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.
A cross-sectional study was carried out in 104 overweight and obese postmenopausal women attending a gynaecological clinic for their annual gynaecological examination.
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.
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.
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.
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.
Nine single nucleotide polymorphisms (SNPs) located at different candidate genes related to the estrogen signalling pathway were analysed in 1980 Spanish postmenopausal women.
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).
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.
To establish whether treatment for three years with pro-juven progesterone cream affects progression of atherosclerotic plaques or bone density in postmenopausal women.
Randomized double-blind placebo-controlled trial.
One hundred and thirty-one healthy postmenopausal women aged between 50 and 75 years with at least one asymptomatic arterial plaque visible on ultrasound of the carotid or femoral bifurcation.
Women were randomly allocated to receive pro-juven progesterone cream, 20 mg twice daily, or placebo, for three years.
Rate of change of plaque thickness, intima-media thickness and bone density of lumbar spine and femoral neck.
There was no difference between the groups.
Pro-juven progesterone cream 20 mg twice daily did not affect progression of asymptomatic atherosclerosis or deterioration in bone density over three years.
The effect of menopause on breathing is not fully understood. We have previously shown that postmenopausal women have a higher sleep-induced increase in transcutaneously measured carbon dioxide tension (TcCO2) than premenopausal women. Therefore, we hypothesized that estrogen therapy (ET) would normalize this sleep-induced TcCO2 increase.
Nine postmenopausal ET users and nine non-users went through an overnight polygraphic sleep study including continuous monitoring of TcCO2.
TcCO2 levels were higher during sleep than evening wakefulness (awake median 6.55 kPa versus sleep median 6.90 kPa, P = 0.001). ET users had a greater sleep-induced increase in TcCO2 than non-users when comparing the difference between wakefulness and slow-wave sleep (0.85 kPa versus 0.28 kPa, P = 0.004). Lower sleep efficiency was associated with higher sleep-induced increase in TcCO2.
In contrast to our initial hypothesis, postmenopausal ET users have a higher sleep-induced increase in TcCO2 than women without ET. Thus, TcCO2 may be sensitive in measuring the peripheral estrogen effect. These findings warrant placebo-controlled intervention studies to confirm the effects of ET on TcCO2 measurements.
The aim of this study was to evaluate the knowledge, attitudes and expectations of patients receiving treatment for postmenopausal osteoporosis, analysing the factors related to good compliance with treatment.
A national, epidemiological, cross-sectional study collected information on personal medical history, family history, bone densitometry, and treatment and compliance of patients over 45 years who were receiving treatment for osteoporosis and provided their informed consent. The patients anonymously completed a questionnaire about their knowledge of osteoporosis and the Morisky and Green treatment compliance evaluation test.
Three hundred and fifteen specialists in gynaecology participated, recruiting 1179 patients with postmenopausal osteoporosis. The mean age was 59.9 years (standard deviation [SD] = 7.5). Only 22.6% of the patients showed an acceptable knowledge of osteoporosis (the criterion established was correct response to 80% of the questions). Treatment compliance was evaluated using a combination of Morisky–Green and Haynes–Sackett criteria. Of the patients 39.2% were classified as compliant, 74.6% of the patients were very or quite concerned about their condition and 53.3%; described their health status as excellent or good. However, 63.6% of the patients indicated that they needed more information about osteoporosis. The factors related to good compliance were the existence of one or no concomitant disease (odds ratio [OR] = 1.38, P = 0.025) and the type of knowledge about their disease (acceptable knowledge: OR = 1.33, P = 0.043).
Correct knowledge about osteoporosis would increase the possibility of appropriate compliance with the prescribed treatment, thus reducing the risk of osteoporotic fractures.
Determine women's experiences of premenstrual symptoms.
Cross-sectional survey.
In all, 4085 women aged 14–49 years recruited by random telephone digit dialing in France, Germany, Hungary, Italy, Spain, UK, Brazil and Mexico.
Telephone interview checklist of 23 premenstrual symptoms, sociodemographic variables and lifestyle variables.
The most prevalent symptoms were abdominal bloating, cramps or abdominal pain, breast tenderness, irritability and mood swings. Severity of symptoms is directly proportional to duration (R = 0.79). Hierarchical clustering found the following mental and physical domains and a typology: ‘Mild’ type (40.8%) with minimal symptoms; ‘Moderate M’ type (28.7%) with moderately severe, mostly mental symptoms; ‘Moderate P’ type (21.9%) with moderately severe, mostly physical symptoms; and ‘Severe’ type (8.6%) with severe intensity of both mental and physical symptoms. Multiple stepwise regression found significant effects on symptom duration severity index of age (linear and quadratic effects), current smoking and country.
Further research is needed on the impact of premenstrual symptoms on quality of life, and whether a brief symptom list could be developed as a valid and reliable tool globally.
To assess the correlation between vertebral body T-score and intervertebral disc height in premenopausal and postmenopausal women.
A total of 203 women were recruited from a large bone densitometer directory. The disc heights measured were those between the 12th thoracic and third lumbar vertebra. The discs were assigned the symbols D, whereby D1 applies for the disc between the 12th thoracic and first lumbar vertebra. The disc height of the group of women (n = 38) with osteoporotic vertebral fractures was compared with the disc heights of hormone-treated women (n = 47), untreated postmenopausal women (n = 77) and another group of premenopausal women (n = 41). Bone density measurements were taken by a Norland Bone Densitometer (DEXA 586).
The lowest disc heights were found in the fracture group. The total disc height in the fracture group was 1.42 ± 0.25 cm, significantly lower (P < 0.0001) than the untreated group (1.82 ± 0.3 cm), which in turn was significantly (P < 0.0001) lower than the hormone-treated group (2.2 ± 0.26 cm) and the premenopausal group (2.11 ± 0.21 cm). The lowest T-scores were also noted in the vertebral fracture group (T-score = –3.1 ± 0.3) (P < 0.0001). The highest T-score recorded for the premenopausal group was –0.38 ± 45, higher than that of the untreated menopausal –1.4 ± 0.32 and hormone treated women –0.65 ± 0.3, all three significantly higher than the fracture group (P < 0.0001).
The lowest T-scores were also noted in the vertebral fracture group (T-score = –3.1 ± 0.3) (P < 0.0001). The highest T-score recorded for the premenopausal group was –0.38 ± 45, higher than that of the untreated menopausal –1.4 ± 0.32 and hormone treated women –0.65 ± 0.3, all three significantly higher than the fracture group (P < 0.0001). Bone density across all groups revealed a correlation with disc height (R = 0.29) (P < 0.05). The group with vertebral osteoporotic fractures was the only group to show a negative correlation (–0.21) between disc height and vertebral bone density. Conversely, a significant correlation (R = 0.47) (P < 0.001) between the T-score and the total lumbar intervertebral disc height was noted in the premenopausal group of women. The menopausal group of untreated women also showed a significant correlation between the T-score and disc height (R = 0.25 P < 0.05); however, an insignificant positive correlation was found in the hormone-treated group.
The fracture group was noted to have the lowest intervertebral disc height and lowest T-scores compared with the other three groups. The hormone-treated and the premenopausal women had the highest disc heights and T-scores recorded. Positive correlations between T-score and disc height were noted for all the groups except for the fracture group. These results suggest a coupling between the vertebral body and intervertebral disc, which if disrupted may lead to increased risk for fracture. The combination of both T-score and disc height may improve the screening sensitivity for vertebral body fracture risk.
To evaluate the effect on climacteric symptoms and quality of life, and the safety of four doses of progestelle progesterone cream administered for 24 weeks to postmenopausal women complaining of moderate to severe menopausal symptoms.
Single-centre, double-blind, randomized, placebo-controlled study.
Two hundred and twenty-three healthy postmenopausal women, aged between 40 and 60 years and complaining of severe menopausal symptoms were recruited through newspaper advertisements.
Women were randomly allocated to progestelle progesterone cream 60, 40, 20, 5 mg or placebo, to be applied daily for six months.
The primary efficacy variable was the psychological, somatic and vasomotor components of the Greene Climacteric Scale after six months. Secondary endpoints were incidence of hot flushes and night sweats, the nine subscales of the Medical Outcome Survey Short Form-36 (SF-36), serum progesterone, endometrial thickness and histology after six months. Adverse events were sought and recorded and followed up to resolution.
There were no statistically significant differences between any of the treatment groups and placebo for any of the components of the Greene Score. A statistically significant difference between the 20 mg group and placebo was found for the physical functioning (95% confidence interval [CI] 1.7–12.3; P = 0.01) and social functioning (95% CI 1.9–16.7; P = 0.01) scales of SF-36 after six months. No other statistically significant differences were found between any treatment group and placebo for any of the other secondary efficacy variables. There appeared to be a higher incidence of headache in the groups treated with progesterone cream.
Progesterone cream was no more effective than placebo for relief of menopausal symptoms.
Gender differences, related to varying sexual hormone levels and hormone secretion patterns across the lifespan, contribute to women's vulnerability to mood disorders and major depression. Women are more prone than men to depression, from puberty onwards, with a specific exposure across the menopausal transition. However, controversy still exists in considering fluctuation/loss of estrogen as a specific aetiologic factor contributing to depression in perimenopause and beyond.
To briefly review the interaction between changes in menopausal hormone levels, mood disorders, associated neuropsychological co-morbidities and ageing, and to evaluate the currently available therapeutic options for perimenopausal mood disorders: (a) treatment of light to moderate mood disorders with hormonal therapy (HT); (b) treatment of major depression with antidepressants; (c) the synergistic effect between HT and antidepressants in treating menopausal depression.
Depression across the menopause has a multifactorial aetiology. Predictive factors include: previous depressive episodes such as premenstrual syndrome and/or postpartum depression; co-morbidity with major menopausal symptoms, especially hot flashes, nocturnal sweating, insomnia; menopause not treated with HT; major existential stress; elevated body mass index; low socioeconomic level and ethnicity. Postmenopausal depression is more severe, has a more insidious course, is more resistant to conventional antidepressants in comparison with premenopausal women and has better outcomes when antidepressants are combined with HT.
The current evidence contributes to a re-reading of the relationship between menopause and depression. The combination of the antidepressant with HT seems to offer the best therapeutic potential in terms of efficacy, rapidity of improvement and consistency of remission in the follow-up.
The objective of this study is to use the internet to survey the effect of menopause on women's experience of libido.
A questionnaire incorporating the Brief Profile of Female Sexual Function (B-PFSF) on a UK menopause website.
Questions on reduced libido, distress, level of help sought and treatment.
Eighty-four percent of women (n = 2112/2527) felt that an active sex life was important. One thousand and fifty-one perimenopausal and 560 postmenopausal women reported reduced libido causing distress with 23% and 35% discussing this with health professionals. Eighteen percent perimenopausal and 30% postmenopausal women had tried non-testosterone hormone replacement therapy with 34% and 37%, respectively, finding it helpful. Testosterone was deemed useful in some perimenopausal (n = 6/17) and postmenopausal (n = 23/50) women. Twenty-seven percent premenopausal, 38% perimenopausal and 56% postmenopausal women reported vaginal dryness with 78% peri- and 87% postmenopausal women believing it a factor causing reduced libido. Twenty-two percent premenopausal, 28% perimenopausal and 46% postmenopausal women had discussed this with health professionals and 17%, 36% and 55%, respectively, were on treatment. Women in all reproductive epochs completed the B-PFSF (a validated tool for postmenopausal women only).
An active sex life was deemed to be important but many women were not seeking help for menopause-related reduced libido causing distress. For many, vaginal changes contributed to their symptoms. In those seeking advice, treatment was commonly not prescribed. Health professionals must ask appropriate direct questions to all women, especially as part of menopausal assessment. A need for the B-PFSF to be validated in non-postmenopausal women was also indicated.
Sleep disturbances have been reported to be one of the most troubling manifestations of menopause. While hormone replacement therapy (HRT) has historically been considered a first-line treatment for menopausal insomnia, many women are now seeking alternative treatments due to concerns about the risks and side-effects of HRT. The goal of this study was to evaluate the effect of ramelteon, a selective melatonin receptor agonist, for the treatment of menopausal insomnia.
A total of 20 healthy peri- and postmenopausal women with insomnia participated in this six-week, prospective, open-label trial of ramelteon (8 mg) at an academic medical centre. Participants completed sleep–wake diaries on a daily basis for six weeks. Self-report measures of sleep impairment, daytime functioning, quality of life and mood were also completed on a bi-weekly basis.
Significant improvements in latency to sleep onset, total sleep time and sleep efficiency were observed in diary data while gains in sleep quality, sleep impairment, daytime functioning, quality of life and mood were found in self-report measures. There was no evidence of tolerance or rebound over the course of the trial.
Overall, results suggest that ramelteon is an effective non-hormonal approach for the treatment of insomnia in menopause. Randomized-controlled trials are needed to further evaluate the efficacy of this intervention.
To estimate the cost-effectiveness of five-year treatment of hormone replacement therapy (HRT) compared with no treatment for women with menopausal symptoms in the UK.
A Markov cohort simulation model with tunnel techniques was used to assess the cost-effectiveness of HRT in women aged 50 years. For the clinical effects of HRT we used, where possible, results taken from the Women's Health Initiative (WHI). The model had a life-time horizon with cycle lengths of one year and contained the following disease states: hip fracture, vertebral fracture, wrist fracture, breast cancer, colorectal cancer, coronary heart disease, stroke and venous thromboembolic events. An intervention was modelled by its impact on the disease risks during and after stopping treatment. The model was populated with UK-specific data on risks, mortality rates, quality-of-life weights and costs. The main outcome of the model was cost per quality-adjusted life year (QALY) gained of HRT compared with no treatment.
The results indicated that it was cost-effective to treat women with menopausal symptoms with HRT in the UK. The severity of menopausal symptoms was the single most important determinant of cost-effectiveness, but HRT remained cost-effective even where symptoms were mild or effects on symptom relief were small.
Treatment of women with menopausal symptoms with HRT is cost-effective.