Menopause-related Symptoms Research Articles

Ovarian tissue cryopreservation and transplantation as a natural means to delay menopause.

Ovarian tissue cryopreservation and transplantation (OTCT) offers hope for preserving fertility and endocrine functions in patients undergoing gonadotoxic treatments. Advancements in techniques for the procedure have transformed OTCT from an experimental procedure into a viable option. There is a growing interest in utilizing OTCT to delay menopause and alleviate associated health issues. Menopausal transition affects women globally, leading to symptoms and long- term health risks. OTCT has the potential to restore endocrine functions, reducing menopause-related symptoms while mitigating health consequences such as osteoporosis and cardiovascular diseases. Although the use of OTCT for delaying menopause is not clinically proven, the discussion around shows potential for future utilization. In essence, the remarkable advancements in OTCT have bestowed upon us the ability to safeguard fertility and sustain the delicate endocrine functions of the ovaries. However, it is the tantalizing prospect of utilizing this technique to postpone menopause and alleviate its associated symptoms that truly captivates the imagination. Further research is imperative to substantiate the clinical efficacy of OTCT; nonetheless, its potential in menopausal therapy is both promising and warrants comprehensive exploration. This review highlights advancements and the feasibility of OTCT to postpone menopause as an alternative approach to currently used conventional menopause therapy methods.

Women's Experiences of Intimate and Sexual Relationships During Menopause: A Qualitative Synthesis.

The aim of this literature review was to explore women's experiences of their intimate and sexual relationships during menopause. Evidence shows that the menopause transition can be a difficult time for women due to symptoms of menopause. There is little research evidence about how menopause-related symptoms impact women's intimate and sexual relationships. A qualitative synthesis was carried out on research published between May 2005 and July 2023 using five electronic databases: ASSIA, CINAHL, PubMed, PsycINFO and Web of Science. We also searched Google Scholar and used backward and forward chaining methods to identify results not listed in the databases and ensure that no relevant literature was omitted. Eighteen qualitative studies were included in this review. Six main themes were identified: the meaning of menopause to women in different cultures; factors affecting women's sexual lives; changes in sexual desire and orgasm; talking about sexual issues; women's attempts to overcome the impact of ageing and menopause on their sexual lives; and concerns about partner sexual satisfaction during the menopause. During the menopause transition, women can experience sexual difficulties that have an impact on their lives and intimate relationships. Qualitative studies showed that sexual changes associated with menopause can be difficult to manage and must be viewed in the social and cultural contexts of the women's lives. The results of this review will be of interest to nurses to assess patient needs while offering health services to women in menopause. In addition, the results can be used to inform education and support programmes for women. We have adhered to relevant EQUATOR guidelines and used the PRISMA-ScR reporting method. No patient or public contribution was required for this study.

Ultra-low dose estradiol and dydrogesterone for the treatment of menopausal symptoms in a pooled, multi-ethnic population

ObjectivesEvidence suggests ethnicity-specific differences in postmenopausal symptoms, highlighting the need for therapies that are efficacious across different ethnicities. We evaluated the efficacy of an ultra-low dose combination of 0.5 mg estradiol and 0.25 mg dydrogesterone (E 0.5 mg/D 2.5 mg) in alleviating vasomotor symptoms across a multi-ethnic population. Study designData from two controlled trials were pooled to form a dataset of 583 postmenopausal women from across Europe and China. Participants were randomized to receive treatment with E 0.5 mg/D 2.5 mg or placebo for 12 weeks. Main outcome measuresThe main efficacy variable was absolute change in the number of hot flushes from baseline to end of treatment. Health-related quality of life and safety were also assessed. ResultsChange in the number of hot flushes per day was greater with E 0.5 mg/D 2.5 mg versus placebo (mean difference − 1.5, 95 % confidence interval − 2.1, −1.0; p < 0.001). Participants treated with E 0.5 mg/D 2.5 mg reported improvement in health-related quality of life (including psychological symptoms, vaginal dryness), and high amenorrhea rates. Combined E 0.5 mg/D 2.5 mg was well tolerated: there were no differences between groups in the percentage of participants with at least one serious adverse event or treatment-emergent serious adverse events. Analysis of change in body weight indicated no differences between groups. ConclusionsThis pooled analysis demonstrates the consistent efficacy of E 0.5 mg/D 2.5 mg in the treatment of menopause-related symptoms across a multi-ethnic population of postmenopausal women.

Long-Term Treatment for Unspecified Anxiety Disorders with Cannabidiol: A Retrospective Case Series from Real-World Evidence in Colombia

Introduction: Preclinical and clinical evidence has elucidated that cannabis-based medical formulations (CBMFs) may display anxiolytic, antidepressive, and neuroprotective properties. CBMFs are often considered as novel therapeutic anxiolytic agents that can be prescribed as pharmacotherapy for symptomatic domains in anxiety disorders (ADs). Our aim was to explore effectiveness and tolerability of enriched cannabidiol (CBD) oil extract formulations in adults with anxiety symptoms in an outpatient mental health program in Colombia during the COVID-19 pandemic. Methods: We conducted an observational, retrospective, real-world evidence case series from electronic health records at Zerenia Clinic in Bogotá, Colombia between June 2021 and December 2022. Our convenience sample consisted of people searching for CBMFs for the treatment of anxiety symptoms. A cohort of 24 adults was prescribed with enriched CBD in the form of non-sterile oral liquids suspended in sesame seed oil extracts for DSM-5 unspecified anxiety disorder and followed throughout the first year of treatment. CBMFs were prepared by dissolving full-spectrum cannabis extracts in sesame seed oil to a standardized concentration of active ingredients which is CBD-enriched. The oil extract contained 100 mg/mL of CBD and less than 1.9 mg/mL of THC. Primary outcome measures established were the anxiety subscale in the Hospital Anxiety and Depression Scale (HADS-A), and the clinical global impression scale with regard to severity (CGI-S) and improvement (CGI-I) at baseline, 6 months, and 12 months during follow-up. Secondary outcome measures established were HADS depression subscale (HADS-D) and the Epworth Sleepiness Scale (ESS), respectively. Participants also completed the patient-reported outcome measures (PROMs) during each visit throughout the 12-month follow-up. PROMs documented both participantʼs subjective improvement experience and progressive adverse effects. Results: After 6 months of treatment with sublingually administered enriched CBD oil extracts in a median dosage of 100 mg, more than half (54.17%) of the sample continued to report significant anxiety symptoms. After 12 months, only 37.50% persisted with significant anxiety symptoms with a median dose of 120 mg of enriched CBD oil extracts. Similar subjective improvements were reported with regard to sleep disturbances (SDs) as a secondary outcome. At baseline, less than half (46.83%) of the sample reported significant daytime sleepiness. After 6 months of enriched CBD oil extract treatment, less than one third (29.17%) continued to report SDs. At end point, a high proportion of the sample (87.50%) were considered to have normal daytime sleepiness. The cohort showed no clinically relevant depressive symptoms at baseline based on HADS-D scores; therefore, no improvement could be reported throughout the 12-month follow-up. Minimal gender differences with regard to HADS-D scores may be attributed to modifying effects of menopause-related symptoms. No significant adverse drug reactions or deaths were reported during the 12-month follow-up. Conclusions: Further research should determine the long-term efficacy, safety, and appropriate dosages of enriched CBD oil extracts in treating specific ADs rather than broad and unspecified anxiety symptoms. The state of the art of CBMFs for ADs should be warranted by future randomized controlled trials. The next stage for cannabis research should be focused in performing head-to-head trials comparing enriched CBD extracts or capsules versus first-line treatments proven to be effective in ADs.

Factors affecting shared decision-making concerning menopausal hormone therapy.

Menopausal hormone therapy (MHT) is an effective treatment for menopause-related symptoms. Menopause management guidelines recommend a personalized approach to menopause care, including MHT use. Decision-making around menopause care is a complex, iterative process influenced by multiple factors framed by perspectives from both women and healthcare providers (HCPs). This narrative review aims to summarize evidence around factors affecting decision-making regarding menopause-related care. For HCPs, the provision of individualized risk estimates is challenging in practice given the number of potential benefits and risks to consider, and the complexity of the data available, especially within time-limited consultations. Women seeking menopause care have the difficult task of making sense of the benefit versus risk profiles to make choices in line with their decisional needs influenced by sociocultural/economic, educational, demographic, and personal characteristics. The press, social media, and influential celebrities also impact the perception of menopause and decision-making around it. Understanding these factors can lead to improved participation in shared decision-making, satisfaction with the decision and decision-making process, adherence to treatment, reduced decisional regret, efficient use of resources, and ultimately long-term satisfaction with care.

The 2017 Women’s Health Initiative study and use of hormone therapy: an emulated repeated cross-sectional study

BackgroundHormone therapy (HT) use among menopausal women declined after negative information from the 2002 Women’s Health Initiative (WHI) HT study. The 2017 post-intervention follow-up WHI study revealed that HT did not increase long-term mortality. However, studies on the effects of the updated WHI findings are lacking. Thus, we assessed the impact of the 2017 WHI findings on HT use in Taiwan.MethodsWe identified 1,869,050 women aged 50–60 years, between June and December 2017, from health insurance claims data to compare HT use in the 3 months preceding and following September 2017. To address the limitations associated with interval-censored data, we employed an emulated repeated cross-sectional design. Using logistic regression analysis, we evaluated the impact of the 2017 WHI study on menopausal symptom-related outpatient visits and HT use. In a scenario analysis, we examined the impact of the 2002 trial on HT use to validate our study design.ResultsStudy participants’ baseline characteristics before and after the 2017 WHI study were not significantly different. Logistic regressions demonstrated that the 2017 study had no significant effect on outpatient visits for menopause-related symptoms or HT use among women with outpatient visits. The scenario analysis confirmed the negative impact of the 2002 WHI trial on HT use.ConclusionsThe 2017 WHI study did not demonstrate any impact on either menopause-related outpatient visits or HT use among middle-aged women in Taiwan. Our emulated cross-sectional study design may be employed in similar population-based policy intervention studies using interval-censored data.

The beneficial potential of ginseng for menopause

Korean Red Ginseng (KRG) has long been used not only as a food supplement but also as a treatment for various diseases. Ginseng originated in South Korea, which later spread to China and Japan, has a wide range of pharmacological activities including immune, endocrine, cardiovascular, and central nervous system effects. KRG is produced by repetitions of steaming and drying of ginseng to extend preservation. During this steaming process, the components of ginseng undergo physio-chemical changes forming a variety of potential active constituents including ginsenoside-Rg3, a unique compound in KRG. Pandemic Coronavirus disease 2019 (COVID-19), has affected both men and women differentially. In particular, women were more vulnerable to COVID-related distress which in turn could aggravate menopause-related disturbances. Complementary and alternative medicinal plants could have aided middle-aged women for several menopause-related symptoms during and post COVID-19 pandemic. This review aimed to explore the beneficial effects of KRG on menopausal symptoms and gynecological cancer.

A fNIRS investigation of menopausal-related symptoms and brain cortical activity in menopause.

This study aimed to delineate the association between menopausal-related symptoms and brain cortical hemodynamics in peri-postmenopause women. Cross-sectional data from a total of 358 Han-Chinese women who visited the Menopause Clinic in the Shanghai Sixth People's Hospital from August 2019 to August 2022. Menopausal-related symptoms were analyzed through Kupperman index (KMI) scale and PSQI scale, while cerebral blood flow was measured using a functional near-infrared spectroscopy (fNIRS). Multiple linear regression model was used to assess the risk factors for subregions of brain hemodynamic response. After adjusting for confounding factors, we identified that menopausal symptom (B=-1.575, 95% CI (-2.661, -0.488), p=0.005) and duration of menopause (B=-14.583, 95% CI (-26.753, -4.192), p=0.007) were independently associated with the lower brain hemodynamic response in the prefrontal lobe, while in the temporal lobe, overweight (BMI≥24kg/m2) was negatively associated with the lower brain cortical activity (B=-36.882, 95% CI (-72.708, -1.056), p=0.044) after adjusting for other confounding variables. Our findings proposed that menopausal symptom and overweight should be attached great importance to the postmenopausal women, which provides clinical evidence for the feasible early detection and effective prevention such as menopausal hormone therapy (MHT) of brain health in postmenopausal women.

EMAS position statement: Thyroid disease and menopause

IntroductionThyroid diseases are common in women in their late reproductive years; therefore, thyroid disease and menopause may co-exist. Both conditions may present with a wide range of symptoms, leading to diagnostic challenges and delayed diagnosis.AimTo construct the first European Menopause and Andropause Society (EMAS) statement on thyroid diseases and menopause. Materials and methodsLiterature review and consensus of expert opinion (EMAS executive board members/experts on menopause and thyroid disease). Summary recommendationsThis position paper highlights the diagnostic and therapeutic dilemmas in managing women with thyroid disease during the menopausal transition, aiming to increase healthcare professionals' awareness of thyroid disorders and menopause-related symptoms. Clinical decisions regarding the treatment of both conditions should be made with caution and attention to the specific characteristics of this age group while adopting a personalized patient approach. The latter must include the family history, involvement of the woman in the decision-making, and respect for her preferences, to achieve overall well-being.

Altered brain morphology and functional connectivity in postmenopausal women: automatic segmentation of whole-brain and thalamic subnuclei and resting-state fMRI.

The transition to menopause is associated with various physiological changes, including alterations in brain structure and function. However, menopause-related structural and functional changes are poorly understood. The purpose of this study was not only to compare the brain volume changes between premenopausal and postmenopausal women, but also to evaluate the functional connectivity between the targeted brain regions associated with structural atrophy in postmenopausal women. Each 21 premenopausal and postmenopausal women underwent magnetic resonance imaging (MRI). T1-weighted MRI and resting-state functional MRI data were used to compare the brain volume and seed-based functional connectivity, respectively. In statistical analysis, multivariate analysis of variance, with age and whole brain volume as covariates, was used to evaluate surface areas and subcortical volumes between the two groups. Postmenopausal women showed significantly smaller cortical surface, especially in the left medial orbitofrontal cortex (mOFC), right superior temporal cortex, and right lateral orbitofrontal cortex, compared to premenopausal women (p < 0.05, Bonferroni-corrected) as well as significantly decreased functional connectivity between the left mOFC and the right thalamus was observed (p < 0.005, Monte-Carlo corrected). Although postmenopausal women did not show volume atrophy in the right thalamus, the volume of the right pulvinar anterior, which is one of the distinguished thalamic subnuclei, was significantly decreased (p < 0.05, Bonferroni-corrected). Taken together, our findings suggest that diminished brain volume and functional connectivity may be linked to menopause-related symptoms caused by the lower sex hormone levels.

Complementary and Alternative Medicine for Menopausal Symptoms Management

Menopause is the permanent cessation of menstruation for a complete 12 consecutive months while post-menopause is the period following menopause marked by changes in hormonal status. Studies stated that menopausal women experience symptoms like hot flashes/flushes, night sweats, sleep disturbances, sexual dysfunction, mood disorders, weight gain and cognitive decline which overall affect their lives. Though hormonal therapies are used for symptom management, it was found to have some side effects and increase the chance of cancer. Complementary and alternative medicines (CAM) have a positive impact on the same management. Relaxation, biofeedback, meditation, aromatherapy, use of mineral products and other methods like traditional Chinese medicines, reflexology, acupuncture, acupressure and homeopathy are found to be effective in controlling menopause-related symptoms. We should make them aware of these complementary and alternative medicines. Keywords: Menopause, post-menopause, complementary and alternative medicine.

Body composition, physical activity, and menopause symptoms: how do they relate?

This study characterized the impact of physical activity (light, moderate, and vigorous [VIG] active minutes per day) and body composition (percent body fat [%BF] and fat-free mass index) on total menopausal symptoms (TMSs) in 72 premenopausal, perimenopausal (PERI), or postmenopausal women. Activity minutes were collected from wearable fitness trackers. Body composition was evaluated using a whole-body dual-energy x-ray absorptiometry scan. TMSs were quantified using The North American Menopause Society Questionnaire. Significant associations were observed between TMSs and %BF ( r = 0.464, P < 0.001) and VIG ( r = -0.245, P = 0.038). %BF and VIG were significant predictors for TMSs across groups ( R2 = 0.146 and R2 = 0.092, respectively), but only %BF maintained for PERI ( R2 = 0.421, P < 0.001). %BF predicted nearly half of the variance in PERI TMSs, whereas VIG predicted 9% of the sample variance, demonstrating an important influence of body fat accumulation and intense physical activity in the menopause transition. High-intensity exercise interventions to alleviate body composition changes may also reduce menopausal-related symptoms for PERI women.

A Novel Method for the Measurement of the Vaginal Wall Thickness by Transvaginal Ultrasound: A Study of Inter- and Intra-Observer Reliability.

Background and Objectives: A consensus regarding the optimal sonographic technique for measuring vaginal wall thickness (VWT) is still absent in the literature. This study aims to validate a new method for measuring VWT using a biplanar transvaginal ultrasound probe and assess both its intra-operator and inter-operator reproducibility. Material and Methods: This prospective study included patients with genitourinary syndrome of menopause-related symptoms. Women were scanned using a BK Medical Flex Focus 400 with the 65 × 5.5 mm linear longitudinal transducer of an endovaginal biplanar probe (BK Medical probe 8848, BK Ultrasound, Peabody, MA, USA). Vaginal wall thickness (VWT) measurements were acquired from the anterior and posterior vaginal wall at three levels. Results: An inter-observer analysis revealed good consistency between operators at every anatomical site, and the intra-class coefficient ranged from 0.931 to 0.987, indicating high reliability. An intra-observer analysis demonstrated robust consistency in vaginal wall thickness measurements, with an intra-class coefficient exceeding 0.9 for all anatomical sites. Conclusions: The measurement of vaginal wall thickness performed by transvaginal biplanar ultrasound was easy and demonstrated good intra- and inter-operator reliability.

The benefits and risks of menopause hormone therapy for the cardiovascular system in postmenopausal women: a systematic review and meta-analysis

BackgroundMenopause hormone therapy (MHT), as an effective method to alleviate the menopause-related symptoms of women, its benefits, risks, and potential influencing factors for the cardiovascular system of postmenopausal women are not very clear.ObjectivesTo evaluate cardiovascular benefits and risks of MHT in postmenopausal women, and analyze the underlying factors that affect both.Search strategyThe EMBASE, MEDLINE, and CENTRAL databases were searched from 1975 to July 2022.Selection criteriaRandomized Clinical Trials (RCTs) that met pre-specified inclusion criteria were included.Data collection and analysisTwo reviewers extracted data independently. A meta-analysis of random effects was used to analyze data.Main resultsThis systematic review identified 33 RCTs using MHT involving 44,639 postmenopausal women with a mean age of 60.3 (range 48 to 72 years). There was no significant difference between MHT and placebo (or no treatment) in all-cause death (RR = 0.96, 95%CI 0.85 to 1.09, I2 = 14%) and cardiovascular events (RR = 0.97, 95%CI 0.82 to 1.14, I2 = 38%) in the overall population of postmenopausal women. However, MHT would increase the risk of stroke (RR = 1.23, 95%CI 1.08 to 1.41,I2 = 0%) and venous thromboembolism (RR = 1.86, 95%CI 1.39 to 2.50, I2 = 24%). Compared with placebo, MHT could improve flow-mediated arterial dilation (FMD) (SMD = 1.46, 95%CI 0.86 to 2.07, I2 = 90%), but it did not improve nitroglycerin-mediated arterial dilation (NMD) (SMD = 0.27, 95%CI − 0.08 to 0.62, I2 = 76%). Compared with women started MHT more than 10 years after menopause, women started MHT within 10 years after menopause had lower frequency of all-cause death (P = 0.02) and cardiovascular events (P = 0.002), and more significant improvement in FMD (P = 0.0003). Compared to mono-estrogen therapy, the combination therapy of estrogen and progesterone would not alter the outcomes of endpoint event. (all-cause death P = 0.52, cardiovascular events P = 0.90, stroke P = 0.85, venous thromboembolism P = 0.33, FMD P = 0.46, NMD P = 0.27).ConclusionsMHT improves flow-mediated arterial dilation (FMD) but fails to lower the risk of all-cause death and cardiovascular events, and increases the risk of stroke and venous thrombosis in postmenopausal women. Early acceptance of MHT not only reduces the risk of all-cause death and cardiovascular events but also further improves FMD, although the risk of stroke and venous thrombosis is not reduced. There is no difference in the outcome of cardiovascular system endpoints between mono-estrogen therapy and combination therapy of estrogen and progesterone.

Advances in diagnosis and treatment of perimenopausal syndrome.

With the development and progress of society, people's average life expectancy has increased, and relevant literature reports that the number of postmenopausal women in China continues to increase. With lifespans extended, the transition period and post-menopause period have become the longest essential period in every woman's life. The life quality of women troubled by perimenopausal syndrome has been significantly reduced, which also places a burden on families and society. It is well known that hormone replacement therapy plays a vital role in improving women's menopause-related symptoms and is the most effective medical measure. With research ongoing into the treatment of menopausal symptoms in different patients, dose size, treatment duration, and medication regimens for hormones are still hot topics of discussion. This article reviews the definition, clinical diagnosis, staging, clinical manifestations, and treatment of menopause and explores the current diagnosis and treatment scenarios of perimenopausal syndrome.

Electroacupuncture for hot flashes in early postmenopause: A study protocol for a randomized sham-controlled trial

IntroductionMany early postmenopausal women experience hot flashes (HFs). Electroacupuncture (EA) is a safe and effective therapy for menopause-related symptoms. However, there are few rigorous clinical trials on this topic. This randomized controlled trial is designed to explore the feasibility and efficacy of EA in the treatment of early postmenopausal HF. MethodsThis study is a randomized, controlled trial involving 72 early postmenopausal patients. Patients will be randomized 1:1 to the EA or sham acupuncture (SA) group. The acupuncture points that will be used are Hegu (LI4), Fuliu (KI7), Taixi (KI3), Shenshu (BL23), Guanyuan (CV4), and Sanyinjiao (SP6). Participants in each group will receive 18 acupuncture sessions over 6 weeks (three times per week). The primary outcome is the hot-flash score at the end of the 6 week of intervention. Secondary outcome measures are the Pittsburgh Sleep Quality Index, Menopause-Specific Quality of Life, Menopause Rating Scale, Traditional Chinese Medicine Syndrome Score Scale, and estradiol, follicle-stimulating hormone, luteinizing hormone, and anti-Mullerian hormone levels. Safety will be assessed at every visit. ConclusionThis prospective trial will evaluate the efficacy of EA in the treatment of HFs among early postmenopausal women. Our results will provide additional knowledge for clinicians in the treatment of HFs.

Minding menopause in patients with cognitive impairment: a patient’s perspective and reflections on clinical practice

Many women experience impairment in cognitive function during perimenopause. These symptoms are often not attributed to perimenopause by women themselves, by family and friends, or by healthcare professionals. In this article, we present a case in which perimenopausal complaints were attributed to early dementia and discuss mechanisms contributing to the low level of awareness of perimenopausal symptoms amongst patients and clinicians. Stigma amongst women and healthcare professionals impairs the recognition of perimenopausal complaints, and consideration of treatment options by clinicians. We advocate raising awareness in patients and physicians with more education, and the incorporation of potential menopause-related symptoms in general clinical guidelines.

Menopausal vasomotor symptoms and subclinical atherosclerotic cardiovascular disease

Abstract Background Menopausal vasomotor symptoms (VMS) have been associated with subclinical and manifest atherosclerotic cardiovascular disease (ASCVD) but the scientific basis is limited and VMS have not been studied in relation to image-detected coronary atherosclerosis. PURPOSE To assess, in peri- and postmenopausal women, associations between VMS and subclinical ASCVD detected through computed tomography angiography (CCTA), coronary artery calcium score (CACS) or carotid ultrasound, and if potentially determined associations are modified by menopausal hormone therapy (MHT) or regular physical activity (PA). Methods This cross-sectional population-based study was conducted on a subset of participants from the Swedish CArdioPulmonary BioImage Study (SCAPIS), including women 50-65 years of age. The women underwent comprehensive cardiovascular assessments and completed an extensive questionnaire, which included questions about current and previous menopause-related symptoms. VMS was assessed on a 4-point scale and analyzed in relation to subclinical ASCVD, detected via CCTA, CACS and carotid ultrasound using multivariate logistic regression analyses. Results Of 2995 women included, 14.2% reported severe VMS (n= 425), 18.1% moderate VMS (n=543), and 67.7% no or mild VMS (n=2027). Women with severe, but not those with moderate, VMS had higher prevalence of CCTA detected atherosclerosis (34.1% vs 27.8%, p&amp;lt;0.05), but not CACS &amp;gt;100 (5.8% vs 6.6% p &amp;gt;0.05) or any carotid plaque (47.6% vs 46.6%, p&amp;gt;0.05) than women with no or mild VMS. Using the same reference category, severe but not moderate VMS was significantly associated with CCTA-detected atherosclerosis, odds ratio (OR) before and after multivariable adjustment 1.36, 95% confidence interval (CI) 1.08 – 1.72 and 1.33, 95% CI 1.02 – 1.72, respectively. This association became stronger when requiring an over 5-year duration of severe VMS, multivariable adjusted OR 1.53, 95% CI 1.09 – 2.14. Additional adjustment for MHT strengthened the association (OR 1.64, 95% CI 1.16 – 2.32). No significant association with CACS &amp;gt;100 or with the presence of any carotid plaque was observed. Additional adjustment for PA did not change any associations. Conclusions Severe but not moderate VMS were significantly associated with CCTA detected atherosclerosis, independent of a broad range of cardiovascular risk factors. Further research is required to determine the eventual causality of this relationship.Figure 1.Forest plots

Menopause in Sickle Cell Disease: Unchartered Territory

Menopause is a natural part of every women's life, but it may also be a time of change leading to biopsychosocial complications. Perimenopause is the time during which the body transitions to menopause, marking the end of the reproductive years. The Society for Women's Health Research Menopause Working Group cites that signs of progression toward menopause such as menstrual irregularity may be noted in the 40s, but some women may notice changes as early as their mid-30s. Perimenopause can last several years. Perimenopausal care plays an important role in the promotion of healthy aging and quality of life. For some, symptoms of menopause can have a detrimental impact on quality of life and pose serious risks to bone, cardiovascular and genitourinary health. There is a paucity of literature in menopause and sickle cell disease (SCD). A longitudinal study in Brazil of 15 women with SCD and a multi-center study of hydroxycarbamide exposure and ovarian reserve by Pecker et al have both indicated that women with SCD may have early menopause. Our exploratory study sought to determine menopause health-literacy and describe bothersome menopausal symptoms in women with SCD. A multi-faceted approach (one-on-one semi-structured interview, focus group, and registry analysis) was used for this single-institution exploratory study. Individuals were recruited during their routine clinic visit. Inclusion criteria included age &amp;gt;30 and ongoing menstruation OR prior menstruation. Exclusion criteria included pregnancy, breast-feeding, and history of stem-cell transplant. First, a mixed-methods survey was utilized. Next, a focus group was conducted to further elicit the views of patients about menopause and the role of healthcare providers in management of menopause for individuals with SCD. The focus group discussion was transcribed and then examined for recurring themes. The individual surveys and focus groups indicated a perceived exacerbation of SCD symptoms and complications as individuals became perimenopausal. To further assess this, data from the Sickle Cell Disease Implementation Consortium (SCDIC) registry from our site was analyzed to compare healthcare utilization between age-matched males and females. A total of 17 individuals were interviewed individually with a semi-structured questionnaire during their routine clinic visit. Individuals with HbSS on hydroxyurea underwent menopause at a median age of 50 years while those on no disease modifying treatment underwent menopause at a median age of 39 years. Many patients felt uninformed about menopause. Those who felt knowledgeable about the topic received their information from their own career in healthcare, friends, family, and the internet (Table 1). The focus group consisted of 5 female participants (3 perimenopausal and 2 post-menopausal) to elicit each individual's experiences around menopause and menopause specific care. Participants indicated worsening of SCD, hot flashes, and genitourinary complaints as their most bothersome issues with menopause. Participants reported having more frequent crises as they went through the menopause transition. Overall participants indicated that, after menopause, pain crises and hot flashes improved but genitourinary symptoms persisted. In addition, participants cited frustration over inability to address menopause related symptoms with their healthcare providers and even mentioned that providers were dismissive of their symptoms or attributed them to SCD without considering menopause transition. Further information was gathered and analyzed from the SCDIC registry; results showed that non-pregnant women have increased numbers of admissions as they enter age group of 30-40 years (Poisson regression eβ [95% CI]: 1.4 [1.3-1.7], P &amp;lt;0.001), while admissions for men decrease as they enter age group of 30-40 years (Poisson regression eβ [95% CI]: 0.49 [0.36-0.68], P &amp;lt;0.001). For the 30-40 age group, women are more likely to have admissions compared to men (Table 2). This finding could potentially be related to premature menopause contributing to increased admissions. While this study is limited due to the small size and exploratory nature, our preliminary work indicates that menopause is unchartered territory, and that many gaps exist in menopause health literacy and menopause related care delivery for women with SCD. Our findings highlight the need for further research on menopause in SCD.

Identifying Variables Associated with Menopause-Related Shame and Stigma: Results from a National Survey Study.

Background: Despite the significance of menopause as a natural biological milestone experienced by approximately half the population, few studies have evaluated factors associated with menopause-related shame and stigma. Given previous research indicating increased shame and stigma are associated with negative outcomes that directly impact health (e.g., reduced access to health care), it is critical to identify variables associated with menopause-related shame and stigma. Materials and Methods: As part of a larger, national survey, 214 perimenopausal (n = 111) and postmenopausal (n = 103) individuals completed self-report questionnaires assessing demographics and menopause-related symptoms, shame, and stigma. Regression analyses examined variables associated with shame and stigma. Results: Over a third of respondents reported feeling shame related to their menopause-related symptoms (37.4%), while the majority of respondents reported feeling stigma associated with symptoms (82.7%). In addition, most respondents endorsed talking about their symptoms with friends, family, partners, or doctors (80.8%), and felt that their peers might experience the same symptoms (93.9%). Regression analyses identified several significant predictor variables; in particular, more severe psychosocial and urogenital symptoms, higher education level, and younger age were significantly associated with greater odds of reporting shame and stigma. Conclusions: Overall, findings suggest that even though menopausal individuals report feeling their symptoms are similar to their peers, shame and stigma are significantly associated with these symptoms, which may be impacted by symptom severity and socioeconomic factors. Results suggest that younger individuals (i.e., those just entering perimenopause) with more education may be more likely to feel shame and stigma, which could inform interventional strategies and improve clinical outcomes.