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Malaysian Family Physician : the... 2023Menopause is an important phase in the life of older women. Women's life expectancy has increased worldwide. As women experience and perceive menopause differently...
Menopause is an important phase in the life of older women. Women's life expectancy has increased worldwide. As women experience and perceive menopause differently depending on their personal, family and sociocultural backgrounds, perimenopausal symptoms can often go unnoticed and missed by general practitioners. General practitioners are uniquely placed in the healthcare delivery pyramid to close this gap and improve patients' quality of life by identifying perimenopausal signs and symptoms early. This article shares knowledge about continuing medical education for general practitioners to close the existing gap. As there is great variability within each menopausal woman's experience as well as among individual women, there is a need to individualise and render personalised care. By being able to discuss accepted and safe standards of care and by advocating for a holistic approach incorporating both non-pharmacological and pharmacological strategies, general practitioners would be able to improve the confidence of their patients for better health outcomes.
PubMed: 37719692
DOI: 10.51866/cm.264 -
Maturitas Jun 2024Abnormal uterine bleeding is a frequent symptom in the perimenopause. Causes are numerous, ranging from physiological reactions due to decreasing/unstable ovarian... (Review)
Review
Abnormal uterine bleeding is a frequent symptom in the perimenopause. Causes are numerous, ranging from physiological reactions due to decreasing/unstable ovarian function to premalignant and malignant conditions. Benign findings such as endometrial polyps and myomas increase with age, leading to more abnormal uterine bleeding in the perimenopause. Cervical and vaginal causes of abnormal uterine bleeding should be excluded by speculum examination. Sexually transmitted diseases or pregnancy should be ruled out. Measurement of haemoglobin and iron levels, human chorion gonadotropin and thyroid hormones are relevant in selected cases. Transvaginal ultrasound is an ideal first step for the evaluation of perimenopausal abnormal uterine bleeding. Saline or gel contrast sonohysterography improves the diagnostic accuracy. Based on the ultrasound findings, invasive procedures such as endometrial biopsy or hysteroscopy can be planned. Once premalignant and malignant causes are excluded, the necessity for treatment can be evaluated in collaboration with the patient. Heavy menstrual bleeding causing anaemia will need immediate treatment. In less severe cases and in intermenstrual bleeding, expectant management can be considered. Hormonal treatment, such as oral progestogens, combined oral contraceptives or insertion of the levonorgestrel intrauterine system, may be a possibility if anovulatory bleeding is interfering with quality of life. The amount of bleeding can be reduced both by antifibrinolytic and non-steroidal anti-inflammatory drugs, progestogens and the levonorgestrel intrauterine system. Focal intrauterine lesions such as endometrial polyps or submucous myomas may require operative hysteroscopic procedures. Endometrial ablation or endometrial resection are good choices in selected cases, but some women will need a hysterectomy to treat their abnormal uterine bleeding in perimenopause.
Topics: Humans; Female; Perimenopause; Uterine Hemorrhage
PubMed: 38412750
DOI: 10.1016/j.maturitas.2024.107944 -
JAMA Jan 2024
Topics: Female; Humans; Dementia; Estrogen Replacement Therapy; Estrogens; Menopause; Postmenopause
PubMed: 38109125
DOI: 10.1001/jama.2023.23784 -
Climacteric : the Journal of the... Aug 2023It is estimated that the 25-50% of women who are reaching menopause every year report symptoms related to the genitourinary syndrome of menopause (GSM). The symptoms are... (Review)
Review
It is estimated that the 25-50% of women who are reaching menopause every year report symptoms related to the genitourinary syndrome of menopause (GSM). The symptoms are not due simply to lack of estrogen. One possible contributing cause of symptoms is the vaginal microbiota. The vaginal microbiota is a dynamic entity and plays a critical role in the pathogenic interplay of postmenopausal changes. Treatment of this syndrome depends on the severity and type of the symptoms and on the preferences and expectations of women. As there are many treatment options, therapy should be individualized. While new evidence on the role of Lactobacilli in premenopause is emerging, the role of Lactobacilli is still unclear in GSM and the impact of microbiota on vaginal health remains conflictual. However, some reports show promising data on the effect of probiotic therapy in menopause. In the literature there are few studies and small population samples on the role of an exclusive therapy with Lactobacilli and further data will be mandatory. Studies involving large numbers of patients and different intervention periods will be necessary to obtain evidence of the preventive and curative role of vaginal probiotics.
Topics: Female; Humans; Menopause; Vagina; Vaginal Diseases; Premenopause; Perimenopause; Genital Diseases, Female; Atrophy
PubMed: 37366082
DOI: 10.1080/13697137.2023.2223923 -
CMAJ : Canadian Medical Association... Jul 2023
Topics: Female; Humans; Perimenopause
PubMed: 37524397
DOI: 10.1503/cmaj.148952-l -
The Psychiatric Clinics of North America Sep 2023Depression is a disabling condition that often leads to significant burden. Women are more vulnerable to depression during reproductive-related "windows of... (Review)
Review
Depression is a disabling condition that often leads to significant burden. Women are more vulnerable to depression during reproductive-related "windows of vulnerability" such as the menopause transition and early postmenopausal years. This heightened vulnerability can be attributed, at least in part, to the neuromodulatory effects of estrogen on mood and cognition and the exposure to rapid fluctuations of estradiol levels during midlife years. The management of midlife depression can be challenging due to the presence and severity of other complaints such as vasomotor symptoms and sleep disturbances. Psychopharmacologic, behavioral, and hormonal interventions should be part of the treatment armamentarium.
Topics: Female; Humans; Depression; Menopause; Estrogens; Cognition
PubMed: 37500244
DOI: 10.1016/j.psc.2023.04.004 -
Menopause (New York, N.Y.) May 2024The increasing attention to the management of perimenopausal and postmenopausal women parallels the growth of the aging population. Although hormone therapy is commonly... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
The increasing attention to the management of perimenopausal and postmenopausal women parallels the growth of the aging population. Although hormone therapy is commonly used to alleviate menopausal symptoms, it carries a potential risk of cancer. Recently, mind-body exercises have emerged as innovative approaches for improving menopausal symptoms and bone health. However, research findings have needed to be more consistent, highlighting the significance of this study's systematic review of mind-body exercise effects on perimenopausal and postmenopausal women.
OBJECTIVE
This study aims to evaluate the impact of mind-body exercises, including tai chi, yoga, Pilates, qigong, baduanjin, and mindfulness-based stress reduction, on bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women.
EVIDENCE REVIEW
Four electronic databases-PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science-were systematically searched from inception until July 2023. The search focused exclusively on randomized controlled trials to examine the impact of mind-body exercise interventions on perimenopausal and postmenopausal women. The methodological quality of the included studies was evaluated using the Cochrane Bias Risk Assessment tool.
FINDINGS
A total of 11 randomized controlled trials, comprising 1,005 participants, were included in the analysis. Traditional meta-analysis indicated that mind-body exercise significantly enhanced bone mineral density in perimenopausal and postmenopausal women compared with control groups, with a standardized mean difference (SMD) of 0.41 (95% CI, 0.17 to 0.66; P = 0.001, I2 = 7%). In addition, significant improvements were observed in sleep quality (SMD, -0.48; 95% CI, -0.78 to -0.17; P = 0.002, I2 = 76%), anxiety reduction (SMD, -0.80; 95% CI, -1.23 to -0.38; P = 0.0002, I2 = 84%), depressive mood (SMD, -0.80; 95% CI, -1.17 to -0.44; P < 0.0001, I2 = 79%), and fatigue (SMD, -0.67; 95% CI, -0.97 to -0.37; P < 0.0001, I2 = 0%).
CONCLUSIONS AND RELEVANCE
The findings of this meta-analysis demonstrate that mind-body exercise positively influences bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women.
Topics: Humans; Female; Perimenopause; Postmenopause; Bone Density; Mind-Body Therapies; Middle Aged; Depression; Sleep Quality; Randomized Controlled Trials as Topic; Anxiety; Fatigue; Exercise; Tai Ji; Yoga
PubMed: 38669625
DOI: 10.1097/GME.0000000000002336 -
Frontiers in Endocrinology 2023Natural menopause is an inevitable biological process with significant implications for women's health. However, the molecular mechanisms underlying menopause are not...
INTRODUCTION
Natural menopause is an inevitable biological process with significant implications for women's health. However, the molecular mechanisms underlying menopause are not well understood. This study aimed to investigate the molecular and cellular changes occurring in the ovary before and after perimenopause.
METHODS
Single-cell sequencing data from the GTEx V8 cohort (30-39: 14 individuals; 40-49: 37 individuals; 50-59: 61 individuals) and transcriptome sequencing data from ovarian tissue were analyzed. Seurat was used for single-cell sequencing data analysis, while harmony was employed for data integration. Cell differentiation trajectories were inferred using CytoTrace. CIBERSORTX assessed cell infiltration scores in ovarian tissue. WGCNA evaluated co-expression network characteristics in pre- and post-perimenopausal ovarian tissue. Functional enrichment analysis of co-expression modules was conducted using ClusterprofileR and Metascape. DESeq2 performed differential expression analysis. Master regulator analysis and signaling pathway activity analysis were carried out using MsViper and Progeny, respectively. Machine learning models were constructed using Orange3.
RESULTS
We identified the differentiation trajectory of follicular cells in the ovary as ARID5B+ Granulosa -> JUN+ Granulosa -> KRT18+ Granulosa -> MT-CO2+ Granulosa -> GSTA1+ Granulosa -> HMGB1+ Granulosa. Genes driving Granulosa differentiation, including RBP1, TMSB10, SERPINE2, and TMSB4X, were enriched in ATP-dependent activity regulation pathways. Genes involved in maintaining the Granulosa state, such as DCN, ARID5B, EIF1, and HSP90AB1, were enriched in the response to unfolded protein and chaperone-mediated protein complex assembly pathways. Increased contents of terminally differentiated HMGB1+ Granulosa and GSTA1+ Granulosa were observed in the ovaries of individuals aged 50-69. Signaling pathway activity analysis indicated a gradual decrease in TGFb and MAPK pathway activity with menopause progression, while p53 pathway activity increased. Master regulator analysis revealed significant activation of transcription factors FOXR1, OTX2, MYBL2, HNF1A, and FOXN4 in the 30-39 age group, and GLI1, SMAD1, SMAD7, APP, and EGR1 in the 40-49 age group. Additionally, a diagnostic model based on 16 transcription factors (Logistic Regression L2) achieved reliable performance in determining ovarian status before and after perimenopause.
CONCLUSION
This study provides insights into the molecular and cellular mechanisms underlying natural menopause in the ovary. The findings contribute to our understanding of perimenopausal changes and offer a foundation for health management strategies for women during this transition.
Topics: Female; Humans; Adult; Middle Aged; Ovary; Transcriptome; HMGB1 Protein; Serpin E2; Menopause; Transcription Factors
PubMed: 37564980
DOI: 10.3389/fendo.2023.1004245 -
Osteoporosis International : a Journal... Nov 2023To critically evaluate systematic reviews (SRs) of the Tai Chi (TC) exercise on bone health and provide more recently available evidence. (Review)
Review
PURPOSE
To critically evaluate systematic reviews (SRs) of the Tai Chi (TC) exercise on bone health and provide more recently available evidence.
METHODS
SRs with or without meta-analysis (MA) of TC on bone health were comprehensively searched in eight electronic databases (PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database, and Chinese Scientific Journals Database) and in the international prospective register of systematic reviews of (PROSPERO) from initiation to March 2023. Descriptive analyses of SRs were performed, and reporting and methodological quality of the included SRs were evaluated using the updated version of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2). The certainty of the synthesized evidence was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
RESULTS
Eighteen SRs, 15 with MAs, were included. Forty-nine RCTs and 16 NRSIs with 3956 and 1157 participants, respectively, were included in these SRs. The reporting quality of the included SRs ranged from high to low, but most received critically low AMSTAR-2 scores. Efficacy of TC on nine bone health biomarkers has been explored, covering bone mineral density (BMD) and serum biomarkers. The results showed that compare to non-intervention, perimenopausal and postmenopausal participants who practiced TC may benefit in BMD of the lumbar spine [MD = 0.04, 95% CI (0.02, 0.07)], and femoral neck [MD = 0.04, 95% CI (0.02, 0.06)], but not BMD of the femoral proximal trochanter [MD = 0.02, 95% CI (0.00, 0.03)], ward's triangle [MD = 0.02, 95% CI (-0.01, 0.04)], and femoral shaft [SMD = 0.16, 95% CI (-0.11, 0.44)]. Elders practicing TC may benefit in BMD of the femoral neck [SMD = 0.28, 95% CI (0.10, 0.45)], femoral proximal trochanter [SMD = 0.39, 95% CI (0.05, 0.73)], and ward's triangle [SMD = 0.21, 95% CI (0.05,0.37)], but may not in BMD of lumbar spine [SMD = 0.03, 95% CI (-0.22, 0.27)].
CONCLUSION
We have low certainty that for perimenopausal and postmenopausal women, compare to those with no exercise, TC could improve BMD of the lumbar spine, femoral neck. We also have low certainty that in elder population, TC practitioners may benefit in BMD of femoral neck, and Ward's triangle.
REGISTRATION
PROSPERO (CRD42020173543).
Topics: Aged; Female; Humans; Biomarkers; Bone Density; Femur; Femur Neck; Tai Ji; Systematic Reviews as Topic
PubMed: 37430003
DOI: 10.1007/s00198-023-06830-7