Postmenopausal Symptoms Research Articles

Quality of life and sexual function of naturally postmenopausal women on an ultralow-concentration estriol vaginal gel.

This study aims to evaluate the sexual function and quality of life (QoL) of naturally postmenopausal women affected by genitourinary syndrome of menopause who were treated with an ultralow-concentration estriol vaginal gel (0.005%). Postmenopausal women with vulvovaginal atrophy symptoms and sexual disorders were enrolled in a case-control study. Women were treated with vaginal gel (containing 50 μg of estriol) daily for 3 weeks and then twice weekly up to 12 weeks. Determination of vaginal maturation index, evaluation of vaginal pH, and assessment of vaginal atrophy symptoms were carried out. QoL, sexual function, and distress were investigated using the Short Form 36, Female Sexual Function Index, and Female Sexual Distress Scale questionnaires. Changes between baseline and week 12 were assessed. Sixty-eight women were included in the study group, and 42 women were included in the control group. Women on estriol vaginal gel had a significant increase in vaginal maturation index and improvement of vaginal pH compared with baseline (P < 0.05). Mean total Female Sexual Function Index score improved, and Female Sexual Distress Scale score decreased from baseline to follow-up. Results from the Short Form 36 questionnaire showed a significant improvement in the overall index of somatic aspects (P < 0.05). The control group showed no changes from baseline evaluation (P = NS). Estriol vaginal gel (0.005%) therapy significantly improves the trophism of the vaginal mucosa and the sexual health and QoL of naturally postmenopausal women. These results confirm that low doses of vaginal estrogen must be considered as the first choice for the initial treatment of postmenopausal genitourinary symptoms.

Profile, Morbidities and Symptoms Management of Menopausal Women, in Cotonou

Objective: In Benin, as life expectancy continues to increase, the number of postmenopausal women increases. Menopause is a physiological phenomenon that can be quiet for some+, tumultuous in others. Few studies are devoted to menopause in Africa and Benin in particular. The objective of this study was to describe the profile, clinical symptoms of menopausal women as well as management of postmenopausal symptoms in Cotonou, Benin. Materials and method: This is an analytical cross-sectional study in Cotonou, the capital city of Benin Republic during the month of August 2014. 2021 women were included in the study out of a female population of 11,669 people aged 40 and older. Results: 52.7% of the participating women 40 or older were postmenopausal. The mean age at menopause in the sample was 47.5 years, and the largest age group was 50 to 59 years old. Clinically, the most frequent menopausal side effects were hot flashes (58.7%), libido disorders (67%), and joints pain (38.8%). The most frequent associated pathology was hypertension in 37.7% of cases. Factors that limit access to hormonal treatment of menopause in Cotonou include lack of information (66.17%) and financial barriers (19.65%). Conclusion: Health promotion must address obesity, hypertension and smoking to reduce the negative effects of menopause in Sub Saharan Africa.

Effect of Nigella sativa on reproductive system in experimental menopause rat model.

Menopause is the condition when regular menstrual periods cease and may be accompanied by psychological and physical symptoms. The purpose of current study was to determine Nigella sativa effects on reproductive system in experimental menopause animal models. A series of experiments was conducted to investigate the effects of different dosages of N. sativa (first experiment), various extracts of N. sativa (second experiment) and some of its ingredients (third experiment) on selected menopausal parameters of ovariectomized (OVX) rats. Forty different OVX rats were equally divided into 5 groups and administered with one of the following treatments for 21 days: conjugated equine estrogen (positive control), distilled water or olive oil (negative control), treatment groups (N. sativa300, 600 and 1200 mg/kg in the first experiment), (300mg/kg methanol, hexane and SFE extracts of N. sativa in the second experiment) and (linoleic acid 50 mg/kg, gamma linolenic acid 10mg/kg, and thymoquinone 15mg/kg in the third experiment). The results demonstrated that N.sativa exert estrogenic effect were exhibited through uterotrophic assay and vaginal cell cornification as well as blood estrogen level. Furthermore, low dose N. sativa, methanol extract and linoleic acid had prominent estrogenic like effects which were significantly different from those of control group (p<0.05) in different experiments. The finding indicated the probable beneficial role for N. sativa in the treatment of postmenopausal symptoms and possibility of using N. sativa as an alternative to hormone replacement therapy (HRT) for post menopause in human.

Anti-Hyperglycemic Effect of a Kudzu (Pueraria lobata) Vine Extract in Ovariectomized Mice.

Postmenopausal diabetes is exacerbated by estrogen deficiency. Ovariectomized (OVX) animal models can be used to develop strategies for preventing or treating postmenopausal symptoms. We previously found that a diet containing kudzu (Pueraria lobata) vine ethanol extract (PVEE) suppressed weight gain in OVX mice. Therefore, this study further elucidated how PVEE affected OVX mice. Ten-week-old OVX or sham-operated mice were fed diets containing either no PVEE (control) or 20 mg•kg-1•d-1 PVEE for 8 wk, 5 mg•kg-1•d-1 PVEE for 24 wk, or 20 mg•kg-1•d-1 puerarin (daidzein-8-C-glucoside), a major isoflavone present in PVEE, for 10 wk. The effects of puerarin on glucose tolerance were also tested in OVX mice. The experimental diets were not associated with any abnormalities in any mice tested in the present study. Weight gain and serum glucose levels were increased in OVX mice and these effects were significantly attenuated in OVX mice that consumed PVEE (5 or 20 mg•kg-1•d-1) or puerarin. Puerarin-treated OVX mice also showed reduced serum glucose levels following administration of 1,000 mg•kg-1 glucose. These results suggested that puerarin contributed to PVEE-mediated improvements in glucose metabolism in OVX mice. Although further studies are needed to clarify the molecular mechanism underlying these observations, PVEE and puerarin could provide effective approaches to the amelioration of postmenopausal diabetes.

Phytoestrogens dietary intake and health status of retiree from middle-north Slovakia region

Phytoestrogens found in foods of plant origin presents chemical substances that possess a wide range of biochemical benefits. It has been found that they contribute in different health related problems. A wide range of commonly consumed foods contain appreciable amounts of phytoestrogens. Consumption of diet rich to phytoestrogen acts as a protective factor against many diseases such as cardiovascular diseases, post-menopausal symptoms in the context of osteoporosis, cancerous illnesses of colon, prostate and breast. Three main classes of phytoestrogens covers: isoflavones, lignans and coumestans. Selected nine major phytoestrogens had been analyzed simultaneously in the same foods. Questionnaire designed to determine intake frequency as well as amount of selected foods and the most common diseases presented in the population has been used to find relationships between dietary habits and health status. Evaluation of selected goals in the present study has been realized in cooperation with 140 respondents in retired age (divided into Males - covered by 34 individuals and Females - 106 individuals), comming from middle-north Slovakia region. On the base of collected data it can be concluded, that evaluated population is presented by high values of lignans intake and particularly secoisolariciresinol, mainly caused by relative high proportion of cereals and linseed in the diet. Furthermore, the relationship between phytoestrogens intake and eating habits as well as its contribution in protection against selected diseases was demonstrated.

Gynaecological and other health problems of postmenopausal women and their health seeking behaviour in rural Terai, Nepal

Background: There is very few data available in menopausal study done in Nepal. The data is even less on the various gynecological and medical problems postmenopausal women are suffering from. This study was done in Duhabi area, a community in Eastern Nepal, around the Comprehensive Health Service area of a community hospital under B.P Koirala Institute of Health Sciences.Objective: This study was done to document the various gynecological problems among the postmenopausal women and their relation with the socio-demographic characteristics.Methods: By using specific questionnaire, 234 post-menopausal women were interviewed regarding menopausal symptoms, other gynaecological problems and medical problems and their health seeking behaviour. Results: Our study showed that the most common symptoms among the post-menopausal women were loss of libido (53%) and hot flushes (41.5%). Other noted symptoms found were vaginal dryness (29.1%) and excessive vaginal bleeding (14.5%). The most common urinary symptoms were urgency (34.2%), dysuria (17.1%) and incontinence (17.1%). Uterine prolapse was reported by 6.4% of respondents. The most common medical condition seen in our study was low back ache (70.1%). Despite majority (62%) seeking medical treatment for their symptoms only 1.7% of the respondents were using hormone replacement therapy.Conclusion: The prevalence of gynaecological problems among the post-menopausal women was high in our study with the main symptoms of loss of libido and hot flushes. Majority of women with postmenopausal symptoms sought medical care for their problems. Health Renaissance 2014;12(2): pp: 87-91

Black cohosh (Cimicifuga racemosa) is a non-estrogenic alternative to hormone replacement therapy

Hormone replacement therapy is still a popular and most effective treatment for vasomotor symptoms and bone loss prevention in the postmenopause but it is not without risks. This has driven many climacteric women to seek for alternatives, chiefly natural products. Phytoestrogens containing soy or red clover preparations, however, when taken at the recommended daily doses, proved to be ineffective to ameliorate climacteric complaints and to prevent osteoporosis. Cimicifuga racemosa (CR) preparations, on the other hand, have been shown to ease climacteric distress. There is a widespread, but false, belief that the efficacy of CR preparations is linked to the presence of phytoestrogens in the plant. This review aims at summarizing the available in vitro and in vivo evidence showing that compounds in CR extracts do not bind to oestrogen receptors and thus do not exert any estrogenic effects in the uterus and mammary gland, as shown in vivo in experiments on ovariectomized rats and clinically in postmenopausal women. Studies in ovariectomized rats and in women suffering from climacteric complaints have indicated that substances with neurotransmitter-like activities affect beneficially postmenopausal symptoms such as hot flushes. Some of these compounds, such as actein-like triterpenes with GABA-ergic activity and a serotonin analogue, are present and have been identified in the CR extracts. We conclude that these activities explain most likely the beneficial effects of CR extracts on climacteric complaints.

No effect on pharmacokinetics of tamoxifen and 4-hydroxytamoxifen by multiple doses of red clover capsule in rats.

Tamoxifen is used in clinical practice for breast cancer patients and to prevent osteoporosis. Red clover (Trifolium pratense) preparations are consumed worldwide as dietary supplements for relieving postmenopausal symptoms. In the present study we investigated the possible herb-drug interaction between red clover and tamoxifen in rats. 15 days pre-treatment with red clover did not alter the tamoxifen and its active metabolite 4-hydroxytamoxifen pharmacokinetics significantly (p > 0.05). Therefore the therapeutic efficacy of the tamoxifen may not be compromised by the co-administration with red clover. Tamoxifen metabolism is primarily mediated by CYP2D6, CYP3A4 with minor contribution from CYP2C9, CYP2E1 and CYP1A2 isoforms. Although, red clover pre-treatment significantly (p < 0.05) decreased the mRNA expression and activity of CYP3a2, no effect on CYP2d4 and increased expression and activity of CYP2c11 could be the plausible reasons for lack of effect on tamoxifen and its metabolite pharmacokinetics in rats. CYP1a1 and CYP2b2 mRNA expression and activity were also significantly reduced by red clover. To extend the clinical utility of the present study, effect of red clover extract on major CYPs using human liver microsomes and HepG2 cell lines were also determined. Similar finding were observed in the human liver preparations as in rats.

Prevalence of postmenopausal symptoms in North America and Europe.

This study aims to evaluate differences and similarities in the prevalence of postmenopausal symptoms and their impact on postmenopausal women and male partners of postmenopausal women in North America and Europe. The Internet-based survey Clarifying Vaginal Atrophy's Impact on Sex and Relationships (CLOSER) was conducted in North America and Europe. The questionnaire included questions on symptoms experienced by women after menopause and the impact of these symptoms overall and specifically on emotional and physical relationships. This study included 8,200 respondents: 4,100 were postmenopausal women who had experienced vaginal discomfort and 4,100 were male partners of postmenopausal women with this symptom. Differences were significant at the 95% level of confidence. The survey identified vaginal dryness, hot flashes, night sweats, disrupted sleep, and weight gain as the top five symptoms experienced by postmenopausal women in North America and Europe. Overall, symptoms were found to be more prevalent in women from the United States, United Kingdom, and Canada (P < 0.05), and less prevalent in women from Sweden and Italy compared with other countries. In regards to the impact of symptoms overall and on emotional and physical relationships, the greatest number of women from the United States, United Kingdom, and Canada found the impact to be "worse than expected." The impact of postmenopausal symptoms on relationships is greater in women from countries where symptoms are more prevalent. Postmenopausal women and male partners of postmenopausal women may benefit from greater education about menopause and open discussions with their healthcare provider.

What therapy options are effective for postmenopausal symptoms?

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PIH2 - Comparison of Bazedoxifene/Conjugated Oestrogens Vs Current Therapies in the Treatment of Postmenopausal Symptoms: Systematic Review and Meta-Analysis

PIH2 - Comparison of Bazedoxifene/Conjugated Oestrogens Vs Current Therapies in the Treatment of Postmenopausal Symptoms: Systematic Review and Meta-Analysis

High Estradiol Levels During Postmenopause - Pitfalls in Laboratory Analysis.

A 54-year-old woman was admitted with a result of high serum estradiol levels (> 4300 pg/ml) and typical postmenopausal symptoms. She had a history of an adnexectomy (normal histopathology) due to the elevated estradiol levels. After surgery, estradiol levels were as high as before. Analyzing the anti-mullerian hormone (AMH), inhibin B, DHEA-S and estrone, typical postmenopausal levels were found. Serum estradiol levels were controlled several times with rabbit-derived polyclonal as well as monoclonal antibodies to optimize the selectivity of the test system. Secondary, a radioimmunoassay was performed to exclude interferences of the detection system where lower, but still elevated estradiol levels (186 pg/ml) were found. Hypothesizing that our patient underwent a cross reaction with irregular antibodies, a control was done using sheep-derived antibodies, which proved a postmenopausal hormone level (estradiol level < 5 pg/ml). This result was confirmed using a fluorescence enzyme immunoassay (FEIA) revealing high levels of irregular antibodies (> 200 mg/l; reference < 30 mg/l). This case depicts the pitfalls of estradiol measurement detecting false elevated estradiol levels in a postmenopausal woman.

Commissioning for menopause specialist services: A local perspective: An internet-based survey to assess the potential demand for menopause care in West Cheshire and the skills of local primary care clinicians in this field, with a view to informing future commissioning locally.

This study explores the perceived volume of women affected by peri- or post-menopausal issues that present to primary care clinicians in West Cheshire, plus the self-reported confidence of those clinicians in managing the menopause, and whether or not they feel that they and their patients should have access to a specialist menopause service. Completion of an electronic survey. General practitioners and practice nurses working in West Cheshire. To provide evidence for future local commissioning of menopause services. Ninety-one clinicians working within West Cheshire were sent an email request to complete the survey with 53 responses received (58%). The majority were general practitioners and were within the 35-54 year age range. The majority perceived that, each week in their clinical practice, they see between one and eight women who are affected by peri- or post-menopausal symptoms. Regarding their self-reported skills and knowledge in managing the menopause, almost half felt they had 'good' knowledge but 'recognised (they) had learning needs'. Seven of the 53 (13%) felt their skills were 'not good'. Two-thirds of those clinicians who completed the survey felt that they and their patients should have access to a specialist menopause service locally. In the area covered by West Cheshire clinical commissioning group, there is no currently commissioned menopause service. This study has demonstrated that a substantial number of women present each week to clinicians working in this area who are felt to have peri- or post-menopausal symptoms. The clinicians have self-reported learning needs. Qualitative data from the survey would suggest training can be difficult to access. There is a clear need, both ethically and medically, for the commissioning of a West Cheshire specialist menopause service, with the proposed model being an integrated and holistic care model. Menopause care, and post-reproductive healthcare generally, provides an opportunity for collaboration and partnership working within an outcomes-based commissioning model. This study could be reviewed and replicated in other areas for comparison.

Climaterio y menopausia.

El autor considera que el impacto que la menopausia tiene y tendrá en el futuro de la mujer peruana obliga al médico peruano y, en especial, al ginecólogo, a obtener un conocimiento amplio sobre la fisiopatología de la mujer a esta edad, las consecuencias tempranas y tardías, los medios terapéuticos disponibles y su efectividad, de manera de poder ofrecer lo más adecuado para cada caso. En toda mujer con síndrome climatérico y menopáusico y/o con perfil de riesgo de enfermedad cardiovascular u osteoporosis, se debe considerar la administración de estrógenos. La evaluación pretratamiento incluirá una buena anamnesis y un examen clínico general, de mamas y pelvis, así como el descarte de cáncer hormono dependiente. Serán de rutina el Papanicolaou y los análisis de laboratorio básicos, que incluirán de preferencia el estudio de colesterol HDL y LDL y triglícéridos. También será de utilidad en casos específicos la mamografía, la ecografía pélvica y la densitometría ósea. Decidido el uso de estrógenos, se empleará la dosis efectiva más baja, combinada con progestágenos cíclica o permanentemente si la mujer tiene útero. El seguimiento será a los 2 y 6 meses, inicialmente, y luego en forma anual, objetivando la efectividad del estrógeno y la ausencia de efectos secundarios y de cáncer. Si bien se ha demostrado los beneficios de la terapia hormonal, es posible que la expectativa de vida sólo se elevaría en menos de un año. (Ginecol. Obstet. Perú 1994; 40: 6-25).

Livial R: Perfil clínico y metabólico.

La terapia de reemplazo hormonal, está llegando a ser cada vez más, un área importante. Todos los tratamientos actuales presentan problemas de seguridad o de aceptación por parte de los pacientes. En especial, el sangrado vaginal regular, comúnmente es inaceptable en mujeres postmenopáusicas. Livial, un esteroide gonadomimético, trata con efectividad los síntomas climatéricos, y previene la pérdida ósea postmenopáusica, sin estimular el endometrio, de tal forma que no causa sangrado en mujeres que se encuentran en esta etapa. Livial parece tener efectos secundarios poco significativos, más aún puede ejercer efecto benéfico sobre el sistema cardiovascular y el perfil sérico de los lípidos.

Evaluation of Levothyroxine Bioavailability after Oral Administration of a Fixed Combination of Soy Isoflavones in Post-menopausal Female Volunteers.

Post-menopausal women under treatment with levothyroxine for their medical conditions may take concomitantly dietary supplements containing soy isoflavones in combination to treat their post-menopausal symptoms. The aim of this study was to investigate the effect of a fixed combination of soy isoflavones on the oral bioavailability of levothyroxine in post-menopausal female volunteers. 12 healthy post-menopausal female, who were on stable oral levothyroxine as replacement/supplementation therapy for hypothyroidism, received a single recommended oral dose of a food supplement containing 60 mg of soy isoflavones (>19% genistin and daidzin) concomitantly with (test) and 6 h later (reference) the administration of levothyroxine in a randomized, open label, crossover fashion. Plasma concentrations of levothyroxine and soy isoflavones (daidzin, daidzein, genistin, genistein, S-equol) were determined by LC-MS/MS. Pharmacokinetic (PK) parameters were determined by non-compartmental analysis. No effect of soy isoflavones was assumed if the 90% confidence intervals (CIs) for the estimated ratio test/reference was included in the acceptance limits 0.80-1.25 for PK parameters Cmax and AUCt. The test/reference ratios Cmax and AUCt of levothyroxine were very close to unity (1.02 and 0.99, respectively) and the corresponding 90% CIs (0.99-1.04 and 0.88-1.12, respectively) fell entirely within the acceptance bioequivalence limits. The combination of soy isoflavones used in the present investigation does not affect the rate and extent of levothyroxine absorption when administered concomitantly in post-menopausal women.

K-targeted isolation of C-glycosylflavones from Vitex agnus-castus by countercurrent methodology

C-glycosylated flavones, including orientin, isoorientin, vitexin, and isovitexin, are minor but biologically significant constituents of fruit extracts of the chaste-tree (Vitex agnus-castus L.), a botanical supplement used to treat PMS and postmenopausal symptoms. The partition coefficient, or K-value, is the ratio of the concentration of a compound in each phase of a biphasic solvent mixture and is a physicochemical property of a particular compound in a particular solvent system. This value can be used to predict retention volume (V ret) in a countercurrent separation procedure. The K-values of C-glycosylflavones present in complex botanical fractions have been determined in a number of solvent system families (HEMWat, EBWat, HterAcWat, terAcWat) using the shake-flask technique combined with relative LC-MS quantification. This K-value database has been used to develop targeted centrifugal partition (CPC) and high-speed countercurrent chromatography (HSCCC) methods. In each separation procedure the actual K value and V ret was reasonably predicted by the shake-flask partition experiment, confirming the utility of this approach in choosing a solvent system and targeting the fraction that contains the desired compound. This K-value database allowed for the efficient isolation of C-glycosylflavones from V. agnus-castus using orthogonal CCC and CPC methods.

Possible role of estrogen receptor-alpha in the signaling mechanism of progesterone receptor membrane component-1 in human breast cancer

Hormone therapy (HT) is commonly recommended clinically to relieve postmenopausal symptoms. Since the early 1940 s, when estrogen was introduced into clinical practice, there were concerns that HT may cause breast cancer. Research data from our laboratory suggest that a signaling pathway activated via progesterone receptor membrane component 1 (PGRMC1) may be important in terms of HT related breast cancer risk.

The Comparison of Two Method Effectiveness on Postmenopausal Hot Flash Therapy: Acupuncture versus Hormone Therapy

Background: Postmenopausal hot flash is a common disease amongst women with high prevalence of 75%. Hormone Replacement Therapy (HRT) is a well-known relief of symptoms which has disadvantages such as side effects and contraindication for certain types of hormone related diseases and breast or Estrogen related cancers. One of the alternatives is acupuncture which is an East Asian and more specifically Chinese method. In this study hormone therapy and acupuncture effectiveness have been compared in postmenopausal hot flash treatment. Materials and Methods: This study is aimed to initially diagnose vasomotor symptoms such as elevated body temperature, palpitation, headache and perspiration. Afterwards, assessment and finally comparing the efficacy of two methods for each symptom treatment have been carried out. In this clinical trial study, 20 climacteric female samples participated. Two study and control groups have been formed and each method efficacy has been evaluated on each of four major vasomotor symptoms. Results: For all postmenopausal vasomotor symptoms, acupuncture and HRT had similar notably high relief of symptoms effectively; namely in hot flash 90% and 85%, in palpitation 65% and 70%, in perspiration 77.77% and 81.25%, and in headache 50% and 81.3%, respectively. Although in all fields except hot flashes, HRT had slightly better success. Conclusion: This survey pointed out that acupuncture is as effective as hormone therapy in relief of symptoms hot flash for postmenopausal women. Further researches are needed to assess the clear side effects of acupuncture method. [GMJ.2015;4(2):83-89]

Cancer Chemoprevention with Korean Angelica: Active Compounds, Pharmacokinetics, and Human Translational Considerations.

Angelica gigas Nakai (AGN) is a major medicinal herb used in Korea and several other Asian countries. Traditionally, its dried root has been used to treat anemia, pain, infection and articular rheumatism, most often through boiling in water to prepare the dosage forms. AGN extract or AGN-containing herbal mixtures are sold in the US and globally as dietary supplements for pain killing, memory enhancement and post-menopausal symptom relief. Decursin (D) and its isomer decursinol angelate (DA) are the major chemicals in the alcoholic extracts of the root of AGN. The anti-cancer activity of AGN alcoholic extract has been established in a number of animal cancer models, including a transgenic model of prostate carcinogenesis. Cell culture structure-activity studies have uncovered distinct cellular and molecular effects of D and DA vs. their pyranocoumarin core decursinol (DOH) with respect to cancer cells and those associated with their microenvironment. Pharmacokinetic (PK) study by us and others in rodent models indicated that DOH is the major and rapid in vivo first-pass liver metabolite of D and DA. Cognizant of metabolic differences among rodents and humans, we carried out a first-in-human PK study of D/DA to inform the translational relevance of efficacy and mechanism studies with rodent models. The combined use of vigorous animal tests and human PK studies can provide stronger scientific rationale to inform design and execution of translational studies to move AGN toward evidence-based herbal medicine.