OBJECTIVE: To examine whether the combined assessment of low handgrip strength (HGS) and low adductor pollicis muscle thickness (APMT) represents a simple and integrated risk stratification approach for identifying adult...OBJECTIVE: To examine whether the combined assessment of low handgrip strength (HGS) and low adductor pollicis muscle thickness (APMT) represents a simple and integrated risk stratification approach for identifying adult women at increased likelihood of low muscle mass and low bone mass. METHODS: In this cross-sectional study, 296 adult women aged 24-59 years were evaluated. HGS and APMT were measured using a manual dynamometer and anthropometric calipers, respectively. Muscle mass, bone mineral density, and femoral geometry were assessed through dual-energy x-ray absorptiometry. Low muscle mass and low bone mass were defined using established criteria. Low HGS and low APMT were categorized using data-derived cutoffs obtained through receiver operating characteristic curve analysis. Associations were examined using adjusted linear and logistic regression models. RESULTS: Both HGS and APMT were independently associated with muscle mass (P < 0.001) and femoral bone outcomes (P = 0.001 and P = 0.005, respectively). When categorized, the combination of low HGS and low APMT showed stronger associations with reduced muscle mass and low bone mass (OR: 7.52, 95% CI: 2.88-19.63; P < 0.001), including the femoral neck (OR: 7.20, 95% CI: 2.34-22.16; P < 0.001), lumbar spine (OR: 3.28, 95% CI: 1.02-10.56; P = 0.047), and at least one site (OR: 4.47, 95% CI: 1.62-12.36; P = 0.004). CONCLUSION: The combined assessment of HGS and APMT captures complementary dimensions of musculoskeletal health and may serve as a practical approach for preliminary risk stratification, particularly in resource-limited settings where access to standard diagnostic methods, such as dual-energy x-ray absorptiometry, remains limited.
OBJECTIVES: To examine the association between body mass index (BMI), Body Roundness Index (BRI), and A Body Shape Index (ABSI), with handgrip strength (HGS) and dynapenia in postmenopausal women. METHODS: This is a cros...OBJECTIVES: To examine the association between body mass index (BMI), Body Roundness Index (BRI), and A Body Shape Index (ABSI), with handgrip strength (HGS) and dynapenia in postmenopausal women. METHODS: This is a cross-sectional study involving 259 postmenopausal women. Age, age at menopause, alcohol consumption, height, weight, waist circumference, and smoking status were recorded. BMI, BRI, and ABSI were separately calculated. Serum creatinine, glucose, glycated hemoglobin, and uric acid were evaluated. HGS was measured using a digital dynamometer, and physical activity was assessed by the International Physical Activity Questionnaire. Student t test, χ2 test, Pearson correlation coefficient, and multivariable linear and logistic regression models were performed for data analysis. RESULTS: HGS was not correlated with BMI (r=-0.004, P=0.930), BRI (r=-0.080, P=0.190), and ABSI (r=-0.019, P=0.750). The multivariable linear regression models showed that HGS was not significantly associated with BMI (β= 0.01; 95% CI, -0.11 to 0.12), BRI (β= -0.04; 95% CI, -0.34 to 0.25), and ABSI (β= 43; 95% CI, -38 to 124). The multivariable logistic regression models displayed no significant association between dynapenia with BMI (OR= 1.00; 95% CI, 0.92-1.09), BRI (OR= 1.06; 95% CI, 0.84-1.34), and ABSI (OR= 0.80; 95% CI, 0.55-1.14). CONCLUSIONS: There were no associations between BMI, BRI, and ABSI with HGS. Furthermore, in postmenopausal women, dynapenia was also not associated with these anthropometric indices of obesity.
OBJECTIVE: To examine whether clinicians' awareness of a recent US Food and Drug Administration (FDA) regulatory communication on menopausal hormone therapy (MHT) was associated with reported changes in clinical practice...OBJECTIVE: To examine whether clinicians' awareness of a recent US Food and Drug Administration (FDA) regulatory communication on menopausal hormone therapy (MHT) was associated with reported changes in clinical practice, counseling priorities, and treatment choices in standardized clinical vignettes. METHODS: This cross-sectional, web-based survey included 600 practicing obstetricians and gynecologists providing menopause or perimenopause care. A composite Regulatory Awareness Score was created from survey items addressing recognition of the regulatory action, perceived relevance, understanding of its rationale, and appraisal of its correctness and timeliness. The primary outcome was self-reported change in routine clinical approach after the regulatory communication. Multivariable logistic regression was used to examine the association between awareness and reported practice change. Ranked counseling factors were compared across awareness tertiles, and vignette choices were examined using multinomial logistic regression. RESULTS: Regulatory awareness was not independently associated with reporting a change in clinical practice (adjusted odds ratio [aOR]: 0.89; 95% CI: 0.69-1.14; P=0.345). Higher odds of reported change were associated with use of a standard hormone therapy protocol (aOR: 1.50; 95% CI: 1.05-2.14; P=0.024), more favorable perceptions of compounded bioidentical hormone therapy (BHT) (aOR: 1.85; 95% CI: 1.35-2.54; P<0.001), stronger prioritization of patient preference (aOR: 1.21; 95% CI: 1.06-1.38; P=0.004), and higher menopause patient volume (aOR: 1.01; 95% CI: 1.00-1.01; P=0.042). Across awareness tertiles, counseling priorities were broadly similar, with only modest differences for symptom severity. In vignette analyses, higher awareness was associated with lower relative selection of compounded BHT in a context-dependent manner. CONCLUSION: Regulatory awareness alone did not explain self-reported change in menopausal hormone therapy practice after adjustment for clinician characteristics, protocol use, BHT perceptions, and counseling priorities. BHT perceptions, use of a standard protocol, and patient-preference prioritization showed stronger associations with reported change, whereas awareness was more clearly reflected in vignette-based treatment choices than in global self-reported practice change.
OBJECTIVES: A plant-based diet has been shown to reduce hot flashes, partly by weight loss. Because some plant-based foods are highly processed, this secondary analysis assessed associations between consumption of proces...OBJECTIVES: A plant-based diet has been shown to reduce hot flashes, partly by weight loss. Because some plant-based foods are highly processed, this secondary analysis assessed associations between consumption of processed foods, body weight, and severe hot flashes in postmenopausal women. METHODS: Participants (N=84) were randomly assigned to a low-fat vegan diet supplemented with soybeans (n=42) or an omnivorous control group (n=42) for 12 weeks. Three-day diet records were analyzed using the Nutrition Data System for Research software; the NOVA classification was used to assess processed food consumption. A repeated measures ANOVA was used for statistical analyses. RESULTS: Consumption of unprocessed or minimally processed animal foods decreased in the vegan group, compared with the control group; effect size: -106 g/d (95% CI: -169 to -42); P=0.002. The reduction in consumption of unprocessed or minimally processed animal foods was associated with weight loss (r=+0.45; P<0.001) and a reduction in severe hot flashes (r=+0.31; P=0.01). Similarly, consumption of ultra-processed animal foods decreased in the vegan group by 60 g/d (95% CI: -105 to -15); P=0.004, with no significant change in the control group; effect size: -65 g/d (95% CI: -115 to -16); P=0.01. The reduction in consumption of ultra-processed animal foods was associated with weight loss (r=+0.43; P<0.001). Consumption of ultra-processed plant-based foods changed only minimally and nonsignificantly and was not associated with changes in weight or hot flash frequency. CONCLUSIONS: These findings suggest that, in the context of a soybean-supplemented vegan diet, replacing the consumption of both unprocessed or minimally processed and ultra-processed animal foods with plant foods (regardless of the level of processing), was associated with significant weight loss and a reduction in severe hot flashes.
OBJECTIVES: To assess male and female factors associated with low sexual function and the components of sexual function in women between 50 and 70 years cohabiting with their partners. METHODS: This cross-sectional study...OBJECTIVES: To assess male and female factors associated with low sexual function and the components of sexual function in women between 50 and 70 years cohabiting with their partners. METHODS: This cross-sectional study, employing snowball sampling, involved 266 couples. Each couple member completed two questionnaires, providing data on sociodemographics, clinical, and behavioral characteristics, the Short Personal Experiences Questionnaire (SPEQ), Male Sexual Quotient (QS-M), and Menopause Rating Scale (MRS). Multiple logistic regression analyses were used to investigate the factors associated with female sexual function. RESULTS: Multiple regression analysis showed factors associated with low global female sexual function: satisfaction with a partner (P=0.004, OR: 0.16, 95% CI: 0.05-0.55), vaginal dryness (P=0.001, OR: 0.27, 95% CI: 0.14-0.52), men's erection disorders (P=0.009, OR: 3.57, 95% CI: 1.38-9.24), formal education (P=0.038, OR: 0.23, 95% CI: 0.06-0.92), and men's sexual performance according to partner's satisfaction (P=0.027, OR: 0.15, 95% CI: 0.03-0.81). Frequency of female sexual desire ≥1 times a week was associated with less vaginal dryness, male sexual desire ≥1 times a week, and men's ability to seduce most of the time/always. Frequency of female arousal was associated with satisfaction with a partner as a lover, less vaginal dryness, men's satisfactory erection, and excellent/good women's health self-perception. The frequency of female orgasm was associated with excellent/good women's health self-perception and frequent male sexual performance. CONCLUSIONS: This study showed male and female factors impacting female sexual function. There is a need for a couple's approach.
Nocturia, defined as waking during the night to urinate one or more times, is a prevalent condition among postmenopausal women, significantly affecting quality of life. The postmenopausal period is associated with hormon...Nocturia, defined as waking during the night to urinate one or more times, is a prevalent condition among postmenopausal women, significantly affecting quality of life. The postmenopausal period is associated with hormonal, anatomical, functional, and psychosocial changes that predispose women to nocturia. Understanding nocturia's etiology is essential for targeted management. This Practice Pearl investigates the many factors contributing to nocturia in postmenopausal women and reviews available treatment strategies.
OBJECTIVES: This study characterized longitudinal changes in the associations between modifiable health behaviors (MHBs) and health outcomes, considering variations by menopausal status and hormone therapy (HT) use. METH...OBJECTIVES: This study characterized longitudinal changes in the associations between modifiable health behaviors (MHBs) and health outcomes, considering variations by menopausal status and hormone therapy (HT) use. METHODS: Baseline and 3-year follow-up data from the Canadian Longitudinal Study on Aging were used. Participants were categorized into pre/perimenopausal, postmenopausal-HT-naïve, postmenopausal-current HT users, and postmenopausal-previous HT users. MHBs included diet quality (PURE diet score), total physical activity, and sleep duration; health outcomes included fat mass index (FMI), appendicular skeletal muscle index, gait speed, handgrip strength, and metabolic health z-score. Linear mixed models were used to examine the main and interaction effects of time, MHBs, and menopausal/HT group on each outcome, adjusting for age and demographic covariates. RESULTS: In all, 10,165 females were included (age: 61.3±9.9 y; 67.6% postmenopausal). The PURE diet score did not demonstrate time-dependent interactions with study groups. The association between physical activity and FMI was stronger over time in all postmenopausal groups (time × physical activity × group interaction: P=0.008). The associations between sleep with FMI (P<0.001) and appendicular skeletal muscle index (P=0.020) strengthened over time, but the association with gait speed (P<0.001) and handgrip strength (P<0.001) weakened. Relationships between sleep and gait speed weakened in postmenopausal-HT-naïve and postmenopausal-current HT users, while sleep-handgrip association weakened only among postmenopausal-current HT users (all P<0.005). CONCLUSIONS: These findings underscore the evolving influence of MHBs on key health outcomes and the importance of considering menopausal and HT status in longitudinal assessments of aging-related health.
OBJECTIVES: There is limited data on the prevalence and severity of menopausal symptoms among the Canadian population. This study aims to characterize and compare the prevalence and severity of menopausal symptoms among...OBJECTIVES: There is limited data on the prevalence and severity of menopausal symptoms among the Canadian population. This study aims to characterize and compare the prevalence and severity of menopausal symptoms among Canadian women experiencing menopause around the average age and those with premature ovarian insufficiency. METHODS: This cross-sectional observational study included women attending specialized menopause and premature ovarian insufficiency clinics at an academic center in Toronto, Canada. Participants completed a standardized intake questionnaire and the Menopause Rating Scale, a validated instrument assessing psychological, somato-vegetative, and urogenital symptoms. Symptom prevalence and severity were compared between cohorts using nonparametric and categorical statistical tests. RESULTS: The study included 374 women experiencing menopause at an average age (median age 53 y) and 149 women with premature ovarian insufficiency (median age 34 y). Menopausal symptoms were common in both groups, with most women reporting symptoms in at least one domain. Urogenital symptoms were the most prevalent and severe across cohorts. Total Menopause Rating Scale scores were higher among women with menopause compared with premature ovarian insufficiency (P=0.003), driven by greater somato-vegetative symptom burden (P=0.002); psychological and urogenital symptom scores did not differ significantly between groups. CONCLUSIONS: Menopausal symptoms are common and frequently severe for both average-age menopause and premature ovarian insufficiency. Younger age in premature ovarian insufficiency may not confer protection against psychological or urogenital symptoms, given similar symptom burden with average-age menopause. This underscores the need for proactive, comprehensive symptom assessment and management-particularly for urogenital and sexual health-in all individuals experiencing estrogen deficiency.
OBJECTIVE: To evaluate whether self-reported sleep disturbances during perimenopause are associated with cognitive function decades later in postmenopausal women. METHODS: We analyzed 2,097 postmenopausal women without k...OBJECTIVE: To evaluate whether self-reported sleep disturbances during perimenopause are associated with cognitive function decades later in postmenopausal women. METHODS: We analyzed 2,097 postmenopausal women without known dementia in the St Louis Baby Tooth-Later Life Health Study (2019‑2023). At one postmenopausal visit, participants retrospectively reported perimenopausal sleep, rated current sleep, and completed a cognitive battery. Sleep disturbances were assessed with the Neuro-QoL Sleep Disturbance scale and classified as none to slight, mild, or moderate to severe. Cognitive function was summarized as a composite Z-score from the TestMyBrain battery. Multiple linear regression estimated adjusted differences (SD units) in cognition across sleep disturbance categories, stratified by frequency of being woken by menopausal symptoms (ie, "never or rarely" vs. "sometimes to always"). RESULTS: Perimenopausal sleep disturbances were associated with lower cognitive scores compared with none to slight (mild: -0.07; 95% CI, -0.17 to 0.02; moderate to severe: -0.15; 95% CI, -0.29 to -0.02). No association was observed among women never or rarely woken by menopausal symptoms, whereas larger deficits were seen among those woken sometimes to always (mild: -0.17; 95% CI, -0.28 to -0.06; moderate to severe: -0.31; 95% CI, -0.47 to -0.16). Findings were unchanged after adjustment for hormone therapy or for concurrent sleep disturbances measured at the time of cognitive testing. CONCLUSIONS: Perimenopausal sleep disturbances were linked to poorer cognitive function decades later, particularly in women frequently woken by menopausal symptoms. These results suggest that sleep and menopausal symptoms in midlife may be relevant markers of later-life cognitive health, and warrant confirmation in prospective studies.
Daniels K, Gandhi S, Wenziger C
… +13 more, Parlett L, Wang L, Tave A, Coley B, Shanmugasandaram S, Wolter K, Dai F, Azarmina P, Santos AC, Hoti F, Wells K, Loyo-Berríos N, Lanes S
OBJECTIVE: To estimate the incidence of endometrial cancer in women who used low, moderate, or high-dose vaginal estrogen compared with women who used estrogen plus progestogen therapy (EPT). METHODS: This cohort study i...OBJECTIVE: To estimate the incidence of endometrial cancer in women who used low, moderate, or high-dose vaginal estrogen compared with women who used estrogen plus progestogen therapy (EPT). METHODS: This cohort study included postmenopausal women from the United States Healthcare Integrated Research Database (HIRD) and the Swedish National Registers. The index date was the date of treatment initiation between January 1, 2007 and December 31, 2021, in the HIRD or between July 1, 2007 and December 31, 2019, in Sweden. Participants had at least 1 year of baseline continuous health plan enrollment or 2 years of Swedish residency, and no history of hormone therapy use, hysterectomy, or endometrial cancer. Hazard ratios (HR) and confidence intervals were estimated using Cox proportional hazards models adjusted for demographic, comorbid, and prescription history. RESULTS: In the HIRD, the HR for endometrial cancer when comparing low-dose vaginal estrogen to EPT was 0.74 (0.45-1.22). In the Swedish Registers, this association was 1.34 (0.84-2.13). Moderate-dose vaginal estrogen initiation was positively associated with endometrial cancer compared with EPT in the HIRD (HR= 1.95 ;0.86-4.45) but not in Sweden (HR=1.15; 0.73-1.83). High-dose Premarin vaginal cream had an association of 0.84 (0.49-1.44) compared with EPT (HIRD). CONCLUSIONS: Rates of endometrial cancer among women using low and high-dose vaginal estrogens were comparable to rates among women using EPT.
IMPORTANCE: Cardiovascular disease risk increases significantly in postmenopausal women, largely due to estrogen deficiency, which contributes to the progression of atherosclerosis. Animal models, particularly those invo...IMPORTANCE: Cardiovascular disease risk increases significantly in postmenopausal women, largely due to estrogen deficiency, which contributes to the progression of atherosclerosis. Animal models, particularly those involving ovariectomy, are widely used to simulate postmenopausal conditions and evaluate potential therapeutic interventions. OBJECTIVE: This systematic review aims to summarize current findings on interventions tested in animal models of postmenopausal atherosclerosis, focusing on their interventional class and therapeutic efficacy. EVIDENCE REVIEW: A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science up to May 2025. Studies were selected based on inclusion criteria emphasizing original research involving ovariectomized animal models of atherosclerosis. Data were extracted on animal species, interventional class type, and outcomes related to plaque development, inflammation, and lipid profiles. FINDINGS: A total of 140 studies met the inclusion criteria. Estrogen-based therapies were the most extensively studied and were frequently associated with improvements in lipid profiles, inflammatory markers, and endothelial function. Many interventions also modulated oxidative stress and vascular function. However, the magnitude and consistency of therapeutic effects varied across models, treatment duration, and experimental design. While some combination and non-hormonal therapies demonstrated beneficial effects, they were not consistently superior to monotherapy. Across studies, interventions commonly targeted lipid metabolism, inflammatory signaling, oxidative stress and vascular function. CONCLUSIONS AND RELEVANCE: Numerous therapeutic interventions have shown promise in preclinical models of postmenopausal atherosclerosis. Estrogen-based therapies remain central due to their mechanistic relevance to estrogen deficiency. However, treatment outcomes are influenced by intervention timing, disease stage, and model variability. Standardization of study designs and translation into human trials are the essential next steps for developing effective interventions to prevent and treat postmenopausal cardiovascular disease.