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Background: Understanding the correlation between lipid profile, glucose levels, and depression/dementia in postmenopausal women is crucial for developing effective prevention and treatment strategies. Aim: Hence, the aim of this study is to investigate the correlation between lipid profile, urea, creatinine, uric acid, and glucose levels, and depression/dementia in postmenopausal women. Materials & methods: At SMS Medical College and Attached Hospitals in Jaipur, India, researchers from the Departments of Biochemistry and Gynecology and Obstetrics performed a comparative cross-sectional study on one hundred postmenopausal women (PMWs) suffering from depression. The research evaluated cognitive functioning and the degree of depression using the Beck's depressive inventory, respectively. One hundred healthy postmenopausal women served as a control group, and the patients were split into two categories according to their scores. Results: Depressed PMWs had lower HDL values and higher serum total and LDL cholesterol. They had higher uric acid levels and blood glucose levels. Beck's score showed a strong positive association with total cholesterol, inverse correlation with HDL and LDL, and positive correlation with VLDL. Conclusion: The research indicates a connection between menopause and depression, but additional investigation is necessary to comprehend its root causes. Treatment strategies should concentrate on dietary intake, estrogens, and social support systems. [ABSTRACT FROM AUTHOR]

Background/Aims: Vasomotor symptoms (VMS) adversely affect postmenopausal quality of life. However, their association with bone health has not been elucidated. This study aimed to systematically review and meta-analyze the evidence regarding the association of VMS with fracture risk and bone mineral density (BMD) in peri- and postmenopausal women. Methods: A literature search was conducted in PubMed, Scopus and Cochrane databases until 31 August 2023. Fracture, low BMD (osteoporosis/osteopenia) and mean change in lumbar spine (LS) and femoral neck (FN) BMD were assessed. The results are presented as odds ratio (OR) and mean difference (MD), respectively, with a 95% confidence interval (95% CI). The I2 index quantified heterogeneity. Results: Twenty studies were included in the qualitative and 12 in the quantitative analysis (n=49,659). No difference in fractures between women with and without VMS was found (n=5, OR 1.04, 95% CI 0.93–1.16, I2 16%). However, VMS were associated with low BMD (n=5, OR 1.54, 95% CI 1.42–1.67, I2 0%). This difference was evident for LS (MD -0.019 g/cm2, 95% CI -0.03 to -0.008, I2 85.2%), but not for FN BMD (MD -0.010 g/cm2, 95% CI -0.021 to 0.001, I2 78.2%). These results were independent of VMS severity, age and study design. When the analysis was confined to studies that excluded menopausal hormone therapy use, the association with BMD remained significant. Conclusions: The presence of VMS is associated with low BMD in postmenopausal women, although it does not seem to increase fracture risk. [ABSTRACT FROM AUTHOR]

The objective of this meta-analysis is to study the effect of different strengths of resistance training programs on the severity and frequency of hot flushes in postmenopausal women with vasomotor symptoms. Menopause is defined as the state in which the menstrual cycle of a biological female spontaneously comes to a halt for a period of about 1 year. Through a detailed analysis of much of the research, it is found that the resistance training program is beneficial not only for reducing the severity as well as the frequency of hot flushes in postmenopausal women. Online research was conducted through databases such as PubMed, Cochrane Trial Register, and Google Scholar till the 20th of March 2023. The Review Manager (version 5.4.1) was used to statistically analyze the data from the studies. Studies meeting the inclusion criteria, comparing the vasomotor symptoms in resistance training groups as compared to control were used for this meta-analysis. The primary outcome of interest was the alleviation of hot flushes in the resistance training group. Random-effect model was used to pool the studies and the result was reported in SMD with 95% Confidence Interval (CI). 5 studies were selected for this review. Statistical analysis shows that vasomotor symptoms were more common in the control group and decreased significantly in the resistance training group after the intervention (SMD = −1.31, 95% CI: -1.85 to −0.77, p = 0.002). Resistance Training significantly affects vasomotor symptoms and can be considered for such symptoms in postmenopausal women. • Hormone Replacement Therapy is commonly used for the treatment of menopausal symptoms. • HRT is associated with increased risk of Venous Thromboembolism, Cardiovascular events, ovarian and breast malignancies. • Resistance training is associated with a decrease in the frequency and severity of hot flushes in Postmenopausal women. [ABSTRACT FROM AUTHOR]

• Fezolinetant significantly reduces frequency/severity of menopausal symptoms. VMS episodes decrease, severity scores improve at 4/12 weeks. • Fezolinetant enhances menopause-specific quality of life scores at 4/12 weeks, suggesting meaningful well-being improvement. • Fezolinetant shows efficacy but poses increased risk of adverse events: drug-related, serious adverse events, fatigue, arthralgia, elevated liver enzymes. • Fezolinetant offers non-hormonal alternative for managing VMS, despite safety considerations, improving quality of life for postmenopausal women. Vasomotor symptoms (VMS) are the most common symptoms during menopause including hot flushes and night sweats. They are highly disruptive to the quality of life. Fezolinetant is an FDA-approved non-hormonal selective neurokinin3 receptor antagonist for the treatment of VMS. In this study, we aim to assess the efficacy and safety of fezolinetant for VMS associated with menopause. Databases were searched until September 2023 for relevant studies comparing fezolinetant against placebo. Data was extracted into an online form and analyzed using RevMan (Version 5.4.1). The GRADE approach was conducted to evaluate the quality of evidence regarding efficacy outcomes. We included randomized controlled trials (RCTs) comparing fezolinetant to placebo in postmenopausal women experiencing VMS. Exclusion criteria comprised studies involving participants with contraindications to fezolinetant or those evaluating its efficacy for indications other than VMS associated with menopause. Six studies were included in this study involving 3301 patients. Compared to placebo, fezolinetant reduced the frequency of VMS episodes from baseline (SMD = -0.64, 95 % CI [-0.77, −0.5]) and (SMD = -0.63, 95 % CI [-0.72, −0.53] at weeks 4 and 12 respectively. Additionally, fezolinetant reduced VMS severity score (SMD = -0.59, 95 %CI [-0.77, −0.42]) and (SMD = -0.4, 95 % CI [-0.54, −0.27]) at weeks 4 at 12 respectively. These reductions were positively reflected on Menopause specific quality of life score (SMD = -0.46, 95 %CI [-57, −0.34]), (SMD = -0.37, 95 %CI [-0.48, −0.25]) at weeks 4 and 12 respectively. Regarding safety analysis, fezolinetant showed increased risk for drug-related TEAEs (RR = 1.47, 95 %CI [1.06,2.04]), serious TEAEs (RR = 1.67, 95 %CI [1.09,2.55]), fatigue (RR = 4.05, 95 %CI [1.27,12.88]), arthralgia (RR = 2.83, 95 %CI [1.02,7.8]) and ALT or AST > 3 times (RR = 2, 95 %CI [1.12,3.57]), with no other statistically significant difference regarding other safety terms. Fezolinetant has demonstrated efficacy in reducing the frequency and severity of VMS in postmenopausal women, leading to an improvement in their quality of life. These findings suggest that Fezolinetant may serve as a viable alternative to hormonal therapy for managing VMS. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate whether single measurements of serum estradiol (E2), estrone (E1) and sex hormone-binding globulin (SHBG) concentration distinguishes between women with and without menopausal symptom bother. STUDY DESIGN: We analyzed baseline data from two clinical trials conducted in 2012-2017: MsFLASH 03 (178 peri-/post-menopausal women aged 40-62 years with bothersome vasomotor symptoms, mean age 54) and MsFLASH 05 (181 post-menopausal women aged 45-70 years with moderate-to-severe vulvovaginal symptoms, mean age 61). MAIN OUTCOME MEASURES: Symptom bother (hot flushes or flashes, night sweats, sweating, aching in muscles and joints, change in sexual desire, vaginal dryness during intercourse, and avoiding intimacy) in the past month was assessed using the Menopause-Specific Quality of Life questionnaire. Using logistic regression, we calculated the area under the receiver operating characteristic curve (AUC) values for E1, E2, and SHBG concentration in relation to being at least somewhat bothered (symptom bother score ≥3) by each symptom within each trial study population. RESULTS: AUC values (95% confidence interval) ranged between 0.51 (0.41-0.60) and 0.62 (0.53, 0.72) for MsFLASH 03 and between 0.51 (0.42, 0.59) and 0.64 (0.53, 0.75) for MsFLASH 05. There was little evidence of associations between serum hormone levels and bother by a given menopausal symptom. CONCLUSION: These findings do not support the clinical utility of a single measurement of serum of E1, E2, or SHBG concentrations in differentiating between women who are bothered by a given menopausal symptom and those who are not.

Vasomotor symptoms (VMS) are often considered the classic menopausal symptom and are experienced by most women during the menopause transition. VMS are well established to be associated with decrements in quality of life during the menopause. More recent research also links VMS to poorer cardiovascular health. This review summarizes key insights about links between VMS and cardiovascular disease (CVD) risk that come from the Study of Women's Health Across the Nation (SWAN), a longitudinal epidemiologic cohort study of the menopause transition, as well as from the MsHeart/MsBrain studies, clinical studies that leverage vascular imaging and brain imaging as well as wearable technologies that provide objective indicators of VMS. Using a range of methodologies and extensive consideration of confounders, these studies have shown that frequent and/or persistent VMS are associated with adverse CVD risk factor profiles, poorer underlying peripheral vascular and cerebrovascular health, and elevated risk for clinical CVD events. Collectively, the SWAN and MsHeart/MsBrain studies form complementary epidemiologic and clinical studies that point to the importance of VMS to women's cardiovascular health during the menopause transition and beyond. [ABSTRACT FROM AUTHOR]

Insomnia is one of the major complaints of menopausal women with advancing age and may be complexly related to a variety of causes. However, there is still a lack of standards on the general approach and treatment for insomnia in menopausal women. The aim of this review is to summarize recent pathogenic theories of sleep disturbance in the menopausal period and discuss the approach and management of insomnia in postmenopausal women. Sleep disturbances in menopausal women may be associated with physical and psychiatric factors and other comorbid diseases. Careful history taking and multidisciplinary physical and psychosocial evaluation are necessary and, in particular, comorbidities related to sleep disorders, such as obstructive sleep apnea, must be taken into consideration. A unique aspect of insomnia in postmenopausal women is that menopausal symptoms due to hormonal decline can be closely related to sleep disturbances. Therefore, menopausal hormone therapy (MHT) should be considered as the treatment of choice among pharmacological treatments following cognitive behavioral therapy, which is suggested as the first-line treatment in the general population insomnia treatment guidelines. Additionally, melatonin and 5HT-based drugs, which have fewer side effects, along with MHT should be preferentially recommended in menopausal women. [ABSTRACT FROM AUTHOR]

Women at high inherited risk of ovarian cancer are offered risk‐reducing salpingo‐oophorectomy (RRSO) from age 35 to 45 years. Although potentially life‐saving, RRSO may induce symptoms that negatively affect quality of life and impair long‐term health. Clinical care following RRSO is often suboptimal. This scoping review describes how RRSO affects short‐ and long‐term health and provides evidence‐based international consensus recommendations for care from preoperative counselling to long‐term disease prevention. This includes the efficacy and safety of hormonal and non‐hormonal treatments for vasomotor symptoms, sleep disturbance and sexual dysfunction and effective approaches to prevent bone and cardiovascular disease. [ABSTRACT FROM AUTHOR]

Risk-reducing salpingo-oophorectomy (RRSO) is advised before 40–45 years of age for BRCA1/2 mutation carriers. This study describes the effect of RRSO on lipid determinants, hemoglobin A1c (HbA1c) and C-reactive protein (CRP). A total of 142 women with increased risk of ovarian cancer were included, 92 premenopausal and 50 postmenopausal. Serum levels of low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol and total cholesterol, triglycerides, HbA1c and CRP were determined at three points in time: before (T0) and 6 weeks (T1) and 7 months (T2) following RRSO. The Hot Flush Rating Scale was administered at the same time points. In premenopausal women, levels of HDL-cholesterol, the cholesterol ratio and HBA1c increased significantly over time, although still staying within the reference range. In this group, hot flushes increased over time (p < 0.001). In postmenopausal women, no significant changes were observed following RRSO. At T2, serum LDL-cholesterol, triglycerides, HbA1c and CRP were significantly lower in premenopausal women compared to postmenopausal women, whereas HDL was increased. Seven months after RRSO, the lipid profile in premenopausal women had changed, although still staying within the reference range. For postmenopausal women, we did not observe any significant changes. Our results do not suggest a worsening of cardiovascular risk within 7 months of RRSO. [ABSTRACT FROM AUTHOR]

Research into non-hormonal, alternative therapies is necessary for women for whom menopausal hormone therapy is contraindicated or for women who do not wish to take hormones. This review focuses on one such non-hormonal option, namely, purified and specific cytoplasmic pollen extract, or PureCyTonin®. This extract has been evaluated in several preclinical and clinical studies, where it demonstrated its value as a safe and non-estrogenic alternative for menopause. This review presents the beneficial effects of PureCyTonin® in the treatment of menopausal symptoms (e.g. hot flushes) in healthy women, as well as in premenstrual syndrome. We discuss the mechanism of action of PureCyTonin®, an SSRI-'like' therapy. The lack of estrogenic effect demonstrated in preclinical studies suggests that PureCyTonin® may also be a suitable option for the management of menopausal symptoms in women with breast cancer.

Background: Androgen deprivation therapy (ADT) for prostate cancer (PCa) is accompanied by side effects affecting health-related quality of life (HRQL). Objective: To assess the effects of the fetal estrogen estetrol (E4) on symptoms related to estrogen and androgen deficiency, and on HRQL measured using the validated Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire. Design, setting, and participants: This was a phase 2, double-blind, randomized, placebo-controlled study in patients with advanced PCa. Intervention: Patients receiving ADT were randomly assigned at a 2:1 ratio to daily treatment with a high dose of E4 (HDE4; n = 41) or placebo (n = 21) for 24 wk. Outcome measurements and statistical analysis: The primary outcome was the effect of HDE4 cotreatment on hot flushes (HFs). Secondary outcomes were the Q-Man questionnaire for evaluation of the effect on estrogen and androgen deficiency symptoms, and the FACT-P questionnaire for evaluating HRQL. Results and limitations: At 24 wk, the number of patients experiencing HFs was significantly lower in the HDE4 group than in the placebo group (14.3% vs 60.0%; p

Background: Tibolone is an alternative to conventional estrogen and progesterone in relieving post-menopausal symptoms in Indian women. Material and Methods: A prospective short-term observational study was done at a tertiary care teaching hospital in New Delhi from November 2019 to September 2021. Fifty-three women, less than 60 years of age, presenting with moderate to severe intensity of menopausal symptoms as assessed by measuring menopausal rating score (MRS > 8) were enrolled and given Tibolone 2.5 mg daily for 3 months. Improvements in symptoms were seen at 1 month and 3 months. Side effects were also noted. Results: Marked improvement was seen as reduction in scores of psychological, somatic and genitourinary symptoms was noted. The psychological symptoms reduced from 8.92 ± 1.959 to 2.905 ± 1.042, the somatic symptoms decreased from 8.33 ± 2.299 to 3.4 ± 1.167, and genitourinary symptoms decreased from 3.64 ± 1.42 to 2.150 ± 0.948 after 3 months of treatment with Tibolone. Only 3 patients (5.6%) experienced vaginal spotting with no major side effects. Conclusions: Tibolone is a highly effective and well accepted drug to reduce moderate to severe menopausal symptoms, especially psychological symptoms including depression. [ABSTRACT FROM AUTHOR]

Introduction and purpose. Menopause causes complaints such as hot flashes, night sweats, sleep problems and vaginal dryness. Hormone replacement therapy (HRT) is an effective treatment option for women with moderate to severe symptoms. In women who are unable to undergo HRT, plant-based preparations containing phytoestrogens can be used as an alternative. The purpose of this paper is to summarize the effectiveness of phytoestrogen supplementation. State of knowledge. Phytoestrogens are natural compounds structurally similar to estrogens, such as estradiol. They are divided into different classes, including isoflavones and lignans. Isoflavones, including genistein, found in soy products, cause a significant reduction in the severity of hot flashes, as well as improvements in vaginal dryness and sexual function. Lignans, found in flaxseed, sesame seeds and whole grains, have effects similar to endogenous estrogens, but studies to date have not shown significant efficacy of this group of substances in reducing menopausal symptoms. Resveratrol, a naturally occurring compound found in grapes and berries, has a weak estrogenic effect, whereby several clinical trials have demonstrated the effectiveness of resveratrol supplementation in alleviating menopausal symptoms. Conclusions. Phytoestrogens have been shown to alleviate some symptoms of menopause, such as hot flashes and night sweats, and may also have positive effects on bone density and cognitive abilities. Effects may vary depending on the source, dose and duration of treatment. There are also potential risks associated with their use, for which reason more research is needed to fully understand their effectiveness and safety.

Background: Menstrual periods do not normally end suddenly; instead, there is frequently a period of transitional changes before and following the cessation of the period. Women typically endure physiological changes as a result of hormonal fluctuations, which impact their physical, emotional, and quality of life. Therefore, this study explored menopausal associated problems occurring in women residing in Lusaka, Zambia. Methods: A cross-sectional study was conducted for a period of six months on 171 women aged 40 - 60 years old who were bedsitters for a hospital patient or visited the hospital. The univariate (unadjusted) and multivariable (adjusted) logistic regression using backwards stepwise analysis was performed to identify factors associated with the most common symptom women face after menopause reporting at 95 % confidence interval (95 % CI). Results: The study revealed that the average age of menopause onset was 47.43 ± 4.46 years, with 75% of the women experiencing menopause between the ages of 45 and 55. Women complained of back pain (66.1%), headache (45%), hot flushes (30.6%), and mood changes (24.0%). Widowed (AOR 2.94; 95 % CI: 1.24-6.63), Obese (AOR 3.19; 95 % CI: 1.16 - 8.73), overweight (AOR 3.91; 95 % CI: 1.31 - 11.73) and early menopause (AOR 0.35, 95% CI: 0.13 - 0.92) were associated with back pain. Conclusion: Women experience a variety of menopausal and postmenopausal problems like back pain, headache, hot flushes and mood changes which will require interventions to improve the health of women. [ABSTRACT FROM AUTHOR]

Abstract Introduction Resistance training may be an effective intervention to improve menopausal symptoms and increase women’s quality of life. However, most postmenopausal women do not perform regular resistance training. The purpose of this study was to explore postmenopausal women’s experiences of participation in a resistance-training intervention to find barriers and motivators for the training. Methods Fifteen postmenopausal women with low physical activity, who participated in a randomized controlled trial evaluating the effect of a resistance-training program on vasomotor symptoms and health-related outcomes, were consecutively recruited to this qualitative study. After completion of the 15-week resistance-training program, they took part in individual semi-structured interviews, followed by a telephone interview 1 year later. All interviews were transcribed verbatim and thematic analysis was used to analyse the data. Results The analysis generated three themes that were involved at different time points. These were: “Trigger—Hopes of symptom relief”, “An evolving motivation as a driving force for change” and “Finding new triggers”. Accountability, and continuous professional and emotional support, were factors that fueled the women’s motivation to perform regular resistance training during the study. Resistance training improved general well-being and most women experienced improvement in vasomotor symptoms. The women’s motivation changed from being driven by a wish to improve bothersome symptoms, into a wish to achieve feelings of well-being and enjoyment. The change was seen regardless of effects of the intervention on vasomotor symptoms. Conclusion This first qualitative evaluation of physical exercise as an intervention to treat vasomotor symptoms in postmenopausal women, found that the symptoms acted as a motivational trigger to initiate resistance training in low-active women. The motivation to exercise changed during the intervention from a wish to ameliorate symptoms into something the women did for enjoyment and well-being in general. This change in motivating factors may have contributed to a behavior change since all participants had increased their physical activity after 1 year regardless of effects on VMS. Trial registration The trial was preregistered at ClinicalTrials.gov; www.clinicaltrials.gov , ID: NCT01987778 , date of first registration: 19/11/2013.

• Symptoms due to adjuvant endocrine therapy may reduce compliance with breast cancer therapies. • This study investigates symptom severity during adjuvant endocrine therapy. • The severity of menopausal symptoms was similar in breast cancer survivors and control menopausal women. • Less severe depressive symptoms were observed in survivors on aromatase inhibitors. To compare menopausal symptoms of breast cancer survivors on adjuvant endocrine therapy with those of menopausal women. In a retrospective nested case-control study menopausal symptoms were compared of breast cancer survivors in pre-, peri- or post-menopause at the time of diagnosis, on tamoxifen or an aromatase inhibitor, plus a gonadotrophin-releasing hormone analogue, if pre- or peri-menopausal, and age-matched control women either in the late peri-menopause, or in surgical or in physiological post-menopause on no hormone replacement therapy. Differences between women on tamoxifen and those on aromatase inhibitors were also evaluated. Weighted and non-weighted t -tests, chi-square tests, and linear or logistic regressions were applied as appropriate. Score on the Greene's Climacteric Scale and so of its subscales evaluating vasomotor, anxiety, depression, somatisation and sexuality symptoms. A total of 99 breast cancer survivors (45 on tamoxifen, 54 on aromatase inhibitors) and 554 controls (173 in late perimenopause, 353 in natural and 28 in surgical menopause) were enrolled. The score on the Greene's Climacteric Scale was similar in cases and controls (means ± standard deviation) (21.3 ± 10.4 vs. 22.8 ± 11.5, p = 0.199), as were the subscale scores for vasomotor symptoms, anxiety, and somatisation. The depression score was lower (4.63 ± 3.3 vs. 5.98 ± 3.8; p = 0.001) in breast cancer survivors on adjuvant endocrine therapy, mainly due to a lower score of −2.132 (95 % confidence interval − 3.858/−0.407; p = 0.016) for users of aromatase inhibitors. The sexuality score was higher (1.76 ± 1.1 vs. 1.50 ± 1.1, p = 0.011) than in controls. Differences remained significant when corrected for age, menarche, body mass index, menopausal status (peri- or post-), type of menopause (natural, surgical), use of gonadotrophin-releasing hormone analogues, years of amenorrhea, smoking, alcohol use, and for breast radiotherapy, chemotherapy, tamoxifen or aromatase inhibitors. Among breast cancer survivors, women on aromatase inhibitors had lower scores for anxiety (5.75 ± 2.5vs.5.75 ± 2.5; p = 0.045) and depression (3.89 ± 2.5 vs. 5.13 ± 3.6; p = 0.046) than women on tamoxifen. In breast cancer survivors, adjuvant therapy induces symptoms similar in type and intensity to those of symptomatic menopausal women. Compared with menopausal women, breast cancer survivors, particularly those on aromatase inhibitors, appear to experience less severe depressive symptoms. [ABSTRACT FROM AUTHOR]

Progress in understanding the causes of physiological and behavioral changes in post-menopausal women is hampered by the paucity of animal models that accurately recapitulate these age-associated changes. Here we evaluate the translational potential of female rhesus macaques (Macaca mulatta). Like women, these long-lived diurnal primates show marked neuroendocrine changes during aging, as well as perturbed sleep-wake cycles and cognitive decline. Furthermore, the brains of old rhesus macaques show some of the same pathological hallmarks of Alzheimer's disease as do humans, including amyloidosis and tauopathology. Importantly, unlike humans, rhesus macaques can be maintained under tightly controlled environmental conditions, such as photoperiod, temperature and diet, and tissues can be collected with zero postmortem interval; this makes them especially suitable for studies aimed at elucidating underlying molecular mechanisms. Recent findings from female macaques are helping to elucidate how sex-steroids influence gene expression within the brain and contribute to the maintenance of cognitive function and amelioration of age-associated pathologies. Taken together, these findings emphasize the translational value of female rhesus macaques as a model for elucidating causal mechanisms that underlie normative and pathological changes in post-menopausal women. They also provide a pragmatic platform upon which to develop safe and effective therapies. • Female rhesus macaques are long-lived nonhuman primates that undergo menopause at ∼25 years of age. • They show age-related changes in behavior and physiology, similar to elderly women. • They represent a valuable translational animal model in which to study causes of human aging. • They offer a pragmatic model in which to develop novel safe and effective therapies for the elderly. [ABSTRACT FROM AUTHOR]

Background: Women in the menopausal phase of their lives often experience the vasomotor symptoms of menopause, namely, hot flushes or flashes and disturbances of sleep. About 75–85% of menopausal women tend to experience one or more vasomotor symptoms of menopause. Menopausal hormone therapy (MHT) is considered to be the mainstay treatment in treating vasomotor symptoms of menopause. However, MHT tends to be accompanied by adverse outcomes and there exist contraindications to it. Hence, an alternative treatment strategy is required in view of contraindications, intolerance, or side effects of MHT. Recently, paroxetine is the first and only selective serotonin reuptake inhibitor antidepressant which is United States Food and Drug Administration approved as a non-hormonal management method of vasomotor/climacteric symptoms in menopausal women. Objective: In the present study, we systematically reviewed paroxetine’s role in the management of hot flashes in menopausal women. Material and Methods: For the review purpose, we included the previously published relevant original, review, meta-analysis, and randomized controlled trial articles that were published in the English language using a 4-phase process of the preferred reporting items for systematic reviews and meta-analyses statement. Results: The severity and frequency of hot flashes were significantly reduced among menopausal women who received paroxetine compared to placebo. Five studies also showed improvement in the night-time sleep duration among menopausal women who received paroxetine in low doses. Conclusion: Thus, this study shows that low-dose paroxetine can be a beneficial and effective non-hormonal management option in managing hot flashes among menopausal women. [ABSTRACT FROM AUTHOR]

Introduction: Menopause, a natural occurrence in women's lives, is characterised by a drop in ovarian hormones, oestrogen, and progesterone levels. Sudden hypoestrogenic state, that is caused by hysterectomy leads to the development of menopausal symptoms. Aim: To assess the occurrence and severity of menopausal symptoms in women who underwent hysterectomy for benign gynaecologic conditions. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India, over a period of three months. The study included 100 women in the age group of 35-55 years who had undergone hysterectomy for benign conditions were invited to participate in the study. Those who agreed to the study and completed the questionnaire after six weeks and three months postoperatively were included in this study. Menopausal symptoms and severity were assessed using modified Menopause Rating Scale (MRS) scale. Posthysterectomy menopausal symptoms at six weeks and three months were compared using Chi-square test. Results: The mean age of the study participants was 45.85±6.24 years. Most of them, 52 (52%) had heavy menstrual bleeding, 28 (28%) of the study participants had no associated comorbidities. A total of 54 (54%) of the women of this study was diagnosed as Abnormal Uterine Bleeding-Leiomyomas (AUB-L). Majority 76 (76%) of them had undergone total abdominal hysterectomy with or without bilateral salphingoopherectomy. Mean duration of hospital stay 7.48±2.02 days. Postoperative diet of these women included calcium containing foods 57 (57%), iron containing foods 68 (68%). There was a statistically significant difference in majority of menopausal symptoms like hot flushes, palpitations, night sweats, reduced duration of sleep, anxiety, lack of interest in sex, forgetfulness and joint and muscle pains between six weeks and three months postoperatively. Conclusion: The present study concluded that the symptoms of hot flushes, difficulty in urinating, anxiety, joint and muscle pain was significantly higher at six weeks when compared to three months. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD), the leading cause of death among US adults, is more prevalent in menopausal females compared with age-matched males. Vasomotor symptoms of menopause (VMS; hot flashes/flushes and night sweats) are common among females undergoing menopausal transition and have been associated with elevated blood pressure (BP) and increased CVD risk. Autonomic dysregulation of BP has been posited as a contributing factor to the elevated CVD risk in menopausal females with VMS. This review includes 1) a brief overview of the relationship between VMS and CVD, 2) mechanisms of hot flushes and their potential impact on short- and long-term BP regulation, and 3) how the disruption of autonomic function associated with VMS might provide a mechanistic pathway to CVD development. Finally, this review will highlight knowledge gaps and future directions toward better understanding of hot flush physiology and VMS contributions to CVD. [ABSTRACT FROM AUTHOR]

Purpose: To examine utilization of a dedicated menopause symptoms after cancer clinic (MSAC) and to determine whether women referred to the MSAC for management of severe hot flush symptoms are more likely to adhere to endocrine therapy compare to those with severe symptoms not referred to MSAC., Patients and Methods: Breast cancer patients prescribed endocrine therapy with a diagnosis of estrogen-receptor positive breast cancer between January 2003 and December 2011 were identified from the Royal Perth Hospital Breast Unit database. Details of breast cancer pathology, endocrine therapy, endocrine therapy related side effects, referral to MSAC and patient reported adherence to endocrine therapy for up to 4 years were ascertained from the database and medical records systems. For those with severe vasomotor symptoms, total duration of endocrine therapy was compared between women referred to MSAC and those who were not referred to MSAC., Results: About 1275 women were identified from the database, with the cohort followed up until Dec 2016. Of these women, 120 (9.4%) were referred to MSAC and 1155 (90.1%) received usual care. In total, 147 reported severe vasomotor symptoms of whom almost half (71) were referred to MSAC. Women with severe vasomotor symptoms managed by MSAC were less likely to discontinue endocrine therapy (15.5%) compared with those managed with usual care (26.3%). However, this difference was not statistically significant (chi-square test statistic = 2.584, 1df, P = .1)., Conclusion: Management of severe vasomotor symptoms at a dedicated menopause clinic may increase adherence to endocrine therapy for breast cancer., Competing Interests: Disclosure The authors have stated that they have no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Menopause, a natural occurrence in women’s lives, is characterised by a drop in ovarian hormones, oestrogen, and progesterone levels. Sudden hypoestrogenic state, that is caused by hysterectomy leads to the development of menopausal symptoms. Aim: To assess the occurrence and severity of menopausal symptoms in women who underwent hysterectomy for benign gynaecologic conditions. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India, over a period of three months. The study included 100 women in the age group of 35-55 years who had undergone hysterectomy for benign conditions were invited to participate in the study. Those who agreed to the study and completed the questionnaire after six weeks and three months postoperatively were included in this study. Menopausal symptoms and severity were assessed using modified Menopause Rating Scale (MRS) scale. Posthysterectomy menopausal symptoms at six weeks and three months were compared using Chi-square test. Results: The mean age of the study participants was 45.85±6.24 years. Most of them, 52 (52%) had heavy menstrual bleeding, 28 (28%) of the study participants had no associated co-morbidities. A total of 54 (54%) of the women of this study was diagnosed as Abnormal Uterine Bleeding-Leiomyomas (AUB-L). Majority 76 (76%) of them had undergone total abdominal hysterectomy with or without bilateral salphingoopherectomy. Mean duration of hospital stay 7.48±2.02 days. Postoperative diet of these women included calcium containing foods 57 (57%), iron containing foods 68 (68%). There was a statistically significant difference in majority of menopausal symptoms like hot flushes, palpitations, night sweats, reduced duration of sleep, anxiety, lack of interest in sex, forgetfulness and joint and muscle pains between six weeks and three months postoperatively. Conclusion: The present study concluded that the symptoms of hot flushes, difficulty in urinating, anxiety, joint and muscle pain was significantly higher at six weeks when compared to three months.

Our aim is to evaluate the efficacy of bazedoxifene (BZA) plus conjugated estrogens (CE) on menopausal symptoms in postmenopausal women. A series of databases including PubMed, EMBASE, Medline, Web of science, China national knowledge internet and Wanfang database up to 31 October 2021 were searched, and randomized controlled trials (RCTs) of BZA/CE for menopausal symptoms were included. Seven RCTs involving 5431 patients were included in this study. Compared with placebo group, there were significantly reduce in daily number of hot flushes, daily number of moderate or severe hot flushes, the percentages of parabasal cells and the time to fall sleep when patients treated with BZA/CE. Besides, there were significant improvement in sleep disturbance and total MENQOL. However, no significant improvements in sleep adequacy were observed in the three groups. Furthermore, BZA 20 mg/CE 0.625 mg was more effective than BZA 20 mg/CE 0.45 mg in improving the menopausal symptoms. Therefore, both bazedoxifene 20 mg plus conjugated estrogens 0.45 mg and bazedoxifene 20 mg plus conjugated estrogens 0.625 mg could significantly improve the menopause-related symptoms and MENQOL in postmenopausal women, and the curative effects of BZA 20 mg/CE 0.625 mg were better than that of BZA 20 mg/CE 0.45 mg. These findings need to be further confirmed by more high-quality RCTs. [ABSTRACT FROM AUTHOR]

Objectives: To describe the epidemiology and treatment of vasomotor symptoms (VMS) in the UK.Study Design: Retrospective study that used electronic medical records from UK primary care centers.Main Outcome Measures: The prevalence and incidence of moderate-to-severe VMS, the proportion treated, persistence with initial treatment, treatment patterns, and menopausal hormone therapy (HT) experience were investigated over the study period (Jan. 2009-Dec. 2018). The study population comprised women aged 40-65 years registered at general practitioner clinics. For incident cases, the uptake of pharmacological non-hormonal or hormonal treatment was recorded, which included experience of HT.Results: Over the 10-year study period, 1,481,646 women were included from the database, among whom there were 313,031 prevalent and 90,434 incident cases of VMS. Annual prevalence and incidence rates were stable over time, with a weighted average of 21.1 % and 15.3 per 1000 person-years, respectively (results varied across age groups). Among women who were incident VMS cases, 32.4 % (29,275) were initially prescribed non-hormonal treatments for a median of 3.9 months, 49.4 % (44,700) were prescribed hormonal treatments for 4.0 months, and 18.2 % (16,459) had no treatment. Approximately one-third of treated women switched between non-hormonal and hormonal treatments. The HT experience results showed that 52.7 % (47,639) of women were HT-eligible, 13.1 % (11,872) were HT-contraindicated (they may or may not have received HT), and 34.2 % (30,923) did not receive HT.Conclusions: Variations in prescribed treatment patterns suggest that education may be needed for clinicians and women regarding the potential pharmacological options for treating VMS in the UK. [ABSTRACT FROM AUTHOR]

This care pathway from the European Menopause and Andropause Society (EMAS) provides an updated pathway for monitoring and guidance of women at midlife, focusing on those approaching the end of the reproductive life-cycle, going through the menopausal transition and beyond. The care pathway is written by professionals involved in women's health and provides a stepwise individualized approach, stratified according to needs, symptoms and reproductive stage. Furthermore, the pathway provides details on screening for chronic diseases related to menopause and ageing. Treatment options for climacteric symptoms range from menopausal hormone therapy to non-hormonal alternatives and lifestyle modifications. Therapy should be tailored to personal needs and wishes. The pathway aims to offer a holistic, balanced approach for monitoring middle-aged women, aiming to control health problems effectively and ensure healthy ageing. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate whether single measurements of serum estradiol (E2), estrone (E1) and sex hormone-binding globulin (SHBG) concentration distinguishes between women with and without menopausal symptom bother.Study Design: We analyzed baseline data from two clinical trials conducted in 2012-2017: MsFLASH 03 (178 peri-/post-menopausal women aged 40-62 years with bothersome vasomotor symptoms, mean age 54) and MsFLASH 05 (181 post-menopausal women aged 45-70 years with moderate-to-severe vulvovaginal symptoms, mean age 61).Main Outcome Measures: Symptom bother (hot flushes or flashes, night sweats, sweating, aching in muscles and joints, change in sexual desire, vaginal dryness during intercourse, and avoiding intimacy) in the past month was assessed using the Menopause-Specific Quality of Life questionnaire. Using logistic regression, we calculated the area under the receiver operating characteristic curve (AUC) values for E1, E2, and SHBG concentration in relation to being at least somewhat bothered (symptom bother score ≥3) by each symptom within each trial study population.Results: AUC values (95% confidence interval) ranged between 0.51 (0.41-0.60) and 0.62 (0.53, 0.72) for MsFLASH 03 and between 0.51 (0.42, 0.59) and 0.64 (0.53, 0.75) for MsFLASH 05. There was little evidence of associations between serum hormone levels and bother by a given menopausal symptom.Conclusion: These findings do not support the clinical utility of a single measurement of serum of E1, E2, or SHBG concentrations in differentiating between women who are bothered by a given menopausal symptom and those who are not. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy/effectiveness and safety of acupuncture for the treatment of hot flushes and its impact on serum hormone levels in menopausal women. Methods: A total of 10 databases were searched from their inception to August 2018. Reference lists of reviews and included articles were also hand-searched. Randomized controlled trials (RCTs) comparing the effect of acupuncture versus sham acupuncture, or acupuncture versus hormone therapy (HT), as treatment for menopausal hot flushes were included. Outcomes included hot flush frequency, hot flush severity and serum hormone levels of estradiol (E2), luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Meta-analyses were performed using Review Manager 5.3 software. Results: Thirteen RCTs including 1784 patients were selected, seven of which were available for meta-analysis. Compared with sham acupuncture, acupuncture significantly decreased hot flush frequency (mean difference (MD) −0.84, 95% confidence interval (CI) [−1.64, −0.05], I2 = 54%) from baseline to the end of study, but did not impact end scores of hot flush frequency (MD 0.19, 95% CI [−0.61, 0.99], I2 = 0%) or severity (MD 0.02, 95% CI [−0.13, 0.17], I2 = 0%). No differences were found between acupuncture and HT in serum levels of E2 (MD 6.56, 95% CI [−3.77, 16.89], I2 = 76%), FSH (MD 1.06, 95% CI [−1.44, 3.56], I2 = 0%) or LH (MD −3.36, 95% CI [−13.37, 6.65], I2 = 89%). Conclusion: Acupuncture may not decrease hot flush frequency, but yet appears to have similar effects on serum hormone levels as HT, that is, increased E2 and decreased FSH and LH. Considering that no firm conclusions could be drawn due to the low quality and limited number of included trials included, further high-quality RCTs need to be conducted. [ABSTRACT FROM AUTHOR]

Background: Androgen deprivation therapy (ADT) for prostate cancer with luteinizing hormone-releasing hormone (LHRH) agonists can be improved. Objective: To assess safety, the frequency and severity of hot flushes (HFs), bone health, and antitumor effects of high-dose estetrol (HDE4) when combined with ADT. Design, setting and participants: A phase II, double-blind, randomized, placebo-controlled study was conducted in advanced prostate cancer patients requiring ADT (the PCombi study). Intervention: Patients receiving LHRH agonist treatment were randomized 2:1 to 40 mg HDE4 (n = 41) or placebo (n = 21) cotreatment for 24 wk. Outcome measurements and statistical analysis: Coprimary endpoints were frequency/severity of HFs and levels of total and free testosterone (T). Secondary endpoints included assessments of bone metabolism (osteocalcin and type I collagen telopeptide [CTX1]), prostate-specific antigen (PSA), and follicle-stimulating hormone (FSH). Efficacy analysis was based on the selected per-protocol (PP) population. Results and limitations: Of 62 patients included in the study, 57 were suitable for a PP analysis (37 HDE4; 20 placebo). No E4-related serious cardiovascular adverse events occurred at 24 wk. Weekly HFs were reported by 13.5% of patients with HDE4 and 60.0% with placebo (p

The objective of this study was to conduct a systematic review and network meta-analysis to evaluate and compare the effectiveness of various types of acupuncture for menopausal hot flashes (HF). Randomized controlled trials (RCTs) were retrieved from 8 electronic databases, and the risk of bias was evaluated for the included studies. Pairwise meta-analysis and network meta-analysis were performed using Review Manager and R software for indirect comparison and ranking, respectively. In total, 23 RCTs (2,302 patients) were eligible for systematic review, of which 10 were included in network meta-analysis. Network meta-analysis showed manual acupuncture (MA) had the highest probability of reducing HF frequency and severity, followed by sham acupuncture (SA), electroacupuncture, usual care, or no treatment; furthermore, warm acupuncture significantly improved menopause-specific quality of life compared with MA or electroacupuncture. Compared with hormone replacement therapy, acupuncture had less efficacy in reducing HF frequency but enhanced menopause-specific quality of life. There was no significant difference between MA and SA in mitigating HF. The existing evidence showed that MA could be used for alleviating menopausal HF. However, it is recommended that more high-quality RCTs should be performed.

Introduction: Resistance training may be an effective intervention to improve menopausal symptoms and increase women's quality of life. However, most postmenopausal women do not perform regular resistance training. The purpose of this study was to explore postmenopausal women's experiences of participation in a resistance-training intervention to find barriers and motivators for the training.Methods: Fifteen postmenopausal women with low physical activity, who participated in a randomized controlled trial evaluating the effect of a resistance-training program on vasomotor symptoms and health-related outcomes, were consecutively recruited to this qualitative study. After completion of the 15-week resistance-training program, they took part in individual semi-structured interviews, followed by a telephone interview 1 year later. All interviews were transcribed verbatim and thematic analysis was used to analyse the data.Results: The analysis generated three themes that were involved at different time points. These were: "Trigger-Hopes of symptom relief", "An evolving motivation as a driving force for change" and "Finding new triggers". Accountability, and continuous professional and emotional support, were factors that fueled the women's motivation to perform regular resistance training during the study. Resistance training improved general well-being and most women experienced improvement in vasomotor symptoms. The women's motivation changed from being driven by a wish to improve bothersome symptoms, into a wish to achieve feelings of well-being and enjoyment. The change was seen regardless of effects of the intervention on vasomotor symptoms.Conclusion: This first qualitative evaluation of physical exercise as an intervention to treat vasomotor symptoms in postmenopausal women, found that the symptoms acted as a motivational trigger to initiate resistance training in low-active women. The motivation to exercise changed during the intervention from a wish to ameliorate symptoms into something the women did for enjoyment and well-being in general. This change in motivating factors may have contributed to a behavior change since all participants had increased their physical activity after 1 year regardless of effects on VMS. Trial registration The trial was preregistered at ClinicalTrials.gov; www.Clinicaltrials: gov , ID: NCT01987778 , date of first registration: 19/11/2013. [ABSTRACT FROM AUTHOR]

Most women experience vasomotor symptoms (VMS) around menopause that may affect quality of life negatively. Effective pharmacological treatment exists but is not recommended for all women, and there is a demand for alternatives to reduce symptoms and improve quality of life. The objective of this study was to investigate the effect of a resistance training intervention on health-related quality of life (HRQoL) in postmenopausal women with VMS. This open randomized controlled trial included 65 postmenopausal women >45 years old with daily VMS. The participants were randomized to 15 weeks of resistance training three times per week or an untreated control group. The Women's Health Questionnaire (WHQ) and Short Form Health Survey (SF-36) were used to assess HRQoL at baseline and after 15 weeks. The resistance training group improved compared to the control group in the WHQ domains of VMS (p = 0.002), sleep problems (p = 0.003) and menstrual symptoms (p = 0.01) from baseline to post intervention. No significant between-group differences were found in SF-36 summary scores, or in any of the domains. In postmenopausal women with moderate to severe VMS, resistance training three times per week for 15 weeks improved menopause-specific HRQoL. [ABSTRACT FROM AUTHOR]

Background: Surgical menopause is the emergency procedure to be carried out in a woman when it is essential due to reproductive pathology. The post-surgical consequences should be monitored and controlled effectively with various intervention protocols. Cognitive-behavioral therapy is one of the commendable protocols to improve the emotional and social profile in women with surgical menopause. Objective: To find the effectiveness of Cognitive Behavioural Therapy on emotional and social wellbeing among women with surgical menopause. Material & methods: It is a randomized controlled trial carried out in 230 women who have undergone surgical menopause. The participants were randomly allocated into the intervention and control groups. After obtaining demographics, CBT intervention was introduced - Cognitive Behaviour Therapy program-, which lasted seven months and included all six sessions. The pre and post-test questionnaires were obtained using the Emotional well-being scale and social concern scale respectively from both groups. Results: The scores were significantly improved after intervention, in the experiment group, in pretest, the mean score was 9.45 and the post-test mean score was 14.18, the mean difference is 4.73 whereas, in the control group, the mean score of 9.06 and the post-test mean score was 9.41, the mean difference is 0.35 for social wellness. Posttest emotional wellness level was increased to 23.65%. Whereas in the control group, the posttest increased to 2.25%. Conclusion: The CBT is an effective therapeutic intervention to improve social and emotional wellbeing among women with surgical menopause.

Background: Women's health has been a global concern for many decades. As menopause is midway between the challenges of adulthood and despair of old age, comes the changes of menopause in women. The menopause rating scale (MRS) is widely used to assess menopause-related symptoms. The MRS was first published in 1990 for assessing menopause symptoms. However, no reliable and valid tools are available in the Gujarati language to assess the individuals with menopause symptoms. Aim: The aim of the study was to translate and find out reliability and validity of the Gujarati version of MRS in postmenopausal women. Methods: The study was carried out in three phases: The first phase was the translation of scale into the Gujarati language; the second phase was a pilot study on 30 postmenopausal women age assesses the comprehensibility of the prefinal version; and the third phase was to find out the reliability and validity of the final version of scale. Results: The total value of intraclass correlation coefficient of test–retest reliability was 0.88, with the all items having individual intraclass correlation coefficients score ranging from 0.74 to 0.92. Reliability estimated by internal consistency reached a Cronbach's alpha of 0.94 and ranging from 0.85 to 0.95 test–retest. Conclusion: The Gujarati version of MRS is a reliable and valid tool for assessing the menopausal symptoms and health-related quality of life in Guajarati-speaking populations.

Introduction: Several studies have shown that preparations based on the rhizomes and roots of black cohosh (Cimicifuga racemosa (L.) Nutt.) can be useful in alleviating the menopausal symptoms. The aim of this study is to perform an update bibliographic review of the efficacy and safety of black cohosh in the treatment of the vasomotor symptoms of menopause. Method: A review of published articles from January 2005 to March 2021 in the resource search engine of the University of La Laguna, el punto Q”. Randomized and controlled clinical trials, which had the key words in the abstract, text or title, in both English and Spanish, were selected. Results: We found 13 trials which met the selection criteria. The studies reviewed showed that the black cohosh preparations (mainly commercial extracts standardized in their content of active ingredients) produced in most of the studies a significant reduction compared to placebo in the vegetative (hot flashes and night sweats) and psychological symptoms of menopause, as well as an improvement in the quality of life. No serious adverse effects were reported at the dose administered. Conclusions: Cimicifuga racemosa extracts can be effective and safe for the treatment of vegetative and psychological symptoms of menopause, being well tolerated. However, more clinical trials with a larger number of patients, more extensive, the use of standardized preparations, as well as similar criteria for inclusion and assessment of symptoms, are necessary to obtain more conclusive data. [ABSTRACT FROM AUTHOR]

Background: Studies in the adjuvant setting have shown that endocrine therapy related side effects predict breast cancer recurrence risk. Here, we assess the relationship between early reported side effects and incidence of breast cancer in women randomised to tamoxifen for cancer prevention in the International Breast Intervention Study (IBIS)–I trial. Methods: Women randomised to tamoxifen in the IBIS-I trial and for whom side effect status was known at the 6-month follow-up visit were included in this analysis. Side effects included in this analysis were hot flushes, vaginal discharge, and vaginal dryness. The primary endpoint was all breast cancer and secondary endpoint was oestrogen receptor (ER) positive breast cancer. Cox proportional hazard models were used to investigate breast cancer incidence in the tamoxifen group with and without side effects reported within 6 months of randomisation. Results: Women randomised to tamoxifen and reporting hot flushes at the 6-month follow-up visit had a non-statistically significant increase in breast cancer compared to those without hot flushes (HR = 1.26 (0.98–1.62), P = 0.08). A significant higher breast cancer risk was observed for postmenopausal women who reported hot flushes at the 6-month follow-up visit compared to those without hot flushes (HR = 1.59 (1.12–2.26), P = 0.01). A higher risk was observed for ER-positive breast cancer in postmenopausal women (HR = 1.81 (1.19–2.74), P = 0.01). No significant associations between gynaecological side effects and breast cancer occurrence was observed. Conclusions: Overall, no association between side effects reported at 6 months and subsequent breast cancer occurrence was observed. Some side effects might be useful markers for breast cancer occurrence in postmenopausal women.

Background: Climacterium is a series of physical and mental symptoms occurring in women and men due to decreased levels of sex hormones. Women lose the ability to become pregnant due to decreased ovarian estrogen production; the initial symptom being hot flushes. In addition, urogenital atrophy, sexual dysfunction, mood changes, and osteoporosis occur. Extracts of Stauntonia hexaphylla (SH) and Vaccinium bracteatum (VB) fruits, with a wide range of biological activities, are widely used in traditional herbal medicine. Objective: The purpose of this study was to investigate the mitigation of menopausal symptoms, such as hot flushes and postmenopausal osteoporosis after combinatorial treatment with SH and VB (SHVB) of ovariectomized (OVX) rats. Design: We measured the bone regenerative effect of SHVB on receptor activator of nuclear factor-κB (NF-κB) ligand-induced osteoclast differentiation in vitro and on ovariectomy-induced osteoporosis in vivo. We investigated the effect of SHVB in a rat model of menopausal hot flushes, in which the tail skin temperature increases following ovariectomy-induced rapid decline in estrogen levels. Results: SHVB inhibited osteoclast formation and tartrate-resistant acid phosphatase activity in primary mouse bone marrow-derived cells. In an estrogen deficiency-induced rat model, measurement of serum bone turnover factors showed that treatment with SHVB lowered the increased bone turnover. Additionally, SHVB decreased OVX-induced bone loss of the total femur. SHVB inhibited osteoclast differentiation, prevented bone mass reduction, and improved trabecular bone structure and biochemical markers in OVX-induced osteoporosis. In addition, administration of SHVB significantly ameliorated the changes in skin temperature in OVX rats. Conclusion: SHVB improved the symptoms of menopause. These results provide the foundation for developing SHVB as a natural substance to replace hormones in the future.

Abstract Background Women commonly seek medical advice about menopausal symptoms. Although menopausal hormone therapy is the most effective treatment, many women prefer non-pharmacological treatments, such as physical activity. The effectiveness of physical activity has been inconclusive when assessed by randomised controlled trials, and it remains unclear how women feel about it as a possible treatment approach. The aim of the study was to explore symptomatic menopausal women’s views and experiences of physical activity as a treatment for vasomotor and other menopausal symptoms. Methods An in-depth qualitative study was embedded within a randomised controlled trial that assessed the effectiveness of physical activity as a treatment for vasomotor menopausal symptoms in previously inactive vasomotor symptomatic women. Participants were randomised to one of two physical activity interventions or a usual care group. Both physical activity interventions involved two one-to-one consultations, plus either supporting materials or access to physical activity support groups, over 6 months. Semi-structured interviews were conducted with 17 purposively selected participants from all three trial groups after they had completed trial follow-up. Interviews were audio recorded, transcribed verbatim, and analysed by constant comparison. Results All participants talked positively about physical activity as a treatment for their menopausal symptoms, with most reporting participation had improved their hot flushes and night sweats. They reported that they had experienced improved sleep, physical health and psychological well-being. Those who received the physical activity plus social-support intervention reported their ability to cope with their menopausal symptoms had improved. Many participants commented that they would prefer doctors to discuss physical activity as a possible treatment for their hot flushes and night sweats, before offering medication. Conclusions Based on the views and experiences of the women who participated in this study, healthcare professionals should continue discussing physical activity as a potential first treatment option with menopausal women. Furthermore, healthcare professionals should ensure they prepare, support, and encourage these women both physically and emotionally. Trial registration ISRCTN ISRCTN06495625 Registered 10/11/2010

Aim. To review scientific publications on clinical effectiveness and potential application of phytoestrogens (PE) in the treatment of climacteric syndrome.Materials and methods. The PRISMA approach was used. The systematic search was performed in three electronic scientific databases: Cochrane library, PubMed/MEDLINE, and eLIBRARY.ru. The publications were also manually searched for in the reference lists of the relevant articles.Results. The filters were used to select 79 publications; 26 of them were included in the final review. The main method of treatment for the manifestations of the climacteric syndrome is menopausal hormonal therapy (MHT). One of the alternative methods for the control of its symptoms is the application of phytoestrogens (PE), primarily, isoflavones, lignans, and coumestans. Active metabolites of PE are expressed under the influence of gut microflora that is different in various groups of women, which can determine the differences in the effectiveness. Taking into account multidirectional character of the studies as well as numerous publications of low quality, it is still impossible to come to the final conclusion on the effectiveness of PE-containing food supplements (FS) when it comes to a decrease in the occurrence rate and expression of such symptoms as hot flushes, night sweats, and cognitive deterioration. The conclusions on the prevention of cardio-vascular diseases are not definite either.Conclusions. The review showed that scientists could not come to the conclusion on the effectiveness and safety of PE-containing FS. Probably, the most prospective means of the control of climacteric syndrome are FS that contain isoflavones of red clover and soy in the maximum effective concentration. Considering free access to such FS on the market, they must meet high safety requirements.

Objective: To assess whether folic acid supplementation ameliorates hot flushes. Design: Double‐blind, placebo‐controlled randomised trial. Setting: Nine hospitals in England. Population: Postmenopausal women experiencing ≥50 hot flushes weekly. Methods: Women (n = 164) were randomly assigned in a 1:1 ratio to receive folic acid 5 mg tablet or placebo daily for 12 weeks. Participants recorded frequency and severity of hot flushes in a Sloan Diary daily and completed Greene Climacteric and Utian Quality of Life (UQoL) Scales at 4‐week intervals. Main outcome measures: The change in daily Hot Flush Score at week 12 from randomisation based on Sloan Diary Composite Score B calculation. Results: Data of 143 (87%) women were available for the primary outcome. The mean change (SD) in Hot Flush Score at week 12 was −6.98 (10.30) and −4.57 (9.46) for folic acid and placebo group, respectively. The difference between groups in the mean change was −2.41 (95% CI −5.68 to 0.87) (P = 0.149) and in the adjusted mean change −2.61 (95% CI −5.72 to 0.49) (P = 0.098). Analysis of secondary outcomes indicated an increased benefit in the folic acid group regarding changes in total and emotional UQoL scores at week 8 when compared with placebo. The difference in the mean change from baseline was 5.22 (95% CI 1.16–9.28) and 1.88 (95% CI 0.23–3.52) for total and emotional score, respectively. Conclusions: The study was not able to demonstrate that folic acid had a statistically significant greater benefit in reducing Hot Flush Score over 12 weeks in postmenopausal women when compared with placebo. Folic acid may ameliorate hot flushes in postmenopausal women but confirmation is required from a larger study. Folic acid may ameliorate hot flushes in postmenopausal women but confirmation is required from a larger study. [ABSTRACT FROM AUTHOR]

Abstract Hypogonadism as a cause of depression, daytime sleepiness, and flushing is often missed in young males. Our case report highlights the importance of screening for hypogonadotropic hypogonadism and its treatment in symptomatic men with severe obesity, especially if they have depression, excessive sleepiness, and narcolepsy.

Introduction. It is not known exactly from what times Vitex agnus-castus began to be used in medical practice to alleviate the symptoms of menopause, but this practice seems to have a relatively recent history. This article discusses the basis for the use of the Vitex agnus-castus, which is confirmed by the results of pharmacological and clinical studies. Methods. Mechanisms of the potential relevance of the drug in the context of treating menopausal symptoms are studied taking into account the current understanding of the endocrinology and neuroendocrinology of menopause and related symptoms. Conclusions. Considering that the results of carefully conducted randomized controlled trials are insufficient to confirm the use of each individual plant component, the new results of pharmacological studies confirm the role of the Vitex agnus-castus in alleviating the symptoms of menopause, as well as the need for further research

Abstract Background Beneficial effects of placebos are high in double-blind hot flush trials. Studies in various conditions suggest that honestly prescribed placebos may elicit symptom improvement. Objective To determine whether open label placebo (OLP) treatment is efficacious in alleviating hot flushes among peri- and postmenopausal women. Methods/design In this assessor-blinded, randomized-controlled trial, n = 100 women experiencing five or more daily hot flushes of at least moderate severity and bothersomeness are assigned 1:1 to a 4-week OLP treatment or no treatment. To explore the duration and maintenance of placebo effects, the OLP group is randomized a second time to either discontinue or continue the OLP treatment for another 4 weeks. All participants receive a briefing about placebo effects and study visits at baseline, post-treatment (4 weeks), and follow-up (8 weeks, OLP group only). Qualitative interviews about subjective experiences with the OLP treatment are conducted. Primary outcomes are differences between the OLP and the no-treatment group in the hot flush composite score (frequency × severity), and bothersomeness of hot flushes as assessed with the Hot Flush Rating Scale at post-treatment. Secondary outcomes include hot flush frequency, health-related quality of life, global improvement, and the number of responders at post-treatment. Data are analyzed by fitting (generalized) linear mixed models. An exploratory analysis of maintenance and duration is performed including follow-up data. Discussion This trial will contribute to the evaluation of OLP treatments in clinical practice and further our understanding about the magnitude of placebo effects in hot flush treatments. Trial registration Clinicaltrials.gov, NCT03838523. Retrospectively registered on February 12th, 2019. The first patient was enrolled on October 10th, 2018.