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Journal of Family Medicine and Primary... May 2024Postmenopausal bleeding (PMB) refers to any uterine bleeding in a menopausal women. In the early menopausal years, endometrial hyperplasia, polyps and submucosal...
INTRODUCTION
Postmenopausal bleeding (PMB) refers to any uterine bleeding in a menopausal women. In the early menopausal years, endometrial hyperplasia, polyps and submucosal fibroids are common etiologies of post menopausal bleeding. The most common cause of postmenopausal bleeding is endometrial atrophy, comprises of 60-80%, while endometrial hyperplasia and endometrial cancer contribute to only 11% of Post menopausal bleeding. The aim of study is to analyses histomorphological pattern of endometrium in patients presenting with post-menopausal bleeding in Jharkhand.
MATERIALS AND METHODS
103 postmenopausal women presenting to tertiary center of Jharkhand in 2020-22 with bleeding were subjected to endometrial curettage for histopathology. Analysis is based on morphological criteria to assess endometrium. Endometrial histology is of four categories: Proliferative, Secretory, premalignant and carcinoma.
RESULTS
The highest incidence of postmenopausal bleeding was noticed in age group of < 60 years and incidence of malignancy was higher after 57 years of age. The majority of patients had parity between 1 and 3 (78.6%). Malignant & premalignant lesions comprises about 22.3% among that 77.7% were due to benign causes. Among the benign causes of postmenopausal bleeding, proliferative endometrium was the commonest finding. Types of hyperplasia encountered were simple hyperplasia without atypia (6.8%), Complex hyperplasia without atypia (3.9%),Complex hyperplasia with atypia (4.8%) and Simple hyperplasia with atypia (4.8%). 21.4% of cases of postmenopausal bleeding were associated with atrophic endometrium. Secretory endometrium seen in 17.5% of women. Endometrial carcinoma accounted for 12.6% of cases of postmenopausal bleeding. Out of these 69.2% were of endometroid type of endometrial carcinoma, 15.3% were of papillary serous carcinoma and 15.3% had clear cell carcinoma. The mean age of patients with endometrium carcinoma was 62.3 years. All cases of endometrial carcinoma were associated with 1 or more risk factor like diabetes/hypertension/Nulligravida.
CONCLUSION
Proliferative Endometrium was a major cause of postmenopausal bleeding. Among the malignant causes, endometrial adenocarcinoma of endometroid type was most frequent with a lower mean age at presentation than other high grade cancers like papillary serous carcinoma & clear cell carcinoma.
PubMed: 38948580
DOI: 10.4103/jfmpc.jfmpc_1331_23 -
Journal of Family Medicine and Primary... May 2024(body constitution) is the essential fundamental of Ayurveda. In female physiology, it plays a crucial role in determining the age of menarche and menopause. Recent...
INTRODUCTION
(body constitution) is the essential fundamental of Ayurveda. In female physiology, it plays a crucial role in determining the age of menarche and menopause. Recent research has shown that early menopause occurs in tribal women. Vagbhata states that a female has a longer menstrual life [i.e., reproductive period] compared to the and females. This study was done to estimate in females who attain early and premature menopause in the tribal population to provide optimal care for tribal women through primary and whole health systems.
MATERIALS AND METHODS
This cross-sectional questionnaire survey study was carried out in four villages of Nagpur district territory of Eastern Maharashtra, the central zone of India after seeking permission from IEC. A multistage sampling technique was used to select the 80%, and above tribal people, 169 married women who attained early or premature menopause were included. Post-menopausal women were selected for the study, and females with hysterectomy, secondary amenorrhea, and other major illnesses were excluded from the study. Data were collected by survey method with the help of a pre-validated questionnaire.
OBSERVATION AND RESULT
Out of 169 females 57.98% of females were of , 24.85% of females were of , and 17.15% of females were of . The prevalence of early or premature menopause of females is 57.98.
DISCUSSION
characteristics such as , , , and in females lead to early or premature menopause. To avoid early or premature menopause in tribal females, ghee (ghrit) and milk can be included in dietary habits, lifestyle modification, and awareness counseling may prove beneficial.
CONCLUSION
Early or premature menopause is observed largely in females of Nagpur district, Eastern Maharashtra, tribal zone of Central Inda.
PubMed: 38948555
DOI: 10.4103/jfmpc.jfmpc_376_23 -
Human Reproduction Open 2024Are women's reproductive factors associated with physical frailty and comprehensive frailty in middle-age and later life?
STUDY QUESTION
Are women's reproductive factors associated with physical frailty and comprehensive frailty in middle-age and later life?
SUMMARY ANSWER
Early menarche at <13 years, age at menopause <45 years, surgical menopause, experiencing miscarriage and a shorter reproductive period of <35 years were associated with increased odds of frailty, while having two or three children was related to decreased likelihood of frailty.
WHAT IS KNOWN ALREADY
Evidence has shown that women are frailer than men in all age groups and across different populations, although women have longer lifespans. Female-specific reproductive factors may be related to risk of frailty in women.
STUDY DESIGN SIZE DURATION
A population-based cross-sectional study involved 189 898 women from the UK Biobank.
PARTICIPANTS/MATERIALS SETTING METHODS
Frailty phenotype and frailty index were used to assess physical frailty and comprehensive frailty (assessed using 38 health indicators for physical and mental wellbeing), respectively. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% CI between reproductive factors and likelihood of physical frailty and comprehensive frailty. Restricted cubic spline models were used to test the non-linear associations between them. In addition, we examined the combined effect of categorized age at menopause and menopause hormone therapy (MHT) on frailty.
MAIN RESULTS AND THE ROLE OF CHANCE
There was a J-shape relationship between age at menarche, reproductive period, and frailty; age at menarche <13 years and >16 years, and reproductive period <35 years or >40 years were all associated with increased odds of frailty. There was a negative linear relationship between menopausal age (either natural or surgical) and odds of frailty. Surgical menopause was associated with 30% higher odds of physical frailty (1.34, 1.27-1.43) and 30% higher odds of comprehensive frailty (1.30, 1.25-1.35). Having two or three children was linked to the lowest likelihood of physical frailty (0.48, 0.38-0.59) and comprehensive frailty (0.72, 0.64-0.81). Experiencing a miscarriage increased the odds of frailty. MHT use was linked to increased odds of physical frailty in women with normal age at natural menopause (after 45 years), while no elevated likelihood was observed in women with early natural menopause taking MHT.
LIMITATIONS REASONS FOR CAUTION
The reproductive factors were self-reported and the data might be subject to recall bias. We lacked information on the types and initiation time of MHT, could not identify infertile women who later became pregnant, and the number of infertile women may be underestimated. Individuals participating in the UK Biobank are not representative of the general UK population, limiting the generalization of our findings.
WIDER IMPLICATION OF THE FINDINGS
The reproductive factors experienced by women throughout their life course can potentially predict frailty in middle and old age. Identifying these reproductive factors as potential predictors of frailty can inform healthcare providers and policymakers about the importance of considering a woman's reproductive history when assessing their risk for frailty.
STUDY FUNDING/COMPETING INTERESTS
This work was supported by the National Key Research and Development Program of China (2022YFC2703800), National Natural Science Foundation of China (82273702), Science Fund Program for Excellent Young Scholars of Shandong Province (Overseas) (2022HWYQ-030), Taishan Scholars Project Special Fund (No. tsqnz20221103), and the Qilu Young Scholar (Tier-1) Program (202099000066). All authors have no conflicts of interest to declare.
TRIAL REGISTRATION NUMBER
N/A.
PubMed: 38948112
DOI: 10.1093/hropen/hoae038 -
Sexual Medicine Jun 2024Breast cancer (BC) is considered a risk factor for sexual dysfunction, which may be associated with the diagnosis itself or with oncological treatments. However, sexual...
BACKGROUND
Breast cancer (BC) is considered a risk factor for sexual dysfunction, which may be associated with the diagnosis itself or with oncological treatments. However, sexual dysfunction often remains underdiagnosed and unaddressed among BC survivors.
AIM
The study sought to evaluate the sexual function of postmenopausal BC survivors compared with postmenopausal women without BC.
METHODS
This case-control study included 178 postmenopausal BC survivors (stages I-III), 45 to 70 years of age, with amenorrhea for ≥12 months and sexually active. They were compared with 178 women without BC, matched (±2 years) for age and time since menopause in a 1:1 ratio. Sexual function was evaluated using the Female Sexual Function Index (FSFI), which consists of 6 domains (desire, arousal, lubrication, orgasm, satisfaction, and pain), with a total score ≤26.5 indicating risk of sexual dysfunction. Statistical analysis included Student's test, chi-square test, and logistic regression (odds ratio [OR]).
OUTCOMES
Evaluation of sexual function in postmenopausal women treated for BC.
RESULTS
Postmenopausal BC survivors showed poorer sexual function in the desire domain ( .002). No significant differences were observed between groups in the other FSFI domains and total score ( .05). Postmenopausal BC survivors had a higher prevalence of risk of sexual dysfunction (64.6% with a total score ≤26.5) compared with the control group (51.6%) ( .010). Adjusted risk analysis for age and time since menopause revealed a higher risk of sexual dysfunction in BC survivors compared with women without cancer (OR, 1.98; 95% confidence interval, 1.29-2.96; .007). Among BC survivors, the use of hormone therapy was associated with a higher risk of sexual dysfunction (OR, 3.46; 95% confidence interval, 1.59-7.51; .002).
CLINICAL IMPLICATIONS
Postmenopausal BC survivors should be regularly assessed before and throughout treatment to enable the early detection and diagnosis of sexual dysfunction.
STRENGTH AND LIMITATIONS
The main strength is that this study might contribute to a better understanding of sexual function in postmenopausal BC survivors compared with women without BC. The main limitation is that while the FSFI is a valid and reliable tool for the evaluation of female sexual function, it does not allow a comprehensive diagnosis of sexual dysfunction, as it is not applicable to partners.
CONCLUSION
Compared with postmenopausal women without BC, postmenopausal BC survivors face a higher risk of sexual dysfunction, especially when treated with adjuvant hormone therapy.
PubMed: 38948072
DOI: 10.1093/sexmed/qfae035 -
Determinants of knowledge and perception about menopause among Saudi women: A cross-sectional study.Heliyon Jun 2024Healthcare professionals and educators closely monitor the occurrence of climacteric symptoms in women's primes. Knowledge and perception of menopause play a crucial...
BACKGROUND
Healthcare professionals and educators closely monitor the occurrence of climacteric symptoms in women's primes. Knowledge and perception of menopause play a crucial role in improving quality of life. This study aimed to assess the knowledge and perceptions of menopause among Saudi women and identify its predictors. This study is the first of its kind in the southern region of Saudi Arabia.
METHODS
Conducted in accordance with the STROBE guidelines, this cross-sectional study was carried out in the Jazan region from May 2022 to January 2023 and involved 480 Saudi women who provided consent. Data were collected through interviews using a validated questionnaire and random sampling. The questionnaire consisted of four parts: informed consent, demographics, 21 knowledge questions, and ten menopause perception questions. The validity of the content and the internal consistency were evaluated before data collection. Primary healthcare centers were randomly selected from four governorates with a proportional sample size to the population. Descriptive analysis, Pearson correlation, and multivariate logistic regression analyses were performed using IBM-SPSS.
RESULTS
Among the participants, 64 % were under 40 years old, 80 % had experienced menarche between the ages of 10 and 15, 48 % were employed, approximately half held a bachelor's degree, and they had a good family income. The mean knowledge score of the participants was 48.87 ± 11.72, with a minimum score of 27 and a maximum score of 78. In terms of knowledge categories, 56.3 % of the participants (N = 270) were classified as having low knowledge, while 43.8 % (N = 210) were classified as having high knowledge. Most of the participants had positive perceptions and agreed that menopause is a natural event in women's lives. There was a significant positive correlation between knowledge and perception (R = 0.219, P < 0.01). Variable findings were observed regarding the role of explanatory variables in women's knowledge of menopause between univariate and multivariate models. The results of the multivariate model showed that age (46-50 years, OR = 0.42), having children (OR = 1.09), residence (OR = 0.45-5.73) and family income categories (medium: OR = 3.98, good: OR = 3.78, and excellent: OR = 1.95) had a significant impact on knowledge, highlighting the correlation between demographic factors and knowledge.
CONCLUSIONS
Based on the study findings, we recommend implementing workplace and community-based activities to increase women's awareness of menopause and incorporating it as an integral part of counseling sessions for women in this age group. Therefore, the results of the study will be shared with the relevant authorities responsible for women's health, enabling them to effectively support and educate women
PubMed: 38948045
DOI: 10.1016/j.heliyon.2024.e32935 -
Cureus May 2024Pyometra is a very uncommon condition in postmenopausal women that rarely improves with standard antibiotic treatments. It is usually overlooked as the patient presents...
Pyometra is a very uncommon condition in postmenopausal women that rarely improves with standard antibiotic treatments. It is usually overlooked as the patient presents with vague symptoms. Our case presented a postmenopausal woman with sepsis due to a huge pyometra. Swabs for sensitivity, tubercular gene testing, and basic blood workup were done, and the patient was started on intravenous antibiotic therapy. Pyometra drainage could not be done due to thin, friable uterine walls. When the patient had improved, a clinically total abdominal hysterectomy was done after ruling out malignant causes. Delay in the diagnosis of this condition may lead to perforation, which may, in turn, cause peritonitis, which may gravely affect the patient.
PubMed: 38947584
DOI: 10.7759/cureus.61394 -
Alzheimer's & Dementia : the Journal of... Jul 2024Evidence for the effect of early menopause on cognition among older women is not consistent and is scant among the Indian population.
BACKGROUND
Evidence for the effect of early menopause on cognition among older women is not consistent and is scant among the Indian population.
METHODS
We aimed to examine the effect of early menopause (≤45 years) on cognitive performance and brain morphology among older dementia-free females of the TLSA cohort using a multiple linear regression analysis.
RESULTS
In a sample of 528 women, 144 (27%) had early menopause. The linear regression analysis showed that women with early menopause performed poorly in cognition and had lesser total gray matter volume [β = -11973.94, p = 0.033], left middle frontal [β = -353.14, p = 0.033], and left superior frontal [β = -460.97, p < 0.026] volume.
CONCLUSION
Dementia-free women with early menopause had poorer cognition, lower total gray matter, and frontal lobe. More research is needed to explore the link between earlier menopause and cognitive decline and develop ways to address it.
HIGHLIGHTS
Evidence on the effect of early menopause on brain morphology is inconsistent and scant in low and middle-income countries, such as India. In a cohort of dementia-free individuals in urban Bangalore, we observed that participants with early menopause had significantly lower cognitive performance and lower total gray matter and frontal lobe volume. We recommend increasing awareness of this fact among the medical community and the general public. There is an urgent need to explore the underlying biological mechanism and to discover effective interventions to mitigate the effect.
PubMed: 38946683
DOI: 10.1002/alz.14069 -
Journal of Nutritional Science and... 2024Osteoporosis is characterized by bone loss and deterioration in bone microstructure, leading to bone fragility. It is strongly correlated with menopause in women....
Osteoporosis is characterized by bone loss and deterioration in bone microstructure, leading to bone fragility. It is strongly correlated with menopause in women. Previously, we reported that diets supplemented with a kudzu (Pueraria lobata) vine extract suppressed bone resorption in ovariectomized (OVX) mice, a postmenopausal model. The main isoflavone in kudzu is puerarin (daidzein-8-C-glycoside). Puerarin (daidzein-8-C-glycoside), which is main isoflavone of kudzu, probably contributes to the beneficial effect. However, the underlying mechanism is unclear. Therefore, the nutrikinetics of puerarin and the comparison with the suppressive effects of kudzu isoflavones on osteoclast differentiation was examined in this study. We demonstrated that orally administered puerarin was absorbed from the gut and entered the circulation in an intact form. In addition, puerarin accumulated in RAW264.7 pre-osteoclast cells in a time-dependent manner. Tartrate-resistant acid phosphatase activity was decreased by puerarin treatment in a concentration-dependent manner in RAW264.7 cells stimulated with the receptor activator of nuclear factor kappa-B ligand. Ovariectomy-induced elevated bone resorption was suppressed, and the fragile bone strength was improved by puerarin ingestion in the diet. These findings suggested that orally administered puerarin was localized in bone tissue and suppressed bone resorption and osteoclastogenesis in ovariectomized mice.
Topics: Animals; Isoflavones; Ovariectomy; Osteoclasts; Female; Mice; Femur; Pueraria; Cell Differentiation; RAW 264.7 Cells; Bone Resorption; Plant Extracts; Osteoporosis; Tartrate-Resistant Acid Phosphatase
PubMed: 38945892
DOI: 10.3177/jnsv.70.262 -
Hormones and Behavior Jun 2024In a subset of females, postmenopausal status has been linked to accelerated aging and neurological decline. A complex interplay between reproductive-related factors,...
In a subset of females, postmenopausal status has been linked to accelerated aging and neurological decline. A complex interplay between reproductive-related factors, mental disorders, and genetics may influence brain function and accelerate the rate of aging in the postmenopausal phase. Using multiple regressions corrected for age, in this preregistered study we investigated the associations between menopause-related factors (i.e., menopausal status, menopause type, age at menopause, and reproductive span) and proxies of cellular aging (leukocyte telomere length, LTL) and brain aging (white and gray matter brain age gap, BAG) in 13,780 females from the UK Biobank (age range 39-82). We then determined how these proxies of aging were associated with each other, and evaluated the effects of menopause-related factors, history of depression (= lifetime broad depression), and APOE ε4 genotype on BAG and LTL, examining both additive and interactive relationships. We found that postmenopausal status and older age at natural menopause were linked to longer LTL and lower BAG. Surgical menopause and longer natural reproductive span were also associated with longer LTL. BAG and LTL were not significantly associated with each other. The greatest variance in each proxy of biological aging was most consistently explained by models with the addition of both lifetime broad depression and APOE ε4 genotype. Overall, this study demonstrates a complex interplay between menopause-related factors, lifetime broad depression, APOE ε4 genotype, and proxies of biological aging. However, results are potentially influenced by a disproportionate number of healthier participants among postmenopausal females. Future longitudinal studies incorporating heterogeneous samples are an essential step towards advancing female health.
PubMed: 38944998
DOI: 10.1016/j.yhbeh.2024.105596 -
Mymensingh Medical Journal : MMJ Jul 2024Abnormal uterine bleeding (AUB) is the most common and frequent presenting complaint in Gynaecology in all age group especially in perimenopausal and postmenopausal... (Observational Study)
Observational Study
Abnormal uterine bleeding (AUB) is the most common and frequent presenting complaint in Gynaecology in all age group especially in perimenopausal and postmenopausal women. The spectrum of AUB in women of our country includes a wide varieties of organic pathology. The objective of this study was to assess the role of endometrial thickness as a predictor of endometrial malignancy among the women presenting with AUB. This cross-sectional descriptive type of observational study was conducted among 122 women of perimenopausal (40-50 years) and 87 women of postmenopausal (>50 years) age group presenting with AUB in the Obstetrics and Gynaecology department of Mymensingh Medical College Hospital, Bangladesh from February 2020 to August 2021. These patients were subjected to a detailed history and meticulous general, systemic and local examination. The relevant investigations like Transvaginal Sonography (TVS) followed by endometrial biopsy by dilatation and curettage were done in all study participants. Most of the women were in the age group 41-45 years in perimenopause and 51-55 years in postmenopause. Mean±SD was 45.8±4.1 years in perimenopause and 56.3±6.4 years in postmenopause. There was statistical significance in developing endometrial malignancy regarding risk factors of nulliparity, Hypertention (HTN), Diabetes mellitus (DM) and hormone intake between perimenopause and postmenopause. Endometrial thickness was measured in perimenopause and postmenopause. Mean±SD of Endometrial thickness (ET) in perimenopause and postmenopause was 11.3±4.4mm and 7.2±6.3mm with statistical significance (p<0.001). Sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV) and accuracy of TVS were 85.5%, 67.4%, 81.2%, 73.8% and 78.7% in perimenopause and 85.9%, 20%, 89%, 75% & 83.9% in postmenopause. Cut off limit of ET in detection of endometrial malignancy was 18.5mm with sensitivity 74.8% and specificity 63.6% in perimenopause and 12.2mm with sensitivity 81.0% and specificity 65.8% in postmenopausal women. Women with AUB, endometrial malignancy should be suspected when endometrial thickness on TVS >18.5mm and >12.2mm in perimenopause and postmenopausal age group respectively. TVS has high sensitivity in detection of endometrial malignancy both in perimenopausal and postmenopausal women with AUB and TVS is a reliable, noninvasive method.
Topics: Humans; Female; Middle Aged; Endometrial Neoplasms; Cross-Sectional Studies; Endometrium; Uterine Hemorrhage; Adult; Ultrasonography; Risk Factors; Predictive Value of Tests; Bangladesh; Perimenopause; Postmenopause
PubMed: 38944706
DOI: No ID Found