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Revista Da Associacao Medica Brasileira... 2023This study aimed to analyze the evidence and controversies about the use of vaginal energy-based devices (laser and radiofrequency) for treatment of genitourinary... (Review)
Review
OBJECTIVE
This study aimed to analyze the evidence and controversies about the use of vaginal energy-based devices (laser and radiofrequency) for treatment of genitourinary syndrome of menopause, recurrent urinary tract infection, urinary incontinence, and genital prolapse through a literature review.
METHODS
A search of literature databases (PubMed, Medline) was performed for publications in December 2022. Keywords included genitourinary syndrome of menopause, vaginal laxity, vaginal/vulvovaginal atrophy, urinary tract infection, urgency incontinence, frequency, urgency, stress urinary incontinence, genital prolapses AND energy-based devices, AND vaginal laser, AND vaginal radiofrequency, AND CO2 laser, AND Er:YAG laser. Publications in English from the last 7 years were reviewed and selected by the authors.
RESULTS
The literature regarding vaginal energy-based devices in the treatment of urogynecological conditions is primarily limited to prospective case series with small numbers and short-term follow-up. Most of these studies showed favorable results, improvement of symptoms with low risk, or no mention of serious adverse events. Consensus statement documents from major medical societies suggest caution in recommending these therapies in clinical practice until more relevant data from well-designed studies become available.
CONCLUSION
The potential of the vaginal laser and radiofrequency as a therapeutic arsenal for the evaluated urogynecological conditions is great, but qualified research must be done to prove their efficacy and long-term safety, define application protocols, and recommend the use of these technologies in clinical practice.
Topics: Female; Humans; Menopause; Vaginal Diseases; Vagina; Urinary Incontinence, Stress; Lasers, Solid-State
PubMed: 37556648
DOI: 10.1590/1806-9282.2023S129 -
BMC Women's Health Aug 2023To evaluate women's knowledge and attitudes towards the menopause by comparing three groups of women: perimenopause, post menopause and those women not in either the...
OBJECTIVES
To evaluate women's knowledge and attitudes towards the menopause by comparing three groups of women: perimenopause, post menopause and those women not in either the peri or post menopause (other).
METHODS
A 35 question online survey was advertised on social media to evaluate women's attitudes and knowledge of the menopause. Three groups of women were compared: perimenopause, post menopause and those women not in either the peri or post menopause (other).
RESULTS
Most women were completely uninformed or only had some knowledge of the menopause before the age of 40. Most women thought that the menopause should be taught at school, but over 80% had received no menopause education at school themselves. The most popular sources of menopause information were independent websites and friends. Perimenopausal women were significantly more likely than postmenopausal women to use online resources for menopause information. The perimenopausal and postmenopausal groups had more positive attitudes towards the menopause than the other group. 57.5% of postmenopausal women found the menopause difficult or very difficult. Most women were happy about no longer menstruating, although some expressed sadness regarding fertility loss.
CONCLUSIONS
Most women had limited knowledge and negative attitudes towards the menopause, leaving them unprepared to cope with the physical and psychological changes associated with this stage of life. Improved menopause education is required to improve quality of life during the menopausal transition and a most positive narrative of life postmenopause.
Topics: Female; Humans; Postmenopause; Perimenopause; Quality of Life; Menopause; Attitude
PubMed: 37648988
DOI: 10.1186/s12905-023-02424-x -
BMC Women's Health Jan 2024Menopause hormone therapy (MHT), as an effective method to alleviate the menopause-related symptoms of women, its benefits, risks, and potential influencing factors for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Menopause hormone therapy (MHT), as an effective method to alleviate the menopause-related symptoms of women, its benefits, risks, and potential influencing factors for the cardiovascular system of postmenopausal women are not very clear.
OBJECTIVES
To evaluate cardiovascular benefits and risks of MHT in postmenopausal women, and analyze the underlying factors that affect both.
SEARCH STRATEGY
The EMBASE, MEDLINE, and CENTRAL databases were searched from 1975 to July 2022.
SELECTION CRITERIA
Randomized Clinical Trials (RCTs) that met pre-specified inclusion criteria were included.
DATA COLLECTION AND ANALYSIS
Two reviewers extracted data independently. A meta-analysis of random effects was used to analyze data.
MAIN RESULTS
This systematic review identified 33 RCTs using MHT involving 44,639 postmenopausal women with a mean age of 60.3 (range 48 to 72 years). There was no significant difference between MHT and placebo (or no treatment) in all-cause death (RR = 0.96, 95%CI 0.85 to 1.09, I = 14%) and cardiovascular events (RR = 0.97, 95%CI 0.82 to 1.14, I = 38%) in the overall population of postmenopausal women. However, MHT would increase the risk of stroke (RR = 1.23, 95%CI 1.08 to 1.41,I = 0%) and venous thromboembolism (RR = 1.86, 95%CI 1.39 to 2.50, I = 24%). Compared with placebo, MHT could improve flow-mediated arterial dilation (FMD) (SMD = 1.46, 95%CI 0.86 to 2.07, I = 90%), but it did not improve nitroglycerin-mediated arterial dilation (NMD) (SMD = 0.27, 95%CI - 0.08 to 0.62, I = 76%). Compared with women started MHT more than 10 years after menopause, women started MHT within 10 years after menopause had lower frequency of all-cause death (P = 0.02) and cardiovascular events (P = 0.002), and more significant improvement in FMD (P = 0.0003). Compared to mono-estrogen therapy, the combination therapy of estrogen and progesterone would not alter the outcomes of endpoint event. (all-cause death P = 0.52, cardiovascular events P = 0.90, stroke P = 0.85, venous thromboembolism P = 0.33, FMD P = 0.46, NMD P = 0.27).
CONCLUSIONS
MHT improves flow-mediated arterial dilation (FMD) but fails to lower the risk of all-cause death and cardiovascular events, and increases the risk of stroke and venous thrombosis in postmenopausal women. Early acceptance of MHT not only reduces the risk of all-cause death and cardiovascular events but also further improves FMD, although the risk of stroke and venous thrombosis is not reduced. There is no difference in the outcome of cardiovascular system endpoints between mono-estrogen therapy and combination therapy of estrogen and progesterone.
Topics: Female; Humans; Middle Aged; Aged; Venous Thromboembolism; Postmenopause; Progesterone; Arteries; Stroke; Estrogens; Hormone Replacement Therapy; Venous Thrombosis; Risk Assessment
PubMed: 38263123
DOI: 10.1186/s12905-023-02788-0 -
Journal of Ovarian Research Oct 2023Premature ovarian insufficiency (POI) is an important cause of infertility characterized by the functional decline of the ovary. Granulosa cells (GCs) around oocytes are...
BACKGROUND
Premature ovarian insufficiency (POI) is an important cause of infertility characterized by the functional decline of the ovary. Granulosa cells (GCs) around oocytes are critical for folliculogenesis, and GC dysfunction is one of the important etiologies of POI. The aim of this study was to explore the potential biomarkers of POI by identifying hub genes and analyze the correlation of biomarkers with immune infiltration in POI using RNA profiling and bioinformatics analysis.
METHODS
RNA sequencing was performed on GCs from biochemical POI (bPOI) patients and controls. Differential expression analysis and weighted gene co-expression network analysis (WGCNA) were used to explore the candidate genes. qRT‒PCR was performed to verify the expression of hub genes. Western blot, Cell Counting Kit-8, 5-ethynyl-2'-deoxyuridine (EdU) assays, TUNEL (TdT-mediated dUTP Nick-End Labeling) and flow cytometry analysis were used to validate the possible role of ubiquitin-conjugating enzyme 2C (UBE2C) in POI. CIBERSORT was adopted to explore immune cell infiltration and the correlation between UBE2C and immune cells in bPOI.
RESULTS
Through analysis of differentially expressed genes (DEGs) and WGCNA, we obtained 143 candidate genes. After construction of the protein‒protein interaction (PPI) network and analysis with Cytoscape, 10 hub genes, including UBE2C, PBK, BUB1, CDC20, NUSAP1, CENPA, CCNB2, TOP2A, AURKB, and FOXM1, were identified and verified by qRT‒PCR. Subsequently, UBE2C was chosen as a possible biomarker of POI because knockdown of UBE2C could inhibit the proliferation and promote the apoptosis of GCs. Immune infiltration analysis indicated that monocytes and M1 macrophages may be associated with the pathogenesis of POI. In addition, UBE2C was negatively correlated with monocytes and M1 macrophages in POI.
CONCLUSIONS
This study identified a hub gene in GCs that might be important in the pathogenesis of POI and revealed the key role of UBE2C in driving POI. Immune infiltration may be highly related with the onset and etiology of POI.
Topics: Female; Humans; Transcriptome; Ubiquitin-Conjugating Enzymes; Primary Ovarian Insufficiency; Menopause, Premature; Granulosa Cells; Biomarkers
PubMed: 37848988
DOI: 10.1186/s13048-023-01266-3 -
Journal of Healthcare Engineering 2023100 healthy perimenopausal women were recruited and randomly assigned to two groups, with 50 subjects in each group. In the control group, placebo was administrated... (Randomized Controlled Trial)
Randomized Controlled Trial
METHOD
100 healthy perimenopausal women were recruited and randomly assigned to two groups, with 50 subjects in each group. In the control group, placebo was administrated daily for 3 cycles (4 weeks of treatment for 1 cycle and drug withdrawals for 1 week). The study group received 3 mg oral melatonin treatment daily in the same period of time. All subjects completed the study. We compared the uterine volume, endometrial thickness, LH (luteinizing hormone), FSH (follicle generating hormone), E2 (estradiol), and melatonin levels during daytime between the two groups before and after the study. Moreover, perimenopause syndrome, sleep, mood, and QoL were analyzed at the baseline and 3 cycles by the questionnaires of the Kupperman index, the Pittsburgh sleep quality index (PSQI), the Hamilton anxiety scale (HAMA), and the Hamilton depression scale (HAMD), as well as menopausal QoL (MENQOL), respectively. Any adverse reactions experienced by the subjects were also compared in the study. Finally, 91 participants (92%) completed the whole study, 47 and 44 in the study and control groups, respectively, and their data were considered in subsequent analyses.
RESULTS
After therapy, the two groups were similar in the uterine volume and endometrial thickness. In contrast to the control group, the study group showed notably decreased LH and FSH levels. No notable difference was discovered in E2 and melatonin levels between the two groups in the study. Moreover, the study group exhibited a significantly lower score in the Kupperman index, PSQI, HAMA, HAMD, and MENQOL scale than the control group. Moreover, the two groups had no notable difference in adverse reactions.
CONCLUSION
Melatonin was a useful treatment to relieve climacteric symptoms and improve sleep, mood, and life quality in perimenopausal women without obvious adverse reactions.
Topics: Female; Humans; Perimenopause; Melatonin; Quality of Life; Sleep; Affect; Follicle Stimulating Hormone
PubMed: 37854169
DOI: 10.1155/2023/2198804 -
Gynecological Endocrinology : the... Dec 2023To assess the prevalence of metabolic syndrome (MetS) and its components in Chinese women with premature ovarian insufficiency (POI) and to explore the metabolic profile...
OBJECTIVES
To assess the prevalence of metabolic syndrome (MetS) and its components in Chinese women with premature ovarian insufficiency (POI) and to explore the metabolic profile of Chinese women with POI.
METHODS
118 POI women aged 20-38 years and 151 age-and-BMI-matched control women were recruited. Measurements included body height, weight, waist circumference (WC), hip circumference (HC), blood pressure, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG) and fasting insulin (FINS). Prevalence and components of MetS and metabolic indices were compared between the two groups.
RESULTS
The prevalence of MetS in POI women and age-and-BMI-matched control women was 16.9% and 11.3%, respectively, which was not significantly different ( > .05). The prevalence of hypertriglyceridemia and high fasting glucose was significantly higher in POI than control (17.8% vs. 9.3%, = .039; 16.9% vs. 6.6%, = .008), without significant differences in the prevalence of other components of MetS ( > .05). The levels of TG, FINS, and HOMA-IR in POI were significantly higher than in control ( < .05) but without significant differences in WC, WHR, SBP, DBP, TC, HDL-C, LDL-C, and FPG ( > .05). HOMA-IR was positively correlated with WC, DBP, TG, and FPG and negatively correlated with HDL-C in both POI women and control ( < .05).
CONCLUSIONS
POI women presented with more unfavorable cardiovascular risk factors (higher prevalence of hypertriglyceridemia and high fasting glucose; higher TG, FINS, and HOMA-IR). So, women diagnosed with POI should always be covered with special care of metabolic profile.
Topics: Female; Humans; Cholesterol, HDL; Cholesterol, LDL; East Asian People; Glucose; Hypertriglyceridemia; Menopause, Premature; Metabolic Syndrome; Prevalence; Primary Ovarian Insufficiency; Young Adult; Adult
PubMed: 37673099
DOI: 10.1080/09513590.2023.2254847 -
Nutrients Aug 2023Recent years have witnessed the emergence of growing evidence concerning vitamin D's potential role in women's health, specifically in postmenopausal women. This... (Review)
Review
Recent years have witnessed the emergence of growing evidence concerning vitamin D's potential role in women's health, specifically in postmenopausal women. This evidence also includes its connection to various genitourinary disorders and symptoms. Numerous clinical studies have observed improvements in vulvovaginal symptoms linked to the genitourinary syndrome of menopause (GSM) with vitamin D supplementation. These studies have reported positive effects on various aspects, such as vaginal pH, dryness, sexual functioning, reduced libido, and decreased urinary tract infections. Many mechanisms underlying these pharmacological effects have since been proposed. Vitamin D receptors (VDRs) have been identified as a major contributor to its effects. It is now well known that VDRs are expressed in the superficial layers of the urogenital organs. Additionally, vitamin D plays a crucial role in supporting immune function and modulating the body's defense mechanisms. However, the characterization of these effects requires more investigation. Reviewing existing evidence regarding vitamin D's impact on postmenopausal women's vaginal, sexual, and urological health is the purpose of this article. As research in this area continues, there is a potential for vitamin D to support women's urogenital and sexual health during the menopausal transition and postmenopausal periods.
Topics: Female; Humans; Vitamin D; Postmenopause; Vitamins; Sexual Behavior; Receptors, Calcitriol
PubMed: 37686835
DOI: 10.3390/nu15173804 -
Frontiers in Endocrinology 2024This research investigated menopausal women older than 50 years to find whether there were any independent relationships between the duration of sleep they got and their...
AIMS
This research investigated menopausal women older than 50 years to find whether there were any independent relationships between the duration of sleep they got and their prevalence of depression.
METHODS
National Health and Nutrition Examination Survey (NHANES) datasets from 2011-2020 were utilized in a cross-sectional study. Using multivariate linear regression models, the linear relationship between sleep duration and depression in menopausal women was investigated. Fitted smoothing curves and thresholds impact evaluation were used to investigate the nonlinear relationship. Then, subgroup analyses were performed according to smoking, drinking alcohol, diabetes, hypertension, heart disease, and moderate activities.
RESULTS
This population-based study included a total of 3,897 menopausal women (mean age 65.47 ± 9.06 years) aged≥50 years; 3,159 had a depression score <10, and 738 had a depression score≥10. After controlling for all covariates, the prevalence of depression was 17% higher among participants with short sleep duration [=1.17, 95%CI=(0.65, 1.70), <0.0001] and 86% [=1.86, 95%CI=(1.05, 2.66), <0.0001] compared to participants with normal sleep duration. In subgroup analyses stratified by smoking and diabetes, the sleep duration and depression scores of non-smokers [=-0.18, 95%CI= (-0.33, -0.02), =0.0241] and diabetics were independently negatively correlated [=-0.32, 95%CI= (-0.63, -0.01), =0.0416]. Using a two-segment linear regression model, we discovered a U-shaped relationship between sleep duration and depression scores with an inflection point of 7.5 hours. Less than 7.5 hours of sleep was associated with an increased risk of developing depression [=-0.81, 95%CI= (-1.05, -0.57), <0.001]. However, sleeping more than 7.5 hours per night increased the risk of depression considerably [=0.80, 95%CI= (0.51, 1.08), <0.001].
CONCLUSIONS
Depression is associated with sleep duration in menopausal women. Insufficient or excessive sleep may increase the risk of depression in menopausal women.
Topics: Humans; Female; Middle Aged; Aged; Sleep Duration; Nutrition Surveys; Cross-Sectional Studies; Depression; Menopause; Diabetes Mellitus
PubMed: 38440789
DOI: 10.3389/fendo.2024.1301775 -
Medicine Oct 2023Potential associations between menopause, age at menopause, and clinical indicators related to cardiovascular disease (CVD) have not been elucidated. To identify the...
Potential associations between menopause, age at menopause, and clinical indicators related to cardiovascular disease (CVD) have not been elucidated. To identify the risk of CVD early and contribute to its prevention and intervention, the present study used relevant biomarkers to evaluate the risk of CVD among pre- and postmenopausal women. An overall population of 816 women (aged 40-60 y) was evaluated as premenopause, natural early menopause, or natural late menopause (ages ≤ 48 and ≥52 y), with ages 49-51 years as reference (natural menopause). High-sensitivity C-reactive protein, carotid intima-media thickness, and brachial-ankle pulse wave velocity were measured. Triglycerides (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol (LDL-C) of the postmenopausal group were each significantly higher than that of the premenopausal. However, the 3 menopausal groups were similar regarding hypertension, diabetes, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. In the logistic regression model, the CRP, brachial-ankle pulse wave velocity, and carotid intima-media thickness levels were similar among the premenopause and early and late menopause groups. These results were unchanged after further adjustment for multiple confounders including age, smoking, drinking, salt intake habits, presence of hypertension, or diabetes mellitus. Menopause itself is a more important risk factor for CVD compared with menopause that begins at early or late age.
Topics: Female; Humans; Ankle Brachial Index; C-Reactive Protein; Cardiovascular Diseases; Carotid Intima-Media Thickness; Cholesterol, LDL; East Asian People; Hypertension; Lipoproteins, HDL; Menopause; Pulse Wave Analysis; Risk Factors; Triglycerides; Adult; Middle Aged; Age Factors; Heart Disease Risk Factors
PubMed: 37861482
DOI: 10.1097/MD.0000000000035629 -
Nature Communications Feb 2024We explore the relation between age at menarche, parity and age at natural menopause with 249 metabolic traits in over 65,000 UK Biobank women using multivariable...
We explore the relation between age at menarche, parity and age at natural menopause with 249 metabolic traits in over 65,000 UK Biobank women using multivariable regression, Mendelian randomization and negative control (parity only). Older age of menarche is related to a less atherogenic metabolic profile in multivariable regression and Mendelian randomization, which is largely attenuated when accounting for adult body mass index. In multivariable regression, higher parity relates to more particles and lipids in VLDL, which are not observed in male negative controls. In multivariable regression and Mendelian randomization, older age at natural menopause is related to lower concentrations of inflammation markers, but we observe inconsistent results for LDL-related traits due to chronological age-specific effects. For example, older age at menopause is related to lower LDL-cholesterol in younger women but slightly higher in older women. Our findings support a role of reproductive traits on later life metabolic profile and provide insights into identifying novel markers for the prevention of adverse cardiometabolic outcomes in women.
Topics: Adult; Humans; Male; Female; Aged; Menarche; Menopause; Reproduction; Body Mass Index; Metabolome; Risk Factors; Age Factors
PubMed: 38320991
DOI: 10.1038/s41467-023-44459-6