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Journal of the American Heart... Aug 2023Background Premature and early menopause are independently associated with greater risk of cardiovascular disease (CVD). However, mechanisms linking age of menopause...
Background Premature and early menopause are independently associated with greater risk of cardiovascular disease (CVD). However, mechanisms linking age of menopause with CVD remain poorly characterized. Methods and Results We measured 71 circulating CVD protein biomarkers in 1565 postmenopausal women enrolled in the FHS (Framingham Heart Study). We examined the association of early menopause with biomarkers and tested whether early menopause modified the association of biomarkers with incident cardiovascular outcomes (heart failure, major CVD, and all-cause death) using multivariable-adjusted linear regression and Cox models, respectively. Among 1565 postmenopausal women included (mean age 62 years), 395 (25%) had a history of early menopause. Of 71 biomarkers examined, we identified 7 biomarkers that were significantly associated with early menopause, of which 5 were higher in women with early menopause including adrenomedullin and resistin, and 2 were higher in women without early menopause including insulin growth factor-1 and CNTN1 (contactin-1) (Benjamini-Hochberg adjusted <0.1 for all). Early menopause also modified the association of specific biomarkers with incident cardiovascular outcomes including adrenomedullin (<0.05). Conclusions Early menopause is associated with circulating levels of CVD protein biomarkers and appears to modify the association between select biomarkers with incident cardiovascular outcomes. Identified biomarkers reflect several distinct biological pathways, including inflammation, adiposity, and neurohormonal regulation. Further investigation of these pathways may provide mechanistic insights into the pathogenesis, prevention, and treatment of early menopause-associated CVD.
Topics: Female; Humans; Middle Aged; Cardiovascular Diseases; Adrenomedullin; Menopause, Premature; Menopause; Biomarkers; Risk Factors
PubMed: 37548169
DOI: 10.1161/JAHA.122.028849 -
Maturitas Jul 2024Thyroid diseases are common in women in their late reproductive years; therefore, thyroid disease and menopause may co-exist. Both conditions may present with a wide...
INTRODUCTION
Thyroid diseases are common in women in their late reproductive years; therefore, thyroid disease and menopause may co-exist. Both conditions may present with a wide range of symptoms, leading to diagnostic challenges and delayed diagnosis. Aim To construct the first European Menopause and Andropause Society (EMAS) statement on thyroid diseases and menopause.
MATERIALS AND METHODS
Literature review and consensus of expert opinion (EMAS executive board members/experts on menopause and thyroid disease).
SUMMARY RECOMMENDATIONS
This position paper highlights the diagnostic and therapeutic dilemmas in managing women with thyroid disease during the menopausal transition, aiming to increase healthcare professionals' awareness of thyroid disorders and menopause-related symptoms. Clinical decisions regarding the treatment of both conditions should be made with caution and attention to the specific characteristics of this age group while adopting a personalized patient approach. The latter must include the family history, involvement of the woman in the decision-making, and respect for her preferences, to achieve overall well-being.
Topics: Female; Humans; Menopause; Thyroid Diseases
PubMed: 38658290
DOI: 10.1016/j.maturitas.2024.107991 -
Nursing Open Jan 2024The aim of the study was to explore and understand the organizational culture of a workplace in terms of support and well-being for staff experiencing perimenopausal and... (Review)
Review
AIM
The aim of the study was to explore and understand the organizational culture of a workplace in terms of support and well-being for staff experiencing perimenopausal and menopausal symptoms at work.
DESIGN
It is widely acknowledged that perimenopause and menopause symptoms are experienced by a large percentage of the female workforce. There is a lack of research into how nurses are supported through menopause (Cronin et al. Issues in Mental Health Nursing, 42, 2021, 541-548). The perimenopause and menopause transition can be a challenging time where many may require symptom management and support (RCN, The Menopause and Work: Guidance for RCN Representatives, 2020). This paper presents a case study research (CSR) approach to examine one healthcare organization.
METHODS
CSR design was used: A survey distributed to all staff employed, a review of the available documentation on menopause and interviews with managers from different levels of the organization. The COREQ consolidated criteria was used for reporting the qualitative research reported this study.
RESULTS
The case study generated both quantitative and qualitative data using surveys, interviews and documentation. Data from the organization (n = 6905) showed a majority female workforce of 81.9% with 40.6% aged between 41 and 55 years old, meaning a third of the organization working through perimenopause and menopause. Survey responses (n = 167) collected biographical and psychometric data on the prevalence of perimenopausal and menopausal symptoms. Seven managers were interviewed highlighting two themes: Access to support and culture of menopause and 13 documents from the organization on menopause were analysed for content. The study design permitted an iterative approach to data collection and providing an in-depth understanding of the needs and support for those experiencing perimenopause and menopause. The findings help healthcare organizations to understand their workforce and take in to account the larger numbers of female employees particularly nurses with the need to provide person-centred support mechanisms and an organizational approach for all employees.
Topics: Female; Humans; Adult; Middle Aged; Menopause; Perimenopause; Case-Control Studies; Workforce; Research Design
PubMed: 38268277
DOI: 10.1002/nop2.2058 -
Best Practice & Research. Clinical... Jan 2024A continuous process of bone turnover is central to bone health and strength. If bone resorption exceeds bone formation, bone strength deteriorates with resultant... (Review)
Review
A continuous process of bone turnover is central to bone health and strength. If bone resorption exceeds bone formation, bone strength deteriorates with resultant fractures. Osteoporosis is defined by a fracture or bone mineral density. The lack of ovarian estrogen after menopause causes a significant loss in bone strength, placing women at higher risk of osteoporosis. The probability of future fractures can be calculated by identifying risk factors in all menopausal women. Preventive action starts with a bone-friendly lifestyle. The need for and type of interventive medication can best be determined by classifying fracture risk as low, high, or very high using a combination of fracture history, bone mineral density, 10-year fracture probability or country-specific values. As osteoporosis is an incurable disease, treatment should be seen as a lifelong strategy consisting of the correct sequencing of available bone-specific drugs and appropriate drug-free periods when applicable.
Topics: Female; Humans; Bone Density; Osteoporosis; Menopause; Fractures, Bone; Bone and Bones
PubMed: 37230869
DOI: 10.1016/j.beem.2023.101782 -
Best Practice & Research. Clinical... Jan 2024To summarise the dosing options, regimens, pharmacokinetics, risks and benefits of oestrogen-based therapies for the treatment of menopausal symptoms. (Review)
Review
PURPOSE
To summarise the dosing options, regimens, pharmacokinetics, risks and benefits of oestrogen-based therapies for the treatment of menopausal symptoms.
METHODS
A review of the literature was undertaken using multiple databases. Randomised trials, observational studies, meta-analyses and review papers were included.
RESULTS
Multiple systemic preparations of oestrogen exist and all appear comparable in terms of efficacy. They differ by pharmacokinetics and those preparations that avoid hepatic metabolism have a lower risk profile in general although their use can be limited by skin barriers or patient acceptability. All vaginal oestrogen treatments are comparable in efficacy and have not been associated with any health risks. Side-effects between all preparations differ.
CONCLUSIONS
With regards to oestrogen treatments there is not a one size fits all. Multiple treatments are available and a clinician's role is to guide and help women make evidence based, unbiased and informed choices.
Topics: Humans; Female; Estrogens; Hormone Replacement Therapy; Menopause
PubMed: 37453831
DOI: 10.1016/j.beem.2023.101789 -
Maturitas Sep 2023Menopausal transition, resulting from a decline in estrogen concentrations, may compromise musculoskeletal health. However, it is unclear if early menopause (defined as... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Menopausal transition, resulting from a decline in estrogen concentrations, may compromise musculoskeletal health. However, it is unclear if early menopause (defined as age at menopause <45 years) and premature ovarian insufficiency (defined as age at menopause <40 years) are associated with increased risk of sarcopenia. The aim of this systematic review and meta-analysis was to synthesize studies evaluating the association between age at menopause and risk of sarcopenia.
METHODS
A comprehensive search was conducted in PubMed, CENTRAL and Scopus, up to 31 December 2022. Data were expressed as standardized mean difference with 95 % confidence intervals. The I index was employed to evaluate heterogeneity.
RESULTS
Six studies were included in the qualitative and quantitative analysis, with a total of 18,291 post-menopausal women. Compared with women of normal age at menopause (>45 years), women with early menopause demonstrated lower muscle mass, assessed by appendicular skeletal muscle mass/body mass index [standardized mean difference (SMD) -0.14, 95 % confidence interval (CI) -0.20 to -0.07, p < 0.001; I 0%]. However, no differences in muscle strength, assessed by handgrip strength (SMD -0.15, 95 % CI -0.31 to 0.01, p = 0.071; I 72%), and muscle performance, assessed by gait speed (SMD -0.11, 95 % CI -0.29 to 0.05, p = 0.18; I 79%), were found. Women with premature ovarian insufficiency had lower handgrip strength (SMD -0.3, 95 % CI -0.58 to -0.01, p = 0.04; I 74.6 %) and gait speed (SMD -0.13, 95 % CI -0.23 to -0.04, p = 0.004; I 0%) compared with women of normal age at menopause.
CONCLUSION
Early menopause is associated with reduced muscle mass and premature ovarian insufficiency with reduced muscle strength and performance compared with normal age at menopause.
Topics: Female; Humans; Sarcopenia; Hand Strength; Menopause, Premature; Primary Ovarian Insufficiency; Menopause; Muscle, Skeletal
PubMed: 37331156
DOI: 10.1016/j.maturitas.2023.05.006 -
Menopause (New York, N.Y.) Jun 2024
Topics: Humans; Female; Menopause; Hot Flashes
PubMed: 38787352
DOI: 10.1097/GME.0000000000002379 -
Acta Obstetricia Et Gynecologica... Oct 2023Endometriosis is largely considered a premenopausal disease with symptoms often improving during menopausal transition. However, 2%-4% of postmenopausal women are...
Endometriosis is largely considered a premenopausal disease with symptoms often improving during menopausal transition. However, 2%-4% of postmenopausal women are affected by endometriosis symptoms. At the same time, many peri- and postmenopausal women experience menopausal symptoms and inquire about treatment. Because of the estrogen-dependent nature of endometriosis, treatment with menopausal hormone therapy requires careful assessment of the patient but should nevertheless be considered. Recurrence of endometriosis symptoms and risk for malignant transformation are potential risks to weigh when prescribing menopausal hormonal therapy. Choice of treatment should be guided by the presence and severity of current endometriosis symptoms, nature of menopausal symptoms, risk assessment of potential contraindications for treatment in patient history, and preferences of the woman after an informative discussion. Recurrence of endometriosis symptoms in a postmenopausal patient should always prompt rigorous evaluation, both in the presence and absence of hormonal treatment. Many recommendations on the topic are based on expert opinion and new studies are urgently needed to obtain evidence for optimal patient care.
Topics: Female; Humans; Endometriosis; Estrogen Replacement Therapy; Menopause; Hormone Replacement Therapy; Risk Assessment
PubMed: 37186303
DOI: 10.1111/aogs.14583 -
JAMA Network Open Sep 2023Although premenstrual disorders (PMDs) end at menopause, it is unclear whether they are associated with the timing and symptom severity of menopause.
IMPORTANCE
Although premenstrual disorders (PMDs) end at menopause, it is unclear whether they are associated with the timing and symptom severity of menopause.
OBJECTIVE
To prospectively examine whether women with PMDs have increased risks of early menopause and menopause-related vasomotor symptoms (VMS).
DESIGN, SETTING, AND PARTICIPANTS
This population-based cohort study was nested in the Nurses' Health Study II (data collected from questionnaire sent between June 1991 and June 2017). Analysis of menopause timing included participants who did not have natural or surgical menopause before study entry, while the analysis of VMS was restricted to women who provided information on VMS. Data were analyzed from August 2022 to March 2023.
EXPOSURES
PMDs were identified by self-reported diagnosis and confirmed with symptom questionnaires from 1991 to 2005. Participants were age-matched to women without PMD diagnoses and confirmed absence of or minimal premenstrual symptoms.
MAIN OUTCOMES AND MEASURES
During follow-up through 2017, timing of natural menopause was assessed biennially, and VMS were assessed in 2009, 2013, and 2017. The association of PMDs with early menopause was assessed by Cox proportional hazards models and with VMS by logistic regression models.
RESULTS
Of 1220 included women with PMDs, the median (IQR) age was 40.7 (37.3-43.8) years; of 2415 included women without PMDs, the median (IQR) age was 41.7 (38.3-44.8) years. The median (IQR) follow-up in this study was 20.3 (17.8-22-2) years. Early natural menopause (menopause before age 45 years) was reported by 17 women with PMDs (7.1 per 1000 person-years) and 12 women without PMDs (2.7 per 1000 person-years; adjusted hazard ratio, 2.67; 95% CI, 1.27-5.59). In addition, 795 women with PMDs (68.3%) and 1313 women without PMDs (55.3%) reported moderate or severe VMS (adjusted odds ratio, 1.68; 95% CI, 1.32-2.14). There was no observed association between PMDs and mild VMS (adjusted odds ratio, 0.99; 95% CI, 0.76-1.28).
CONCLUSIONS AND RELEVANCE
In this cohort study of US women, PMDs were associated with increased risks of early menopause and moderate or severe VMS. PMDs may be indicative of underlying physiology linked to early menopause and VMS, suggesting a phenotype observable during the reproductive years that may allow clinicians to target women at risk of earlier menopause and subsequent health risks later in the life course.
Topics: Female; Humans; Adult; Middle Aged; Cohort Studies; Menopause; Menopause, Premature; Logistic Models; Odds Ratio
PubMed: 37725375
DOI: 10.1001/jamanetworkopen.2023.34545 -
Menopause (New York, N.Y.) Nov 2023
Topics: Female; Humans; Postmenopause; Vagina; Menopause; Microbiota
PubMed: 37889611
DOI: 10.1097/GME.0000000000002270