OBJECTIVES: Cardiovascular disease risk increases for women during the menopause transition. While cardiorespiratory fitness (CRF) is linked to lower cardiovascular disease risk, its predictive relationship with cardiova...OBJECTIVES: Cardiovascular disease risk increases for women during the menopause transition. While cardiorespiratory fitness (CRF) is linked to lower cardiovascular disease risk, its predictive relationship with cardiovascular health and quality of life during menopause is unclear. This study investigated the relationships between CRF, cardiovascular health markers, and quality of life in peri- and postmenopausal women. METHODS: Fifty-eight participants underwent a graded exercise test to assess CRF, alongside measurements of vascular function, blood lipids, blood pressure, and anthropometrics. Questionnaires were used to evaluate physical activity (International Physical Activity Questionnaire [IPAQ]) and quality of life (Menopause-Specific Quality of Life [MENQOL] questionnaire and general health [EQ-5D]). Linear and ordinal regression analyses were conducted to assess associations. RESULTS: After adjusting for age and physical activity, regression models indicated that CRF was significantly associated with high-density lipoprotein cholesterol, waist-to-hip ratio, and triglycerides, explaining 11%-15% of their variance. Higher CRF was also linked to a lower burden of self-reported menopause-related symptoms in the MENQOL physical domain (odds ratio = 0.91 per unit increase in CRFs). However, no significant associations were found between CRF and vascular function measures. CONCLUSIONS: These findings suggest that CRF is independently associated with a more favorable cardiometabolic risk profile and may be related to fewer menopause-related symptoms in midlife women. In our sample, we did not find an association with vascular function, which may indicate that other factors might play a more prominent role in vascular health during the menopause transition.
OBJECTIVE: To determine the feasibility of using a novel negative pressure device for effectiveness and safety in treating genitourinary syndrome of menopause (GSM). METHODS: An unblinded feasibility study was performed...OBJECTIVE: To determine the feasibility of using a novel negative pressure device for effectiveness and safety in treating genitourinary syndrome of menopause (GSM). METHODS: An unblinded feasibility study was performed in 12 women with GSM using the VITA AV Clinical System: a system with a disposable intravaginal tip with circumferential orifices, connected to a vacuum pump. Negative pressure draws the vaginal epithelium into the orifices, inducing microtrauma and a regenerative physiological response. Women underwent familiarization sessions with increasing negative pressure to the vaginal epithelium for 3 minutes, followed by three monthly sessions at 3, 4, and 5 minutes, respectively. Efficacy was assessed on the change in the most bothersome symptom (MBS) and vaginal health maturation index scores at 1 and 12 months after treatment. Tolerability was determined by pain scores during treatment. Safety data were collected throughout. RESULTS: All women completed the study and tolerated maximum negative pressure while reporting negligible to no pain during treatment. Seven of the 12 reported improvement, and 3 reported complete resolution in MBS at 1 month. Nine remained improved at 12 months. Vaginal maturation index improved in 92% at 1 month and 66% at 12 months. All women rated their satisfaction with the device as good to very good. No adverse or device-related events occurred. CONCLUSION: Negative pressure treatment was tolerated by women affected by GSM with no safety issues, and with observed favorable changes in reported symptoms and objective assessments. Controlled studies are warranted with larger sample sizes and increased frequency of follow-up to assess the time course of improvements.
OBJECTIVE: Menopause and hormone therapy (HT) may influence modifiable health behaviors (MHBs), but their independent and combined effects are not well understood. This study examined dietary intake, physical activity, a...OBJECTIVE: Menopause and hormone therapy (HT) may influence modifiable health behaviors (MHBs), but their independent and combined effects are not well understood. This study examined dietary intake, physical activity, and sleep, overall and in relation to guidelines, by menopausal and HT status. METHODS: This cross-sectional analysis used self-reported data from 10,381 females from the Canadian Longitudinal Study on Aging, classified into four groups: (1) pre/perimenopausal, (2) postmenopausal/never HT, (3) postmenopausal/current HT, or (4) postmenopausal/past HT. MHBs were self-reported. Diet was grouped into six categories; physical activity included walking/light, moderate-vigorous, and strength-based (min/wk); sleep was average nightly duration. Primary analyses used linear mixed models to compare MHBs across groups, and binary logistic regressions assessed meeting physical activity and sleep guidelines, adjusting for sociodemographic and lifestyle factors. When significant, secondary analyses for pairwise comparisons were conducted. RESULTS: Postmenopausal females who never used HT reported lower intake of fruit/vegetables (P = 0.012). Never-HT users were also 19% less likely to meet strength-based activity guidelines (P = 0.049). Sleep duration was shorter in postmenopausal females who had never used HT or had used HT in the past, compared to pre/perimenopausal females (P = 0.001, P = 0.035). The likelihood of meeting sleep guidelines was 14% lower in never, 26% lower in current, and 24% lower in past HT users compared with pre/perimenopausal females (P = 0.048, P = 0.004, P = 0.002). CONCLUSION: Menopausal and HT status are related to differences in MHBs, including meeting established physical activity and sleep guidelines. Findings highlight the need to consider hormonal and life-stage factors in strategies to support healthy aging of females.
OBJECTIVE: To evaluate the relationship between physical activity (PA) and health-related quality of life (HRQoL) in Korean postmenopausal women and determine whether this relationship differs according to the presence o...OBJECTIVE: To evaluate the relationship between physical activity (PA) and health-related quality of life (HRQoL) in Korean postmenopausal women and determine whether this relationship differs according to the presence of chronic diseases. METHODS: This population-based, cross-sectional study used data from 7,846 postmenopausal women who participated in the 2016-2020 Korean National Health and Nutrition Examination Survey. PA was assessed using the Global Physical Activity Questionnaire and categorized according to total intensity (low, moderate, and high) and domains (occupational, leisure time, and commuting). The HRQoL was evaluated using the EuroQol 5-dimension index and its five domains. Multivariate logistic regression was used to estimate the odds ratios and 95% CIs for high HRQoL according to the PA levels and domains stratified according to chronic disease status. RESULTS: Higher PA levels were significantly associated with better HRQoL, particularly in women with chronic diseases (moderate PA: odds ratio = 1.35, 95% CI =1.17-1.57). In this group, greater walking time and lower sedentary time were positively associated with HRQoL, whereas occupational PA showed an inverse relationship. Leisure time and commuting PA were positively correlated with HRQoL, whereas no significant associations were observed among healthy women, except in the mobility domain. CONCLUSIONS: Among postmenopausal women, PA, particularly light-to-moderate activities such as walking and active commuting, was associated with higher HRQoL; stronger effects were observed in those with chronic diseases. These findings highlight the importance of promoting feasible and context-appropriate PA and reducing sedentary behaviors in postmenopausal women to improve their overall well-being.
OBJECTIVE: To evaluate the association between menopausal status, oral contraceptive use, and choroidal thickness in a nationally representative Korean population. METHODS: This study included 12,326 women (6,721 menstru...OBJECTIVE: To evaluate the association between menopausal status, oral contraceptive use, and choroidal thickness in a nationally representative Korean population. METHODS: This study included 12,326 women (6,721 menstruating and 5,605 menopausal) from the 2017 to 2021 Korea National Health and Nutrition Examination Survey. Survey-weighted linear regression was used to examine associations of subfoveal choroidal thickness and central macular thickness with menopausal status, adjusting for demographic, ocular, and systemic covariates. A subanalysis was performed among 5,886 menstruating women with available information on oral contraceptive use (742 users and 5,144 nonusers). RESULTS: In the multivariate model, menopausal status was not significantly associated with either subfoveal choroidal thickness (β=-0.51 µm; 95% confidence interval (CI), -7.31 to 6.29; P=0.883) or central macular thickness (β=1.01 µm; 95% CI, -1.20 to 3.22; P=0.370). However, a significant interaction between menopausal status and blood pressure was observed in subgroup analyses (P for interaction=0.007). Likewise, oral contraceptive use was not associated with either subfoveal choroidal thickness (β=5.45 µm; 95% CI, -4.58 to 15.48; P=0.287) or central macular thickness (β=-1.67 µm; 95% CI, -4.81 to 1.47; P=0.297). CONCLUSIONS: Menopausal status and oral contraceptive use were not associated with subfoveal choroidal thickness and central macular thickness in this large-scale, nationally representative cohort. These findings provide reliable population-level evidence that menopause has little effect on choroidal thickness, helping resolve prior inconsistent results. However, the observed interaction with blood pressure indicates that this association may vary across cardiovascular risk subgroups and warrants further investigation.
Blümel JE, Chedraui P, Vallejo MS
… +15 more, Aedo S, Gómez-Tabares G, Monterrosa-Castro Á, Tserotas K, Ñañez M, Ojeda E, Rey C, Rodrigues MAH, Rodríguez-Vidal D, Salinas C, Calle A, Elizalde-Cremonte A, Escalante C, Espinoza MT, Dextre M
OBJECTIVES: In light of US Food and Drug Administration (FDA) warnings about adverse effects of statin therapy, some of which resemble menopausal complaints, this study compared menopause-related manifestations [Menopaus...OBJECTIVES: In light of US Food and Drug Administration (FDA) warnings about adverse effects of statin therapy, some of which resemble menopausal complaints, this study compared menopause-related manifestations [Menopause Rating Scale (MRS), cognitive, and musculoskeletal symptoms] between users and non-users of statins among postmenopausal women. METHODS: This multinational, cross-sectional sub-analysis of the REDLINC XII study included 1,184 postmenopausal women from nine Latin American countries. Menopausal symptoms were assessed with the MRS, cognitive function with the Montreal Cognitive Assessment (MoCA), and sarcopenia risk with the SARC-F questionnaire. Multivariable logistic regression models evaluated associations between statin therapy and outcomes (menopausal symptoms, cognition, and sarcopenia risk) after adjustment for sociodemographic, lifestyle, and clinical factors. RESULTS: Of the 1,184 women, 307 (25.9%) used statins. Compared with non-users, statin users had a higher prevalence of severe menopausal symptoms (47.2% vs. 30.6%), more intense musculoskeletal symptoms (53.1% vs. 33.9%), and higher sarcopenia risk (28.7% vs. 16.5%; all P=0.0001). In multivariable logistic regression analyses, statin therapy was not associated with mild cognitive impairment defined by the MoCA global score, although exploratory analyses suggested poorer performance in delayed recall memory and visuospatial function among users. Statin therapy remained independently associated with severe menopausal symptoms [odds ratio (OR): 1.56; 95% CI: 1.17-2.10] and sarcopenia risk (OR: 1.65; 95% CI: 1.19-2.29). CONCLUSIONS: In postmenopausal women, statin therapy was not associated with mild cognitive impairment; however, statin use was linked to poorer delayed recall memory and visuospatial function and a higher burden of menopausal symptoms and sarcopenia risk. Statin-related cognitive and somatic effects may overlap with menopausal symptomatology and contribute to symptom burden during midlife.
Chlebowski RT, Rapp S, Aragaki AK
… +13 more, Manson JE, Pan K, Neuhouser ML, Johnson KC, Snetselaar LG, Henderson VW, Qi L, Hayden KM, Baker LD, Garcia O, Pichardo MD, Wactawski-Wende J, Prentice RL
OBJECTIVES: In the Women's Health Initiative (WHI) Dietary Modification (DM) randomized trial, the dietary intervention significantly reduced breast cancer mortality and, in a subgroup of women 65 years old or above, sig...OBJECTIVES: In the Women's Health Initiative (WHI) Dietary Modification (DM) randomized trial, the dietary intervention significantly reduced breast cancer mortality and, in a subgroup of women 65 years old or above, significantly lowered possible cognitive impairment based on Modified Mini-State Examination (3MSE) scores. Based on this background, we examined the dietary intervention association with long-term dementia mortality. METHODS: The WHI DM clinical trial randomized 48,835 postmenopausal US women, aged 50-79 years, with dietary fat intake ≥32% of energy and anticipated ≥3-year survival. Cognitive function was not an eligibility criterion. Randomization was to a low-fat dietary pattern intervention (40%; n=19,541) with goals to reduce fat intake and increase fruit, vegetable, and grain intake or a usual diet comparison (60%; n=29,294). All dietary targets were significantly reduced. Mortality findings were confirmed by central medical record review enhanced by serial National Death Index findings. Dementia mortality was examined after an 8.5-year (median) dietary intervention and 20-year cumulative follow-up. RESULTS: Dietary intervention did not influence dementia mortality (n=1,386) (HR: 0.94, 95% CI: 0.85-1.05), with similar findings for Alzheimer (HR: 1.00, 95% CI 0.85-1.17) and non-Alzheimer dementia mortality (HR: 0.90, 95% CI 0.77-1.05). Of 13 subgroup analyses, with dietary intervention, there was a trend for lower dementia mortality in younger women (50-59 y, HR: 0.73, 95% CI: 0.44-1.21; 60-69 y, HR: 0.85, 95% CI: 0.72-1.01; 70-79 y, HR: 1.06, 95% CI: 0.91-1.23; P-trend 0.03). CONCLUSIONS: A low-fat eating pattern did not reduce dementia mortality in postmenopausal women.
OBJECTIVE: This secondary analysis evaluated whether changes in plant and animal protein intake were associated with changes in body weight among postmenopausal women participating in a 12-week randomized dietary interve...OBJECTIVE: This secondary analysis evaluated whether changes in plant and animal protein intake were associated with changes in body weight among postmenopausal women participating in a 12-week randomized dietary intervention. METHODS: A secondary analysis of a 12-week randomized clinical trial compared the effects of a vegan diet supplemented with 86 g cooked soybeans (n=42) to a usual diet (n=42) in postmenopausal women. An analysis of 3-day diet records examined animal and plant protein intake as predictors of body weight changes. Effect size was defined as the between-group difference (vegan minus control) for the 12-week change. RESULTS: Total protein intake did not change in either group. Animal protein decreased in the vegan group by 23.3 g (95% confidence interval [CI]: -31.3 to -15.4), with no change in the control group; effect size: -24.5 g (95% CI: -33.9 to -15.1; P<0.001). Plant protein increased in the vegan group by 22.1 g (95% CI: 17.4 to 26.8), with no change in the control group; effect size: 23.8 g (95% CI: 16.3 to 31.3; P<0.001). Changes in animal protein correlated positively with changes in body mass index (r=0.59; P<0.001), while changes in plant protein correlated negatively with changes in body mass index (r=-0.51; P<0.001), even after adjustment for energy intake changes (r=0.53; P<0.001; and r=-0.54; P<0.001, respectively). A 1-kg of weight loss was associated with a reduction in animal protein intake by 16.2 g/day (P<0.001) and an increase in plant protein intake by 12.7 g/day (P<0.001). Methionine intake decreased in the vegan group by 0.37 g (95% CI: -0.56 to -0.18), with no change in the control group; effect size: -0.41 g (95% CI: -0.66 to -0.15; P=0.002). CONCLUSIONS: Replacing animal protein with plant protein was associated with decreased body weight, independent of changes in energy intake. A dose-response relationship was observed between reducing animal protein intake and increasing plant protein consumption, and weight loss.
OBJECTIVES: The aim of the study is to determine the relationship between adverse childhood experiences (ACEs) and menopausal symptoms and quality of life. METHODS: The descriptive and cross-sectional study was completed...OBJECTIVES: The aim of the study is to determine the relationship between adverse childhood experiences (ACEs) and menopausal symptoms and quality of life. METHODS: The descriptive and cross-sectional study was completed with 221 women aged 40-65 years who actively used the internet and social media platforms (eg, WhatsApp, Instagram, Facebook). Data were collected using a Personal Information Form, the ACE Scale, the Menopause Rating Scale (MRS), and the Menopause-specific Quality of Life (MENQOL) Scale. RESULTS: ACEs were reported by 58.4% of participants. Women with ACEs had significantly higher total MRS scores (16.90 ± 8.14 vs. 12.86 ± 7.20, P = 0.001) and MENQOL scores (2.60 ± 1.43 vs. 1.93 ± 1.20, P = 0.009) than those without ACEs. Significant differences were observed in somatic, psychological, and urogenital MRS domains and in psychosocial, physical, and sexual MENQOL domains (P < 0.05). In adjusted regression models controlling for sociodemographic and clinical variables, ACEs independently predicted greater menopausal symptom severity (B = 3.21, β = 0.20, P = 0.001) and poorer MENQOL (B = 0.81, β = 0.30, P = 0.001). CONCLUSIONS: ACEs were associated with greater menopausal symptom severity and poorer MENQOL. Although causality cannot be inferred due to the cross-sectional design, the findings suggest the potential long-term relationship between early life stress and midlife women's health. Screening for ACEs may help health care professionals identify women at higher risk of severe menopausal symptoms and develop more holistic, trauma-informed management strategies.
OBJECTIVES: To compare genitourinary syndrome of menopause (GSM) symptoms and objective examination findings between women with surgical and natural menopause, and to evaluate the association between menopausal type and...OBJECTIVES: To compare genitourinary syndrome of menopause (GSM) symptoms and objective examination findings between women with surgical and natural menopause, and to evaluate the association between menopausal type and GSM severity. METHODS: This retrospective, single-center cross-sectional study included 422 postmenopausal women (218 surgical, 204 natural menopause). GSM was assessed using a standardized eight-component examination score (elasticity, lubrication, tissue integrity, introitus, labia, urethra, rugae, color; total score 0-22) and structured symptom inquiry. Group comparisons were performed with non-parametric and χ2 tests. Multivariable logistic regression analysis was used to explore the association between menopausal type and GSM-related findings. RESULTS: Women with surgical menopause had significantly higher total GSM scores and more pronounced impairment in lubrication, tissue integrity, introitus, labial, and urethral components. Genital dryness, dyspareunia, reduced sexual desire, postcoital bleeding, dysuria, and urinary frequency were also more common in this group. In regression analysis, total GSM score was found to be independently associated with surgical menopause (adjusted odds ratio: 1.08, 95% CI: 1.04-1.12). CONCLUSIONS: Surgical menopause is associated with a more severe GSM phenotype. The total GSM score may serve as a practical tool to assess symptom severity and support timely clinical management. Routine assessment of GSM, particularly in surgically menopausal women, should be integrated into gynecological care to improve quality of life.
OBJECTIVES: To challenge the perception that endometriosis uniformly regresses after menopause by presenting the case of repeated, pathology-confirmed symptomatic recurrences spanning two decades after menopause, and to...OBJECTIVES: To challenge the perception that endometriosis uniformly regresses after menopause by presenting the case of repeated, pathology-confirmed symptomatic recurrences spanning two decades after menopause, and to emphasize key considerations for hormone therapy use and surgical management in postmenopausal endometriosis. METHODS: We report the case of a 70-year-old postmenopausal patient with prior hysterectomy, bilateral salpingo-oophorectomy, appendectomy, and pathology-confirmed endometriosis who presented with pelvic pain while receiving subcutaneous estrogen pellet therapy. Preoperative imaging was suggestive of recurrent endometriosis. The patient underwent laparoscopic excision for diagnostic and therapeutic purposes, with final pathology confirming recurrent disease. Written informed consent was obtained for publication of this case report and use of de-identified clinical images. A focused narrative literature review was performed to contextualize this case within existing data on postmenopausal endometriosis. RESULTS: Laparoscopy revealed a cystic mass arising from the right round ligament with associated retroperitoneal fibrosis and multiple peritoneal implants consistent with endometriosis. Surgical management included resection of the round ligament mass, excision of peritoneal implants, lysis of adhesions, and right ureterolysis. Histopathologic examination confirmed a round ligament adenomyoma and peritoneal endometriosis. Postoperatively, the patient experienced symptomatic improvement and was transitioned to low-dose transdermal estradiol combined with progestogen therapy. CONCLUSIONS: Endometriosis can develop, persist, or recur after menopause, particularly in the setting of unopposed and potentially supraphysiologic exogenous estrogen. This case highlights the importance of appropriate menopausal hormone therapy selection, including consideration of progestogen use regardless of uterine status, and reinforces the role of surgical excision in postmenopausal patients with suspected disease.
OBJECTIVE: Our goal was to assess the relationship between menopause stage and resting-state functional connectivity during midlife. METHODS: Data from the Human Connectome Project-Aging 2.0 release were utilized in this...OBJECTIVE: Our goal was to assess the relationship between menopause stage and resting-state functional connectivity during midlife. METHODS: Data from the Human Connectome Project-Aging 2.0 release were utilized in this study. Imaging and demographic data of 151 female participants between 40 and 55 years of age were included. To investigate functional connectivity, we utilized Conn Toolbox to assess the strength of functional associations between brain regions at rest at both connection and cluster levels. RESULTS: Differences in resting-state functional connectivity between the supramarginal gyrus, right anterior division, and right planum temporale at the connection level were identified between participants in the pre-, peri-, and postmenopausal groups when all groups were compared. Further analysis comparing the pre- and postmenopausal groups revealed one cluster of altered resting-state connectivity that was lower in the postmenopausal group compared to the premenopausal group. Regions with altered connectivity included the left and right supramarginal gyrus, the anterior division, and the right and left planum temporale. CONCLUSIONS: Resting-state functional connectivity differed between menopause stages, highlighting the relationship between menopause and brain functioning during midlife in females. Differences in functional connectivity between pre- and postmenopausal participants suggest that the menopause transition may be relevant to brain functioning during the female aging process.
Obesity is one of the complications of menopause. Menopausal obesity (MO) may progress to high-risk MO (high cardiovascular risk menopausal obesity; HRMO), which is associated with clinical cardiovascular disease and sho...Obesity is one of the complications of menopause. Menopausal obesity (MO) may progress to high-risk MO (high cardiovascular risk menopausal obesity; HRMO), which is associated with clinical cardiovascular disease and shortened lifespan. Weight control is the key to preventing MO/HRMO. Estrogen in the form of menopausal hormone treatment (MHT) has been shown to prevent or retard the development of MO and the development of intrathoracic visceral fat. This article reviews the mechanisms by which estrogen, as MHT, may prevent or improve MO and its progression to HRMO. We present this personal perspective to emphasize this clinical effect of MHT as further justification for its use in menopausal women.
OBJECTIVES: To analyze the association between primary infertility and infertility type with the age of natural menopause. METHODS: This is a retrospective cohort study reviewing a subset of women from the Mayo Primary I...OBJECTIVES: To analyze the association between primary infertility and infertility type with the age of natural menopause. METHODS: This is a retrospective cohort study reviewing a subset of women from the Mayo Primary Infertility Cohort (MPIC). The MPIC is a cohort of 1,001 women diagnosed with primary infertility and 1,001 age-matched referent women. In this study, we included all women at risk for natural menopause and further evaluated those who had reported natural menopause in the medical record. We compared the risk of natural menopause using Cox proportional hazard models with infertility status and infertility type as covariates. In those with documented menopause during the study period, the association between primary infertility and early and premature menopause was analyzed with χ2 testing. We evaluated the association between age at natural menopause, primary infertility status, and infertility type in this group using linear regression. RESULTS: In all, 461 women with primary infertility, with 530 referent individuals, were at risk of natural menopause, and of these, 340 women with infertility and 346 referent women underwent documented natural menopause on review of medical records. Women with primary infertility had an increased risk of natural menopause (hazard ratio: 1.25, 95% CI: 1.06-1.46) and underwent menopause 1 year earlier than referent individuals (β=-1.17, 95% CI: -1.82 to -0.52) after adjustment for body mass index, tobacco use, race, menstrual cycle regularity, and previous contraception use. Women with primary infertility were more likely to undergo early menopause (age 40-45) than referent women (7.6% vs. 3.0%, P=0.01). Compared with referent women, women with endometriosis underwent menopause 2.75 years earlier (95% CI: -4.38 to -1.13, P=0.0009), and women with unexplained infertility underwent menopause 1.45 years earlier (95% CI: -2.26 to -0.64, P=0.0005). CONCLUSIONS: Women with primary infertility had an increased risk of early menopause and collectively underwent menopause 1 year earlier than women without a history of primary infertility.