17β-estradiol, progesterone, androstenedione, testosterone, and dehydroepiandrosterone-sulphate (DHEA-sulphate) were measured. Bivariate analyses by the Spearman correlation test were done between physical activity and each hormone concentration. Multivariate analyses (linear regression) using concentration of each hormone as the dependent variable and physical activity, age, marital status, BMI, Charlson Comorbidity Index, tumour stage, previous radiotherapy, or previous chemotherapy as predictor variables. Estrone concentration was positively and significantly correlated with BMI (ρ = 0.332, p = 0.022), but no other correlations were found between BMI and the other hormone concentrations, nor were concentrations of any hormone associated with age or Charlson Comorbidity Index (p &gt; 0.05 in all cases). Physical activity was significantly and inversely correlated with estrone concentration (ρ = −0.308; p = 0.035). Linear regression analysis confirmed a statistically significant association between estrone concentration and BMI and physical activity, after adjusting for all potential confounders (for BMI: standardised β coefficient = 0.407; non-standardised β coefficient = 1.054; t = 2.898; p = 0.006; 95% CI for non-standardised beta: 0.318- to 1.790; for physical activity: standardised β coefficient = −0.300; non-standardised β coefficient = −0.005; t = −2.135; p = 0.039; 95% CI for non-standardised beta: −0.010- to 0.000). The relationship between estrone concentration and physical activity may be further explored as a biomarker for evaluating the protective effect of physical activity against breast cancer recurrence in women receiving anti-estrogen therapies.

Background: There are numerous concerns that women have regarding menopause. The purpose of this study was to identify any changes in hormone levels or visceral fat that laser acupuncture could alleviate in postmenopausal women. Methods: This randomized controlled trial involved 40 menopausal women aged from 50 to 65 years with visceral obesity, body mass index (BMI) &gt; 30 Kg/m2, and waist-tohip ratio (WHR) &gt; 0.8. All cases were classified into two groups: Group A was given laser acupuncture in addition to traditional lifestyle change in a low-calorie diet and aerobic exercise, and Group B received traditional treatment only. Results: Pre-intervention (weight, BMI, waist circumference, WHR, serum insulin, and satiety-hunger zone) were insignificantly different in both groups (P &gt; 0.05); in contrast to Group B, Group A experienced a substantial decrease in post-intervention (P &lt; 0.05). The satiety zone was markedly lower at post-intervention in Group A compared to Group B (P &lt; 0.05). After-intervention BMI, weight, WHR, waist circumference, and serum insulin were significantly lower than pre-intervention values in both groups (P &lt; 0.05). Conclusion: Laser acupoints were associated with an improvement in visceral fat and serum insulin levels in postmenopausal women, demonstrating reduced satiety and increased hunger.

The decline in estrogen levels in postmenopausal women is a major risk factor for the high prevalence of osteoporosis and vascular calcification in this population. Estrogen deficiency leads to an imbalance in the RANKL/OPG ratio, abnormalities in the Wnt/β-catenin pathway, and disruptions in bone morphogenetic protein (BMP) signaling, thereby inducing osteoporosis and vascular calcification. Moreover, estrogen deficiency affects calcium and phosphorus metabolism and induces the release of extracellular vesicles from the aging bone matrix, which mediate interactions between bone and vascular tissues and promote the occurrence of the "calcification paradox." The epigenetic regulation of estrogen receptors, including DNA methylation, histone modification, and miRNA activity, exerts different effects in bone and vascular tissues, underscoring the complexity of estrogen regulation. Future research should focus on the precise regulation of estrogen receptor subtypes and tissue-specific epigenetic modulation mechanisms to develop effective therapeutic strategies for osteoporosis and vascular calcification in postmenopausal women.

Effects of habitual exercise on serum lipids, antioxidant capacity and circulating Klotho levels in postmenopausal women with dyslipidemia

Background:To investigate the association between melatonin levels and bone mineral density (BMD) in postmenopausal women with type 2 diabetes mellitus (T2DM).Methods:One hundred and ninety postmenopausal women who visited the clinic between September 2023 and September 2024 were selected and divided into 4 groups according to their disease status: the normal group (n = 45); the abnormal bone mass group (n = 43); the T2DM group (n = 46); and the T2DM with abnormal bone mass group (n = 56). Relevant glycolipid metabolism biochemical indexes, bone metabolism markers and melatonin levels were detected and statistically analyzed.Results:Comparison of melatonin levels showed that melatonin levels were significantly lower in the abnormal bone mass group, the T2DM group, and the T2DM with abnormal bone mass group [100.00 (94.00, 110.00), 99.00 (91.75, 100.25), and 92.50 (84.75, 99.00)] than in the normal group [127.71 (116.23, 137.68)], and melatonin levels were the lowest in the T2DM with abnormal bone mass group (P < .01). Melatonin levels were positively correlated with both lumbar spine L1 to L4 BMD and femoral neck BMD. T2DM differed in the role of melatonin in associating with BMD at different sites. For lumbar spine L1 to L4 BMD, the mediating effect of T2DM was not significant (percentage: −8.16%, 95% CI, −90.39 to 57.00), and for femoral neck BMD, T2DM played a significant mediating role, with its effect accounting for 33.95% (95% CI, 5.38-70.00) of the total effect. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of the operating characteristics of subjects with melatonin levels diagnosing osteoporosis (OP) was 0.942 (95% CI, 0.902-0.982). The optimal cut-off value was 124.29 pg/mL when the Jordon index was 0.571, corresponding to a sensitivity and specificity of 57.8% and 99.3%, respectively. Multiple linear regression analysis showed that a decreased melatonin level was a risk factor for decreased BMD.Conclusion:Lower serum melatonin levels in postmenopausal women with T2DM are an independent risk factor for decreased BMD, and T2DM partially mediates the protective effect of melatonin on femoral neck BMD. Serum melatonin levels have a specific diagnostic value for abnormal bone mass in postmenopausal women with T2DM.

Background: Post-menopausal women experience hormonal changes that may result in accentuated decline in pulmonary functions as assessed by spirometry. Cortisol, a stress related glucocorticoid, has been implicated in systemic inflammation but its relation with lung functions in this population remains under explored. Objective: To observe the relationship of spirometric lung functions with serum cortisol in post-menopausal women. Methods: This cross-sectional study was conducted on 80 post-menopausal women (age:52-60 years) with different duration of menopause (2-12 years). Lung functions (FVC, FEV1, FEV1/FVC, PEFR and FEF25-75%) were estimated by a computer-based spirometer (Spiro-tech, India) and early morning serum cortisol level was measured by Automated Analyzer method. Spearman’s rank correlation test was used for statistical analysis. Results: The spirometric measurements showed reduction in FVC, FEV1, PEFR and FEF25-75% and an increase in FEV1/FVC ratio in the participants. In this study, significant negative correlations of the percentage of predicted values of FVC, FEV1 and FEF25-75% were observed with serum cortisol level (p&lt;0.01, p&lt;0.01 and p&lt;0.05 respectively). FEV1/FVC ratio exhibited positive and PEFR showed negative correlation with serum cortisol level in this group of participants but both the relations were statistically non-significant. Conclusion: Spirometric lung functions were inversely related with serum cortisol level in post-menopausal women. J Bangladesh Soc Physiol 2025;20(2): 53-57

This study aimed to determine the risk levels of osteoporotic fractures in postmenopausal women (PW). PW aged 50 years and over whose bone mineral density was measured by dual-energy X-ray absorptiometry between January 1, 2024, and December 31, 2024, were included in the study. Demographic and clinical characteristics of PW were recorded. Fracture risk level was determined according to the risk classification determined in the consensus report. PW were classified as low, moderate, and high risk. Data from 143 women were analyzed. Among all PW over 50 years of age, 29.4% (n=42) were low risk, 35.7% (n=51) were moderate risk, and 35% (n=50) were high risk. Among PW with rheumatoid arthritis, 80% (n=8) were found to be at high risk, 10% (n=1) were found to be at medium risk, and 10% (n=1) were found to be at low risk. Among PW with diabetes mellitus, 21.3% (n=10) were found to be at low risk, 55.3% at moderate risk, and 23.4% (n=11) at high risk. In conclusion, two-thirds of PW over 50 years of age are in the moderate and high-risk group and need anti-osteoporotic treatment. Knowing the osteoporotic risk levels in PW will facilitate the follow-up and treatment process of patients.

Introduction. Vulvovaginal atrophy (VVA) is characterized by severe hypoestrogenism, impaired microcirculation, chronic inflammation, and decreased mucosal regeneration. In women with a varying clinical history, including applied antitumor treatment, such changes may differ in severity level. Despite that the role for pro-inflammatory cytokines in VVA has been extensively investigated, systemic immuno-inflammatory changes, primarily resulting in complement activation remained understudied. Aim: to assess blood serum levels of C3 and C4 complement component levels in postmenopausal women with VVA coupled to clinical history, including various types of antitumor therapy, as well as in women without oncology history and in control group of healthy women. Materials and Methods. A cross-sectional comparative study included five groups of postmenopausal women (n = 215): VVA after radical surgery (n = 52); VVA after chemoradiotherapy (CRT) (n = 27); VVA during antiestrogen therapy (n = 48); VVA without oncology history (n = 53); control group – healthy postmenopausal women (n = 35). The blood serum C3 and C4 levels were quantitated by immunoturbidimetry. The statistical analysis included the Kruskal–Wallis criterion and pairwise intergroup comparisons using the Mann–Whitney criterion with the Bonferroni correction. Results. In all studied groups C3 and C4 levels were within the reference range, however, they differed significantly between the groups depending on the clinical history. The most prominent intergroup differences were observed in patients after CRT, who had higher C3 (1.62 g/L) and C4 (0.32 g/L) levels compared with control group (1.12 g/L for C3; 0.19 g/L for C4). In antiestrogenic therapy group (group 3) and surgical treatment group (group 1), C3 (1.48 g/L and 1.35 g/L, respectively) and C4 (0.28 g/L and 0.25 g/L, respectively) levels held an intermediate place between CRT group and control group. In women with VVA without oncology history, C3 (1.28 g/L) and C4 (0.23 g/L) levels were comparable to those in control group. Conclusion. The data obtained evidence about variability of the systemic immuno-inflammatory profile in VVA driven by patient clinical history. Within the framework of the study, changes in C3 and C4 levels reflected general intergroup differences, which, however, remained within the reference range. The results emphasize a need for further research aimed at studying activated complement system components and their clinical significance in VVA.

To explore all-cause mortality risk and its influencing factors in female patients with young-onset type 2 diabetes mellitus (YOD). This cohort study included 5,984 female patients diagnosed with type 2 diabetes mellitus (T2DM) who were registered in the National Basic Public Health Service Management Program between December 2013 and January 2014 in Qinghe District (now Qingjiangpu District) and Huai'an District, Huai'an City, Jiangsu Province, China. All-cause mortality data were obtained by comprehensive matching with the Huai'an city Resident Mortality Database as of December 31, 2024. All patients were divided into four groups according to age of onset and menopause status: the young menopausal group (YM), the young premenopausal group (YP), the nonyoung menopausal group (NYM), and the nonyoung premenopausal group (NYP). Multivariate Cox regression analysis was used to calculate hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) for all-cause mortality risk during the follow-up period. 1) A total of 5984 T2DM patients, comprising 387 YOD patients and 5597 late-onset T2DM patients (LODs), with an average age of 61.77±9.87 years, were included. During the ten-year follow-up, 1293 deaths were recorded, with an all-cause mortality rate of 21.6%. The mortality rate of YOD was lower than that of LOD. 2) Subgroup analysis revealed that NYM had the highest all-cause mortality rate at 24%, followed by YM at 15%, and YP had the lowest mortality rate at 3.7%. The cumulative survival curve indicated that the YM group had the lowest survival curve, followed by the NYM group, and the YP group had the highest survival curve. 3) Multivariate Cox regression analysis revealed that the triglyceride-glucose-body mass index (TyG-BMI) was an independent protective factor for the YM group (HR=0.980, 95% CI=0.965-0.997) (P=0.018). For every one standard deviation increase in the TyG-BMI, the mortality risk decreased by 2%. UA was a common risk factor for all-cause mortality in women with different ages of onset before and after menopause. In this study, the overall all-cause mortality rate for YOD patients was lower than that for LOD patients. However, postmenopausal women with YOD have greater all-cause mortality than premenopausal women with LOD do, and their risk of death decreases with increasing TyG-BMI. Therefore, early identification and intervention of TyG-BMI levels in postmenopausal women with YOD may help identify high-risk individuals and guide early intervention.

Perimenopausal symptoms affect most women and often substantially impair their quality of life, whereas conventional estrogen therapy alone does not fully address clinical needs. Baoqing granules (BQG), derived from Zuo Gui Wan in Jingyue's Complete Works, were modified to target kidney Yin deficiency and have shown promising clinical efficacy, although robust randomized evidence remains limited. The trial was registered with the Chinese Clinical Trial Registry (ChiCTR2300073338; http://www.chictr.org.cn). In this randomized, double-blind, placebo-controlled clinical trial, eligible perimenopausal women received either Femoston plus placebo or Femoston plus BQG for four weeks, followed by a four-week follow-up. The primary outcomes were the Modified Kupperman Menopausal Index (Modified KMI) and traditional Chinese medicine (TCM) syndrome scores. Secondary outcomes included the Menopause-Specific Quality of Life Questionnaire (MENQOL), Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and serum levels of sex hormones and lipids. Safety was evaluated through hepatic and renal function tests and adverse-event monitoring. Both groups showed significant improvements from baseline; however, participants in the BQG group experienced greater short-term improvements that persisted at week 8 in Modified KMI, TCM syndrome scores, MENQOL, and PSQI, while differences in SAS and SDS became significant only at follow-up. Hormone and lipid profiles showed no overall between-group differences, although exploratory subgroup analyses suggested higher estradiol and lower follicle-stimulating hormone levels in postmenopausal women receiving BQG. Liver and kidney functions remained within normal ranges, and only one mild adverse event was reported. In this 8-week study, BQG as an adjunct to Femoston was associated with additional short-term improvements in multidimensional perimenopausal symptoms, with acceptable tolerability. These findings support the potential role of BQG as a complementary therapy; however, longer-term studies are needed to confirm the durability of benefit and long-term safety. http://www.chictr.org.cn, identifier ChiCTR2300073338.

Isoflavones, natural bioactive compounds with estrogen-like properties, are increasingly used by postmenopausal women to manage menopausal symptoms. However, research on their efficacy has produced inconsistent results, necessitating a comprehensive review to guide clinical practice. To evaluate the effects of isoflavone interventions on vaginal atrophy, skin health, and sex-related hormone levels in postmenopausal women through a systematic review and meta-analysis of randomized controlled trials. A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Library databases from inception to January 2025. Eligible studies were randomized controlled trials investigating isoflavone interventions in postmenopausal women. Effect sizes were summarized as standardized mean differences (SMDs) with 95% CIs using a random-effects model. The risk of bias was assessed using the Risk of Bias 2 tool. The analysis included 47 studies comprising 2,657 participants. Isoflavone interventions significantly reduced vaginal dryness (SMD=-1.147; 95% CI, -2.077 to -0.216; P =0.016; I2 =95.4%) and increased the vaginal maturation value (SMD=0.605; 95% CI, 0.087 to 1.123; P =0.022; I2 ​​​​​​=88.7%). Improvements in skin health were observed, including reduced skin roughness measure R2 (SMD=-0.209; 95% CI, -0.389 to -0.029; P =0.028; I²=0.0%) and wrinkle surface (SMD=-0.342; 95% CI, -0.560 to -0.124; P =0.002; I2 =0.0%). Isoflavones also significantly increased estradiol levels (SMD=0.247; 95% CI, 0.059 to 0.435; P =0.010; I2 =60.5%). Isoflavone interventions effectively manage vaginal atrophy in postmenopausal women and show potential for improving skin health and sex-related hormone levels. These findings underscore the therapeutic value of isoflavones while emphasizing the need for further research, particularly regarding their effects on skin health.

The relationship between vitamin D deficiency and the uric acid-to-high-density lipoprotein cholesterol ratio (UHR) in postmenopausal women remains unclear. This study aims to investigate the association between these variables and to evaluate the potential interaction between UHR and waist circumference (WC). Data from 5,155 postmenopausal women who participated in the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2016 were included in this cross-sectional investigation. Weighted regression analysis served as the primary methodology employed to examine the association between UHR and vitamin D deficiency. Furthermore, interaction analysis, sensitivity analysis, and restricted cubic splines (RCS) were also conducted. According to multivariate adjusted analysis, vitamin D deficiency was positively correlated with UHR (OR = 1.05, 95% CI 1.02-1.07). The risk of vitamin D deficiency in the highest quartile population of UHR was significantly higher than that in the lowest quartile population (OR = 1.75, 95% CI: 1.36-2.27). Serum 25-hydroxyvitamin D was negatively correlated with UHR (β= -0.74, 95% CI: -1- -0.47). Vitamin D deficiency has a linear dose-response relationship with UHR. In addition, the study also discovered the interaction between UHR and WC. The UHR level in postmenopausal women is positively associated with vitamin D deficiency. Managing WC may contribute to reducing the risk of vitamin D deficiency in individuals with elevated UHR.

BackgroundMacular hole formation is influenced by vitreoretinal dynamics, with hormonal status playing a critical role in retinal stability. Reduced estrogen and testosterone levels in postmenopausal women and men with hypogonadism have been linked to increased macular hole severity. This study investigates the impact of hormonal fluctuations and the efficacy of targeted hormonal interventions in improving macular hole outcomes.MethodsA total of 118 participants were divided into four groups: premenopausal women (n = 30), postmenopausal women (n = 35), men with normal testosterone levels (n = 28), and men with hypogonadism (n = 25). Hormonal profiles were measured using LC–MS/MS, and macular hole severity was assessed with SD-OCT. Hormonal interventions included estrogen replacement therapy (ERT) and testosterone supplementation. Statistical analysis involved ANOVA, chi-square tests, and regression models.ResultsParticipants with low hormone levels exhibited larger macular holes and higher progression rates. Postmenopausal women without ERT and men with hypogonadism had progression rates of 55 and 60%, respectively, while those receiving hormonal interventions showed reduced rates of 30 and 35%. Hormonal interventions significantly improved macular hole closure rates (70% in ERT and 65% in testosterone groups) and visual acuity gains (2.8 lines and 2.5 lines, respectively). Subgroup analysis indicated better outcomes in early postmenopausal women and younger men, while diabetic participants showed poorer results.ConclusionHormonal fluctuations significantly impact macular hole progression, and hormonal interventions can enhance closure rates and visual outcomes. Early hormonal therapy initiation is associated with better results, highlighting the potential for personalized treatment strategies.

Menopause is characterized by significant physiological changes, including cardiovascular and hormonal alterations. Estrogen therapy is a critical intervention for managing menopausal symptoms and preventing long-term complications. Understanding the differences between the estrogen therapy administration routes is essential for optimizing treatment strategies. This study aimed to compare oral and transdermal routes of estrogen therapy among postmenopausal women and assess changes from baseline in key cardiovascular and lipid parameters, including systolic and diastolic blood pressure, heart rate, total cholesterol, low and high-density lipoprotein, and triglyceride levels. PubMed, Scopus, Web of Science, and ClinicalTrials. gov were searched for randomized clinical trials comparing oral and transdermal estrogen therapy in postmenopausal women. Pooled mean differences (MDs) with 95% CIs were estimated using a random effects model. Statistical analyses were performed using R version 4.3.2. Eight randomized clinical trials, with a total of 885 participants, were included. Of these participants, 453 (51.2%) received oral estrogen therapy. Participants receiving oral estrogen therapy had a higher mean change in high-density lipoprotein levels (MD=3.48mg/dL; 95% CI: 1.54-5.43; P <0.01) coupled with a significant rise in mean triglyceride levels (MD=19.82; 95% CI: 6.85-32.78; P <0.01), compared with participants receiving transdermal estrogen therapy. There were no significant differences in the mean changes from baseline in the systolic and diastolic blood pressure, heart rate, total cholesterol, and low-density lipoprotein levels. Compared with transdermal estrogen therapy, oral estrogen therapy was associated with a greater increase in high-density lipoprotein levels in postmenopausal women. However, this was associated with a greater increase in the triglyceride levels. This suggests that the choice of estrogen therapy route should be individualized, considering the patients' baseline hormonal and metabolic parameters, particularly lipid profiles.

Objective Menopause is associated with profound hormonal changes, including declines in estradiol and progesterone and increases in follicle stimulating hormone (FSH) and luteinizing hormone (LH), which contribute to elevated cardiovascular disease (CVD) risk. Digital twin frameworks offer a novel approach to simulate these complex dynamics. Method This study developed a semi-mechanistic digital twin model of menopause using 1000 simulated women (50% age ≥55 years, 50% age <55 years) followed over 90 days. Hormonal dynamics were modeled as cyclical in non-menopausal women and stable in postmenopausal women. Cardiovascular risk was assessed with linear mixed-effects models and generalized estimating equations, adjusting for age, body mass index and smoking. Results The model reproduced expected patterns, with estradiol and progesterone peaks at ovulation and luteal phases in non-menopausal women, and stable, low levels in postmenopausal women, alongside elevated gonadotropins. After adjustment, menopause remained significantly associated with hormonal changes and CVD risk (p < 0.001). CVD-related differences were more pronounced in non-menopausal women, where estradiol peaks and luteal progesterone amplitudes were attenuated. Conclusion This proof of concept highlights the potential of digital twin models to capture menopause-related hormonal dynamics and their cardiovascular implications. Future work should integrate real-world data, perimenopausal variability and ethical governance to enhance clinical translation.

To define the pattern of symptoms and severity of GERD among premenopausal and postmenopausal women in relation to estrogen levels and endoscopy findings. The research was carried out in the Laboratory of Gastrointestinal Motility inside the Gastroenterology Department at PSGIMS&R, Coimbatore and the following approval from Institutional Human Ethics Committee (IHEC). The findings reveal significant variations in estrogen levels between premenopausal and postmenopausal women with gastroesophageal reflux disease (GERD), with premenopausal women having higher levels (82.80 ± 27.91 to 150.43 ± 40.80 pg/mL) compared to postmenopausal women (6.05 ± 2.75 to 17.30 ± 5.43 pg/mL, p < 0.001). This decline in estrogen post-menopause is associated with increased GERD symptoms and endoscopic abnormalities. The study concludes that reduced estrogen levels in postmenopausal women are linked to a higher prevalence of GERD symptoms, including heartburn and dysphagia, compared to premenopausal women. Endoscopic findings further support the correlation between hormonal changes and GERD severity, highlighting the necessity for careful evaluation of GERD risk factors.

Vaginal estrogenization plays a crucial role in alleviating pain during sexual activity while low-dose vaginal estrogen therapy provides benefit often with no increase in systemic estrogen levels after use. This study aimed to compare the effects of estriol applied to the distal or proximal thirds of the vagina on dyspareunia in postmenopausal women, evaluate serum estriol levels, and assess sexual function. This prospective, randomized clinical trial included a total of 116 sexually active postmenopausal women with dyspareunia who were randomized to receive vaginal estriol (1.0mg/application, every other day) for 12 weeks in the proximal estriol group (PEG) or distal estriol group (DEG), or a vaginal lubricant gel (VLG) before intercourse. Plasma estriol levels, coital pain (McGill Pain Questionnaire), sexual function (FSFI), and emotional status (HADS) were assessed at baseline and after 12 weeks. Statistical analyses included the Shapiro-Wilk test for normality, one-way ANOVA with Tukey's post-hoc test, χ 2 test, and Pearson correlation as appropriate. No significant changes in serum estriol levels were observed in any group after the intervention. PEG and DEG showed significant increases in FSFI total scores and all domains. The VLG group showed improvements in FSFI total scores and the domains of desire, arousal, lubrication, satisfaction, and pain. Intergroup analysis revealed that the PEG group showed significantly greater improvement in the lubrication domain compared with DEG (mean difference=0.70; 95% CI: 0.05-1.37; P =0.04) and VLG (mean difference=1.22; 95% CI: 0.58-1.86; P <0.01). All other domains showed no statistically significant differences between groups. Vaginal estriol, applied distally or proximally, improved dyspareunia and sexual function without increasing systemic estriol levels. Lubricant use also enhanced sexual function (except orgasm) and reduced pain comparably to estriol.

BackgroundEstrogen plays a vital role in endometrial physiology, and its deficiency in postmenopausal women leads to endometrial atrophy. However, residual or elevated estrogen levels - endogenous or exogenous - can stimulate endometrial thickening, which may signal an underlying pathology. Transvaginal ultrasound (TVUS) offers a non-invasive, practical method to measure endometrial thickness (ET), potentially serving as a surrogate marker for systemic estrogen exposure. This prospective observational study aims to correlate serum estradiol levels with endometrial thickness in postmenopausal women and to analyze the association between endometrial thickness and known estrogen-related risk factors.MethodsA total of 100 postmenopausal women attending the gynaecology outpatient department at Sree Balaji Medical College and Hospital, Chennai, over a span of two years, from 2023 to 2025, were evaluated using TVUS for endometrial thickness and serum assay for estradiol levels. Baseline characteristics and comorbid conditions such as obesity, diabetes mellitus, hypertension, and parity status were recorded. Statistical analysis was used to assess correlations and significance.ResultsThe mean endometrial thickness was 6.1±2.3 mm, and the mean serum estradiol level was 24.8±9.6 pg/mL. A moderate to strong positive correlation (r=0.78, p<0.001) was observed between serum estradiol levels and endometrial thickness. Endometrial thickness >4 mm was significantly associated with obesity (p=0.003), diabetes mellitus (p=0.005), and nulliparity (p = 0.008), but not with hypertension (p=0.082).ConclusionSerum estradiol levels may act as a surrogate biochemical marker for increased endometrial thickness in postmenopausal women. While elevated estrogenic activity can contribute to endometrial proliferation, increased endometrial thickness should not be interpreted in isolation as a direct indicator of high estrogen levels. Integrating serum hormone evaluation with TVUS findings and clinical risk profiling may enhance the early identification of women predisposed to estrogen-related endometrial pathology, particularly in postmenopausal care settings.