Maturitas[JOURNAL]
Sun
200 papers
Associations of intrinsic capacity and social isolation with cardiometabolic diseases: A prospective multi-cohort study.
Zhu D, Zheng B, Cui J … +5 more , Yang Y, Li D, Sun L, Wang Y, Zhang X
Maturitas · 2026 Jun · PMID 41980428 · Publisher ↗
BACKGROUND: Cardiometabolic disease (CMD) is a widespread public health concern. Few studies have investigated the association of intrinsic capacity (IC) with a range of specific CMD outcomes from an international perspe...
BACKGROUND: Cardiometabolic disease (CMD) is a widespread public health concern. Few studies have investigated the association of intrinsic capacity (IC) with a range of specific CMD outcomes from an international perspective. We examined the association between IC and CMD along with the joint effect of social isolation. METHODS: This prospective, multi-regional cohort study integrated individual-level data from three studies conducted between 2006 and 2020: the Chinese Health and Retirement Longitudinal Study (CHARLS); the English Longitudinal Study of Aging (ELSA); and the Korean Longitudinal Study of Aging (KLoSA). Individuals aged 45 years or more without CMD at baseline and with complete follow-up were included. Cox proportional hazards models were used to assess the IC-CMD association. Whether social isolation modified the IC-CMD association was also investigated. RESULTS: In total, 12,792 participants were included. During a median follow-up of 7 years, 4735 participants developed CMD. After adjusting for confounders, "impaired" IC participants (CHARLS: hazard ratio [HR] 1.25, 95% confidence interval [CI] 1.12-1.39) and "pre-impaired" IC participants (ELSA: HR 1.26, 95% CI 1.08-1.46) had significantly elevated risks of incident CMD than "robust" participants. These relationships were most significant for stroke (CHARLS: HR 1.78, 95% CI 1.28-2.46; KLoSA: HR 1.51, 95% CI 1.05-2.19; ELSA: HR 2.23, 95% CI 1.22-4.09; pooled: HR 1.85, 95% CI 1.48-2.32; I = 0.0%, p = 0.740). Compared with participants with robust IC and social non-isolation, those with impaired IC and social isolation had a higher risk of CMD (CHARLS: HR 1.37, 95% CI 1.08-1.73; pooled: HR 1.34, 95% CI 1.13-1.59; I = 49.6%, p = 0.132), especially diabetes (pooled HR 1.91, 95% CI 1.37-2.66; I = 0.0%, p = 0.531). CONCLUSION: Impaired IC was associated with an increased risk of CMD. The strength of this association varied with the CMD subtypes and across countries. Moreover, IC and social isolation exhibited a joint effect in this relationship.
Cognitive reserve, physical disorders and the trajectory of psychological and cognitive function.
Chen HW, Li QR, Zhong Q … +5 more , Wang SA, Xu ZY, Cao BF, Liu K, Wu XB
Maturitas · 2026 Jun · PMID 41966570 · Publisher ↗
BACKGROUND: Few studies have explored the association between cognitive reserve (CR) and the trajectory of psycho-cognitive function, particularly the interactive effect of physical disorders (PDs). METHOD: Main analyses...
BACKGROUND: Few studies have explored the association between cognitive reserve (CR) and the trajectory of psycho-cognitive function, particularly the interactive effect of physical disorders (PDs). METHOD: Main analyses used data from middle-aged and older adults in the English Longitudinal Study of Ageing (ELSA), with replication using data from the US Health and Retirement Study (HRS). Latent class analysis was applied to classify participants based on baseline CR-related factors (education, occupation, stress, social engagement, physical activities, and marriage). Psycho-cognitive functions (depressive symptoms and global cognition) were measured during follow-up. Combinations of CR classifications and PDs were constructed. A linear mixed-effects model examined the relationships between CR classifications, PDs, and the progression of psycho-cognitive function, including within its specific domains. RESULTS: 4918 middle-aged and older participants were included from the ELSA. A three-class latent model for CR classifications provided the best fit. Compared with the low CR group, the moderate and high CR groups showed better psycho-cognitive performance across all domains. Participants with PDs experienced significantly faster declines in psycho-cognitive function across all domains over time. No significant interactions between CR and PDs were found. However, those with low CR and PDs demonstrated significantly greater declines in cognitive function across all domains and increased depressive symptoms. The replication analysis, with 2175 participants from the HRS, largely supported the findings from the main analysis. CONCLUSION: Higher CR mitigates the decline in psycho-cognitive function over time. A tendency for high CR to attenuate the overall decline in psycho-cognitive function associated with PDs was observed.
Impact of hospitalizations on physical function among older adults: A 13-year longitudinal study.
Ramos-Munell J, Corral-Pernía JA, Gallardo-Gómez D … +9 more , Del Pozo-Cruz J, Del Pozo Cruz B, Alfonso-Rosa RM, Reguera-Rodríguez M, Ceballos-Sánchez JL, Chacón-Borrego F, Galán-López P, Pérez-Sousa MÁ, Álvarez-Barbosa F
Maturitas · 2026 Jun · PMID 41955830 · Publisher ↗
OBJECTIVES: To examine the impact of hospitalizations on objectively assessed physical function among older adults and to determine whether age, sex, and social environment moderate this association. STUDY DESIGN: A long...
OBJECTIVES: To examine the impact of hospitalizations on objectively assessed physical function among older adults and to determine whether age, sex, and social environment moderate this association. STUDY DESIGN: A longitudinal observational study using data from 13 waves (2011-2023) of the U.S. National Health and Aging Trends Study. The analytic sample included 72,705 observations from 18,439 adults aged 65 years or more. Fixed-effects regression models were used to estimate within-person changes in physical function associated with hospitalizations, adjusting for time-varying sociodemographic and health-related covariates. MAIN OUTCOME MEASURES: Physical function was measured using the Short Physical Performance Battery, an objective assessment of balance, gait speed, and lower-body strength. Hospitalizations were self-reported annually. RESULTS: Each additional hospitalization was associated with a 0.26-point decrease in Short Physical Performance Battery score (95% CI -0.29 to -0.23) in the fully adjusted model. Age significantly moderated this relationship, with greater declines in score observed among the oldest participants. In contrast, sex did not significantly modify the effect of hospitalization on physical function. CONCLUSIONS: Hospitalizations exert a cumulative and detrimental effect on the physical function of older adults. These findings highlight the need for preventive strategies to reduce hospital admissions and for comprehensive post-hospital rehabilitation programs aimed at maintaining or restoring functional independence, particularly among the oldest age groups, who are the most vulnerable to declines following hospitalization.
Polypharmacy and potentially inappropriate medications in patients requiring palliative care in hospitals and nursing homes: Evidence from a Ligurian point-prevalence multicenter study.
Peruzzo S, Tagliafico L, Ottaviani S … +6 more , Della Rovere F, Marani C, Mattioli M, Nencioni A, Monacelli F, Genoa's Palliative Care Day Network
Maturitas · 2026 Jun · PMID 41950773 · Publisher ↗
OBJECTIVES AND BACKGROUND: Older adults with multimorbidity and frailty frequently require palliative care, yet prescribing practices often remain focused on primary or secondary disease prevention rather than symptom re...
OBJECTIVES AND BACKGROUND: Older adults with multimorbidity and frailty frequently require palliative care, yet prescribing practices often remain focused on primary or secondary disease prevention rather than symptom relief. Polypharmacy and potentially inappropriate medications (PIMs) may undermine quality of life and alter the benefit-to-harm ratio in this population. This study evaluated the prevalence of polypharmacy, pharmacological prescribing patterns and PIMs in hospitalized older adults requiring palliative care. STUDY DESIGN: This nested study of the Italian multicenter point-prevalence study (Palliative Care 2.0) included patients aged ≥65 years from three metropolitan hospitals and three nursing homes in Genoa, Liguria, Italy. Needs for palliative care were assessed using the NECPAL CCOMS-ICO© tool and those categorized as 'positive' were staged I-III. Polypharmacy (≥5 drugs) and five PIMs were evaluated according to STOPP-Frail criteria. Data were analyzed through appropriate hypothesis tests (Mann-Whitney, Anova, chi-squared) comparing NECPAL positive and negative participants, while associations with number of PIMs were explored through regression analysis. RESULTS: Of 558 patients initially screened, 294 were administered the NECPAL tool, of whom 254 (45.5% of the sample screened) had PC needs (mean age 85 ± 11 years; 61% female). Polypharmacy was reported in 93.9% (276/294), with a median of 9 drugs (IQR 5). PIMs were identified in 68.2% of patients and were strongly associated with polypharmacy (p < 0.001), but were less common in nursing home residents compared with hospital patients (p < 0.001). Drug burden and the prevalence of PIMs did not decline with advancing NECPAL stage, except for increased antidiabetic use in stage III. CONCLUSIONS: Polypharmacy and PIM use are highly prevalent in older adults who require palliative care, persisting even in advanced stages of illness. Current practice appears to fall short of both effective deprescribing and fully aligning pharmacological therapy with goals of care and overall quality of life. Systematic efforts to align pharmacotherapy with patients' care goals and clinical status are essential to minimize harm and promote quality of life in the final stages of life.
Frailty and menopause: A gateway to healthy aging.
Monllor-Tormos A, Artero A, García-Pérez MÁ … +2 more , Tarín JJ, Cano A
Maturitas · 2026 Jun · PMID 41950772 · Publisher ↗
Frailty is a clinical state arising from the progressive erosion of physiological reserves across multiple systems, resulting in heightened vulnerability to stressors and an increased risk of adverse health outcomes. Str...
Frailty is a clinical state arising from the progressive erosion of physiological reserves across multiple systems, resulting in heightened vulnerability to stressors and an increased risk of adverse health outcomes. Strategies to promote healthy aging may benefit from the early identification of frailty and the implementation of targeted interventions aimed at mitigating or potentially reversing this condition. Interest in frailty within the context of women's health stems from epidemiological evidence indicating that women have a higher risk of developing frailty than men. Moreover, menopause has been associated with an increased susceptibility to frailty. On this basis, the present review examines the contribution of key hormonal factors involved in the physiological changes accompanying menopause to the development of frailty in women. Specifically, it focuses on steroid-related pathways, including estrogens, androgens, and vitamin D. By integrating the available evidence, this review aims to clarify their potential roles in frailty susceptibility during midlife and beyond. There are some indications, albeit based on limited evidence, of a protective role of menopausal hormone therapy. Encouragingly, healthy dietary patterns and regular physical activity have demonstrated efficacy in mitigating frailty, reinforcing the importance of lifestyle strategies to counteract the adverse effects of menopause.
The impact of resistance training on the Atherogenic index of plasma and cardiometabolic health-related indicators in middle-aged and older adults with type 2 diabetes: A systematic review and Meta-analysis.
Zhang X, Sun Y, Yang K … +2 more , Guo H, Zhang X
Maturitas · 2026 Jun · PMID 41950771 · Publisher ↗
OBJECTIVE: To examined the effects of resistance training on the atherogenic index of plasma in middle-aged and older adults with type 2 diabetes mellitus. Secondary objectives included evaluating its impact on glycemic...
OBJECTIVE: To examined the effects of resistance training on the atherogenic index of plasma in middle-aged and older adults with type 2 diabetes mellitus. Secondary objectives included evaluating its impact on glycemic markers (hemoglobin A1c, HOMA-IR) and a broad range of cardiovascular risk factors. METHODS: We systematically reviewed and meta-analyzed 33 randomized controlled trials (n = 1396) sourced from four databases. We employed random-effects meta-analyses, along with subgroup and meta-regression analyses, to explore potential moderators of the intervention's effects. RESULTS: Resistance training led to a significant reduction in atherogenic index of plasma (effect size = -0.56), with notably stronger effects observed in overweight/obese participants. Although heterogeneity was substantial across several outcomes, its sources were partly explained by sex, body mass index, and supervision-related moderators, and findings remained consistent after exclusion of high-risk studies. Resistance training also improved glycemic control, reducing hemoglobin A1c by -0.62% and HOMA-IR by -0.90, and lowered systolic blood pressure (-3.91 mmHg) and body fat (-0.54%), while increasing VO₂max (effect size = 0.53). CONCLUSIONS: Despite heterogeneity and varying methodological quality among included trials, the pooled evidence indicates that resistance training produces clinically relevant improvements in atherogenic index of plasma and key cardiometabolic risk markers in adults with type 2 diabetes mellitus. The findings should be interpreted with caution due to differences in study design, population demographics, and geographic concentration of included studies. These results provide evidence-based insights supporting the integration of resistance training into lifestyle interventions aimed at cardiovascular risk reduction in aging populations.
Joint and mediating effects of cardiovascular health in the association between social determinants of health and mortality among postmenopausal women: Evidence from a nationally representative cohort study.
Guo H, Ye Y, Ji J … +1 more , Wang X
Maturitas · 2026 Jun · PMID 41950770 · Publisher ↗
OBJECTIVES: To examine the joint effects and mediating role of cardiovascular health (CVH) in the association between social determinants of health and mortality among postmenopausal women. STUDY DESIGN: A nationally rep...
OBJECTIVES: To examine the joint effects and mediating role of cardiovascular health (CVH) in the association between social determinants of health and mortality among postmenopausal women. STUDY DESIGN: A nationally representative cohort of 7577 postmenopausal women from NHANES 2003-2018, with mortality follow-up through 2019. MAIN OUTCOME MEASURES: Social determinants of health were derived from eight indicators across five Healthy People 2030 domains, and CVH was assessed using the Life's Essential 8 score. Survey-weighted Cox models estimated hazard ratios (HRs), with risk advancement periods (RAPs) quantifying time shifts. Joint associations were examined by combining social determinants of health (<3 vs. ≥3) and CVH (high, moderate, low). Counterfactual mediation analyses quantified the mediating role of CVH. RESULTS: Over a median 79-month follow-up, 1247 deaths occurred. Each unfavorable social determinant of health significantly increased all-cause, CVD, and cancer mortality by 23%, 24%, and 23% (RAPs +2.2, +1.6, +2.7 years), respectively. Each 10-point decrease in CVH score significantly increased mortality by 28%, 36%, and 26% (RAPs +2.6, +2.3, +3.1 years). Women with both high social determinants of health burden (>3) and low CVH had the highest all-cause, CVD, and cancer mortality (HRs = 4.14, 5.01, 5.61), corresponding to RAPs of 15.6, 12.5, and 23.4 years. CVH explained 20.4%, 27.7%, and 19.6% of the associations between cumulative unfavorable social determinants of health and all-cause, CVD, and cancer mortality, respectively. CONCLUSIONS: Cumulative unfavorable social determinants of health and poor CVH jointly contribute to higher and earlier mortality in postmenopausal women. Enhancing CVH can attenuate the mortality disparities driven by social disadvantage.
Does physical activity mediate the reduction of depressive symptoms in older adults treated with behavioural activation? A secondary analysis of a cluster randomised trial.
Janssen NP, Hendriks GJ, Pietersma M … +4 more , Lucassen P, Oude Voshaar RC, Smulders K, Pijnappels M
Maturitas · 2026 May · PMID 41931879 · Publisher ↗
BACKGROUND: Behavioural activation reduces depressive symptoms in older adults but its working mechanisms remain unknown. Physical activity may play a role by decreasing depressive symptoms in older adults. We investigat...
BACKGROUND: Behavioural activation reduces depressive symptoms in older adults but its working mechanisms remain unknown. Physical activity may play a role by decreasing depressive symptoms in older adults. We investigated whether an increase in physical activity explains the effects of behavioural activation on depressive symptoms in older adults. METHODS: Participants were 44 adults aged 65-88 years, who participated in a cluster randomised trial evaluating the effectiveness of an eight-week behavioural activation treatment (n = 25) compared with eight weeks of treatment as usual (TAU; n = 19) in primary care. Mediation analysis was used to evaluate whether the effects of behavioural activation on depression were mediated by physical activity as assessed by trunk accelerometer. RESULTS: Physical activity did not mediate the effect of behavioural activation on depression because physical activity was not related to type of treatment (p = 0.336). An increase in physical activity was associated (R = 0.075) with a decrease in depressive symptoms, regardless of type of treatment (p < 0.05). CONCLUSION: In this sample, physical activity did not explain the difference in effectiveness between behavioural activation and treatment as usual. In line with the literature, our results showed an association of a small increase in physical activity with a decrease in depressive symptoms, regardless of treatment modality. Larger studies are needed to replicate these findings. TRIAL REGISTRATION: Netherlands Trial Register, NL5436.
Menopausal hormone therapy in breast cancer survivors: A review.
Granat LM, Pederson HJ, Kruse M
Maturitas · 2026 May · PMID 41921281 · Publisher ↗
The use of menopausal hormone therapy (MHT) by breast cancer survivors remains controversial. While MHT is effective for the management of menopausal symptoms in the general population, its safety after breast cancer is...
The use of menopausal hormone therapy (MHT) by breast cancer survivors remains controversial. While MHT is effective for the management of menopausal symptoms in the general population, its safety after breast cancer is uncertain due to limited and heterogeneous data. Menopausal symptoms, including vasomotor and genitourinary complaints, can significantly impair quality of life and adherence to therapy. Non-hormonal treatments are the first-line option but are often insufficient. Evidence suggests that low-dose vaginal estrogen can relieve genitourinary symptoms with minimal systemic absorption and without clear evidence of increased recurrence risk. In contrast, systemic MHT remains highly debated, with conflicting data confounded by differences in study design, hormone formulation, and patient selection. Management should therefore be individualized, balancing symptom severity, recurrence risk, and patient preferences. Until more definitive data are available, multidisciplinary collaboration and shared decision-making remain essential in optimizing quality of life while minimizing oncologic risk.
Effects of vaginal dehydroepiandrosterone and estradiol on dyspareunia, a symptom of vulvovaginal atrophy in postmenopausal women - a randomized controlled trial.
Strandberg M, Cockin A, Hirschberg AL
Maturitas · 2026 May · PMID 41903372 · Publisher ↗
OBJECTIVES: The primary objective was to evaluate the efficacy of vaginal dehydroepiandrosterone (DHEA) and estradiol (E2) on dyspareunia, a symptom of vulvovaginal atrophy (VVA) in postmenopausal women. STUDY DESIGN: In...
OBJECTIVES: The primary objective was to evaluate the efficacy of vaginal dehydroepiandrosterone (DHEA) and estradiol (E2) on dyspareunia, a symptom of vulvovaginal atrophy (VVA) in postmenopausal women. STUDY DESIGN: In an open-label, randomized controlled trial, 172 naturally postmenopausal women with a mean age of 62.4 ± 5.7 years and moderate or severe dyspareunia caused by VVA, received DHEA (6.5 mg pessaries) or E2 (10 μg vaginal tablets) daily for 4 weeks and then twice-weekly up to 12 weeks. Symptoms and signs of VVA were assessed at baseline, week 4 and 12 of treatment. MAIN OUTCOME MEASURES: The primary outcome was the proportion of patients in each treatment group achieving an improvement of 1 point or more in dyspareunia score on a 4-point scale (none, mild, moderate, severe). Secondary outcomes included other symptoms and objective signs of VVA. RESULTS: Women in both groups had improved in dyspareunia by week 12 (DHEA 92% and E2 82%), with a tendency of significant difference between the groups (OR 2.87, 95% CI 1.00-8.25; p = 0.051). For those with severe dyspareunia at baseline there was higher odds of improvement in the DHEA group than in the E2 group (OR 3.4, 95% CI 1.07-10.5). Vaginal pH, maturity index, and total score for clinical signs of atrophy improved more in the E2 group than in the DHEA group. CONCLUSION: Vaginal DHEA tended to improve dyspareunia more than E2 and was superior in alleviating severe dyspareunia in postmenopausal women. On the other hand, vaginal E2 was superior in improving clinical subjective and objective signs of VVA. CLINICALTRIAL: gov registration number NCT05586711.
Prevalence of sleep problems and influencing factors among Chinese women aged 35-60 years.
Yang Y, Yang Y, Yong Z … +7 more , Yang L, Zhao Y, Yan M, Luo X, Yu Y, Zhao L, Zheng R
Maturitas · 2026 May · PMID 41903371 · Publisher ↗
OBJECTIVE: To investigate the prevalence of sleep problems and factors influencing sleep problems among Chinese women aged 35-60 years. METHODS: This study was a large-scale, nationwide cross-sectional survey. Using a mu...
OBJECTIVE: To investigate the prevalence of sleep problems and factors influencing sleep problems among Chinese women aged 35-60 years. METHODS: This study was a large-scale, nationwide cross-sectional survey. Using a multistage stratified random sampling method, a total of 52,665 women aged 35-60 years were selected from 12 provinces across China. Sociodemographic information, health status, and physiological indicators were collected. Sleep quality was assessed using the Pittsburgh Sleep Quality Index. A stepwise logistic regression model was used to identify the factors associated with sleep problems. RESULTS: The overall prevalence of sleep problems among Chinese women aged 35-60 years was 38.34%. Women aged 50-55 years had the highest prevalence, at 39.32%.The prevalence among premenopausal women (37.57%) was significantly lower than that among postmenopausal women (39.71%). Poor sleep efficiency was the most common problem, with a prevalence of 47.92%. The amount of green space per capita was significantly negatively associated with the occurrence of sleep problems, particularly among postmenopausal women. In analyses of specific sleep dimensions, the amount of green space was inversely associated with prolonged sleep latency and poor sleep efficiency, but positively associated with poor subjective sleep quality, short sleep duration, and sleep disturbances. CONCLUSION: Sleep problems were prevalent among Chinese women aged 35-60 years and were influenced by a complex interplay of demographic characteristics, lifestyle behaviors, and residential environmental factors. The heterogeneous associations observed across menopausal status and sleep dimensions suggest that tailored prevention strategies addressing modifiable lifestyle factors and environmental conditions may be essential for improving sleep health and reducing the overall burden of sleep problems in midlife women.
The association between pulse pressure index (PPI) and atrial fibrillation (AF) from a gender difference perspective in Chinese adults with hypertension.
Yan C, Peng Q, Wang X … +7 more , Zhou W, Yu C, Wang T, Zhu L, Bao H, Cheng X, Yu J
Maturitas · 2026 May · PMID 41903370 · Publisher ↗
AIMS: The pulse pressure index, derived on a theoretical basis from arterial elasticity characteristics, represents an optimized metric calculated by determining the ratio of pulse pressure to systolic blood pressure. Pr...
AIMS: The pulse pressure index, derived on a theoretical basis from arterial elasticity characteristics, represents an optimized metric calculated by determining the ratio of pulse pressure to systolic blood pressure. Previous studies have confirmed the association between pulse pressure index and cardiovascular diseases. However, research on the relationship between pulse pressure index and atrial fibrillation remains insufficient. METHODS: This study had a total of 9091 hypertensive patients in the final analysis, including 245 patients with new-onset atrial fibrillation. Cox proportional hazards regression models and restricted cubic spline were applied to explore the association between pulse pressure index and atrial fibrillation. RESULTS: After adjusting for potential confounding factors, the analysis revealed a positive association between pulse pressure index and atrial fibrillation (HR 1.20, 95% CI 1.05-1.38). A gender-stratified analysis showed that this association was statistically significant in women (HR 1.28, 95% CI 1.04-1.57) but not in men (HR 1.14, 95% CI 0.95-1.37). Further subgroup analyses indicated that the relationship between pulse pressure index and atrial fibrillation remained consistent across different subgroups (all interaction P values >0.05). CONCLUSIONS: Our findings suggest that the pulse pressure index may assist in identifying patients at high risk of atrial fibrillation. Additionally, it could help hypertensive patients implement stricter blood pressure management to reduce their risk of atrial fibrillation.
Breast plastic surgery in perimenopausal and postmenopausal women: Menopause-informed counseling on screening, safety, and long-term breast health.
Yanay N, Babb G, Williams-Medina E … +3 more , Allbright ML, Ogbonnah CO, Schwarz GS
Maturitas · 2026 May · PMID 41903369 · Publisher ↗
OBJECTIVES: To synthesize evidence on breast plastic surgery in peri- and postmenopausal women and provide menopause-informed guidance on surgical safety, cancer screening, and long-term implant surveillance. STUDY DESIG...
OBJECTIVES: To synthesize evidence on breast plastic surgery in peri- and postmenopausal women and provide menopause-informed guidance on surgical safety, cancer screening, and long-term implant surveillance. STUDY DESIGN: Narrative review of clinical trials, observational cohorts, registries, guideline statements, and high-quality reviews addressing breast augmentation, reduction, mastopexy, and reconstruction in women aged 50 years or more. MAIN OUTCOME MEASURES: Perioperative complications, venous thromboembolism, wound-healing and donor-site problems, long-term device outcomes (reoperation, capsular contracture, rupture, breast implant-associated malignancies, breast cancer screening performance, implant integrity surveillance, and patient-reported outcomes. RESULTS: Across procedures, chronological age alone is not an independent predictor of major short-term complications; risk is driven primarily by comorbidities (diabetes, obesity, smoking, prior radiation) and by hormone-related changes in skin quality, vascularity, and coagulation. Hypoestrogenic states and certain hormone therapies are associated with modestly higher rates of wound-healing problems and venous thromboembolism, particularly in microsurgical reconstruction, but absolute risks remain acceptable with optimization and prophylaxis. For implant-based surgery, reoperation rates of roughly 20-40% at 10 years reflect capsular contracture, rupture, and aesthetic change, while rare late events such as breast implant-associated anaplastic large-cell lymphoma become increasingly relevant as women age with implants in situ. Implants reduce mammographic sensitivity, necessitating implant-displacement views and individualized imaging strategies that distinguish cancer screening from device surveillance. Despite these complexities, postmenopausal women report high satisfaction and meaningful quality-of-life gains across aesthetic and reconstructive procedures. CONCLUSIONS: Breast plastic surgery after menopause is safe and beneficial when comorbidities, frailty, and hormone therapy are thoughtfully managed. Menopause-informed, risk-stratified counseling and coordinated screening and surveillance plans are key to supporting durable, patient-centered breast health in midlife and beyond.
Effect of Lactobacillus-based probiotics on genitourinary syndrome of menopause in post-menopausal women: A systematic review.
Tsuboi I, Inoue S, Maruyama Y … +4 more , Mitsui Y, Hirakawa H, Araki M, Sadahira T
Maturitas · 2026 May · PMID 41903368 · Publisher ↗
BACKGROUND AND OBJECTIVE: Genitourinary syndrome of menopause is a chronic condition caused by estrogen deficiency after menopause and includes both vaginal and urinary symptoms that significantly impair quality of life....
BACKGROUND AND OBJECTIVE: Genitourinary syndrome of menopause is a chronic condition caused by estrogen deficiency after menopause and includes both vaginal and urinary symptoms that significantly impair quality of life. Although local estrogen therapy is effective, non-hormonal alternatives are needed for women in whom hormonal treatment is contraindicated or unacceptable. We investigated the clinical evidence on the efficacy of Lactobacillus-based probiotic interventions for the management of genitourinary syndrome of menopause. METHODS: In January 2026, PubMed, Scopus, and Embase were searched for studies evaluating oral or intravaginal Lactobacillus-based probiotics in women with genitourinary syndrome of menopause. RESULTS: Nine studies with a total of 751 patients were included - five randomized controlled trials and four prospective studies. Five studies evaluated urinary outcomes, including recurrent cystitis, recurrent urinary tract infection, and lower urinary tract symptoms, while four focused on vaginal outcomes such as vaginal microbiota composition, vaginal pH, vaginal health index, and vulvar pain. Intravaginal Lactobacillus showed a preventive effect for recurrent cystitis in single-arm and prospective cohort studies, whereas randomized controlled trials demonstrated mixed or negative results compared with antibiotic prophylaxis. Evidence for improvement in lower urinary tract symptoms and vaginal manifestations of genitourinary syndrome of menopause was limited and heterogeneous, particularly in studies using oral probiotic administration. CONCLUSION: Lactobacillus-based interventions may represent a complementary therapeutic option for selected women with genitourinary syndrome of menopause, especially for urinary manifestations associated with vaginal dysbiosis. However, current evidence is limited by heterogeneity in study design, probiotic formulations, and routes of administration. Well-designed randomized clinical trials, particularly those evaluating intravaginal Lactobacillus formulations, are required to clarify their clinical role in genitourinary syndrome of menopause management. PROSPERO REVIEW REGISTRATION: CRD420251244350.
Severity of menopausal symptoms is associated with lower work-related quality of life and job satisfaction in midlife Latin American women: REDLINC XIII.
Vallejo MS, Blümel JE, Chedraui P … +30 more , Matsumura-Kasano J, Meza P, Monterrosa-Castro Á, Ñañez M, López M, Ojeda E, Rey C, Valadares ALR, Rodríguez-Vidal D, Rodrigues MAH, Saavedra J, Salinas C, Sosa L, Tserotas K, Acuña-San Martín M, Aguirre MS, Arteaga E, Ayala F, Bencosme A, Calle A, Costa-Paiva L, Dextre M, Díaz K, Elizalde-Cremonte A, Elizalde-Cremonte S, Escalante C, Espinoza MT, García I, Gómez-Tabares G, Gutiérrez-Crespo H
Maturitas · 2026 May · PMID 41894950 · Publisher ↗
BACKGROUND: Female participation in the workforce has increased, particularly among women over 50; hence, the influence of menopause on occupational well-being requires greater attention. Although the epidemiology of cli...
BACKGROUND: Female participation in the workforce has increased, particularly among women over 50; hence, the influence of menopause on occupational well-being requires greater attention. Although the epidemiology of climacteric symptoms has been well documented, their impact on job satisfaction and work-related quality of life remains underexplored, especially in low- and middle-income countries, and is virtually absent from large, multinational studies in Latin America. OBJECTIVE: To evaluate the relationship between severe menopausal symptoms and occupational well-being among salaried, employed midlife women in Latin America. METHODS: A cross-sectional study was conducted between June 2024 and January 2025 across 30 centres in 12 Latin American countries, with a total of 2035 employed women (aged 40 to 60 years). Menopausal symptoms were assessed with the Menopause Rating Scale, and occupational well-being domains were assessed using the Work-Related Quality of Life Scale and the Job Satisfaction Scale. Hierarchical multiple linear regression analyses were conducted to assess the contribution of menopausal symptom severity to occupational well-being. RESULTS: Women with severe menopausal symptoms scored significantly lower across all domains of both the Job Satisfaction Scale and the Work-Related Quality of Life Scale. Hierarchical regression analyses showed that menopausal symptoms were the strongest predictors of job satisfaction (R = 0.133). Higher education, menopausal hormone therapy use, and physical activity were positive predictors, whereas number of children, comorbidities, psychotropic medication use, and higher body mass index were associated with lower job satisfaction. For work-related quality of life (R = 0.121), education, physical activity, and sexual activity were the main positive predictors, while psychological and severe menopausal symptoms were the strongest negative predictors. The final models explained 13.3% of the variance in job satisfaction and 18.7% in work-related quality of life. CONCLUSIONS: This study, one of the first large multinational analyses in Latin-American, shows that the severity of menopausal symptoms is negatively associated with occupational well-being. These findings highlight the necessity for workplace strategies and public policies that recognise menopause as a significant determinant of women's occupational well-being.
Prescribing practices for menopausal hormone therapy in France in 2025: A national online survey (MENOPRAT).
Hardy C, Gosset A, Rouchou L … +4 more , Frantz S, Hocke C, Tremollieres F, Bernard V
Maturitas · 2026 May · PMID 41886876 · Publisher ↗
OBJECTIVES: This study was performed to provide an updated overview of menopause management among French gynaecologists in 2025, with a focus on prescribing practices for menopausal hormone therapy (MHT), perceived barri...
OBJECTIVES: This study was performed to provide an updated overview of menopause management among French gynaecologists in 2025, with a focus on prescribing practices for menopausal hormone therapy (MHT), perceived barriers, and the use of alternative therapies. STUDY DESIGN: This national, cross-sectional, anonymous online survey was conducted between March and June 2025. MAIN OUTCOME MEASURES: The primary outcome was the proportion of respondents prescribing MHT as first-line therapy for moderate to severe vasomotor symptoms (VMS) in women without contraindications. The secondary outcomes were physicians' perceptions assessed using 0-10 scales, barriers to prescribing, and the use of alternative therapies. RESULTS: In total, 440 questionnaires were analysed. Overall, 76.4% of physicians reported prescribing MHT as first-line treatment for VMS. The median rating of 'comfort with prescribing' was 8.0 (interquartile range 7.0-9.0), and perceived benefit was high (median 9.0, interquartile range 8.0-10.0). The most frequently reported barriers were patients' hesitancy (59.8%), physicians' concern regarding elevated risks of breast cancer and cardiovascular events (34.8% and 29.5%, respectively). Alternative therapies were commonly used, mainly in cases of contraindication to or refusal of MHT; dietary supplements (70.0%), acupuncture (39.0%), and phytoestrogens (37.0%) were the most frequently prescribed. Finally, 67% of respondents expressed interest in additional training on MHT. CONCLUSIONS: Despite strong perceived benefits and a high level of comfort with prescribing, one in four gynaecologists does not systematically offer MHT as first-line therapy for moderate to severe VMS. A gap persists between guidelines and real-life menopause care. Patient hesitancy and risk perceptions underline the need for improved education and decision-support tools.
Evaluation of handgrip strength and prostate cancer risk using propensity score matching in 64,371 European men.
Qaisar R, Hussain MA, Karim A … +4 more , Ahmad F, Naheed S, Saeed K, Alkahtani SA
Maturitas · 2026 May · PMID 41880876 · Publisher ↗
BACKGROUND: The predictive value of low handgrip strength (HGS) for prostate cancer remains unclear. This study assessed whether low HGS is associated with increased prostate cancer risk among older European men. METHODS...
BACKGROUND: The predictive value of low handgrip strength (HGS) for prostate cancer remains unclear. This study assessed whether low HGS is associated with increased prostate cancer risk among older European men. METHODS: Data were drawn from a longitudinal cohort of 64,371 men aged 50 and above at baseline, recruited in wave 1 (2004) of the Survey of Health, Ageing, and Retirement in Europe (SHARE), and followed prospectively across multiple waves from 2004 to 2022. Prostate cancer was identified via self-reported physician diagnoses. HGS was measured using a Smedley dynamometer. We applied pooled logistic regression, fixed-effects models, and propensity score matching (PSM), adjusting for age, body mass index (BMI), mental health, chronic conditions, and country-level effects. RESULTS: Initial models showed that low HGS was associated with a 1.13 percentage point increase in prostate cancer risk. However, this association became statistically insignificant after adjusting for covariates. Logistic regression yielded an unadjusted odds ratio of 1.742, which lost significance when adjusted. Fixed-effects models showed no significant association of low HGS with prostate cancer. PSM estimated a 66% relative increase in risk (1.04 percentage points; OR = 1.641) - though statistically insignificant after country-level matching. CONCLUSION: Low HGS does not independently predict prostate cancer risk in older European men. While HGS is a valuable marker of overall health, its role in assessing prostate cancer risk appears to be limited. Future research should investigate the biological pathways that link muscle strength to cancer outcomes.
Frailty, cardiovascular health, and the risk of mortality and extrahepatic diseases in patients with metabolic dysfunction-associated steatotic liver disease.
Li J, Li J, Xu X … +3 more , Wang N, Wang B, Lu Y
Maturitas · 2026 May · PMID 41880875 · Publisher ↗
AIMS: To evaluate the association of frailty with mortality and incident extrahepatic diseases in individuals with metabolic dysfunction-associated steatotic liver disease and the interaction between frailty and cardiova...
AIMS: To evaluate the association of frailty with mortality and incident extrahepatic diseases in individuals with metabolic dysfunction-associated steatotic liver disease and the interaction between frailty and cardiovascular health. METHODS: This prospective cohort study included 107,867 participants with metabolic dysfunction-associated steatotic liver disease from the UK Biobank. Metabolic dysfunction-associated steatotic liver disease is defined as hepatic steatosis plus cardiometabolic abnormality. Frailty was assessed as physical frailty based on five components (weight loss, exhaustion, physical activity, gait speed, and grip strength) and the Rockwood frailty index, while cardiovascular health was evaluated using the Life's Essential 8 score. RESULTS: Frailty was associated with increased risks of all-cause mortality (physical frailty: HR 2.01, 95% CI 1.87-2.16; frailty index: HR 1.63, 95% CI 1.54-1.74) and incident extrahepatic diseases with the exception of cancer (physical frailty: HRs ranged from 1.62 to 3.35; frailty index: HRs ranged from 1.34 to 8.07). Among the five components of physical frailty, slow gait speed exhibited the strongest associations with most adverse outcomes. There were significant multiplicative and additive interactions between frailty and cardiovascular health on respiratory disease mortality, heart failure, and peripheral arterial disease. Compared with participants with no frailty and good cardiovascular health, those with both frailty and poor cardiovascular health had the highest risks of all adverse outcomes. CONCLUSION: Frailty was associated with increased risks of mortality and extrahepatic complications in metabolic dysfunction-associated steatotic liver disease, particularly in those with suboptimal cardiovascular health. Early detection and interventions for frailty are needed alongside cardiovascular health promotion to enhance the prognosis of metabolic dysfunction-associated steatotic liver disease.
Safety of vaginal estrogen in breast cancer survivors: Current evidence on systemic absorption and oncologic outcomes.
Mainar LB, Nieto-Pascual L, Bravo EI … +5 more , García-Ramos BO, Llaneza IP, Vilanova CT, Lloret AM, Alsina JC
Maturitas · 2026 May · PMID 41864136 · Publisher ↗
Vaginal estrogen is widely used to manage the genitourinary syndrome of menopause. However, its use by breast cancer survivors remains controversial, since some labeling indicates that it may increase the risk of recurre...
Vaginal estrogen is widely used to manage the genitourinary syndrome of menopause. However, its use by breast cancer survivors remains controversial, since some labeling indicates that it may increase the risk of recurrence, based on the known risks of systemic hormone therapy. This review synthesizes current evidence on breast cancer incidence and the use of vaginal estrogen in postmenopausal women, and its systemic absorption, as well as recurrence, mortality, and comparative data among vaginal estrogen formulations in breast cancer survivors, including those receiving aromatase inhibitors. Our findings show that vaginal estrogen results in minimal systemic absorption, and no demonstrated increase in the incidence of breast cancer, its recurrence, or mortality from breast cancer. In breast cancer survivors treated with aromatase inhibitors, vaginal estrogen has not been associated with increased mortality, although evidence on its effect on recurrence remains controversial and the issue warrants further investigation. The absence of head-to-head comparisons of different formulations of vaginal estrogen in breast cancer survivors emphasizes the need for comparative studies to guide individualized treatment strategies. Recent updates from the US Food and Drug Administration, which removed boxed warnings related to breast cancer and acknowledged that vaginal estrogens have a safety profile that is distinct from that of systemic hormone therapy, reinforce our findings and represent an important step toward evidence-based regulation. Building on these regulatory advances, the increasing diagnosis of breast cancer in younger women and the prolonged burden of genitourinary syndrome of menopause underscore the need to translate this evidence into clinical practice by strengthening clinical confidence and supporting individualized, patient-centered decision-making for breast cancer survivors.
Nonlinear association between triglyceride-glucose frailty index and new-onset stroke in adults at cardiovascular-kidney-metabolic syndrome stages 0-3: a CHARLS cohort study.
Wei J, Liu Y
Maturitas · 2026 May · PMID 41864135 · Publisher ↗
BACKGROUND: The triglyceride-glucose frailty index integrates metabolic load and physiological vulnerability. Its association with incident stroke among individuals at cardiovascular-kidney-metabolic syndrome stages 0-3...
BACKGROUND: The triglyceride-glucose frailty index integrates metabolic load and physiological vulnerability. Its association with incident stroke among individuals at cardiovascular-kidney-metabolic syndrome stages 0-3 remains unclear. METHODS: We performed an observational cohort analysis in the China Health and Retirement Longitudinal Study. Adults at cardiovascular-kidney-metabolic syndrome stages 0-3 who were free of stroke at baseline were included. The exposure of interest was the triglyceride-glucose frailty index, and the outcome was incident stroke during follow-up. Cox proportional hazards models estimated adjusted associations. Nonlinearity was assessed with restricted cubic splines. Effect modification by baseline cognitive function was tested using interaction terms. Regression-based mediation evaluated self-rated health and hypertension. RESULTS: A total of 6882 adults without stroke at baseline were included, among whom 583 incident strokes occurred during follow-up, an incidence of 8.47%. Stroke incidence increased across tertiles of the triglyceride-glucose frailty index, from 5.14% to 8.24% and 12.03%, with clear separation of Kaplan-Meier curves. In Cox proportional hazards models, each 5-unit increase in the triglyceride-glucose frailty index was associated with a higher hazard of stroke, with a hazard ratio of 1.46 and a 95% confidence interval of 1.31 to 1.64. Compared with the lowest tertile, the hazard ratios were 1.54 (95% confidence interval 1.22 to 1.95) and 2.16 (95% confidence interval 1.71 to 2.73) for the middle and highest tertiles, respectively. Restricted cubic spline analyses indicated a nonlinear association, with an inflection point at a triglyceride-glucose frailty index value of approximately 8.31. Below this level, stroke risk increased more steeply, whereas the association was attenuated above this threshold. Baseline cognitive function significantly modified the association, with stronger effects observed among individuals with better cognitive function. Exploratory mediation analyses suggested that self-rated health and hypertension accounted for approximately 23.0% and 7.6% of the overall statistical association, respectively. Subgroup and sensitivity analyses yielded results that were broadly consistent with the primary findings. CONCLUSIONS: Among adults at cardiovascular-kidney-metabolic syndrome stages 0-3, a higher triglyceride-glucose frailty index was associated with an increased risk of incident stroke. This association was nonlinear, varied by baseline cognitive function, and was partially mediated by self-rated health and hypertension.
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