Onset Of Menopause Research Articles

Menopause improves the predictive value of common cardiovascular risk scores in women with premature coronary artery disease.

Menopause, particularly its early stage (≤3 years from onset), may be an important risk factor for premature coronary artery disease. The objective of the study was to assess whether the addition of the presence of menopause in women with premature coronary artery disease could improve the predictive value of the Atherosclerotic Cardiovascular Disease risk estimator and the Systematic COronary Risk Evaluation model. The case-control study included 307 women with coronary artery disease aged 55 or less, and 347 age-matched controls without coronary artery disease. Diagnostic accuracy parameters were evaluated for traditional risk models versus those enriched with menopausal status. Early and late postmenopausal periods were defined as ≤3 and >3 years from the onset of menopause, respectively. Only the addition of the presence of the early postmenopausal stage to the 10-year Atherosclerotic Cardiovascular Disease risk classes resulted in significantly increased c-statistics from 0.66 (95% confidence interval [CI] 0.62-0.7) to 0.705 (95%CI 0.66-0.75) (P = 0.0003) and an increase of accuracy from 61.3% to 63.8% (P = 0.0025).Adding the presence of early postmenopause to the Systematic COronary Risk Evaluation risk classes also resulted in significantly increased c-statistics from 0.59 (95% CI 0.55-0.63) to 0.641 (95%CI 0.6-0.68) (P = 0.0024) and an increase of accuracy from 64.1% versus 57.5% (P = 0.001). Adding the early menopausal period may significantly improve the predictive value of the 10-year Atherosclerotic Cardiovascular Disease risk score and the Systematic COronary Risk Evaluation model in women with premature coronary artery disease.

Risk factors associated with intensity of climacteric symptoms in Brazilian middle-aged women: a population-based household survey.

To determine the factors associated with the intensity of climacteric somatovegetative, psychological, and urogenital symptoms among middle-aged women in the Metropolitan Region of Campinas, Brazil. A cross-sectional population-based household survey was conducted with 749 women aged 45 to 60 years. The dependent variable was the intensity of menopausal symptoms assessed using the Menopause Rating Scale. The independent variables were sociodemographic data, health-related habits and problems, self-perception of health, and gynecological background. The mean age of the women was 52.5 ± 4.4 years, and the mean age at onset of menopause was 46.5 ± 5.8 years. The intensity of menopausal symptoms was defined using the subscale scores of the median Menopause Rating Scale. Poisson multiple regression for somatovegetative, psychological, and urogenital symptoms showed several associated factors of each subscale, though some factors were common. Factors associated with moderate to severe climacteric symptoms in all the subscales of the Menopause Rating Scale were self-perception of health as "fair"/"poor"/"very poor" (P < 0.01), depression/anxiety (P < 0.01), and osteoarticular diseases (P < 0.01). The severity of climacteric symptoms in the different Menopause Rating Scale domains was related to a broad set of factors. Each Menopause Rating Scale subscale had its own set of factors, but some were common. Presence of chronic diseases, depression or anxiety, and worst self-perception of health were highlighted. A better understanding of these factors may help to not only reduce the effect of climacteric symptoms on the quality of life of middle-aged women, but also identify groups of women who need multidisciplinary health care.

Transient Increase in Sympathetic Constriction of Mesenteric Arteries from High Fat Diet‐Fed Dahl Salt‐sensitive Female Rats

Obesity (BMI ≥ 30) is a risk factor for hypertension. Obesity‐associated hypertension is a risk factor for cardiovascular disease, stroke, type 2 diabetes and kidney failure. Hypertension is less common in premenopausal women compared to age‐matched men. This disparity fades away after the onset of menopause. Increased sympathoexcitation in the neuroeffector junction leads to increase in constriction of blood vessels. Differences in the mechanism/s neurogenic arterial constriction in male and female are not well understood. We hypothesized that sympathetic nerve activity in high fat diet‐induced hypertension is greater in male than female rat mesenteric arteries (MA). Rats were fed either control (C) or high fat (HF) diet beginning at 3 weeks of age, and used at 10, 17 and 24 weeks on diet. Body weight and systolic blood pressure (SBP) were measured weekly. HF males gained more weight than HF females at all time points. SBP was higher in HF rats compared to C rats in both sexes and across all time points. The estrus cycle stage was determined cytologically by vaginal lavage prior to euthanasia. Mesenteric arteries (Inner diameter; male=275–350 μm, female=245–315 μm) were harvested and mounted in a pressure (60 mmHg) myograph and inner diameter was measured continuously. MA contractile responses to electrical field stimulation (30 stimuli at 0.2–30 Hz) and drug applications were measured. Neurogenic constriction of MA from HF females was greater than HF males at 5 and 10 Hz at 10 wks, and at 5–30 Hz at 17 wks. At 24 wks the difference disappears. Constrictions caused by norepinephrine (NE) and ATP were similar in MA from HF male and female rats. Immunostaining for tyrosine hydroxylase (sympathetic nerve marker) and vesicular nucleotide transporter (ATP marker) revealed greater sympathetic nerve intensity in HF male than female rats at 10 and 24 wks. There was also greater intensity in MA from HF males than HF females at 10 and 17 wks. Moreover, HF males have higher NE and ATP nerve density than HF females at 10 and 17 but not for ATP at 24 wks. MA NE levels were similar in male and female rats. Prejunctional α2‐AR and NE transporter functions were not impaired in MA from HF Dahl salt‐sensitive rats. Taken together, despite sex differences in sympathetic nerve density in MA, we detected only transient sex differences in sympathetic neurogenic arterial constrictions. Contrary to our hypothesis, we found that HF females transiently have an upregulation of neurogenic sympathetic activity and this warrants further investigation into the mechanism.Support or Funding InformationResearch supported by PPG NIH Grant P01HL070687This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Cross-cultural validation of the Modified Falls Efficacy Scale in Serbian community-dwelling women at risk for osteoporotic fracture.

Cross-cultural validation of the Serbian version of the Modified Falls Efficacy Scale (MFES). This cross-sectional study involved 257 women aged 65 years and above who were referred for dual-energy x-ray absorptiometry examination at the Railway Healthcare Institute in Belgrade, Serbia, between January and April 2016. Data collection comprised of a sociodemographic questionnaire and Geriatric Depression Scale-Short Form (GDS-SF) questionnaire, and data related to fractures, level of physical activity, use of medications that can increase the risk of falls, and frequency of falls in the past 12 months. None of the study participants had been previously treated for osteoporosis. The internal consistency of the questionnaire items was assessed via Cronbach's alpha, whereas the interclass correlation coefficient (ICC) was used to calculate test-retest reliability based on the sample of 257 women. We also evaluated concurrent, convergent, and construct validity. Cronbach's alpha for the total assay score was 0.98. Correlations among the items ranged from 0.84 to 0.93. While ICC for the scale as a whole was 0.99 (95% confidence interval 0.98-0.99), ICC pertaining to individual items ranged from 0.82 to 0.99. Concurrent validity analysis revealed a significant positive correlation between MFES scores and the reported level of physical activity (ρ = 0.34; P < 0.01). Convergent validity was tested through the ratio of MFES and sociodemographic variables. The findings indicated presence of a significant negative correlation between the MFES scores and age (ρ = -0.32; P < 0.01), age of menopause onset (ρ = -0.16; P = 0.01), and GDS-SF scores (ρ = -0.12; P = 0.04), and positive correlation between MFES and the level of social activity (ρ = 0.22; P < 0.01). Significant differences were noted between the MFES scores of participants who had no history fractures and those who did (U = 5277.50; P < 0.01), and between scores of women who reported falling in the past 12 months and those who did not (U = 4968.50; P < 0.01). Similarly, significant differences (P < 0.01) in the scores pertaining to each MFES item were observed between women who had experienced falls in the past (n = 101) and those who had not (n = 156). The Serbian version of the MFES is a reliable and valid instrument that can be used in both clinical practice and research to describe and measure self-perceived fear of falling in older individuals.

Quality of Life of Peri and Postmenopausal Women attending Outpatient Department of Obstretics and Gynecology of A Tertiary Care Hospital

Many women experience menopausal symptoms during menopausal transition and postmenopausal years. This natural phenomenon often results in various psychological, somatic and urinary symptoms which impair the overall quality of life of women. This study aimed to access the quality of life of women during perimenopausal and early postmenopausal years attending outpatient department of OBGYN at Kathmandu Medical College Teaching Hospital. A descriptive cross-sectional study of 240 perimenopausal women of aged 45-60 years attending gynaecological outpatient clinic was carried out between 15th January to 13th April 2017. Data were collected using Women Health Questionnaire, containing 37 questions by interview technique and analyzed using chi-square test to assess the association between sociodemographic information and the quality of life. The median age of onset of menopause was 50 years and 50.8% of respondents were having good quality of life. Sociodemographic variables such as age of women, marital status, educational level, last menstrual period and regular menstrual period were statistically significant with the quality of life of peri and postmenopausal women. Menopausal symptoms are common but due to lack of awareness, they do not seek medical advice. Hence priority lies on generating awareness among women about menopause and menopausal symptoms and establishment of dedicated elderly clinic to help these women live a healthy and comfortable life.

Is in utero exposure to maternal socioeconomic disadvantage related to offspring ovarian reserve in adulthood?

BackgroundBecause the ovarian follicle pool is established in utero, adverse exposures during this period may be especially impactful on the size and health of the initial follicle endowment, potentially shaping trajectories of ovarian follicle loss and the eventual onset of menopause. Building on a robust literature linking socioeconomic status (SES) and menopausal timing, the current study examined adverse prenatal exposures related to maternal SES, hypothesizing that greater maternal socioeconomic disadvantage would be associated with lower ovarian reserve in the adult offspring.MethodsIn a healthy, community-based sub-sample (n = 350) of reproductive age participants in the OVA Study (2006–2011), prenatal maternal SES was examined in relation to two biomarkers of ovarian reserve, antimullerian hormone (AMH) and antral follicle count (AFC). Prenatal maternal SES was assessed indirectly using maternal addresses abstracted from participant birth certificates, geocoded, and linked to US Census-derived variables, including neighborhood-level characteristics: education (% of individuals with a HS diploma); poverty (% of families below the poverty line); unemployment (% of individuals > 16 years who are unemployed); and income (median family income).ResultsIn separate covariate-adjusted linear regression models (following the backward elimination of main effects with P > .10), greater maternal neighborhood education was related to higher ovarian reserve as marked by higher levels of offspring AMH (beta = .142, P < .001) and AFC (beta = .092, P < .10) with models accounting for 19.6% and 21.5% of the variance in AMH and AFC, respectively. In addition, greater maternal neighborhood poverty was related to lower ovarian reserve as marked by lower offspring AMH (beta = −.144, P < .01), with the model accounting for 19.5% of the variance in AMH.ConclusionsMaternal socioeconomic disadvantage measured indirectly at the neighborhood level was associated with lower ovarian reserve among the adult offspring, independently of offspring SES and other potential confounding factors. This suggests SES-related adversity exposures may have a detrimental impact on the size or health of the initial follicle endowment, leading to accelerated follicle loss over time.

Age at natural menopause and its associated factors in Canada: cross-sectional analyses from the Canadian Longitudinal Study on Aging.

Early onset of menopause is associated with long-term disease and higher mortality risks. Research suggests that age at natural menopause (ANM) varies across populations. Little is known about factors that affect ANM in Canadian women. This study aims to estimate the median ANM and examine factors associated with earlier ANM among Canadian women. Baseline data from the Tracking cohort of the Canadian Longitudinal Study on Aging was used for this analysis. The relation of sociodemographic, lifestyle, and health-related factors with ANM was examined among 7,719 women aged 40 and above. Nonparametric Kaplan-Meier cumulative survivorship estimates were used to assess the timing of natural menopause. Univariate and multivariate Cox proportional hazard regression models were used to characterize ANM and its association with relevant covariates. Overall, median ANM was 51 years. Having no partner, low household income and education levels, current and former smoking, and cardiovascular disease were all associated with an earlier ANM, whereas current employment, alcohol consumption, and obesity were associated with later ANM. These findings provide a national estimate of ANM in Canada and show the importance of lifestyle factors and health conditions in determining menopausal age. These factors might help in risk assessment, prevention and early management of chronic disease risk during the menopausal transition.

Hemostasis and female sex hormones

The review considers modern concepts of the pathogenesis of coagulation disorders in women and the participation of endogenous and exogenous sex steroids in it. The analysis of the results of studies in recent years demonstrates significant contradictions on the influence of endogenous female sex steroids on the development of thrombotic events. In the context of thromboembolic complications association with the use of modern hormone containing medications, in particular combined hormonal contraceptives, genetically determined thrombophilia appears to be essential, but the possibility of their routine diagnostics to reduce risks is still not fully defined. To date, recent clinical studies support the early use of menopausal hormone therapy (MHT) to slow the rate of atherosclerosis development and primary prevention of cardiovascular disease in women in early menopause. At the same time, researchers put forward a temporary theory of the use of MHT (the early beginning of the use of MHT from the onset of menopause provides the best protective effect of hormones on the vascular wall) as a way of successful prevention of cardiovascular diseases. Correctly chosen tactics of preventive measures for a specific gynecologic patient can significantly reduce the risk of thromboembolic complications, prevent the development of disseminated intravascular coagulation syndrome or at least reduce its severity, shorten treatment time, and reduce morbidity and mortality caused by this pathology. Strict individual approach and targeted prevention, if it is carried out in all medical institutions and at all stages of management of pregnant and gynecological patients, can significantly reduce the frequency of these formidable complications.

Factors Associated with Delayed Menopause in Iran: Findings from Fasa Cohort Study, a Branch of Persian Cohort Study.

Background: The investigation of middle-aged women’s mental and physical health measures should be focused on menopause-a predictable physiological phenomenon in their lives. The prevalence of a majority of chronic diseases increases after this period. This study aimed to determine the risk factors of delayed menopause (climacterium tardum). Materials and Methods: The current cross-sectional research was conducted on 1930 menopausal women who were referred to the cohort study of Fasa University of Medical Sciences, Fars Province, Iran, during 2014-2015. The data were extracted from the database, and then the variables were checked for accuracy. Finally, the data were analyzed using logistic regression analysis. Results: The study population included 1930 menopausal women with the mean age of 57.98 ± 5.8 years. Of these, 1555 (80.6%) were married, and the rest were single and widowed. The mean age at menarche was 13.7 ± 1.64 years. Additionally, 1726 women (89.4%) had experienced natural menopause, whereas the rest had experienced delayed menopause. The results of the multivariate analysis indicated that delayed menopause was associated with marital status, education level, age at menarche, occupation, abortion, and use of contraceptive methods. However, no significant relationship was found between delayed menopause and smoking, duration of lactation, duration of using contraceptive pills, and number of childbirths. Conclusion: Considering the increased life expectancy among women, delayed menopause, and its risk factors should be taken into account. Although genetic factors play key roles in age at the onset of menopause, the role of sociodemographic factors such as marital status and pregnancy should not be ignored.

Musculoskeletal pain and menopause.

Musculoskeletal pain, arthralgia and arthritis are all more common in women, and their frequency increases with age and in some appears to be associated with the onset of menopause. The clinical assessment, investigation and management of women presenting with musculoskeletal pain, arthralgia or arthritis at the time of menopause are reviewed. Common causes of arthralgia and arthritis in this population are discussed. The epidemiological and trials evidence for the effects of hormone replacement therapy on musculoskeletal pain and arthritis (primarily from RCTs of HRT for other menopausal symptoms) are discussed. Lastly, the possible underlying aetiological roles of sex hormones including estrogen, and their deficiency, in predisposing to musculoskeletal pain and arthritis are overviewed. Although the association appears strong, a causal link between estrogen deficiency and musculoskeletal pain or different types of arthritis is lacking; there have been few studies specifically within this group of symptomatic patients, and there is much still to understand about musculoskeletal pain and arthritis at the time of the menopause, and about how we might prevent or treat this.

A study of hormonal effects in cervical smear samples using Raman spectroscopy.

Raman spectroscopy is a powerful tool that has the potential to be used as a screening method for cervical cancer. It is a label-free, low-cost method providing a biochemical fingerprint of a given sample. The objective of this study was to address patient-to-patient variability contributed by hormonal effects due to the menstrual cycle, the use of hormone-based contraceptives (HC) and the onset of menopause, and to determine if these changes would affect the ability to successfully identify dyskaryotic cells. Raman spectra were recorded from unstained ThinPrep cervical samples (45 cytology negative and 15 high-grade dyskaryosis (high-grade squamous intraepithelial lesion, HSIL) samples using a HORIBA Jobin Yvon XploRA system. HPV DNA testing was also performed. Clinical data collected included date of the last menstrual period, the use of HC and/or menopausal status. Spectral changes were observed depending on the day of the menstrual cycle and on the use of HC. Despite this, HSIL could be discriminated from normal cells regardless of the day on which the sample was taken or the use of HC.

Особливості ліпідного обміну в жінок із гострим коронарним синдромом без підйому сегмента ST залежно від гормонального статусу

Introduction. The role of lipid metabolism disorders in the process of atherogenesis has long been established. It is known little about the effects of dyslipidemia on the development of coronary artery disease in women. There is a perception that the effect of endogenous estrogens during the fertile period of woman's life slows down the manifestation of atherosclerosis in women and before the onset of menopause, the incidence of CVD in women is lower. Hypercholesterolemia or atherogenic dyslipidemia is a particular danger in the development of CVD in women and the risk of macrovascular injury associated with it is due to the long asymptomatic course and significant prevalence in the female population.The aim of the study – toconduct a comparative analysis of lipid metabolism in women with acute coronary syndrome without ST segment elevation(STEMI) and practically healthy women, depending on the hormonal status.Materials and Methods. We examined 157 women aged 35–72 years (average age 56.54±0.87 years). Among them, 112 female patients with STEMI (group 1) aged 39 to 72 years (average age 58.52±0.99 years). The comparison group (group 2) were 45 practically healthy women aged 35 to 71 years (average age 52.58±1.58 years). The levels of female sex hormones were determined. The lipid metabolism indices in women were measured.Depending on the type of hormonal status, women of the 1 and 2 groups were divided into subgroups A and B consisted of 64 patients with STEMI, aged from 39–72 (middle age – 60.77±1.16), 2А – 26 practically healthy women 42–71 years (average age 58.64 ± 2.18 years) with hormonal signs of postmenopause: estradiol level &lt;80 pmol/l (21.79 pg/ml) and LH/FSH &lt;1 ratio index. The subgroup 1Bincluded 48 female patients with non STEMI at the age of 35 to 65 years (mean age 52.29±1.63), IIB-19 practically healthy individuals of the female population aged 35 to 58 years (middle age – 49.84±1.84years) with estradiol levels&gt; 80 pmol/l (21.79 pg/ml) and a ratio of LH/FSH&gt; 1.Resultsand Discussion. Almost all female patients of the IA subgroup had a level of total cholesterol level more than 4 mmol/l, which was 1.3 times significantly greater than that of IB subgroup (95.31±2.64% (IA) vs 75.00±6.25 % (IB)). The mean level of LDL cholesterol is significantly higher in women IA subgroups (4.50±0.21 mmol/l (IA) vs 3.44±0.24 mmol/l (IB)). In 73,43±5,52% of the IA subgroup, hypertriglyceridemia was detected, which was 1.6 times more likely to be registered (45.83±8.19%) than in patients with IB subgroups. The proportion of patients with lowered LDL cholesterol was almost 1.5 times lower in the IA subgroup (37.50±6.05% (IA) vs 52.08±7.21% (IB)). The mean HDL cholesterol level in the IB was significantly lower in comparison with the subgroup 1A (1.04±0.03 mmol/l (1B) versus 1.16±0.05 mmol/l (IA). Diabet (31.25±5.15 %), smoking (54.16±7.19 %) and occupationally hazardous labor (89.58±4.41 %) was significantly higher in patients of the subgroup 1B.Conclusions.In women with STEMI, regardless of the hormonal balance of female sex hormones, there is a greater prevalence and severity of dyslipidemia compared with healthy individuals. Estrogen deficiency in postmenopausal women with STEMI cause severe lipid and lipid metabolism disorders, which contributes to the development of acute coronary syndrome. Lower levels of HDL cholesterol in patients with estrogen retained estrogen compared to estrogen-deficient patients are due to higher prevalence of diabetes (31.25±5.15 %), smoking (54.16±7.19 %) and occupationally harmful work (89.58±4.41 %), along with the presence of traditional risk factors of STEMI in these women.

Estrogen deprivation aggravates cardiometabolic dysfunction in obese-insulin resistant rats through the impairment of cardiac mitochondrial dynamics

The incidence of cardiovascular disease and metabolic syndrome increases after the onset of menopause, suggesting estrogen has a vital role in their prevention. Mitochondrial dynamics are known to play an important role in the maintenance of cardiac physiological function. However, the effects of estrogen deprivation on cardiometabolic status and cardiac mitochondrial dynamics under conditions of obese-insulin resistance have never been investigated. We hypothesized that estrogen deprivation aggravates cardiac dysfunction through increased cardiac mitochondrial fission in obese-insulin resistant rats. Female rats were fed on either a high fat (HFD, 57.60% fat) or normal (ND, 19.77% fat) diet for 13 weeks. The rats were then divided into 4 groups. Two sham groups (HFS and NDS) and 2 operated or ovariectomized (HFO and NDO) groups (n = 8/group). Six weeks after surgery, metabolic status, heart rate variability (HRV), left ventricular (LV) function, cardiac mitochondrial function and dynamics, and metabolic parameters were determined. Insulin resistance developed in NDO, HFS and HFO rats as indicated by increased plasma insulin and HOMA index. Although rats in both NDO and HFS groups had markedly impaired LV function indicated by reduced %LVFS and impaired cardiac mitochondrial function, rats in the HFO group had the most severe impairments. Moreover, the estrogen deprived rats (NDO and HFO) had increased cardiac mitochondrial fission through activation of phosphorylation of Drp-1 at serine 616. Our findings indicated that estrogen deprivation caused the worsening of LV dysfunction through increased cardiac mitochondrial fission in obese-insulin resistant rats.

Cervical Cytopathological Changes Associated with Onset of Menopause.

Background:In the life of a woman, after 40 years of age, onset of menopause occurs during which hormonal imbalances take place. The present study is aimed at finding out cytopathological changes in the cervical epithelium associated with this hormonal disturbance.Materials and Methods:Cervical cancer screening program is in progress under auspices of Era's Lucknow Medical College and Hospital, Lucknow, since May 2013, in the villages of Lucknow West through camp approach. Till September 2017, 140 camps have been organized and 2440 women attending the camp have been cytologically examined. Out of these, 1534 women were perimenopausal, 165 premenopausal, and 441 postmenopausal. The cytopathological changes have been studied in these three categories of women in relation to different predisposing factors to the cervical carcinogenesis.Results:The squamous intraepithelial lesion (SIL) rate was higher with onset of menopause in the premenopausal women. The SIL rate was higher with nulliparity in these women as well as in the postmenopausal women and also with different gynecological symptoms and clinical lesions of the cervix. The SIL changes associated with HPV and HSV were also higher in them.Conclusion:A high SIL rate found with onset of menopause may be the outcome of gradual estrogen withdrawal in the premenopausal women. Hence, cytological evaluation is mandatory in women between 41 and 45 years of age to rule out any occurrence of cervical cytopathology.

The Association between Oligomenorrhea, Onset of Menopause and Metabolic Syndrome in Thai Postmenopausal Women.

ObjectivesThis study explored the association between a history of oligomenorrhea and onset of menopause and metabolic parameters.MethodsThe study population was 605 postmenopausal women who were patients at the Menopause Clinic, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand between February 2015 and December 2015. A questionnaire was used to ask all women about their history of oligomenorrhea. The study also collected medical data, including weight, height, waist circumference, blood pressure, and blood glucose and lipid profile.ResultsOf the 231 postmenopausal women with a complete data record, 31 had a history of oligomenorrhea and 200 did not. The age of onset of menopause was around 48 years in both groups. Prevalence of metabolic syndrome was 12.1%. More women with a waist circumference larger than 80 cm had a history of oligomenorrhea at the interview than women who had not, but a history of oligomenorrhea did not relate to other metabolic parameters. The adjusted odds ratio of a history of oligomenorrhea to waist circumference was 3.69 (95% confidence interval, 1.17–11.64).ConclusionsA history of oligomenorrhea did not affect the age at menopause, but was associated with waist circumference during menopause.

Migraine and Ménière's disease

The article describes a series of seven cases characterized by a change in the type of attack in the perimenopausal period: migraine attacks before menopause and cochleovestibular paroxysms after the onset of menopause. Clinical data and results of diagnostic tests are presented and the possible link of both attack variants with cervical pathology is discussed. The authors explain this dynamics by stem neural integrator dysfunction during hormonal changes.

Klotho and Postmenopausal Hormone Replacement Therapy in Women with Chronic Kidney Disease.

Kidney function is highly susceptible to age-related changes, with chronic kidney disease (CKD) serving as an important cause of morbidity and mortality in older patients. The prevalence of CKD in Korea is higher among the elderly, relative to the general population, with the most significant increases seen following the onset of menopause. Under normal conditions, estrogen attenuates renal superoxide production and protects the kidney from oxidative damage. As estrogen levels are known to decrease by as much as 80% during menopause, this represents a significant risk for older women. Postmenopausal hormone replacement therapy (HRT) modulates the renin-angiotensin system, thereby reducing the progressive deterioration of renal function. Use of estrogen-based HRT has been shown to ameliorate renal function in postmenopausal women, and delay CKD progression. Renal expression of klotho, an important suppressor of aging, is markedly decreased in CKD patients, making it a promising candidate for use as a prognostic biomarker in CKD. Here, we review the key links between renal function, sex, age, and estrogen levels during menopause, and discuss the use of postmenopausal HRT in CKD attenuation.

The Relationship between Follicle-stimulating Hormone and Bone Health: Alternative Explanation for Bone Loss beyond Oestrogen?

Bone loss in women commences before the onset of menopause and oestrogen deficiency. The increase of follicle-stimulating hormone (FSH) precedes oestrogen decline and may be a cause for bone loss before menopause. This review summarizes the current evidence on the relationship between FSH and bone derived from cellular, animal and human studies. Cellular studies found that FSH receptor (FSHR) was present on osteoclasts, osteoclast precursors and mesenchymal stem cells but not osteoblasts. FSH promoted osteoclast differentiation, activity and survival but exerted negligible effects on osteoblasts. Transgenic FSHR or FSH knockout rodents showed heterogenous skeletal phenotypes. Supplementation of FSH enhanced bone deterioration and blocking of FSH action protected bone of rodents. Human epidemiological studies revealed a negative relationship between FSH and bone health in perimenopausal women and elderly men but the association was attenuated in postmenopausal women. In conclusion, FSH may have a direct action on bone health independent of oestrogen by enhancing bone resorption. Its effects may be attenuated in the presence of overt sex hormone deficiency. More longitudinal studies pertaining to the effects of FSH on bone health, especially on fracture risk, should be conducted to validate this speculation.

Effects of six weeks of resistance-endurance training on microRNA-29 expression in the heart of ovariectomised rats.

IntroductionHeart disease risk rises with age. However, women’s symptoms become more pronounced following the onset of menopause. The aim of the present study was to evaluate the effects of six weeks of combined resistance-endurance (RE) training on microRNA-29 expression in the heart of ovariectomised rats.Material and methodsThirty female Wistar rats were divided into three groups: 1) sham (SHAM); 2) ovariectomy (OVX); and 3) OVX with RE training (OVX + RE). The effects of these treatments on cardiac microRNA-29 expression were measured using real-time PCR. Data were analysed using a 2 × 3 ANOVA and Tukey post-hoc comparisons and presented as mean ±SEM.ResultsOvariectomy resulted in a significant down-regulation in the heart microRNA-29 gene expression of OVX (0.265 ±0.031 fold changes), OVX + RE (0.699 ±0.038 fold changes) in animals vs. sham animals (1 ±0 fold changes; all, p < 0.05) following six weeks of treatment. However, microRNA-29 expression in the OVX + RE group was significantly greater than in the OVX group (p < 0.05).ConclusionsOur findings suggest that the six weeks of regular RE training attenuate the reduction in heart muscle microRNA-29 expression observed in ovariectomised rates. If our findings carry over to humans, such an exercise regimen could be beneficial to the cardiovascular disease risk in women during menopause.

Menopause and menopausal hormone therapy in women: cardiovascular benefits and risks

The last decade has brought many challenges and uncertainties regarding the use of menopausal hormone therapy in women. Two early key studies, the Heart and Estrogen/Progestin Replacement Study (HERS) and the Women's Health Initiative (WHI) failed to prove beneficial effects of exogenous estrogen, and estrogen combined with progestin, in cardiovascular prevention. More recent studies, however, introduced the concept of a possible “window-of-opportunity” for hormonal therapy, in which menopausal hormone therapy is used early after the onset of menopause, and may lead to more favorable, cardio-protective outcomes. Despite the increasing wealth of clinical data, menopausal hormone therapy is not currently recommended for primary or secondary prevention of coronary heart disease in women. Further research is needed to understand the risk-benefit balance of menopausal hormone therapy.