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Obstetrics and Gynecology Clinics of... Dec 2018Vulnerability to depression is increased across the menopause transition and in the early years after the final menstrual period. Clinicians should systematically screen... (Review)
Review
Vulnerability to depression is increased across the menopause transition and in the early years after the final menstrual period. Clinicians should systematically screen women in this age group; if depressive symptoms or disorder are present, treatment of depression should be initiated. Potential treatments include antidepressants for moderate to severe symptoms, psychotherapy to target psychological and interpersonal factors, and hormone therapy for women with first-onset major depressive disorder or elevated depressive symptoms and at low risk for adverse effects. Behavioral interventions can improve physical activity and sleep patterns.
Topics: Antidepressive Agents; Cognitive Behavioral Therapy; Depression; Female; Gene-Environment Interaction; Gonadal Steroid Hormones; Hormone Replacement Therapy; Humans; Longitudinal Studies; Perimenopause; Psychotherapy
PubMed: 30401549
DOI: 10.1016/j.ogc.2018.07.007 -
Acupuncture in Medicine : Journal of... Dec 2021
Topics: Acupuncture Points; Acupuncture Therapy; Female; Humans; Middle Aged; Perimenopause; Sleep; Sleep Initiation and Maintenance Disorders
PubMed: 34231419
DOI: 10.1177/09645284211026316 -
Australian Family Physician Jun 2017Women who are perimenopausal are at risk of unintended pregnancy despite relatively low fertility at this stage. Contraceptive choice can be limited by increased...
BACKGROUND
Women who are perimenopausal are at risk of unintended pregnancy despite relatively low fertility at this stage. Contraceptive choice can be limited by increased comorbidities, but the UK Medical Eligibility Criteria (UKMEC) system provides a framework for safe prescribing.
OBJECTIVE
This article provides evidence-based guidance on contraceptive options, and information to support decision-making about stopping contraception at menopause.
DISCUSSION
Contraceptive choice is determined by several factors, including medical eligibility, side effects and risks, non-contraceptive benefits, cost and personal preference. Long-acting reversible contraceptives (LARCs) are an effective, acceptable and safe choice for many women. For women aged ≥50 years who are using a non-hormonal method, contraception is recommended until after 12 months of amenorrhoea, or 24 months if they are aged 50 years; serial follicle-stimulating hormone (FSH) levels can guide method cessation given amenorrhoea is not a reliable indicator of menopause in this context.
Topics: Adult; Aniline Compounds; Contraception; Contraceptive Devices; Drug Therapy, Combination; Female; Humans; Intrauterine Devices, Copper; Levonorgestrel; Perimenopause; Pregnancy; Pregnancy, Unplanned; Progesterone
PubMed: 28609592
DOI: No ID Found -
Worldviews on Evidence-based Nursing Aug 2017Improvement of the quality of life in perimenopausal women has recently become an important global health issue. Extensive research reports provide evidence of Tai Chi... (Review)
Review
BACKGROUND
Improvement of the quality of life in perimenopausal women has recently become an important global health issue. Extensive research reports provide evidence of Tai Chi for the quality of life, but no systematic review has individually investigated Tai Chi as a main intervention on the quality of life in perimenopausal women.
OBJECTIVE
To assess clinical evidence of Tai Chi for the quality of life in perimenopausal women.
METHODS
Studies related to the effect of Tai Chi on the quality of life in perimenopausal women in the databases of China and abroad were searched. RevMan version 5.2 software was used, and the Medical Outcomes Study 36-item short form health survey (SF-36) and bone mineral density (BMD) were selected as evaluation indices.
RESULTS
Five trials were included. The results of this study showed that Tai Chi had a significant effect on bodily pain, general health, vitality, mental health of SF-36, and the spine dimension of BMD, as supported by the following data: bodily pain (Standard Mean Difference [SMD] = -3.63; 95% confidence interval [CI] [-6.62, -0.64]; p = .02); general health (SMD = -5.08; 95% CI [-7.60, -2.56]; p < .0001); vitality (SMD = -5.67; 95% CI [-8.54, -2.81], p = .0001); mental health (SMD = -2.51; 95% CI [-4.82, -0.20], p = .03); and spine dimension of BMD (SMD = -0.06; 95% CI [-0.10, -0.01]; p = .01). However, Tai Chi had no effect on physical function, emotional health, social function, role-physical of SF-36, and the hip dimension of BMD, as supported by the following data: physical function (SMD = -1.79; 95% CI [-5.15, 1.57]; p = .30); emotional health (SMD = -2.90; 95% CI [-7.23, 1.43], p = .19]; social function (SMD = -2.23, 95% CI [-5.08, 0.61], p = .12; role-physical (SMD = - 1.18; 95% CI [-4.84, 2.47], p = .53; and hip dimension of BMD (SMD = -0.01; 95% CI [-0.03, 0.01]; p = .31).
LINKING EVIDENCE TO ACTION
This systematic review found significant evidence for Tai Chi improving bodily pain, general health, vitality, mental health of SF-36, and the spine dimension of BMD in patients with perimenopausal syndrome. Findings suggest that Tai Chi might be recommended as effective and safe adjuvant treatment for patients with perimenopausal syndrome. More high-quality randomized controlled trials are urgently needed to confirm these results.
Topics: Aged; Exercise; Female; Health Surveys; Humans; Middle Aged; Perimenopause; Quality of Life; Tai Ji
PubMed: 28742289
DOI: 10.1111/wvn.12234 -
Current Pain and Headache Reports Oct 2009Perimenopause marks a time of change in a woman's hormonal environment, which is apparent from the resultant irregular periods and vasomotor symptoms. These symptoms can... (Review)
Review
Perimenopause marks a time of change in a woman's hormonal environment, which is apparent from the resultant irregular periods and vasomotor symptoms. These symptoms can start in the early 40s and continue through to the early 50s. Migraine is also affected by hormonal fluctuations, particularly the natural decline in estrogen in the late luteal phase of the menstrual cycle. This effect of estrogen "withdrawal" on migraine appears to become more predominant during perimenopause. Despite the increased prevalence of headache and migraine in women in their 40s, migraine is underdiagnosed in this population. In women attending with symptoms suggestive of perimenopause, it is important to ask about headache symptoms. Once diagnosed, a number of strategies can be used to manage both perimenopausal migraine and menopausal symptoms effectively, with the potential to reduce the associated morbidity.
Topics: Analgesics; Estrogen Replacement Therapy; Female; Humans; Menopause; Migraine Disorders; Perimenopause
PubMed: 19728968
DOI: 10.1007/s11916-009-0065-2 -
Current Psychiatry Reports Dec 2014The menopause transition is associated with a two to fourfold increased risk in major depressive disorder (MDD) and clinical elevations in depressive symptoms. While the... (Review)
Review
The menopause transition is associated with a two to fourfold increased risk in major depressive disorder (MDD) and clinical elevations in depressive symptoms. While the pathophysiological mechanisms underlying this increased risk remain uncertain, ovarian hormone fluctuation is believed to play a role. To the extent that this is the case, hormone replacement therapy (HRT), through its hormone-stabilizing effects, represents a viable antidepressant treatment. The current review summarizes the most recent literature evaluating the efficacy of HRT in treating MDD in peri- and postmenopausal women. In addition, to provide a clinical context in which to interpret this research, the endocrinology and clinical phenomenology related to depression with onset in the menopause transition (D-MT) are discussed. The available evidence suggests that HRT, specifically involving estrogen delivered through a skin patch, is a promising intervention in the treatment of D-MT. However, HRT of any form is an ineffective antidepressant in women who are well into the postmenopausal period.
Topics: Depressive Disorder, Major; Estradiol; Female; Hormone Replacement Therapy; Humans; Perimenopause
PubMed: 25308388
DOI: 10.1007/s11920-014-0517-1 -
Journal of Neuroinflammation Oct 2020The peri-menopause or menopausal transition-the time period that surrounds the final years of a woman's reproductive life-is associated with profound reproductive and... (Review)
Review
The peri-menopause or menopausal transition-the time period that surrounds the final years of a woman's reproductive life-is associated with profound reproductive and hormonal changes in a woman's body and exponentially increases a woman's risk of cerebral ischemia and Alzheimer's disease. Although our understanding of the exact timeline or definition of peri-menopause is limited, it is clear that there are two stages to the peri-menopause. These are the early menopausal transition, where menstrual cycles are mostly regular, with relatively few interruptions, and the late transition, where amenorrhea becomes more prolonged and lasts for at least 60 days, up to the final menstrual period. Emerging evidence is showing that peri-menopause is pro-inflammatory and disrupts estrogen-regulated neurological systems. Estrogen is a master regulator that functions through a network of estrogen receptors subtypes alpha (ER-α) and beta (ER-β). Estrogen receptor-beta has been shown to regulate a key component of the innate immune response known as the inflammasome, and it also is involved in regulation of neuronal mitochondrial function. This review will present an overview of the menopausal transition as an inflammatory event, with associated systemic and central nervous system inflammation, plus regulation of the innate immune response by ER-β-mediated mechanisms.
Topics: Estrogen Receptor beta; Estrogens; Female; Humans; Immunity, Innate; Menopause; Menstrual Cycle; Neurodegenerative Diseases; Perimenopause
PubMed: 33097048
DOI: 10.1186/s12974-020-01998-9 -
Menopause (New York, N.Y.) May 2015Between 15% and 50% of women experience depressive symptoms during the menopausal transition; in 15% to 30% of perimenopausal women, they are severe enough to be... (Review)
Review
OBJECTIVE
Between 15% and 50% of women experience depressive symptoms during the menopausal transition; in 15% to 30% of perimenopausal women, they are severe enough to be regarded as a depressive disorder. Fluctuations in gonadal hormone levels are thought to contribute to these depressive conditions. Hormone therapy is commonly used to alleviate climacteric symptoms, but its effects on mood are less clear. We narratively reviewed the literature on the effects of different types of hormone therapy on mood.
METHODS
Using PubMed/Medline, we searched for studies of hormone therapy in relation to depressive symptoms and disorders in perimenopause and postmenopause.
RESULTS
A number of studies consistently reported estrogen therapy to be effective in improving mood in perimenopausal women. However, its efficacy for overt depression or during postmenopause was more questionable. The progestogenic component in combined hormone therapy was found to potentially counteract the beneficial influence of estrogens on mood and to even induce negative mood symptoms. In specifically focused studies, a combination of hormone therapy and antidepressants was effective in depressed perimenopausal and postmenopausal women.
CONCLUSIONS
Hormone therapy may contribute to alleviating menopause-related depressive symptoms. Its administration should be followed across time and should be specifically individualized. In cases of more severe depressive conditions, a combination of antidepressant and hormone therapy should be considered.
Topics: Adult; Affect; Antidepressive Agents; Brain; Depression; Estrogens; Female; Humans; MEDLINE; Middle Aged; Perimenopause; Postmenopause; Progesterone
PubMed: 25203891
DOI: 10.1097/GME.0000000000000323 -
Bone Mar 2018Investigators and clinicians have had few normal bone histomorphometry data available to compare with those found in diseased patients, or in the results of treatments....
Investigators and clinicians have had few normal bone histomorphometry data available to compare with those found in diseased patients, or in the results of treatments. The Goals and Objectives of this work are two-fold: 1. to present static and dynamic bone histomorphometry data from transilial bone biopsies performed on 76 healthy, premenopausal women. 2. To present paired static and dynamic bone histomorphometry data from bone biopsies on a subset (N=51 pairs) of these same healthy women whose biopsies were repeated 12months after their last menses. Statistical comparisons between the pre- and postmenopausal data are presented. These data will shrink this important gap, both for clinicians and investigators. We enrolled 76 healthy, premenopausal women over age 46, performed transilial bone biopsies after tetracycline labeling, and during a period of 9.5years, we re-biopsied 51 of them who passed through menopause and remained healthy the entire time. We also obtained serum biochemical measurements, and serial DXA exams during the period of observation. The dynamic bone histomorphometry demonstrated a doubling of bone remodeling, and increases in serum bone markers at the time of the second biopsy. Lumbar spine bone density also declined, and there were significant correlations between serum markers and histomorphometry variables. The data demonstrate that healthy menopause results in an important increase in bone remodeling, and a loss of bone density. We do not fully understand the mechanisms of these transmenopausal changes, but the data provide some clues that are helpful.
Topics: Absorptiometry, Photon; Alkaline Phosphatase; Amino Acids; Biomarkers; Bone and Bones; Female; Humans; Hydroxyproline; Menopause; Middle Aged; Perimenopause; Vitamin D
PubMed: 29258873
DOI: 10.1016/j.bone.2017.12.016 -
Post Reproductive Health Dec 2023To explore perimenopausal women's feelings towards their periods, the impact on their wellbeing and how we can support them.
OBJECTIVE
To explore perimenopausal women's feelings towards their periods, the impact on their wellbeing and how we can support them.
STUDY DESIGN
Participants were recruited for focus groups through social media advertisements. In 6 online focus groups, 31 perimenopausal women aged 40-55 living in the UK were asked 5 questions relating to periods and perimenopause, support and education.
MAIN OUTCOME MEASURES
Content analysis.
RESULTS
When asked How do you feel about having a period? The participants often related back to the stress of menarche and said their period negatively impacted their wellbeing their whole lives. During perimenopause, their periods had become unpredictable, heavy, and a debilitating disruption to their lives. The women desired support at work through policy, and from family and friends. They believed that educating girls and boys during school was the best place to start, but that education through work and community groups was also needed. They felt healthcare professionals should have mandatory training regarding women's health issues and menopause.
CONCLUSION
The study highlights the impact of menstrual experiences on the wellbeing of perimenopausal women, emphasising the need for improved menstrual education from an early age. Comprehensive menstrual education in schools involving both genders to enable informed decision-making and improved training for healthcare professionals are recommended. Support networks for perimenopausal women will promote better quality of life for women as they go through their perimenopause journey.
Topics: Male; Female; Humans; Perimenopause; Quality of Life; Menopause; Women's Health; Menstruation
PubMed: 37984554
DOI: 10.1177/20533691231216162