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Background: The present study examined the potential use of computed tomography radiomorphometric mandibular indices on cone beam CT (CBCT) for the assessment of bone density in postmenopausal women with low bone mass. Methods: We included 104 postmenopausal women who received dual-energy X-ray absorptiometry (DXA) using a DXA scanner and mental foramen (MF) region CBCT using a NewTom VGi EVO Cone Beam 3D system. We assessed the relationships between the following DXA parameters: lumbar, femoral neck, and total hip T-scores, bone mineral density (BMD), lumbar trabecular bone score (TBS), and mandibular inferior cortical bone thickness at 4 sites. The cross-sectional images were obtained, as follows: anterior (A)—10 mm anterior from the MF; molar (M)—10 mm posterior from the MF; posterior (P)—25 mm posterior from the MF; symphysis (S)—equidistant from the centers of the right and left MF. Results: We found that A and M indices showed statistically significant moderate positive correlations with lumbar spine, femoral neck, and total hip BMD, as well as TBS. The P index demonstrated moderate positive correlations with these measurements, while the S index did not show significant correlations with BMD or TBS in postmenopausal women. Conclusions: These findings support the potential usefulness of CBCT-derived radiomorphometric mandibular indices for non-invasive bone health assessment in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives Oral contraceptives (OC) and menopausal hormone therapy (MHT) contain exogenous sex hormones and are used by millions of women around the world. However, their effect on the development of rheumatoid arthritis (RA) is still debated and the current literature suggests that they may exert opposite effects on the risk of RA. The present study aimed to estimate the effects of exogenous hormones on the development of RA, both during the reproductive lifespan and later in life. Methods The association between OC and RA, as well as between MHT and late-onset RA (LORA), was investigated using time-dependent Cox regression modelling in white British women from the UK Biobank (n  = 236 602 and n  = 102 466, respectively) and replicated in women from all ethnic groups. Results OC use was associated with a decreased risk of RA in ever-users [hazard ratio (HR) = 0.89; 95% CI = 0.82–0.96], as well as in current (HR = 0.81; 0.73–0.91) and former users (HR = 0.92; 0.84 –1.00), compared with never-users. In contrast, MHT use was associated with an increased risk of LORA in ever-users (HR = 1.16; 1.06–1.26) as well as in former users (HR = 1.13; 1.03–1.24) compared with never-users. Conclusion OC use appears to protect against RA, while MHT may increase the risk of LORA. This study provides new insights into the possible inverse effect of exposure to different exogenous sex hormones on the risk of RA. [ABSTRACT FROM AUTHOR]

Menopause is a biological process experienced by all people assigned female at birth. A significant number of women experience mental ill health related to the major brain gonadal hormone shifts that occur in their midlife. There is poor understanding and management of the complex mental ill health issues, with the biological brain hormone changes receiving little formal attention. The current treatment advice is to manage this special type of mental ill health in the same way that all mental ill health is managed. This leads to poor outcomes for women and their families. Many women leave the workforce earlier than expected due to menopause-related depression and anxiety, with subsequent loss of salary and superannuation. Others describe being unable to adequately parent or maintain meaningful relationships – all ending in a poor quality of life. We are a large and diverse group of national and international clinicians, lived experience and social community advocates, all working together to innovate the current approaches available for women with menopausal mental ill health. Above all, true innovation is only possible when the woman with lived experience of menopause is front and centre of this debate. [ABSTRACT FROM AUTHOR]

In recent years, there has been increased cultural interest in perimenopause and menopause. The importance of peri/menopause in many women's lives makes this topic particularly pertinent for feminist psychologists. Some feminist scholars have acknowledged both physical and psychological factors as important aspects of women's experiences within their wider social and cultural contexts. However, consideration of relational aspects during peri/menopause remains sparse. We report our research exploring peri/menopausal women's experiences of friendships, family, and relationships. Thematic analysis was used to analyse responses to an online qualitative survey in which 71 mainly British women participated. In our analysis, we discuss the Menopause Sisterhood and how these women described social support as grounded in embodied experiences shared with other women. However, there were tensions concerning partners, whose understanding varied, which we report in the second theme: Accounting for (lack of) partner support: Men as heroes (or as absolved of any blame). We discuss the importance and implications of our findings for feminist scholars and psychologists more widely. [ABSTRACT FROM AUTHOR]

Background: Atherosclerotic cardiovascular disease (ASCVD) remains the most common cause of death in women. Pregnancy is an exposure unique to women leading to significant changes in maternal cardiovascular function. However, studies of the relationship between the number of pregnancies and ASCVD are rare. We aimed to clarify the association between the number of pregnancies and ASCVD. Methods: In this cross-sectional study, we used publicly available data from the National Health and Nutrition Examination Survey from 1999 to 2018. The number of pregnancies was divided into 0 (reference), 1, 2–3, 4–5, or ≥6, to create more stable estimates. A multiple logistic regression approach was used to examine the correlation between pregnancy and ASCVD in women aged 45 years or older who reported no menstruation in the past 12 months due to menopause, as well as in those aged 55 years or older, encompassing various age groups. We also separately estimated the association between the exposure of pregnancy and individual components of ASCVD. Results: In this study, age-adjusted data showed that women with six or more pregnancies had a doubled risk (odds ratio [OR]: 2.07) of ASCVD. The risk remained elevated at 1.69 times in women with four to five pregnancies and further increased to 1.90 times in women with six or more pregnancies, after adjusting for social factors. Similar patterns were observed when considering reproductive health and cardiovascular risk factors. Across the full population, every model that accounted for these variables consistently indicated that with an increasing number of pregnancies, we observed higher ORs for ASCVD risk (all p values <0.05). Conclusions: A higher number of pregnancies was associated with a higher risk of ASCVD after menopause, especially among women aged 45–64 years. Moreover, this association is particularly significant in the risk of stroke, cardiovascular heart disease, and heart attack. [ABSTRACT FROM AUTHOR]

An association between the menopause and depression is widely reported. This review aims to determine the global prevalence of depression in menopausal women (this includes women in perimenopause and postmenopause). PubMed, Web of Science, Embase, and PsycINFO databases were systematically searched from database inception until March 1, 2024. Studies with validated methods for assessing the prevalence of depression in perimenopausal and postmenopausal women were included. Two authors independently extracted relevant data. Random effects meta-analysis and Meta-regression analysis were performed using Stata software. Total of 55 studies (76,817 participants) were included in the review. A random effects model was used to calculate pooled prevalence. The pooled depression prevalence in menopausal women was 35.6 % (95 % CI: 32.0–39.2 %), with 33.9 % (95 % CI: 27.8–40.0 %) in perimenopausal women, and 34.9 % (95 % CI: 30.7–39.1 %) in postmenopausal women. Subgroup analyses indicated that region, screening tool, study design, and setting moderated the prevalence of depression. Meta-regression indicated that smaller sample sizes and poorer study quality were significantly associated with a higher prevalence. There was a high degree of heterogeneity across the included studies. Only articles published in English were included. There was significant publication bias in this meta-analysis. There is insufficient information about many risk factors of menopausal depression in current meta-analysis. Depression is common among menopausal women worldwide. To reduce the negative impact of depression on health outcomes in menopausal women, regular screening and the availability of effective prevention and treatment measures should be made available for this population. • First review of the global prevalence of depression in menopausal women. • The pooled depression prevalence in menopausal women was 35.6 % (95 % CI: 32.0–39.2 %). • More research should be conducted in under-researched areas such as low-income countries. [ABSTRACT FROM AUTHOR]

Objective: The critical phase of perimenopausal period is marked by a reduction in estrogen levels, leading to various clinical issues (vasomotor and neurodegenerative symptoms, increased osteoporosis risk and cardiovascular risk). These complex clinical scenarios pose challenges to clinicians in providing the right support for diagnosis and treatment. A group of Italian cardiologists, endocrinologists, and gynecologists conducted a survey among expert colleagues to assess consensus on controversial issues and best practices for screening and treating peri‐ and postmenopausal women. Methods: The Delphi methodology was used to analyze responses from a qualitative expert panel comprising 25 cardiologists, 25 endocrinologists, and 25 gynecologists, selected nationwide. Two consecutive questionnaires were proposed between February and May 2023. Agreement among experts was assessed following the Delphi method as developed by the RAND Corporation. Results: The results of this Delphi Consensus have been shared by the leading scientific societies: Italian Society of Cardiology, Italian Society of Endocrinology, Italian Society of Gynecology and Obstetrics, and Italian Hospital Obstetricians Gynecologists Association. Conclusions: The experts highlighted comorbidities and hormone deprivation as crucial clinical problems to be evaluated in perimenopausal women, requiring investigation from cardiovascular and endocrinologic perspectives to assess cardiovascular risk, involving the use of BMI, standard blood samples, endocrine‐metabolic tests, and lifestyle assessment, particularly in women with higher cardiovascular and metabolic risks candidates for hormone replacement therapy (HRT). The experts also agreed on the benefits of HRT in improving lipid metabolism and reducing insulin resistance, thereby mitigating the metabolic risks associated with menopause. However, this therapy should be tailored considering individual women's comorbidities and thrombotic risk. Synopsis: The leading scientific societies agree that comorbidities and hormone deprivation are crucial clinical problems to be evaluated in peri‐ and postmenopause requiring specific cardiovascular and endocrinologic investigations. [ABSTRACT FROM AUTHOR]

The increasing prevalence of obesity imposes significant health challenges, particularly in women undergoing menopause. Effective obesity management is essential to mitigate associated comorbidities and improve quality of life. The pillars of obesity treatment encompass lifestyle modifications, pharmacotherapy and surgical interventions. Pharmacotherapy may be considered for women who do not achieve adequate weight loss through lifestyle changes alone and have obesity or overweight with risk factors. Bariatric surgery is reserved for individuals with severe obesity or those with obesity-related complications. During menopause, hormonal changes contribute to weight gain and fat redistribution, complicating obesity management. Tailored treatment strategies are necessary to address the unique challenges faced by this population. The role of physicians and gynecologists is pivotal in the multidisciplinary approach to obesity management during menopause. Gynecologists are often the primary health-care providers for menopausal women and are in a unique position to offer guidance on weight management. They can provide personalized counseling, coordinate with nutritionists, endocrinologists and bariatric specialists, and monitor the effects of obesity and its treatment on reproductive health. By integrating obesity management into routine gynecological care, gynecologists can significantly impact the overall health and well-being of menopausal women. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to document the prevalence and severity of vasomotor symptoms (VMS) and sexual symptoms among refugee women in Melbourne, Australia. Methods: This cross-sectional study included refugee women, aged 18–63 years, recruited from community centers and social media between February and July 2023. The Menopause-specific Quality of Life (MENQOL) questionnaire measured VMS and sexual symptoms. The scores were compared between different menopausal states. Results: Of 333 participants, 62.8% were premenopausal, 8.0% perimenopausal and 29.2% postmenopausal, with a median age of 40 years (range 18–63 years). Moderate–severe VMS was most prevalent amongst perimenopausal (20.8%; 95% confidence interval [CI]: 8.9–41.4%) versus postmenopausal (9.5%; 95% CI: 5.0–17.3%) and premenopausal (0%) women. Moderate–severe sexual symptoms affected 15.8% (95% CI: 5.2–39.3%) of perimenopausal and 16.9% (95% CI: 10.4–26.1%) of postmenopausal women versus 1.4% (95% CI: 0.3-5.3%) of premenopausal women. Perimenopausal and postmenopausal women had higher VMS and sexual symptom scores than premenopausal women (both p < 0.0001); the scores were also higher in perimenopausal women than postmenopausal women (p = 0.016 and p = 0.013, respectively). Conclusion: While perimenopausal and postmenopausal VMS and sexual symptoms are not uncommon amongst refugee women, these symptoms were less prevalent in postmenopausal refugees than in the non-refugee population. Further research is warranted to confirm and expand on these findings. [ABSTRACT FROM AUTHOR]

Many women seek treatment to improve menopausal vasomotor symptoms (VMS). The selection of women most likely to benefit from menopause hormone therapy (MHT) is crucial in clinical practice. There is general agreement that women younger than 60 years or who initiate MHT within the first 10 years of menopause, with no contraindications, have greater benefits considering symptomatic relief and additional advantages. This group may have the advantage of protection from osteoporosis and from other chronic diseases that affect postmenopausal women, namely cardiovascular disease (CVD). Cumulating evidence supports MHT for symptomatic women. However, inadequate use according to the needs of symptomatic women led to a burden of suffering worldwide. In recent years, the emergent use of non-regulated body-identical hormones (non-rBHT) can expose patients to potential harms. These hormone preparations are not regulated through the same tests of safety, efficacy or dosing consistency as regulated-BHT (r-BHT). The POESIT (Portugal + Spain + Italy) recommendations highlight the use of 17β-estradiol (E2) and micronized progesterone (P4) as the real r-BHT. In addition, the group emphasizes as an example the data from the REPLENISH study with 1 mg E2/100 mg P4. The combination of the two hormones in one convenient pill showed a clear reduction or elimination of hot flashes and an improvement in sleep quality and, consequently, quality of life. At the same time, this combination has shown high rates of amenorrhea and no significant impact on lipid, glucose or coagulation parameters. Both the REPLENISH study and a real-life retrospective study pointed to the possibility of a lower risk of venous thromboembolism (VTE) with this formulation than with other combinations. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the possible association of adherence to the Mediterranean diet (MD) with muscle strength and body composition. Methods: The cross-sectional study evaluated 112 postmenopausal women (aged 41–71 years). Fasting blood samples were obtained for biochemical/hormonal assessment. The Mediterranean Dietary Score (MedDietScore) was calculated and used to stratify adherence by tertiles (low [T1], moderate [T2] or high [T3]). Handgrip strength (HGS) was measured by dynamometry and body composition with dual-X-ray absorptiometry. Results: Women with low–moderate MedDietScore (T1/T2) had lower HGS values than those with higher scores (19.5 ± 4.9 kg vs. 21.9 ± 3.9 kg, p = 0.023). A linear stepwise increase of HGS values per MedDietScore tertile was found (T1 vs. T2 vs. T3: 18.4 ± 4.4 kg vs. 20.6 ± 5.2 kg vs. 21.9 ± 3.9 kg, ANOVA p-value for linear trend = 0.009, ANCOVA p-value = 0.026). Multivariable models confirmed that HGS values were independently associated with the MedDietScore (β-coefficient = 0.266, p = 0.010). Lean mass values were associated with the MedDietScore (β-coefficient = 0.205, p = 0.040). All models were adjusted for age and cardiometabolic risk factors. Conclusions: The data suggest that the higher the adherence to the MD, the better the muscle strength and lean mass in postmenopausal women. Prospective studies are required to evaluate the significance of these observations in cardiovascular prevention strategies at midlife. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the association between severity of menopausal symptoms and cardiovascular disease (CVD) risk among middle-aged Chinese women. Methods: A cross-sectional study recruited 9679 women aged 40–70 years from three socioeconomic regions of China in 2018. Menopausal symptoms were assessed by the modified Kupperman Menopausal Index (KMI). The severity of individual symptoms was classified as none (0 points), mild (1 points) and moderate-to-severe symptoms (2–3 points), and overall menopausal symptoms were classified as none (<15 points), mild (15–24 points) or moderate-to-severe (≥25 points) according to the sum score of the KMI. Logistic regression models were used to examine associations of the severity of menopausal symptoms with CVD risk. Results: A total of 5.6% of participants reported being diagnosed with CVD. Overall menopausal symptoms were more common in women aged 60–70 years than in women aged 40–59 years. After multiple adjustment, mild (odds ratio [OR] = 2.07, 95% confidence interval [CI]: 1.64–2.61) and moderate-to-severe (OR = 2.64, 95% CI: 1.92–3.63) overall menopausal symptoms were associated with increased risk of CVD compared with no symptoms. Significant positive associations between the severity of individual menopausal symptoms and CVD risk were observed for all 13 items. Conclusion: The severity of menopausal symptoms was positively associated with CVD risk in middle-aged Chinese women. [ABSTRACT FROM AUTHOR]

Objective: Menopause is a physiological period characterized by the cessation of ovarian activity. Sequential changes during this transition affect multiple systems, including the brain. Sixty percent of women experience cognitive impairment. The objective of this review is to show the neuroprotective effect of hormone replacement therapy (HRT) through the different scales and whether there is a benefit of this in women. Method: A search was conducted in six databases. Eligibility criteria included women within 10 years of menopause, receiving HRT controlled with placebo, studies lasting more than 6 months and women without a history of chronic underlying pathology. Results: A total of nine randomized controlled trials met the inclusion criteria. Regarding memory, two studies reported better performance of HRT with a significant odds ratio (OR) of 0.67; regarding attention, one study reported potential improvement in women receiving HRT with a significant OR of 0.87; and neuroimaging assessment found an increase in ventricular volume compared to placebo over a 3-year period. Conclusions: The early initiation of menopausal HRT in healthy women appears to yield a positive effect on certain cognitive aspects, such as attention and cortical volume in the central nervous system. These findings should be confirmed through future prospective studies. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the association of hormone replacement therapy (HRT) use, type, duration and age of commencement with myocardial infarction (MI) and stroke in postmenopausal Korean women. Methods: This nested case–control study used data from the National Health Insurance Service database to analyze 2017 data from women aged ≥50 years and diagnosed with natural menopause between 2004 and 2007. Among 356,160 eligible women, 36,446 used HRT for ≥1 year and 319,714 did not (controls). These two groups were matched 1:1 for statistical analysis. Type and duration were categorized into three categories. Results: Women who started estrogen–progestogen therapy (EPT) or estrogen therapy (ET) in their 50s, or EPT or tibolone in their ≥60s exhibited a lower stroke risk than controls. MI risk was lower among women who used tibolone – regardless of duration – or EPT or ET for 1–3 years than among controls. Stroke risk was lower with tibolone use for ≥5 years or with EPT or ET use for 1–3 years or ≥5 years than non-users. Conclusion: Our study may support the beneficial effect of HRT by showing that Korean postmenopausal women who used HRT at a relatively younger and healthier age had a relative benefit for MI and stroke. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine sex differences in factors associated with mood and anxiety in midlife men and women during the COVID-19 pandemic. Methods: During a remote visit, 312 adults aged 40–60 years (167 female; 23.6% perimenopausal) from the Human Connectome Project in Aging completed PROMIS measures of depression, anxiety and anger/irritability; perceived stress; and questions about social support, financial stress and menopause stage. Multivariate linear regression models assessed sex differences in mental health and the association of social support, financial stress and menopause stage with mental health. Results: Anxiety was higher in women than in men (b = 2.39, p = 0.02). For women only, decreased social support was associated with increased anxiety (b = −2.26, p = 0.002), anger/irritability (b = −1.89, p = 0.02) and stress (b = −1.67, p = 0.002). For women only, not having close family was associated with increased depressive symptoms (b = −6.60, p = 0.01) and stress (b = −7.03, p < 0.001). For both sexes, having children was associated with lower depressive symptoms (b = −3.08, p = 0.002), anxiety (b = −1.93, p = 0.07), anger/irritability (b = −2.73, p = 0.02) and stress (b = −1.44, p = 0.07). Menopause stage was unrelated to mental health. Conclusion: Social support, but not financial stress, influenced mental health during the COVID-19 pandemic at midlife, particularly for women. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine physicians' and patients' perceptions regarding symptom burden and impact in women experiencing natural vasomotor symptoms (nVMS) or vasomotor symptoms induced by endocrine therapy for breast cancer (iVMS). Methods: The cross-sectional survey based on real-world clinical consultations was conducted in the USA and five European countries. Obstetrician–gynecologists, primary-care physicians and oncologists provided demographic and symptom data for patients experiencing VMS; patients optionally self-reported their experiences via questionnaires, including their symptom profile and work/activity burden through the Menopause Quality of Life (MENQOL) and Work Productivity and Activity Impairment (WPAI) tools. Results: Physicians completed survey forms on 2451 consulting patients; patients completed 1029 questionnaires. nVMS and iVMS severity was significantly associated with the severity of mood symptoms and sleep disturbances (p < 0.0001). However, around half of the patients with mild nVMS/iVMS also experienced moderate–severe mood changes (55.4%/43.7%) or sleep disturbances (42.4%/40.4%). Presence of mood/sleep disturbances alongside nVMS increased MENQOL vasomotor scores (p = 0.004/p < 0.001). Presence of sleep disturbances increased WPAI activity impairment (p < 0.001) but mood changes did not. Similar findings were reported for iVMS patients. Conclusion: Significant burden from the triad of natural or induced menopausal symptoms, sleep disturbances and mood changes affected women's daily activities, work and quality of life more than vasomotor symptoms alone. [ABSTRACT FROM AUTHOR]

Drawing on feminist scholarship that interrogates cultural representations of ageing women, this article examines UK news coverage of menopause from 2001 to 2021. We show that not only has there been a dramatic rise in menopause's visibility since 2015, and especially since 2021, but that the coverage is concentrated in the conservative right-wing press. We also document six peaks in coverage, which are driven by celebrity stories, news about menopause-related medical guidelines, national hormone replacement therapy shortages and menopause-related governmental interventions, as well as the use of menopause as a metaphor for the economy. Based on these findings, we discuss some key social, cultural and economic forces that may help explain menopause's heightened visibility. These include the rise of popular neoliberal feminism, celebrity culture, changing demographics and changes to UK work policy, ideological notions of biological womanhood and the influence of Big Pharma. We conclude by highlighting how menopause's new luminosity contributes to challenging its traditional invisibility and negative framing, and gendered ageism more broadly. Yet, at the same time, in its current iteration, menopause's increased visibility may reinforce a neoliberal feminist framework that deflects attention away from understanding menopause as a social and cultural issue, while also buttressing narrow conceptions of femininity and supporting neoliberal policies that aim to keep older women in the workforce for longer. [ABSTRACT FROM AUTHOR]

Menopausal hormone therapy (MHT) is an effective treatment for menopause‐related symptoms. Menopause management guidelines recommend a personalized approach to menopause care, including MHT use. Decision‐making around menopause care is a complex, iterative process influenced by multiple factors framed by perspectives from both women and healthcare providers (HCPs). This narrative review aims to summarize evidence around factors affecting decision‐making regarding menopause‐related care. For HCPs, the provision of individualized risk estimates is challenging in practice given the number of potential benefits and risks to consider, and the complexity of the data available, especially within time‐limited consultations. Women seeking menopause care have the difficult task of making sense of the benefit versus risk profiles to make choices in line with their decisional needs influenced by sociocultural/economic, educational, demographic, and personal characteristics. The press, social media, and influential celebrities also impact the perception of menopause and decision‐making around it. Understanding these factors can lead to improved participation in shared decision‐making, satisfaction with the decision and decision‐making process, adherence to treatment, reduced decisional regret, efficient use of resources, and ultimately long‐term satisfaction with care. [ABSTRACT FROM AUTHOR]

Breast cancer has distinct causes and molecular characteristics at premenopausal and postmenopausal ages. The age-standardized incidence rate for postmenopausal breast cancer is more than 10 times higher than in premenopausal breast cancer. Here, we showed that the expression of 10 out of 20 most frequently mutated genes in breast cancer (namely, PIK3CA, CDH1, MUC16, PTEN, FAT3, FAT1, SPEN, ARID1A, LRP1B and RUNX1) is higher in premenopausal women with breast cancer than in postmenopausal women with breast cancer. The most significant differences in the expression in terms of menopause status were observed for RUNX1 and FAT1. Furthermore, we found that the majority of these 10 genes also show ER (estrogen receptor) or PR (progesterone receptor) status-dependent expression in both premenopausal and postmenopausal breast cancer patients. Unlike what we observed in the case of ER or PR status, the expression of most of these genes does not change depending on HER2 (human epidermal growth factor receptor 2) status in both premenopausal and postmenopausal breast cancer patients. Combined, our analysis suggests that menopause status might influence the expression of most frequently mutated genes in breast cancer, and that the most of these genes whose expression differ between pre- and post-menopausal women with breast cancer also show ER or PR status-dependent expression in women with breast cancer. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Menopause is a phase of physiological alteration in women that leads to changes in both systemic and oral health. Buccal smears were collected from 28 premenopausal women and 28 early postmenopausal women who visited the outpatient Department of Oral medicine and radiology of our college. The Oral changes were observed and the patients were asked about complaints of their menstrual history, dry mouth, systemic conditions, signs of inflammation, focal infections, ulceration, white and red lesions, and periodontal diseases. The results were obtained by correlating the changes observed in premenopausal and early postmenopausal women by the influence of hormones on oral health using oral exfoliative cytology. The results of the study were then correlated with various other similar studies and revealed that there is a high chance that the early postmenopausal women are more prone to oral discomfort than the premenopausal women. The data obtained from this study will be used to plan preventive health care programs (creating awareness about oral hygiene maintenance, measures to improve salivary parameters) for the menopausal and early postmenopausal women to improve their oral health related quality of life. [ABSTRACT FROM AUTHOR]

The sympathetic nervous system is critical for regulating blood pressure (BP) via the arterial baroreflex and sympathetic transduction in the peripheral vasculature. These mechanisms interact, and both may be altered with aging and impacted by menopause. Although age-related decreases in sympathetic transduction have been demonstrated in women, it remains unclear whether sympathetic baroreflex sensitivity (BRS) is impaired in postmenopausal women (POST). We tested the hypothesis that sympathetic BRS would be enhanced in POST compared with premenopausal women (PRE). We examined beat-by-beat BP and muscle sympathetic nerve activity (MSNA) in 19 PRE (22 ± 2 yr, 22 ± 3 kg/m2) and 12 POST (57 ± 5 yr, 24 ± 2 kg/m2) during 10 min of rest. Spontaneous sympathetic BRS was quantified as the slope of a linear regression between MSNA burst incidence and diastolic BP. Sympathetic transduction to mean arterial pressure (MAP) for the 10 cardiac cycles following spontaneous MSNA bursts was assessed via signal averaging method. Resting MAP was similar (PRE: 82 ± 8 vs. POST: 85 ± 8 mmHg, P = 0.43), whereas resting MSNA was elevated in POST (PRE: 10 ± 6 vs. POST: 45 ± 16 bursts/100 heart beats, P < 0.0001). Spontaneous sympathetic BRS was enhanced in POST (PRE: −2.0 ± 1.2 vs. POST: −5.2 ± 1.9 bursts/beat/mmHg, P < 0.0005). Sympathetic transduction to MAP was attenuated in POST (time: P < 0.001, group: P < 0.001, interaction: P < 0.01). These data suggest that sympathetic BRS may be enhanced in POST. Consistent with recent hypotheses, enhanced sensitivity of the arterial baroreflex's neural arc may signify a compensatory response to reduced efficiency of the peripheral arterial baroreflex arc (i.e., sympathetic transduction) to preserve BP buffering capacity. NEW & NOTEWORTHY: Studies examining sympathetic baroreflex function with aging remain equivocal, with some studies showing an increase, decrease, or no change in sympathetic baroreflex sensitivity (BRS) in older adults compared with younger adults. With aging, women experience unique physiological changes due to menopause that influence autonomic function. For the first time, we show that postmenopausal women exhibit a greater sympathetic BRS compared with young premenopausal women. [ABSTRACT FROM AUTHOR]

Background: Studies have shown a strong correlation between probiotics and incidence of antibiotic resistance. Many studies have reported antibiotic resistance in the vaginal microbiome especially in women with dysbiosis condition, and it is possible that the antibiotic resistance plays a role in the alteration of the vaginal microbiome and disease complications. Consequently, this study aims to investigate the vaginal microbiome with antibiotic resistance in healthy, menopausal and post-menopausal women and the mitigating effect of probiotics. In this narrative review, a comprehensive review of web of science, PubMed, Scientific information database, Google scholar and Scopus with no time limit. The keyword “Probiotics”, “Antibiotic resistance”, “Vaginal Microbiome”, “Vaginal Microbiota” were used to provide a synopsis of mitigating antibiotic resistance in the vaginal microbiome. Among the 917 sources identified, 12 articles were found most appropriate for the study. Our findings recommend administration of probiotics to alleviate antibiotic resistance. The study revealed that probiotics may mitigate antibiotic resistance in the vaginal microbiome and possibly improve the female reproductive health at all levels including menopausal and post- menopausal. [ABSTRACT FROM AUTHOR]

Progesterone is a natural steroid hormone, while progestins are synthetic molecules. In the female reproductive system, progesterone contributes to the control of luteinizing hormone and follicle-stimulating hormone secretion and their pulsatility, via its receptors on the kisspeptin, neurokinin B, and dynorphin neurons in the hypothalamus. Progesterone together with estradiol controls the cyclic changes of proliferation and decidualization of the endometrium; exerts anti-mitogenic actions on endometrial epithelial cells; regulates normal menstrual bleeding; contributes to fertilization and pregnancy maintenance; participates in the onset of labor. In addition, it exerts numerous effects on other endocrine systems. Micronized progesterone (MP) is natural progesterone with increased bioavailability, due to its pharmacotechnical micronized structure, which makes it an attractive diagnostic and therapeutic tool. This critical literature review aims to summarize and put forward the potential diagnostic and therapeutic uses of MP in the field of endocrinology. During reproductive life, MP is used for diagnostic purposes in the evaluation of primary or secondary amenorrhea as a challenge test. Moreover, it can be prescribed to women presenting with amenorrhea or oligomenorrhea for induction of withdrawal bleeding, in order to time blood-sampling for diagnostic purposes in early follicular phase. Therapeutically, MP, alone or combined with estrogens, is a useful tool in various endocrine disorders including primary amenorrhea, abnormal uterine bleeding due to disordered ovulation, luteal phase deficiency, premenstrual syndrome, polycystic ovary syndrome, secondary amenorrhea [functional hypothalamic amenorrhea, premature ovarian insufficiency], perimenopause and menopause. When administrated per os, acting as a neurosteroid directly or through its metabolites, it exerts beneficial effects on brain function such as alleviation of symptoms of anxiety and depression, asw well as of sleep problems, while it improves working memory in peri- and menopausal women. Micronized progesterone preserves full potential of progesterone activity, without presenting many of the side-effects of progestins. Although it has been associated with more frequent drowsiness and dizziness, it can be well tolerated with nocturnal administration. Because of its better safety profile, especially with regard to metabolic ailments, breast cancer risk and veno-thromboembolism risk, MP is the preferred option for individuals with an increased risk of cardiovascular and metabolic diseases and of all-cause mortality. [ABSTRACT FROM AUTHOR]

Background: women aging is a normal process of life; however, hormonal changes create an imbalance between prooxidants and antioxidants and could be measured as the antioxidant capability (AC) of an organism. Objective: to find the association between plasma AC levels, dietary intakes, and body composition in 18–64-year-old women living in the northeast of Mexico. Methods: A total of n = 514 women (18–64 years old) were grouped according to STRAW criteria as reproductive, menopausal transition, and postmenopausal. Anthropometrics, body mass index (BMI), weight–hip ratio (WHR), and weight–height ratio WHtR were determined, and percentage of body fat was analyzed by bioelectrical impedance. Dietary intake of macronutrients and vitamins A, E, and C were analyzed by a 3-day food recall. The AC status in plasma was analyzed by the ORACFL assay. Results: Plasma AC levels were higher in postmenopausal women (815 µmol TE/L), and menopausal transition women (806 µmol TE/L) than in reproductive women (633 µmol TE/L). BMI was overweight (>25 kg/m2) in all three groups. WHtR and WHR are above the healthy limit of 0.5 and 0.8, respectively for both menopausal transition and postmenopausal women. In reproductive women, negative relationships were calculated between plasma AC and age (Rho = −0.250, p = 0.007), BMI (Rho = −0.473, p < 0.001), WHtR (Rho = −0.563, p < 0.001), WHR (Rho = −0.499, p < 0.001), and % body fat (Rho = −0.396, p < 0.001). A negative association was determined between plasma AC and WHtR in reproductive women (B = −2.718, p = 0.026). No association resulted for those in menopausal transition, and a positive association was obtained between plasma AC and protein (B = 0.001, p = 0.024) and vitamin E (B = 0.003, p = 0.013) intakes in postmenopausal women. Conclusions: the antioxidant capability (AC) in plasma was lower in reproductive women, and anthropometric parameters marking decreased physical fitness were associated with decreased AC. [ABSTRACT FROM AUTHOR]

Menopause is currently a 'hot' topic in the UK. This article examines the Channel 4 television documentary Davina McCall: Sex, Myths and the Menopause as a key cultural text in the current UK 'menopause moment', demonstrating how the programme both reflects and contributes to the broader trend of menopause's growing visibility and the emerging menopause market. We begin by situating Davina within broader social, cultural and economic processes which provided a conducive context for the show's largely positive reception, and which constitute some of the key forces fuelling menopause's heightened public profile more broadly. We then move to investigate the discourses that Davina draws upon, mobilises and highlights. Our analysis shows how the programme invokes feminist terms, while discussing crucial structural conditions that underpin the continued stigma and shame around menopause. At the same time, we demonstrate that there is a striking disconnect between the structural inequalities that the documentary highlights and its consistent emphasis on individualised and privatised solutions. This disconnect, we argue, provides important insight into the dominant forces currently animating the current menopause moment in the UK. We conclude by underscoring how even the more recent critical renditions of menopause have thus far remained largely curtailed by biomedical and neoliberal logics. [ABSTRACT FROM AUTHOR]

Context The co-occurrence of hormonal changes during menopause and the risk of cardio-metabolic disorders has been well studied. Objective We explored the association of circulating levels of follicle-stimulating hormone (FSH) with diabetes (DM) among postmenopausal women. Method In this systematic review and meta-analysis, the search was performed in PubMed, Scopus, Web of Sciences, Epistemonikos, and Cochrane Library up to September 2023. Risk of bias was assessed by Newcastle-Ottawa Quality Assessment Scale. Pooled estimates of mean differences in FSH levels were compared between postmenopausal women with and without DM. Correlations between FSH and fasting blood glucose (FBG)/insulin/homeostatic model assessment for insulin resistance (HOMA-IR) as well as pooled effect sizes with their 95% CIs for risk of DM were calculated. Results In this study, 14 articles, including 7878 postmenopausal women, met eligibility criteria. Most of the included studies had a low/moderate risk of bias. Women with DM had significantly lower FSH levels than those without DM (standardized mean difference [SMD] −0.751 [95% CI, −1.129 to −.372], I2 = 82.46%, n = 1416). The pooled effect size for diabetes was 0.861 (95% CI, 0.740-1.001; I2 = 80.11%). The pooled risk estimate for DM based on the categorical FSH levels (high vs low) was (HR = 0.550; 95% CI, 0.356-0.850, I2 = 0). The significant inverse correlation was found between FSH levels and glycemic parameters: FBG (r = −0.285 [95% CI −0.441 to −0.113]; n = 1229), HOMA-IR (r = −0.241[−0.378 to −0.0924]; n = 1229) and insulin (r = −0.337 [−0.434 to −0.232]; n = 959)]. There were no statistically significant differences between estradiol levels among diabetic and nondiabetic groups; however, the SMD for luteinizing hormone was similar to that reported for FSH. Conclusion The available data indicated an indirect association between FSH levels and glucose disturbances among postmenopausal women, notwithstanding heterogeneity among included studies, and the complexity of various influential factors needs to be considered. Further efforts should be made to clarify the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes (T2D) is a risk factor for female breast cancer (FBC). Obesity has also been associated with FBC, also depending on menopausal status. This study aimed to evaluate the impact of obesity and T2D on the development, aggressiveness, and invasiveness of FBC. Methods: Demographic, clinical, and histopathological data from 335 women with FBC were collected, and analyzed according to weight category (102 normal weight, 117 overweight, and 116 living with obesity) and the presence/absence of T2D. Results: Age at oncologic diagnosis was not statistically significantly different for body weight; women with overweight or obesity were more likely to have an oncologic diagnosis after menopause than normal weight (p < 0.001). The presence of overweight/obesity and T2D seemed to be associated with a higher incidence of metastasis, recurrence, and triple‐negative breast cancer (TNBC) subtype (p < 0.001). Excess body weight was also associated with high histologic grade (G3) (p < 0.005). Conclusions: These results confirm excess body weight and T2D as unfavorable prognostic factors in terms of the presence of the TNBC subtype, tumor metastasis, recurrence, and aggressiveness (G3 and Ki‐67 > 20%). This study highlights the importance of prevention in all women, with early screening, and adequate nutritional programs. [ABSTRACT FROM AUTHOR]

Purpose of Review: We summarise the physiological changes and risk factors for hypertension in females, potential sex-specific management approaches, and long-term prognosis. Key Findings: Pregnancy and menopause are two key phases of the life cycle where females undergo significant biological and physical changes, making them more prone to developing hypertension. Gestational hypertension occurs from changes in maternal cardiac output, kidney function, metabolism, or placental vasculature, with one in ten experiencing pregnancy complications such as intrauterine growth restriction and delivery complications such as premature birth. Post-menopausal hypertension occurs as the protective effects of oestrogen are reduced and the sympathetic nervous system becomes over-activated with ageing. Increasing evidence suggests that post-menopausal females with high blood pressure (BP) experience greater risk of cardiovascular events at lower BP thresholds, and greater vulnerability to treatment-related adverse effects. Summary: Hypertension is a key risk factor for cardiovascular disease in females. Current BP treatment guidelines and recommendations are similar for both sexes, without addressing sex-specific factors. Future investigations into ideal diagnostic thresholds, BP control targets and treatment regimens in females are needed. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis, characterized by reduced bone mass and increased fracture risk, presents a significant public health challenge. Dual-energy X-ray Absorptiometry (DEXA) scans offer a reliable means of assessing bone mineral density (BMD) and detecting osteoporosis. The aim of this study is to assess awareness, attitude, and practice of women in the Jazan region toward DEXA scan. Methods: Data were collected through a self-administered online questionnaire. Statistical analysis was conducted using SPSS version 29.0. The total knowledge scores of participants were calculated to assess potential associations with sociodemographic data. A p-value of less than 0.05 was considered statistically significant. Results: Among 400 women, 230 (57.5%) had low knowledge scores primarily due to poor knowledge of the DEXA scan procedure. Merely 39 women had undergone a DEXA scan mainly due to medical prescription (n = 22, 56.4%). Total knowledge scores were significantly higher among women with high monthly incomes (p = 0.019) and those working in medical-related jobs (p = 0.017). Conclusions: This study underscores the need for targeted interventions to improve awareness of DEXA scans among women in Jazan City. Additionally, the findings suggest that socioeconomic factors may influence awareness levels, emphasizing the importance of tailored educational strategies to reach diverse demographics. [ABSTRACT FROM AUTHOR]

Objective. This study examined the potential use of computed tomography panoramic mandibular indices on cone beam CT (CBCT) for assessing bone density in postmenopausal women with low bone mass. Study design. The study enrolled 104 postmenopausal women who underwent dual-energy X-ray absorptiometry (DXA) using a DXA scanner and mental foramen region CBCT alongside the NewTom VGi EVO Cone Beam 3D system. We assessed the relationship between the following DXA parameters: lumbar, femoral neck, and total hip T score, bone mineral density (BMD), and lumbar trabecular bone score (TBS). The following panoramic mandibular indices were also considered: the computed tomography mandibular index superior (CTI(S)), computed tomography mandibular index inferior (CTI(I)), and computed tomography mental index (CTMI). Results. The study revealed moderate correlations between CBCT indices and BMD/TBS scores: CTMI showed the highest correlation with the femoral neck T-score (r = 0.551, p < 0.0001). TBS scores were also moderately correlated with CBCT indices: CTMI showed a moderate positive correlation with TBS (r = 0.431, p < 0.0001); CTI(S) had a similar moderate positive correlation with TBS (r = 0.421, p < 0.0001). AUC values ranged from 0.697 to 0.733 for osteoporosis versus the osteopenia/normal group and from 0.734 to 0.744 for low versus normal bone quality groups, p < 0.0001. The comparison of the values of the studied indices between low versus normal bone quality (quantified with TBS) groups showed high sensitivity but low specificity. Conclusions. CBCT-measured indices CTI(S), CTI(I), and CTMI are useful in assessing patients with low bone mass to improve, by specific treatment, the prognosis of dental implants. [ABSTRACT FROM AUTHOR]

Purpose: To examine the effects of Hodgkin's lymphoma and its treatment on reproductive health in female adolescent and young adults (AYA). Methods: We conducted a retrospective, population-based, matched-cohort study of female patients with Hodgkin's lymphoma diagnosed at 15–39 years of age from 1995 to 2014 in Ontario, Canada. Three female individuals with no history of cancer (unexposed) were matched by birth year and census subdivision to each patient with cancer (exposed). In a subset of the cohort (2005 onwards), the Hodgkin's lymphoma patients were further classified into two groups for analysis based on treatment exposure: (1) chemotherapy alone or (2) combined chemotherapy and radiation. Reproductive health outcomes were infertility, childbirth, and premature ovarian insufficiency (POI). Relative risks (RR) were calculated using modified Poisson regression adjusted for income quintile, immigration status, and parity. Results: A total of 1443 exposed and 4329 unexposed individuals formed our cohort. Hodgkin's lymphoma patients were at an increased risk of infertility (aRR 1.86; 95% CI 1.57 to 2.20) and POI (aRR 2.81; 95% CI 2.16 to 3.65). While the risk of infertility persisted in both treatment groups (chemotherapy alone, combined chemotherapy plus radiotherapy), the increased risk of POI was only statistically significant in the chemotherapy plus radiotherapy group. No differences in childbirth rates were observed, overall or by treatment exposure compared with unexposed individuals. Conclusions: Female AYA survivors of Hodgkin's lymphoma face an increased risk of infertility, independent of exposure to chemotherapy alone, or chemotherapy plus radiotherapy. The risk of POI is higher in those requiring radiotherapy vs. chemotherapy alone. Implications for cancer survivors: These results emphasize the importance of pre-treatment fertility counseling and reproductive health surveillance for AYAs diagnosed with Hodgkin's lymphoma. [ABSTRACT FROM AUTHOR]

Background: Vitamin D (VD) plays a crucial role in regulating calcium and phosphorus metabolism and bone growth and has emerging roles beyond the skeleton. Deficiency is linked to various health issues, especially in postmenopausal women. The burden of T2DM in India, particularly among women, emphasizes the need for exploring the VD-diabetes connection. Aim and Objective: To investigate VD levels in postmenopausal women with T2DM compared to premenopausal women, assessing the association between VD deficiency and glycemic control. Materials and Methods: A case-control study was conducted in Chennai, India, involving pre-menopausal and post-menopausal women with T2DM. Ethical clearance was obtained, and participants were recruited with informed consent. Fifty pre-menopausal and post-menopausal women, each with T2DM, were included. Exclusions involved individuals taking calcium and vitamin D supplements, anticonvulsants, and those afflicted with osteoporosis, renal disease, asthma, and hypertension. Blood samples were collected for glucose and VD level assessments, employing standard methodologies. Results: Pre-menopausal women exhibited significantly higher VD levels compared to their post-menopausal counterparts. Blood sugar levels did not significantly differ based on menopausal status. Conclusion: This study contributes valuable insights into the complex interplay between VD, menopausal status, and glycemic control in women with T2DM. The high prevalence of VD deficiency and its association with suboptimal glycemic control emphasize the need for further research. Understanding these relationships is crucial for developing targeted interventions for postmenopausal women with diabetes. [ABSTRACT FROM AUTHOR]

Background: A woman's entry into the menopause period is associated with a number of changes in the body, including those related to the immune system. Immune aging is a consequence of age-related changes in the function of immune cells and the composition of their subpopulations. Menopausal hormone therapy (MHT) is thought to partially neutralize the negative effects of aging on the immune system. Objective: We aimed to evaluate the effect of oral and transdermal MHT on cellular immunity parameters and cytokine profile in menopausal women. Methods: Fifty peri- and early postmenopausal women were included. Immune parameters were assessed by flow cytometry and multiplex analysis. Results: We showed that different routes of MHT administration led to significant changes in monocyte phenotype and a decrease in monocyte chemoattractant protein-1 (MCP-1) level in menopausal patients. In addition, oral MHT resulted in a significant increase in NK and B cells. A significant increase in the number of T-helper cells was observed with transdermal MHT. In addition, oral MHT resulted in a significant decrease in IL-1β level. Conclusions: We have demonstrated for the first time that oral therapy, in contrast to transdermal therapy, has a more pronounced effect on specific immune subpopulations of blood cells in menopausal women. This effect is likely to be responsible for its anti-aging properties in the context of immune aging as well as its protective effects in infectious diseases. Perhaps testing blood immune parameters or assessing immune status before prescribing MHT could become a routine step in clinical practice before choosing a patient management strategy. [ABSTRACT FROM AUTHOR]

The vaginal microbiota (VMB) plays a crucial role in women's health from puberty to menopause. Traditional studies have focused on the microorganisms present within the vaginal environment and their roles in disease onset. However, the dynamic relationship between the VMB and its host remains underexplored. Common narratives emphasize the presence of Lactobacilli spp. as an indicator of vaginal health, yet this does not fully explain the occurrence of asymptomatic yet significant dysbiosis. Moreover, a wide array of bacterial types can inhabit the vaginal environment, suggesting that probiotic Lactobacilli could offer a natural, safe solution for balancing vaginal microbiota. This review examines the current literature on VMB, key factors affecting its composition, and the changes it undergoes during different life stages. Given the health-promoting potential of probiotics, we also examine their role in maintaining a healthy VMB and overall women's health throughout life. [ABSTRACT FROM AUTHOR]

Endometriosis, an inflammatory disease primarily affecting the pelvis and peritoneum, manifests with pelvic pain, dysmenorrhea, dyschezia, dyspareunia, and infertility. Despite its ubiquity, the management of endometriosis is challenging due to its heterogeneous presentation, limitations in diagnostic methods, variable therapeutic responses, and personal and socio-cultural impact on quality of life. This review attempts to consolidate the current literature on endometriosis occurring during and beyond menopause, and to present details regarding management strategies that take into account individual outcomes and goals when managing this condition. The topics included in this review are the clinical features and differential diagnosis of pelvic pain in postmenopausal patients, imaging considerations, serum and laboratory biomarkers, indications for surgery, the principles of hormone replacement therapy, the de novo development of endometriosis after menopause, and malignant transformation. Each topic includes a summary of the current literature, utilizing clinical research, case reports, and expert opinion. Despite a better understanding of the impact of endometriosis beyond menopause, there are many limitations to this condition, specifically with regard to cancer risk and indications for surgery. The existing evidence supports the use of shared decision making and the incorporation of patient preferences in guiding clinical management. Future research endeavors must shed light on the natural history of postmenopausal endometriosis through longitudinal studies in order to foster a deeper understanding of its complicated disease course across women's lifespans. [ABSTRACT FROM AUTHOR]

Background/Objectives: Osteoporosis is a common general disease that mostly affects the skeletal system, including the jawbone. There is a link between systemic and mandibular osteoporosis. This study aimed at assessing the association between systemic (lumbar spine L1–L4, femoral neck, total hip) bone mineral density (BMD) and mandible BMD sites in Romanian postmenopausal females. Methods: A total of 97 menopausal patients were studied, 62 with osteoporosis and 35 females with no osteoporosis. For each patient, dual-energy X-ray absorptiometry (DXA) assessments of BMD in the mandible, proximal femur, total hip, and lumbar spine (L1–L4) were performed. Mandibular measurements were performed using the distal forearm software, followed by manual analysis after the bone contour was defined in each case. Results: Comparing the osteoporosis and control groups, there were significant differences in BMD at each examined location. The mandibular BMD (1.125 ± 0.181506 g/cm2) in the osteoporosis group was considerably smaller than in the control group (1.35497 ± 0.244397 g/cm2). Correlations between the BMD at different sites were significant: lumbar spine and femoral neck (r = 0.738, p < 0.0001), lumbar spine and total hip (r = 0.735, p < 0.0001), lumbar spine and mandible (r = 0.506, p < 0.0001), femoral neck and total hip (r = 0.891, p < 0.0001), femoral neck and mandible (r = 0.482, p < 0.0001), and total hip and mandible (r = 0.466, p < 0.0001). Conclusions: There were correlations between mandible BMD and lumbar spine, femoral neck, and total hip BMD, suggesting that osteoporosis affects mandibular bone density. BMD assessments at common locations may help predict mandibular BMD and the probability of osteoporosis. [ABSTRACT FROM AUTHOR]

Background: The attention on improving health literacy (HL) for self-management at the population level in many countries has been increasing. Although self-management among middle-aged women in the menopausal transition are important public health issues, few studies have developed the menopausal HL intervention reflecting the multidimensional aspects of HL. We aimed to generate consensus from an expert panel on the core contents of the menopausal HL intervention for middle-aged women based on the HL conceptual framework of the European Health Literacy Survey. Methods: The panel comprised 20 experts from multiple disciplines (nursing, medicine, public health, and food and nutrition). We conducted the e-Delphi process in three rounds, asking the panel to evaluate and prioritize the appropriateness of the core contents and provide open-ended responses to additional comments about the menopausal HL intervention. The e-Delphi questionnaire was developed based on the HL framework, integrating health and HL domains. Results: The experts reached a consensus on 38 components of the intervention. Among the 19 components of the four health domains, health topics in healthcare and disease prevention were more appropriate than those in health promotion. For the 19 HL competency components, strengthening the ability to access, appraise, and apply health information was more important than strengthening the ability to understand information. Finally, a consensus was achieved on the 12 priorities for intervention content by HL domains integrated with health domains. For example, contents included proper access to reliable information resources, understanding the definition and process of menopause, judging abnormal health symptoms, and performing the health checkups necessary for menopausal women. Conclusions: Our findings provide evidence for HL skills that nurses and other health professionals can consider when developing interventions to improve self-management among middle-aged women. Future research should focus on incorporating the core contents of multidimensional HL skills into menopausal HL interventions to improve self-management among middle-aged women. [ABSTRACT FROM AUTHOR]

A prerequisite for interventions for sexual satisfaction in postmenopausal women is a clear, objective measurement of the concept. Despite the large number of studies on the sexual satisfaction of postmenopausal women, there is no clear definition of sexual satisfaction in menopause. This study was conducted to investigate the concept of sexual satisfaction in postmenopausal women. The present study was carried out using an integrated review of data obtained from secondary sources, utilizing Whittemore and Knafl's method of bibliographic search. A literature search was performed without any data limitations in journals and international databases. The primary inclusion criterion was relevance to sexual satisfaction in postmenopausal women. The full texts of all these articles were evaluated using the checklists of the MMAT and PRISMA. Data were analyzed using MAXQDA 10 software using a constant comparison method. Meaning units were identified and coded. The codes were classified into subgroups and categories according to the characteristics, antecedents, and consequences of sexual satisfaction in postmenopausal women. During the integrative review of the 62 articles and three books, 580 codes about sexual satisfaction in menopause were extracted. The codes were grouped into three main attributes, five main antecedents, and three main consequences of sexual satisfaction in postmenopausal women. Four attributes, symptoms, or components were identified for the concept. These attributes were as follows: Change in sexual objective and subjective dimensions of sexual satisfaction after menopause, conditional sexual consent, change in behavior, and sexual function. These dimensions distinguish sexual satisfaction in menopause from other conditions. The concept of sexual satisfaction in menopause is a subjective (emotional interaction) and objective (physical interaction) experience that is conditioned by the fulfillment of expectations and the reconstruction of sexual relations while also being influenced by the change in sexual capacity during menopause. [ABSTRACT FROM AUTHOR]

Pueraria lobata root and Glycine max (L.) Merrill are rich in phytoestrogens. However, these bioactive ingredients have limited bioavailability due to their high molecular weight. In this study, we extracted two natural products and fermented with Lactiplantibacillus plantarum before mixing the fermented extracts (FPE‐FGE). To understand whether FPE‐FGE could alleviate menopause with dyslipidemia, we examined their effects on ovariectomy (OVX)‐induced dyslipidemia in mice. Oral administration of the FPE‐FGE (1:9, 3:7, and 9:1) did not affect safety‐related biomarkers, such as uterus index (%), vagina index (%), aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, and creatinine. Furthermore, FPE‐FGE (1:9, 3:7, and 9:1) increased the levels of 17β‐estradiol (E2) and expression of uterus estrogen receptor β (ERβ); there was little effect on the expression of uterus estrogen receptor α (ERα), and reduced the levels of gonadotropins, such as luteinizing hormone (LH) and follicle‐stimulating hormone (FSH). However, only the FPE‐FGE (3:7) reduced the levels of blood lipids, including total cholesterol (TC) and LDL‐cholesterol (LDL‐C). Accordingly, FPE‐FGE (3:7) upregulated endothelial nitric oxide synthase (eNOS), nitric oxide (NO), cyclic guanosine monophosphate (cGMP), and protein kinase G (PKG). In conclusion, FPE‐FGE (3:7) attenuated the menopausal dyslipidemia by upregulating eNOS‐NO‐cGMP signaling pathway. [ABSTRACT FROM AUTHOR]

AbstractFifty-one percent of humans are born with ovaries. As the ovarian production of estrogen diminishes in midlife and ultimately stops, it is estimated that more than 47 million women worldwide enter the menopause transition annually. More than 70% will experience musculoskeletal symptoms and 25% will be disabled by them through the transition from perimenopause to postmenopause. This often-unrecognized collective of musculoskeletal symptoms, largely influenced by estrogen flux, includes arthralgia, loss of muscle mass, loss of bone density and progression of osteoarthritis, among others. In isolation, it can be difficult for clinicians and patients to adequately appreciate the substantial role of decreasing estrogen, anticipate the onset of related symptoms and actively treat to mitigate future detrimental processes. Thus, in this review we introduce a new term, the musculoskeletal syndrome of menopause, to describe the collective musculoskeletal signs and symptoms associated with the loss of estrogen. Given the significant effects of these processes on quality of life and the associated personal and financial costs, it is important for clinicians and the women they care for to be aware of this terminology and the constellation of musculoskeletal processes for which proper risk assessment and prophylactic management are of consequence. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Research documents effects of skin features on assessments of age, health and attractiveness of female faces. Ethnic variation also has been reported for the impact of age‐related changes in skin features on face assessments. Here, we investigate women's self‐ratings across age cohorts and ethnic groups and discrepancies with (non‐expert) assessor ratings of facial appearance together with age‐dependent changes in skin features.Faces of women 20–65 years from five ethnic groups (each n = 36) were imaged. Participants provided self‐ratings of age, health and attractiveness, and were judged on these attributes by members of the same ethnic group (each n = 120). Digital image analysis was used to quantify skin gloss, tone evenness, wrinkling and sagging. Age‐dependent changes in ratings and skin features within and between ethnic groups were assessed by comparing information from 10‐year cohorts. We also tested whether menopausal status could be predicted by self‐ratings, assessor ratings and image‐based skin features.Women of all ethnic groups judged themselves younger and higher in attractiveness and health compared to third‐party assessors, with the largest discrepancies for age in French women and for attractiveness and health in South African women. In Indian and South African women, specular gloss and skin tone evenness were lower compared to other participants, and sagging was higher in Indian, Japanese and South African women compared to Chinese and French women. Women's menopausal status could be predicted from assessor ratings and image‐based skin features but not from self‐ratings.There are differences between women's self‐ratings and assessor ratings of facial appearance. These discrepancies vary with female age and ethnicity. Age and ethnicity effects also are evident in age‐dependent changes in skin features within and across ethnic groups, which together with assessor (but not self‐) ratings of facial appearance predict menopausal status. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMethodsResultsConclusionObservational studies have suggested an association between age at natural menopause (ANM) and ventricular structure and function. Nevertheless, the causal relationship remains unclear. This study aimed to evaluate the causal effects of ANM on ventricular structure and function by Mendelian randomization (MR) analysis.Genome-wide association summary statistics for ANM and 16 ventricular structures and functions were obtained. The inverse variance weighted (IVW) method was the primary MR approach for assessing causal associations. In addition, three additional MR methods (MR-Egger, weighted median and weighted mode) were performed to complement the IVW method. Furthermore, various sensitivity tests were conducted to evaluate the reliability of the MR results.The IVW method identified no causal association between ANM and all 16 ventricular structures or functions (p > 0.05). Three additional MR methods yielded parallel results to the IVW approach (p > 0.05). Various sensitivity tests revealed stability of the MR results, indicating no heterogeneity or horizontal pleiotropy.The present MR study indicated that ANM would not causally affect ventricular structure or function. Therefore, the correlation between ANM and ventricular characteristics in previous observational studies might be attributed to shared upstream cardiovascular risk factors or unidentified genetic mutations that simultaneously affect both ANM and ventricular structure and function. [ABSTRACT FROM AUTHOR]

Background: Individuals with a uterus experience menopause, the cessation of menses, on average at age 51 years in the United States. While menopause is a natural occurrence for most, over 85% of women experience multiple interfering symptoms. Menopausal women face health disparities, including a lack of access to high-quality healthcare and greater disparities are experienced by women who are black, indigenous, and people of color. Some women are turning away from hormone therapy, and some seek integrative health interventions. Objective: Some menopausal women who seek healthcare do not receive it as they lack access to medical and integrative healthcare providers. A potential solution to this problem is a medical group visit (MGV), during which a provider sees multiple patients at once. The aims of this study were to gather women's opinions about the menopause, provider access, and conventional and integrative health interventions for later use to develop a menopause MGV. Methods: We conducted a Community Engagement Session and a Return of Results (RoR) with midlife women to learn about their menopause experiences, barriers and facilitators to accessing health providers, and their interest in and suggestions for designing a future integrative MGV (IMGV). Thematic qualitative research methods were used to summarize session results. Results: Nine women participated in the Session and six attended the RoR. Participants were well-educated and diverse in race and ethnicity. Themes included: an interest in this topic; unfamiliar medical terms; relevant social factors; desired whole person care; interest in integrative health; barriers and facilitators to accessing healthcare. The group expressed interest in ongoing participation in the future process of adapting an IMGV, naming it MENOGAP. Conclusion: These findings highlight the importance of stakeholder engagement before designing and implementing MENOGAP and the great need among midlife women for education about the menopausal transition, integrative self-care, and healthcare. [ABSTRACT FROM AUTHOR]

Menopausal women may experience symptoms of depression, sometimes even progressing clinical depression requiring treatment to improve quality of life. While varying levels of estrogen in perimenopause may contribute to an increased biological vulnerability to mood disturbances, the effectiveness of estrogen replacement therapy (ERT) in the relief of depressive symptoms remains controversial. Menopausal depression has a complex, multifactorial etiology, that has limited the identification of optimal treatment strategies for the management of this psychiatric complaint. Nevertheless, clinical evidence increasingly supports the notion that estrogen exerts neuroprotective effects on brain structures related to mood regulation. Indeed, research using preclinical animal models continues to improve our understanding of menopause and the effectiveness of ERT and other substances at treating depression-like behaviors. However, questions regarding the efficacy of ERT in perimenopause have been raised. These questions may be answered by further investigation using specific animal models of reduced ovarian function. This review compares and discusses the advantages and pitfalls of different models emulating the menopausal stages and their relationship with the onset of depressive-like signs, as well as the efficacy and mechanisms of conventional and novel ERTs in treating depressivelike behavior. Ovariectomized young rats, middle-to-old aged intact rats, and females treated with reprotoxics have all been used as models of menopause, with stages ranging from surgical menopause to perimenopause. Additionally, this manuscript discusses the impact of organistic and therapeutic variables that may improve or reduce the antidepressant response of females to ERT. Findings from these models have revealed the complexity of the dynamic changes occurring in brain function during menopausal transition, reinforcing the idea that the best approach is timely intervention considering the opportunity window, in addition to the careful selection of treatment according to the presence or absence of reproductive tissue. Additionally, data from animal models has yielded evidence to support new promising estrogens that could be considered as ERTs with antidepressant properties and actions in endocrine situations in which traditional ERTs are not effective. [ABSTRACT FROM AUTHOR]

Background: Consistent across cultures and throughout time is the male preference for younger females. Given its prevalence, the mate choice theory proposes that age–disparate relationships may have contributed to the evolution of maternal mortality and menopause. Objectives: The objective is to document evidence for age disparity in marriage from past and present populations and evaluate their relevance to maternal mortality and menopause. Design: Cross-sectional data were collected from various regions and time points, ranging from the Roman era to the current decade. Methods: To analyze both the age disparity in marriage and age at marriage, data were collected from Ancestry.ca for Quebec, Massachusetts, India, South Africa, and England and Wales. Additional data were taken from the United Nations as a more recent and comprehensive source. To analyze the relationships between age disparity in marriage and different social factors, data on gross domestic product, maternal mortality rates, fertility, primary school enrollment, child marriage rates, and percentage of women in the total labor force were collected from the World Health Organization, World Bank, and United Nations International Children's Emergency Fund. Results: The results showed that males were significantly older than females at first marriage in all populations and time frames sampled, supporting the assumption underlying the mate choice theory. Maternal mortality rates were strongly associated with age–disparate relationships, increasing by 275 per 100,000 live births for each additional year in the age disparity. Conclusion: The results from this study provide support for the assumption underlying the mate choice theory of maternal mortality and menopause. Plain language summary: Changing patterns of global age disparity in marriage provide support for the mate choice theory of menopause, raising the possibility of a gradual shift in delayed reproduction and delayed menopause. Living things have inherent capacity to survive and reproduce until they die, with one exception: humans. Women go through menopause while men remain fertile. Among the many explanations offered for the origin of menopause, grandmother hypothesis is the leading one. Being too old to reproduce, it is argued, grandmothers stop reproducing and make up for the loss of fitness through helping (grand mothering) their grand offspring. There are two problems with this theory: first, grand mothering and menopause need not be connected, and second, grandmothers cannot be simultaneously too old to reproduce and not too old to be able to gather resources to make up for their loss of fitness. We proposed a mate choice theory of menopause which posits that human mating system is non-random, that is, males have preference for younger females, depriving older females from reproduction and allowing deleterious fertility mutations to accumulate giving rise to menopause. Male preference for younger females is consistent across cultures and dominates all social relations affecting mate choice including monogamy, serial monogamy, widowers remarrying, polygamy, harem, and others. In this study, we wanted to test if male preference for younger females has been widespread through time. We collected data on age disparity in marriage from past and present populations, from Roman era to the current decade, and evaluated their relevance to the origin of maternal mortality and menopause. The results showed that males were significantly older than females at first marriage in all populations and time frames sampled, supporting the assumption underlying the mate choice theory of menopause. Maternal mortality rates were strongly associated with age–disparate relationships, increasing by 275 per 100,000 live births for each additional year in the age disparity. Through repeated cycles of widowers marring younger women, maternal mortality would have functioned as a reinforcer of the origin of menopause. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionsThis study aimed to investigate the effectiveness, tolerability and application of estradiol metered-dose transdermal spray (EMDTS) in postmenopausal women during real-world use.This was a prospective, non-interventional, multicenter, observational phase IV cohort study. The Menopause Rating Scale II (MRS II) was used to assess symptoms and clinical response. Safety was assessed by the occurrence of adverse events and adverse drug reactions (ADRs).A total of 451 postmenopausal women were enrolled at 52 gynecological practices across Germany; 383 patients were evaluated for effectiveness and 430 patients for safety. Mean age was 54.3 ± 7.4 years. In total, 228 patients (59.5%) received EMDTS monotherapy and 155 patients (40.5%) received EMDTS plus progestogens. Significant improvements (p < 0.0001) from baseline in symptom severity were recorded for all 11 items of the MRS II at 3, 6 and 12 months of treatment. At 12 months, 81.4% of patients reported improvement in hot flushes/sweating. At final visit, 73% of patients and 77% of physicians were ‘satisfied/very pleased’ with EMDTS. Most common ADRs were headache (n = 6), nausea (n = 4), dizziness (n = 4) and pruritus (n = 3).EMDTS is an effective, well tolerated and easily applied hormone replacement therapy for women experiencing postmenopausal symptoms. [ABSTRACT FROM AUTHOR]

Oestradiol withdrawal at menopause predisposes women to metabolic syndrome, a cluster of interrelated conditions including obesity, insulin resistance, dyslipidaemia and hypertension that together confer an increased risk of developing type 2 diabetes mellitus and cardiovascular disease. Hormone replacement therapies are commonly used to treat acute symptoms of the perimenopausal period, and whilst they have been associated with metabolic improvements in many studies, long-term use is considered unviable. Novel approaches are required to mitigate the risk of postmenopausal metabolic syndrome. In 2012, the exercise-inducible myokine irisin was isolated from the skeletal muscle of mice and identified to have anti-obesity and antidiabetic effects in vivo. Irisin is now recognised to exert pleiotropic action on cognitive, bone and metabolic health. There is accumulating evidence from in vitro and in vivo rodent studies that irisin can mitigate each component condition of metabolic syndrome. In postmenopausal women, independent associations have been observed between (a) exercise and plasma irisin concentration and (b) plasma irisin concentration and reduced incidence of metabolic syndrome. To date, however, no study has considered the mechanistic basis by which irisin, whether exercise-induced or exogenously administered, could reduce the incidence or severity of metabolic syndrome in postmenopausal women. This review aims to analyse the literature concerning the metabolic actions of irisin, with a focus on its therapeutic potential for metabolic syndrome driven by a state of oestradiol depletion. It evaluates the practicality of exercise as a therapy and discusses other irisin-based therapeutic strategies that may alleviate postmenopausal metabolic syndrome. Finally, it highlights areas where future research is required to advance knowledge of irisin’s biological action such that it could be considered a viable candidate for clinical application. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionKnowing the important repercussions of menopause for women’s health and that female longevity can be better understood through studies based on aging biomarkers, studies on the relationship between menopause and telomere shortening may help to better understand this stage of life. This study aimed to analyze what research has been produced regarding the relationship between menopause and telomere length.This integrative literature review included searches in PubMed, CINAHL, LILACS, Web of Science and Scopus databases. Four studies were selected for the final sample.The findings of these studies indicate that older age for menopause and longer reproductive life (difference between age at menopause and menarche) are associated with longer telomeres, that is, with longevity.The relationship between menopause and telomere length is uncertain. The small number of studies included in this review, and the fact that the results indicate that the relationship between menopause and telomere length may be dependent on the stage of the menopause and race/ethnicity, suggest that additional research focusing on these variables should be carried out. [ABSTRACT FROM AUTHOR]

BACKGROUND: Postmenopausal osteoporosis significantly increases the risk of fracture, which seriously affects the quality of life of patients. Exercise therapy is an important non-drug means and prevention and treatment strategy for patients with osteoporosis, in which strength training is the best mode, but its specific biological mechanism has not been determined. OBJECTIVE: To investigate the effects of strength training on bone morphology, materials and biomechanics in ovariectomized rats and to explore the mechanism of extracellular matrix remodeling. METHODS: Forty-eight female Sprague-Dawley rats were divided into sham operation group, sham operation exercise group, ovariectomized group and ovariectomized exercise group according to the random number table method. The menopausal animal model was established by bilateral ovariectomy in the ovariectomized group and ovariectomized exercise group, while sham operation was performed in the sham operation group and sham operation exercise group. Four weeks after operation, the sham operation exercise group and the ovariectomized exercise group underwent 12-week tail weight-bearing ladder training, and the sham operation group and the ovariectomized group were raised quietly in the cage. The bilateral femur and tibia were separated after training. The right tibia was used for dual-energy X-ray densitometry and biomechanical, biophysical and biochemical analyses, the left tibia was detected using micro-computed tomography for bone microstructural examination, the right femur was subjected to hematoxylin-eosin staining for histological observation, and the left femur was used for western blot and gelatin zymography detection of protein expression and enzyme activity of extracellular matrix metabolismrelated factors, respectively. RESULTS AND CONCLUSION: Compared with the sham operation group, the maximal load and stiffness decreased (P < 0.05), bone density, bone mineral density, bone inorganic matter content, bone calcium content decreased (P < 0.05), bone water content increased (P < 0.05), trabecular bone volume fraction, trabecular connectivity density, and trabecular number decreased (P < 0.05), trabecular separation, structural model index increased (P < 0.05), bone adipocyte number and cross-sectional area increased (P < 0.05), matrix metalloproteinase-2 activity decreased (P < 0.05), and protein expression of tissue inhibitor of metalloproteinase-1 and osteoprotegerin increased (P < 0.05) in the ovariectomized group. Compared with the ovariectomized group, the maximal load, stiffness, fracture load and resilience increased (P < 0.05), bone mineral density, bone mineral content, bone mineral density, bone inorganic matter content, and bone calcium content increased (P < 0.05), bone water content decreased (P < 0.05), trabecular separation and bone marrow area decreased (P < 0.05), trabecular bone thickness, cortical bone volume fraction, cortical bone area fraction, cortical bone thickness, and cortical bone porosity increased (P < 0.05), bone adipocyte number and cross-sectional area reduced (P < 0.05), matrix metalloproteinase-2 activity increased (P < 0.05), and protein expression of tissue inhibitor of metalloproteinase-1, Runt-related transcription factor 2 and osteoprotegerin decreased (P < 0.05) in the ovariectomized exercise group. To conclude, strength training can protect against bone injury caused by estrogen deficiency, which is characterized by improvement of bone biomechanical properties, bone tissue composition and bone microstructure, and its mechanism is related to the regulation of extracellular matrix remodeling. [ABSTRACT FROM AUTHOR]