Menopause Factors Research Articles

Associations between hypertension with reproductive and menopausal factors: An integrated women's health programme (IWHP) study.

Women are less likely to have classic cardiovascular risk factors than men, and events during their reproductive and menopausal years may increase hypertension risk. The aim of this study is to examine woman-specific factors, including menstrual, reproductive and pregnancy complications, in relation to the prevalence of hypertension in mid-life Asian women. This is a cross-sectional study of 1146 healthy women aged 45-69 years, from a multi-ethnic Asian cohort. The women completed an extensive questionnaire that included their sociodemographic details, medical history, lifestyle and physical activity, and reproductive and menopausal history. They also underwent objectively measured physical performance tests and a dual X-ray absorptiometry scan. Hypertension was defined as a systolic BP ≥140 and/or diastolic BP ≥90mm Hg, past diagnosis by a physician, or use of antihypertensive medications. Multivariable logistic regression was used to assess the independent risk factors for hypertension. The average age of the 1146 women analysed was 56.3 (SD 6.2) years, and 55.2 percent of them were hypertensive. The prevalence of gestational diabetes and gestational hypertension was 12.6% and 9.4%, respectively. Besides age, abnormal menstrual cycle length at 25 years of age (OR:2.35, CI:1.34-4.13), preeclampsia (OR:2.46, CI:1.06-5.74), increased visceral adiposity (OR:4.21, CI:2.28-7.79) and reduced physical performance (OR:2.83, CI:1.46-5.47) were independently associated with hypertension in Asian women. Our findings highlight the necessity of including features of menstrual and reproductive history as possible indicators of hypertension risk in cardiovascular disease risk assessment and prevention among Asian women. Reducing visceral adiposity and exercise to improve physical performance may help women avoid developing hypertension.

Targeting psychological and menopausal factors linked to non-adherence to anti-estrogen therapy in women with early-stage hormone-receptor positive breast cancer: Aweb-based feasibility study of Finding My Way.

Key Points Reduced adherence to anti‐estrogen therapy (AET; tamoxifen and aromatase inhibitors) in women with early‐stage hormone‐receptor‐positive (HR+) breast cancers leads to adverse clinical outcomes. Modifiable psychological factors (e.g., depressive symptoms and anxiety) and menopausal symptoms (e.g., sleep disturbance and hot flashes) are linked with diminished adherence. An intervention targeting psychological and menopausal symptoms has potential to improve AET adherence. We conducted a pilot study to evaluate the feasibility of a remotely administered behavioral intervention in women with early‐stage HR+ breast cancer taking AET at‐risk for non‐adherence with psychological and menopausal symptoms. Findings from this preliminary study show that a web‐based behavioral intervention is feasible and may be a potential method of reducing risk for AET non‐adherence in some patients.

A Cross-sectional Assessment of Depression, Anxiety, and Cognition in Perimenopausal and Menopausal Women.

Menopausal transition involves failure of ovarian function followed by cessation of menstruation. This has been said to lead to psychiatric comorbidities such as depression and anxiety. Estrogen also has beneficial effects on cognition and thus fluctuation in the same can lead to cognitive decline. Given the number of women undergoing menopause, timely screening of the comorbidities is of importance. Our study aimed at assessment of anxiety, depression, and cognitive impairment in perimenopausal and postmenopausal women presenting in the medicine and gynecology units of a tertiary care hospital. The objectives were to screen the peri- and postmenopausal women presenting with medical and gynecological complaints for the presence of depression and anxiety and assess their cognitive function. To find association of their symptoms with psychosocial and menopausal factors with the psychiatric parameters. Our study was conducted among the perimenopausal and postmenopausal women visiting gynecology and medicine units in a tertiary care hospital. One hundred and five women in the age group of 45-55 were assessed using a specialized pro forma, Beck's Anxiety Inventory, Beck's Depression Inventory, and Addenbrooke's Cognitive Examination III. The results were analyzed using SPSS software (version 20.0). 21.9% of females had moderate levels of anxiety, 24.76% had clinical depression, and 13.33% had mild cognitive impairment. The presence of psychosocial stressors had a significant impact on the anxiety, depression, and cognitive impairment. There was no significant association found between psychiatric parameters and peri- and postmenopausal stage as well between natural or surgical menopause.

Resolution of the III International menopause expert forum

The III International Menopause Expert Forum took place on November 24, 2021. The working group of the expert council included leading experts in endocrine gynaecology from Belarus, Armenia, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine.To date, menopause hormone therapy (MHT) initiated during the “therapeutic window of opportunity” has proved to have a protective effect against various age-associated diseases. Despite this, the percentage of women using MHT remains low and, for example, in Ukraine and Kazakhstan, equals nearly 2%. However, only one in four of these women have been using MHT for more than a year. The main reasons for such low percentage of women using MHT are as follows:1. Low patient adherence to MHT (due to misunderstanding of the menopause factors, menopause symptoms, treatments, hormonophobia, poor communication with healthcare professionals etc.).2. Healthcare professional’s vigilance due to the possible risks associated with MHT (breast cancer, venous thromboembolism, cardiovascular diseases etc.).3. Healthcare professionals face difficulties during the MHT prescription or subsequent patient management (unplanned haemorrhages, concomitant pathologies in a woman, i.e. fibroids, varicose veins, arterial hypertension etc.). Aiming to improve medical care for menopausal women, experts attending the Forum focused on the latest data on the risks of breast cancer and venous thromboembolism, MHT effect on the risk of coronary heart disease and arterial hypertension, the potential of prescribing MHT to patients with uterine myoma and on increasing treatment adherence.

Menopause and the Risk of Developing Age-Related Macular Degeneration in Korean Women.

Previous studies have shown that menopausal hormone therapy in postmenopausal women results in a higher prevalence of age-related macular degeneration. This study aimed to evaluate the effects of menopause and patient factors on the development of age-related macular degeneration in Korean women. Data between 2011 and 2014 were collected from the Korean National Health Insurance database. In this retrospective cohort study, 97,651 participants were premenopausal and 33,598 were menopausal. Participants were divided into menopausal and premenopausal groups to analyze the risk factors associated with the development of age-related macular degeneration. The prevalence of age-related macular degeneration was compared between the two groups. Other patient factors were also analyzed. Using a 1:1 propensity score matching method and adjusting for variables, the incidence of age-related macular degeneration was not significantly different between the two groups. Age and diabetes mellitus were associated with an increased risk of developing age-related macular degeneration, regardless of menopause. Menopause was not a risk factor for age-related macular degeneration. These findings may help physicians identify women with diabetes who are at a greater risk of developing age-related macular degeneration.

Cognitive Health After MenoPause (CHAMP) Study: A study of the health of the cholinergic system and risk factors for future cognitive decline in postmenopausal women aged 50‐70

AbstractBackgroundMenopause is associated with changes in hormone balances, and also to cognition in some women. These changes have been proposed to lead to an increased risk of developing Alzheimer’s disease (AD). However, there is not a clear understanding of how these changes are linked to neurodegeneration. One theory of what may be driving cognitive changes may be linked to how estrogen depletion affects cholinergic system activity. Preclinical studies have shown that estrogen is necessary for normal cholinergic functioning and its withdrawal leads to cholinergic dysfunction and cognitive impairment. And previous studies in postmenopausal women have shown that anticholinergic blockade is effective at modulating activity when performing working memory tasks.MethodThe CHAMP study will determine whether menopause‐related cognitive changes correlate with both cholinergic functional integrity and established AD biomarkers in a sample of 120 healthy postmenopausal women aged 50‐70 years. Using an anticholinergic challenge model, this study will examine cognitive performance on memory tasks using fMRI. The present study will collect established AD biomarkers of amyloid and tau levels in both blood and CSF samples, as well as through amyloid PET imaging, and markers of neurodegeneration including medial temporal lobe volume through structure MRI. In addition, the study will also collect genomic markers of impairment, such as APOE and COMT genotypes.ResultWe predict that women with poor compensation following menopause will be more sensitive to anticholinergic blockade, and will show decreased working memory performance, reduced brain activation, and decreased basal forebrain cholinergic system volume.ConclusionIn addition, we predict that these cholinergic markers will also be related to menopausal factors associated with poor cognition and biomarkers that are related to AD.

A cohurt study on association and inflammatiory markers of cardio metabolic risk factors in pre and post menopausal women

Pre and post menopause were the complications faced by women globally that not only interferes in physical health but also in mental health of a woman. The menopause factors includes many traditional CVD risk factors, including changes in body fat distribution from agynoid to an android pattern, reduced glucose tolerance, abnormal plasma lipids, increased blood pressure, increased sympathetic tone, endothelial dysfunction and vascular inflammation . Menopause is a risk factor for (CVD) because estrogen withdrawal has a detrimental effect on cardiovascular function and metabolism .The present study aimed for inflammatory markers of cardio metabolic risk factors in post menopausal women and premenopausal women and the results recorded the significant level of elevation in all parameters compared with case and control samples and the significance was given as student’s t test(p<0.001).

Association of Socio-economic and Demographic Factors with Indonesian Women’s Premature Menopause: Analysis of the Demographic and Health Surveys Program (DHS) of 2017

The research objective of this study was to analyse the influence of early menopause factors on Indonesian women with demographic and socio-economic indicators, such as age, wealth index, education, employment status, rural-urban settlements, including those associated with media exposure and smoking. The data used in this study were from the Indonesian Demographic and Health Survey in Indonesia in 2017. The relationship between the variables and the significant influence of socio-economic and demographic variables on early menopause was analysed using bivariate and multivariate analysis. The results showed that Indonesian women who experienced premature menopause were 12.35 percent. Early menopause tends to be shared more by Indonesian women in urban areas than in rural areas. Women with higher education, and women with the richest wealth quintile were more likely to experience premature menopause. Meanwhile, women who are housewives, and women who smoke are more likely to experience premature menopause. The problem of premature menopause should receive serious attention because it has negative health consequences.

Elevated Anti-Citrullinated Protein Antibodies Prior to Rheumatoid Arthritis Diagnosis and Risks for Chronic Obstructive Pulmonary Disease or Asthma.

To investigate elevation of anti-citrullinated protein antibodies (ACPAs) before diagnosis of rheumatoid arthritis (RA) and risks for chronic obstructive pulmonary disease (COPD) or asthma. We performed a matched cohort study nested within the Nurses' Health Studies among women who donated blood. Women with incident RA after blood draw (self-reported, then confirmed by medical records) were each matched to 3 controls by age, cohort, year, and menopausal factors. Pre-RA ACPA positivity was defined as >99th percentile of control distribution by a research assay or by cyclic citrullinated peptide in a subset. Incident COPD and asthma after index date (date of blood draw) were identified by questionnaires. Cox regression estimated hazard ratios (HRs) for incident COPD or asthma (in separate analyses) associated with pre-RA, pre-RA ACPA+, or pre-RA ACPA- phenotypes each compared to their matched non-RA controls. We analyzed 283 women who were pre-RA and 842 controls; blood was donated a mean ± SD of 9.7 ± 5.8 years before RA diagnosis. Fifty-nine women (20.8%) were pre-RA ACPA+. There were 107 cases of incident COPD and 105 incident asthma cases during 21,489 person-years of follow-up. Pre-RA ACPA+ was associated with increased COPD risk (HR 3.04 [95% confidence interval (95% CI) 1.33-7.00]) after adjusting for covariates including smoking pack-years. Pre-RA ACPA+ had an HR for asthma of 1.74 (multivariable 95% CI 0.72-4.24), similar to the risk of asthma for pre-RA ACPA- (HR 1.65 [95% CI 1.11-2.46]). Women with elevated ACPA before RA diagnosis had increased risk for developing COPD compared to controls. Women who later developed RA were more likely to develop asthma than controls, regardless of pre-RA ACPA status.

Menopausal factors and risk of seropositive rheumatoid arthritis in postmenopausal women: a nationwide cohort study of 1.36 million women

In previous literature regarding development of rheumatoid arthritis (RA), female reproductive factors have been described as protective factors, risk factors, or irrelevant, leading to inconsistent results. The aim of this study was to investigate the effect of female reproductive factors on the incidence of seropositive RA. A large population-based retrospective cohort of the National Health Insurance Service data in South Korea was used. Postmenopausal women who participated in both cardiovascular and breast cancer screening in 2009 were included and followed until date of seropositive RA diagnosis, death, or December 31, 2018. Multivariable-adjusted Cox proportional hazards model was used to assess the association between reproductive factors and incident seropositive RA. Of 1,357,736 postmenopausal women, 6056 women were diagnosed with seropositive RA, and the incidence rate was 54.16 cases/100,000 person-years. Reproductive factors other than hormone replacement therapy (HRT) were not significantly associated with seropositive RA incidence. Postmenopausal women who used HRT ≥ 5 years were associated with a higher aHR of incident seropositive RA than never-users (aHR 1.25; 95% CI 1.09–1.44). Alcohol consumption less than 30 g per day (aHR 0.80; 95% CI 0.74–0.87), regular physical activity (aHR 0.90; 95% CI 0.84–0.97), diabetes mellitus (aHR 0.85; 95% CI 0.78–0.93), and cancer (aHR 0.77; 95% CI 0.64–0.92) were associated with lower risk of seropositive RA. Most female reproductive factors did not significantly affect the development of seropositive RA in postmenopausal women. Only HRT is associated with a small but significant increase in risk of seropositive RA.

Effect of 12-months of isoflavone intake on menopausal symptoms, bone metabolism and risk factors of cardiovascular disease

Effect of 12-months of isoflavone intake on menopausal symptoms, bone metabolism and risk factors of cardiovascular disease

Abstract C052: Premenopausal oophorectomy and survival among women with breast cancer: Evidence of effect measure modification by family history status

Abstract In the US, bilateral oophorectomies are frequently performed before menopause for one of two reasons: 1) in concert with hysterectomy for benign gynecologic conditions or 2) prevention of breast or ovarian cancer risk and mortality. Prior literature has consistently shown a reduction in breast cancer-specific mortality among women who had premenopausal hysterectomy with bilateral oophorectomy (H +BO) prior to their breast cancer diagnosis. The present study sought to assess whether the relationship between prediagnosis premenopausal H + BO and breast cancer-specific mortality differed by family history status in women with breast cancer. It is hypothesized that women who may have prognostically different breast cancer due to having family history disproportionately benefit from premenopausal H+ BO compared to more average-risk women with no family history. This study analyzed data from Phases 1 and 2 of the Carolina Breast Cancer Study (CBCS), a population-based study of Black and White women prospectively identified in central and eastern North Carolina with newly diagnosed breast cancer between 1993 and 2001. Women with invasive breast cancer with known gynecologic surgical status were included (n=1,723). Gynecologic surgery was defined as: no surgery; hysterectomy with bilateral oophorectomy (H+BO); hysterectomy with conservation of ≥1 ovary (H + OC). Cause-specific mortality was ascertained using the National Death Index, last updated in 2016. Hazard ratios (HR) and 95% confidence intervals (CI) for breast cancer-specific mortality were estimated with Cox proportional hazard models. Models were then stratified by family history status, the self-reporting of one or more first-degree relatives with a family history of breast cancer. Models were adjusted for race, age at diagnosis, smoking, alcohol use, menopausal hormone therapy use and reproductive history factors. All participants still living at the end of follow-up were right censored. Among 1,723 women in the sample, 44% (n=759) were Black and 56% (n=964) were White. There were 836 deaths, of which 447 were from breast cancer. In this population, 74.1% (n=1,276) of women reported having no previous premenopausal gynecologic surgery, 8.8% (n=152) reported having H + BO and 17.1% (n=295) reported H + OC. Compared to women who had not had premenopausal gynecologic surgery, the overall adjusted HR for breast cancer-specific mortality associated with H+BO was 0.68 (95% CI: 0.49,0.96) and 0.90 (95% CI: 0.72,1.12) for women with H+OC. In models stratified on family history, the HR for women with H+BO was 0.11 (95% CI: 0.03,0.42) for those with family history and 0.90 (95% CI: 0.63, 1.29) for those without. The HR for women with family history who had H+ OC was 0.77 (95% CI: 0.45, 1.29) and 0.90 (95% CI: 0.63,1.29) for women without. This study suggests that the overall protective relationship observed between premenopausal hysterectomy with bilateral oophorectomy and breast-cancer specific mortality may be driven by a small subset of especially high-risk women. Citation Format: Mya L. Roberson, Whitney R. Robinson, Hazel B. Nichols, Andrew F. Olshan, Melissa A. Troester. Premenopausal oophorectomy and survival among women with breast cancer: Evidence of effect measure modification by family history status [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C052.

Is Midlife Metabolic Syndrome Associated With Cognitive Function Change? The Study of Women's Health Across the Nation.

Metabolic syndrome (MetS) affects cognitive function in late life, particularly in women. But longitudinal research is scarce on associations of MetS with cognitive function during midlife. To determine associations between MetS exposure and cognitive function trajectories in midlife women. This is a 17-year prospective, longitudinal study of multiracial/ethnic women in 7 US communities, with annual/biennial assessments. Participants were 2149 US women traversing menopause. Exposure consisted of MetS assessments (median 4 assessments over 4 years). Main outcome measures were assessments of cognitive function in 3 domains: perceptual speed (symbol digit modalities test, SDMT), episodic memory (East Boston Memory Test, EBMT), and working memory (Digit Span Backward Test, DSB). By their first cognitive assessment (age 50.7 ± 2.9 years), 29.5% met the criteria for MetS. Women completed a median (interquartile range [IQR]) of 6 (IQR 4-7) follow-up cognitive assessments over 11.2 (IQR 9.2-11.5) years. Women with MetS, compared with those without, had a larger 10-year decline in SDMT z-score (estimate -0.087, 95% confidence interval, -0.150 to -0.024; P = 0.007), after adjustment for cognitive testing practice effects, sociodemographics, lifestyle, mood, and menopause factors. As such, MetS accelerated the 10-year loss of perceptual speed by 24%. MetS did not differentially affect the rate of decline in either immediate (P = 0.534) or delayed (P = 0.740) episodic memory or in working memory (P = 0.584). In midlife women MetS exposure was associated with accelerated decline in perceptual speed, but not episodic or working memory.

Abstract P2-10-08: Racial disparities in breast cancer: Identifying predisposing clinical and molecular features associated with African American patients

Abstract Background: Breast cancer (BC) mortality is higher in African-American women (AA) than in Caucasian women (CA). AA are also diagnosed at a younger age, have more aggressive subtypes and greater incidence of metabolic dysfunction such as obesity and diabetes. These disparities have been attributed to a confluence of socioeconomic, genetic and epigenetic factors. However, the distinctive tumor biology of AA BC is not yet fully elucidated, as AA remain underrepresented in breast cancer studies and databases. Here, we compared clinical and molecular BC features of AA and CA patients for insights into mechanisms associated with these racial disparities. Methods: The FLEX Registry Trial (NCT03053193) is a prospective study evaluating tissue collected from patients with stage I-III BC who have consented to receive MammaPrint(MP)/BluePrint(BP) and clinically annotated full genome (FG) data. FLEX subset analyses investigate new gene associations that may be relevant to BC biology. This sub-study includes 160 AA and 199 CA patients (n=359) enrolled since April 2017. Clinical characteristics used in the analysis include menopausal status, metabolic factors, stage, grade and IHC results. A comprehensive publication search (PubMed) was conducted to validate candidate genes involved in BC in AA, BC genes associated with epigenetic regulation and genes associated with metabolic syndrome. Hierarchical clustering was performed on FG microarray (Agilent) intensity data focusing on the candidate genes (50 probes targeting 37 unique genes). Gene expression was compared between race and MP/BP risk groups. Results: AA were predominately MP High Risk (HR) 67.5%, BP Luminal B 40.2%, BP Basal 22.6%. Interestingly, 40.0% of AA BP Basal were classified by IHC as ER+. CA were MP Low Risk (LR) 54.8%, BP Luminal A 54.8%. Clinically, there were no differences in histology, tumor size, nodal or menopausal status between AA and CA patients. AA had higher grade tumors, higher rates of type 2 diabetes and obesity. Three comparisons were performed: 1) AA and CA, irrespective of MP result, 2) AA and CA HR MP only, and 3) AA only, irrespective of MP result. In comparison 1) 15 unique genes showed significant differences (p<0.05) in gene intensities between AA and CA patients. A heatmap showed four major clusters; cluster 1 included mainly (72.3%) AA patients, and these were predominantly MP HR and BP Basal. In comparison 2) 9 unique genes had significant differences (p<0.05) in gene intensities, 6 of which were common to the first comparison. This showed three major clusters and a significant cluster among AA patients. Finally, comparison 3) found 20 unique genes with significant differences (p<0.05) in gene intensities, 10 of which were common to the previous comparisons. This showed two major clusters with one significant cluster among AA MP HR, BP Basal patients. In total, 11 unique genes showed significant differences in intensities in AA or AA with HR MP including CYP4F8, TWIST1/2, CCND2, FOXA1 and GSTP1. These genes have known functions regulating metabolism and cell cycle. Conclusions: Here we show AA patients were enriched for genes associated with metabolic syndrome and epigenetic regulation of metabolic syndrome. The aberrant function of these genes has been implicated in tumorigenesis, dysregulation of metabolism and drug resistance. Further validation is warranted to fully understand the association of these genes with the unique biology of breast cancer in AA. Citation Format: Raquel Nunes, Lisa E. Blumencranz, Heather M Kling, Sahra Uygun, Sarah Untch, Erin B Yoder, Jennifer A Crozier, William Audeh. Racial disparities in breast cancer: Identifying predisposing clinical and molecular features associated with African American patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-10-08.

Abstract 191: BRAVE: Blood Pressure and Vascular Health Around Menopause

Background: Post-menopausal women are more likely to have uncontrolled hypertension and are at higher risk of cardiovascular disease compared with age-matched men. Blood pressure variability (BPV) has recently emerged as a predictor of adverse cardiovascular outcomes. It is unknown if there is a relationship between BPV and menopause and whether BPV can predict vascular health in perimenopausal women. Methods: BRAVE (Blood pRessure And Vascular hEalth around menopause) is an observational study recruiting perimenopausal healthy women, aimed at studying the relationship between BPV, the menopause transition and vascular health. A 24-hour blood pressure (BP) measurement [including 24-hour coefficient of variation, night dipping and maximum BP] was used to define the BPV. Menopausal status and cardiovascular risk factors were collected through questionnaires. Arterial stiffness, as a marker of vascular health status, was measured using pulse wave velocity. Multivariable models were performed to identify factors associated with BPV as well as those associated with arterial stiffness in perimenopausal women. Results: Fifty healthy women (mean age 52.9 ± 4.0, 62% post-menopausal) were recruited. There was a low prevalence of cardiovascular risk factors, except physical inactivity (60%). In around 40% of patients, we observed an abnormal pattern of BPV. However, all measures of BPV were similar between peri and post menopausal women. In the multivariable analysis, BMI was the only factor associated independently with maximum overnight BP (ß=1.95, p<0.0001) and maximum daytime BP (ß=2.46, p=0.008). Furthermore, maximum overnight BP was found to significantly associated with the arterial stiffness measurement (ß=0.035, p=0.048) after adjusting for confounders, including mean BP and cardiovascular risk factors. Conclusion: An abnormal pattern of BPV is common in perimenopausal women with normal office BP measurement. Maximum overnight BP provides useful information on vascular health beyond mean blood pressure in this population. BPV measurements in normotensive perimenopausal women may therefore have additional clinical value in stratifying their cardiovascular risk.

Assessment of menopausal symptoms in different transition phases using the Greene Climacteric Scale among rural women of North India

Background: Menopause is the universal physiological process of women’s midlife and exhibits a wide variety of symptoms. However, there is little data on the menopausal symptoms and factors associated with their severity among rural Indian women.Aim: To evaluate the prevalence of menopausal symptoms during the different transition phases of menopause among rural women of North India.Subjects and methods: This cross-sectional study consisted of 351 women aged 35–55 years (mean age 44.6 years) residing in rural areas of North India. A structured questionnaire was used to collect data regarding menopausal status, demographic profile and reproductive history of the participants. Frequency and severity of menopausal symptoms were evaluated using the Greene Climacteric Scale in different stages of menopause. All statistical procedures were accomplished using SPSS version 19.0.Results: In the present study the mean ages of attainment of menarche and menopause were 14.3 years and 47.2 years, respectively. Mean score of total Greene Climacteric Scale was highest among perimenopausal women (16.12 ± 8.1) over post-menopausal (14.78 ± 7.3) and pre-menopausal women (11.08 ± 6.1). Logistic regression analysis revealed that advancing age, low educational attainment, low socioeconomic status, menopausal status, later age at menarche and higher BMI were all associated with more severe menopausal symptoms.Conclusion: The climacteric symptoms were more prevalent among women who were perimenopausal followed by post-menopausal women and were the lowest in pre-menopausal women. Age, menopausal status, socio-economic status, and reproductive factors significantly influenced the severity of menopausal symptoms.

Reproductive and menopausal factors and risk of second primary breast cancer after in situ breast carcinoma.

In situ breast cancer patients have a higher risk of developing a second primary breast cancer than women in the general population have of developing breast cancer. We have limited understanding of why some women with a previous in situ breast cancer develop second primary breast cancers while others do not. In this population-based nested case-control study, we evaluated the association between reproductive and menopausal factors and risk of developing a second primary breast cancer among women with a previous in situ breast cancer. Using conditional logistic regression, these associations were evaluated in 552 cases and 1032 individually matched controls. Older age at menarche was associated with risk of second primary breast cancer among women with a previous in situ breast cancer (compared to age < 12, age 13: OR 0.60 (0.42, 0.85); age ≥ 14: OR 0.69 (0.47, 1.00); Ptrend = 0.07). Breastfeeding for > 12months was associated with a decreased risk of developing a second primary breast cancer (OR 0.62 (0.39, 0.98)). No associations were observed for other reproductive or menopausal factors evaluated. Results from this study suggest that reproductive factors may play a role in development of a second primary breast cancer after diagnosis of in situ breast carcinoma.

Physical performance in relation to menopause status and physical activity.

The aim of this study was to examine differences in physical performance (muscle power, muscle strength, aerobic capacity, and walking speed) across menopausal stages and potential of leisure physical activity (PA) to modify the impact of menopause on physical performance. In this cross-sectional study, women aged 47 to 55 were randomly selected from the Finnish National Registry and categorized as premenopausal (n = 233), perimenopausal (n = 381), or postmenopausal (n = 299) based on serum concentrations of follicle-stimulating hormone and bleeding diary. Physical performance was measured by knee extension force, handgrip force, vertical jumping height, maximal walking speed, and 6-minute walking distance. PA level was assessed by self-report and categorized as low, moderate, or high. Multivariate linear regression modeling was used for data analysis. After including fat mass, height, PA, and education in the model, the postmenopausal women showed 12.0 N weaker (P < 0.001) handgrip force and 1.1 cm lower (P < 0.001) vertical jumping height than the premenopausal women. There was no significant interaction between menopausal stage and PA on physical performance. The peri- and postmenopausal women with a high PA, however, showed better performance in the maximal knee extension strength and 6-minute walking test, and showed greater lower body muscle power than those with a low PA. Menopause status is associated with muscle strength and power, whereas the association between menopause status and mobility/walking is clearly weaker. A high leisure PA level provides more capacity to counteract the potential negative influence of menopausal factors on muscle function.

Role of reproductive and menopausal factors in functional and structural progression of rheumatoid arthritis: results from the SCQM cohort.

To study the relationship between female reproductive and menopausal factors on functional and structural joint damage progression in women with RA. This is an observational cohort study of RA patients enrolled in the Swiss Clinical Quality Management Program for Rheumatoid Arthritis. Information about female hormonal factors, such as pregnancies, menopause and hormonal therapy, were retrospectively retrieved using a specific questionnaire. The primary outcome was functional disability progression (HAQ) and the secondary outcome radiographic joint damage progression. We compared the functional progression between pre- and post-menopausal women using a multilevel regression model for longitudinal data, adjusting for potential confounders, such as baseline age, years of education, disease duration, seropositivity, DAS28 and treatment. A total of 1667 women were analysed, of whom 1025 (61%) were post-menopausal. Participants had a median of 6 HAQ assessments (interquartile range 3-10) during 5.1 (interquartile range 2.2-9.8) years of follow-up. At baseline, post-menopausal women had higher HAQ and erosion scores than pre-menopausal women. The evolution of HAQ scores over time differed between pre- and post-menopausal women (P < 0.001), with a less favourable evolution in post-menopausal women, particularly with earlier age at menopause. Erosion progression did not differ between pre- and post-menopausal women. In women with RA, functional disability progression differed between pre- and post-menopausal women. The more favourable evolution of function in pre-menopausal women was not explained by disease duration, age or radiographic damage.

Identification of Menopausal and Reproductive Risk Factors for Microscopic Colitis—Results From the Nurses’ Health Study

Microscopic colitis is a chronic inflammatory disorder of the colon primarily affecting postmenopausal women. However, the relation between hormonal determinants, including reproductive and menopausal factors, and risk of microscopic colitis has yet to be characterized. We collected data from 227,766 women who participated in the Nurses' Health Study (NHS) and the NHSII without a baseline history of microscopic colitis. Reproductive and menopausal factors were assessed in 1988 in the NHS and 1989 in the NHSII and updated biennially. Cases of microscopic colitis were confirmed through review of pathology records. We used Cox proportional hazards modeling to estimate hazard ratios and 95% confidence intervals. Through 2014 in the NHS and 2015 in the NHSII, we confirmed 275 incident cases of microscopic colitis over 5,147,282 person-years. Compared with never use, current use of menopausal hormone therapy was associated with increased risk of microscopic colitis (multivariable-adjusted hazard ratio 2.64; 95% confidence interval 1.78-3.90). The risk increased with longer duration of use (P for trend < .0001) and decreased after discontinuation (P for trend= .002). The association did not differ according to disease subtype (P for heterogeneity= .34). Similarly, ever use of oral contraceptives was associated with increased risk of microscopic colitis (multivariable-adjusted hazard ratio 1.57; 95% confidence interval 1.16-2.13). There were no associations between age at menarche, parity, age at first birth, age at menopause, or menopause type and incident microscopic colitis. In 2 large prospective cohort studies, we observed an association between exogenous hormone use and incident microscopic colitis. Further studies are needed to determine the mechanisms underlying these associations.