Stevenson JC, Baber R, Kagan R
… +8 more, Nappi RE, Palacios S, Panay N, Paszkowski T, Stute P, Heroux J, Zablotna-Pociupany R, Boolell M
Climacteric
· 2025 Dec · PMID 40773298
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OBJECTIVE: Using real-world data, the current study compared the risk of major adverse cardiovascular events (MACE) between two regulated combined oral hormonal products that are currently available to women in the USA:...OBJECTIVE: Using real-world data, the current study compared the risk of major adverse cardiovascular events (MACE) between two regulated combined oral hormonal products that are currently available to women in the USA: body-identical oral 17β-estradiol/micronized progesterone (E2/P4) and conjugated equine estrogens/medroxyprogesterone acetate (CEE/MPA). METHODS: Women aged ≥40 years treated with E2/P4 or CEE/MPA were selected from a US claims database (April 2019-June 2021). The E2/P4 or CEE/MPA cohorts were defined based on the first dispensation of E2/P4 or CEE/MPA (index) as prescribed in the real world. Women with pre-index MACE hospitalization were excluded. Confounding was controlled via inverse probability of treatment (IPT) weighting. MACE risk was compared between the IPT-weighted cohorts using Cox and Poisson/negative binomial regression models. RESULTS: The E2/P4 and CEE/MPA cohorts included 6520 and 29,426 women respectively (mean follow-up 1.2 and 1.4 years). In the IPT-weighted analyses, MACE rates were 23.5 versus 85.4 per 10,000 women-years among women treated with E2/P4 and CEE/MPA (IPT-weighted incidence rate ratio [IRR] 0.28, 95% confidence interval [CI] 0.17 - 0.45; IPT-weighted hazard ratio [HR] 0.37, 95% CI 0.27 - 0.50). CONCLUSIONS: Real-world evidence suggests that the MACE risk is significantly lower among women treated with E2/P4 compared to CEE/MPA.
Jahangirifar M, Davis SR, Fooladi E
… +1 more, Islam RM
Climacteric
· 2026 Feb · PMID 40773295
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OBJECTIVE: This study aimed to document the prevalence of sexual difficulties, sexually-related personal distress, sexual dysfunction and associated factors among refugee women in Australia. METHOD: The cross-sectional s...OBJECTIVE: This study aimed to document the prevalence of sexual difficulties, sexually-related personal distress, sexual dysfunction and associated factors among refugee women in Australia. METHOD: The cross-sectional study included refugee women aged 18-63 years. Sexual difficulties were defined as selecting 'always' or 'very often' on the Profile of Female Sexual Function, while distress was a score of at least 11 on the Female Sexual Distress Scale - Revised. Female sexual dysfunction (FSD) combined these scores. Participants also completed the Woman Abuse Screening Tool and the Bristol Female Lower Urinary Tract Symptoms questionnaire. RESULTS: Among 299 participants (median age 41 years), sexual difficulties, sexually-related personal distress and FSD were present in 39.3%, 33.2% and 7.0%, respectively. Perimenopausal/postmenopausal status (adjusted odds ratio [aOR] = 2.8, 95% confidence interval [CI]: 1.4-5.6, = 0.003) and sexual activity (aOR = 0.2, 95% CI: 0.1-0.4, < 0.001) predicted sexual difficulties. Intimate partner abuse (aOR = 5.9, 95% CI: 2.4-14.5, < 0.001) and urinary incontinence (aOR = 4.5, 95% CI: 1.5-13.0, = 0.006) were associated with sexually-related personal distress. CONCLUSION: Perimenopausal/postmenopausal status and sexual inactivity were associated with sexual difficulties, while intimate partner abuse and urinary incontinence were associated with sexually-related distress, highlighting the importance of proactive screening for psychosocial and physical health issues in sexual health assessments among refugee women.
Climacteric
· 2026 Feb · PMID 40735871
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OBJECTIVE: This study aimed to investigate socio-demographic, reproductive, lifestyle and health factors associated with the age of natural menopause in the Brazilian context. METHOD: The cross-sectional study was conduc...OBJECTIVE: This study aimed to investigate socio-demographic, reproductive, lifestyle and health factors associated with the age of natural menopause in the Brazilian context. METHOD: The cross-sectional study was conducted with data from 3538 women who reported natural menopause from the baseline (2008-2010) to the date of the second visit (2012-2014) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The outcome of the study was the age of natural menopause. The association between socio-demographic, reproductive, lifestyle and health characteristics and the age of menopause were investigated using multiple linear regression. RESULTS: The mean age of natural menopause was 49.5 years. The following conditions were associated with a younger age at onset of menopause: lower education level, historically marginalized races/skin colors and smoking. By contrast, multiparity and contraceptive use for less than 3 years were associated with a higher mean age at the onset of menopause, related to no previous pregnancies and no contraceptive use. CONCLUSION: The study findings provide relevant support for the development of public policies aimed at preventing early menopause and promoting comprehensive and continuous care for women's health.
Saadedine M, Banks V, Dinkel-Keuthage C
… +9 more, Caetano C, Argyriou G, Moeller C, Schoof N, Vizcaya D, Francuski M, Golozar A, Römer T, Kubba A
Climacteric
· 2026 Feb · PMID 40735862
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OBJECTIVES: This study aimed to describe treatment patterns among naturally menopausal women from the USA, the UK and Germany. METHODS: Using health claims (the USA) and electronic health records (the UK and Germany), wo...OBJECTIVES: This study aimed to describe treatment patterns among naturally menopausal women from the USA, the UK and Germany. METHODS: Using health claims (the USA) and electronic health records (the UK and Germany), women aged 40-65 years with a first record of natural menopause (index date) from 2009 to 2022 were identified. Women with a history of bilateral oophorectomy, total hysterectomy, endocrine therapy for breast cancer or hormone/non-hormone therapy for menopausal symptoms were excluded. Treatments evaluated following the index date were hormone therapy, benzodiazepines, antidepressants, anticonvulsants and the antihypertensive clonidine. RESULTS: In total, 1,260,742 (the USA), 214,374 (the UK) and 124,542 (Germany) women were included, and treatments were recorded in 38.8%, 33.4% and 28.8%, respectively. Among these, the majority received one treatment class, mostly hormone therapy (44.2% for the USA, 41.1% for the UK, 92.6% for Germany), benzodiazepines (25.3% for the USA, 6.8% for the UK, 2.2% for Germany) and antidepressants (18.6% for the USA, 33.5% for the UK, 4.1% for Germany). Discontinuation rates at 6 months from starting initial treatment were 75.0-88.0% for hormone therapy, 65.0-85.0% for antidepressants and ≥98% for benzodiazepines. Treatment switches occurred in 25.4% (the USA), 21.8% (the UK) and 1.7% (Germany). CONCLUSIONS: Continuation rates with current treatments for women experiencing natural menopausal symptoms are low, indicating an unmet need for effective and acceptable therapies.
Climacteric
· 2026 Feb · PMID 40726383
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The decline in bone mineral density (BMD) is common among older adults, especially due to reduced sex hormone production in women (menopause). Understanding the impact of resistance training on bone tissue is essential f...The decline in bone mineral density (BMD) is common among older adults, especially due to reduced sex hormone production in women (menopause). Understanding the impact of resistance training on bone tissue is essential for developing effective strategies for the prevention and treatment of this condition. This study investigated the effects of resistance training on BMD in rodent models of osteopenia induced by ovariectomy. The protocol was registered on PROSPERO (CRD42024549460). Inclusion criteria focused on ovariectomized (OVX) female rats and mice engaged in resistance training, with no restrictions on duration, frequency or intensity. A comprehensive search across six databases (and grey literature) identified 314 articles, of which 18 were selected. Resistance training, compared to control groups, significantly increased BMD, particularly in the femur and tibia. The included studies employed various training protocols, such as climbing, jumping and squatting, with variations in training duration and intensity. The meta-analysis demonstrated standardized mean differences of 3.02 (95% confidence interval 1.81-4.24) for climbing and 1.27 (95% confidence interval 0.72-1.82) for jumping protocols, quantifying the extent of improvement in BMD - particularly in the femur and tibia - observed in OVX rodents subjected to resistance training, as compared to sedentary controls. These findings suggest that resistance training positively impacts bone remodeling and may help restore bone microarchitecture in postmenopausal conditions.
Maunder A, Vermeulen N, Vincent AJ
… +2 more, Panay N, Ee C
Climacteric
· 2026 Feb · PMID 40719542
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OBJECTIVE: Premature ovarian insufficiency (POI) is associated with reduced quality of life and increased health risks. While hormone therapy (HT) is standard treatment, some women seek other options to treat its sequela...OBJECTIVE: Premature ovarian insufficiency (POI) is associated with reduced quality of life and increased health risks. While hormone therapy (HT) is standard treatment, some women seek other options to treat its sequelae. This review explores the role of complementary therapies for POI. METHOD: A systematic search of four databases up to January 2024 identified randomized controlled trials, systematic reviews, meta-analyses and umbrella reviews that examined the use of complementary therapies by women with POI. Outcomes included menopausal symptoms, gonadotropins, antral follicle count, ovarian volume and quality of life. Study quality was evaluated using Cochrane Risk of Bias and A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2). RESULTS: The search identified 1869 citations, with nine studies meeting the inclusion criteria. Findings suggest that Chinese herbal medicine and acupuncture may alleviate menopausal symptoms and regulate gonadotropins in women with POI, although evidence is very limited. There is insufficient evidence for other complementary therapies for POI. CONCLUSION: While Chinese herbal medicine may improve menopausal symptoms, there is insufficient evidence specific to POI. There is a clear need for additional and rigorous research on the efficacy and safety of complementary therapies for POI. Evidence does not support complementary medicines as replacements for HT.
He L, Jaff NG, Bahhar N
… +2 more, Proctor D, Spector A
Climacteric
· 2026 Feb · PMID 40719532
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OBJECTIVE: Women experience menopause around the age of 45-55 years. Cognitive dysfunction is one of the most prevalent menopausal complaints. This focus group study aimed to explore cognitive experiences and management...OBJECTIVE: Women experience menopause around the age of 45-55 years. Cognitive dysfunction is one of the most prevalent menopausal complaints. This focus group study aimed to explore cognitive experiences and management during the menopause transition. METHODS: Eighteen participants, including 15 women in menopause transition from multi-ethnic backgrounds and three healthcare professionals, were recruited to five focus groups conducted between June and August 2024. RESULTS: Thematic analysis yielded three overarching themes: cognitive changes relevant to the menopause transition; multidimensional impacts of cognitive changes; and holistic management of cognitive changes. From participants' narratives, 12 cognitive domains were affected in the menopause transition. These in turn had psychological, social and behavioral impact, resulting in the need to use various coping strategies. CONCLUSION: The findings of this study identified cognitive challenges in the menopause transition. Women's current coping with cognitive dysfunction addressed the multidimensionality of menopausal management and highlighted unmet needs regarding cognitive health. The research identified cognitive challenges beyond memory and concentration in the menopause transition. Associations of menopause-related factors, culture and ethnicity with cognitive function warrant further investigation for potential intervention development.
Terauchi M, Kato M, Lee T
… +2 more, Miki T, Mishina S
Climacteric
· 2026 Feb · PMID 40709659
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OBJECTIVE: This study aimed to investigate the association between the severity of vasomotor symptoms (VMS) and the burden of the condition in the real-world setting within Japan. METHODS: The cross-sectional survey stud...OBJECTIVE: This study aimed to investigate the association between the severity of vasomotor symptoms (VMS) and the burden of the condition in the real-world setting within Japan. METHODS: The cross-sectional survey study was administered as a web-based questionnaire involving perimenopausal and postmenopausal women. Respondents were female at birth, 40-64 years old and had ≥1 episode of VMS in the prior 12 months. The primary objective was to understand the treatment landscape related to mild to severe VMS. Secondary objectives were to understand attitudes to VMS, opinions on available treatments and impact of VMS on quality of life (QoL). RESULTS: The target population included 2188 respondents. Only 219 (10.0%) respondents visited a medical facility for VMS, and 123 (5.6%) women consulted a doctor when visiting for other treatment. Being able to cope with symptoms was the most common reason for not attending a medical institution. More than half who received treatment were prescribed traditional Chinese medicine (181/325 [55.7%] respondents) and one-third received hormone therapy (108 [33.2%] respondents). Severe VMS were associated with lower QoL, worse sleep quality and reduced work productivity. CONCLUSIONS: Women in Japan with VMS do not typically visit medical institutions or receive appropriate medical intervention even when they are aware of VMS and feel some burden.
Climacteric
· 2025 Dec · PMID 40704422
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OBJECTIVE: Menopausal hormone therapy (MHT) is the most effective treatment for menopausal symptoms. While guidelines recommend an individualized risk-benefit assessment of MHT, real-world studies on use of MHT are limit...OBJECTIVE: Menopausal hormone therapy (MHT) is the most effective treatment for menopausal symptoms. While guidelines recommend an individualized risk-benefit assessment of MHT, real-world studies on use of MHT are limited. METHOD: Nationwide claims data in South Korea (2015-2020) were used to assess the prevalence of hospital visits for menopausal symptoms and use of MHT among women aged 40-59 years. MHT was classified into three classes including estrogen therapy (ET), estrogen plus progestogen therapy (EPT) and tibolone, with routes of administration categorized as systemic (oral, transdermal) and local (transvaginal). A longitudinal study was conducted to evaluate treatment patterns of MHT. RESULTS: Approximately 9% of women visited hospitals for menopausal symptoms, with fewer than half prescribed MHT. Of 1,774,674 women with menopausal symptoms, 1,036,294 were prescribed MHT: 89,237 patients were started on systemic ET, 300,999 on systemic EPT, 306,538 on tibolone and 378,764 on local ET. Use of tibolone and local ET increased over time, while systemic ET and EPT decreased. Systemic MHT was discontinued after an average of 13.2 months, while local MHT was discontinued after 2.4 months. CONCLUSION: Despite guidelines recommending MHT for treating menopausal symptoms, many women remain untreated and continued MHT for an average of only 1 year.
Climacteric
· 2025 Dec · PMID 40668201
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OBJECTIVE: The association of hormone therapy (HT) combined with statin use for primary prevention of cardiovascular disease remains uncertain. This study aimed to assess the effect of HT, initiated before the age of 60 ...OBJECTIVE: The association of hormone therapy (HT) combined with statin use for primary prevention of cardiovascular disease remains uncertain. This study aimed to assess the effect of HT, initiated before the age of 60 years, on all-cause mortality and cardiovascular events in females using statins for primary prevention. METHOD: This population-based, retrospective cohort study included all females aged 40-60 years in British Columbia, Canada, who used statins for primary prevention. The exposure was defined as systemic HT, including estrogen alone or combined with a progestogen, excluding local preparations of estrogen. The study used Cox proportional hazards models from the study start date to the outcome. RESULTS: After exact matching on age using up to a 1-to-4 match, 685 (20%) of the 3,425 statin users initiated HT within the first year of follow-up. HT use was not significantly associated with all-cause mortality after adjusting for confounders (adjusted hazard ratio [aHR], 1.17; 95% confidence interval [CI], 0.87-1.58). Similarly, for the secondary outcome of composite cardiovascular events, HT use did not significantly increase risk (aHR, 0.95; 95% CI, 0.75-1.20). CONCLUSION: This study found that HT, when initiated before age 60 years, was not associated with an increased risk of all-cause mortality or cardiovascular events in females using statins for primary prevention.
Wang Z, Ruan X, Jiang L
… +10 more, Zhang M, Yang Y, Liu A, Li J, Gu M, Li Y, Cheng J, Jin F, Du J, Mueck AO
Climacteric
· 2026 Feb · PMID 40637020
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OBJECTIVE: This study aimed to investigate the characteristics of bone mineral density (BMD) in patients with premature ovarian insufficiency (POI), compare BMD between iatrogenic POI and idiopathic POI patients, and inv...OBJECTIVE: This study aimed to investigate the characteristics of bone mineral density (BMD) in patients with premature ovarian insufficiency (POI), compare BMD between iatrogenic POI and idiopathic POI patients, and investigate the factors affecting BMD in POI patients. METHOD: This cross-sectional study recruited a total of 88 iatrogenic POI patients, 45 idiopathic POI patients and 45 normal reproductive-age women, all of whom met the study criteria and were treated at the Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University from 1 January 2023 to 30 June 2024. Medical history was collected for all patients, and follicle stimulating hormone (FSH), estradiol (E2), total testosterone (TT), free testosterone (FT), biologically active testosterone (BioT), dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) were measured. Height and weight were measured, and the body mass index (BMI) was calculated. BMD of the lumbar spine and left femur was measured in POI patients. Multiple linear regression analyses were performed to determine the correlation between characteristics and BMD. RESULTS: The incidence of osteoporosis was significantly higher in iatrogenic POI patients than in idiopathic POI patients (40.9% vs. 20.0%, < 0.05). The femoral shaft BMD, greater trochanter BMD -score, total femoral BMD and total femoral BMD -score were significantly lower in iatrogenic POI patients compared to idiopathic POI patients (all < 0.05). Multiple linear regression analysis revealed that delay in diagnosis negatively affected the lumbar BMD -score ( < 0.05) and the BMI and DHEAS positively affected the total femur BMD -score in iatrogenic POI patients ( < 0.05). No significant correlations were found in idiopathic POI patients. CONCLUSION: The incidence of osteopenia and osteoporosis in POI patients is high, especially in iatrogenic POI patients, who experience more severe bone loss and a higher incidence of osteoporosis. BMI and a delay in diagnosis significantly affected BMD in iatrogenic POI patients. This, to our knowledge, is the first study showing that DHEAS positively affects BMD in iatrogenic POI patients, which, however, needs further studies for confirmation.
Climacteric
· 2026 Feb · PMID 40636999
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OBJECTIVE: Diet significantly modulates immunological responses and can impact climacteric symptoms. This study evaluated the association between Dietary Inflammatory Index (DII) scores and climacteric symptoms in postme...OBJECTIVE: Diet significantly modulates immunological responses and can impact climacteric symptoms. This study evaluated the association between Dietary Inflammatory Index (DII) scores and climacteric symptoms in postmenopausal women. METHOD: The study was conducted with postmenopausal women between May and July 2024. A face-to-face questionnaire including demographic characteristics, the Menopause Rating Scale (MRS) and the Kupperman Menopausal Index (KMI) was administered. The DII score was computed based on dietary data. Anthropometric measurements were based on participants' self-reports. The data were analyzed using SPSS 24.0. RESULT: s: In total, 193 postmenopausal women were recruited. Participants in T3, who had the highest DII scores and thus followed the most pro-inflammatory diets, had higher MRS and KMI scores, with significant differences between the groups ( < 0.001 and = 0.033, respectively). T3 had higher intakes of energy and total fat ( = 0.018 and = 0.030, respectively) but lower intakes of n-3 fatty acids ( = 0.038). Multivariate linear regression analysis revealed that moderate to high DII scores correlated with elevated MRS scores (odds ratio 1.100, < 0.001 and 1.106, < 0.001, respectively). After adjusting for age, marital status, education, employment, physical activity, year of menopause, supplement use and socioeconomic status, the results remained consistent. CONCLUSION: A pro-inflammatory diet might be associated with higher symptoms. Further studies are needed to confirm these findings.
Climacteric
· 2025 Oct · PMID 40575963
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The effectiveness of various exercise types in improving sleep quality in menopausal women remains controversial. This network meta-analysis was designed to evaluate and rank the efficacy of five exercise modalities on s...The effectiveness of various exercise types in improving sleep quality in menopausal women remains controversial. This network meta-analysis was designed to evaluate and rank the efficacy of five exercise modalities on sleep quality in peri-postmenopausal women. Five English databases and three Chinese databases were searched for randomized controlled trials (RCTs) published from inception to July 2024. Pairwise meta-analysis and frequentist network meta-analyses were performed based on the random effects model. The analysis revealed that younger menopausal women (age ≤55 years) (standardized mean difference [SMD] = -2.00; 95% confidence interval [CI] [-2.70, -1.31]), those with sleep disorders (SMD = -2.29; 95% CI [-2.79, -1.78]) and those from Asia (SMD = -2.50, 95% CI [-3.62, -1.38]) were able to derive greater health benefits. Flexibility exercise (low certainty) and aerobic exercise (low certainty), combined exercise (moderate certainty) and mind-body exercise (moderate certainty) significantly improved sleep quality. Combined exercise showed the highest efficacy (surface under the cumulative ranking curve [SUCRA] = 93.5%), followed by flexibility exercise (SUCRA = 76%), and these exercises also showed a positive effect on women's quality of life (SMD = 0.49; 95% CI [0.13, 0.84]; = 0.007). Future research should develop more acceptable exercise intervention models and use combined and flexibility exercises to explore the optimal parameters of exercise for menopausal women.
Rattley CA, Felton M, Ansdell P
… +2 more, Dewhurst S, Neal RA
Climacteric
· 2025 Dec · PMID 40575952
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Maintaining fitness throughout menopause is crucial for sustaining functional capacity and supporting healthy aging. Declines in physical activity and changes in physiology threaten cardiovascular health in menopause. Ae...Maintaining fitness throughout menopause is crucial for sustaining functional capacity and supporting healthy aging. Declines in physical activity and changes in physiology threaten cardiovascular health in menopause. Aerobic capacity is an indicator of current health status that can be measured directly, by maximal rate of oxygen uptake (V̇O), or using submaximal predictive methods that require fewer resources. This study aimed to establish the validity of these predictive methods for midlife women. Forty-four women (age 52 ± 4 years) completed three predictive cycle ergometer protocols (YMCA, Astrand-rhyming and Ekblom-Bak) and an incremental cycle ergometer V̇O test. Predicted V̇O scores were compared for agreement with directly measured V̇O. All methods evidenced moderate correlations with V̇O. The mean V̇O value derived from the YMCA (35.6 ± 9.7 ml·kg-·min-) and Astrand-Rhyming (35.5 ± 8.8 ml·kg-·min-) tests was no different to measured V̇O (34.5 ± 7.2 ml·kg-·min-), but the Ekblom-Bak test (37.5 ± 7.2 ml·kg-·min-, < 0.01) overpredicted V̇O. All methods showed wide limits of agreement, suggesting variability in the accuracy of predictions. When measuring aerobic capacity or prescribing exercise using these predictive methods, the results should be interpreted with caution. Where possible, direct measurement of aerobic capacity should be utilized for prescription of exercise intensity in menopausal women.
Climacteric
· 2025 Dec · PMID 40569045
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OBJECTIVE: This study aimed to determine whether live birth affects the age at menopause (AAM), explore the relationship between different characteristics and AAM, and develop a model to project the AAM in middle-aged wo...OBJECTIVE: This study aimed to determine whether live birth affects the age at menopause (AAM), explore the relationship between different characteristics and AAM, and develop a model to project the AAM in middle-aged women. METHOD: A cross-sectional study was conducted with 630 postmenopausal women in Cyprus between January 2022 and June 2022. Postmenopausal women between ages 40 and 90 years completed a 90-question questionnaire that assessed reproductive, socio-demographic, familial, lifestyle and newborn/childhood parameters. Linear regression analysis was used to determine the associations related to AAM, which was questioned in the questionnaire. Multiple linear regression analysis was applied to determine the effect of potential associations on AAM. RESULTS: The mean AAM was 48.7 years. In univariate analysis, the strongest associations observed were the positive correlation between AAM and the number of grown-up children and live births. Other reproduction-related parameters were mildly correlated with AAM. In the multivariable analysis, the effect of reproduction became less critical, including live birth. The strongest associations with AAM were the years of marriage before the AAM, relationship quality with the partner, the participant's mother's AAM and the average AAM of any sisters. A formula including parameters strongly associated with AAM contributed to a 26.7% variation in AAM between women ( < 0.001). CONCLUSIONS: As the AAM can be determined to an extent, we can separate early and late AAM groups and prepare for the high-risk conditions related to later or earlier AAM to increase longevity.
Porcari I, Uccella S, Casprini C
… +3 more, Bosco M, Zorzato PC, Garzon S
Climacteric
· 2026 Feb · PMID 40569036
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OBJECTIVE: This study aimed to summarize available evidence on the efficacy of vulvovaginal topical estrogen therapy on lower urinary tract symptoms (LUTS) of genitourinary syndrome of menopause. METHOD: Multiple databas...OBJECTIVE: This study aimed to summarize available evidence on the efficacy of vulvovaginal topical estrogen therapy on lower urinary tract symptoms (LUTS) of genitourinary syndrome of menopause. METHOD: Multiple databases were systematically searched from inception to October 2024 to identify all studies providing pretreatment and post-treatment data for menopausal women with LUTS who received vulvovaginal estrogen therapy. A random effect meta-analysis was conducted (PROSPERO registration number: CRD42024517516). RESULTS: Seventeen studies were included for a total of 2111 patients. The pooled odds ratio for the occurrence of considered outcomes after versus before treatment was 0.14 (95% confidence interval [CI] 0.05-0.36; = 73%) for recurrent urinary tract infections, 0.12 (95% CI 0.05-0.29; = 62%) for stress urinary incontinence, 0.22 (95% CI 0.16-0.32; = 0%) for urge incontinence, 0.11 (95% CI 0.06-0.18; = 23%) for urgency, 0.22 (95% CI 0.16-0.23; = 0%) for frequency and 0.24 (95% CI 0.17-0.34; = 0%) for nocturia. The pooled mean difference for vaginal pH was -1.29 (95% CI -1.66 to -0.91; = 96%). CONCLUSIONS: Vulvovaginal topical estrogen therapy appears to improve all analyzed LUTS in menopausal women. Available evidence supports current guidelines recommending vulvovaginal topical estrogen therapy for the management of these symptoms in menopausal women.