Relief Of Menopausal Symptoms Research Articles

The Effects of Prolonged Indoor Inhalation of Nature-Derived Odors on Menopausal Women.

This study aimed to investigate the effects of prolonged inhalation of nature-derived odors indoors on humans. Twenty-six women participated in this study. Heart rate variability, heart rate, blood pressure, pulse rate, estradiol, testosterone, and cortisol were used as indicators of autonomic nervous system and endocrine system activities. Profile of mood state, state-trait anxiety inventory, menopause rating scale and general sleep disturbance scale were used as psychological indicators. The order was as follows: After the participants relaxed in a chair for 5 min, their heart rate variability and heart rate were measured for 3 min with their eyes closed. Subsequently, blood pressure and pulse rate were measured, salivary samples were collected for estradiol, testosterone, and cortisol analyses, and a subjective assessment was conducted. The participants received a diffuser containing fir essential oil and were instructed on its usage and precautions. Subsequently, they returned home and inhaled the fir oil for a week. After 7 days, participants revisited the laboratory for posttest measurements, conducted at the same time as the pretest. Prolonged inhalation of the fir essential oil resulted in increased estradiol concentration, decreased systolic and diastolic blood pressure, relief of menopausal symptoms, reduced anxiety levels, improved sleep quality and mood states. Prolonged inhalation of the fir essential oil induced physiological and psychological relaxation on menopausal women.

Effects of transformative tourism activity on the mitigation of menopause symptoms and life satisfaction

AbstractThis study aims to determine whether five tourism activities have an impact on menopausal symptom relief and life satisfaction. This study surveyed 278 menopausal women experiencing menopausal symptoms, and after excluding two nonresponses, 276 responses were used in the final analysis. This study used confirmatory factor analysis to verify the validity of the measurement instruments and the fit of the research model. The results provided empirical evidence that cultural tourism, wellness tourism, sports tourism, and shopping tourism, except food tourism, have a positive impact on menopausal symptom relief and life satisfaction. This study successfully established a meaningful conceptual framework to understand the tourism activities that can lead to menopausal symptom relief and life satisfaction among menopausal women, beyond the existing literature that has only been studied in the field of leisure studies for middle‐aged and older adults.

Estrogen-like Cell Proliferation Abilities of Korea Forest Plant Resources on MCF-7 Cells and Analysis of Active Compounds

This study conducted a comprehensive analysis of functional substances and explored their biological activities using colorimetric and chromatographic techniques to identify high-value materials from 14 species of forest plants native to Korea. Comparative analysis between plant species included calculating the total polyphenol and flavonoid contents and qualitative and quantitative analysis of the phytochemical compounds caffeic acid (1), p-coumaric acid (2), and quercetin (3) using HPLC, and antioxidant activity tests (DPPH and ABTS+) and menopausal symptom relief tests (E-screen assay) to investigate their biological activities. The results highlighted Cercidiphyllum japonicum (FR 4), Aruncus dioicus (FR 6), and Pseudocydonia sinensis (FR 8) as excellent forest plant resource materials among the 14 forest plant resources. Notably, FR 4 exhibited significant activity in the E-screen assay. On the basis of these findings, we propose the use of FR 4 as a valuable material. Further analysis identified the phytochemical compounds maltol (4), chlorogenic acid (5), ellagic acid (6), and quercitrin (7) in FR 4 and analyzed their biological activities. Compounds 2–6 found in FR 4 were confirmed to possess strong antioxidant activity, and an E-screen assay revealed an excellent cell proliferation rate for quercitrin (7). This suggests that quercitrin (7) in FR 4 may be a significant indicator of the alleviation of menopausal symptoms.

The influence of menopausal hormone therapy on somatic morbidity in postmenopausal women

Menopausal hormone therapy (MHT) which is initiated in women less than 60 years old or within 10 years after the onset of menopause for the relief of menopausal symptoms, treatment of urogenital syndrome or osteoporosis, is currently the only way to reduce the risk of developing cardiovascular diseases, thrombotic and metabolic disorders in healthy middle-aged women. This article presents the results of evaluating the use of hormone therapy in women during the menopausal transition to the state of somatic health in postmenopause by determining its effect on the state of the cardiovascular and bone systems, changes in the lipid profile, as well as on the risk of thrombosis in the postmenopause period.The objective: to determine the effect of MHT on somatic morbidity in postmenopausal women.Materials and methods. An analysis of the anamnesis, anthropometric indicators, results of general clinical and biochemical data of 120 women of menopausal age, who were divided depending on the use of menopausal hormone therapy into a study group (patients used MHT, n=60) and a control group (patients did not use MHT, n=60), is presented.All women were observed on the basis of the communal non-profit enterprise “Kyiv Perinatal Center” in the period from 2013 to 2023. Results. There was no significant difference in the indicators of the metabolic profile (levels of lipid fractions and glucose), as well as in anthropometric parameters (systolic and diastolic blood pressure, body mass index) between women of both groups (p>0.05). The risk of cardiovascular events (especially angina pectoris, hypertension) was higher in women of the control group who did not use hormonal drugs (related risk (RR) 0.5 with a 95% confidence interval (CI) from 0.28 to 0.91; p<0.007). However, it was found that there were significant differences between the groups in bone mineral density (the frequency of women with osteopenia was 43.3% in the control group versus 35% in the study group, and osteoporosis was diagnosed in 15% of women in the group without MHT versus 5% of women from the study group; RR is 0.69 with 95% CI≥0.5 at the confidence level p=0.05) and parameters affecting the risk of thrombotic complications (platelet level was 239.4±28.4×109/l in the control group versus 295.6±28.2×109/l in the study group, p<0.001; the level of fibrinogen was 7.7±1.2 mmol/l in women without MHT versus 8.7±2.0 mmol/l in women with MHT, p=0.001; prothrombin time was 13.2±1.3 sec in the control group versus 15.0±1.1 sec in the study group, p<0.001).Conclusions. Menopausal hormone therapy (MHT) is an effective method of preventing the development of osteopenic and osteoporotic conditions in women during the perimenopause period, but it also reliably significantly affects certain indicators of blood coagulation properties – the level of platelets, fibrinogen and prothrombin time – in the direction of their increase. It was established that the use of hormone replacement therapy the risks of developing adverse cardiovascular events (especially arterial hypertension and angina pectoris) are reduced, but, given the lack of difference between the compared groups of women in indicators of lipid metabolism, glucose, as well as in anthropometric data (which are the main risk factors for the development of cardiovascular diseases), further research is needed to establish the relationships of these parameters in more detail.During the appointment of MHT, one should be guided by the results of an individual risk/benefit assessment for the patient, paying special attention to the study of her anamnestic data.

Development of a selective estrogen β‐receptor phytoestrogen formulation – PhytoSERM – for the reduction of Alzheimer’s risk and relief of menopausal symptoms in women: a phase 2 randomized clinical trial framework

AbstractBackgroundThe greatest risk factors for Alzheimer’s disease (AD) are age, APOɛ4 allele and female sex. The estimated lifetime risk for AD is 19.5% for women compared to 10.3% in men. Accumulating evidence points to life‐time estrogen exposure as a protective factor against cognitive decline and AD in women, and to the menopause transition as a trigger for an existing AD predisposition. Estrogen replacement therapy (ERT) is effective for sustaining neurological health, but fear of breast cancer is the principal reason menopausal women reject it. Instead, women utilize over the counter products labeled as natural and considered to be safer. Thus, to attain brain protection and address breast protection we developed a rationally designed combination of select ERβ‐selective phytoestrogens that promote brain health to reduce AD risk without increasing breast cell proliferation.MethodA total of 100 participants, 50 per treatment arm, will be enrolled. Eligible participants are woman, 45‐60 years, peri or post‐menopausal (last menstrual period completed ≥ 60 days and ≤ 4 years), MoCA≥22, and experiencing ≥7 hot flashes per day. Participants will be randomized to 50 mg of PhytoSERM or placebo (orally, once‐per‐day) for a 24‐week period. FDG‐PET scans will be conducted at baseline and 24 weeks. Cognitive measures and clinical ratings will be assessed. Hot flashes will be measured both subjectively with a diary and objectively with a digital wristband measuring electrodermal activity.ResultPrimary endpoint is change from baseline to 24 weeks in regional brain glucose metabolism standardized uptake value ratio (SUVR). Secondary outcome measures include cognitive test battery scores, hot flash score and clinical ratings scores. Exploratory measures will include MRI brain volumes, fractional anisotropy, quantitative anisotropy, functional connectivity, and cerebral blood perfusion.ConclusionHerein we present a phase 2 proof‐of‐concept framework to assess the efficacy of PhytoSERM as a potential non‐pharmacologic therapeutic to improve cognitive health and reduce menopausal symptoms. Results from this study will validate previous findings that indicate that PhytoSERM is a safe alternative to hormone therapy and has the potential to sustain neurological health during the menopausal transition.

Design, synthesis, and in-silico study of novel triarylethylene analogs with dual anti-estrogenic and serotonergic activity.

Estrogen receptor is an important target in breast cancer. Serotonin receptors (5-HT2A and 5-HT2C , in particular) were investigated for a potential role in development and progression of breast cancer. Ligands that interact with estrogenic receptors influence the emotional state of females. Thus, designing selective estrogen receptor modulator (SERM) analogs with potential serotonergic activity is a plausible approach. The dual ligands can augment cytotoxic effect of SERMs, help in both physical and emotional menopausal symptom relief, enhance cognitive function and support bone health. Herein, we report triarylethylene analogs as potential candidates for treatment of breast cancer. Compound 2e showed (ERα relative β- galactosidase activity = 0.70), 5-HT2A (Ki = 0.97 µM), and 5-HT2C (Ki = 3.86 µM). It was more potent on both MCF-7 (GI50 = 0.27 µM) and on MDA-MB-231 (GI50 = 1.86 µM) compared to tamoxifen (TAM). Compound 4e showed 40 times higher antiproliferative activity on MCF-7 and 15 times on MDA-MBA compared to TAM. Compound 4e had higher average potency than TAM on all nine tested cell line panels. Our in-silico model revealed the binding interactions of compounds 2 and 2e in the three receptors; further structural modifications are suggested to optimize binding to the ERα, 5-HT2A , and 5-HT2C .

(017) Systemic Estradiol Menopause Management: Return to the Old-Fashioned Way

Abstract Introduction The mean systemic estradiol value in menopausal women is < 10 pg/ml, consistent with ovarian failure. Such low values are associated with multiple symptoms including hot flashes, night sweats, insomnia, mood changes and irritability, cognitive changes, weight gain and slowed metabolism. Contemporary management with systemic estradiol, maximizing safety and efficacy, emphasizes non-oral, non-injection estradiol replacement therapies including systemic daily gels, twice weekly or weekly patches or three-month vaginal rings. Most women (>60%) who try these systemic therapies in our sexual medicine clinic have been successful at reducing bothersome symptoms. We have identified a subset of women who cannot achieve sufficient symptom relief despite using contemporary estradiol strategies due to lack of efficacy, negative side effects, (rings cannot stay in the vagina or values are too high initially and then too low, patches cause rashes or fall off, gels are too messy) or financial concerns. For these patients, we have advised a return to the “old-fashioned way” using weekly intramuscular (IM) injection of either estradiol valerate or cypionate. Estradiol cypionate was first described as well as introduced for medical use in 1952. Objectives This study examines the experiences of this subset of women in one practice using weekly injections of estradiol valerate or cypionate for either efficacy or financial reasons. Methods This chart review identified a subset of 16 patients (mean age 59 +/− 8 years) at a single site who had been prescribed estradiol valerate or cypionate when symptoms of genitourinary syndrome of menopause (GSM) persisted despite use of estradiol replacement gels, patches or rings, or cost was prohibitive. We have advised weekly IM injection of either estradiol valerate (20 mg/ml; starting dose 0.05 ml or 1 mg) or estradiol cypionate (5 mg/ml; starting dose 0.2 ml or 1 mg). We compared relief of bothersome symptoms from earlier estradiol treatments to current IM injection and compared monthly costs of each treatment based on GoodRx prices, assuming medications were not covered by insurance. Results All patients using weekly injections of estradiol valerate or cypionate had their estradiol-based GSM symptoms ameliorated without complaint of inconvenience or discomfort using injections. The risks of IM injections of estradiol are similar to those of topical administration, requiring concomitant progesterone use in women with a uterus. Concerning finances, using a GoodRx coupon, a 5 ml bottle of estradiol valerate costs approximately $50 and should last at least one year, reducing monthly cost to approximately $5/month. A 5 ml bottle of estradiol cypionate costs approximately $150 and should last at least 6 months, thus about $25/month. In contrast, generic patches are approximately $40/month, gels $150/month and the ring $170/month. While there remains an abhorrence for injections, the motivation for systemic estradiol replacement superseded any inconvenience of using an injectable medication and the 27-gauge ½ inch needle is associated with minimal pain. No significant side effects were noted with IM injection. Conclusions For certain individuals, sometimes the “old-fashioned way” works better both in terms of efficacy and cost, providing relief of bothersome menopausal symptoms. Disclosure No.

Herbal therapy for menopausal symptom relief

Most peri- and post-menopausal women suffer from various symptoms including vegetative (e.g., vasomotor symptoms (VMS)), physical (e.g., body weight increase), psychological (e.g., insomnia, depressive mood), and urogenital symptoms (e.g., sexual dysfunction) which may last for many years. Internationally, hormone replacement therapy (HRT) is recommended as 1st-line therapy for menopausal symptom relief. However, many physicians and women are reluctant to prescribe or use MHT, respectively, due to safety concerns. Thus, alternative treatment options with only minimal or no side effects such as herbal preparations are of great interest. Cimicifuga racemosa (black cohosh) and Hypericum perforatum (St. John's wort) are among the best known and most studied herbal treatments. In some countries, they are approved as drugs and covered by health insurances. The main indication of black cohosh is menopausal psycho-vegetative symptom relief. St. John's wort has successfully been used for the treatment of mild to moderate depression, and efficacy is reported to be comparable to conventional antidepressants.

Black Cohosh Induced Posterior Reversible Encephalopathy Syndrome (P12-5.015)

<h3>Objective:</h3> Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder of reversible subcortical vasogenic edema resulting from endothelial injury due to abrupt blood pressure changes or direct effects of cytokines. PRES is characterized by encephalopathy, headaches, seizures, and visual disturbances. PRES is often seen in the setting of renal failure, autoimmune disorders, or may be induced by medications or drugs. Neuroimaging may reveal ischemic strokes, intraparenchymal hemorrhage, or sulcal subarachnoid hemorrhage. Black cohosh is a dietary supplement of the buttercup family claimed to have estrogenic effects used primarily for relief of menopausal symptoms. <h3>Background:</h3> We describe a case of a 36 year-old woman who developed PRES shortly after initiating black cohosh for the treatment of hot flashes. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> A 36 year-old woman with history of hypertension and uterine fibroids post hysterectomy presented with sudden onset headache. She had started taking black cohosh the day of presentation. CT brain showed a right posterior parietal intraparenchymal hemorrhage with surrounding edema and adjacent sulcal subarachnoid hemorrhage. Cerebral angiogram revealed multifocal irregularity of the right parietal branches of the MCA. The patient was started on verapamil 120mg three times daily and treated with strict blood pressure control. She was initially monitored in the neurointensive care unit and discharged home three days later. The patient was instructed to stop using black cohosh and her headache resolved over the next three weeks. Follow up cerebral angiography three months later revealed resolution of multifocal vasoconstriction of the right parietal branches. <h3>Conclusions:</h3> Early diagnosis, treatment, and discontinuation of the offending agent are important to minimize long term neurological sequelae in PRES. Review of patient medications and herbal supplements may help determine unusual triggers for PRES. Further studies are warranted to determine the association of black cohosh with PRES. <b>Disclosure:</b> Dr. Imam has nothing to disclose. Dr. Salahuddin has nothing to disclose.

The biological responses of vitamin K2: A comprehensive review.

Vitamin K1 (VitK1) and Vitamin K2 (VitK2), two important naturally occurring micronutrients in the VitK family, found, respectively, in green leafy plants and algae (VitK1) and animal and fermented foods (VitK2). The present review explores the multiple biological functions of VitK2 from recently published in vitro and in vivo studies, including promotion of osteogenesis, prevention of calcification, relief of menopausal symptoms, enhancement of mitochondrial energy release, hepato- and neuro-protective effects, and possible use in treatment of coronavirus disease. The mechanisms of action associated with these biological effects are also explored. Overall, the findings presented here suggest that VitK, especially VitK2, is an important nutrient family for the normal functioning of human health. It acts on almost all major body systems and directly or indirectly participates in and regulates hundreds of physiological or pathological processes. However, as biological and clinical data are still inconsistent and conflicting, more in-depth investigations are warranted to elucidate its potential as a therapeutic strategy to prevent and treat a range of disease conditions.

RF34 | PMON202 The Human Metabolic Profile of Estetrol

Abstract Objectives Estetrol (E4), a native estrogen produced by the fetal human liver, has four hydroxyl-groups, making it structurally distinct from other estrogens. We determined the human metabolic profile of E4, which is recently marketed combined with drospirenone as a novel contraceptive and is currently in development for the relief of menopausal symptoms. Method: We studied the in vitro metabolism of E4 using human hepatocytes, human liver microsomes and recombinant CYP enzymes in reaction phenotyping studies to evaluate the role of human cytochrome P450 enzymes, UDP-glucuronosyltransferases (UGT) and sulfotransferases (SULT). Furthermore, we evaluated the in vivo metabolism of E4 in an open-label, non-randomised phase 1 human absorption, distribution, metabolism, and excretion study, in which six healthy postmenopausal participants received a single oral solution containing 15 mg [14C]-E4. We analysed blood (up to 240h), urine and faecal samples (up to 312h). Metabolite profiling and identification was performed using liquid chromatography with tandem mass spectrometry. Results The in vitro studies showed that E4 undergoes extensive phase 2 metabolism to form glucuronide and sulphate conjugates. UGT2B7 is the key enzyme catalysing the direct glucuronidation of E4 and SULT1E1 is the dominant sulfotransferase for sulphate conjugation in vitro. Unlike for other estrogens, oxidative phase 1 metabolism by P450 enzymes does not play a major role in the metabolism of E4. Following oral administration of E4 to humans, the major metabolites observed in human plasma were E4-16-glucuronide, E4-3-glucuronide and E4-glucuronide-sulfate (respectively 62%, 17% and 9% of radioactivity at the time of maximum plasma concentration [Tmax]). At Tmax, unchanged E4 accounts for only 7.5% of plasma radioactivity. Main metabolites quantified in urine during the first 6 hours after administration were E4-16-glucuronide and E4-3-glucuronide (respectively 77.4% and 16.5% of urine radioactivity). Approximately 69% of the total administered radioactivity was recovered in urine and 22% in faeces. Mass spectrometry showed that E4 was not present in urine but was detected in faeces and that E4 is not converted back into one of the other natural estrogens (estriol, estradiol, estrone). Conclusions Altogether, these data suggest that E4 has a unique metabolic profile. E4 is a terminal end-product of estrogen metabolism, which is not converted back, in vivo, into active metabolites like estriol, estradiol or estrone. Unlike for other estrogens, CYP450 enzymes do not play a major role in the metabolic pathway of E4. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 12:48 p.m. - 12:53 p.m.

A review of adverse events in animals and children after secondary exposure to transdermal hormone-containing medicinal products.

Hormonal replacement therapy is widely used to treat conditions in humans, the most well-known indication being the relief of menopausal symptoms in women. Many of the hormone-containing products (HCP) are applied to the skin. This transdermal delivery poses a risk to animals and humans through secondary exposure, especially when product information is not strictly followed. The aim of this article is to raise awareness among veterinarians and human healthcare providers of this risk; based on evidence from spontaneous reporting of suspected adverse events (AEs) in animals and humans. Interventions are also explored to mitigate the risk of secondary exposure to transdermal HCP (THCP). The Swedish Medical Products Agency has received several, mainly serious, AE reports in animals and children following secondary exposure to THCPs. The AE reports were reviewed together with worldwide data from the EudraVigilance Veterinary database and human EudraVigilance Data Analysis System. The clinical signs reported in animals included persistent signs of oestrus, poor growth rate and birth defects. In humans, reported clinical signs included precocious puberty, unresolved virilisation, accelerated growth rate and female infertility. It is important that THCP are used according to manufacturer's instructions and users are made aware of risks and mitigating measures. This review of AEs in animals and children provides evidence to show that the use of THCP poses a risk for secondary exposure. Efficient communication strategies that stretch across veterinary and human medicinal disciplines are required to raise mutual awareness and minimise the risk of AEs in animals and humans.

Human Placental Extract Delays In Vitro Cellular Senescence through the Activation of NRF2-Mediated Antioxidant Pathway.

Senescent cells accumulate in the organs of aged animals and exacerbate organ dysfunction, resulting in age-related diseases. Oxidative stress accelerates cellular senescence. Placental extract, used in the alleviation of menopausal symptoms and promotion of wound healing and liver regeneration, reportedly protects against oxidative stress. In this study, we investigated the effects of human placental extract (HPE) on cellular senescence in normal human dermal fibroblasts (NHDFs) under oxidative stress conditions. We demonstrated that HPE delays the onset of cellular senescence. Next-generation sequencing analysis revealed that under oxidative stress conditions, HPE treatment enhanced the expression of the antioxidant genes CYGB, APOE, NQO1, and PTGS1. Further, HPE treatment under oxidative stress conditions increased the protein level of nuclear factor-erythroid factor 2-related factor 2 (NRF2)—a vital molecule in the antioxidant pathway—via post-transcriptional and/or post-translational regulations. These findings indicate that HPE treatment in NHDFs, under chronic oxidative stress, delays cellular senescence by mitigating oxidative stress via upregulation of the NRF2-mediated antioxidant pathway, and HPE treatment could potentially ameliorate skin-aging-associated damage, in vivo.

Use of laser and radiofrequency for genitourinary syndrome of menopause: do Brazilian women know it? / Laser e rádio frequência como opções terapêuticas na síndrome geniturinária da menopausa: as mulheres brasileiras conhecem?

Objective: to verify how many women between 35 and 69 years old would undergo laser and/or radiofrequency as treatment for genitourinary syndrome of menopause and how many report improvements after having undergone for those procedures. The study also seeks to identify how many women resort to these treatments for aesthetic reasons and how many as genitourinary syndrome of menopause symptom relief. The whole research was done in Brazil. Methods: literature review followed by the formulation of a Google Forms questionnaire that was sent to 339 Brazilian women. Female individuals participated in the research, regardless of race, education, religious belief, or number of children. The collected data was descriptively analyzed; Pearson’s chi-squared test was used when appropriated. Results: 173 responses were obtained, 170 of which were used, and three were excluded due to inconsistencies. Of the 170 respondents, 79 were in menopause, and six already have undergone the mentioned treatments. The main symptoms presented by women in menopause were vaginal dryness (79,7%) and urinary incontinence (51,9%). A minority of the participants reported having knowledge regarding the treatments. Conclusion: Although the treatment effectiveness in improving genitourinary syndrome of menopause, they are not widely known by women. This highlights the need for a greater dissemination of information regarding these therapeutic options.

Radical scavenging activity of fruit extracts Tribulus Terrestris with natural antioxidant Ascorbic acid: A comparative study

The main aim of this work was to analyze through a systematic review the ability of Tribulusterrestris to promote the increase of hormonal levels as a mechanism for the relief of menopausal symptoms. The criteria used for the selection were: studies involving menopausal women and use of Tribulusterrestris as a treatment for sexual dysfunction and / or other menopausal symptoms. The survey of literature shows that women who used Tribulusterrestris had drastic improvement in symptoms such as vaginal lubrication, sensation in the genitals during intercourse and other constructive activities. In this study, we have found a significant increase in bioavailable testosterone after the use of the plant extracts which has great potential in the treatment of sexual intercourse and unique symptoms of menopause.

Prevalence of menopausal hormone therapy and alternative methods, health benefits experienced by peri- and postmenopausal Polish women.

The aim of the study was to assess the prevalence of menopausal symptoms, and the use of menopausal hormone therapy (MHT) and nonconventional methods of alleviating menopausal symptoms and their health benefits in peri- and postmenopausal women. A sample of 349 peri- or postmenopausal women were studied, all of whom had experienced menopausal symptoms. A pre-tested questionnaire was used to assess the kinds of menopausal symptoms experienced, the types of therapies used, and the health benefits of using MHT or alternative therapies (AT). The mean age of peri- and postmenopausal women was 49.55 (±2.51) and 61.32 (±6.77) years, respectively. The most common symptoms in both groups of peri- and postmenopausal women related to mental health. Altogether 45% of women used MHT and 27.8% AT. Those using MHT reported significant benefits in their sexual life (p < 0.001), whereas those using AT reported significant benefits of better sexual life (p < 0.001), skin condition (p < 0.001), and physical activity (p < 0.05).This study indicated that the most common symptoms connected with the menopausal transition were mental ailments. In order to prevent them, the women more frequently applied MHT in comparison to alternative methods, with postmenopausal women using MHT more often than perimenopausal women. Satisfaction was found with both conventional and alternative treatments for the relief of menopausal symptoms.

Long term impact of the WHI studies on information-seeking and decision-making in menopause symptoms management: a longitudinal analysis of questions to a medicines call centre

BackgroundWhile women are taking a greater role in decisions about menopause symptom management, the legacy of the Women’s Health Initiative (WHI) studies persist. Despite hormone therapy (HT) being effective in reducing all-cause mortality, many women seeking relief of menopausal symptoms exaggerate HT harms and overstate the perceived benefits or ignore the risks of alternative therapies. We aimed to explore the longitudinal impact of the widely-publicised WHI 2002 study on women’s information-seeking and describe determinants of decision-making about managing menopausal symptoms.MethodsIn a longitudinal analysis of both quantitative and qualitative data, we explored consumer questions about menopause-related medicines received by two Australian medicines call centres (1996–2010) before, during, and after WHI 2002. We analysed calls by age and gender of caller and patient, their relationship, postcode, enquiry type, and motivation to help-seek. We compared calls regarding HT and herbal medicines (HM) with the rest of calls, and thematically analysed question narratives across the three time-periods.ResultsThere were 1,829 menopause-related calls received of over this time-period, with a call surge, primarily from women in their mid-fifties, in the two months after the WHI 2002 publication. Two in three calls were motivated by negative media reports as women sought support for decision-making, primarily reassurance to cease HT. While HT safety concerns persisted for eight years post-publication, the nature of information-seeking changed over time. Callers subsequently sought reassurance to use menopause treatments together with their other medicines; and pursued HT substitutes, including HM, in response to HT product discontinuation.ConclusionsWomen sought information or reassurance to support a decision, based on dynamic changes in internal (symptom or risk intolerance, attitude towards menopause and treatment preferences) and external factors (perceived source trust and changes in treatment availability). In assessing HT benefit versus risk, women tend to overestimate risk with HT safety concerns persisting over time. Decision-making in managing menopause symptoms is complex and dynamic. Reassurance to reach or justify decisions from a perceived trusted source can support informed decision-making.

Lactobacillus intestinalis YT2 restores the gut microbiota and improves menopausal symptoms in ovariectomized rats.

There are many studies focusing on the alleviation of menopausal symptoms; however, little is known about the role of gut microorganisms in menopausal symptoms. Ovariectomized (OVX) rats were administered a novel strain (YT2) of Lactobacillus intestinalis (a species with significantly reduced abundance in OVX rats) and the potential probiotic effect on the improvement of menopausal symptoms was evaluated. Of note, the gut microbial composition completely shifted after ovariectomy in rats. Treatment with L. intestinalis YT2 significantly alleviated menopausal symptoms, such as increased fat mass, decreased bone mineral density, increased pain sensitivity, depression-like behaviour, and cognitive impairment. Additionally, the administration of L. intestinalis YT2 restored the intestinal microbial composition, including an increased Firmicutes/Bacteroides ratio. L. intestinalis YT2 also promoted gut barrier integrity by increasing the mRNA levels of tight junction-related markers. In conclusion, L. intestinalis YT2 treatment alleviated menopausal symptoms via the modulation of the gut microbiota. Importantly, these results suggest that L. intestinalis YT2 should be considered as a therapeutic probiotic agent for menopausal women.

Hormone therapy in the postmenopausal years: considering benefits and risks in clinical practice.

Menopausal symptoms can be very distressing and considerably affect a woman's personal and social life. It is becoming more and more evident that leaving bothersome symptoms untreated in midlife may lead to altered quality of life, reduced work productivity and, possibly, overall impaired health. Hormone therapy (HT) for the relief of menopausal symptoms has been the object of much controversy over the past two decades. At the beginning of the century, a shadow was cast on the use of HT owing to the concern for cardiovascular and cerebrovascular risks, and breast cancer, arising following publication of a large randomized placebo-controlled trial. Findings of a subanalysis of the trial data and extended follow-up studies, along with other more modern clinical trials and observational studies, have provided new evidence on the effects of HT. The goal of the following paper is to appraise the most significant clinical literature on the effects of hormones in postmenopausal women, and to report the benefits and risks of HT for the relief of menopausal symptoms. A Pubmed search of clinical trials was performed using the following terms: estrogens, progestogens, bazedoxifene, tibolone, selective estrogen receptor modulators, tissue-selective estrogen complex, androgens, and menopause. HT is an effective treatment for bothersome menopausal vasomotor symptoms, genitourinary syndrome, and prevention of osteoporotic fractures. Women should be made aware that there is a small increased risk of stroke that tends to persist over the years as well as breast cancer risk with long-term estrogen-progestin use. However, healthy women who begin HT soon after menopause will probably earn more benefit than harm from the treatment. HT can improve bothersome symptoms, all the while conferring offset benefits such as cardiovascular risk reduction, an increase in bone mineral density and a reduction in bone fracture risk. Moreover, a decrease in colorectal cancer risk is obtainable in women treated with estrogen-progestin therapy, and an overall but nonsignificant reduction in mortality has been observed in women treated with conjugated equine estrogens alone or combined with estrogen-progestin therapy. Where possible, transdermal routes of HT administration should be preferred as they have the least impact on coagulation. With combined treatment, natural progesterone should be favored as it is devoid of the antiapoptotic properties of other progestogens on breast cells. When beginning HT, low doses should be used and increased gradually until effective control of symptoms is achieved. Unless contraindications develop, patients may choose to continue HT as long as the benefits outweigh the risks. Regular reassessment of the woman's health status is mandatory. Women with premature menopause who begin HT before 50 years of age seem to have the most significant advantage in terms of longevity. In women with bothersome menopausal symptoms, HT should be considered one of the mainstays of treatment. Clinical practitioners should tailor HT based on patient history, physical characteristics, and current health status so that benefits outweigh the risks.

Fezolinetant in the treatment of vasomotor symptoms associated with menopause

ABSTRACT Introduction: Although international clinical practice guidelines recognize a continued role for menopausal hormone therapy (HT), particularly for symptomatic women <60 years of age or within 10 years of menopause, safety and tolerability concerns have discouraged HT use due to potential links with a perceived increased risk of hormone-dependent cancers, and an established risk of stroke and venous thromboembolism. There is therefore a need for safe, effective non-hormonal therapy for relief of menopausal vasomotor symptoms (VMS). Areas covered: This narrative review summarizes the dataset accrued for fezolinetant, a neurokinin-3 receptor (NK3R) antagonist in clinical development for menopause-associated VMS. Expert opinion: Altered signaling in neuroendocrine circuits at menopause leads to VMS wherein NK3R activity plays a key role to modulate the thermoregulatory center in a manner conducive to triggering the ‘hot flash’ response. Thus, a new generation of NK3R antagonists has entered clinical development to specifically target the mechanistic basis of VMS. Fezolinetant is the most advanced NK3R antagonist in terms of stage of clinical development. Results to date have demonstrated rapid and substantial reduction in VMS frequency and severity and associated improvements in health-related quality of life. NK3R antagonists offer a non-hormonal alternative to HT for the treatment of menopause-related VMS.