Menopausal Transition Symptoms Research Articles

Presbyopia, Dry Eye, and Retinal Thickness in the Middle-Aged Population: Focusing on Sex Differences.

Risk factors for presbyopia have not been fully determined although previous studies suggested presbyopia was associate with age, dry eye, and retinal ganglion cell complex thickness (GCC). We accessed these signs and common ocular symptoms in the middle-aged population focusing on sex differences when women have drastic hormonal change. This cohort study consecutively enrolled 2743 patients aged 36-45 years (n=1000), 46-55 years (n=1000), and 56-65 years (n=743). All underwent ocular surface tests and had near add power and GCC measured. Common ocular symptoms were asked using questionnaire. Among female participants, visual symptoms (eye strain and photophobia) were more prevalent in the age group 46-55, whereas non-visual symptoms (dryness, irritation, and pain) were not. We identified symptomatic presbyopia (near add power ≥ 1.5D) in 14.4%, 73.8%, and 97.8%, positive corneal staining in 29.1%, 23.8%, and 23.9%, and a mean GCC of 98.2 μm, 105.3 μm, and 89.6 μm in the age groups 36-45, 46-55, and 56-65, respectively. Mean tear break-up time were 3.3, 3.5, and 3.3 seconds, respectively. Results indicated a large progression of presbyopia (P<0.01) from the period of 36-45 years onward and significantly increased GCC (P<0.01) in women of age group 46-55. No notable tendency was observed in symptoms and GCC for male participants. Visual symptoms in women were worse between 46 and 55 years than before or after these ages. The increase of symptomatic presbyopia and GCC may be contributing to visual symptoms in addition to menopausal transition symptoms in this age group.

Validation and Application of Thresholds to Define Meaningful Change in Vasomotor Symptoms Frequency: Analysis of Pooled SKYLIGHT1 and 2 Data.

Vasomotor symptoms (VMS), the characteristic symptoms of menopausal transition, are often the primary reason women seek treatment. Current treatment options for VMS include fezolinetant, a nonhormonal, selective neurokinin3 receptor antagonist. This study aimed to define a clinically meaningful threshold for reduction of moderate-to-severe VMS in postmenopausal women treated with fezolinetant and then apply it in a responder analysis of the pooled trial data. This analysis pooled data from two identical phase3, double-blind, placebo-controlled studies that randomized women with moderate-to-severe VMS to once-daily fezolinetant 30mg, 45mg, or placebo (SKYLIGHT1 and 2). The frequency of VMS was collected daily using an electronic diary. Patients completed the Patient Global Impression of Change in VMS (PGI-C VMS) instrument, which assessed changes in hot flushes/night sweats at weeks4 and 12 compared with baseline using a seven-point Likert scale. VMS frequency data were anchored to PGI-C VMS data; the anchor level for meaningful within-patient change in PGI-C VMS was "moderately better." In the pooled population (N = 1022), the mean (standard deviation) estimated thresholds for a meaningful within-patient change in moderate-to-severe VMS frequency were - 5.73 (3.47) at week4 and - 6.20 (5.18) at week12. Applying the thresholds for meaningful within-patient change to responder analyses ("missing as non-responder" imputation method) indicated a favorable clinical benefit: greater proportions of responders were observed in the fezolinetant 30-mg and 45-mg groups compared with placebo at week4 (odds ratio range 2.48-2.91; P < 0.001) and week12 (odds ratio range 1.908-2.68; P < 0.001). PGI-C VMS is sensitive to change and correlates with VMS frequency: a reduction of approximately six VMS episodes per day from baseline to week12 was meaningful at the individual patient level. Fezolinetant provides a meaningful clinical benefit for women with moderate-to-severe VMS associated with menopause and represents an important nonhormonal treatment option. NCT04003155 and NCT04003142.

Menopause

The female reproductive system matures in a continuous, natural process from menarche to menopause as the finite numbers of oocytes produced during fetal development are gradually lost to ovulation and senescence. Menopause is defined as the permanent cessation of menses; by convention, the diagnosis of menopause is not made until the individual has had 12 months of amenorrhea. Menopause is thus characterized by the menstrual changes that reflect oocyte depletion and subsequent changes in ovarian hormone production. However, hormonal changes, rather than the cessation of menstruation itself, cause the manifestations that occur around the time of menopause. Therefore, a woman who has undergone a hysterectomy but who retains her ovaries can experience normal menopausal symptoms as oocyte depletion leads to changes in estrogen levels, even though cessation of menstruation occurred with surgery. This review covers definitions, natural menopause, menopausal transition and postmenopausal symptom management, and premature ovarian insufficiency. Figures show stages of reproductive aging, serum concentrations of hormones during menopausal transition and postmenopause, hormonal changes associated with reproductive aging, symptoms of menopausal transition and menopause, treatment algorithm(s), and Women’s Health Initiative findings: risks and benefits of estrogen alone and estrogen plus progestin by age group: 50 to 59, 60 to 69, and 70 to 79 years. Tables list target tissues, physical manifestations, and menopausal symptoms; selective estrogen receptor modulators used in postmenopausal women; differential diagnosis and evaluation of common menopausal symptoms; estrogen doses; progestogen dosing for endometrial protection; nonhormonal pharmaceutical hot flash therapies; and pharmacologic therapy for genitourinary atrophy. This review contains 6 figures, 8 tables, and 122 references.

Menopause

The female reproductive system matures in a continuous, natural process from menarche to menopause as the finite numbers of oocytes produced during fetal development are gradually lost to ovulation and senescence. Menopause is defined as the permanent cessation of menses; by convention, the diagnosis of menopause is not made until the individual has had 12 months of amenorrhea. Menopause is thus characterized by the menstrual changes that reflect oocyte depletion and subsequent changes in ovarian hormone production. However, hormonal changes, rather than the cessation of menstruation itself, cause the manifestations that occur around the time of menopause. Therefore, a woman who has undergone a hysterectomy but who retains her ovaries can experience normal menopausal symptoms as oocyte depletion leads to changes in estrogen levels, even though cessation of menstruation occurred with surgery. This review covers definitions, natural menopause, menopausal transition and postmenopausal symptom management, and premature ovarian insufficiency. Figures show stages of reproductive aging, serum concentrations of hormones during menopausal transition and postmenopause, hormonal changes associated with reproductive aging, symptoms of menopausal transition and menopause, treatment algorithm(s), and Women’s Health Initiative findings: risks and benefits of estrogen alone and estrogen plus progestin by age group: 50 to 59, 60 to 69, and 70 to 79 years. Tables list target tissues, physical manifestations, and menopausal symptoms; selective estrogen receptor modulators used in postmenopausal women; differential diagnosis and evaluation of common menopausal symptoms; estrogen doses; progestogen dosing for endometrial protection; nonhormonal pharmaceutical hot flash therapies; and pharmacologic therapy for genitourinary atrophy. This review contains 6 figures, 8 tables, and 122 references.

Menopause

The female reproductive system matures in a continuous, natural process from menarche to menopause as the finite numbers of oocytes produced during fetal development are gradually lost to ovulation and senescence. Menopause is defined as the permanent cessation of menses; by convention, the diagnosis of menopause is not made until the individual has had 12 months of amenorrhea. Menopause is thus characterized by the menstrual changes that reflect oocyte depletion and subsequent changes in ovarian hormone production. However, hormonal changes, rather than the cessation of menstruation itself, cause the manifestations that occur around the time of menopause. Therefore, a woman who has undergone a hysterectomy but who retains her ovaries can experience normal menopausal symptoms as oocyte depletion leads to changes in estrogen levels, even though cessation of menstruation occurred with surgery. This review covers definitions, natural menopause, menopausal transition and postmenopausal symptom management, and premature ovarian insufficiency. Figures show stages of reproductive aging, serum concentrations of hormones during menopausal transition and postmenopause, hormonal changes associated with reproductive aging, symptoms of menopausal transition and menopause, treatment algorithm(s), and Women’s Health Initiative findings: risks and benefits of estrogen alone and estrogen plus progestin by age group: 50 to 59, 60 to 69, and 70 to 79 years. Tables list target tissues, physical manifestations, and menopausal symptoms; selective estrogen receptor modulators used in postmenopausal women; differential diagnosis and evaluation of common menopausal symptoms; estrogen doses; progestogen dosing for endometrial protection; nonhormonal pharmaceutical hot flash therapies; and pharmacologic therapy for genitourinary atrophy. This review contains 6 figures, 8 tables, and 122 references.

Sensor-Based Smart Clothing for Women's Menopause Transition Monitoring.

Aging women usually experience menopause and currently there is no single diagnosing highly-sensitive and -specific test for recognizing menopause. For most employed women at their perimenopause age it is not convenient to visit a clinic for the hormone test, which lasts for consecutive days. This paper develops a suit of sensor-based smart clothing used for home-based and ambulatory health monitoring for women’s menopause transition. Firstly, a survey analysis is conducted to determine the biological signals measured by sensors for indicating the symptoms of menopausal transition and also the body areas with salient symptoms to implant the sensors on the clothing. Then, the smart clothing is designed with a set of temperature and relative humidity sensors on different locations and with a microcontroller to transmit the measured data to the computer. With the smoothed data as input, a new detection algorithm for hot flashes is proposed by recognition of the concurrent occurrence of heat and sweating rise/down, and can figure out the frequency, intensity, and duration—triple dimension information of a hot flash, which is helpful to achieve precise diagnosis for menopausal transition. The smart clothing and the detection algorithm are verified by involving a group of women subjects to participate in a hot flash monitoring experiment. The experimental results show that this smart clothing monitoring system can effectively measure the skin temperature and relative humidity data and work out the frequency, duration, and intensity information of a hot flash pertaining in different body areas for individuals, which are accordant with the practice reported by the subjects.

Sampling Trial Showed S-equol Supplementation Helped Relieve Menopausal Symptoms (P06-111-19)

ObjectivesWomen experience a variety of symptoms during each stage of the menopausal transition (perimenopause, menopause, and post menopause) and search out various approaches for relief including complementary and alternative treatments such as phytoestrogens. Phytoestrogens are plant compounds that have a similar chemical structure to that of estrogen. Common examples include red clover and soy isoflavones. S-equol, a metabolite of soy isoflavone daidzein, is naturally produced by intestinal bacteria following soy consumption. However, only 20–30% of the US population are equol producers, indicating that many may benefit from S-equol supplementation. The aim of this sampling trial was to assess the impact of a dietary S-equol supplement on menopausal symptoms. MethodsPerimenopausal and menopausal women were recruited into an open label trial on a rolling basis; subjects were provided a four week supply of a S-equol supplement 3 times resulting in 12 week supplementation. Participants were instructed to consume a 5 mg S-equol tablet twice daily for total of 10 mg S-equol daily. Participants completed an online survey at weeks 0, 3, 7, and 12 during the trial. They reported on the occurrence of various menopausal symptoms including: anxiety, change in sexual desire, depression, fatigue, hair loss, hot flashes, mood swings, memory problems, night sweats, sleep disturbances, and weight gain. ResultsBaseline survey (n = 1164) showed common menopausal transition symptoms include: anxiety (78%), change in sexual desire (83%), depression (70%), fatigue (89%), hair loss (57%), hot flashes (97%), mood swings (85%), memory problems (86%), night sweats (95%), sleep disturbances (95%), and weight gain (81%). After 12 weeks of S-equol supplementation (n = 247), 90% of women noted a difference in one or more menopausal symptoms. Among individuals that noted any difference in one or more symptoms (n = 223), 82%, 71% and 40% noticed a difference in hot flashes, night sweats, and sleep disturbances, respectively. Over 90% of the differences observed for hot flashes, night sweats, and sleep disturbances were reported as improvements. ConclusionsFollowing 12 week supplementation of 10 mg S-equol per day, over 90% of women identified an effect on 1 or more menopausal symptom. For the most common symptoms (hot flashes, night sweats, and sleep disturbances), over 90% were reported as improved. Funding SourcesThis study was funded by Pharmavite LLC.

DEMO REVIEW - Menopause

The female reproductive system matures in a continuous, natural process from menarche to menopause as the finite numbers of oocytes produced during fetal development are gradually lost to ovulation and senescence. Menopause is defined as the permanent cessation of menses; by convention, the diagnosis of menopause is not made until the individual has had 12 months of amenorrhea. Menopause is thus characterized by the menstrual changes that reflect oocyte depletion and subsequent changes in ovarian hormone production. However, hormonal changes, rather than the cessation of menstruation itself, cause the manifestations that occur around the time of menopause. Therefore, a woman who has undergone a hysterectomy but who retains her ovaries can experience normal menopausal symptoms as oocyte depletion leads to changes in estrogen levels, even though cessation of menstruation occurred with surgery. This review covers definitions, natural menopause, menopausal transition and postmenopausal symptom management, and premature ovarian insufficiency. Figures show stages of reproductive aging, serum concentrations of hormones during menopausal transition and postmenopause, hormonal changes associated with reproductive aging, symptoms of menopausal transition and menopause, treatment algorithm(s), and Women’s Health Initiative findings: risks and benefits of estrogen alone and estrogen plus progestin by age group: 50 to 59, 60 to 69, and 70 to 79 years. Tables list target tissues, physical manifestations, and menopausal symptoms; selective estrogen receptor modulators used in postmenopausal women; differential diagnosis and evaluation of common menopausal symptoms; estrogen doses; progestogen dosing for endometrial protection; nonhormonal pharmaceutical hot flash therapies; and pharmacologic therapy for genitourinary atrophy. This review contains 6 highly rendered figures, 7 tables, and 119 references.

Muscle and joint pains in middle-aged women are associated with insomnia and low grip strength: a cross-sectional study

Background: Although muscle and joint pains are among the most common symptoms in menopausal transition, their underlying mechanisms are not precisely known. This study aimed to investigate the factors associated with myalgia and arthralgia in middle-aged women.Methods: We analyzed in a cross-sectional manner the first-visit records of 305 Japanese women aged 40–59 years who enrolled in a health and nutrition education program at a menopause clinic. The prevalence of muscle and joint pains was estimated according to the participants’ responses to the Menopausal Health-Related Quality of Life Questionnaire. Background characteristics including age, menopause status, body composition, cardiovascular parameters and physical fitness, as well as other menopausal symptoms including vasomotor symptoms, insomnia, depression and anxiety, were assessed for associations with daily myalgia and arthralgia.Results: The percentage of women who were bothered by muscle and joint pains almost every day of the previous week was 56.1%. Characteristics associated with these symptoms were: low stature; high body fat percentage; low grip strength; and high vasomotor, insomnia, depression and anxiety symptom scores. Multivariate logistic regression analysis revealed that independently associated factors (adjusted odds ratio [95% confidence interval]) for daily myalgia/arthralgia were low hand-grip strength (kgf) (0.92 [0.87–0.97]) and insomnia symptom score (1.20 [1.07–1.34]).Conclusion: Muscle and joint pains are highly prevalent in Japanese middle-aged women. Low grip strength and insomnia are independently associated with these symptoms. Treatment of insomnia in this population might improve myalgia/arthralgia, and in turn, help restore grip strength, or treatment of hand pain might conversely reduce insomnia in addition to improvement in grip strength.

Menopause

The female reproductive system matures in a continuous, natural process from menarche to menopause as the finite numbers of oocytes produced during fetal development are gradually lost to ovulation and senescence. Menopause is defined as the permanent cessation of menses; by convention, the diagnosis of menopause is not made until the individual has had 12 months of amenorrhea. Menopause is thus characterized by the menstrual changes that reflect oocyte depletion and subsequent changes in ovarian hormone production. However, hormonal changes, rather than the cessation of menstruation itself, cause the manifestations that occur around the time of menopause. Therefore, a woman who has undergone a hysterectomy but who retains her ovaries can experience normal menopausal symptoms as oocyte depletion leads to changes in estrogen levels, even though cessation of menstruation occurred with surgery. This review covers definitions, natural menopause, menopausal transition and postmenopausal symptom management, and premature ovarian insufficiency. Figures show stages of reproductive aging, serum concentrations of hormones during menopausal transition and postmenopause, hormonal changes associated with reproductive aging, symptoms of menopausal transition and menopause, treatment algorithm(s), and Women’s Health Initiative findings: risks and benefits of estrogen alone and estrogen plus progestin by age group: 50 to 59, 60 to 69, and 70 to 79 years. Tables list target tissues, physical manifestations, and menopausal symptoms; selective estrogen receptor modulators used in postmenopausal women; differential diagnosis and evaluation of common menopausal symptoms; estrogen doses; progestogen dosing for endometrial protection; nonhormonal pharmaceutical hot flash therapies; and pharmacologic therapy for genitourinary atrophy. This review contains 6 highly rendered figures, 7 tables, and 119 references.

Acupuncture for symptoms in menopause transition: a randomized controlled trial

Acupuncture has been used for women during menopause transition, but evidence is limited. We sought to evaluate the efficacy of electroacupuncture on relieving symptoms of women during menopause transition. We conducted a prospective, multicenter, randomized, participant-blinded trial in China mainland. Subjects were randomized to receive 24 treatment sessions of electroacupuncture at traditional acupoints or sham electroacupuncture at nonacupoints over 8 weeks with 24 weeks' follow-up. Primary outcome was the change from baseline in the total score of Menopause Rating Scale at week 8. Secondary outcomes included the changes from baseline in the average 24-hour hot flash score, the Menopause Rating Scale subscale scores, the total score of Menopause-Specific Quality of Life Questionnaire and its subscales, and serum female hormones. All analyses were performed with a 2-sided P value of < .05 considered significant based on the intention-to-treat principle. A total of 360 women (180 in each group) with menopause-related symptoms during menopause transition were enrolled from June 9, 2013, through Dec 28, 2015. At week 8, the reduction from baseline in the Menopause Rating Scale total score was 6.3 (95% confidence interval, 5.0-7.7) in the electroacupuncture group and 4.5 (95% confidence interval, 3.2-5.8) in the sham electroacupuncture group with a between-group difference of 1.8 (95% confidence interval, 0.9-2.8; P= .0002), less than the minimal clinically important difference of 5 points' reduction. For secondary outcomes, the between-group differences for the decrease in the mean 24-hour hot flash score were significant at weeks 8, 20, and 32, but all were less than the minimal clinically important difference in previous reports. Interestingly, the between-group differences for the Menopause-Specific Quality of Life Questionnaire total score reduction were 5.7 at week 8, 7.1 at week 20, and 8.4 at week 32, greater than the minimal clinically important difference of 4 points. Changes from baseline in follicle-stimulating hormone, luteinizing hormone, and estradiol levels at weeks 8 and 20 (P > .05 for all), with the exception of follicle-stimulating hormone/luteinizing hormone ratios (P= .0024 at week 8 and .0499 at week 20), did not differ between groups. Among women during menopause transition, 8 weeks' electroacupuncture treatment did not seem to relieve menopausal symptoms, even though it appeared to improve their quality of life. Generalizability of the trial results may be limited by mild baseline menopausal symptoms in the included participants.

Neuropéptide Y, anti-mullerian and reproductive hormones and their relationship with vasomotor symptoms in menopausal transition

Neuropéptide Y, anti-mullerian and reproductive hormones and their relationship with vasomotor symptoms in menopausal transition

Climacteric-related symptoms in menopause transition and beyond: a prospective 19-year follow-up study on previously hysterectomized women

Only a few extended follow-up studies have investigated the natural progress of climacteric-related symptoms. The results have been conflicting. Thus, our aim was to evaluate, through a 19-year longitudinal study, whether these symptoms decrease or disappear as time elapses after menopause. Our study was a prospective follow-up survey of 65 hysterectomized peri or postmenopausal women. The women were interviewed at the baseline, and at 6 and 19 years thereafter. Changes in various climacteric-related symptoms were evaluated by repeated-measures analysis of variance with time as the independent variable. The analyses were adjusted for baseline age, body mass index, employment, and use of hormone therapy. Climacteric-related symptoms were evaluated with the Women's Health Questionnaire, of which we included seven symptom domains (vasomotor, sleep, depressive, anxiety/fears, cognitive, sexual, and somatic). Vasomotor symptoms decreased remarkably during the follow-up period. In addition, a statistically significant decrease was found in sleep problems and cognitive difficulties. However, the decrease was minor, and thus probably clinically insignificant. The only symptom with notable decrease was vasomotor symptoms. The etiology of other symptoms, commonly connected to menopause transition, is probably multifactorial and not substantially dependent on the climacteric.

Hormone therapy effective in preventing depressive symptoms in menopause transition

Transdermal estradiol plus intermittent micronized progesterone over 12 months was more effective than placebo in preventing the development of clinically significant depressive symptoms in perimenopausal and early postmenopausal women, a randomized trial has found. The benefits seen from hormonal therapy did not extend to women in later stages of the menopause transition, according to the researchers. Study results were published online Jan. 10 in JAMA Psychiatry.

A new animal model for menopausal transition: combination of ovariectomy and empty bottle stimulation

Previous small animal models for menopausal transition are mainly performed to mimic the biochemical changes of patients with menopausal transition. The psychological symptoms in animal models are often overlooked. To mimic clinical situation, we developed a new mouse model of menopausal transition: the combination of bilateral ovariectomy (OVX) and empty bottle stimulation (EBS). After OVX and 21 days of EBS, behavioral test and pentobarbital-induced sleep test were carried out. Then all the animals were euthanized for further investigations. Compared with the control group, the combination of OVX and EBS group (OVX + EBS) showed higher bodyweight, lower organ index of uteri, and lower concentrations of serum estradiol. In addition, behavioral manifestations, sleep quality, and morphologic features in OVX + EBS group showed significant differences compared with the control group. OVX alone or EBS alone failed to include all the changes of OVX + EBS group. These findings indicate ovariectomy or EBS alone could not well mimic the symptoms of menopausal transition. The combination of bilateral ovariectomy and EBS offers an easy and repeatable method for building comprehensive menopausal transition model in mice.

Electrodermal response to auditory stimuli in relation to menopausal transition period.

Menopause-associated estrogen deficiency results in climacteric symptoms like vasomotor, psychological and sleep disturbances that cause a decline in the quality of life. Electrodermal activity (EDA), a psychophysiological measure, reflects sympathetic activity, which provides information associated with individual's emotions, phobias, arousal, cognition and stress. The study compared electrodermal response to auditory stimuli between postmenopausal and perimenopausal women with and without symptoms and also correlated the association of scores of the menopausal transition symptoms with indices of EDA. Seventy-five women volunteers in the age group of 45-60 years, 25 in each group who were postmenopausal, perimenopausal with symptoms and perimenopausal without symptoms, were recruited. Indices of EDA such as latency, amplitude, rise time and half recovery time for auditory stimuli were quantified using standard techniques. Symptoms of menopausal transition were assessed using Women Health Questionnaire. Analysis using one-way analysis of covariance after controlling for variables showed that mean skin conductance level of EDA was significantly higher among perimenopausal women with symptoms compared with perimenopausal women without symptoms and postmenopausal women. Perimenopausal women with symptoms had significantly lower latency of response when compared with other groups. Analysis using Pearson correlation test showed that latency of EDA had significant positive correlation and amplitude had significant negative correlation with menopausal transition symptom scores. Perimenopausal women with symptoms exhibited increased sympathetic sudomotor activity when compared with perimenopausal women without symptoms and postmenopausal women as measured by EDA. Further, select measures of EDA exhibited significant association with the symptoms of menopausal transition.

Depression and its link to other symptoms in menopausal transition

Abstract Background: Menopausal transition may occur between 45 and 55 years old and take 3–9 years. During this transition, the hormonal changes may contribute to the physical and psychological complaints in women. One of the psychological complaints is a sign of depression. However, not all of the women will experience those complaints. Objective: To assess the relationship between depression in menopause transition and other menopausal symptoms and factors contribute to depression among Indonesian people. Methods: Cross-sectional study on 133 female subjects between 45 and 55 years old. Depression measured using Beck Depression Inventory-II (BDI-II), and menopausal symptoms were collected using Menopause Rating Scale (MRS). The comparison and relation were assessed for every aspect regarding depression and menopausal symptoms. Results: Out of 133 subjects, depression was found in 17 subjects (12.8%). Somato-vegetative symptoms were complained by 50.4% and urogenital symptoms by 75.9% subjects. There was significant correlation between depression and somato-vegetative (p = 0.008) as well as urogenital complaints among women who underwent menopause transition (p = 0.016). These findings were consistent with previous studies. Conclusion: Depression on menopausal transition significantly correlated with somato-vegetative and urogenital symptoms among women. Future investigations should be conducted with a cohort design to observe mood alterations during the menopause transition.

Efficacy of Tribulus terrestris L. (fruits) in menopausal transition symptoms: A randomized placebo controlled study

IntroductionTo compare the efficacy of Tribulus terrestris Linn. (fruits) with placebo in menopausal transition symptoms. Materials and methodsPerimenopausal women (n=60) were equally randomized either to receive orally 3g powder of Tribulus or placebo twice daily for 8 weeks in this single-blind, placebo-controlled, parallel study. The primary outcome included the total score of Menopause Rating Scale (MRS). The secondary outcomes included the MRS composite subscale scores and severity of symptoms. Statistical tests were used to analyze the results. ResultsAt post-intervention, Tribulus in comparison to placebo showed a statistically significant reduction in the severity of menopausal transition symptoms, MRS total and composite subscale scores (P<0.001) without any significant side effects. The intra-group comparison showed a significant reduction in the MRS total, subscale scores (P<0.001) and severity of symptoms (P<0.05). At post-intervention, Tribulus group showed higher mean reduction in MRS score than the placebo group in the MRS total mean score (19.80 vs 11.97). Tribulus group showed comparatively higher mean reduction in MRS score than the placebo group in somatic (8.23 vs 4.72), psychological (6.63 vs 4.47) and urogenital (4.93 vs 2.73) composite subscale scores with a statistically significant difference (P<0.001) at post-intervention. ConclusionTribulus was more effective than placebo for alleviation of menopausal transition symptoms and may offer a safe alternative to hormone replacement therapy.

Clinical research of effects of retaining the uterine blood supply hysterectomy on ovarian function

Objective To evaluate the effect of hysterectomy for reserving the uterine blood supply on ovarian endocrine function and on symptoms of menopausal transition. Methods Uterine benign lesions should be line the uterus times total resection in 100 patients were randomly divided into hysterectomy group of retaining uterus vascular supply group(research group,n = 50) and traditional total hysterectomy group (the control group, n = 50), comparing two groups in operation time, intraoperative bleeding ,postoperative fever and residual polyp, blood tests were taken to check the serum sex hormone levels change and clinical observation for perimenopausal symptoms before and postoperative three months, six months, one year and two years at the same time respectively. Results There was no significant difference between two groups in operation time, intraoperative blood loss, postoperative fever and residual polyp (P 0.05),the symptoms of the menopausal transition hardly appear; postoperative FSH, LH increased significantly in control group (P<0.05),E2 decrease (P<0.05), perimenopausal symptoms appeared more often. Conclusion The effect of uterus hysterectomy for retaining vascular supply on ovarian endocrine function is less than the traditional total hysterectomy, this operation has a certain importance to preserve ovarian function and delay the occurrence of premature ovarian aging.

How women manage their type 1 diabetes during the menopausal transition: a qualitative study using a grounded theory approach

AbstractThis study aimed to explore the experiences of women with type 1 diabetes during the menopausal transition using a grounded theory approach and, from the data, develop a substantive theory with implications for service users and service providers.A qualitative exploratory research framework was employed using a grounded theory approach. Data were collected from 10 participants using transcribed audiotaped semi‐structured interviews and field notes. The transcripts, audio recordings and field notes were reviewed and a coding process facilitated data analysis. This approach enabled themes to emerge from the data and ultimately a theory.A wide range of conceptions was revealed. Data are presented in seven categories that reflect the experience of the subjects: ‘Blank wall’ (relates to the lack of information regarding menopause and diabetes); ‘Juggling game’ (relates to glycaemic control); Anxiety and fear; ‘Haywire’ (relates to the signs and symptoms of menopausal transition); Treating symptoms; Depression and mood; and ‘I'm old’ (relates to ageing and mortality).A substantive theory emerged. Absence of information regarding the menopause and its impact on type 1 diabetes (‘Blank wall’) was identified as the main problem facing women with type 1 diabetes during their menopausal transition. The findings could enable practitioners to identify the types of information, advice and support that should be made available to these women, and contribute to the limited knowledge base currently available. The findings indicate also that further research into this under‐studied but important area of diabetes care is required.