Onset Of Menopause Research Articles

Exploring the causal association between epigenetic clocks and menopause age: insights from a bidirectional Mendelian randomization study.

Evidence suggests a connection between DNA methylation (DNAm) aging and reproductive aging. However, the causal relationship between DNAm and age at menopause remains uncertain. Employing established DNAm epigenetic clocks, such as DNAm Hannum age acceleration (Hannum), Intrinsic epigenetic age acceleration (IEAA), DNAm-estimated granulocyte proportions (Gran), DNAm GrimAge acceleration (GrimAgeAccel), DNAm PhenoAge acceleration (PhenoAgeAccel), and DNAm-estimated plasminogen activator inhibitor-1 levels (DNAmPAIadjAge), a bidirectional Mendelian randomization (MR) study was carried out to explore the potential causality between DNAm and menopausal age. The primary analytical method used was the inverse variance weighted (IVW) estimation model, supplemented by various other estimation techniques. DNAm aging acceleration or deceleration, as indicated by Hannum, IEAA, Gran, GrimAgeAccel, PhenoAgeAccel, and DNAmPAIadjAge, did not exhibit a statistically significant causal effect on menopausal age according to forward MR analysis. However, there was a suggestive positive causal association between age at menopause and Gran (Beta = 0.0010; 95% confidence interval (CI): 0.0004, 0.0020) in reverse MR analysis. The observed increase in granulocyte DNAm levels in relation to menopausal age could potentially serve as a valuable indicator for evaluating the physiological status at the onset of menopause.

Systematic review of mediterranean diet interventions in menopausal women.

The increasing lifespan of women and their extended time spent in menopause pose significant challenges for health care systems, primarily due to the impacts of postmenopausal estrogen deficiency and aging on health. Menopause's onset is linked to a heightened prevalence of obesity, metabolic syndrome, cardiovascular disease, and osteoporosis. Diet is particularly relevant during menopause given its impact on quality of life and longevity and its modifiability. Because the Mediterranean diet is currently regarded as one of the healthiest dietary models in the world, the aim of this systematic review was to assess current evidence regarding the effectiveness of studies on the Mediterranean diet as an intervention for menopausal women. A systematic review of intervention-based studies involving the Mediterranean diet among menopausal women was performed in Scopus, PubMed, and Web of Science. The results of seven that met the inclusion criteria suggests that adherence to the Mediterranean diet can have beneficial impacts on menopausal women's health, including reductions in weight, blood pressure, blood ω6: ω3 ratio, triglycerides, total cholesterol, and LDL levels. Those results seem to be relevant for public health interventions aimed at improving menopausal women's quality of life.

Генитоуринальный менопаузальный синдромом: возможности локальной комбинированной терапии

Genitourinary syndrome of menopause (GSM) is the second most common marker of the onset of menopause, with early symptoms that can occur during perimenopause. Objective. To study the dynamics of clinical symptoms of the disease and characteristics of the vaginal microbiota in patients with GSM receiving local therapy with the medication containing Lactobacillus acidophilus and estriol. Patients and methods. The study included 62 patients with postmenopausal atrophic vaginitis. Diagnosis verification consisted of clinical examination (general and gynecological) and laboratory tests (microscopy and molecular biology testing by real-time polymerase chain reaction, determination of vaginal pH). Results. Local therapy with the medication containing Lactobacillus acidophilus and estriol in patients with postmenopausal atrophic vaginitis allowed to restore the vaginal microbiota and eliminate the symptoms of this nosological form of the disease with a statistically significant efficacy. Conclusion. The study of the vaginal microbiota showed that the type of bacterial community in women with menopause for up to 10 years or more without systemic hormone therapy was associated with the absence of Lactobacilli. Therefore, when verifying the diagnosis of atrophic vulvovaginitis, it is necessary to consider not only the presence of clinical symptoms, but also the characteristics of the vaginal microbiota, which will enable the specialists to personalize the management strategies for postmenopausal patients. Key words: atrophic vulvovaginitis, postmenopause, vaginal microbiota, vaginal tablet containing Lactobacillus acidophilus and estriol

Age of Onset of Menopause and Factors Associated with Common Symptoms Among Women in Lusaka District, Zambia

Background: Menstrual periods do not normally end suddenly; instead, there is frequently a period of transitional changes before and following the cessation of the period. Women typically endure physiological changes as a result of hormonal fluctuations, which impact their physical, emotional, and quality of life. Therefore, this study explored menopausal associated problems occurring in women residing in Lusaka, Zambia. Methods: A cross-sectional study was conducted for a period of six months on 171 women aged 40 – 60 years old who were bedsitters for a hospital patient or visited the hospital. The univariate (unadjusted) and multivariable (adjusted) logistic regression using backwards stepwise analysis was performed to identify factors associated with the most common symptom women face after menopause reporting at 95 % confidence interval (95 % CI). Results: The study revealed that the average age of menopause onset was 47.43 ± 4.46 years, with 75% of the women experiencing menopause between the ages of 45 and 55. Women complained of back pain (66.1%), headache (45%), hot flushes (30.6%), and mood changes (24.0%). Widowed (AOR 2.94; 95 % CI: 1.24–6.63), Obese (AOR 3.19; 95 % CI: 1.16 – 8.73), overweight (AOR 3.91; 95 % CI: 1.31 – 11.73) and early menopause (AOR 0.35, 95% CI: 0.13 – 0.92) were associated with back pain. Conclusion: Women experience a variety of menopausal and postmenopausal problems like back pain, headache, hot flushes and mood changes which will require interventions to improve the health of women.

ANTIOXIDANT EFFECTIVENESS OF THE PROPHYLACTIC COMPLEX WITH QUERCETIN IN OVARIECTOMIZED RATS

Introduction. Premature ovarian failure is characterized by the onset of menopause before age 40 and is accompanied by a decrease in estrogen levels in the body. This condition has a negative impact on almost all physiological systems of the body. Recently, there has been an increase in the number of patients with this pathology, which is associated with the spread of medical intervention in the reproductive sphere, environmental pollution, and stress. Aim. The purpose of this study was to experimentally clarify the state of such indicators of the antioxidant-prooxidant system as catalase, malondialdehyde, antioxidant-prooxidant index in blood serum, mucous membranes of the digestive tract, liver and alveolar process of the lower jaw of female rats after surgical menopause (ovariectomy) in in combination with a diet deficient in calcium and protein composition, as well as establishing the antioxidant efficiency of a complex based on quercetin, vitamins and macro and microelements. Methods. The research was conducted on 24 female Wistar rats aged 2.5 months, which were divided into 3 groups (8 in each): 1 – intact animals; 2 – animals in which surgical menopause was modeled by ovariectomy and kept on a diet with inferior composition; 3 – animals that, against the background of ovariectomy, were prophylactically administered a complex of quercetin, vitamins, macro- and microelements at a dose of 500 mg/kg. After 4 months, the animals were removed from the experiment. Malondialdehyde (MDA) content, catalase activity, and antioxidant-prooxidant index (API) were determined in blood serum, homogenates of mucous membranes of the digestive tract, liver, and alveolar process. Results. The analysis of the data obtained by us showed that in the group of rats with which the pathology was modeled, there was a drop in the activity of the catalase enzyme in the mucous membranes of the digestive tract and liver from 5.61% to 38.49%, an increase in the MDA content from 25.78% to 50.00% and a decrease in the API index from 25.08 to 56.24% relative to the indicators of the group of intact rats with a high level of reliability (p < 0.05–0.001). The content of MDA in the blood serum increased by 31,91%, and in the bone tissue of the jaws – by 23,28%, API was lower in the blood by 16,45% and by 10,39% in the bone tissue (p < 0,05–0,001). The obtained data allow us to assert about the increased formation of reactive oxygen species and inhibition of their inactivation processes. It should be noted that the activity of catalase in the blood serum and alveolar process of the jaws of animals with pathology, on the contrary, increased by 10.19% and 10.78%, respectively, which indicates compensatory antioxidant capabilities in these tissues. When using the biologically active complex, there was an increase in catalase activity in the mucous membranes of the digestive tract by 5,63–40,8%, a decrease in the activity of MDA by 17.84–23.03%, and an increase in the API index by 27,93–80,84% (p<0,05–0,001). In the bone tissue of the jaws of animals under the influence of the complex, the activity of catalase increased by 7,52%, and API – by 33,3%, while the content of MDA decreased by 19,43%. In the blood of animals with pathology, the complex of drugs contributed to a decrease in the MDA level by 17,38%, an increase in the activity of catalase by 6,16% and the API index by 28,44%. Based on the above, it can be stated that the complex developed by us has a powerful antioxidant effect in conditions of estrogen, dietary protein and calcium deficiency in female rats. Conclusions. Menopause of surgical genesis in combination with nutritional deficiency of protein and calcium contributed to suppression of antioxidant protection against the background of activation of pro-oxidant processes. The use of a biologically active complex with quercetin, vitamins, calcium citrate, macro- and microelements increased the activity of the antioxidant defense system directed against free radical processes.

Remodeling of murine vaginal smooth muscle function with reproductive age and elastic fiber disruption

Advanced maternal age during pregnancy is associated with increased risk of vaginal tearing during delivery and maladaptive postpartum healing. Although the underlying mechanisms of age-related vaginal injuries are not fully elucidated, changes in vaginal microstructure may contribute. Smooth muscle cells promote the contractile nature of the vagina and contribute to pelvic floor stability. While menopause is associated with decreased vaginal smooth muscle content, whether contractile changes occur before the onset of menopause remains unknown. Therefore, the first objective of this study was to quantify the active mechanical behavior of the murine vagina with age. Further, aging is associated with decreased vaginal elastin content. As such, the second objective was to determine if elastic fiber disruption alters vaginal contractility. Vaginal samples from mice aged 2–14 months were used in maximum contractility experiments and biaxial extension-inflation protocols. To evaluate the role of elastic fibers with age, half of the vaginal samples were randomly allocated to enzymatic elastic fiber disruption. Contractile potential decreased and vaginal material stiffness increased with age. These age-related changes in smooth muscle function may be due, in part, to changes in microstructural composition or contractile gene expression. Furthermore, elastic fiber disruption had a diminished effect on smooth muscle contractility in older mice. This suggests a decreased functional role of elastic fibers with age. Quantifying the age-dependent mechanical contribution of smooth muscle cells and elastic fibers to vaginal properties provides a first step towards better understanding how age-related changes in vaginal structure may contribute to tissue integrity and healing. Statement of significanceAdvanced maternal age at the time of pregnancy is linked to increased risks of vaginal tearing during delivery, postpartum hemorrhaging, and the development of pelvic floor disorders. While the underlying causes of increased vaginal injuries with age and associated pathologies remain unclear, changes in vaginal microstructure, such as elastic fibers and smooth muscle cells, may contribute. Menopause is associated with fragmented elastic fibers and decreased smooth muscle content; however, how reproductive aging affects changes in the vaginal composition and the mechanical properties remains unknown. Quantifying the mechanical contribution of smooth muscle cells and elastic fibers to vaginal properties with age will advance understanding of the potential structural causes of age-related changes to tissue integrity and healing.

Unraveling the Link: A Comprehensive Literature Review of Type 2 Diabetes and Menopause Onset.

Women with diabetes mellitus (DM), a metabolic endocrine illness, may experience a variety of reproductive problems. The age at menopause onset has been extensively studied as a major predictor of women's health in the future; however, its relationship to diabetes in Indian women has received less attention. This literature review looked at the consequences of diabetes in women as well as the association between diabetes and the age at which menopause begins. The average age at menopause onset among women with type 2 diabetes mellitus (T2DM) has decreased globally. According to one Indian study, the average menopause age dropped to 45 years for 26% of women with T2DM. In the current review, 10 studies indicated that women with T2DM displayed an imbalanced hormonal profile resulting in an extended anovulatory period. Two investigations highlighted the significance of altered body composition of women with T2DM, thereby suggesting obesity as the primary risk factor of ovarian aging and early climacteric symptoms. T2DM may lower the average age at menopause onset; however, further research on Indian women is necessary. There is a need of studies on T2DM in premenopausal women are needed to demonstrate how the changes in body composition impact the age at which menopause begins. Delaying the onset of menopause in women with T2DM necessitates diet and lifestyle interventions to minimize ovarian aging and hormonal imbalance.

Bone mass, fracture risk, and associated factors in postmenopausal women living with HIV.

The aim of this study was to assess the prevalence of low bone mass (osteopenia/osteoporosis), the factors associated with low bone mass, and the risk of fractures in Brazilian postmenopausal women living with HIV (WLH) in the Amazon region. This is a cohort study with a cross-sectional assessment at baseline conducted between March 2021 to August 2022 with 100 postmenopausal WLH undergoing antiretroviral therapy (ART) between 45 and 60 years of age and 100 age-matched HIV-negative women. Data on bone mineral density in the lumbar spine (LS) and femoral neck (FN) were collected using dual x-ray absorptiometry and the 10-year risk of hip and major osteoporotic fractures was assessed using the Fracture Risk Assessment tool (FRAX). The age of menopause onset occurred earlier in WLH ( P < 0.001). No differences in prevalence of osteoporosis and osteopenia in LS and FN were observed except for a lower T score in FN in WLH ( P = 0.039). The FRAX for major osteoporotic fracture and hip fracture were low in both groups, despite the mean of both FRAX scores was higher in WLH ( P < 0.001). Multivariate analysis showed that years since menopause onset, higher body mass index and higher FRAX major osteoporotic fracture were associated with the WLH group, while a higher frequency of physical activity was registered in the HIV-negative group. Multivariate analysis also showed that in WLH, a lower T score in FN was associated with years since menopause onset and body mass index and that the number of years since menopause onset was associated with a lower T score in the LS and a higher score in the FRAX hip fracture. Our findings show a high prevalence of low bone mass (osteopenia/osteoporosis) in Brazilian postmenopausal women from the Amazon region. Women living with HIV have higher FRAX scores than HIV-negative women and a lower T score in the FN.

Impact of violence against women on quality of life and menopause-related disorders

Violence against women is a pressing global issue that poses a number of significant health risks. The influence of violence on women's health during the menopause has been underestimated, especially its impact on the early onset of menopause and on the exacerbation of symptoms that determine quality of life.The objectives of our study were to analyse whether experiencing any type of violence increases the risk of early menopause, worsens menopausal symptoms, and results in a lower quality of life.This cross-sectional observational study recruited 29 postmenopausal women who had experienced violence from a partner in their lifetimes. Additionally, 89 postmenopausal who had not suffered from violence were included as a control group. All the women who had experienced violence from a partner reported psychological and economic violence, 75 % reported physical violence, 57.1 % reported sexual violence, and 39.3 % reported all types of violence.Violence was found to be associated with menopausal symptoms and poorer quality of life. These associations persisted after adjustment for multiple factors, and women who had experienced any form of violence reported a worse quality of life during menopause. Moreover, violence-exposed women reached menopause approximately 20 months earlier (p < 0.05), and 20.7 % of these women developed premature ovarian insufficiency (p < 0.001).

Menopausal symptoms, exercise practices, and advice received in active women: a multi-country survey of strava app users

ABSTRACT The study aimed to identify the prevalence of symptoms, changes in exercise levels, and exercise advice received during the menopausal transition in a large multi-country sample. Using total population sampling, 2.5 percent of female Strava app users (n = 970) from 7 countries completed an online survey between 14 February 2019 and 11 March 2019. The survey discussed menopause status (perimenopausal or postmenopausal), menopausal symptoms, changes to exercise behaviors, and advice received concerning exercise during menopause. Frequencies, chi-square statistics, and linear regressions were used to analyze data. The most commonly reported menopausal symptoms were sexual (18–83 percent) and cognitive/psychological (77–78 percent). 41 percent of women reported no change in exercise behavior since menopause began (46 percent increased and 11 percent decreased behaviors). The majority (88 percent) of women did not receive advice regarding exercise during menopause. Women who received advice were more likely to report an increase in their exercise than those not receiving advice (60 percent vs 46 percent; X2 (df 2, n = 927) = 7.1, p = .03). Exercise behaviors increased the longer it had been since the menopausal onset (X2 (df 8, n = 937) = 77.42, p < .001). The results suggested high menopausal symptom prevalence in active women and a general lack of exercise advice. More women reported higher symptom prevalence and an increase in exercise participation, the longer it had been since menopause onset. Future research should determine whether these increased exercise behaviors are being used as a coping mechanism.

Cardiometabolic outcomes in Kronos Early Estrogen Prevention Study continuation: 14-year follow-up of a hormone therapy trial.

This study aimed to determine long-term cardiometabolic effects of hormone therapies initiated within 3 years of onset of menopause after a 14-year follow-up study of participants of the Kronos Early Estrogen Prevention Study (KEEPS). KEEPS was a multisite clinical trial that recruited recently menopausal women with good cardiovascular health for randomization to oral conjugated equine estrogens (Premarin, 0.45 mg/d) or transdermal 17β-estradiol (Climara, 50 μg/d) both with micronized progesterone (Prometrium, 200 mg/d) for 12 d/mo, or placebo pills and patch for 4 years. KEEPS continuation recontacted KEEPS participants 14 years after randomization and 10 years after the completion of the 4-year clinical trial to attend in-person clinic visits. Participants of KEEPS continuation (n = 299 of the 727 KEEPS participants; 41%) had an average age of 67 years (range, 58-73 y). Measurements of systolic and diastolic blood pressures, waist-to-hip ratio, fasting levels of glucose, insulin, lipid profiles, and homeostasis model assessment of insulin resistance were not different among the treatment groups at either KEEPS baseline or at KEEPS continuation visits, or for change between these two visits. The frequency of self-reported diabetes ( P = 0.007) and use of diabetes medications was higher in the placebo than the oral conjugated equine estrogens ( P = 0.045) or transdermal 17β-estradiol ( P = 0.02) groups, but these differences were not supported by the laboratory measurements of glycemia or insulin resistance. There was no evidence of cardiovascular and/or metabolic benefits or adverse effects associated with 4 years use of oral or transdermal forms of hormone therapy by recently menopausal women with good cardiovascular health after 10 years.

Quality of life after risk-reducing salpingo-oophorectomy in women with a pathogenic BRCA variant.

Risk-reducing salpingo-oophorectomy (RRSO) is recommended to women with a pathogenic BRCA variant, but as a main side effect, RRSO could lead to an early onset of menopause. To evaluate the impact of RRSO and preoperative menopausal status on menopausal symptoms, sexual functioning, and quality of life (QOL). The study was conducted between November 2019 and April 2020. Women were included who tested positive for a pathogenic BRCA1/2 variant between 2015 and 2018. Depression levels, QOL, and global health status were measured and compared with those of women who opted against RRSO. Furthermore, women who underwent RRSO treatment were asked to report menopausal complaints that they experienced at 1 month postsurgery and any current complaints. RRSO had no significant impact on QOL, but women who were premenopausal at the time of surgery reported more sexual complaints than postmenopausal women. In total, 134 carriers of a BRCA mutation were included: 90 (67%) underwent RRSO and 44 (33%) did not. At the time of the survey, neither the control nor experimental group experienced significant changes in QOL (b = -0.18, P = .59). Women who underwent RRSO reported a significantly lower global health status (b = -0.66, P = .05). Women who were premenopausal at the time of surgery were bothered more by sexual symptoms (b = 0.91, P = .19) but experienced fewer vasomotor complaints (b = -1.09, P = .13) than women who were postmenopausal at the time of RRSO. The decrease of sexual functioning after RRSO should be an integral part of preoperative counseling because it is important for BRCA carriers, especially for premenopausal women. Some strengths of the present study were the long follow-up, a high response rate, and the existence of a control group, whereas defining menopausal status by last menstrual bleeding and self-report of data (eg, breast cancer history) increased the risk of errors. Our study indicated that women who underwent RRSO experienced no difference in QOL when compared with women without RRSO and that patients with premenopausal status seemed to be at higher risk to experience sexual complaints after surgery.

Hippocampal glial inflammatory markers are differentially altered in a novel mouse model of perimenopausal cerebral amyloid angiopathy.

Dementia is often characterized by age-dependent cerebrovascular pathology, neuroinflammation, and cognitive deficits with notable sex differences in risk, disease onset, progression and severity. Women bear a disproportionate burden of dementia, and the onset of menopause (i.e., perimenopause) may be a critical period conferring increased susceptibility. However, the contribution of early ovarian decline to the neuroinflammatory processes associated with cerebrovascular dementia risks, particularly at the initial stages of pathology that may be more amenable to proactive intervention, is unknown. To better understand the influence of early ovarian failure on dementia-associated neuroinflammation we developed a model of perimenopausal cerebral amyloid angiopathy (CAA), an important contributor to dementia. For this, accelerated ovarian failure (AOF) was induced by 4-vinylcyclohexene diepoxide (VCD) treatment to isolate early-stage ovarian failure comparable to human perimenopause (termed "peri-AOF") in transgenic SWDI mice expressing human vasculotropic mutant amyloid beta (Aβ) precursor protein, that were also tested at an early stage of amyloidosis. We found that peri-AOF SWDI mice showed increased astrocyte activation accompanied by elevated Aβ in select regions of the hippocampus, a brain system involved in learning and memory that is severely impacted during dementia. However, although SWDI mice showed signs of increased hippocampal microglial activation and impaired cognitive function, this was not further affected by peri-AOF. In sum, these results suggest that elevated dysfunction of key elements of the neurovascular unit in select hippocampal regions characterizes the brain pathology of mice at early stages of both CAA and AOF. However, neurovascular unit pathology may not yet have passed a threshold that leads to further behavioral compromise at these early periods of cerebral amyloidosis and ovarian failure. These results are consistent with the hypothesis that the hormonal dysregulation associated with perimenopause onset represents a stage of emerging vulnerability to dementia-associated neuropathology, thus providing a selective window of opportunity for therapeutic intervention prior to the development of advanced pathology that has proven difficult to repair or reverse.

The role of lipotropic factors in the correction of metabolic disorders in women during the perimenopausal period

In women during perimenopause, changes in metabolic parameters are detected, such as weight gain, which triggers a cascade of pathological reactions leading to the formation of metabolic disorders (lipid, carbohydrate metabolism) and endothelial dysfunction, during the development of which a deficiency of sex hormones plays a certain role in the onset of menopause. There is a connection between hormonal changes and an increase in the amount of abdominal and/or visceral fat, which is accompanied by a weakening of oxidative processes in adipose tissue, a decrease in energy consumption and a predisposition to the development of metabolic syndrome. As a nutritional correction, it is advisable to introduce into the diet lipotropic substances that help catalyze the breakdown of fats and ensure the processes of hydroxylation and methylation of toxic substances in the liver, such as methionine, inositol and choline. Each of the lipotropic substances affects the mobilization of fats, and their combination can provide a synergistic effect and increase the natural metabolic function of the liver.

Vital issue of intimate care for women

The vulva and vagina are a unique anatomical region, which anatomy and physiology changes throughout a woman's life. The most noticeable changes are hormone-mediated and are associated with the onset of puberty, menstrual cycle, pregnancy and menopause. The microbiome changes over time due to various factors, such as hormones, which leads to a change in pH. Various hygiene practices and habits also have a huge impact on the microflora of the vulva and vagina, and therefore on a woman’s health. Today, the market offers a huge number of care and hygiene products designed for the genital area of women. But, unfortunately, information about their correct use and safety of use is limited. For example, various health behaviours, such as vaginal douching and pubic hair removal are still widely used, although there is some evidence of their negative impacts on the health of the vulva and vagina. Despite the abundance of specialized intimate hygiene products, the use of general care products that are not intended for the genital area and therefore can cause irritation, itching and other unpleasant effects is reported. Foreign guidelines for intimate female hygiene practices resolve itself to recommendations of daily vulva cleansing with a gentle hypoallergenic liquid wash. There is a need to increase women's awareness about rational choice of feminine hygiene products and disorders of the vulva and vagina to improve their intimate health.

Palmoplantar keratoderma climactericum successfully treated with topical oestrogen

AbstractKeratoderma climactericum is characterized by palmoplantar hyperkeratosis developing after the onset of menopause. Although rare, keratoderma climactericum can profoundly impact quality of life and may be refractory to prescription‐strength topical steroids and keratolytics. We report a 52‐year‐old female with a 1‐year history of palmoplantar keratoderma. She had a medical history of generalized anxiety disorder and had reached menopause 2 years before presentation. Previously failed treatments included clotrimazole 1% cream twice daily, triamcinolone 0.1% cream twice daily, and betamethasone 0.05% cream mixed with tazarotene 0.1% cream twice daily. She was diagnosed with keratoderma climactericum, and conjugated oestrogen 0.625 mg/g cream twice daily was initiated. After 4 weeks, she had dramatically reduced erythema and hyperkeratosis of her bilateral palms and soles. No adverse effects to treatment were reported. Although the utility of topical oestrogen for keratoderma climactericum has been debated, our case provides further evidence for its efficacy and safety.

Treatments and Management of Menopausal Symptoms: Current Status and Future Challenges

In the United States (US), menopause occurs at an average age of 52. Menopausal symptoms tend to be maximal during the few years before and the year after menopause (during perimenopause), except for symptomatic vulvovaginal atrophy, which may worsen over time. Up to 20% of bone density loss occurs during the first 5 years after menopause, followed by an age-related bone loss rate similar to that in men. Menopause should be considered confirmed if an age-appropriate woman who is not pregnant has not had a menstrual period for 12 months. Regarding treatment, for vaginal dryness or dyspareunia due to menopause, vaginal stimulation and vaginal lubricants and moisturizers are recommended, and if these are ineffective, low-dose vaginal estrogen, in the form of creams, tablets, suppositories, or rings should be considered; other options include oral ospemifene or intravaginal dehydroepiandrosterone (DEHA) suppositories. Before prescribing hormone replacement therapy (HRT) and periodically while therapy continues, women should be informed of risks (e.g., deep vein thrombosis [DVT], pulmonary embolism [PE], stroke, breast cancer, gallbladder disease, and urinary incontinence); potential harms are greatest for women who start HRT after 60 years of age or who are 10-20 years past menopause onset. If women choose HRT to relieve hot flushes, estrogen plus, a progestin or conjugated estrogen/bazedoxifene could be prescribed for women who still have the uterus. Treatment with HRT should be tailored to maximize benefits and minimize harms, and periodically benefits and harms should be reassessed; low-dose transdermal HRT may lead to a lower risk of DVT and stroke. Selective serotonin reuptakereuptake inhibitors (SSRIs), selective serotonin-nor-epinephrine reuptake inhibitors (SNRIs), and gabapentin could be considered as less effective alternatives to HRT for relieving hot flushes; paroxetine 7.5 milligrams (mg) is the only non-hormonal drug approved in the US for the relief of hot flushes. Effective non-drug options include cognitive behavioral therapy and hypnosis.

Prevalence of Insomnia in Menopausal Women

Menopause represents a pivotal period in a women’s life, encompassing significant biological, psychological, and social transformations. The majority of women going through menopause commonly encounter the challenge of experiencing recurring and frequent insomnia. Objective: To determine the prevalence of insomnia in menopausal women in Rawalpindi and Islamabad. Methods: Between November 2022 and June 2023, following the duration of 6 months, a descriptive cross-sectional investigation was undertaken, involving 267 menopausal women. The data were gathered from the general population of Rawalpindi/Islamabad, encompassing both housewives and hospital outpatients, utilizing a convenience sampling. Those individuals fulfilling the eligibility criteria underwent evaluation for insomnia employing the Athens Insomnia Scale. Data analysis were conducted utilizing SPSS version-25. Results: Out of 267 participants, 43.1% had insomnia when assessed by AIS-8. The mean age of the participants was 51.80 ± 7.197, onset of menopause was &lt; 5 years by majority (70.8%) of the females with the most prevalent symptom of insomnia, "Final awakening earlier than desired" while the least common was "Impairment in functioning during the day" reported by menopausal women. Conclusions: Our study findings indicated that insomnia is prevalent among menopausal women, with the most common symptom being waking up earlier than desired. On the other hand, the least commonly reported symptom among menopausal women was impaired daytime functioning due to insomnia.

Quality of life in heterosexual menopausal women: The indirect effect of sexual and marital satisfaction, menopause representations, and psychological morbidity

Menopause may negatively impact Quality of Life (QoL). Our study used a cross-sectional design and research participants were 99 women in natural menopause. In our study, we analyzed the relationship between age at menopause onset, hormone therapy use, duration of couple relationship, menopause duration, psychological morbidity, marital satisfaction, menopause representations, and QoL following the Wilson and Cleary Health-Related QoL conceptual model. The authors found that negative representations, lower marital satisfaction, psychological morbidity, and shorter duration of menopause contributed to lower QoL. Moreover, the authors found that psychological morbidity and menopause representations (identity and control/cure dimensions) had an indirect effect between marital satisfaction and vasomotor, psychosocial, and sexual QoL. Also, we found that age at the onset of menopause showed a moderating effect in the final model. Future studies should replicate these results in a longitudinal design and analyze how the variables that showed a moderating role and indirect effects will function as moderators and mediators, respectively, over time.

Menopausal transition in multiple sclerosis: relationship with disease activity and brain volume measurements.

Recent evidence has shown a significant association between menopause and multiple sclerosis (MS) progression. This study investigated the possible role of menopause in influencing MS from clinical and neuroradiological perspectives. Notably, the possible association between menopause and brain atrophy has been evaluated. This study included women with MS whose ages ranged from 45 to 55 years. Demographic and clinical characteristics were collected, and the reproductive phase was defined as non-menopausal or menopausal based on the final menstrual period. Thus, MS activity over the past year was reported as the annualised relapse rate (ARR), and MRI activity (defined as new T2 lesions and/or the presence of gadolinium-enhancing lesions at the last MRI assessment in comparison with the MRI performed within the previous 12 months) were compared between non-menopausal women (non-MW) and menopausal women (MW). Volume measurements of the whole brain (WB), white matter (WM), grey matter (GM), and cortical GM were estimated using the SIENAX software, and the possible relationship with menopausal status was assessed by regression analysis. The study included 147 women with MS. Eighty-four (57.1%) were MW, with a mean age of 48.5 ± 4.3 years at menopause onset and a mean duration of menopause of 4.1 ± 1.1 years. When compared for ARR, MW reported a lower rate than the non-MW (ARR of 0.29 ± 0.4 vs. 0.52 ± 0.5; p < 0.01). MRI activity was observed in 13.1% of MW and 20.6% of non-MW (p = 0.03). Lower cortical GM volumes (578.1 ± 40.4 mL in MW vs. 596.9 ± 35.8 mL in non-MW; p < 0.01) have also been reported. Finally, multivariate analysis showed a significant association of lower ARR (p = 0.001) and cortical GM volume (p = 0.002) with menopausal status after correction for chronological age and other variables. Menopause may be an adverse prognostic factor of MS. Our preliminary results suggest that menopause may facilitate cortical GM atrophy, probably due to a decline in the neuroprotective effects of estrogen, with negative effects on MS evolution.