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Advances in Therapy Jun 2024Perimenopause is a time of transition in a woman's life that links her reproductive years to the cessation of ovulation, or menopause. For many women, this time is...
INTRODUCTION
Perimenopause is a time of transition in a woman's life that links her reproductive years to the cessation of ovulation, or menopause. For many women, this time is characterized by a variety of physiological and lifestyle changes, including increasing irregularity in menstrual bleeding, frequency and severity of vasomotor symptoms, etc. Therapies evaluated specifically for the perimenopausal women are very limited. This study aimed to evaluate the effectiveness and safety of Amberen (a succinate-based non-hormonal supplement) combined with a Smart B (vitamin B) complex in women with typical (without complications) mild to moderate climacteric syndrome during perimenopause.
METHODS
Women up to 50 years of age, in perimenopause, with vasomotor and psychosomatic symptoms of the climacteric syndrome were enrolled for the study. The trial was randomized, double-blinded, placebo-controlled, comparative, and prospective.
RESULTS
A total of 106 participants were enrolled in the trial and, per protocol, 105 completed the trial. We observed statistically significant improvements in most of the Greene Climacteric Scale symptoms, State-Trait Anxiety Inventory (STAI), Hospital Anxiety and Depression Scale (HADS), and Well-being, Activity, and Mood (WAM) scores. The intervention was well tolerated with few adverse effects reported to be mild and transient.
CONCLUSION
The use of this dietary supplement is safe and eliminates or improves vasomotor and psychosomatic symptoms of climacteric symptoms in perimenopausal women: it improves sleep and cognitive abilities, lowers depression and anxiety, improves mood and well-being, and positively affects quality of life.
GOV IDENTIFIER
NCT03897738.
PubMed: 38904899
DOI: 10.1007/s12325-024-02910-0 -
Scientific Reports Jun 202417β-estradiol, the most biologically active estrogen, exerts wide-ranging effects in brain through its action on estrogen receptors (ERs), influencing higher-order...
17β-estradiol, the most biologically active estrogen, exerts wide-ranging effects in brain through its action on estrogen receptors (ERs), influencing higher-order cognitive function and neurobiological aging. However, our knowledge of ER expression and regulation by neuroendocrine aging in the living human brain is limited. This in vivo brain F-fluoroestradiol (F-FES) Positron Emission Tomography (PET) study of healthy midlife women reveals progressively higher ER density over the menopause transition in estrogen-regulated networks. Effects were independent of age, plasma estradiol and sex hormone binding globulin, and were highly consistent, correctly classifying all women as being postmenopausal or premenopausal. Higher ER density in target regions was associated with poorer memory performance for both postmenopausal and perimenopausal groups, and predicted presence of self-reported mood and cognitive symptoms after menopause. These findings provide novel insights on brain ER density modulation by female neuroendocrine aging, with clinical implications for women's health.
Topics: Humans; Female; Middle Aged; Cognition; Brain; Aging; Receptors, Estrogen; Positron-Emission Tomography; Adult; Estradiol; Neurosecretory Systems; Menopause
PubMed: 38902275
DOI: 10.1038/s41598-024-62820-7 -
The British Journal of General Practice... Jun 2024The average age of the menopause in the United Kingdom is 52 but symptoms of the perimenopause (PMP) can start at 40 or earlier. The UK Armed Forces (UKAF) has a young...
BACKGROUND
The average age of the menopause in the United Kingdom is 52 but symptoms of the perimenopause (PMP) can start at 40 or earlier. The UK Armed Forces (UKAF) has a young demographic but women serving over the age of 40, potentially with PMP symptoms, has increased. Recent evidence suggested PMP management by Defence GPs was satisfactory but variable. Because of small numbers, Defence GPs have less exposure to the PMP than NHS GPs, a problem exacerbated for Uniformed GPs who have reduced clinical contact time due to military duties.
AIM
This study aimed to explore Defence GP knowledge and confidence in managing the PMP, identifying factors contributing to disparities.
METHOD
This study used a sequential mixed-methods approach. A survey with self-rating questions and vignettes was undertaken, followed by semi-structured interviews of selectively sampled respondents.
RESULTS
164 out of 542 Defence GPs responded to a survey, which identified reasonable knowledge (91.3% managing cases per guidelines) but reduced confidence (54.3%). Regression analysis identified case exposure to the PMP, education, and gender as significant factors affecting confidence in PMP management. Themes identified from interviews which were felt to affect knowledge and confidence included: Characteristics of the GP (such as gender); lifelong learning and reflective practice; professional exposure to, and awareness of, the PMP; the changing demographic of Defence; an integrated PMP service to provide experiential learning. Case exposure and experiential learning emerged as the main drivers for confidence. For Uniformed GPs, this was affected by limited clinical time, but confidence returned once exposed to just a few PMP cases.
CONCLUSION
Establishing an integrated PMP service in Defence was seen as crucial for improving care as well as providing educational opportunities through experiential learning for Defence GPs.
Topics: Humans; Female; Perimenopause; United Kingdom; Middle Aged; Male; General Practitioners; Primary Health Care; Clinical Competence; Adult; Surveys and Questionnaires; Health Knowledge, Attitudes, Practice; Attitude of Health Personnel; Military Personnel
PubMed: 38902071
DOI: 10.3399/bjgp24X738057 -
The British Journal of General Practice... Jun 2024The average age for menopause is 51 years, this is preceded by a transitional perimenopausal stage, with vasomotor symptoms, muscular and joint pain, lowered libido and...
BACKGROUND
The average age for menopause is 51 years, this is preceded by a transitional perimenopausal stage, with vasomotor symptoms, muscular and joint pain, lowered libido and disordered sleep, impacting on mental health. In some women, the quality of life is considerably affected. This remains under-reported. There is no national screening service, or specialised clinics for menopausal services available in primary care.
AIM
We undertook a survey of women in primary care as part of a needs assessment to understand the prevalence of peri- and menopausal symptoms, women's knowledge of these symptoms, and available treatment options.
METHOD
A questionnaire was sent to women aged 45-65 years registered with the practice.
RESULTS
Of a total of 73 women, 78.1% complained of >4 symptoms. The most common symptoms were memory problems and brain fog (80.6%), sleep disturbance (72.1%) and muscle/joint pain (72.1%). Women were asked to rate their knowledge of therapy options on a self-reported scale of 0-10; a high proportion (64.3%) rated <4 points. They had better knowledge of symptoms, 79.3% rated >4 points. A high proportion (58.9%) rated inadequate support received from primary care and 75.3% felt they had no support at all.
CONCLUSION
Our results of this preliminary study showed the vast majority of women were unaware of treatment options for their menopausal symptoms and felt they received inadequate to no support from primary care providers. The present ongoing study highlights lack of resource allocation to women's health and insufficient commissioning of services to address this health need.
Topics: Humans; Female; Middle Aged; Primary Health Care; Aged; Menopause; Needs Assessment; Surveys and Questionnaires; Quality of Life; Sleep Wake Disorders; Health Knowledge, Attitudes, Practice; Health Services Needs and Demand; Hot Flashes; Arthralgia
PubMed: 38902062
DOI: 10.3399/bjgp24X737949 -
Journal of Medical Case Reports Jun 2024Abnormal uterine bleeding, formerly known as menometrorrhagia, is estimated to occur in up to one-third of women, commonly at menarche or perimenopause. Among many other...
BACKGROUND
Abnormal uterine bleeding, formerly known as menometrorrhagia, is estimated to occur in up to one-third of women, commonly at menarche or perimenopause. Among many other causes, abnormal uterine bleeding is known to be caused by leiomyomas, and is itself a leading cause of severe iron deficiency and iron deficiency anemia in women. Rarely, abnormal uterine bleeding can lead to critically low hemoglobin values of less than 2 g/dL. We report here a case of a woman with abnormal uterine bleeding caused by leiomyomas presenting with severely low hemoglobin.
CASE PRESENTATION
We report the case of a 42-year-old Asian American woman who presented to the emergency department with chronic abnormal uterine bleeding and symptoms of anemia, including multiple syncopal episodes and abnormally pale skin but otherwise alert and oriented. Laboratory tests found a record-low hemoglobin of 1.6 g/dL and hematocrit of 6%. Transabdominal pelvic ultrasound revealed a lower uterine segment/cervical fibroid measuring 7.5 × 5 × 7.8 cm (length × depth × width). Patient was diagnosed with abnormal uterine bleeding-leiomyoma and received five units of packed red blood cells, one unit of fresh frozen plasma, Venofer infusions, tranexamic acid, and medroxyprogesterone. She was discharged from the hospital after 4 days.
CONCLUSION
To date, only a handful of cases have been reported of female patient survival following severely low hemoglobin caused by abnormal uterine bleeding. This case adds to this literature, highlighting the remarkable degree of compensation that can lead to an alert, ambulatory, and oriented patient with abnormal uterine bleeding caused by leiomyoma.
Topics: Humans; Female; Adult; Uterine Neoplasms; Leiomyoma; Hemoglobins; Uterine Hemorrhage; Treatment Outcome; Metrorrhagia
PubMed: 38898492
DOI: 10.1186/s13256-024-04593-1 -
Psychoneuroendocrinology Jun 2024Increased sensitivity to ovarian hormone changes is implicated in the etiology of reproductive mood disorders across the female lifespan, including menstrually-related...
Increased sensitivity to ovarian hormone changes is implicated in the etiology of reproductive mood disorders across the female lifespan, including menstrually-related mood disorders, perinatal mood disorders, and perimenopausal depression. Developing a method to accurately quantify sensitivity to endogenous hormone fluctuations may therefore facilitate the prediction and prevention of these mental health conditions. Here, we propose one such method applying a synchrony analysis to compute time-lagged cross-correlations between repeated assessments of endogenous hormone levels and self-reported affect. We apply this method to a dataset containing frequent repeated assessments of affective symptoms and the urinary metabolites of estradiol (E2) and progesterone (P4) in 94 perimenopausal females. These preliminary findings suggest that, with further refinement and validation, the proposed method holds promise as a diagnostic tool to be used in clinical practice and to advance research investigating the etiology of reproductive mood disorders.
PubMed: 38896987
DOI: 10.1016/j.psyneuen.2024.107095 -
Sports Medicine (Auckland, N.Z.) Jun 2024The purpose of this review is to delineate aspects of energy metabolism at rest and during exercise that may be subject to sex differences and the potential underlying... (Review)
Review
The purpose of this review is to delineate aspects of energy metabolism at rest and during exercise that may be subject to sex differences and the potential underlying mechanisms involved. It focuses on distinct aspects of female physiology with an oriented discussion following the reproductive life stages of healthy, eumenorrheic females, including premenopausal time frames, pregnancy, perimenopause, and menopause. Finally, this review aims to address methodological challenges surrounding sexual dimorphism in energy metabolism investigations and confounding factors in this field. During resting conditions, females tend to have higher rates of non-oxidative free fatty acid clearance, which could contribute to lower respiratory exchange ratio measures. At the same time, carbohydrate energy metabolism findings are mixed. In general, females favor lipid energy metabolism during moderate-intensity exercise, while men favor carbohydrate energy metabolism. Factors such as age, dietary intake, genetics, and methodological decisions confound study findings, including properly identifying and reporting the menstrual cycle phase when female subjects are eumenorrheic. Pregnancy presents a unique shift in physiological systems, including energy metabolism, which can be observed at rest and during exercise. Changes in body composition and hormonal levels during the post-menopausal period directly impact energy metabolism, specifically lipid metabolism. This change in physiological state factors into the evidence showing a reduction in our understanding of sex differences in lipid metabolism during exercise in older adults. This review reveals a need for a focused understanding of female energy metabolism that could help exercise and nutrition professionals optimize female health and performance across the lifespan.
PubMed: 38888855
DOI: 10.1007/s40279-024-02063-8 -
Menopause (New York, N.Y.) Jul 2024Brain fog, referring to menopause-related subjective cognitive difficulties, is common in midlife women. Longitudinal studies find small but reliable declines in... (Review)
Review
Brain fog, referring to menopause-related subjective cognitive difficulties, is common in midlife women. Longitudinal studies find small but reliable declines in objective memory performance as women transition into perimenopause, and these are not explained by advancing age alone. When memory declines occur, performance levels remain within normal limits for all but a very small number of women. Women's experience of brain fog extends beyond memory complaints, reflecting the negative effect on a broad range of cognitive abilities. Clinicians can counsel women about how menopause symptoms, estrogen, hormone therapy, and modifiable risk factors (eg, hypertension, sedentary lifestyle) can influence cognitive health.
Topics: Humans; Female; Menopause; Middle Aged; Estrogen Replacement Therapy; Risk Factors; Cognition Disorders; Counseling; Memory Disorders; Cognitive Dysfunction
PubMed: 38888619
DOI: 10.1097/GME.0000000000002382 -
Maturitas Jun 2024For women under age 65, varying recommendations and the need to apply clinical risk calculators can lead to underscreening for osteoporosis. The resulting undertreatment... (Review)
Review
For women under age 65, varying recommendations and the need to apply clinical risk calculators can lead to underscreening for osteoporosis. The resulting undertreatment may lead to a risk of osteoporotic fractures with significant morbidity and impact on functional status. Factors that must be considered when deciding to screen a woman under age 65 include a history of fragility fractures, race, family history, body mass index, smoking, high alcohol use, and secondary causes of osteoporosis. Secondary causes of osteoporosis are much more common in younger women. These include common conditions such as glucocorticoid use, hyperthyroidism, hypogonadism, chronic kidney disease, diabetes, anticonvulsant use, rheumatoid arthritis, malabsorption, and a history of anorexia nervosa. The reasons why these conditions confer an increased risk of osteoporosis are discussed. Recommendations are provided for the clinician to be aware of when screening women under age 65 for osteoporosis and initiating treatment when indicated.
PubMed: 38885594
DOI: 10.1016/j.maturitas.2024.108044 -
International Journal of Gynaecology... Jun 2024This study aimed to explore the relationship between urogenital symptom frequency and severity, perception of vaginal treatment burden, and female sexual desire,...
OBJECTIVE
This study aimed to explore the relationship between urogenital symptom frequency and severity, perception of vaginal treatment burden, and female sexual desire, arousal, and satisfaction.
METHODS
A cross-sectional study was conducted with a sample of 326 patients from three tertiary care hospitals in the United Arab Emirates. The frequency and severity of urogenital symptoms, emotional and physical functioning, and treatment burden were assessed using the validated genitourinary syndrome of menopause symptoms and vaginal treatments acceptability questionnaire (GSM-SVATQ). To examine the mediating roles of emotional and physical functioning, as well as the perceived treatment burden on sexual functioning, a partial least squares-structural equation model was developed using the SmartPLS 4 Software.
RESULTS
The measurement model was successfully established. All constructs had a reliability of > 0.70 and discriminant validity of < 0.90. Emotional, physical and sexual functioning showed an adjusted R values of 0.377, 0.282 and 0.169, respectively.The multistep multiple mediator model revealed a full mediation effect of both emotional and physical functioning between symptom, treatment burden and sexual functioning. The model showed high predictive performance with all manifest variables showing lower mean absolute errors compared to the naiive benchmark model.
CONCLUSION
This study enhances our understanding of the relationships between urogenital symptoms, perceived treatment burden, emotional functioning, and sexual well-being. The findings emphasize the importance of addressing emotional well-being in managing urogenital symptoms and in addressing emotional factors associated with the use of vaginal treatments.
PubMed: 38874110
DOI: 10.1002/ijgo.15736