Maturitas[JOURNAL]
Sun
200 papers
The role of frailty in the association between testosterone levels and mortality risk in older men.
Zhang P, Hao W, Ji W … +5 more , Yuan T, Dai J, Ji L, Sheng W, Li S
Maturitas · 2026 Mar · PMID 41558148 · Publisher ↗
BACKGROUND: Testosterone plays an important role in male aging, yet its impact on mortality remains unclear. Frailty, a syndrome of physiological decline, may mediate this relationship. This study investigates the mediat...
BACKGROUND: Testosterone plays an important role in male aging, yet its impact on mortality remains unclear. Frailty, a syndrome of physiological decline, may mediate this relationship. This study investigates the mediating role of frailty in the association between testosterone levels and both all-cause and cardiovascular disease mortality in older men. METHODS: We analyzed data from 1478 men aged 60 years or more in the National Health and Nutrition Examination Survey (2011-2016). Cox proportional hazards models evaluated the direct association between testosterone and mortality. Mediation analysis on the log-hazard scale was conducted using the product-of-coefficients approach and Sobel tests to quantify indirect effects via the frailty index, and the proportion mediated was calculated as the ratio of the indirect to total effect. RESULTS: Higher testosterone levels were associated with lower risks of all-cause mortality (hazard ratio (HR) 0.892, 95% confidence interval (CI) 0.830-0.959; P = 0.002) and cardiovascular disease mortality (HR 0.820, 95% CI 0.716-0.939; P = 0.004). Frailty score was strongly associated with both all-cause (HR 1.648 per 0.1 increase) and cardiovascular disease mortality (HR 1.723 per 0.1 increase). Mediation analysis demonstrated that frailty substantially explained the association between testosterone and mortality. For all-cause mortality, the indirect pathway through frailty accounted for 35.9% of the total effect. After adjustment for frailty, the residual direct effect of testosterone was attenuated and no longer statistically significant, a pattern consistent with near-complete mediation. For cardiovascular disease mortality, frailty accounted for 21.7% of the association. Although the direct effect was reduced, its effect size and confidence interval indicated the possibility of remaining direct pathways, supporting a partial rather than complete mediation. CONCLUSION: Frailty mediates the relationship between testosterone and mortality in older men. Targeting frailty may enhance the survival benefits associated with testosterone, offering potential strategies for aging-related health interventions.
Home-based exercise reduces fall risk in older adults with mild cognitive impairment who have sustained a hip fracture: A 6-month randomized controlled trial.
Rice J, Falck RS, Seo YS … +8 more , Dian L, Davis JC, Jehu DA, Parmar N, Madden K, Guy P, Roffey D, Liu-Ambrose T
Maturitas · 2026 Mar · PMID 41548385 · Publisher ↗
OBJECTIVES: Falls cause more than 85% of hip fractures in older adults. Older adults with cognitive impairment have been largely excluded from research on people who have sustained a hip fracture. As a consequence, wheth...
OBJECTIVES: Falls cause more than 85% of hip fractures in older adults. Older adults with cognitive impairment have been largely excluded from research on people who have sustained a hip fracture. As a consequence, whether exercise reduces fall risk in this high-risk population is unknown. We address this gap by examining the effect of a home-based exercise program on fall risk in older adults with mild cognitive impairment after hip fracture. METHODS: This was a 6-month randomized controlled trial comparing the effect of the Otago Exercise Program (OEP) versus standard care (SC) on fall risk measured with the Physiological Profile Assessment. Participants with mild cognitive impairment (Montreal Cognitive Assessment score <26/30 and no dementia) who sustained a hip fracture were included. Secondary outcomes included the Short Physical Performance Battery, gait speed, Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test immediate and delayed recall, and Clinical Frailty Scale. RESULTS: Sixty participants, mean age 80 years (SD 7 years), were randomized (OEP, n = 30; SC, n = 30). At 6 months, compared with SC participants, OEP participants had significantly better Physiological Profile Assessment performance (estimated mean difference -0.73; 95% CI [-1.45, -0.11]; p = 0.048), delayed recall performance (estimated mean difference 1.11; 95% CI [0.14, 2.09]; p = 0.025), and Clinical Frailty scores (estimated mean difference -0.71; 95% CI [-1.40, -0.01]; p = 0.046). There were no effects of the intervention on other secondary outcomes at 6 months. CONCLUSIONS: The Otago Exercise Program was efficacious at reducing fall risk in older adults with mild cognitive impairment after hip fracture. Exercise also improved cognitive function and frailty, highlighting its critical role in recovery after hip fracture in this high-risk population.
Associations of DNA methylation algorithm measures of aging with type 2 diabetes and mortality risk among US older adults.
Zhao X, Ding C, Zhang H … +5 more , Xu Y, Gong Y, Hao D, Wang Z, Li X
Maturitas · 2026 Mar · PMID 41547195 · Publisher ↗
BACKGROUND: DNA methylation algorithm values show promise as biomarkers for aging and adverse health outcomes, However, their comparative predictive utility for type 2 diabetes mellitus and its related mortality remains...
BACKGROUND: DNA methylation algorithm values show promise as biomarkers for aging and adverse health outcomes, However, their comparative predictive utility for type 2 diabetes mellitus and its related mortality remains inadequately characterized. This study systematically evaluated twelve established epigenetic algorithms to address this knowledge gap. METHODS: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 1999-2002, we assessed twelve DNA methylation algorithms (e.g., PhenoAgeAcc, GrimAgeMortAcc, GrimAge2MortAcc) in relation to type 2 diabetes mellitus risk and mortality among 2532 participants aged 50 years or more. DNA methylation was measured using the Infinium Methylation EPIC BeadChip kit. Statistical models quantified effect estimates as odds ratios for type 2 diabetes mellitus risk and subdistribution hazard ratios for mortality, with 95% confidence intervals expressed per one-standard deviation increment in epigenetic age Acceleration metrics. RESULTS: Significant associations were observed for PhenoAgeAcc, GrimAgeMortAcc, and GrimAge2MortAcc with type 2 diabetes mellitus risk, with multivariable-adjusted odds ratios (95% confidence interval) per standard deviation increase of 1.24 (1.04-1.49), 2.08 (1.39-3.13), and 2.95 (1.97-4.43), respectively. These associations remained consistent across biological sex and age subgroups (50-64 vs. ≥65 years). For mortality risk, eight algorithm measures were positively associated with type 2 diabetes mellitus mortality, with GrimAgeMortAcc and GrimAge2MortAcc showing the strongest predictive performance, with adjusted subdistribution hazard ratios (95% confidence interval) per standard deviation increase of 1.61 (1.39-1.87) and 1.69 (1.48-1.93), respectively. CONCLUSIONS: DNA methylation algorithm values, particularly GrimAgeMortAcc and GrimAge2MortAcc, are strongly associated with prevalent type 2 diabetes mellitus and show significant utility for mortality risk stratification, highlighting the potential of these algorithms as tools for identifying high-risk populations. These findings highlight the potential of epigenetic biomarkers in guiding targeted prevention strategies.
Impact of long-term medication on estrobolome-associated β-glucuronidase and sulfatase activities: Implications for estrogen homeostasis in postmenopausal women.
Martínez-Nortes ME, Carrascosa-Romero C, Ávila-Gálvez MÁ … +1 more , Espín JC
Maturitas · 2026 Mar · PMID 41534157 · Publisher ↗
Menopause leads to a decline in circulating estrogen levels, increasing cardiometabolic risk, contributing to bone loss, and decreasing quality of life. The estrobolome, a subset of microbes with β-glucuronidase (GUS) an...
Menopause leads to a decline in circulating estrogen levels, increasing cardiometabolic risk, contributing to bone loss, and decreasing quality of life. The estrobolome, a subset of microbes with β-glucuronidase (GUS) and sulfatase activities, regulates estrogen homeostasis through deconjugation and enterohepatic recycling, thereby influencing systemic estrogen availability. Common long-term pharmacological treatments in postmenopausal women may alter gut microbial composition and function, potentially affecting estrobolome activity and systemic estrogen levels. This narrative review examines current evidence on how long-term pharmacological treatments may affect estrobolome-associated GUS and sulfatase activities, with implications for estrogen metabolism and health outcomes in postmenopausal women. A targeted literature search was performed to identify clinical studies on commonly prescribed drugs for hypertension, diabetes, dyslipidemia, osteoporosis, and depression in postmenopausal women, focusing on microbial taxa with reported GUS or sulfatase activity. Among the evaluated pharmacological classes, antidiabetic drugs, particularly metformin, are the most extensively studied, followed by antidepressants. These treatments can modulate key gut bacterial genera with GUS and sulfatase activities, including Bifidobacterium, Roseburia, Faecalibacterium, and Clostridium, which are relevant to metabolic and estrogen homeostasis. However, no studies have directly assessed the impact of pharmacological treatments on GUS and sulfatase activity in postmenopausal women. Understanding how chronic medication influences estrobolome dynamics may help identify strategies to support estrogen balance and improve systemic metabolic, hormonal, vascular, and inflammatory profiles. This review highlights the interplay between long-term medication, gut microbiota, and estrogen homeostasis as a promising avenue for personalized microbiota-targeted therapies in postmenopausal health.
Menopause and multiple sclerosis: A scoping review of symptoms, disease course, and lived experience.
Morgan D, Flores VA, Buxhoeveden S … +6 more , Motl R, Brounsuzian N, Simpson AC, Hill J, Hardy Y, Román CAF
Maturitas · 2026 Mar · PMID 41529424 · Full text
Menopause influences disease activity in women with multiple sclerosis. This scoping review mapped current evidence on menopause in women with multiple sclerosis across symptom, disease, biological, and lived experience...
Menopause influences disease activity in women with multiple sclerosis. This scoping review mapped current evidence on menopause in women with multiple sclerosis across symptom, disease, biological, and lived experience domains. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses and was preregistered on Open Science Framework (DOI 10.17605/OSF.IO/H8QBM). PubMed/MEDLINE, Embase, Web of Science, Scopus, CINAHL, and PsycINFO were searched for studies between January 1, 2018, and April 29, 2025. Two reviewers independently screened records with third-party adjudication. Eligible studies included women with multiple sclerosis (peri-, menopausal, or postmenopausal) and examined menopause-related outcomes. Data were synthesized descriptively across four domains: symptomatology, disease course, biological mechanisms, and quantitative patient perspectives. Of 7862 records, 19 studies were included, of which 18 were observational (cross-sectional, retrospective, longitudinal) and one a feasibility trial of menopausal hormone therapy. Menopause definitions varied (≥12 months amenorrhea, self-reported, biological, or analytic/time-varying). Most participants had relapsing-remitting multiple sclerosis with mild to moderate disability. Relapse activity declined after menopause, whereas indices of neurodegeneration and functional decline worsened. Symptoms often intensified and overlapped with aging. No studies captured patient perspectives using qualitative or mixed-method designs and relied solely on patient-reported outcomes. Evidence suggests menopause may accelerate multiple sclerosis progression, with reduced inflammation but greater neurodegeneration and symptom burden. Research is constrained by heterogeneity in accounting for age, inconsistent menopause definitions, and lack of qualitative studies. Clinicians should recognize overlapping menopausal and multiple sclerosis symptoms to inform individualized care. Future priorities include standardized menopause definitions and age-specific analytic frameworks in future mechanistic and qualitative MS research.
Risk of thyroid disorders after diagnosis of endometriosis: A 20-year retrospective cohort study.
Shih YH, Lu CH, Lung CC
Maturitas · 2026 Mar · PMID 41520457 · Publisher ↗
BACKGROUND: Emerging evidence suggests a potential link between endometriosis and thyroid disorders; however, long-term risks remain understudied. METHODS: We conducted a retrospective cohort study using data from the Tr...
BACKGROUND: Emerging evidence suggests a potential link between endometriosis and thyroid disorders; however, long-term risks remain understudied. METHODS: We conducted a retrospective cohort study using data from the TriNetX global Collaborative Network. Women aged 21-60 with endometriosis who received surgical or pharmacologic treatment were included in the endometriosis cohort. The comparison cohort comprised women without endometriosis who had undergone pelvic ultrasonography. Patients with pre-existing metabolic, cardiovascular, autoimmune, or thyroid conditions were excluded. Propensity score matching was performed based on demographic characteristics and clinical factors. RESULTS: After 1:1 matching, 118,360 patients were included. Over a 20-year follow-up, the endometriosis group had significantly higher risks of several thyroid conditions, including hypothyroidism (HR 1.19; 95% CI 1.13-1.25), hyperthyroidism (HR 1.21; 95% CI 1.09-1.35), Graves' disease (HR 1.27; 95% CI 1.04-1.56), non-toxic goiter (HR 1.31; 95% CI 1.23-1.39), thyroiditis (HR 1.32; 95% CI 1.18-1.48), and both malignant (HR 1.55; 95% CI 1.21-1.97) and benign (HR 2.47; 95% CI 1.73-3.52) thyroid neoplasms. The risk of thyroid disease did not differ significantly between women who received medical management and those who received surgical management, suggesting that the association may be intrinsic to endometriosis rather than treatment-related. Additionally, a history of delivery was associated with an increased risk of hypothyroidism (HR 1.39; 95% CI 1.17-1.66). CONCLUSION: Endometriosis is associated with an elevated long-term risk of diverse thyroid diseases. These findings highlight the need for proactive thyroid monitoring in patients with endometriosis.
Frailty transitions and relevant factors in midlife: A longitudinal analysis of the ELSA cohort with multi-state Markov models.
Yang J, Gao M, Jiang L … +2 more , Li Y, He L
Maturitas · 2026 Mar · PMID 41520456 · Publisher ↗
BACKGROUND: Frailty is an ageing-related health condition, but it is not restricted to older adults. Understanding the characteristics of frailty transitions and relevant factors in midlife would benefit frailty preventi...
BACKGROUND: Frailty is an ageing-related health condition, but it is not restricted to older adults. Understanding the characteristics of frailty transitions and relevant factors in midlife would benefit frailty prevention and management later in life. METHODS: Data on 3405 participants aged between 50 and 64 were selected from the English Longitudinal Study of Ageing (ELSA) across six waves (2008-2018). Frailty status at each wave was evaluated by a 52-item frailty index (FI), defining frailty as FI ≥ 0.25, pre-frailty as FI ≥ 0.12 and robustness as FI < 0.12. Multi-state Markov models were constructed to explore frailty transitions, and socioeconomic, behavioral and nutritional factors related to changes in frailty status. RESULTS: The incidence and improvement rates of frailty were 5.23 and 1.15 per 100 person-years, respectively. Among socioeconomic factors, high gross wealth (HR = 1.61, 95%CI [1.12, 2.33]) increased the likelihood of transition from frailty to pre-frailty. Among behavioral factors, using the internet (HR = 0.65, 95%CI [0.53, 0.80]) inhibited the progression from robustness to pre-frailty. Regular alcohol consumption (HR = 1.55, 95%CI [1.14, 2.11]) promoted a shift from pre-frailty to robustness. Living with others (HR = 0.52, 95%CI [0.39, 0.69]) and participating in voluntary activities (HR = 0.86, 95%CI [0.80, 0.94]) lessened progression from pre-frailty to frailty. Moderate (HR = 2.49, 95%CI [1.50, 4.14]) and vigorous (HR = 2.93, 95%CI [1.42, 6.07]) physical activity promoted the transition from frailty to pre-frailty. Among nutrition-related factors, high hemoglobin concentration (HR = 0.15, 95%CI [0.05, 0.47]) inhibited the development from robustness to frailty. CONCLUSION: Encouraging healthy lifestyle, active social participation, and balanced nutrition may be beneficial to middle-aged people in diminishing the development of frailty.
Bidirectional transitions of depressive symptoms among middle-aged and older Chinese adults: A multi-state Markov model analysis.
Zhu J, Wei C, Wu Y … +4 more , Chen H, Lin Y, Wang Z, Fang Y
Maturitas · 2026 Feb · PMID 41506083 · Publisher ↗
OBJECTIVE: Evidence on bidirectional transitions of mid- to late-life depressive symptoms and their determinants remains limited. This study aimed to characterize the progression and remission of depressive symptoms in C...
OBJECTIVE: Evidence on bidirectional transitions of mid- to late-life depressive symptoms and their determinants remains limited. This study aimed to characterize the progression and remission of depressive symptoms in Chinese middle-aged and older adults and to identify modifiable risk factors. METHODS: Data from the China Health and Retirement Longitudinal Study (2011-2020) were utilized, including 13,921 participants aged ≥45 years with at least 2 assessments using the Center for Epidemiologic Studies Depression Scale (CESD-10). Depressive symptoms were defined as a CESD-10 score ≥ 10. Continuous-time multi-state Markov models estimated transition intensities, probabilities, and mean sojourn times. Multivariable models provided transition-specific hazard ratios (HRs). RESULTS: Among 45,102 observed transitions, remission intensity exceeded progression intensity (0.255 vs 0.154 per year). The mean sojourn time was longer for non-depressive symptoms than for depressive symptoms (5.241 vs 3.238 years). At 5 years, remission probability was 43.40 % while progression was 26.20 %. Female sex, lower economic status, multimorbidity, limitations in activities of daily living, and short sleep predicted higher progression, with HRs of 1.320, 1.251, 1.238, 1.264, 1.283, respectively, and lower remission, with HRs of 0.816, 0.859, 0.854, 0.830, 0.855, respectively. Falls (HR = 1.147) and smoking (HR = 1.109) increased progression. Urban residence, higher levels of education, participation in activities, and greater life satisfaction reduced progression, with HRs of 0.724, 0.717, 0.842, 0.770, respectively, while urban residence, greater life satisfaction, and drinking at least once per month increased remission, with HRs of 1.109, 1.235, 1.151, respectively. CONCLUSION: Depressive symptoms in mid- to late life were bidirectional and potentially reversible. Socioeconomic disadvantage, multimorbidity, and functional impairment shaped unfavorable transitions, while modifiable behaviors and subjective well-being related to improved remission.
Efficacy and safety of daridorexant for the treatment of insomnia disorder in women of menopausal transition age: Insights from a randomized controlled trial.
Schaedel Z, Bakker TR, Bassetti C … +9 more , Briasoulis O, Cassel P, Pain S, Palacios S, Palmay C, Silvestri R, Stute P, Trémollieres F, Bertisch SM
Maturitas · 2026 Mar · PMID 41506007 · Publisher ↗
OBJECTIVES: To evaluate the efficacy and safety of daridorexant in women aged 47-55 years with insomnia disorder, an age group representative of the menopause transition. STUDY DESIGN: In this randomized, double-blind, p...
OBJECTIVES: To evaluate the efficacy and safety of daridorexant in women aged 47-55 years with insomnia disorder, an age group representative of the menopause transition. STUDY DESIGN: In this randomized, double-blind, placebo-controlled study (NCT03545191), conducted in 10 countries between May 2018 and May 2020, 930 patients with insomnia disorder were randomized using interactive response technology (1:1:1) to receive a single film-coated tablet of daridorexant 25 mg, 50 mg, or placebo every evening for 3 months. Subgroup analyses were performed among the 117 women aged 47-55 (25 mg n = 43; 50 mg n = 35; placebo n = 39). MAIN OUTCOME MEASURES: Efficacy endpoints included change from baseline to Month 3 of treatment in polysomnography-measured wake after sleep onset (WASO) and latency to persistent sleep (LPS), self-reported total sleep time (sTST), and insomnia-related daytime impairment, as recorded on the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ). Safety endpoints included adverse events and score on a visual analog scale for morning sleepiness. Efficacy was analyzed in all randomized subjects, and safety in all who received at least one treatment dose. RESULTS: At Month 3, daridorexant 50 mg vs placebo decreased WASO and LPS by a least-squares mean (LSM) of 13.8 min (95 % CI -29.0, 1.4) and 14.7 min (-30.0, 0.6) respectively, increased sTST by an LSM of 21.8 min (-3.9, 47.4) and decreased (improved) IDSIQ total score by an LSM of 4.1 (-14.4, 6.3). No marked deviations from the effect in the overall population were observed. The incidence of somnolence/fatigue was low and comparable across groups. Morning sleepiness improved in all groups. CONCLUSIONS: These analyses suggest that daridorexant 50 mg provides benefit in sleep outcomes and daytime functioning in women aged 47-55 with insomnia disorder. Daridorexant 50 mg is well tolerated in this population, with no increased risk of next-morning sleepiness or somnolence. GOV IDENTIFIER: NCT03545191.
Postmenopausal labial adhesion: A 5-stage classification system and clinical outcomes in a 14-patient series.
Ibanez RF, Fernandez M, Naduvakkat PP … +1 more , Dominguez-Bali A
Maturitas · 2026 Feb · PMID 41475304 · Publisher ↗
OBJECTIVES: To characterize postmenopausal labial adhesion, or vulvovaginal obliteration, as the end stage of genitourinary syndrome of menopause, propose a standardized 5-stage classification system, and evaluate outcom...
OBJECTIVES: To characterize postmenopausal labial adhesion, or vulvovaginal obliteration, as the end stage of genitourinary syndrome of menopause, propose a standardized 5-stage classification system, and evaluate outcomes following surgical and maintenance interventions. STUDY DESIGN: A retrospective single-center review was conducted of 14 consecutive postmenopausal women diagnosed with labial adhesion between December 2018 and August 2025. Demographic, clinical, and surgical data were collected. A novel 5-stage clinical classification was applied based on anatomical extent and functional limitation. MAIN OUTCOME MEASURES: Clinical presentation, intervention type, recurrence, and symptom resolution were assessed. Postoperative maintenance strategies were compared between estrogen monotherapy and combined estrogen-dilator therapy. RESULTS: The mean age was 76 years, with an average of 25 years since menopause and 22 years of sexual inactivity. Thirteen of 14 patients (92.9 %) presented with advanced disease (stages III-V). Common symptoms included urinary retention, weak urinary stream, and post-void dribbling (each 28.6 %). All advanced cases underwent surgical lysis; one stage II case was treated conservatively. Estrogen-only maintenance resulted in recurrence in 3/3 patients. After the protocol change, all subsequent patients received combined estrogen-dilator therapy, with no recurrences during a mean 24-month follow-up. All reported complete symptom resolution and improved quality of life. CONCLUSIONS: This largest series to date defines a reproducible 5-stage classification system for postmenopausal vulvovaginal obliteration. Surgical lysis effectively restores anatomy, but sustained vaginal patency requires maintenance with estrogen and mechanical dilation. Early recognition, standardized staging, and combined therapy may prevent progression and optimize long-term outcomes.
Patient satisfaction and experiences with menopause care for people with autoimmune diseases: an international mixed-methods study from the Menopause MATTERs Project.
Naidu KK, Taylor S, Kaul A … +13 more , Andreoli L, McLaren Z, D'Cruz D, Piper M, Diment W, Talaulikar V, Naughton F, Gallagher L, Holloway L, Tranah E, Tunks A, Reilly TJ, Sloan M
Maturitas · 2026 Feb · PMID 41468678 · Publisher ↗
OBJECTIVES: To understand the experiences and satisfaction with menopause care for women with autoimmune diseases. STUDY DESIGN: Exploratory, mixed-methods study (between December 2024 and March 2025) using an online sur...
OBJECTIVES: To understand the experiences and satisfaction with menopause care for women with autoimmune diseases. STUDY DESIGN: Exploratory, mixed-methods study (between December 2024 and March 2025) using an online survey for peri-, menopausal, and postmenopausal individuals (≥18 years), with and without confirmed autoimmune diagnoses. Survey participants were purposively selected for semi-structured interviews. MAIN OUTCOME MEASURES: Satisfaction with menopause care as measured across nine (co-designed) domains of: availability and access to clinicians, clinicians' knowledge, involvement in decision-making, consideration of primary disease, clinicians' empathy for physical and mental health symptoms, continuity and follow-up support, information received, flexibility in treatment. Other outcomes included qualitative themes from interviews with patients, types of clinicians consulted for menopause and reasons for seeking private menopause care and process measures of access to care. RESULTS: Satisfaction was significantly lower amongst women with autoimmune diseases (n = 3754) than those without autoimmune diseases (n = 480) across the nine metrics studied (p < 0·001). Qualitative analysis identified three themes: (1) menopause care was reactive and dependent on patients advocating for themselves; (2) there was fragmented and siloed care between specialties, with limited integration of the intersection between autoimmune diseases and menopause; and (3) mental health concerns often overshadowed menopause and autoimmune disease symptoms. CONCLUSION: The menopausal transition must be recognised as a unique stage in the management of autoimmune diseases. Our study suggests that menopause advice and care would benefit from increased clinician proactivity, empathy and knowledge. Greater evidence to inform clinical guidance and interdisciplinary training and integration is required.
Practice guideline for the treatment and management of iatrogenic premature ovarian insufficiency.
Ruan X, Xu C, Huang H … +63 more , Xu B, Yin C, Wu Y, Kong W, Tian Q, Yang X, Cao Y, Wu R, Zhang S, Xu L, Dai Y, Ju R, Jin J, Jin F, Ma F, Qin M, Yang J, Ni X, Cao X, Xue S, Chen J, Sun Y, Jia H, Sun Y, Zhou Q, Zhai J, Luo S, Wang Y, Li X, Zhang J, Xiong X, Lin Y, Wang G, Liu R, Zhang W, Jiao R, Wang J, Hu Z, Li P, Zhang H, Peng X, Li Z, Mi X, Du J, Gu M, Cheng J, Wang D, Wang H, Song Y, Ren M, Wang S, Xu T, Jia Z, Chen L, Shi Y, Li F, Zhang Y, Gu Y, Ding Y, Wang J, Li B, Sun Y, Mueck AO
Maturitas · 2026 Feb · PMID 41447991 · Publisher ↗
It is well known that premature ovarian insufficiency (POI) seriously affects the fertility, quality of life, and health of young women. A meta-analysis of global data indicated that the current population prevalence of...
It is well known that premature ovarian insufficiency (POI) seriously affects the fertility, quality of life, and health of young women. A meta-analysis of global data indicated that the current population prevalence of POI is as high as 3.7 %, but exceeds 10 % in some countries and regions. When POI is caused by disease treatment, it is termed iatrogenic POI. Iatrogenic factors are the most common identifiable cause of POI, and iatrogenic POI has a high prevalence in young cancer survivors. Overall, iatrogenic POI accounts for approximately half of all cases, but data show that its prevalence in female cancer survivors under the age of 24 can reach up to 82.2 %. With the improvement of cancer treatment, this incidence is still rising. It arises in the context of a variety of diseases and has a complex etiology. Patients with iatrogenic POI tend to be younger than those with other types of POI, which means they can experience more harm from the condition, and there is an urgent need to diagnose, treat, and manage them as early as possible. However, there is currently no relevant consensus or guideline either within China or indeed internationally. This guideline expert group gathered data from doctors and patients in 34 provinces, municipalities, and autonomous regions across China through questionnaires to determine guideline-related issues and searched the literature in English-language databases such as Cochrane and PubMed since their establishment. After merging and deduplicating, literature evaluation and evidence grading were carried out. After discussion and induction, the clinical treatment and management guidelines for iatrogenic POI were formulated and combined with China's national conditions. The expert group ultimately addressed 19 clinical questions, as determined through a questionnaire survey and field investigation, and produced 26 recommendations based on international and domestic evidence from evidence-based medicine and clinical practice experience, to provide a reference for colleagues in clinical practice. The recommendations primarily reflect the context and needs within China and are intended for broad nationwide applicability, though regional adaptations based on local resources and practices may be necessary.
Perceptions of ageing and quality of life among menopausal women: A mixed-methods study.
Trujillo-Muñoz PJ, Sánchez-Ojeda MA, Navarro-Prado S
Maturitas · 2026 Feb · PMID 41447990 · Publisher ↗
OBJECTIVE: To investigate subjective perceptions of ageing and quality of life among menopausal women, a quantitative approach and a qualitative approach were combined, with the aim of identifying patterns of beliefs, at...
OBJECTIVE: To investigate subjective perceptions of ageing and quality of life among menopausal women, a quantitative approach and a qualitative approach were combined, with the aim of identifying patterns of beliefs, attitudes and experiences pertaining to this vital life stage. STUDY DESIGN: This study featured a mixed-methods approach. A total of 332 menopausal women participated in the quantitative phase of this research, and the Cervantes scale was used to evaluate their health-related quality of life (HRQoL), including in terms of the ageing subdimension. Subsequently, in the qualitative phase, semistructured interviews were conducted with 12 of these participants with the aim of exploring their experiences with and perceptions of ageing during menopause. In addition, sociodemographic information was collected from the participants, as were data pertaining to related variables, such as their levels of education, physical activity and quality of sleep, which could influence their perceptions and general well-being. RESULTS: Regular physical exercise (F(3,328) = 4.352; p = .005) and higher educational level (r = -0.135; p = .014) were associated with better quality of life and more positive perceptions of ageing. The qualitative phase identified three major themes: a perceived sense of deterioration, changes in body image, and differing attitudes of acceptance or resistance. While some women described feelings of premature ageing and loss of identity, others viewed menopause as a stage of self-rediscovery and empowerment. CONCLUSION: HRQoL among menopausal women is complex and influenced by multiple factors; similarly, perceptions of ageing vary according to the individual context faced by each woman.
Divergent fat deposition in PCOS: A preliminary comparative analysis of pancreatic and hepatic steatosis in aging clinical and unselected populations.
Aksun S, Çelik Eroğlu B, Gunesli I … +3 more , Idilman I, Karçaaltınçaba M, Yildiz BO
Maturitas · 2026 Feb · PMID 41422624 · Publisher ↗
OBJECTIVE: This study investigated differences in hepatic and pancreatic fat accumulation between clinically referred and unselected patients with polycystic ovary syndrome, in comparison with healthy controls matched fo...
OBJECTIVE: This study investigated differences in hepatic and pancreatic fat accumulation between clinically referred and unselected patients with polycystic ovary syndrome, in comparison with healthy controls matched for age and body mass index. METHODS: In this pilot study, a hospital-based cohort comprised 34 women with polycystic ovary syndrome and 32 controls, and an unselected cohort comprised 28 women with polycystic ovary syndrome and 29 controls, all over 35 years of age. Clinical and metabolic assessments were performed, and hepatic and pancreatic fat content was measured using magnetic resonance imaging proton density fat fraction %. RESULTS: Patients with polycystic ovary syndrome in the hospital-based cohort exhibited significantly higher body mass index (29.0 ± 4.5 vs. 25.0 ± 4.0 kg/m, p < 0.001), free androgen index (p < 0.001), and hepatic fat percentage (p = 0.02) compared with those -in the unselected cohort. Hepatic fat was associated with free androgen index after adjustment for body mass index (p = 0.02). In contrast, pancreatic head fat was associated with metabolic parameters and was significantly higher in hospital-based patients with polycystic ovary syndrome compared with both their matched hospital controls (p = 0.03) and unselected patients with polycystic ovary syndrome (p = 0.009). These results indicate differing patterns of association for hepatic and pancreatic fat in polycystic ovary syndrome. CONCLUSIONS: As an exploratory investigation, our findings demonstrate that the distribution of hepatic and pancreatic fat in polycystic ovary syndrome is associated with distinct metabolic and hormonal profiles, with differences evident between unselected and hospital-referred populations. These observations highlight the need to consider recruitment setting in clinical evaluations and support the role of obesity management in reducing organ-specific fat accumulation.
Fezolinetant compared with elinzanetant for the treatment of vasomotor symptoms associated with menopause: A matching-adjusted indirect comparison.
Stute P, Shapiro C M M, Morga A … +8 more , Tai TA, Ajmera M, Muresan B, Martins K, Hua Y, Zhao A, Liu J, Nappi RE
Maturitas · 2026 Feb · PMID 41418588 · Publisher ↗
OBJECTIVES: Vasomotor symptoms (VMS) are a burden for women in menopause. Despite the availability of hormone therapy (HT), many cannot or do not wish to utilise it. The efficacy of the neurokinin receptor antagonists fe...
OBJECTIVES: Vasomotor symptoms (VMS) are a burden for women in menopause. Despite the availability of hormone therapy (HT), many cannot or do not wish to utilise it. The efficacy of the neurokinin receptor antagonists fezolinetant and elinzanetant has been established in clinical trials. Matching-adjusted indirect comparison (MAIC), which controls for the differences in treatment effect modifiers between trials and provides robust estimates of relative treatment effects, was used here to compare the efficacy of fezolinetant and elinzanetant in individuals with VMS associated with menopause. STUDY DESIGN: Patient-level data from the fezolinetant SKYLIGHT-1/2 trials were used to match the population and study design of elinzanetant OASIS-1/2 trials. Treatment effect modifiers were identified and MAIC analyses were performed. MAIN OUTCOME MEASURES: VMS frequency and severity, Patient-Reported Outcomes Measurement Information System Sleep Disturbance - Short Form 8b (PROMIS SD SF 8b), Menopause Specific Quality of Life Questionnaire (MENQOL). RESULTS: The OASIS-1/2 trial populations had higher mean VMS frequency/severity and greater sleep disturbance at baseline. Fezolinetant and elinzanetant had comparable efficacy in reducing VMS frequency and severity. Sleep disturbance improved with both drugs but more with elinzanetant. Improvement in sleep disturbance did not translate into a significant difference in overall QoL, as measured by MENQOL. CONCLUSIONS: MAIC analysis found that fezolinetant and elinzanetant had a similar efficacy profile for reduction of VMS frequency and severity. Differences in reduction of sleep disturbances did not result in differences in QoL. Neurokinin receptor antagonists provide an alternative to HT and other non-HT options for the treatment of VMS associated with menopause.
Underdiagnosed and overmedicated: Investigating the management of urinary tract infection and vaginal estrogen use in a large cohort of postmenopausal women.
Nahum R, Machtinger R, Oberman B … +4 more , Shtrall T, Reichenberg Y, Arbib N, Kaplan B
Maturitas · 2026 Feb · PMID 41406900 · Publisher ↗
OBJECTIVE: Genitourinary syndrome of menopause affects 50 %-70 % of postmenopausal women, among whom the diagnosis is presumably based on their age, menopausal status and possible use of vaginal estrogens. It often leads...
OBJECTIVE: Genitourinary syndrome of menopause affects 50 %-70 % of postmenopausal women, among whom the diagnosis is presumably based on their age, menopausal status and possible use of vaginal estrogens. It often leads to urinary symptoms resembling urinary tract infections. This study assessed the prevalence of positive urine cultures among postmenopausal women with symptoms of urinary tract infection (such as urgency, frequency, and dysuria), antibiotic acquisition and use of vaginal estrogens. STUDY DESIGN AND OUTCOME MEASURES: This retrospective cohort study utilized data from the Dan-Petach Tikva district of Clalit Health Services (2019-2022) from 62,813 postmenopausal women aged 55-90 years, of whom 15,242 had symptoms of urinary tract infection. Medical records were reviewed to assess an assumed clinical diagnosis of urinary tract infections based on symptoms, positive urine cultures, and prescription and acquisition records for antibiotics, and vaginal estrogens. RESULTS: Among 15,242 women (24.3 %) diagnosed with symptoms of urinary tract infection, only 36.2 % had completed a urine culture. Overall, 60.9 % of cultures were positive. Of the women with a positive urine culture, 28 % acquired antibiotics, while 26.2 % of those with negative cultures also acquired antibiotics. Additionally, 11.8 % of the study population used vaginal estrogens, and there was a significantly lower incidence of symptoms of urinary tract infection (11.8 % vs.17.2 %) among these users (p < 0.001). CONCLUSIONS: These findings highlight antibiotic overuse in cases without confirmed urinary tract infections and the underuse of vaginal estrogen therapy, which may help reduce the incidence of urinary symptoms related to genitourinary syndrome of menopause. These results emphasize the need for improved diagnostic strategies and greater adherence to vaginal estrogen therapy to manage genitourinary syndrome of menopause more effectively and reduce unnecessary antibiotic use.
Combined associations of protein intake and resistance exercise with handgrip strength in postmenopausal women.
Baek JK, Kim HR, Lee EJ … +2 more , Chung YS, Seo SK
Maturitas · 2026 Feb · PMID 41406899 · Publisher ↗
OBJECTIVES: To investigate the combined associations of dietary protein intake and resistance exercise with handgrip strength in Korean postmenopausal women, and whether these differ by time since menopause. STUDY DESIGN...
OBJECTIVES: To investigate the combined associations of dietary protein intake and resistance exercise with handgrip strength in Korean postmenopausal women, and whether these differ by time since menopause. STUDY DESIGN: Cross-sectional analysis of 5652 women aged 45-70 years from the Korea National Health and Nutrition Examination Survey (2014-2023). MAIN OUTCOME MEASURES: Participants were grouped by protein intake (<1.0 vs. ≥1.0 g/kg/day, and also <1.2 vs. ≥1.2 g/kg/day) and amount of resistance exercise regularly undertaken (<2 vs. ≥2 times/week). Analyses were stratified by menopausal duration (≤10 vs. >10 years). Low handgrip strength (<18 kg) and mean handgrip strength were evaluated using survey weighted logistic and linear regression, adjusting for demographic, lifestyle, and clinical factors. RESULTS: At the 1.0 g/kg/day threshold, the prevalence of low handgrip strength was 8.9 % in women with low protein and no exercise (G1) versus 4.2 % in those with adequate protein and exercise (G4, p = 0.004). In adjusted models, G4 showed a trend toward lower odds of low handgrip strength (odds ratio 0.57, 95 % confidence interval 0.31-1.05), while G3 (low protein + exercise) consistently showed higher mean handgrip strength. Findings were similar at the 1.2 g/kg/day threshold (overall p = 0.027). Associations were significant in women >10 years postmenopause, though the interaction by menopausal duration was not significant. CONCLUSIONS: Adequate protein intake (≥1.0-1.2 g/kg/day) with regular resistance exercise (≥2 times/week) was associated with stronger handgrip strength and lower odds of weakness. Resistance exercise appeared to be more strongly associated with handgrip strength than protein intake alone. Because of the cross-sectional design, these findings should be interpreted as observational associations rather than causal effects.
Climacteric symptoms and their impact on quality of life among middle-aged rural Turkish women: A preliminary study.
Ozcivit Erkan IB, Gulcicek A, Aydın SN … +2 more , Erel CT, Senturk LM
Maturitas · 2026 Jan · PMID 41385897 · Publisher ↗
This study evaluated the prevalence and severity of climacteric symptoms, their impact on quality of life, and their association with sociodemographic factors among middle-aged women in rural south-eastern Turkey. The pa...
This study evaluated the prevalence and severity of climacteric symptoms, their impact on quality of life, and their association with sociodemographic factors among middle-aged women in rural south-eastern Turkey. The participants were 257 perimenopausal and postmenopausal women aged 40-65 residing in Mardin. They completed the Menopause Rating Scale, Menopause-Specific Quality of Life questionnaire, and demographic forms. The mean age was 48.9 years; most were perimenopausal (55.3 %), married (96.5 %), and either illiterate (38.5 %) or had received only primary education (46.7 %). Only 4.7 % used menopausal hormone therapy. Joint and muscular discomfort predominated in perimenopause, while vasomotor symptoms were most frequent in postmenopause. Poor self-rated health, lack of menopause awareness, medication use, and history of psychiatric consultation predicted poorer quality of life.
A mixed-methods investigation of women's health-friendly organisations as perceived by menopausal working women.
Hardy C, Griffiths A, Thorne E … +1 more , Hunter MS
Maturitas · 2026 Feb · PMID 41353046 · Publisher ↗
OBJECTIVES: To examine women's perspectives on what constitutes a women's health-friendly work culture, and to assess whether perceiving one's organisation as women's health-friendly is associated with menopausal symptom...
OBJECTIVES: To examine women's perspectives on what constitutes a women's health-friendly work culture, and to assess whether perceiving one's organisation as women's health-friendly is associated with menopausal symptom experience and work-related outcomes. METHODS: A cross-sectional mixed-methods online survey collected self-reported quantitative and qualitative data from working menopausal women. Primary outcome measures included presence of menopausal symptoms (past four weeks), vasomotor symptom problem rating, job stress, and whether participants perceived their organisation as supportive of women's health (dependent variable). Two open-ended questions explored participants' views on what makes a work culture friendly or unfriendly to women's health. RESULTS: From the responses of 300 participants, over two-thirds (65.7%) perceived their organisation as supportive of women's health. These participants reported significantly lower job stress and less problematic vasomotor symptoms than those who did not. No significant association was found between menopausal symptom presence. Thematic analysis of qualitative responses revealed two overarching themes capturing shared perceptions of women's health-friendly and unfriendly work cultures. Theme 1 focused on the people at work: awareness and understanding of women's health, attitudes towards women and work, and their talking about women's health at work. Theme 2 addressed more structural factors of organisational arrangements and provisions: flexibility in work arrangements, resources and support, and the physical work environment. CONCLUSIONS: This study provides novel insights into how women perceive a health-friendly work culture and the potential relevance to menopausal experiences and work. The findings have clear implications for policy and practice, warranting further attention and investigation.
Vaginal use of estradiol is associated with a reduced risk of rectal cancer in postmenopausal women: A Finnish nationwide case-control study.
Siitonen H, Joensuu JM, Savolainen-Peltonen H … +3 more , Gissler M, Mikkola TS, Ylikorkala O
Maturitas · 2026 Jan · PMID 41352065 · Publisher ↗
OBJECTIVE: We assessed the impact of vaginal estradiol on the risk of rectal cancer. STUDY DESIGN: We identified in this nationwide case-control study primary rectal cancer cases with five age-matched control cases in 19...
OBJECTIVE: We assessed the impact of vaginal estradiol on the risk of rectal cancer. STUDY DESIGN: We identified in this nationwide case-control study primary rectal cancer cases with five age-matched control cases in 1994-2019 from our dataset of 1.1 million Finnish postmenopausal women. We excluded users of systemic hormone therapy. Then we traced users of vaginal estradiol (10-25 μg twice a week) from the reimbursement register in 1994-2013, a period in which users could be accurately traced in the database (which was not the case for 2014-2019). MAIN OUTCOME MEASURES: Odds ratios with 95 % confidence intervals were calculated for rectal cancer risk with adjusted logistic regression models separately for vaginal estradiol users in 1994-2013 (1640 cases, 7889 controls) and for the whole study period of 1994-2019 (2853 cases, 13865 controls). RESULTS: During follow-up, 494 rectal cancer patients (17 %) and 2826 controls (20 %) used vaginal estradiol (p < 0.001). Users were diagnosed with rectal cancer on average nine years later than non-users (73.9 vs 65.1 years, p < 0.001). Use for ≥3 years was associated with a reduced risk of rectal cancer (OR 0.79, 95 % CI 0.63-0.97) in the 1994-2013 cohort. In the extended 1994-2019 follow-up, risk reductions were similar (0.79, 0.68-0.92), appeared already with <3 years' use (0.85, 0.74-0.97), and persisted for up to 5 years after cessation of vaginal estradiol (0.80, 0.71-0.91). CONCLUSIONS: Vaginal estradiol use may be associated with a reduced risk of rectal cancer - perhaps due to estradiol infiltration into the rectal mucosa. This possible protecting effect could be an important additional health benefit of vaginal estradiol.
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