Menopause-related Changes Research Articles

An exploration of women’s occupational participation and identity during menopause: Descriptive qualitative study

Background: The menopause transition is a significant stage of a woman’s life, marking the transition from reproductive to postreproductive life. Occupational identity often shifts in response to life transitions but this has not been explored in relation to menopause. Therefore, our study aims to explore women’s experiences of menopause through an occupational perspective, in relation to occupational participation and occupational identity. Method: A descriptive qualitative design was implemented. Semistructured interviews were completed with five perimenopausal women online via Microsoft teams. Reflexive thematic analysis was employed to analyse data gathered. Findings: The findings of this study revealed that a lack of understanding and awareness during the initial stages of menopause negatively affected women’s well-being. Women faced disruptions to their engagement in meaningful occupations, which in turn, impacted their occupational competence and occupational identity. The experience of menopausal-related changes influenced women’s sense of self-efficacy in engaging in occupations and roles that aligned with their occupational identity. Conclusion: Women face significant occupational disruption during the menopause transition. Negative impacts on occupational identity and participation were evident from the participants. This study explores menopausal women’s experiences from an occupational perspective and findings offer potential direction for future research.

Subgingival microbial profiles in pre- and postmenopausal women: Associations with serum estradiol levels.

Subgingival dental plaque is an ecosystem playing a key role in supporting both oral health and systemic health. Menopause-related changes have the potential to disrupt its balance, which is crucial to postmenopausal well-being. Our study explored how circulating estradiol levels correlate with subgingival microbial composition using checkerboard DNA-DNA hybridization in premenopausal and postmenopausal women. We also demonstrated that combining this method with 16S ribosomal RNA (rRNA) sequencing insights remains valuable for examining subgingival ecology. We assessed 40 bacterial species in 77 premenopausal and 81 postmenopausal women using checkerboard DNA-DNA hybridization and measured serum estradiol with enzyme-linked immunosorbent assay (ELISA). Women were categorized by subgingival dysbiosis severity using a modified Subgingival Microbial Dysbiosis Index (mSMDI). Six women from each normobiotic and dysbiotic subgroup across premenopausal and postmenopausal women underwent 16S rRNA sequencing analysis. DNA checkerboard analysis revealed that most observed variability in individual bacterial proportions is associated with periodontitis. Two species, Leptotrichia buccalis and Streptococcus constellatus, exhibited differences related to estradiol levels within the premenopausal group (p=0.055 and p=0.009, respectively). 16S rRNA sequencing confirmed the mSMDI's validity in categorizing normobiotic and dysbiotic states. Menopausal status was not associated with a dysbiotic shift in the subgingival microbiome despite significantly more attachment loss in postmenopausal compared to premenopausal women. Our results indicate that decreased estradiol levels or increased attachment loss during menopause are not associated with changes in species abundance or dysbiotic shifts in women. The mSMDI may be a useful tool for classifying subgingival ecology based on its normobiotic or dysbiotic inclination.

Value of gingival crevicular fluid TREM-1, PGLYRP1, and IL-1β levels during menopause.

This study aimed to investigate the association of GCF TREM-1, PGLYRP1, and IL-1β levels with periodontal health in pre- and postmenopausal women. Triggering receptor expressed on myeloid cells 1 (TREM-1), activated through its ligand peptidoglycan recognition protein 1 (PGLYRP1), stimulates proinflammatory cytokine production, such as interleukin (IL)-1β, during periodontal inflammation. Postmenopausal changes may modulate these immune-inflammatory functions. No clinical study has yet investigated the effect of menopause on TREM-1, PGLYRP1, and IL-1β levels in gingival crevicular fluid (GCF). This cross-sectional study included 148 women (age range = 35-65 years), divided into postmenopausal women (PMW) (n = 76, mean age = 54 ± 5 years) and regularly menstruating premenopausal women (RMPW) (n = 72, mean age = 40 ± 4 years). Clinical periodontal parameters were recorded. TREM-1, PGLYRP1, and IL-1β levels were quantified with enzyme-linked immunosorbent assays. Pearson's Chi-squared test and Mann-Whitney-U test were used to compare categorical and numerical variables, respectively. Spearman's Rho correlation analysis was used to test the linear relationship between variables. Analyte level data were categorized based on the periodontal diagnosis and menopause status (2 × 2 nonparametric factorial ANOVA). No significant differences in TREM-1, PGLYRP1, and IL-1β levels between PMW and RMPW were observed (p > .05). Mean values of periodontal indexes including probing depth did not differ significantly between PMW and RMPW groups (p = .474). TREM-1 levels were significantly higher in both PMW and RMPW with periodontitis, compared to gingivitis or health (p = .0021). Menopause-related changes have no observable effect on GCF levels of TREM-1, PGLYRP1, and IL-1β. Higher GCF TREM-1 levels in women with periodontitis regardless of their menopausal status indicate that TREM-1 may be an indicator for periodontitis both in premenopausal and postmenopausal women.

Intellectual disability and menopause: the experience of the PASS project at Careggi University Hospital in Florence, pilot program

Background: Many data underline the difficulty towards a complex health care approach in this menopausal phase that would allow adequate clinical and preventive framing in patients with intellectual disability (ID). The figure of the caregiver plays a key role in this phase of a woman's life because it is essential to inform and educate her about the characteristics of menopause-related changes and the period of onset.

Quality of life in menopause: the Cervantes scale

Background: Menopause-related changes and symptoms have high variability in importance, severity and duration, and the assessment of health-related quality of life (Qol) has become an essential component both to study the effect of menopause on well-being and to assess the benefits of treatments in perimenopause and postmenopause.

Vascular function in women: when studying perimenopause is peri important.

Vascular function in women: when studying perimenopause is peri important.

Menopause-Related Changes in Body Composition Are Associated With Subsequent Bone Mineral Density and Fractures: Study of Women's Health Across the Nation.

During the menopause transition (MT), lean mass decreases and fat mass increases. We examined the associations of these body composition changes during the MT (2 years before to 2 years after the final menstrual period) with bone mineral density (BMD) at the end of the MT and fracture after the MT. We included 539 participants from the Study of Women's Health Across the Nation who were not taking bone-beneficial or bone-detrimental medications before or during the MT. Using multivariable linear regression, we assessed the independent associations of % lean mass loss and % fat mass gain during the MT (mutually adjusted) with femoral neck (FN) and lumbar spine (LS) BMD at the end of the MT, adjusted for pre-MT BMD, pre-MT lean and fat mass, race/ethnicity, Study of Women's Health Across the Nation (SWAN) study site, age, and cigarette use. We used Cox proportional hazards regression to quantify the relations of % lean loss and % fat gain during the MT with fracture after the MT. The Cox model was adjusted for the covariates above plus post-MT use of bone-detrimental medications, and censored at the first use of bone-beneficial medications; we further controlled for FN or LS BMD at the end of the MT. Adjusted for covariates, each standard deviation (SD) (6.9%) increment in lean mass loss was associated with 0.010 g/cm2 lower FN BMD (p < 0.0001); each SD (19.9%) increment in fat mass gain was related to 0.026 g/cm2 greater FN (p=0.009) and LS (p=0.03) BMD. Each SD increment in lean mass loss and fat mass gain was associated with 63% (p=0.001) and 28% (p=0.05) greater fracture hazard after the MT; associations were essentially unchanged by BMD adjustment. MT-related lean mass loss and fat mass gain were associated differentially with BMD; both were independently related to more fractures. Mitigating MT-related body composition changes may reduce fracture risk. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

The Impact of Ballet Program on Appetite Related Hormones, Insulin Resistance, and Body Composition in Postmenopausal Women: A Pilot Study

PURPOSE: Postmenopausal status is associated with an age-related decline in hormones, abnormal appetite regulation, weight gain, and increased risk of cardiovascular disease (CVD). Exercise is a useful non-pharmacological intervention that improves the levels of hormones involved in appetite regulation and weight management while reducing CVD risk factors. The present study aimed to elucidate the effect of a ballet program on menopause-related changes in satiety or levels of appetite regulation hormones, including leptin and ghrelin, homeostatic model of assessing insulin resistance (HOMA-IR).METHODS: The EX group performed the ballet program. In the fasting state, body composition; leptin, ghrelin, insulin, and glucose levels; and HOMA-IR values were assessed before and 12 week after the intervention.RESULTS: A significant group by time interaction (&lt;i&gt;p&lt;/i&gt;&lt;.05) was noted for percentage body fat, leptin, insulin, and HOMA-IR, which significantly decreased (&lt;i&gt;p&lt;/i&gt;&lt;.05), and ghrelin, which significantly increased (&lt;i&gt;p&lt;/i&gt;&lt;.05).CONCLUSIONS: These results indicate that this ballet program may be an attractive and enjoyable intervention for improving menopause-associated appetite regulation hormone changes in postmenopausal women.

Accelerated menopausal changes as human disease model ‘FOCUM’ for the development of osteoarthritis and other degenerative disorders: protocol for a prospective cohort study

IntroductionThe incidence of degenerative disorders, including osteoarthritis (OA), increases rapidly in women after menopause. However, the influence of the menopause is still insufficiently investigated due to the slowness of menopausal...

Menopause-related cortical loss of the humeral head region mainly occurred in the greater tuberosity.

AimsProximal humerus fractures are commonly observed in postmenopausal women. The goal of this study was to investigate menopause-related changes in cortical structure of the humeral head.Materials and methodsClinical computed tomography (CT) scans of 75 healthy women spanning a wide range of ages (20–72 years) were analyzed. For each subject, cortical bone mapping (CBM) was applied to create a color three-dimensional (3D) thickness map for the proximal humerus. Nine regions of interest (ROIs) were defined in three walls of the humeral head. Cortical parameters, including the cortical thickness (CTh), cortical mass surface density (CM), and the endocortical trabecular density (ECTD), were measured.ResultsCompared to premenopausal women, postmenopausal women were characterized by a significantly lower CTh and CM value in the lateral part of the greater tuberosity. Similar changes were only found in ROI 4, but not in ROIs 5–6 in the lesser tuberosity. Linear regression analysis revealed that the CTh and CM value of ROIs 1, 3, and 4 were negatively associated with age. These results showed that menopause-related loss in CTh and CM was mainly in the greater tuberosity besides the proximal part of the lesser tuberosity. Trabecular bone variable measured as ECTD showed a notably lower value in ROIs 1–9 in postmenopausal vs. premenopausal group. Inverse linear associations for ECTD and age were found in ROIs 2, 3, 5, 6, 7, and 9, indicating no site-specific differences of endocortical trabecular bone loss between the greater and lesser tuberosity.ConclusionsMenopause-related cortical loss of the humeral head mainly occurred in the lateral part of the greater tuberosity. The increased rate of humeral bone loss in the greater tuberosity may contribute materially to complex proximal humerus fractures.

Spotlight on the Gut Microbiome in Menopause: Current Insights.

The gut microbiome is an important contributor to human health, shaped by many endogenous and exogenous factors. The gut microbiome displays sexual dimorphism, suggesting influence of sex hormones, and also has been shown to change with aging. Yet, little is known regarding the influence of menopause – a pivotal event of reproductive aging in women – on the gut microbiome. Here, we summarize what is known regarding the interrelationships of female sex hormones and the gut microbiome, and review the available literature on menopause, female sex hormones, and the gut microbiome in humans. Taken together, research suggests that menopause is associated with lower gut microbiome diversity and a shift toward greater similarity to the male gut microbiome, however more research is needed in large study populations to identify replicable patterns in taxa impacted by menopause. Many gaps in knowledge remain, including the role the gut microbiome may play in menopause-related disease risks, and whether menopausal hormone therapy modifies menopause-related change in the gut microbiome. Given the modifiable nature of the gut microbiome, better understanding of its role in menopause-related health will be critical to identify novel opportunities for improvement of peri- and post-menopausal health and well-being.

Body fat distribution and insulin resistance among Korean middle-aged women: a Korean National Health and Nutrition Examination Survey.

ObjectiveTo evaluate menopause-related changes in body fat distribution and their relationship with insulin resistance in middle-aged Korean women.MethodsWe analyzed women aged 40–60 years using data from the National Health and Nutrition Examination Survey conducted from 2008 to 2011. Body fat was measured using dual-energy X-ray absorptiometry. Insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR).ResultsAmong 3,468 participants, menopausal women (n=1,489) had a higher body mass index (BMI) and higher trunk, arm, and head fat percentages than premenopausal women (n=1,979). However, no significant difference was found in the leg fat percentage according to menopausal status. Multivariable regression analysis for HOMA-IR showed that trunk fat percentage, BMI, and waist circumference positively correlated with insulin resistance and leg fat percentage negatively correlated after adjusting for several confounding factors, whereas menopausal status was not associated with HOMA-IR.ConclusionMiddle-aged women not only have different body weights and BMI but also have different body fat distributions according to menopausal status. Each fat percentage change in the trunk and leg is differently associated with metabolic health, particularly insulin resistance. To evaluate the metabolic health of middle-aged women, BMI is generally noted; however, body fat distribution, which can be easily assessed using dual-energy X-ray absorptiometry, should also be considered.

Menopause and sexuality

Many women spend a third of their lives in postmenopause, and it’s a given that sexual life must go on after menopause since its benefits were vastly proven. A number of factors influence sexuality in postmenopause: the age at which menopause sets in, how menopause sets in, physical and mental state, quality of sexual life in perimenopause and the quality and duration of the relationship with the partner. The hypoestrogenism that characterizes menopause leads to a decrease in libido, to changes in the genital apparatus (vaginal atrophy, dyspareunia) or other changes (hot flushes, impaired urination, depression), which negatively affect sexual health. Assessing sexual dysfunction is not easy. The interplay between the types of factors that predispose, precipitate and maintain sexual dysfunction requires preparation on the part of the clinician in identifying the elements of interest and indicating appropriate therapy. Research on the quantification of sexual dysfunction in women has led to the development of various scales or questionnaires to assess the impact of menopausal-related changes on sexual function and quality of intimate life. The ultimate goal of the clinician is to find an optimal method of treatment that will improve the condition and enhance the quality of sexual life. The available knowledge about menopausal sexuality may still be the tip of the iceberg in both medical practice and society and further research and information campaigns are greatly needed.

Menopause and Brain Health: Hormonal Changes Are Only Part of the Story.

Most studies of menopause and brain aging have focused on the role of the sex steroid hormone, estradiol, as a key mechanisms contributing to cognitive and brain aging in women. An emerging literature demonstrates that beyond endogenous estradiol levels, menopausal symptoms, particularly vasomotor symptoms (VMS), are also key determinants of menopause-related changes in cognition and brain function. Critically, that literature shows the importance of using objective techniques to identify associations of VMS with memory performance, brain structure, and brain function. While self-report measures are important patient-centered outcomes in women's health research, objective measures of VMS typically relate more strongly to indices of cognitive and brain health. Currently, it is premature to make a causal claim about VMS and memory dysfunction, but initial findings raise the possibility that women with VMS might experience an improvement in cognition with VMS treatment. More generally, these findings underscore the utility of investigating female-specific risk factors for cognitive decline.

Sleep and Methylation of Estrogen Receptor Genes, ESR1 and GPER, in Healthy Middle-Aged and Older Women: Findings from the Women 40+ Healthy Aging Study.

PurposeSleep problems in middle-aged and older women are very common and have been associated with menopause-related changes in estrogen levels. However, not all women experience sleep problems as they enter perimenopause, and epigenetic mechanisms might contribute to the differences in sleep quality within this population. In this study, we hypothesized that increased methylation of two estrogen receptor (ER) genes (ESR1 and GPER) would be associated with increased sleep problems in healthy pre-, peri-, and postmenopausal women, either directly or indirectly through the experience of vasomotor symptoms (VMS).Materials and MethodsIn 130 healthy women aged 40–73 years, we assessed DNA methylation from dried blood spots (DBS). Women rated their sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and VMS using the Menopause Rating Scale (MRS).ResultsHigher percentage methylation of ESR1 was associated with increased sleep problems, mediated by VMS, even after controlling for age, menopausal status, body mass index, estradiol levels, depressive symptoms, and caffeine consumption. There was no significant association between GPER methylation and either sleep problems or VMS.ConclusionThe study findings support an association between increased ESR1 methylation and sleep problems through increased VMS among healthy women aged 40–73 years.

Determinants of menopause-related symptoms in women during the transition to menopause and the postmenopausal period – A systematic literature review

Introduction: Menopause is a complex physiological, self-perceived health condition caused by the reduction and termination of ovarian function, a process that results in a range of both psychological and physiological symptoms. The aim of this literature review was to synthesize the results of published studies on factors associated with menopausal symptoms in women during the transition to menopause and the postmenopausal period.Methods: This systematic review was carried out according to the PRISMA statement. Primary studies published between 2007 and 2017 were identified through the following databases: PUBMED, SCOPUS, and CINAHL. In total, 3301 studies were identified and 279 were screened in full text. Of these, 54 studies were included for quality assessment using checklists from the Norwegian Institute for Public Health. A total of 22 studies were ultimately selected for inclusion in the results. These were thematically reviewed.Results: A wide range of determinants was sorted as socio-demographic predictors, reproductive factors, clinical characteristics, behavioral, and lifestyle characteristics, and their association with the following outcomes was examined: The prevalence and severity of menopausal symptoms; sexual functioning; health indicators and health behaviors; health-related quality of life; physical performance; cognitive changes and attitudes; and the prevalence and age of natural menopause.Conclusions: The current state of knowledge regarding menopause indicates that a wide array of instruments and variables have been employed and assessed to further understanding about menopause-related symptoms. This systematic review provides information on factors that should be considered in the treatment of menopause-related changes that may be bothersome for menopausal women.

Abdominal Fat Tissue Echogenicity: A Marker of Morbid Obesity.

Menopause-related changes may affect regional but also morphological characteristics of adipose tissue. We sought to assess the clinical value of echogenicity of subcutaneous adipose tissue (SAT) and preperitoneal adipose tissue (pPAT) in postmenopausal women without cardiovascular disease. In 244 consecutively recruited postmenopausal women, subclinical atherosclerosis was assessed in the femoral and carotid arteries by intima-media thickness (IMT) and atheromatous plaques using high-resolution ultrasonography. In 41 women with a second visit (median follow-up 41.5 months), carotid atherosclerosis was re-evaluated. Images of SAT and pPAT were ultrasonographically acquired, and their echogenicity was evaluated by grayscale mean (GSMn) using a dedicated software. A control group of 20 healthy premenopausal women was used for comparisons in fat echogenicity. SAT GSMn but not pPAT was higher in postmenopausal as compared with healthy premenopausal women and was independently associated with metabolic markers of adiposity including body mass index (BMI) and waist circumference (WC). SAT GSMn was associated with carotid IMT and the presence and number of atheromatous plaques [adjusted OR 2.44 and 2.32 per 1-SD increase in GSMn (95% CIs 1.55 to 3.93 and 1.55 to 3.45), respectively]. SAT GSMn conferred incremental value over traditional risk factors, insulin resistance, BMI, and WC for the detection of subclinical atherosclerosis. Increased baseline SAT GSMn was associated with increased rate of progression in carotid IMT. SAT echogenicity may serve as a qualitative marker of adiposity, conferring incremental clinical value over BMI and WC in postmenopausal women. Further investigation is warranted to assess the utility of ultrasonography-derived fat echogenicity as a screening method for morbid obesity.

Dopamine-dependent cognitive processes after menopause: the relationship between COMT genotype, estradiol, and working memory.

The present study examined how a gene related to functioning of the dopaminergic system, catechol-O-methyltransferase (COMT), and estradiol were related to brain functioning in healthy postmenopausal women. Participants were 118 healthy, cognitively normal postmenopausal women between the ages of 50-60 years. All women provided a blood sample for COMT and estradiol analyses and underwent a magnetic resonance imaging scan. Working memory performance and related brain activation were measured with BOLD functional magnetic resonance imaging during the N-back task. Results were examined across each COMT genotype and a median split was performed on the circulating estradiol levels to create high and low estradiol groups for each genotype. COMT genotype and estradiol level were hypothesized to be proxy measures for brain dopamine levels with the Met/Met and high estradiol group having the most dopamine and Val/Val and low estradiol group having the least dopamine. The functional magnetic resonance imaging results showed that the N-back task activated the expected bilateral frontal and bilateral parietal working memory network. However, no main effects of COMT genotype or estradiol group were found. There was COMT-estradiol interaction found in a small area of decreased activation in the right precentral gyrus (Brodmann Area 6) that was related to the increasing hypothesized dopamine level. Specifically, women with a Met/Met genotype in the high estradiol group had the least activation in this frontal lobe working memory region. Women with a Val/Val genotype in the low estradiol group had greater activation in this region relative to the other groups. Performance on the N-back task did not show any group differences. These data indicate that after menopause COMT genotype and potentially the menopause-related changes to the dopaminergic system are not related to cognition. Future studies should examine how the relationship between COMT, estradiol, and cognition around the menopause transition as there appear to be differences in this relationship for premenopausal and postmenopausal women.

A Review of Spouse’s Reactions to Menopausal-Related Changes

Challenges faced by women during their menopausal phases do not only revolve around them, but also their respective spouse. Even though a considerable amount of literature has been published on menopausal context, to date, there is no published review paper regarding spouse’s reaction toward menopausal-related changes. Therefore, the purpose of this paper is to review literature and studies conducted that related to spouse’s reaction to menopausal-related changes. This review paper is based on multiple databases focusing on spouse’s reactions and menopause. As a result, of the thoroughly reviewed literature, three classifications related to the context of spouse’s reactions in menopausal phases have been found as the following; (i) types of reactions, (ii) internal and external factors and (iii) impacts on menopausal women and spouse. In conclusion, this review paper will provide useful information to develop effective health education module which involving spouses to ensure that menopausal women have a meaningful life throughout the menopausal phases.

Prevalence of Postmenopausal Symptoms, Its Effect on Quality of Life and Coping in Rural Couple.

Aim:Menopause is a physiological process, with potential to lead to various pathological/psychological complications, leading to change in quality of life (QOL). Although literature suggests the effect of menopause on various aspects of life, there is scarcity of studies from rural setup in this regard. Thus, it is essential to assess extent of menopause-related changes, its awareness, and coping mechanisms in rural couple. This study aimed to find the prevalence of postmenopausal symptoms, its severity, and effect on QOL of rural women and the couples' coping mechanisms.Materials and Methodology:A cross-sectional survey was conducted by approaching 250 families from two villages of Gujarat, India. Inclusion criteria were any woman having attained menopause naturally within last 10 years and having her husband available for data collection. Hundred such couples consenting for participation were included in the study. Data on demographic variables, menopause-specific QOL, personal health of women, and coping of the couple were collected.Results:The prevalence of menopausal symptoms was found to be 47%. Mean (standard deviation) age at menopause was 44.9 (4.9) years. The prevalence of at least one symptom related to vasomotor was 21.3%, physical 91.5%, psychosocial 44.7%, and sexual was 0%. “QOL and Bother” analysis revealed that all those with menopausal symptoms also had their QOL affected from mild-to-moderate extent. The husbands of women with menopausal symptoms were aware of their condition; however, neither of them exhibited use of the active coping mechanism. The avoidant emotional coping strategy appeared to be followed by most.Conclusion:Couples were found to be aware of menopause; however, the symptoms arising as consequence of it seem to be accepted as natural age-related changes. This could possibly account for not taking any active coping strategy despite reporting of mild-to-moderate botheration by women and awareness in both. Rigorous health education and awareness about menopausal changes might be beneficial.