Studies published - ��ݮ��Ƶ

Study suggests no link between common brain malignancy and hormone therapy

2025-01-15T15:36:21+11:00

Women are more likely to have such debilitating conditions as osteoporosis, migraines, Alzheimer disease, depression, multiple sclerosis, and brain tumors. Sex hormones are often blamed. However, a new study suggests no link between hormone therapy (HT) and common brain tumors known as gliomas.

The debate over the risks and benefits of HT has been ongoing for more than 2 decades. Key to the debate are possible effects on brain and breast health, as well as cancer risks, which counter the proven benefits of hormones in alleviating such common menopause symptoms as hot flushes, mood swings, and vaginal dryness. Glioma, a common brain malignancy with limited effective treatments, is one type of cancer that consistently shows a sex disparity of roughly 1.6. It has been speculated that the disparity is a result of the potential contribution of both exogenous and endogenous sex hormones.

Previous smaller studies have yielded inconsistent findings concerning the relationship between HT and glioma risk. However, a new large-scale study that analysed data from more than 75,000 women and included a median follow-up period of nearly 12 years suggests no significant association between HT use and glioma risk. Similarly, no significant associations were found when considering HT status or duration of use. Data was gathered as part of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.

Abstract

Objective: Gliomas are the most common primary brain tumors in adults, and the role of hormone therapy (HT) in their development remains controversial. This study with a cohort design aimed to investigate the association between HT use and glioma risk using the data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.

Methods: We analyzed data from 75,335 women, aged 50-78, who were enrolled between 1993 and 2001. The median follow-up period was 11.82 years. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the relationship between HT use and glioma risk, adjusting for various potential confounders.

Results: Over the follow-up period, 101 participants were diagnosed with glioma. After adjusting for relevant variables, there was no significant association between HT use and glioma risk (HR, 1.16; 95% CI, 0.75-1.81). Similarly, no significant associations were found when considering HT status or duration of use. However, in subgroup analysis by education, marital status, body mass index, oral contraceptive, hysterectomy, ovariectomy, ever been pregnant, age at menarche, and age at menopause, we found that a significant positive association was only observed in the group with at least college graduate (HR, 3.00; 95% CI, 1.02-8.84). The interaction effect for education was not significant (P = 0.056).

Conclusions: Our findings suggest no overall link between HT use and glioma risk. Further research is needed to confirm these results.

Reference

Jinyu Pan, Chuan Shao, Chao Xu, Gang Zhang, Haotian Jiang, Tao Tang, Hui Tang, Nan Wu. Association between hormone therapy and glioma risk in US women: a cancer screening trial. Menopause. 2025 Jan 14. doi: 10.1097/GME.0000000000002507. Online ahead of print. PMID: 39808122 DOI: 10.1097/GME.0000000000002507

Content created 30 January 2025

Later menopause and the greater risk for asthma

2024-11-28T00:00:00+11:00

Many studies suggest that an earlier age at menopause is more detrimental to a woman’s health, leading to an increased risk for adverse health conditions such as heart disease, diabetes, osteoporosis, and depression, among others. However, a new Canadian study is linking a later age at natural menopause with a greater risk for asthma.

Asthma is a common, chronic disease affecting more than 300 million people worldwide. The prevalence of asthma has been increasing over recent years, creating a substantial economic impact because it is one of the highest diseases for healthcare use. Adult-onset asthma is typically more severe and more difficult to treat than childhood asthma.

Multiple studies have suggested a possible link between asthma and sex hormones. Most notable is the fact that adult-onset asthma is more common in women than men. In childhood, asthma is more prevalent in boys. After puberty, however, asthma occurs more often in girls. Women also tend to have more severe asthma and are less likely to have remission of the disease.

Some studies have found a peak incidence of asthma at around age 40 years, which is commonly the age of the menopause transition, whereas other studies found a peak at the average age at menopause, which is 51 years. Both natural oestrogen and synthetic oestrogen, such as used in hormone therapy, offer similar risk profiles. Women using hormone therapy were shown to have a 63% increased risk of asthma, whereas women who stopped hormone therapy were two times more likely to quit asthma treatment. Higher body mass index also is shown to be a risk factor for women, but not men, because fat produces oestrogen.

Unfortunately, research on the association between menopause and asthma incidence is limited and has yielded conflicting results. That is why this newest study, based on 10 years of follow-up data from more than 14,000 postmenopausal women, was designed to investigate the association between the age at natural menopause and incidence of asthma in nonsmoking postmenopausal women. The study researchers found that women with early menopause (which occurs between 40 and 44 years of age) are at a reduced risk of asthma, which led them to suggest a role of oestrogen with asthma risk. Study results are published in the article “The association between age at natural menopause and risk of asthma among postmenopausal women from the Canadian Longitudinal Study on Aging.”

Abstract

Objective

This study aimed to investigate the association between age at natural menopause and incidence of asthma among postmenopausal Canadian women.

Methods

Women between the ages of 45-85 yr were followed for a 10-yr period. Analysis was restricted to naturally postmenopausal women who are nonsmokers and did not have asthma prior to menopause. Age at natural menopause was examined using the following categories: 40-44, 45-49, 50-54 (reference), and ≥55. Survival analysis was utilized to determine time to onset of asthma. Multivariable Cox regression analysis was performed to assess the relationship between age at natural menopause and asthma after adjusting for covariates.

Results

The multivariable Cox regression analysis showed a 30% decreased risk of asthma in women with age at natural menopause of 40-44 yr compared with age at natural menopause of 50-54 yr with a hazard ratio of 0.7 (95% confidence interval: 0.49-0.95).

Conclusion

Women with later ages at natural menopause may be at increased risk for asthma.

Reference

Durmalouk Kesibi, Michael Rotondi, Heather Edgell, Hala Tamim. The association between age at natural menopause and risk of asthma among postmenopausal women from the Canadian Longitudinal Study on Aging Menopause:2024 Dec 1;31(12):1069-1077. doi: 10.1097/GME.0000000000002443. Epub 2024 Oct 29.

Content created November 2024

Severe menopause symptoms may take toll on brain health

2024-08-27T17:06:03+10:00

With more than 24 million people globally living with dementia without a cure in sight, there is a lot of focus on ways to prevent and delay cognitive impairment. A new study suggests that severe menopause symptoms such as hot flushes and depression can negatively affect cognitive function in postmenopausal women.

In conjunction with our ageing population, dementia diagnoses are on the rise. It is estimated that 4.6 million new cases are diagnosed every year, which translates into one person being diagnosed with dementia every 7 seconds. That means dementia cases are expected to double every 20 years, reaching 81.1 million by 2040.

The good news is that medical experts estimate that 40% of cases of Alzheimer disease, the most common form of dementia, can be prevented or, at minimum, delayed. Because of this fact, there is a lot of interest in identifying risk factors. Recent research has focused on the importance of estradiol in female cognitive ageing. Because the menopause transition is characterized by a decline in estrogen, postmenopausal women are at an increased risk of dementia.

A new study involving nearly 1,300 late-postmenopausal women from nine Latin American countries suggests that severe menopause symptoms such as hot flushes, sleep, and mood disturbances were linked with cognitive impairment. Whether effectively treating hot flushes with hormone therapy or other approved therapies can help improve cognition in the form of memory, attention, language, and executive function, is unknown.

Based on these results, the researchers concluded that there is intricate interplay between hormonal, lifestyle, and sociodemographic factors involved with cognitive health.

Abstract

Objective

To evaluate the association between menopausal symptoms and cognitive decline in postmenopausal women.

Methods

This was a subanalysis of a cross-sectional, observational study conducted among women attending gynecological consultations across nine Latin American countries. The survey involved late postmenopausal women who were asked to complete a general questionnaire and the Menopause Rating Scale (MRS) to assess menopausal symptoms, with the Montreal Cognitive Assessment used to evaluate cognitive function as an outcome. A Montreal Cognitive Assessment score of less than 21 was used to define women with mild cognitive impairment (MCI).

Results

The study included 1,287 postmenopausal women with a mean age of 55.5 years and a mean body mass index of 26.3 kg/m2. On average, participants had 13.8 years of education and 2.3 ± 1.8 children, with 72.8% reporting having a partner. Additionally, 36.7% ever used menopausal hormone therapy. Regarding lifestyle factors, 50.3% engaged in a sedentary lifestyle, whereas 70.5% had never smoked. 15.3% of women had MCI exhibited significantly more intense menopausal symptoms compared with those without MCI (MRS total score 15.24 ± 12.58 vs 10.53 ± 8.84, respectively, P < 0.001). Logistic regression analysis revealed a significant association between severe menopausal symptoms (MRS total score ≥14 points) and MCI (odds ratio [OR], 1.74; 95% CI, 1.25-2.42). Conversely, a lower body mass index (OR, 0.96; 95% CI, 0.95-0.98), sexual activity (OR, 0.70; 95% CI, 0.51-0.96), physical exercise (OR, 0.55; 95% CI, 0.39-0.76), menopausal hormone therapy use (OR, 0.36; 95% CI, 0.24-0.55), and higher educational level (OR, 0.31; 95% CI, 0.21-0.46) were associated with lower odds for MCI.

Conclusion

Severe menopausal symptoms in postmenopausal women were associated with cognitive impairment. This study highlights the intricate interplay between hormonal, lifestyle, and sociodemographic factors and cognitive health.

Reference

Calle, Andrés MD; Blümel, Juan E. MD, PhD; Chedraui, Peter MD, PhD; Vallejo, María S. MD; Belardo, Alejandra MD; Dextre, Maribel MD; Elizalde-Cremonte, Alejandra MD; Escalante, Carlos MD; Espinoza, María T. MD; Gómez-Tabares, Gustavo MD; Monterrosa-Castro, Álvaro MD; Ñañez, Mónica MD; Ojeda, Eliana MD; Rey, Claudia MD; Rodríguez, Doris MD; Rodrigues, Marcio A. MD; Salinas, Carlos MD; Tserotas, Konstantinos MD; Aedo, Sócrates MSc. Severe menopausal symptoms linked to cognitive impairment: an exploratory study. Menopause:10.1097/GME.0000000000002422, August 13, 2024. | DOI: 10.1097/GME.0000000000002422

Content created 24 August 2024

Chronic kidney disease in postmenopausal women is associated with tooth loss

2024-06-26T16:33:40+10:00

Kidneys play a critical role in overall health by removing waste products from the blood. When they fail to sufficiently filter out foreign elements, several serious, lifethreatening, medical conditions can result. A new study suggests that chronic kidney disease may also be linked with tooth loss.

A woman’s glomerular filtration rate shows how well her kidneys are functioning. Kidney function decreases with time after menopause and is associated with declining reproductive hormone levels. These hormone changes during menopause also often lead to abdominal obesity, which is an independent risk factor for the development of chronic kidney disease and also linked with a higher risk of tooth loss.

The consequences of kidney disease are numerous, including an increased probability of experiencing problems with bone and cardiovascular health. Tooth loss, which reflects oral health status, is also associated with systemic diseases, such as diabetes, thyroid disease, and osteoporosis, and is independently associated with an increased risk of stroke. Excessive tooth loss can also impair chewing and speech.

Previous studies have identified an association between kidney function and tooth count. This newest study involving nearly 65,000 participants, however, is the first known to evaluate the association between chronic kidney disease and tooth loss in postmenopausal women across the ages. It concluded that the glomerular filtration rate, a measure of kidney function, is significantly associated with having at least 20 (of a total of 28) adult teeth, suggesting that chronic kidney disease and tooth loss are significantly associated, especially in postmenopausal women aged 66 to 79 years.

These findings suggest that preventing and managing mineral and bone metabolism disorders in postmenopausal women with chronic kidney disease are crucial to prevent tooth loss. It is also important to address kidney disease progression, as the consequences affect multiple body systems beyond just oral health.

Abstract

Objective: Menopause is characterized by changes in reproductive hormone levels that can negatively affect bone. Chronic kidney disease (CKD) and tooth loss are also important and common health issues after menopause. This study aimed to evaluate the association between CKD and tooth loss in postmenopausal women.

Methods: The study evaluated 64,971 participants who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) from 2010-2018, including postmenopausal women, aged 40 to 79 years. Participants were divided into two groups based on the number of teeth in their dentition (≥20 and <20).

Main outcome measures: The association between CKD and tooth loss was analyzed using multivariate logistic regression. Age, income, education, smoking, alcohol intake, body mass index, hypertension, diabetes, annual oral examination, toothbrushing, and the use of oral care products were considered. Subgroup analyses were further conducted according to age (40-65 yr and 66-79 yr).

Results: After adjusting for covariates, CKD and estimated glomerular filtration rate were significantly associated with having ≥20 teeth (PT20; CKD: odds ratio [OR] 1.41, 95% confidence interval [CI] 1.04-1.90; estimated glomerular filtration rate (10 mL/min/1.73 m2): OR 0.90, 95% CI 0.86-0.94). Importantly, the association between CKD and PT20 was significant in postmenopausal women, aged 66 to 79 years (OR 1.45, 95% CI 1.05-2.01).

Conclusions: In postmenopausal women, CKD and tooth loss may be associated. The association is significant in postmenopausal women, aged 66 to 79 years.

Reference

Na-Yeong Kim, Ji-Eun Kim, Choong-Ho Choi, Ki-Ho Chung. Chronic kidney disease in postmenopausal women is associated with tooth lossMenopause. 2024 Jun 11. doi: 10.1097/GME.0000000000002375. Online ahead of print.

Content created June 2024

Premature menopause linked to increased musculoskeletal pain and likelihood of sarcopenia

2024-05-30T01:00:00+10:00

Musculoskeletal pain is a prevalent menopause symptom, which helps explain why women typically experience more pain than men, especially around the age of 50 years. Beyond pain, muscle function and mass are also affected by menopause. A new study suggests premature surgical menopause can lead to an increased risk of muscle disorders.

The highly publicized Study of Women’s Health Across the Nation spotlighted a number of symptoms that are common during the menopause transition. Among other findings, it confirmed that muscle stiffness complaints were most prevalent during menopause, affecting 54% of US women aged 40 to 55 years.

This is also the time when ovarian hormone levels decrease significantly. In women who have experienced premature menopause, either spontaneous or surgical, the decrease is even more prominent. In addition, testosterone levels have also been shown to fall significantly in women with premature menopause.

These facts led researchers to conduct a new study specifically designed to evaluate the effect of different types of menopause on muscle discomfort and function in late-postmenopausal women aged 55 years and older. The study, which included nearly 650 women, concluded that women experiencing premature surgical menopause were more likely to develop musculoskeletal discomfort and sarcopenia than those with natural menopause at age 45 years or older. They theorized that the pain and decline in muscle mass in the late-postmenopause stage was more closely linked to hormone deficiency than to chronologic age alone.

Abstract

Objective: Musculoskeletal disorders frequently affect postmenopausal women. This study aims to compare muscle disorders between women according to the type of experienced menopause: premature (PM) or normal age of menopause (NAM).

Methods: This was a cross-sectional study conducted in nine Latin American countries in which late postmenopausal women (55 to 70 years) were surveyed with a general questionnaire, the Menopause Rating Scale (MRS: item #4 exploring musculoskeletal discomfort), and the trength, assistance with walking, rising from a chair, climbing stairs, and falling questionnaire (risk of sarcopenia).

Results: A total of 644 women were included: 468 who had NAM, and 176 who had PM (116 spontaneous and 60 surgical). The overall mean age of the participants was 60.9 ± 4.2 years. Women who had PM experienced more musculoskeletal discomfort (33.5% vs 20.9%, P < 0.001) and a higher likelihood of sarcopenia (35.2% vs 19.9%, P < 0.001) than women who had a NAM. Women who had surgical PM exhibited a higher prevalence of severe musculoskeletal discomfort (46.7% vs 29.3%, P < 0.02) and a higher likelihood of sarcopenia (45.0% vs 27.6%, P < 0.02) than women who had a NAM. After adjusting for covariates (age, body mass index, menopausal hormone therapy use, physical activity, education, cigarette consumption, use of antidepressants, sexual activity, comorbidities, and having a partner), our logistic regression model determined that spontaneous PM was not associated with higher odds of musculoskeletal discomfort and higher odds of sarcopenia. On the other hand, women who had surgical PM were more likely to experience musculoskeletal discomforts (odds ratio: 2.26; 95% confidence interval: 1.22-4.17) and higher odds for sarcopenia (odds ratio: 2.05; 95% confidence interval: 1.16-3.65) as compared to women who experienced a NAM.

Conclusions: Women experiencing surgical PM have a higher likelihood of developing muscle disorders. This underscores the potential significance of hormonal levels in influencing musculoskeletal health during postmenopause.

María S Vallejo, Juan E Blümel , Peter Chedraui, Konstantinos Tserotas, Carlos Salinas, Marcio A Rodrigues, Doris A Rodríguez, Claudia Rey, Eliana Ojeda, Mónica Ñañez, Álvaro Monterrosa-Castro, Gustavo Gómez-Tabares, María T Espinoza, Carlos Escalante, Alejandra Elizalde, Maribel Dextre, Andrés Calle, Sócrates Aedo. Association of muscle disorders in late postmenopausal women according to the type of experienced menopause. Menopause. 2024 Apr 30. doi: 10.1097/GME.0000000000002367. Online ahead of print.

Climacteric status at age 46 is associated with poorer work ability, lower 2-year participation in working life, and a higher 7-year disability retirement rate: a Northern Finland Birth Cohort 1966 study

2024-04-29T01:00:00+10:00

Since most women will continue working for years after entering menopause, the effect of menopause symptoms on their working ability is an important issue and the focus of a new study. Among other things, the study suggested that premature menopause can limit a woman’s work ability and time spent in the workforce.

Early menopause is the term used when women undergo menopause early—before the age of 45 years. Approximately 5% to 10% of all women fit into this category. At this point, it is assumed that women have almost 20 years of their working life remaining. However, the menopause transition causes roughly 80% of women to suffer from such bothersome symptoms as hot flashes and night sweats, which can adversely affect a woman’s quality of life.

Menopause (estrogen deficiency) can take a toll on women’s health in other ways as well, including an increased risk of cardiovascular disease and osteoporosis, unfavorable changes in body composition, and musculoskeletal pain. To date, however, few studies have analyzed whether menopause symptoms may be negatively associated with work ability and well-being at work.

A previous UK study showed that menopause before 45 years of age was associated with a ninepercentage-point reduction in labor market participation once these women entered their 50s compared with women who did not experience early menopause.

In this latest study that involved nearly 2,700 Finnish women, researchers investigated how women’s menopause status at 46 years of age was associated with their perceived work ability and registered working life participation during subsequent years. It concluded that an early menopause transition is challenging in that it affects women’s work ability and limits their working life participation.

Based on these results, the researchers recommend that healthcare professionals effectively treat menopause symptoms and promote the overall health of women experiencing early onset menopause so that they continue to be productive in the workforce. Further, they suggest that employers consider making working conditions more flexible for women undergoing the menopause transition to help them manage their symptoms to limit the risk of them prematurely ending their careers.

Abstract

Objective: To study the association between an advanced climacteric status at 46 years of age and current perceived work ability, the consequent 2-year accumulation of disability and unemployment days, and the 7-year incidence of disability pensions.

Methods: Study participants (n = 2,661) were recruited from the Northern Finland Birth Cohort 1966 study's 46-year follow-up in 2012. The participants' perceived work ability was investigated using the Work Ability Score (0-7 = poor vs 8-10 = good), along with potential covariates. Data concerning their consequent disability days, unemployment days, and disability pensions were collected from national registers. The association between their climacteric status at age 46 years, work ability, and working life participation was assessed using regression models.

Results: The climacteric women were more often smokers and more often had a lower level of education. The odds ratio for poor perceived work ability was 1.41 (95% CI, 1.06-1.87), and the incidence rate ratios for disability and unemployment days during the 2-year follow-up were 1.09 (95% CI, 1.07-1.11) and 1.16 (95% CI, 1.14-1.18), respectively, for the climacteric women compared with the preclimacteric women in models adjusted for smoking and education. The 7-year hazard ratio for disability pensions was 1.72 (95% CI, 1.02-2.91) for the climacteric women.

Conclusions: An earlier menopausal transition is associated with poorer perceived work ability, and it predicts lower recorded work participation and a higher disability pension rate in subsequent years.

Tiia Saarinen, Susanna M Savukoski, Paula Pesonen, Eeva Vaaramo, Jaana Laitinen, Tuulia Varanka-Ruuska, Leena Ala-Mursula, Maarit Niinimäki. Climacteric status at age 46 is associated with poorer work ability, lower 2-year participation in working life, and a higher 7-year disability retirement rate: a Northern Finland Birth Cohort 1966 study. Menopause. 2024 Apr 1;31(4):275-281. doi: 10.1097/GME.0000000000002327. Epub 2024 Feb 26.

Sleep and your risk of hyperuricemia

2023-05-29T01:00:00+10:00

Sleep deprivation, especially common during postmenopause, has been linked with a number of health problems, including hyperuricemia (elevated serum uric acid), which can often lead to gout and other life-threatening conditions such as heart disease. This study suggests that weekend catch-up sleep may minimize the risk of hyperuricemia in postmenopausal women.

Hyperuricemia is most often associated with gout, an increasingly common form of arthritis characterized by severe pain, redness, and tenderness in joints. Pain and inflammation occur when too much uric acid crystallizes and deposits in the joints. In addition, hyperuricemia is associated with metabolic syndrome, diabetes, hypertension, and kidney and cardiovascular diseases. The prevalence of hyperuricemia increases with age in all populations and especially in women after menopause. That’s because, according to previous studies, hyperuricemia is inversely related to estrogen levels.

A suggested approach to lowering the risk of hyperuricemia is adequate sleep duration that unfortunately becomes more of a challenge during the postmenopausal phase. Sleep is known to be essential for many people’s immune response, cognition, performance, psychological state, and disease status. Several studies have shown that too little or too much sleep is related to poor health problems such as hyperuricemia, hyperlipidemia, hypertension, type 2 diabetes, obesity, cardiovascular disease, and even mortality.

In this latest study involving nearly 1,900 participants, the researchers hypothesized that weekend catchup sleep could be a solution to making up for lost sleep during the week and effectively lowering the risk of hyperuricemia in postmenopausal women, who often struggle to get sufficient sleep. This is the first known study to investigate the relation between weekend catch-up sleep and hyperuricemia in postmenopausal women.

Study results suggest that weekend catch-up sleep is linked with a lower prevalence of hyperuricemia in postmenopausal women with insufficient sleep. Further studies are required to identify the causal relationships between sleep recovery and hyperuricemia in postmenopausal women.

Abstract

Objectives: Hyperuricemia is associated with metabolic and cardiovascular diseases and mortality. Efforts to lower the risk of hyperuricemia in various ways are needed as the prevalence of these diseases increases in postmenopausal women. Studies have shown that one of these methods is associated with adequate sleep duration, which is related to a low risk of hyperuricemia. Considering that it is difficult for people to get enough sleep in modern society, this study hypothesized that weekend catch-up sleep could be an alternative. To our knowledge, no past study has investigated the relation between weekend catch-up sleep and hyperuricemia in postmenopausal women. Hence, the aim of this research was to estimate the relation between weekend catch-up sleep and hyperuricemia with insufficient sleep in postmenopausal women during weekday or workday.

Methods: This study included 1,877 participants extracted from the Korea National Health and Nutrition Examination Survey VII. The study population was divided into weekend catch-up sleep and non-weekend catch-up sleep groups. Odds ratios with 95% confidence intervals were derived using multiple logistic regression analysis.

Results: Weekend catch-up sleep had a significantly lower prevalence of hyperuricemia after adjusting for confounders (odds ratio, 0.758 [95% confidence interval, 0.576-0.997]). In a subgroup analysis, weekend catch-up sleep of 1 to 2 hours was significantly correlated with a lower prevalence of hyperuricemia after adjusting for confounders (odds ratio: 0.522 [95% confidence interval, 0.323-0.845]).

Conclusions: Weekend catch-up sleep had a decreased prevalence of hyperuricemia in postmenopausal women with sleep deprivation.

Reference

Soo Min Son, Eun-Ju Park, Ryuk Jun Kwon, Young Hye Cho, Sang Yeoup Lee, Jung In Choi, Youngin Lee, Sae Rom Lee, Yun Jin Kim, Jeong Gyu Lee, Yu Hyeon Yi, Young Jin Tak, Seung Hun Lee, Gyu Lee Kim, Young Jin Ra. Association between weekend catch-up sleep and hyperuricemia with insufficient sleep in postmenopausal Korean women: a nationwide cross-sectional study Menopause 2023 May 16;doi: 10.1097/GME.0000000000002186.

Content created May 2023

Hormone Therapy Increases Lumbar Spine Bone Mineral Density - Protects Against Bone Loss

2023-05-28T01:00:00+10:00

As the population continues to age, there is greater focus on bone health and minimizing fractures to maintain mobility. A new study suggests that various types of hormone therapies not only increase lumbar spine bone mineral density (BMD) in postmenopausal women but also protect against bone loss, even after hormones have been discontinued.

Osteoporosis is a common debilitating condition, with approximately 14 million cases in the United States alone. Characterized by decreased BMD and an increased risk of bone fragility that results in pain, fracture, and disability, it is often associated with estrogen deficiency. This explains why postmenopausal women have a greater risk of developing osteoporosis than older men.

Hormone therapy (HT), including estrogen-only and estrogen-progestogen combinations, is widely used for the prevention and management of osteoporosis, although there have been conflicting studies about the lingering benefits after the hormone use is discontinued.

In this study, which is based on real-world data from more than 6,000 postmenopausal women involved in the national Health and Nutrition Examination Survey, researchers sought to evaluate the associations of various types of hormone preparations with BMD, postmenopausal bone loss (osteopenia), and postmenopausal osteoporosis. They also explored the withdrawal effect of HT. Multiple therapies were studied, including oral contraceptive pills, estrogen-only pills, estrogen-progestogen combination pills, and estrogen-only patches.

On the basis of the results, researchers concluded that all the therapies evaluated increased lumbar spine BMD in postmenopausal women. Except for the estrogen-only patches, all forms of HT additionally provided protection against osteopenia. These benefits persisted even after the hormone preparations were discontinued. No association, however, was found between HT and osteoporosis prevalence.

Abstract

Objectives: This study aimed to evaluate the associations of hormone preparations with lumbar spine bone mineral density (BMD), osteopenia, and osteoporosis in postmenopausal women, and whether these impacts persisted after hormone preparations were discontinued.

Methods: A total of 6,031 postmenopausal women were enrolled and divided into seven groups based on the types of hormone preparations. Among them, 1,996 participants were further divided into a current users (CU) group and a past users (PU) group. Multivariable linear regression models or logistic regression models were used to evaluate the associations of hormone preparation with lumbar spine BMD, osteopenia, and osteoporosis.

Results: Combined oral contraceptive pills, estrogen-only pills, estrogen/progestin combo pills, estrogen-only patches, or the use of more than two kinds of hormone preparations were positively associated with lumbar spine BMD (all P < 0.05). Except for estrogen-only patches, other hormone preparations also had a protective effect against osteopenia (all OR < 1, all P < 0.05), but none of them were associated with osteoporosis prevalence (all P > 0.05). The BMD increased by 0.10 and 0.04 g/cm2 in the CU and PU groups, respectively, compared with the nonusers group (all P < 0.05). In both the CU and PU groups, the risk of osteopenia was reduced (OR, 0.34 and 0.57, respectively)

Conclusions: Hormone preparations increase lumbar spine BMD in postmenopausal women and exert a protective effect against osteopenia. These impacts persisted after hormone preparations were discontinued. Hormone preparations, however, were not associated with osteoporosis prevalence.

Reference

Yiran Wang, Chao Sun. Association of hormone preparations with bone mineral density, osteopenia, and osteoporosis in postmenopausal women: data from National Health and Nutrition Examination Survey 1999-2018. Menopause 2023 May 2 ;doi: 10.1097/GME.0000000000002180. Online ahead of print.

Content created May 2023

Menopause-like symptoms may become apparent before the menopause transition

2023-04-27T01:00:00+10:00

The menopause transition is often accompanied by a number of symptoms that can affect a woman’s overall quality of life, including hot flashes, sleep disturbances, and depression. This study suggests that women may already experience some of these symptoms several years before menopause, during the late-reproductive stage.

By 2025, an estimated 1.1 billion women worldwide will be postmenopausal. Yet, the number of women experiencing menopause-like symptoms will likely be much higher because there is growing evidence to suggest that women in the late-reproductive stage experience multiple symptoms often associated with menopause years before the official menopause transition. This study involving more than 350 Spanish-speaking respondents is the latest to document the effect of various physiologic and psychosocial changes that affect women in the 4 to 10 years preceding the final menstrual period.

A woman’s late-reproductive stage is characterized by low antral follicle counts and subtle changes to menstrual cycle length, duration, and flow. It typically marks the time when fertility begins to decline and hormone patterns begin to change. This study sought to characterize and compare the symptoms Spanish-speaking women around the world report experiencing during the late-reproductive stage and the menopause transition.

This study identified a similar proportion of women in the late-reproductive stage and the menopause transition reporting 8 of 18 common menopause symptoms. Among other findings, women in the late-reproductive stage had lower age-adjusted odds of musculoskeletal pain and lower odds of decreased interest in sex. But both groups reported a similar interference with personal relationships and overall quality of life. Additional analyses are needed to assess how changes associated with reproductive aging affect quality of life.

Abstract

Objectives: The aim of this study was to characterize and compare the symptoms women self-report during the late reproductive stage and the menopausal transition.

Methods: This cross-sectional analysis used data from the Spanish-language Women Living Better survey. Women aged 35 to 55 years completed an 82-item online survey to assess menstrual cycle patterns, changes, and 61 symptoms sometimes associated with menopause. Women's menstrual patterns were classified as late reproductive stage or menopausal transition using the Stages of Reproductive Aging Workshop. Demographic and health-related data were collected, including age, country of residence, race/ethnicity, education, parity, smoking, and alcohol use. Descriptive statistics characterized reported symptoms, and logistic regression models examined associations between reproductive stage and symptoms.

Results: Of 853 respondents, 358 women were included in the sample analyzed. Participants were on average 40 ± 4.1 years old, 46% reported difficulty paying for basics, 34% lived in Spain, and 20% lived in Mexico. A similar proportion of women in the late reproductive stage and menopausal transition reported 8 of 18 symptom groups. Women in the late reproductive stage had a lower age-adjusted odds of musculoskeletal pain (odds ratio, 0.35; 95% CI, 0.19-0.66) and lower odds of decreased interest in sex (odds ratio, 0.49; 95% CI, 0.25-0.92). Both groups of women reported a similar interference with personal relationships.

Conclusions: Late-reproductive-stage women experience multiple symptoms often associated with menopause. A better understanding of symptoms experienced among Spanish-speaking women may lead to more personalized health care and facilitate anticipatory guidance about menopause. Future cross-cultural studies focusing on symptoms during the late reproductive stage are necessary.

Reference

Yamnia I Cortés, Nina Coslov, Marcie K Richardson, Nancy Fugate Woods. Symptom experience during the late reproductive stage versus the menopausal transition in the Spanish-language Women Living Better survey. Menopause 2023 Mar 1;30(3):260-266. doi: 10.1097/GME.0000000000002132. Epub 2023 Jan 10.

Content created April 2023

Study models the causes of insomnia in menopausal women

2023-03-29T01:00:00+11:00

One of the most common symptoms that women experience during menopause is sleep disruption. Although this change is thought to be associated with depression, hot flashes, and fluctuating hormone levels, few studies have investigated whether they actually influence sleep. In a new study, published in Journal of Women’s Health, researchers have modeled what factors influence sleep in menopausal women. The quality of women’s sleep declines as they progress into menopause. Concerningly, women who report sleep difficulties also report reduced quality of life and overall health. “Women experience incredible amounts of discomforting symptoms during menopause. It is a concern because the effects can be so debilitating and can last for years,” said Megan Mahoney, an associate professor of psychology.

Most researchers have previously hypothesized that changes in reproductive hormone patterns cause poor sleep quality and depression in midlife women. During aging, the decrease in the hormones estradiol and progesterone and increase the levels of follicle-stimulating hormone could cause insomnia. Furthermore, hot flashes can also make it harder for women to fall asleep and stay asleep. However, past studies have not conclusively shown what the underlying causes of sleep deprivation are.

Studies on menopausal women only go back three decades, in part because the symptoms are not lethal. However, researchers now have access to bigger datasets, allowing them to better understand the numerous manifestations of menopause.

The researchers used data from the Midlife Women’s Health Study, which was designed to identify which risk factors can cause menopausal symptoms among midlife women. Over 700 women participated in the fouryear study. In the initial clinic visits they completed questionnaires regarding their medical history and they submitted blood and urine samples. For the next three years they returned to the clinic once a year and completed follow-up questionnaires regarding their menstrual cycles, health status, lifestyle, depressive symptoms, and sleep, and submitted blood and urine samples.

The researchers then used a Bayesian network analysis to model the most likely reason for self-reported insomnia in midlife women. They tested several factors, including hormone concentrations and hot flashes, to see how these may be interacting to influence sleep disruption.

“Surprisingly, we did not find that hormone levels can predict sleep disruption. We did, however, find that women who have hot flashes at night also have insomnia. Moreover, women who had insomnia in the fourth year of the study also had it in the first year. The same was true for depression,” Mahoney said. “The bottom line is that some of these symptoms don’t necessarily go away over the course of menopause. When women go to the doctor, if they address these problems in the early phase of their menopause, they can address longterm problems.” The researchers would like to understand if there are lifestyle factors, such as high cholesterol, that can predict insomnia in menopausal women. If so, exercise and diet could go a long way to help. They are also interested in learning the extent to which exposure to environmental chemicals leads to sleep disruption. “Women are continuously exposed to phthalates through their use of personal care products and plastics. We need to examine the associations of these endocrine disruptors and sleep disruptions and insomnia,” said Jodi Flaws (EIRH co-leader/MME), a professor of comparative biosciences and co-author on the paper. “Such studies will serve as a foundation for strategies to prevent or treat sleep disruptions and ultimately improve women’s health.”

Abstract

Background: Sleep disruptions are among the most common symptoms experienced during menopause and can be associated with depression, hot flashes, and fluctuating hormones. However, few studies have examined how such risk factors influence sleep in midlife women in a network-based approach that will establish the complex relationship between variables.

Materials and Methods: We used a Bayesian network (BN) to examine the relationship between multiple factors known to influence sleep and depression in midlife women, including hormone concentrations, hot flashes, and menopause status among participants of the longitudinal Midlife Women's Health Study. In year 1, 762 women (45-54 years of age) answered questions regarding the frequency of insomnia, hot flashes, and depression; 389 of the same women answered similar questions at year 4. We measured serum hormones and calculated free estradiol index, free testosterone index, and ratios of estradiol:progesterone, and estradiol:testosterone. For our model, we calculated the change in frequency of insomnia, depression, and covariates (body mass index, menopause status, hot flashes at night, and present quality of life) from year 1 to 4.

Results: Using a BN, we found that self-reported hot flashes at night, and no other factors, were direct predictors of self-reported insomnia in year 1. Surprisingly, we did not identify an association between hormone concentrations and self-reported insomnia. Frequency of insomnia in year 4 was only predicted by frequency of insomnia in year 1, whereas frequency of depression in year 4 was predicted by year 4 insomnia and frequency of depression in year 1. No other factors were direct predictors of insomnia or depression in our model.

Conclusions: Therefore, hot flashes at night, previous insomnia, and depression are stronger predictors of how women will self-report frequency of sleep disruptions and treatment may reduce menopausal sleep complaints.

Reference

Katherine M Hatcher, Rebecca L Smith, Catheryne Chiang, Jodi A Flaws, Megan M Mahoney. Nocturnal Hot Flashes, but Not Serum Hormone Concentrations, as a Predictor of Insomnia in Menopausal Women: Results from the Midlife Women's Health Study. J Womens Health (Larchmt). 2023 Jan;32(1):94-101. doi: 10.1089/jwh.2021.0502. Epub 2022 Nov 25.

Content created March 2023