Menopausal Symptoms In Postmenopausal Women Research Articles

Healthy Lifestyle Behaviors and Menopausal Symptoms in Postmenopausal Women: A Cross-sectional Study

Healthy Lifestyle Behaviors and Menopausal Symptoms in Postmenopausal Women: A Cross-sectional Study

The effect of mobile app-based self-care training on the quality of marital relations and the severity of menopausal symptoms in postmenopausal women: a clinical trial study in Iran

BackgroundEducational interventions for self-care are a necessary solution to help postmenopausal women properly deal with menopausal problems. The present study aimed to investigate the effect of self-care training using an application on the quality of marital relations and the severity of menopausal symptoms in postmenopausal women in Iran.MethodsIn this study, 60 postmenopausal women selected using the convenience sampling method were divided into two groups, intervention and control, using simple random allocation (lottery). The intervention group used the menopause self-care application for eight weeks in addition to routine care, but the control group only received the routine care. The Menopause Rating Scale (MRS) and the Perceived Relationship Quality Components (PRQC) questionnaire were completed in two stages, before and immediately after eight weeks, in both groups. Data were analyzed using SPSS software (version 16), descriptive (mean and standard deviation), and inferential (ANCOVA and Bonferroni post hoc) statistics.ResultsThe ANCOVA results showed that the use of the menopause self-care application decreased the severity of the participants’ menopause symptoms (P = 0.001) and improved the quality of their marital relations (P = 0.001).ConclusionImplementation of a self-care training program through the application helped improve the quality of marital relations and reduce the severity of postmenopausal women's symptoms, so it can be used as an effective method to prevent the unpleasant consequences of menopause.Trial registrationThe present study was registered at https://fa.irct.ir/ on 2021–05-28 (registration number: IRCT20201226049833N1).

Prevalence of Metabolic Syndrome and Its Association With Menopausal Symptoms in Post-Menopausal Women: A Scoping Review.

Complex metabolic dysregulation leads to metabolic syndrome (MetS) causing various symptoms such as type II diabetes, central obesity, cardiovascular diseases (CVD), altered glucose metabolism, hypertension, and dyslipidemia, and is thought to be influenced by a number of factors, including migration from rural to urban areas. socioeconomic changes, and a sedentary lifestyle. Therefore, the primary goal of this scoping review was to determine the prevalence of MetS and its components as well as to understand the association between MetS and menopausal symptoms in post-menopausal women. The search strategy included articles that were published from 2010 onwards in MEDLINE/PubMed, Scopus, and Web of Science databases. The eligibility criteria included population, concept and context (PCC) format and based on it, 10 articles were included in this review. The review concluded that in comparison to pre-menopausal women, MetS is more common in post-menopausal women who are likely to experience somatic complaints and positive correlation of vasomotor symptoms with MetS. Hence, post-menopausal women can be counselled regarding menopausal symptoms related to MetS for which appropriate and adequate treatment or measures should be taken.

Menopausal symptoms in postmenopausal women and its association with sarcopenia

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Comparison of the Effect of Fennel and Evening Primrose Oil on Menopausal Problems and Hormonal Levels: A Randomized Controlled Trial.

Using natural oral supplements is one of the methods of complementary medicine that has been widely welcomed in the last decade Since studies have reported contradictory results for effectiveness of herbal medicines during menopause and no other more effective herbal medicine has been suggested yet, the researchers of this study decided to compare the fennel and Evening Primrose Oil (EPO) and their effect on menopause problems and sex hormones. The present study was a triple-blinded, controlled clinical trial with 125 participants randomly assigned to. An intervention group received fennel, another intervention group received evening primrose oil, and the placebo group received placebo twice daily for 8 weeks. Pre-intervention and post-intervention results were obtained using hormonal assay and the Menopause Rating Scale (MRS). In this study, the mean follicle-stimulating hormone (FSH) and estradiol levels changed significantly in the fennel and EPO groups compared to placebo (p < 0.001). The difference in the mean FSH score between the fennel group and EPO group was not significant (p = 0.304), but the difference in the mean estradiol level between these groups was significant (p = 0.043). Moreover, there was a significant difference in the mean MRS score between the intervention groups before the intervention (p < 0.05). However, the difference in the mean MRS score between the fennel and EPO groups was not significant after the intervention (p = 0.322). Consumption of fennel and EPO can significantly change FSH, estradiol, and psychological menopausal symptoms in postmenopausal women.

Evaluation of Efficacy and Safety of EstroG-100® in Alleviating Menopausal Symptoms in Postmenopausal Women in India: A Prospective, Single-center, Single-arm, Interventional Study.

Menopause is a natural stage in a woman's life marked by the cessation of menstrual periods. Common symptoms include hot flashes, mood swings, and vaginal discomfort, among others. These climacteric symptoms lead to a compromised quality of life affecting physical, biological, psychological, and social well-being. There are concerns with long-term clinical use of Hormone replacement therapy (HRT) and alternative therapies that are devoid of adverse risks are required. This study aimed to evaluate the safety and efficacy of EstroG-100®, containing a mixture of standardized extracts of Cynanchum wilfordii, Phlomis umbrosa, and Angelica gigas, on menopausal symptoms and its impact on quality of life. This was a prospective, single-center, single-arm, interventional study. Sixty female subjects, with confirmed menopause and moderate-to-severe symptoms, were enrolled and treated with EstroG-100® twice daily, for 12 weeks. Improvement in the climacteric symptoms was evaluated using the Menopause Rating Scale-11 and Menopause Symptoms Treatment Satisfaction Questionnaire (MS-TSQ). All the results were evaluated by the SPSS software version 23.0. A significant improvement was noticed in the somatic, urogenital, and psychological climacteric symptoms from baseline to 6 weeks (P = 0.001) and a highly significant improvement after 12 weeks (P = 0.0001) of treatment. 96.5% of patients were satisfied with the treatment outcome evaluated by the MS-TSQ. No changes in blood pressure and body mass index were reported. No side effects were reported during the study. The first study of EstroG-100® in Indian menopausal women demonstrated a statistically significant improvement in climacteric symptoms. A 12-week treatment proved safe and effective in enhancing postmenopausal women's quality of life. The remedy was well-tolerated and effectively alleviated menopausal symptoms.

Metabolic Syndrome and Its Association with Menopausal Symptoms among Postmenopausal Women: A Cross-sectional Study.

With increase in postmenopausal population, screening for MetS and its relationship with menopausal symptoms needs evaluation. To identify the frequency of metabolic syndrome (MetS) and assess its relationship with menopausal symptoms in postmenopausal women. This was a cross sectional study performed at a tertiary care centre in Uttarakhand India over a period of 18 months. All postmenopausal women >40 years with natural menopause included in the study sample. We used the Consensus Definition IDF and AHA/NHLBI (2009) criteria to classify subjects as having metabolic syndrome. Menopausal symptoms were assessed using Menopause Rating Scale (MRS) questionnaire. The frequency of metabolic syndrome in our study was 34.38% (55 out of 160 patients). We observed sleeping problems (36.88%) followed by physical & mental exhaustion (33.75%) and hot flushes (33.13%) to be the commonest menopausal symptoms. Significant association was seen for MRS along with its subscales in women with metabolic syndrome (P value <.05). Significant positive correlation was observed between total Menopause rating scale scores as well as all three subscales for triglycerides in patients with metabolic syndrome. Hyper triglyceridemia was associated with severe menopausal symptoms among postmenopausal women with MetS in our study.

Time-of-Day Effect on Postural Balance and Its Associations with Menopausal Symptoms in Postmenopausal Women.

Postmenopausal women suffer from postural balance issues. During a 24-hour time span, postural performance undergoes radical changes as influenced by the circadian rhythm. In this study, we aimed to investigate time-of-day effects on postural balance in postmenopausal women and balance relationships with menopausal symptoms. Two groups of women, aged 40-50years, participated in this study: a menopausal group and a control group. We evaluated their postural balance and menopausal symptoms (mood, sleepiness and fatigue) in five sessions over the course of a day: at 06:00 hours, at 10:00, at 14:00, at 18:00 and at 22:00. The results showed that postural balance (center of pressure area (CoParea)) values of postmenopausal women were significantly worse (p < .05) at 22:00. Moreover, at this time-of-day, participants in the menopausal group were more tired, less vigilant and experienced a lower mood. We found negative correlations between postural balance and both mood and fatigue levels. However, there was no time-of-day effect on postural balance, mood, fatigue, and sleepiness among participants in the control group. Thus, time-of-day should be considered a factor to control when assessing postural balance and designing intervention studies for postmenopausal women; and it is important for these women to be cautious of fall risks at night, as they are then less stable than at other times-of-day.

Effect of yoga on female hormones in peri-menopausal women

Background : One of risk factors for increased rate of cardiovascular diseases and development of menopausal symptoms in perimenopausal/postmenopausal women is reduced estrogen production. Yoga practice improved menopausal symptoms in postmenopausal women. Whether yoga practice had effect on estrogen in perinomopausal/postmenopausal women was not known. Thus, this study was conducted to assess the effect of yoga on female hormones; estrogen, progesterone, luteinizing hormone (LH), and follicular stimulating hormone (FSH) in perimenopausal women. Methods : The study included 60 perimenopausal women, grouped into yoga (n=30, age 44±2.64 years) and control (n=30, age 46±5.09 years) groups. The yoga group practiced meditation, pranayama and few simple asanas for 40 min/day, 6 days/week for 4 weeks. The control group did not practice any kinds of exercise. Levels of female hormones were assessed in all subjects at the beginning of the study and after four weeks of the study, and compared statistically. Institutional Ethical Committee approved the study. Results : Age, body mass index (BMI), blood pressure (BP), Heart rate (HR), and respiratory rate were comparable between the groups at the beginning of the study. Hormones LH and FSH showed no significant changes within and between group comparisons. Serum estrogen [11.95 (5.05-41.32) vs 24.47 (12.54-64.90) pg/ml, p=0.036] and progesterone [0.24 (0.10-1.02) vs 2.0 (0.25-9.73) ng/ml, p=0.012] increased in yoga group after yoga practice in within group comparisons, whereas, the control group showed no changes. Conclusion : Estrogen and progesterone levels increased in perimenopausal women after four weeks of yoga practice, whereas, LH and FSH showed no changes. It reveals that yoga practice can have cardio protective effects in perimenopausal women.

657. Do personality traits affect the perceived severity of menopausal symptoms in postmenopausal women?

Introduction and aims of the study: To investigate the association of personality traits with the severity of vasomotor symptoms (VMS) in a predominantly Greek population. Methods: A questionnaire-based study of women from the Menopause Clinic of a University Hospital in Athens, Greece. Sociodemographic parameters were documented through a structured interview. All women were asked to complete the Menopause Rating Scale (MRS) for the assessment of severity of menopausal symptoms, the Hot Flush Belief (HFB) for the assessment of how women were coping with their symptoms and the Big Five Inventory questionnaires for the assessment of personality traits.

Carbohydrate quality index: Its relationship to menopausal symptoms in postmenopausal women

ObjectiveThe aim of this study was to determine the relationship between carbohydrate quality intake and menopausal symptoms. Study designThis is a cross-sectional study of 393 postmenopausal women attending municipality health houses and health centers in the south of Tehran, Iran, from September 2016 to January 2017. Main outcome measuresThe dietary intake and menopausal symptoms of the participants were assessed with a validated food frequency questionnaire and a menopause rating scale (MRS) carbohydrate quality index (CQI) was calculated using three indices: dietary fiber, glycemic index, and the ratio of solid carbohydrates to total carbohydrates. Linear and logistic regressions were used to assess the relationship between CQI and menopausal symptoms. ResultsAfter adjustment for age, education, time passed since menopause, body mass index, physical activity and energy intake, an inverse association was found between CQI and total MRS score (TMRSS) (β -0.61; p <0.001), somatic score (SS) (β -0.27; p <0.001) and psychological score (PS) (β -0.37; p <0.001) in multivariable linear regression. In addition, logistic regression analysis revealed that compared with the lowest quartile of CQI, participants in the highest quartile of CQI had a lower TMRSS (odds ratio (OR) 0.36, 95% confidence interval (CI) 0.19-0.68). Moreover, CQI was inversely related to SS (OR 0.34; 95% CI 0.17-0.68) and PS (OR 0.32; 95% CI 0.16-0.61). However, there was no significant association between CQI and urogenital score (US). ConclusionsHigher-quality carbohydrate intake was found to be associated with lower somatic and psychological symptoms of menopause. These findings suggest that CQI may be an important basis for developing an effective dietary modification for reducing menopausal symptoms.

The effect of physical activity and depressive mood on menopausal symptoms in postmenopausal women.

The symptoms of menopause in postmenopausal women adversely affect the quality of life. Menopausal symptoms are more severe with comorbid disorders such as depression; it may be lighter in physically active people. The present study aimed to evaluate the relationship between menopausal symptoms and physical activity and depressive mood. One hundred and ninety women under 65years of age who were at least 1year passed since their last menstrual period participated in the study. Sociodemographic data form, Menopause Symptom Rating Scale, International Physical Activity Questionnaire-Short Form and Beck's Depression Inventory were applied to the participants. It was seen that 51.6% (98 subjects) of the women who participated in the study had severe menopausal symptoms. 52.6% (100 subjects) of the participants were physically inactive, and their menopausal symptoms increased as the physical activity scale score decreased (P=.001). Menopausal symptoms increased as the Beck's Depression Inventory score increased (P<.001). It was observed that depression inventory scores decreased as the level of physical activity increased (P<.001). Adoption of regular physical activity habits by postmenopausal women and providing treatment to those with depression will contribute to alleviating the severity of menopausal symptoms.

Lavender essential oil on postmenopausal women with insomnia: Double-blind randomized trial

BackgroundTo evaluate the effect of Lavandula angustifolia essential oil inhalation on sleep and menopausal symptoms in postmenopausal women with insomnia. Participants35 postmenopausal women with a clinical diagnosis of insomnia were included, 17 in Aroma Group (AG) and 18 in Placebo Group (PG). MethodsIn this double-blind, randomized controlled trial, PG participants inhaled sunflower oil and AG participants inhaledLavandula angustifolia essential oil, for 29 days. Both groups received sleep hygiene guidelines before the intervention and weekly follow-up during it. Evaluations were performed before and after intervention. All statistical analyses and intention-to-treat test were performed in SPSS 22. Sleep quality (Primary outcome) was measured by Pittsburgh Sleep Quality Index. Secondary outcomes were polysomnography data, severity of insomnia, anxiety and depression symptoms, and postmenopausal symptoms. ResultsThere were no significant differences between groups after intervention in the primary outcome (P = 0.22; effect size=0.69); however, a tendency of improvement in wake after sleep onset (WASO) was observed (P = 0.07; effect size=0.81; B = 42.2). Both groups presented better sleep quality over time (AG P < 0.001; PG P = 0.011). AG participants showed a significant decrease in sleep onset latency (P = 0.001), depression levels (P = 0.025), hot flashes (P < 0.001), postmenopausal symptoms (P < 0.001) and, in polysomnography data, increased sleep efficiency (P = 0.002) compared to baseline. ConclusionAlthough no significant differences were observed between groups, our data presented a tendency of improvement in WASO. Moreover, AG participants had enhanced overall sleep pattern, quality and sleep efficiency. Weekly follow-up and sleep hygiene instructions were essential for both groups to show improvement in almost all outcomes. Clinical trial registrationBrazilian Registry of Clinical Trials, www.ensaiosclinicos.gov.br, RBR-5q5t5z.

Investigating the Relationship between Physical Activity and Menopausal Symptoms in Postmenopausal Women

Investigating the Relationship between Physical Activity and Menopausal Symptoms in Postmenopausal Women

A research to spot the association between menopausal symptoms and metabolic syndrome in post-menopausal women in a tertiary care hospital

Aim: The current research aims to document the prevalence of metabolic syndrome (MetS) and investigate the association between menopausal symptoms and MetS in post-menopausal women.Materials and Methods: A prospective, cross-sectional study was performed over a period of 6 months in various departments of a tertiary care hospital. One hundred and two post-menopausal women were enrolled in the study randomly. Menopause Rating Scale (MRS) and National Cholesterol Education Program Adult Treatment Panel III Criteria were used to assess menopausal symptoms and MetS, respectively. Data analysis was carried out using the Statistical Package for the Social Sciences version 20.Results: Majority of the post-menopausal women had MetS with a prevalence of 72.54%. Somatic symptoms were the mostly commonly encountered symptoms in the subjects (71.56%) and had association with MetS (P = 0.004). Elevated fasting blood sugar was associated with components of MRS (P = 0.019). Among the somatic symptoms, hot flushes (P = 0.002), sleep problems (P = 0.037) and joint and muscular discomfort (P = 0.004) had significant association with MetS. Psychological symptoms and urogenital sexual problems were not associated with MetS.Conclusion: Prevalence of MetS in post-menopausal women was high. Somatic symptoms such as hot flushes, sleep problem and muscle and joint discomfort were associated with MetS. Menopausal symptoms might be due to the oestrogen deficiency. However, a large study is required to investigate the association between MetS and menopausal symptoms in post-menopausal women.

Efficacy and Safety of Nutraceutical on Menopausal Symptoms in Post-Menopausal Women: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Background Menopausal symptoms severely reduce the quality of life of post-menopausal women worldwide. Nutraceuticals are widely prescribed as a viable and safer alternative and complementary approach to standard therapies. The aim of this study was to evaluate the clinical efficacy and safety of a nutraceutical in post-menopausal women. Methods The study was designed as a randomized, double-blinded, placebo-controlled clinical trial. Post-menopausal women aged 45–60 years old were enrolled and randomly assigned to either treatment (n = 50) or placebo group (n = 51). The intervention, a proprietary combination of soy isoflavone, black cohosh, chasteberry and evening primrose oil extracts, and the placebo, were administered to each group for total of 12 weeks. Menopausal symptoms, endocrine profiles, and blood chemistry were evaluated at baseline, 6 weeks, and 12 weeks of the study. Results Nutraceutical supplementation demonstrated a statistically significant reduction in hot flushes and sweating (p < 0.0001), sleep problems (p < 0.0005), depressed mood (p = 0.0004) and irritability symptoms (p < 0.0003) compared with the placebo group. There were no significant differences in hormonal levels between the test and placebo groups, however levels of C-reactive protein were significantly decreased. Moreover, serum LDL-C and triglyceride levels were significantly lower than baseline levels in the treatment group at 6- and 12-week timepoints. No adverse effects were reported during the treatment. Conclusion These data indicate that a nutraceutical containing a combination of four medicinal herbs effectively and safely improved menopausal symptoms, as well as general health indicators, in post-menopausal women.

The severity of vasomotor symptoms and number of menopausal symptoms in postmenopausal women and select clinical health outcomes in the Women's Health Initiative Calcium and Vitamin D randomized clinical trial

This study evaluated whether vasomotor symptom (VMS) severity and number of moderate/severe menopausal symptoms (nMS) were associated with health outcomes, and whether calcium and vitamin D (CaD) modified the risks. The Women's Health Initiative CaD study was a double blind, randomized, placebo-controlled trial, which tested 400 IU of 25-hydroxyvitamin-D and 1,000 mg of calcium per day in women aged 50 to 79 years. This study included 20,050 women (median follow-up of 7 y). The outcomes included hip fracture, colorectal cancer, invasive breast cancer, all-cause mortality, coronary heart disease, stroke, cardiovascular death, and total cardiovascular disease (CVD). MS included: hot flashes, night sweats, dizziness, heart racing, tremors, feeling restless, feeling tired, difficulty concentrating, forgetfulness, mood swings, vaginal dryness, breast tenderness, migraine, and waking up several times at night. Associations between VMS severity and nMS with outcomes were tested. No association between VMS severity and any outcome were found. In contrast, nMS was associated with higher stroke (hazard ratio [HR] 1.40 95% confidence interval [CI] 1.04-1.89 for ≥ 2 MS vs none; HR 1.20 95% CI 0.89-1.63 for 1 MS vs none, P trend = 0.03) and total CVD (HR 1.35, 95% CI, 1.18-1.54 for ≥ 2 MS vs none; HR 0.99, 95% CI, 0.87-1.14 for 1 MS vs none P trend < 0.001). CaD did not modify any association. Severity of VMS was not associated with any outcome. Having ≥2 moderate or severe MS was associated with an increased risk for CVD. The number of moderate/severe MS may be a marker for higher CVD risk. : Video Summary:http://links.lww.com/MENO/A669.

The effect of Fennel seed powder on estradiol levels, menopausal symptoms, and sexual desire in postmenopausal women.

The present study was designed to determine the effect of Fennel seed powder on menopausal symptoms, sexual desire, and serum estradiol levels in postmenopausal women. The present study was conducted on 80 eligible women (45-60 y) who were referred to the Mofatteh Gynecology Clinic in Yasuj, Iran. Participants were randomized into equal intervention and control (control) groups. The intervention and control groups received four capsules of Fennel seed powder (2 gr) and starch-containing capsules (2 gr) daily over 8 weeks, respectively. Menopausal symptoms and sexual desire of the participants were evaluated using both the menopausal Kupperman index and Hurlbert index of sexual desire. The questionnaires were completed at baseline, week 4 and week 8 of the study by the participants. The serum estradiol levels were measured at baseline and also at the end of the study. The Chi-square test, independent t test, and repeated-measures analysis of variance were used to analyze the data. Menopausal symptoms score significantly decreased from 30.8 ± 6 to 19 ± 5.5 in the intervention group and also from 31.2 ± 6.5 to 26.4 ± 6.2 in the control group (P < 0.05). Treatment with Fennel seed did not significantly enhance the participants sexual desire (P > 0.05). The estradiol levels declined in the intervention (from 60.4 ± 43.4 to 52.6 ± 25.7) and control groups (from 55.1 ± 22.4 to 39.9 ± 26.9). However, this decrease was lower in the intervention group than in the control group. The intergroup differences were not statistically significant (P > 0.05). The results of the present study indicated that daily use of Fennel seed significantly improved menopausal symptoms in postmenopausal women over 8 weeks, though its effect on estradiol levels and sexual desire was not significant. Further studies with a larger sample size and longer duration are needed to verify these findings.

The comparison of the effect of soybean and fish oil on supplementation on menopausal symptoms in postmenopausal women: A randomized, double-blind, placebo-controlled trial

BackgroundThe effect of soybean and omega-3 fatty acid supplementation on menopausal symptoms in postmenopausal women was investigated. Materials and methodsIn a randomized, double-blind, placebo-controlled trial postmenopausal women were randomly given either soybean (Soygan 500 mg capsule; n = 60), or omega-3 fatty acids (Omega-rex 1000 mg soft gel; n = 60), or placebo (n = 60) daily for 12 weeks. The primary outcome was a change on the menopause rating scale score (MRS), while the secondary outcome was any adverse symptoms and effect was effect of soybean or omega-3 fatty acid supplements on the blood lipids and thyroid hormone. ResultsBased on the results of post-hoc in terms of overall MRS score there was a significant difference between the control and Soygan (p < 0.001) and Omega-rex groups (p = 0.03); however, there was no significant difference between the two intervention groups (p = 0.86). Soygan and Omega-rex had no effects on the blood lipids and thyroid hormone. ConclusionSoygan and Omega-rex reduced the MRS score and improved menopausal symptoms in postmenopausal women.

Effect of porcine placental extract on menopausal symptoms in postmenopausal women: A prospective, randomized, double-blind, placebo-controlled trial

ObjectivesTo determine the effect of oral administration of porcine placental extract (PPE) on the menopausal symptoms of Korean women. Materials and methodsThis study was a multicenter, randomized double-blind placebo-controlled trial. A hundred menopausal Korean women were randomly allocated either to the PPE 400 mg per day or the control group during 12 weeks of the study period. Menopausal symptoms were evaluated using the Kupperman Index (KMI). ResultsThe KMI decreased after 12 weeks in both groups; however, the difference in the changes was not statistically significant. Among overweight or obese women whose body mass index (BMI) was 23 kg/m2 or higher, the KMI decreased more significantly in the PPE group than placebo group after 12 weeks (−18.52 ± 9.09 vs −11.40 ± 10.68, P < 0.05). Among 49 early menopausal women whose duration of menopause was less than 3 years, the KMI decreased more significantly in the PPE group after 12 weeks (−17.29 ± 9.07 vs −11.29 ± 10.68, P < 0.05). The baseline estradiol level was not statistically different between the two groups before trial, but the estradiol level of the PPE group was significantly increased at 12 weeks (11.13 ± 35.13 pg/m, P < 0.05). ConclusionsOral administration of 400 mg PPE per day decreases menopausal symptoms in women with BMI 23 kg/m2 or higher or in early menopausal women. PPE may be considered as a short-term complementary treatment to reduce menopausal symptoms, especially in overweight or early menopausal women.