Menopause Int
· 2009 Mar · PMID 19237619
·
Publisher ↗
A long postreproductive lifespan is a characteristic feature in the life history of human females, which is not shared with other primates. The ultimate cause of menopause has been the focus of much study and has generat...A long postreproductive lifespan is a characteristic feature in the life history of human females, which is not shared with other primates. The ultimate cause of menopause has been the focus of much study and has generated a number of evolutionary explanations, most prominently the mother and grandmother hypotheses. Generally, these theories propose that menopause was an adaptive response to changes that led to the divergence of humans from their ancestors, and are based on observations such as the long-dependency time of human infants, early age of weaning of human neonates, high maternal mortality, the supportive role of grandmothers in childcare, and intergroup female transfers. While ongoing debate continues to refine evolutionary theory, the proximate cause of menopause currently receives less attention. Our knowledge about the mechanisms underlying menopause has been largely confined to ovarian exhaustion, the progressive loss of oocytes beginning before birth and continuing to the age of menopause. Most efforts have to date been focused on fitting curves to the few data available, rather than trying to explain why the dynamics of oocyte depletion follows a particular pattern. A few recent studies have attempted to address this problem by demonstrating that oocyte dynamics is a regulated process under tight physiological control, e.g. that ovaries sense both number and quality of their oocytes. In this review we assess our current knowledge from an evolutionary perspective and emphasize the benefit of combining a mechanistic and life history approach.
Lekander I, Borgström F, Ström O
… +2 more, Zethraeus N, Kanis JA
Menopause Int
· 2009 Mar · PMID 19237618
·
Publisher ↗
OBJECTIVE: To estimate the cost-effectiveness of five-year treatment of hormone replacement therapy (HRT) compared with no treatment for women with menopausal symptoms in the UK. METHOD: A Markov cohort simulation model...OBJECTIVE: To estimate the cost-effectiveness of five-year treatment of hormone replacement therapy (HRT) compared with no treatment for women with menopausal symptoms in the UK. METHOD: A Markov cohort simulation model with tunnel techniques was used to assess the cost-effectiveness of HRT in women aged 50 years. For the clinical effects of HRT we used, where possible, results taken from the Women's Health Initiative (WHI). The model had a life-time horizon with cycle lengths of one year and contained the following disease states: hip fracture, vertebral fracture, wrist fracture, breast cancer, colorectal cancer, coronary heart disease, stroke and venous thromboembolic events. An intervention was modelled by its impact on the disease risks during and after stopping treatment. The model was populated with UK-specific data on risks, mortality rates, quality-of-life weights and costs. The main outcome of the model was cost per quality-adjusted life year (QALY) gained of HRT compared with no treatment. RESULTS: The results indicated that it was cost-effective to treat women with menopausal symptoms with HRT in the UK. The severity of menopausal symptoms was the single most important determinant of cost-effectiveness, but HRT remained cost-effective even where symptoms were mild or effects on symptom relief were small. CONCLUSIONS: Treatment of women with menopausal symptoms with HRT is cost-effective.
Dobkin RD, Menza M, Bienfait KL
… +3 more, Allen LA, Marin H, Gara MA
Menopause Int
· 2009 Mar · PMID 19237617
·
Full text
OBJECTIVE: Sleep disturbances have been reported to be one of the most troubling manifestations of menopause. While hormone replacement therapy (HRT) has historically been considered a first-line treatment for menopausal...OBJECTIVE: Sleep disturbances have been reported to be one of the most troubling manifestations of menopause. While hormone replacement therapy (HRT) has historically been considered a first-line treatment for menopausal insomnia, many women are now seeking alternative treatments due to concerns about the risks and side-effects of HRT. The goal of this study was to evaluate the effect of ramelteon, a selective melatonin receptor agonist, for the treatment of menopausal insomnia. STUDY DESIGN: A total of 20 healthy peri- and postmenopausal women with insomnia participated in this six-week, prospective, open-label trial of ramelteon (8 mg) at an academic medical centre. Participants completed sleep-wake diaries on a daily basis for six weeks. Self-report measures of sleep impairment, daytime functioning, quality of life and mood were also completed on a bi-weekly basis. RESULTS: Significant improvements in latency to sleep onset, total sleep time and sleep efficiency were observed in diary data while gains in sleep quality, sleep impairment, daytime functioning, quality of life and mood were found in self-report measures. There was no evidence of tolerance or rebound over the course of the trial. CONCLUSIONS: Overall, results suggest that ramelteon is an effective non-hormonal approach for the treatment of insomnia in menopause. Randomized-controlled trials are needed to further evaluate the efficacy of this intervention.
Menopause Int
· 2009 Mar · PMID 19237616
·
Publisher ↗
OBJECTIVE: The objective of this study is to use the internet to survey the effect of menopause on women's experience of libido. STUDY DESIGN: A questionnaire incorporating the Brief Profile of Female Sexual Function (B-...OBJECTIVE: The objective of this study is to use the internet to survey the effect of menopause on women's experience of libido. STUDY DESIGN: A questionnaire incorporating the Brief Profile of Female Sexual Function (B-PFSF) on a UK menopause website. Main outcome measure Questions on reduced libido, distress, level of help sought and treatment. RESULTS: Eighty-four percent of women (n = 2112/2527) felt that an active sex life was important. One thousand and fifty-one perimenopausal and 560 postmenopausal women reported reduced libido causing distress with 23% and 35% discussing this with health professionals. Eighteen percent perimenopausal and 30% postmenopausal women had tried non-testosterone hormone replacement therapy with 34% and 37%, respectively, finding it helpful. Testosterone was deemed useful in some perimenopausal (n = 6/17) and postmenopausal (n = 23/50) women. Twenty-seven percent premenopausal, 38% perimenopausal and 56% postmenopausal women reported vaginal dryness with 78% peri- and 87% postmenopausal women believing it a factor causing reduced libido. Twenty-two percent premenopausal, 28% perimenopausal and 46% postmenopausal women had discussed this with health professionals and 17%, 36% and 55%, respectively, were on treatment. Women in all reproductive epochs completed the B-PFSF (a validated tool for postmenopausal women only). CONCLUSIONS: An active sex life was deemed to be important but many women were not seeking help for menopause-related reduced libido causing distress. For many, vaginal changes contributed to their symptoms. In those seeking advice, treatment was commonly not prescribed. Health professionals must ask appropriate direct questions to all women, especially as part of menopausal assessment. A need for the B-PFSF to be validated in non-postmenopausal women was also indicated.
Menopause Int
· 2008 Dec · PMID 19037067
·
Publisher ↗
It has been conclusively demonstrated that postmenopausal women can gestate and give birth to children. However, to do so, they require donated oocytes, which are in short supply. In this paper, I explore a number of arg...It has been conclusively demonstrated that postmenopausal women can gestate and give birth to children. However, to do so, they require donated oocytes, which are in short supply. In this paper, I explore a number of arguments for limiting access to donated oocytes to women of normal reproductive age. I consider the idea that older women have already had their chance to reproduce, and have chosen to forego it. I also consider the question of whether younger women have a more compelling clinical need, and ask whether the risks involved in postmenopausal motherhood are excessive. I argue that many of the concerns about postmenopausal motherhood are based on unjustified assumptions. Postmenopausal women are treated very differently to men of similar ages in the context of reproduction. I question whether this constitutes unjust discrimination or whether it reflects intrinsic differences between women's and men's reproductive capacities, and parental roles. In either case, women are often at a disadvantage and are subject to heavy social pressure in their reproductive choices. I conclude that there are no compelling reasons for a systematic ban on the use of donated oocytes in postmenopausal women. However, the procurement of oocytes for use in any woman raises some series ethical issues, and as new technologies and research avenues proliferate, pressure on this resource is likely to increase.
Menopause Int
· 2008 Dec · PMID 19037066
·
Publisher ↗
Vulval disease in the postmenopausal age group is relatively common. Some vulval conditions such as lichen sclerosus are more prevalent in the postmenopausal years. Often more than one condition is present at the same ti...Vulval disease in the postmenopausal age group is relatively common. Some vulval conditions such as lichen sclerosus are more prevalent in the postmenopausal years. Often more than one condition is present at the same time. Accurate diagnosis is essential for effective treatment. The risk of progression to malignancy associated with some of these diseases dictates long-term surveillance.
Fan MD, Maslow BS, Santoro N
… +1 more, Schoenbaum E
Menopause Int
· 2008 Dec · PMID 19037065
·
Publisher ↗
Dramatic improvement in the survival of the HIV population has occurred with the ascendance of highly active antiretroviral therapy (HAART). In the foreseeable future, HIV-infected women who acquired disease during the p...Dramatic improvement in the survival of the HIV population has occurred with the ascendance of highly active antiretroviral therapy (HAART). In the foreseeable future, HIV-infected women who acquired disease during the peak years of the epidemic are expected to survive to experience menopause and even years beyond. The HIV epidemic may be viewed as 'mature', as its earlier victims become part of the geriatric population. Research about the process of menopause in HIV-infected women and, conversely, about HIV infection in women undergoing menopause is currently limited. Existing research suggests that the process of menopause is affected by HIV infection, inasmuch as infected women appear to experience menopause at an earlier age, with greater symptomatology, and with different reproductive hormone profiles compared with HIV-uninfected women. HIV infection also appears to affect bone mineral density, cardiovascular disease and cognition, with some age-related interactions. Lifestyle and demographic factors have pervasive importance for both HIV infection and the menopause in women. This article reviews the current state of knowledge about the menopausal process in HIV-infected women, and the common conditions in postmenopausal women that are likely to be affected by HIV infection. Clinicians should appreciate the potential role of HIV infection in caring for menopause-aged women.
Menopause Int
· 2008 Dec · PMID 19037064
·
Publisher ↗
The global epidemic of obesity continues to grow, with over 1.7 billion people worldwide classified as obese (body mass index; BMI > or = 30 kg/m2). Of special concern is the population of older women, since women are mo...The global epidemic of obesity continues to grow, with over 1.7 billion people worldwide classified as obese (body mass index; BMI > or = 30 kg/m2). Of special concern is the population of older women, since women are more obese than men and gain weight early during menopause. Obesity with co-morbidities is the leading threat to women's health and longevity. Specific female co-morbidities, such as reproductive failure, urinary stress incontinence and disproportionate prevalence of serious diseases such as diabetes, cardiovascular disease and cardiopulmonary failure in addition to breast cancer and gynaecologic malignancies, reduce the fitness benefits grandmothers provide to the species by ensuring reproductive success of their children and health and survival of grandchildren. In fact, female life-expectancy is decreasing in industrialized nations. Non-surgical treatment for obesity itself is ineffective; currently there is not enough evidence to recommend weight loss medications for routine use in the elderly and calorie-burning exercise is problematic. Conversely, antiobesity surgery has been shown to be both effective and safe in the older adult population in studies that predominantly enrol women. Although the risks and benefits of antiobesity surgery performed in high-volume dedicated centres must be carefully weighed for each individual patient, the strong evidence for its safety and efficacy in reducing obesity-related co-morbidities and improving quality of life, with the potential to increase healthy life-expectancy, makes antiobesity surgery a viable treatment option for older obese women.
Menopause Int
· 2008 Dec · PMID 19037063
·
Publisher ↗
Obesity affects over 20% of the UK's adult population and its prevalence is rising. Obesity can lead to a variety of musculoskeletal problems and is independently associated with locomotor disability and joint pain. Obes...Obesity affects over 20% of the UK's adult population and its prevalence is rising. Obesity can lead to a variety of musculoskeletal problems and is independently associated with locomotor disability and joint pain. Obesity increases the risk of radiographic knee osteoarthritis (OA), but has a lesser effect on disease progression. The association with hip and hand OA is weaker, but implies that excess adipose tissue produces humoral factors, altering articular cartilage metabolism. It has been postulated that the leptin system could be a link between metabolic abnormalities in obesity and increased risk of OA. Although obesity was initially thought to increase the risk of rheumatoid arthritis (RA), further studies showed, that heavier patients with RA have less radiological disease progression and possibly better survival. On the other hand, obesity is strongly associated with hypeuricaemia and gouty arthritis. High body weight correlates independently with metabolic syndrome and may contribute to increased cardiovascular morbidity in patients with gout. Weight reduction should be an important part of treatment for OA and gout. Because obesity at a young age correlates with the development of OA and gout in later life, preventive public health strategies aimed at lowering the incidence of obesity are of most importance.
Menopause Int
· 2008 Dec · PMID 19037062
·
Publisher ↗
OBJECTIVE: The purpose of this study was to measure the rate of reoperation for surgically treated pelvic organ prolapse. STUDY DESIGN: An 11-year retrospective audit was conducted of women who had undergone surgery for...OBJECTIVE: The purpose of this study was to measure the rate of reoperation for surgically treated pelvic organ prolapse. STUDY DESIGN: An 11-year retrospective audit was conducted of women who had undergone surgery for pelvic organ prolapse between 1995 and 2005 in a large teaching hospital in the UK. Main outcome measure Variables examined included the type of primary procedure for pelvic organ prolapse overall and per year, the type of the repeat procedure and the interval between primary and repeat procedures. Analysis included calculation of the number and proportion of primary operations, the rate of reoperation, the type of repeat prolapse operation and the cumulative risk of reoperation each year for 11 years. RESULTS: During the study period, 2099 women underwent surgery for pelvic organ prolapse. Of these women, 142 underwent a second operation for prolapse and 13 a third. The overall cumulative rate of reoperation following surgery for pelvic organ prolapse was 10.8% at 11 years following the initial procedure. The majority (61.5%) of repeat procedures did not involve the same compartment as the initial operation and recurrences tended to occur in the first few years after the first operation. CONCLUSION: Women who undergo surgery for pelvic organ prolapse are at 10.8% risk of requiring a reoperation within the next 11 years, usually at a different site.
The British Menopause Society Council aims to aid health professionals to inform and advise women about postreproductive health. This guidance refers to the long-term condition of urogenital atrophy. Treatment choice sho...The British Menopause Society Council aims to aid health professionals to inform and advise women about postreproductive health. This guidance refers to the long-term condition of urogenital atrophy. Treatment choice should be based on up to date information and targeted to individual women's needs. Non-estrogen and estrogen-based treatments are discussed.
Dependent upon sexual behaviour peri- and postmenopausal women are increasingly at risk of sexually transmitted infections, although the overall rates remain low when compared with younger people. Symptoms are often non-...Dependent upon sexual behaviour peri- and postmenopausal women are increasingly at risk of sexually transmitted infections, although the overall rates remain low when compared with younger people. Symptoms are often non-specific or absent and may be misinterpreted as being due to the menopause. In addition, both the women and their clinicians may not be aware of their infection risk, thus leading to a delayed or missed diagnosis. Risk assessment and referral for screening of infections should be carried out wherever appropriate.
Stress influences health and disease and this might be of special relevance for ageing. The present review starts with the description of age-associated changes of the hypothalamic-pituitary-adrenal axis. In this context...Stress influences health and disease and this might be of special relevance for ageing. The present review starts with the description of age-associated changes of the hypothalamic-pituitary-adrenal axis. In this context, the possible modulatory role of estradiol is discussed. Later, the influence of rising stress hormone levels for the ageing brain is illustrated and a few intervention strategies are outlined. At the end, the concept of allostatic load (AL) is described, which aims at a broader assessment of the impact of stress on the individual. The strengths and also the current limitations of the AL concept are highlighted.
It has long been recognized that women are at a higher risk than men to develop depression and that such risk is particularly associated with reproductive cycle events. Recent long-term, prospective studies have demonstr...It has long been recognized that women are at a higher risk than men to develop depression and that such risk is particularly associated with reproductive cycle events. Recent long-term, prospective studies have demonstrated that the transition to menopause is associated with higher risk for new onset and recurrent depression. A number of biological and environmental factors are independent predictors for depression in this population, including the presence of hot flushes, sleep disturbance, history of severe premenstrual syndrome or postpartum blues, ethnicity, history of stressful life events, past history of depression, body mass index, socioeconomic status and the use of hormones and antidepressants. Accumulated evidence suggests that ovarian hormones modulate serotonin and noradrenaline neurotransmission, a process that may be associated with underlying pathophysiological processes involved in the emergence of depressive symptoms during periods of hormonal fluctuation in biologically predisposed subpopulations. Transdermal estradiol and serotonergic and noradrenergic antidepressants are efficacious in the treatment of depression and vasomotor symptoms in symptomatic, midlife women. The identification of individuals whom might be at a higher risk for depression during menopausal transition could guide preventive strategies for this population.
Although women have been treated with testosterone (T) for female sexual dysfunction since the 1950s, the role of T in normal female physiology is not yet fully defined. One of the major safety concerns of androgen thera...Although women have been treated with testosterone (T) for female sexual dysfunction since the 1950s, the role of T in normal female physiology is not yet fully defined. One of the major safety concerns of androgen therapy is whether androgens have a stimulatory effect on the breast that could lead to breast carcinomas. The proposed mechanisms for such stimulation include local estrogen production from the aromatase enzyme complex present in the breast tissue or by the direct stimulation of the androgen receptor. Predominant data from in vitro studies have shown that androgens actually have apoptotic and antiproliferative effects and not stimulatory effects. Animal models have shown similar results to in vitro studies, finding that androgens inhibit breast cancer growth. Prospective and retrospective epidemiological analyses have shown mixed outcomes, with no clear consensus regarding androgen use and breast cancer risk. Hyperandrogenism in patients with polycystic ovarian syndrome with elevated levels of endogenous T is not associated with an increased risk of breast cancer and may, in fact, be protective. Another human model with excess of T is female-to-male transgenderism, in which genotypic women are treated with large doses of exogenous T with no increased risk. High-dose androgen therapy also has been effective in treating patients with advanced breast cancer. Thus, the preponderance of data suggests that T use in females is not associated with an increased risk of breast carcinoma.
Menopause Int
· 2008 Sep · PMID 18714076
·
Full text
OBJECTIVE: To review the data on long-term outcomes in women who underwent prophylactic bilateral oophorectomy, a common surgical procedure that has more than doubled in frequency since the 1960s. STUDY DESIGN: Literatur...OBJECTIVE: To review the data on long-term outcomes in women who underwent prophylactic bilateral oophorectomy, a common surgical procedure that has more than doubled in frequency since the 1960s. STUDY DESIGN: Literature review of the published data on the consequences of prophylactic bilateral oophorectomy. Special emphasis was given to the Mayo Clinic Cohort Study of Oophorectomy and Aging. Main outcome measures Overall mortality, cardiovascular disease, cognitive impairment and dementia, parkinsonism, osteoporosis, psychological wellbeing and sexual function. RESULTS: There is a growing body of evidence suggesting that the premature loss of ovarian function caused by bilateral oophorectomy performed before natural menopause is associated with several negative outcomes. In particular, studies have revealed an increased risk of premature death, cardiovascular disease, cognitive impairment or dementia, parkinsonism, osteoporosis and bone fractures, decline in psychological wellbeing and decline in sexual function. The effects involve different organs (e.g. heart, bone, or brain), and different functions within organs (e.g. cognitive, motor, or emotional brain functions). Estrogen treatment may prevent some but not all of these negative outcomes. CONCLUSION: The potential adverse effects of prophylactic bilateral oophorectomy on heart health, neurological health, bone health and quality of life should be carefully weighed against its potential benefits for cancer risk reduction in women at average risk of ovarian cancer.