Showing papers in "Menopause in 2008"

Estrogen and progestogen use in postmenopausal women: July 2008 position statement of The North American Menopause Society.

Abstract: Objective: To update for both clinicians and the lay public the evidence-based position statement published by The North American Menopause Society (NAMS) in July 2008 regarding its recommendations for menopausal hormone therapy (HT) for postmenopausal women, with consideration for the therapeutic benefit-risk ratio at various times through menopause and beyond Methods: An Advisory Panel of clinicians and researchers expert in the field of women_s health was enlisted to review the July 2008 NAMS position statement, evaluate new evidence through an evidence-based analysis, and reach consensus on recommendations The Panel_s recommendations were reviewed and approved by the NAMS Board of Trustees as an official NAMS position statement Also participating in the review process were other interested organizations who then endorsed the document Results: Current evidence supports a consensus regarding the role of HT in postmenopausal women, when potential therapeutic benefits and risks around the time of menopause are considered This paper lists all these areas along with explanatory comments Areas that vary from the 2008 position statement are noted A suggested reading list of key references published since the last statement is also provided Conclusions: Recent data support the initiation of HT around the time of menopause to treat menopause-related symptoms; to treat or reduce the risk of certain disorders, such as osteoporosis or fractures in select postmenopausal women; or both The benefit-risk ratio for menopausal HT is favorable for women who initiate HT close to menopause but decreases in older women and with time since menopause in previously untreated women

Cortisol levels during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study.

Abstract: Objective: Cortisol levels rise among some women during the late stage of the menopausal transition (MT), but we know little about changes in cortisol levels in relation to menopause-related factors (MT stage, urinary estrone glucuronide [E1G], testosterone, follicle-stimulating hormone [FSH]), stress-related factors (epinephrine, norepinephrine, and perceived stress), symptoms (hot flashes, mood, memory, and sleep), social factors (income adequacy, role burden, social support, employment, parenting, and history of sexual abuse), and health-related factors (depressed mood, perceived health, physical appraisal, body mass index, and smoking) The aim of the study was to examine the influence of menopause-related factors, stress-related factors, symptoms, social factors, and health-related factors on cortisol levels during the MT Methods: Participants were a subset of Seattle Midlife Women's Health Study who provided data during the late reproductive, early and late MT stages, or early postmenopause and who were not using hormone therapy or corticosteroids (N = 132 women, up to 5,218 observations) Data provided included menstrual calendars for staging the MT, annual health reports, health diaries, and overnight urine specimens (assayed for cortisol, catecholamines, E1G, and FSH) between 1990 and 2005 were included Perceived stress, symptoms, and health behaviors were assessed in a health diary Health-related and social factors were assessed in an annual health update Multilevel modeling was used to test the effects of menopause-related and other factors on overnight cortisol levels Results: When tested with age as a measure of time, menopause-related covariates, including E1G, FSH, and testosterone, were associated with significant increases in overnight cortisol levels (P < 00001) Likewise, epinephrine and norepinephrine were each associated significantly with overnight cortisol levels (P < 00001) In multivariate analyses, E1G, FSH, and testosterone constituted the best set of predictors Conclusions: Overnight cortisol levels during the MT were associated with E1G, testosterone, and FSH levels In addition, they were significantly and positively associated with epinephrine and norepinephrine MT stage, symptoms, and social, stress-related, and health-related factors had little relationship to overnight cortisol levels when other biological indicators were considered

Vulvovaginal atrophy is strongly associated with female sexual dysfunction among sexually active postmenopausal women.

Abstract: Objective: The relationship between vulvovaginal atrophy and female sexual dysfunction is unclear. We investigated this association among sexually active postmenopausal women. Design: The Menopause Epidemiology Study is a cross-sectional, population-based study of women 40 to 65 years old in the United States chosen from a source population selected by random digit dialing and probability sampling. We focused on sexually active postmenopausal women (N = 1,480) for our analyses. Vulvovaginal atrophy was defined as one or more of the following: vaginal dryness, itching, irritation; pain on urination; or pain or bleeding on intercourse. The Arizona Sexual Experience Survey was used to define female sexual dysfunction. Sexual dysfunction subtypes for desire, arousal, and orgasm difficulties were individually scored. We evaluated demographic, behavioral, reproductive history, and medication covariates for effect modification and confounding. Multivariate logistic regression was used to assess the relationship between vulvovaginal atrophy and female sexual dysfunction. Results: The prevalence of vulvovaginal atrophy (57%) and female sexual dysfunction (55%) was high. Women with female sexual dysfunction were 3.84 times more likely to have vulvovaginal atrophy than women without female sexual dysfunction (95% CI: 2.99-4.94). Hot flashes modified the association between vulvovaginal atrophy and desire difficulty. Educational level modified the association between vulvovaginal atrophy and arousal difficulty. Parity modified the association between vulvovaginal atrophy and orgasm difficulty. Conclusions: This large population-based study provides evidence of an association between vulvovaginal atrophy and overall female sexual dysfunction and its subtypes. Therapies aiming to reduce symptoms of one condition may also relieve symptoms of the other.

Cycle and hormone changes during perimenopause: the key role of ovarian function.

Abstract: The menopausal transition is the stage in reproductive life commonly defined as commencing with the onset of menstrual irregularity. Classic studies of the endocrinology of the transition postulated the existence of inhibin in women to explain the observed increase in follicle-stimulating hormone (FSH) levels without a significant decrease in estradiol (E2). Descriptions were provided of cycle characteristics during the transition, emphasizing the unpredictability of the endocrine changes rather than the occurrence of an orderly and progressive decline in ovarian function. Women older than the age of 45 exhibited menstrual irregularity when the average number of primordial follicles per ovary decreased to approximately 100. Inhibin B is a major regulator of FSH secretion and a product of small antral follicles. Its levels respond to the early follicular phase increase and decrease in FSH. The age-related decrease in ovarian primordial follicle numbers, which is reflected in a decrease in the numbers of small antral follicles, leads to a decrease in inhibin B, which in turn leads to an increase in FSH, hypothesized to act as a stimulus to the maintenance of circulating E2 in the follicular phase until late in the transition. Concurrently, the concentrations of testosterone do not change significantly. Early follicular phase FSH levels in women reporting menstrual irregularity fluctuate markedly, with a more uniform increase in levels when no menses have occurred for at least 3 months. Anovulatory cycles occur at increased frequency in the last 30 months before final menses or menopause. In ovulatory cycles, FSH shows little, if any, increase, but anovulatory cycles are usually characterized by low levels of inhibin B, markedly increased levels of FSH, and low levels of E2. Thus, the heterogeneity of follicular phase FSH represents a mixture of ovulatory and anovulatory cycles. Longitudinal data indicate that both ovulatory and anovulatory cycles occur after entry into both the early and late menopausal transition and that ovulatory cycles occur even after final menses. There is no endocrine marker of menopause, which may be primarily an endometrial event. Using the hormonal concentrations in ovulatory cycles observed in women in mid-reproductive age as controls and comparing such concentrations in late reproductive age women older than 45 either continuing to cycle regularly or having entered the early or late menopausal transition, a gradual increase in follicular phase FSH and E2 and a decrease in inhibin B were observed in ovulatory cycles. Anovulatory cycles showed markedly increased FSH with low E2 and inhibin B. No specific endocrine change was characteristic of either the early or late menopausal transition, confirming the observations of previous studies regarding the unpredictability of cycle characteristics and hormone changes with the approach of menopause. Antimullerian hormone correlates with follicle numbers and shows a large age-related decrease to reach undetectable levels at menopause. Thus, the marked decrease in follicle numbers during late reproductive age appears to predispose to erratic and unpredictable cycle characteristics, with normal ovulatory cycles continuing to occur episodically. There is no specific endocrine marker of the early or late transition, making measurements of FSH or E2 unreliable in attempting to stage an individual with regard to approaching menopause.

Beneficial effects of Lepidium meyenii (Maca) on psychological symptoms and measures of sexual dysfunction in postmenopausal women are not related to estrogen or androgen content

Abstract: Objective: To examine the estrogenic and androgenic activity of Lepidium meyenii (Maca) and its effect on the hormonal profile and symptoms in postmenopausal women. Design: Fourteen postmenopausal women completed a randomized, double-blind, placebo-controlled, crossover trial. They received 3.5 g/day of powered Maca for 6 weeks and matching placebo for 6 weeks, in either order, over a total of 12 weeks. At baseline and weeks 6 and 12 blood samples were collected for the measurement of estradiol, follicle-stimulating hormone, luteinizing hormone, and sex hormoneYbinding globulin, and the women completed the Greene Climacteric Scale to assess the severity of menopausal symptoms. In addition, aqueous and methanolic Maca extracts were tested for androgenic and estrogenic activity using a yeast-based hormone-dependent reporter assay. Results: No differences were seen in serum concentrations of estradiol, follicle-stimulating hormone, luteinizing hormone, and sex hormoneYbinding globulin between baseline, Maca treatment, and placebo (P 9 0.05). The Greene Climacteric Scale revealed a significant reduction in scores in the areas of psychological symptoms, including the subscales for anxiety and depression and sexual dysfunction after Maca consumption compared with both baseline and placebo (P G 0.05). These findings did not correlate with androgenic or >-estrogenic activity present in the Maca as no physiologically significant activity was observed in yeast-based assays employing up to 4 mg/mL Maca extract (equivalent to 200 mg/mL Maca). Conclusions: Preliminary findings show that Lepidium meyenii (Maca) (3.5 g/d) reduces psychological symptoms, including anxiety and depression, and lowers measures of sexual dysfunction in postmenopausal women independent of estrogenic and androgenic activity.

Beyond frequency: who is most bothered by vasomotor symptoms?

Abstract: Objective: Most menopausal women report vasomotor symptoms (hot flashes, night sweats). However, not all women with vasomotor symptoms, including frequent symptoms, are bothered by them. The primary aim was to identify correlates of vasomotor symptom bother beyond symptom frequency. Design: The Study of Women's Health Across the Nation participants reporting vasomotor symptoms at annual visit 7 comprised the sample (N = 1,042). Assessments included hot flash and night sweats frequency (number per week) and bother (1, not at all- 4, very much). Negative affect (index of depressive symptoms, anxiety, perceived stress, negative mood), symptom sensitivity, sleep problems, and vasomotor symptom duration (number of years) were examined cross-sectionally in relation to bother in ordinal logistic regression models with symptom frequency and covariates. Hot flashes and night sweats were considered separately. Results: In multivariable models controlling for hot flash frequency, negative affect (odds ratio [OR] = 1.27, 95% CI: 1.08-1.51), symptom sensitivity (OR = 1.18, 95% CI: 1.03-1.37), sleep problems (OR = 1.38, 95% CI: 1.04-1.85), poorer health (OR = 1.24, 95% CI: 1.03-1.48), duration of hot flashes (OR = 1.14, 95% CI: 1.06-1.23), younger age (OR = 0.94, 95% CI: 0.89-0.99), and African American race (vs white, OR = 1.59, 95% CI: 1.12-2.26) were associated with hot flash bother. After controlling for night sweats frequency and covariates, sleep problems (OR = 1.84, 95% CI:1.33-2.55) and night sweats duration (OR = 1.10, 95% CI: 1.02-1.20) were associated with night sweats bother. Conclusions: Beyond frequency, factors associated with bothersome hot flashes include mood, symptom sensitivity, symptom duration, sleep problems, age, and race. Correlates of bothersome night sweats include sleep problems and symptom duration. In addition to reducing frequency, interventions for vasomotor symptoms might consider addressing modifiable factors related to symptom bother.

Long-term risk of depressive and anxiety symptoms after early bilateral oophorectomy.

Abstract: Objective:We studied the long-term risk of depressive and anxiety symptoms in women who underwent bilateral oophorectomy before menopause.Design:We conducted a cohort study among all women residing in Olmsted County, MN, who underwent bilateral oophorectomy before the onset of menopause for

Postmenopausal status according to years since menopause as an independent risk factor for the metabolic syndrome.

Abstract: Objective Features of the metabolic syndrome such as abdominal adiposity, insulin resistance, and dyslipidemia develop with the transition from pre- to postmenopausal status in women. We investigated the effects of postmenopausal status on the prevalence of the metabolic syndrome according to years since menopause. Design We studied 1,002 women, 618 premenopausal and 384 postmenopausal, who participated in annual health examinations at Anam Hospital in Seoul, Korea. Results Using multivariate logistic regression analysis, we determined that postmenopausal status was an independent risk factor for the metabolic syndrome. Moreover, after controlling for age and body mass index, postmenopausal women had an increased risk of the metabolic syndrome (odds ratio, 2.93; 95% CI, 1.62-5.33) and the abnormalities of its individual components. The risk for the metabolic syndrome increased up to 14 years since menopause, then decreased. For its individual components, postmenopausal women with 5 to 9 years since menopause had the highest risk of high blood pressure; postmenopausal women with less than 5 years since menopause had an increased risk of abdominal obesity and high glucose. With 10 to 14 years since menopause, postmenopausal women had an increased risk of high triglycerides. Conclusions Postmenopausal status is an independent risk factor for the metabolic syndrome and all of its individual components. The risk for the metabolic syndrome increased up to 14 years since menopause. In addition, postmenopausal status has effects during different periods since menopause for each of these components.

United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity.

Abstract: Objective: Black cohosh [Actaea racemosa L., formerly Cimicifuga racemosa (L.) Nutt.] is a botanical used mainly for the management of menopausal symptoms. Recently, regulatory agencies in Australia, Canada, and the European Union have released statements regarding the Bpotential association^ between black cohosh and hepatotoxicity. In response, the Dietary Supplement Information Expert Committee of the US Pharmacopeia’s Council of Experts reviewed safety information for black cohosh products. Design: The Expert Committee analyzed information from human clinical case reports, adverse event reports, animal pharmacological and toxicological data, historical use, regulatory status, and contemporaneous extent of use. Reports were obtained from diverse sources, including the European Medicines Agency, Health Canada, the Australian Therapeutic Goods Administration, and the US Food and Drug Administration. Case reports pertaining to liver damage were evaluated according to the Naranjo causality algorithm scale. Results: Thirty nonduplicate reports on use of black cohosh products concerning liver damage were analyzed. All the reports of liver damage were assigned possible causality, and none were probable or certain causality. The clinical pharmacokinetic and animal toxicological information did not reveal unfavorable information about black cohosh. Conclusions: Based on this safety review, the Dietary Supplement Information Expert Committee determined that black cohosh products should be labeled to include a cautionary statement. This is a change from the Expert Committee’s decision of 2002, which required no such statement. With this decision, the US Pharmacopeia’s Botanical Expert Committee may develop monographs for black cohosh, and the US Pharmacopeia may offer its verification programs to dietary supplement ingredient and product manufacturers.

Decreased androgen concentrations and diminished general and sexual well-being in women with premature ovarian failure.

Abstract: OBJECTIVE: To describe general and sexual well-being in women with premature ovarian failure (POF) and to investigate whether there is a relationship between androgen levels and sexual functioning. DESIGN: Women with POF and healthy volunteers with regular menstrual cycles participated. Participants completed a written questionnaire and underwent hormonal screening. The questionnaire included standardized measures: the Questionnaire for Screening Sexual Dysfunctions, the Shortened Fatigue Questionnaire, and the Symptom Check List-90. Serum hormone measurements included estradiol, total testosterone, bioavailable testosterone, androstenedione, dehydroepiandrosterone, and dehydroepiandrosterone sulfate. RESULTS: Eighty-one women with POF and 68 control women participated in the study. Compared with control women, women with POF reported more complaints of anxiety, depression, somatization, sensitivity, hostility, and psychological distress. Overall women with POF were less satisfied with their sexual life. They had fewer sexual fantasies and masturbated less frequently. Sexual contact was associated with less sexual arousal, reduced lubrication, and increased genital pain. However, the frequency of desire to have sexual contact and the frequency of actual sexual contact with the partner did not differ between women with POF and control women. Women with POF had lower levels of estradiol, total testosterone, and androstenedione. Multiple regression analysis revealed that androgen levels had only a weak influence on sexual functioning; higher total testosterone levels were associated with increased frequency of desire for sexual contact, and higher androstenedione levels were associated with elevated frequency of sexual contact. CONCLUSIONS: Women with POF have diminished general and sexual well-being and are less satisfied with their sexual lives than control women. Although women with POF had lower androgen levels, we did not find an important independent role for androgens in various aspects of sexual functioning.

Body size affects measures of ovarian reserve in late reproductive age women.

Abstract: Objective:To examine the association between obesity and serum and ultrasound measures of ovarian reserve in late reproductive age women.Design:Cross-sectional study of 36 healthy women, ages 40 to 52 years. Women were recruited in a 1:1 ratio of normal weight (body mass index <25) to obese

Abdominal adiposity and hot flashes among midlife women

Abstract: Objective: Two competing hypotheses suggest how adiposity may affect menopausal hot flashes. The "thin hypothesis" asserts that aromatization of androgens to estrogens in body fat should be associated with decreased hot flashes. Conversely, thermoregulatory models argue that body fat should be associated with increased hot flashes. The study objective was to examine associations between abdominal adiposity and hot flashes, including the role of reproductive hormones in these associations. Design: The Study of Women's Health Across the Nation Heart Study (2001-2003) is an ancillary study to the Study of Women's Health Across the Nation, a community-based cohort study. Participants were 461 women (35% African American, 65% white) ages 45 to 58 years with an intact uterus and at least one ovary. Measures included a computed tomography scan to assess abdominal adiposity; reported hot flashes over the previous 2 weeks; and a blood sample for measurement of follicle-stimulating hormone, estradiol, and sex hormone-binding globulin-adjusted estradiol (free estradiol index). Associations were evaluated within multivariable logistic and linear regression models. Results: Every 1-SD increase in total (odds ratio [OR] = 1.28; 95% CI: 1.06-1.55) and subcutaneous (OR = 1.30; 95% CI: 1.07-1.58) abdominal adiposity was associated with increased odds of hot flashes in age- and site-adjusted models. Visceral adiposity was not associated with hot flashes. Associations were not reduced when models included reproductive hormone concentrations. Conclusion: Increased abdominal adiposity, particularly subcutaneous adiposity, is associated with increased odds of hot flashes, favoring thermoregulatory models of hot flashes. Body fat may not protect women from hot flashes as once thought.

Dietary and lifestyle predictors of age at natural menopause and reproductive span in the Shanghai Women's Health Study

Abstract: Objectives: Modifiable factors predicting the onset of menopause, a transition with important implications for women's health, have not been fully characterized. We evaluated the impact of dietary, lifestyle and reproductive factors on age at natural menopause and reproductive span in Chinese women.

Objective hot flashes are negatively related to verbal memory performance in midlife women.

Abstract: Objective:To test the hypothesis that hot flashes specifically relate to verbal memory performance by examining the relationship between objective hot flashes and cognitive test performance in women with moderate to severe vasomotor symptoms.Design:In an observational study, 29 midlife women

Effects of ovariectomy on PPAR alpha, SREBP-1c, and SCD-1 gene expression in the rat liver.

Abstract: OBJECTIVE To investigate whether estrogen deficiency modifies the expression of important genes involved in hepatic lipid regulation, PPAR alpha, SREBP-1c, and SCD-1, in association with fat accumulation in the liver of ovariectomized rats. DESIGN Thirty female Sprague-Dawley rats were divided into three groups: sham-operated (n = 12), ovariectomized (n = 12), and ovariectomized with 17beta-estradiol replacement (n = 6). All animals were killed 8 weeks after surgery. In addition to liver triacylglycerol determination, transcripts levels and protein content of peroxisome proliferator-activated receptor alpha, liver sterol regulatory element-binding protein 1c, and stearoyl coenzyme Adesaturase 1 were quantified by quantitative real-time polymerase chain reaction and Western blot, respectively. RESULTS As expected, liver triacylglycerol levels were higher (51%; 21.9 +/- 2.6 vs 14.5 +/- 1.2 mg/g; P < 0.01) in ovariectomized compared with sham-operated rats. Peroxisome proliferator-activated receptor alpha mRNA levels were 66% lower (P < 0.01), whereas sterol regulatory element-binding protein 1 and stearoyl coenzyme A desaturase 1 transcript levels were 80% and 41% higher (P < 0.05), respectively, after estrogen removal. Our data on gene expression obtained with quantitative real-time polymerase chain reaction for peroxisome proliferator-activated receptor alpha and sterol regulatory element-binding protein 1c were confirmed by Western blots. All the effects of ovariectomy were prevented by 17beta-estradiol replacement, indicating a role for estrogens in the prevention of hepatic fat accumulation. CONCLUSIONS Our results suggest that a reduction in lipid oxidation and an increase in lipogenesis are defective mechanisms leading to lipid accumulation in the liver of ovariectomized rats. We conclude that estrogen deficiency induced by ovariectomy changes the expression of genes that favor the development of a steatotic phenotype.

Gabapentin for the treatment of menopausal hot flashes: a randomized controlled trial.

Abstract: Objective: To compare the effectiveness and tolerability of gabapentin with placebo for the treatment of hot flashes in women who enter menopause naturally. Design: A randomized, double-blind, placebo-controlled trial was conducted across the greater Toronto area between March 2004 and April 2006 in the community and primary care settings. Eligible participants were 200 women in natural menopause, aged 45 to 65 years, having at least 14 hot flashes per week. Study participants were randomized to receive gabapentin 300 mg oral capsules or placebo three times daily for 4 weeks. The primary outcome measure was the mean percentage change from baseline to week 4 in daily hot flash score, determined from participant diaries. Secondary outcome measures included changes in weekly mean hot flash scores and frequencies, quality of life, and adverse events. Results: Of the 197 participants, 193 (98%) completed the study. Analysis was by intention to treat. Hot flash scores decreased by 51% (95% CI: 43%-58%) in the gabapentin group, compared with 26% (95% CI: 18%-35%) on placebo, from baseline to week 4. This twofold improvement was statistically significant (P < 0.001). The Menopause-Specific Quality-of-Life vasomotor score decreased by 1.7 (95% CI: 1.3-2.1; P < 0.001) in the gabapentin group. These women reported greater dizziness (18%), unsteadiness (14%), and drowsiness (12%) at week 1 compared with those taking placebo; however, these symptoms improved by week 2 and returned to baseline levels by week 4. Conclusions: Gabapentin at 900 mg/day is an effective and well-tolerated treatment for hot flashes.

Associations of endogenous sex hormones with the vasculature in menopausal women: the Study of Women's Health Across the Nation (SWAN).

Abstract: Objective: As associations between endogenous sex hormones and the vasculature are not well characterized, the objective was to examine the cross-sectional associations of menopausal status and endogenous sex hormones with vascular characteristics. Design: Common carotid artery adventitial diameter and intima-media thickness were determined using B-mode ultrasonography among 483 middle-aged women enrolled in the Pittsburgh and Chicago sites of the Study of Women's Health Across the Nation. Results: Sixty-two percent of women were pre- or early perimenopausal (<3 mo amenorrhea), 12% were late perimenopausal (3-12 mo amenhorrhea), and 27% were postmenopausal (≥12 mo amenorrhea). After adjustment for age, compared with pre-/early perimenopause, late perimenopause was associated with a 0.28-mm larger adventitial diameter (P = 0.001), whereas postmenopause was associated with a 0.15-mm larger adventitial diameter (P = 0.040). Adjustment for traditional cardiovascular risk factors slightly attenuated these associations, but the association with late perimenopause remained statistically significant (P = 0.001). Each SD lower log estradiol value was associated with a 0.07-mm larger adventitial diameter after adjustment for traditional cardiovascular risk factors (P = 0.023), whereas other endogenous hormones showed no associations. Intima-media thickness values were not significantly associated with menopausal status or endogenous sex hormones after adjustment for age. Conclusions: The menopausal transition and declining estrogen levels are associated with alterations of the peripheral vasculature, which may help to explain the increased risk of cardiovascular disease with postmenopause.

Treating the climacteric symptoms in Indian women with an integrated approach to yoga therapy: a randomized control study.

Abstract: Objective:To study the effect of yoga on the climacteric symptoms, perceived stress, and personality in perimenopausal women.Design:One hundred twenty participants (ages 40-55 y) were randomly divided into two study arms, ie, yoga and control. The yoga group practiced an integrated approach

Use of complementary and alternative medicine during the menopause transition: longitudinal results from the Study of Women's Health Across the Nation.

Abstract: Objective This study examined whether use of complementary and alternative (CAM) therapies during the menopause transition varied by ethnicity. Design The Study of Women's Health Across the Nation is a prospective cohort study following a group of 3,302 women from five racial/ethnic groups at seven clinical sites nationwide. Using longitudinal data encompassing 6 years of follow-up, we examined trends in use of five categories of CAM (nutritional, physical, psychological, herbal, and folk) by menopause status and ethnicity. To account for potential secular trends in CAM use or availability, we also evaluated the trends in CAM use over calendar time. Results Approximately 80% of all participants had used some form of CAM at some time during the 6-year study period. White and Japanese women had the highest rates of use (60%), followed by Chinese (46%), African American (40%), and Hispanic (20%) women. Overall use of CAM therapy remained relatively stable over the study period. In general, CAM use did not seem to be strongly associated with change in menopause transition status. Use of CAM among white women did not change with transition status. Among Chinese and African American participants, we observed an increase in CAM use as women transitioned to perimenopause and a decrease in use of CAM with transition to postmenopause. Among Hispanic and Japanese women, we observed a decrease in use of CAM in early perimenopause, followed by an increase as women entered late perimenopause and a decrease as they progressed to postmenopause. Patterns of use for the five individual types of CAM varied. White women had relatively stable use of all CAM therapies through the transition. Japanese women decreased use of nutritional and psychological remedies and increased use of physical remedies as they transitioned into late perimenopause. Among African American women, use of psychological remedies increased as they progressed through menopause. Conclusions Although CAM use did vary in some ethnic groups in relation to advancing menopause status, there was no evidence of influence of calendar time on CAM use. Patterns of CAM use during menopause are likely to be driven by personal experience, menopausal health, and access to therapies. Women's personal preferences should be taken into consideration by healthcare providers for medical decision making during menopause and throughout the aging process.

A randomized, controlled pilot study of acupuncture treatment for menopausal hot flashes.

Abstract: Objective: To investigate the feasibility of conducting a randomized trial of the effect of acupuncture in decreasing hot flashes in peri- and postmenopausal women. Design: Fifty-six women ages 44 to 55 with no menses in the past 3 months and at least four hot flashes per day were recruited from two clinical centers and randomized to one of three treatment groups: usual care (n = 19), sham acupuncture (n = 18), or Traditional Chinese Medicine acupuncture (n = 19). Acupuncture treatments were scheduled twice weekly for 8 consecutive weeks. The sham acupuncture group received shallow needling in nontherapeutic sites. The Traditional Chinese Medicine acupuncture group received one of four treatments based on a Traditional Chinese Medicine diagnosis. Usual care participants were instructed to not initiate any new treatments for hot flashes during the study. Daily diaries were used to track frequency and severity of hot flashes. The mean daily index score was based on the number of mild, moderate, and severe hot flashes. Follow-up analyses were adjusted for baseline values, clinical center, age, and body mass index. Results: There was a significant decrease in mean frequency of hot flashes between weeks 1 and 8 across all groups (P = 0.01), although the differences between the three study groups were not significant. However, the two acupuncture groups showed a significantly greater decrease than the usual

Vaginal, endometrial, and reproductive hormone findings: randomized, placebo-controlled trial of black cohosh, multibotanical herbs, and dietary soy for vasomotor symptoms: the Herbal Alternatives for Menopause (HALT) Study.

Abstract: Author(s): Reed, Susan D; Newton, Katherine M; LaCroix, Andrea Z; Grothaus, Louis C; Grieco, Verena S; Ehrlich, Kelly | Abstract: ObjectiveTo evaluate vaginal, endometrial, and reproductive hormone effects of three herbal regimens compared with placebo and hormone therapy (HT).DesignThis was a 1-year, randomized, double-blind, placebo-controlled trial of 351 women, ages 45 to 55, with two or more vasomotor symptoms per day. Women were randomly assigned to (1) black cohosh, (2) a multibotanical containing black cohosh, (3) the same multibotanical plus dietary soy counseling, (4) HT, or (5) placebo. Women were ineligible if they had used HT in the previous 3 months or menopausal herbal therapies in the previous month. Data on vaginal cytology and dryness were collected (at baseline and 3 and 12 mo). Daily menstrual diaries were maintained by 313 women with a uterus, and abnormal bleeding was evaluated. Serum estradiol, follicle-stimulating hormone, luteinizing hormone, and steroid hormone-binding globulin were assessed (baseline and 12 mo) among 133 postmenopausal women. Gynecologic outcomes of the five groups were compared.ResultsThe five groups did not vary in baseline vaginal cytology profiles, vaginal dryness, menstrual cyclicity, or hormone profiles. The HT group had a lower percentage of parabasal cells and vaginal dryness than the placebo group at 3 and 12 months (P l 0.05). Abnormal bleeding occurred in 53 of 313 (16.9%) women. There were no differences in frequency of abnormal bleeding between any of the herbal and placebo groups, whereas women in the HT group had a greater risk than those in the placebo group (P l 0.001). Among postmenopausal women, HT significantly decreased follicle-stimulating hormone and increased estradiol; none of the herbal interventions showed significant effects on any outcomes at any time point.ConclusionBlack cohosh, used alone or as part of a multibotanical product with or without soy dietary changes, had no effects on vaginal epithelium, endometrium, or reproductive hormones.

Daidzein-rich isoflavone aglycones are potentially effective in reducing hot flashes in menopausal women.

Abstract: Objective The aim of this study was to determine the effect of DRIs on hot flash symptoms in menopausal women. Design This was a randomized, double-blind, placebo-controlled trial of menopausal women, aged 38 to 60 years, who experienced 4 to 14 hot flashes per day. After a 1-week run-in period, a total of 190 menopausal women were randomized to receive a placebo or 40 or 60 mg/day of a DRI for 12 weeks. The primary outcome was the mean changes from baseline to week 12 in the frequency of hot flashes recorded in the participant diary. The secondary outcomes included changes in quality of life and hormonal profiles. Results A total of 147 women (77%) completed the study. It was found that 40 and 60 mg of DRI improved hot flash frequency and severity equally. At 8 weeks hot flash frequency was reduced by 43% in the 40-mg DRI group and by 41% in the 60-mg DRI group, compared with 32% in the placebo group (P = not significant vs placebo). The corresponding numbers for 12 weeks were 52%, 51%, and 39%, respectively (P = 0.07 and 0.09 vs placebo). When comparing the two treatment groups with the placebo group, there were significant reductions in mean daily hot flash frequency. The supplement (either 40 or 60 mg) reduced hot flash frequency by 43% at 8 weeks (P = 0.1) and 52% at 12 weeks (P = 0.048) but did not cause any significant changes in endogenous sex hormones or thyroid hormones. Menopausal quality of life improved in all three groups, although there were no statistically significant differences between groups. Conclusions DRI supplementation may be an effective and acceptable alternative to hormone treatment for menopausal hot flashes.

Measuring symptom relief in studies of vaginal and vulvar atrophy: the most bothersome symptom approach.

Abstract: Objective:To assess the importance and usefulness of self-reported symptom data, especially the most bothersome symptom, in the evaluation of treatment for vulvovaginal atrophy.Design:This was a double-blind, placebo-controlled multicenter study. Women rated symptoms associated with vaginal

Soy isoflavones in the management of postmenopausal osteoporosis.

Abstract: This is a review article designed to address the effects of soy isoflavones on bone metabolism in postmenopausal women and their place in the prevention and treatment of postmenopausal osteoporosis. Soy isoflavones are natural products that could be used as an alternative to menopausal hormone therapy because they are structurally and functionally related to 17beta-estradiol. In vitro and animal studies have shown that they act in multiple ways to exert their bone-supporting effects. They act on both osteoblasts and osteoclasts through genomic and nongenomic pathways. Epidemiological studies and clinical trials suggest that soy isoflavones have beneficial effects on bone mineral density, bone turnover markers, and bone mechanical strength in postmenopausal women. However, there are conflicting results related to differences in study design, estrogen status of the body, metabolism of isoflavones among individuals, and other dietary factors. The long-term safety of soy isoflavone supplements remains to be demonstrated.

Menopause, the metabolic syndrome, and mind-body therapies

Abstract: Cardiovascular disease risk rises sharply with menopause, likely due to the coincident increase in insulin resistance and related atherogenic changes that together comprise the metabolic or insulin resistance syndrome, a cluster of metabolic and hemodynamic abnormalities strongly implicated in the pathogenesis and progression of cardiovascular disease. A growing body of research suggests that traditional mind-body practices such as yoga, tai chi, and qigong may offer safe and cost-effective strategies for reducing insulin resistance syndrome-related risk factors for cardiovascular disease in older populations, including postmenopausal women. Current evidence suggests that these practices may reduce insulin resistance and related physiological risk factors for cardiovascular disease; improve mood, well-being, and sleep; decrease sympathetic activation; and enhance cardiovagal function. However, additional rigorous studies are needed to confirm existing findings and to examine long-term effects on cardiovascular health.

Serotonin (5-hydroxytryptamine) transporter inhibition causes bone loss in adult mice independently of estrogen deficiency.

Abstract: Objective: Selective serotonin reuptake inhibitors (SSRIs) treat depression by antagonizing the serotonin (5-hydroxytryptamine) transporter (5-HTT). These drugs may also have skeletal effects given the presence of functional serotonergic pathways in bone and evidence demonstrating detrimental effects of SSRIs on postmenopausal bone changes. This study aimed to explore the influence of an SSRI (fluoxetine hydrochloride) on the bone changes associated with estrogen deficiency in adult mice. Design: Adult, female, Swiss-Webster mice underwent ovariectomy (OVX) or sham OVX and were treated daily for 4 weeks with either fluoxetine hydrochloride (5 or 20 mg/kg) or a vehicle solution (control). In vivo assessments of hindlimb areal and tibial volumetric bone mineral density were performed at baseline and after 4 weeks of intervention. Femurs and lumbar vertebrae were subsequently removed and assessed ex vivo for bone mineral density and trabecular bone architecture and turnover. Results: In vivo and ex vivo skeletal measures found no interactions between OVX (estrogen deficiency) and 5-HTT inhibition, indicating that the skeletal effects of these interventions were independent. 5-HTT inhibition had detrimental skeletal effects, with the fluoxetine-treated groups having reduced bone mineral density and altered trabecular architecture. These changes resulted from both a decrease in bone formation and increase in bone resorption. Conclusions: These data indicate that a commonly prescribed SSRI has a negative influence on the adult skeleton, independent of estrogen deficiency. This finding supports clinical data demonstrating SSRI use to be associated with accelerated bone loss after menopause and highlights a need for further research into the skeletal effects of SSRIs.

The prevalence of and potential risk factors for female urinary incontinence in Beijing, China.

Abstract: Objectives: To survey and evaluate the prevalence and potential risk factors of female urinary incontinence (UI) in Beijing, China. Design: A population-based cross-sectional study was performed from April to July 2005. We randomly sampled 1.0% of female residents aged 20 years and older from year 2000 national census data, totaling 5,300 women. All of the women were interviewed face to face using a modified questionnaire based on the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms. Data were collected and analyzed. Results: The overall prevalence of female UI was 38.5%. Prevalence rates of female stress urinary incontinence (SUI), female urge urinary incontinence, and female mixed urinary incontinence were 22.9%, 2.8%, and 12.4%, respectively. The prevalence rate of female UI was more than 50% in postmenopausal women. In multiple logistic models, multiple vaginal deliveries (odds ratio [OR] = 2.1; 95% CI: 1.443-3.179), age (OR = 1.7; 95% CI: 1.039-2.742), postmenopausal status (OR = 1.5; 95% CI: 1.182-1.983), chronic pelvic pain (OR = 1.4; 95% CI: 1.134-1.814), obesity (OR = 1.4; 95% CI: 1.205-1.721), lack of exercise (OR = 1.3; 95% CI: 1.105-1.509), constipation (OR = 1.3; 95% CI: 1.109-1.586), and hypertension (OR = 1.2; 95% CI: 1.053-1.474) were identified as potential risk factors of female SUI. No association between female SUI and offspring birth weight, occupation, or chronic diseases was observed in this study. Only 12.8% of women with UI and 7.4% of women with SUI seek medical help. Conclusions: UI is a major disorder that affects female quality of life. The prevalence of female UI is high (38.5%) in Beijing. Among the different types of UI, SUI was the most prevalent (22.9%). Potential risk factors identified for female SUI were multiple vaginal deliveries, age, postmenopausal status, chronic pelvic pain, obesity, lack of exercise, constipation, and hypertension.

Psychoeducational interventions to alleviate hot flashes: a systematic review.

Abstract: Objective Hot flashes are frequent and bothersome in menopausal women and breast cancer survivors. Most pharmacological interventions or herbal therapies for hot flashes have limitations because of contraindications in breast cancer survivors, side effects, or lack of proven efficacy. The aim of this study was to assess the effects of psychoeducational interventions, including relaxation, on hot flashes in menopausal women and women previously diagnosed with breast cancer. Design MEDLINE, CINAHL, PsycInfo, the Cochrane Library, and reference lists of articles were searched for relevant articles published between January 1980 and December 2006. Data extraction and quality assessment were carried out by two of the authors. Results Fourteen studies involving 475 patients were included. Five studies evaluated psychoeducational interventions, including education, counseling, cognitive-behavioral strategies, and mindfulness-based stress reduction. All showed an improvement in vasomotor symptoms, although the experimental group in the two studies containing the largest numbers of participants also received pharmacological therapies. Nine trials evaluated the efficacy of relaxation techniques to improve hot flashes. Five of these studies showed a significant improvement in hot flashes. Only three of the 14 studies evaluated a psychoeducational intervention in breast cancer survivors. Two of these showed a significant improvement in hot flashes. Conclusions Psychoeducational interventions, including relaxation, seem to alleviate hot flashes in menopausal women and breast cancer survivors; however, the methodological quality of published research is either fair or poor. More studies are required, especially in the breast cancer population where only a few studies are available, before psychoeducational interventions are offered as a treatment option.

Lipid profile of women with premature ovarian failure.

Abstract: Objective: Earlier menopause is associated with a higher incidence of cardiovascular events later in life. Concurrent with the ages of menopausal transition, a shift in lipid profile takes place. Premature ovarian failure (POF) or premature menopause allows LIS to Study the effect of cessation of ovarian function on the lipid profile independent of effects of advanced chronological age. Design: Fasting triglycerides (TGs), total high-density lipoprotein (HDL), and low-density lipoprotein cholesterol levels were measured in 90 women with POF not using any hormone therapy and 198 population controls of the same age range not using oral contraceptives. Correlations between lipids and ovarian function parameters were assessed. Results: After correction for age, body mass index, and smoking, women with POF presented with significantly higher TG levels (mean difference: 0.17 log mmol/L [95% CI: 0.06-0.29]). HDL cholesterol levels were borderline significantly lower in women with POF. No age-corrected correlation between triglycerides or other lipids and estradiol levels or time of estrogen deprivation Could be identified. However, the free androgen index, sex hormone-binding globulin, and testosterone concentrations showed significant correlations with TGs and/or HDL cholesterol concentrations. Conclusions: Loss of ovarian function at a very young age (POF) coincides with subtle changes in the lipid profile (higher TG levels and marginally lower HDL). Androgens (increased free androgen index and testosterone and decreased sex hormone-binding globulin) are better markers for unfavorable lipid changes compared with estrogen levels or duration of estrogen deprivation in women with POF. Elevated TG levels in combination with increased (free) androgens may be an early manifestation of reduced insulin sensitivity.