Menopause International current issue

Mander, T., Seif, M. — Fri, 20 Nov 2009 16:53:46 PST

Multidisciplinary working: the need for competence

Abernethy, K. — Fri, 20 Nov 2009 16:53:47 PST

Menopause likely to become a truly mid-life event

Brown, S. — Fri, 20 Nov 2009 16:53:47 PST

Selenium and health-related quality of life in menopausal women

Fri, 20 Nov 2009 16:53:47 PST

Objectives

The objective of this study was to evaluate whether there is a relation between serum selenium levels and health-related quality of life (HRQoL) in overweight and obese postmenopausal women.

Study design

A cross-sectional study was carried out in 104 overweight and obese postmenopausal women attending a gynaecological clinic for their annual gynaecological examination.

Main outcome measures

Age, anthropometric parameters, educational level, smoking habits, serum glucose, insulin, lipid profile, C-reactive protein, folic acid, vitamin B₁₂, homocysteine and selenium levels were determined, and the Cervantes Scale was used to evaluate HRQoL.

Results

Serum selenium mean value levels were similar in the different groups of HRQoL and there were no differences in the four domains of the Cervantes Scale. When women were classified according to serum selenium tertiles, higher levels of serum cholesterol, low-density lipoprotein cholesterol (LDLc) and triglycerides were found in women in the lowest serum selenium tertile.

Conclusions

In overweight and obese postmenopausal women, serum selenium level is not related to HRQoL but higher levels of cholesterol, LDLc and triglyceride values were detected in women in the lowest serum selenium tertile.

Multigenic combination of estrogen-related genes is associated with age at natural menopause in a Spanish population

Fri, 20 Nov 2009 16:53:47 PST

Objective

Age at natural menopause (ANM) can be considered a complex parameter that depends on the interaction of multiple factors. In the present study, the role of interaction between genetic variants within estrogen synthesis and signalling pathways in the ANM in Spanish women is studied.

Material and methods

Nine single nucleotide polymorphisms (SNPs) located at different candidate genes related to the estrogen signalling pathway were analysed in 1980 Spanish postmenopausal women.

Results

Independently, none of the nine markers were significantly associated with early ANM. Only heterozygosis at the NRIP rs2229741 locus could be associated with early menopause; however, this marker does not maintain statistical significance. In contrast, linear regression analysis suggests several epistatic interactions including these markers in relation to ANM, especially between ESR2, NRIP1 and BMP15. The genetic variant that appears most in these interactions is that of the BMP15 rs3897937. It was observed that AA-TC combined genotype for NRIP-BMP15 (rs3897937), respectively, appears to be associated with a lower ANM than other possible combinations of these SNP (46.1±5.9 versus 50.4±3.3; P = 0.002). In the multilocus analysis, the multigenic interaction formed by ESR2 (AA), BMP15 rs3897937 (TC) and NRIP1 (AA) has the lower ANM (45.37±6.8 versus 48.69±5; P = 0.038).

Conclusions

The results suggest that epistatic interactions of estrogen-related alleles may contribute to variance in ANM in Spanish women. Moreover, BMP15 and NRIP1 also appear as attractive candidate genes for premature menopause but require further investigation to confirm them.

Introduction to an integrated competence framework for health-care support workers and nurses working in menopause

McFall, P., Abernethy, K. — Fri, 20 Nov 2009 16:53:47 PST

The evolving role of the menopause nurse is essential to the provision of expert clinical care, and for the education of both patients and health-care professionals. The new Royal College of Nursing integrated competence framework for health-care support workers and nurses working in menopause has been developed to provide specialist guidance and can be used to ensure practice is safe, effective and accountable. It supports acknowledgement for knowledge, skills and competence in their daily roles whilst caring for women at the time of menopause. It aims to ensure consistent standards across all settings whilst increasing the effectiveness of menopause service provision. Using the competences will help nursing staff identify their own level of practice, career plan in a more structured way and pinpoint education and development needs. The framework is a dynamic document that will continuously evolve in light of changes in menopausal healthcare.

Postmenopausal bleeding

Gale, A., Dey, P — Fri, 20 Nov 2009 16:53:47 PST

Postmenopausal bleeding (PMB) is a symptom of possible gynaecological malignancy. According to present guidelines, women presenting with this symptom should be referred urgently to a team specializing in the management of gynaecological cancer, and be seen within two weeks of referral. Examination and investigation of these women should be able to exclude malignancy, while being acceptable to the patient and cost-effective. The gold standard modality of investigation to visualize the uterine cavity is hysteroscopy, but transvaginal scanning is recommended as the first-line investigation to select those who need further diagnostic evaluation. Hysteroscopy should be performed in women with a thickened endometrium on scan and women with recurrent episodes of bleeding despite negative scan findings. There have been very few studies that have examined women's knowledge, attitudes or concerns about PMB or its assessment. Further research would inform information and support strategies for women presenting and undergoing assessment for this symptom.

Pregnancy in peri- and postmenopausal women: challenges in management

Tower, C. — Fri, 20 Nov 2009 16:53:47 PST

Pregnancy in peri- and postmenopausal women is associated with an increased risk of complications and represents several challenges in terms of clinical management. Women in these age groups typically fall into one of two distinct groups, those who have conceived following assisted reproductive techniques, using ovum donation and those who have conceived spontaneously. While both have age in common, they differ in terms of additional risk factors. Recipients of assisted reproductive technologies have pregnancy risks associated with that treatment, but are at lower risks of a fetus affected by aneuploidy. Furthermore, they have been rigorously screened for medical complications, but are more likely to be primiparous and have multiple pregnancies. In contrast, women conceiving spontaneously are more likely to be of high parity and have additional medical complications such as obesity, hypertension or diabetes. In addition to the increased risk of antenatal complications such as miscarriage, ectopic pregnancies, gestational diabetes and hypertension, these women have a high risk of unexplained stillbirth. They also have a very high rate of Caesarean section. All these risk factors interact to modify clinical management. However, there are no randomized trials available to guide clinical management, thus decisions must be made on a case-by-case basis.

Endometriosis: associations with menopause, hormone replacement therapy and cancer

Palep-Singh, M., Gupta, S. — Fri, 20 Nov 2009 16:53:47 PST

Endometriosis is an estrogen-dependent condition and is characterized by the presence of ectopic endometrial tissue. The pathogenesis of this condition remains an enigma. Endometriosis has well known associations with menopause both in terms of secondary outcomes from medical and surgical therapy in premenopausal women, as well as a natural occurrence/recurrence of the disease in women going through menopause naturally. This review article aims to discuss the current day modalities of management of endometriosis with their pros and cons especially in the context of menopause and cancer.

Menopause, evolution and changing cultures

Shaw, L. M A, Shaw, S. L J — Fri, 20 Nov 2009 16:53:47 PST

The menopause is an isolated event in a much wider process that was probably an evolutionary adaptation essential for survival in the Pliocene. As a reproductive strategy, it is largely vestigial in the 21st century, part of an era that has seen a doubling of the average human longevity compared with that of the past. This process commences as an accelerated decline in female fertility, usually from the fourth decade of life, culminating in a total cessation of reproductive capacity for those surviving. The 20th and 21st century sees a huge increase in the numbers surviving and the duration of that postreproductive life phase extending for decades. This extended period of what is essentially a hormone deficiency state is a recent phenomenon and by no means part of the natural history of the human individual. It is therefore not surprising to see a postmenopausal increase in the incidence of so many disorders above that expected by age alone. Recent reproductive patterns have seen increases in the birth rate and requests for fertility treatments among women in their late 30s and 40s. Many try for pregnancy but are unsuccessful. The genes that permit later reproduction and hence later menopause are therefore being preferentially selected. Slowly over generations we will expect to see the fertility of future 40 year olds increase and the age of menopause to extend much later into our, now, longer lives.