Depression in postmenopause: interdisciplinary approach in management and perspectives for rehabilitation

Surgical and natural menopause is often associated with depression symptoms. Along with the postpartum period, perimenopause is a “window of vulnerability” for depression development, because decline in estrogen level accounts for extinction of reproductive function, emotional disorders, genitourinary menopausal syndrome, which are combined with non-endocrine risk factors, such as decreasing income levels, low social support, and stress. Although a direct relationship between blood estrogens level and depression has not been demonstrated, the relation between menopause symptoms and depression has been proven, i.e., the symptoms of menopause can be considered as risk factors. Here, we summarizes the current view on the correct counseling and routing of menopausal women with depression symptoms in primary health care facilities, the principles of managing patients with risk factors, including genitourinary menopausal syndrome, as well as methods of rehabilitation and informational support. This will aid to improve the quality of medical care for such patients.

Triggers and markers of skin aging in women with menopausal syndrome

Introduction. External manifestations of aging, and especially skin aging are the most important for modern women.Aim. The aim of our study was to identify a set of adverse factors that effect on the skin of women in menopausal transition (MP) and in postmenopause (PM), and to identify markers of skin aging in this category of women.Materials and methods. The study included 36 women in MP and PM suffering from MS. At the first stage, anamnesis was collected, anthropometric data and severity of MS were evaluated, and the hormonal profile of patients was determined. At the second stage, computer mapping of the skin was performed using the digital video camera Aramo SG with the skin XPpro program. Statistic analysis was performed using the SPSS v13.0 program. Spearman’s analysis was used to determine the relationship between anthropometric, clinical and anamnestic data and the measurements of skin condition of women in MP and PM. Results. According to the obtained data, the main triggers of skin aging of women in MP and PM are: the presence of metabolic disorders (obesity, metabolic syndrome), decrease of estradiol and progesterone levels in blood serum as well as increase of prolactin level and rhythm disturbance of melatonin secretion. Markers of skin aging in women with menopausal syndrome are decreased moisture, increased oiliness in T-zone, increased of skin pigmentation and enlarged pore size.Conclusions. The obtained data are useful for management involuting skin changes of women in PM and MP suffering from MS. The data justifies the relevancy to normalization not only the estradiol level, but other sex steroids, melatonin, as well as correction of metabolic endocrine processes, and treatment of MS.

The Utilization of Dehydroepiandrosterone as a Sexual Hormone Precursor in Premenopausal and Postmenopausal Women: An Overview

Dehydroepiandrosterone (DHEA), and its metabolite, dehydroepiandrosterone sulfate ester (DHEAS), are the most abundant circulating steroid hormones, and are synthesized in the zona reticularis of the adrenal cortex, in the gonads, and in the brain. The precise physiological role of DHEA and DHEAS is not yet fully understood, but these steroid hormones can act as androgens, estrogens, and neurosteroids, and perform many roles in the human body. Since both levels decline with age, use of DHEA supplements have gained more attention due to being advertised as an antidote to aging in postmenopausal women, who may have concerns on age-related diseases and overall well-being. However, current research has not reached an overall consensus on the effects of DHEA on postmenopausal women. This overview is a summary of the current literature, addressing the metabolic pathway for DHEA synthesis and utilization, as well as the effects of DHEA on premenopausal and postmenopausal women with disease states and other factors. As for the therapeutic effects on menopausal syndrome and other age-related diseases, several studies have found that DHEA supplementations can alleviate vasomotor symptoms, preserve the integrity of the immune system, reduce bone loss, and increase muscle mass. Intravaginal DHEA has shown significant beneficial effects in menopausal women with severe vulvovaginal symptoms. On the other hand, DHEA supplements have not shown definitive effects in cardiovascular disease, adrenal insufficiency, insulin sensitivity, and cognition. Due to inadequate sample sizes and treatment durations of current studies, it is difficult to assess the safety and efficacy of DHEA and draw reliable conclusions for the physiological role, the optimal dosage, and the effects on premenopausal and postmenopausal women; therefore, the study of DHEA warrants future investigation. Further research into the roles of these steroid hormones may bring us closer to a therapeutic option in the future.

Complex non-drug correction of menopausal disorders in patients with metabolic syndrome

The monograph is devoted to the complex non-drug correction of menopausal disorders in patients with metabolic syndrome in the period of menopausal transition. Modern ideas about menopausal and metabolic syndromes are presented, a review of modern approaches to their treatment is carried out. A complex personalized system of non-drug correction of functional disorders in patients with metabolic syndrome and menopausal syndrome of mild and moderate severity in the period of menopausal transition is presented, including preformed therapeutic factors (vibrotherapy, chromotherapy, aeroionotherapy, musicotherapy (melotherapy), aromatherapy), physical therapy with pelvic floor muscle training, drinking balneotherapy, vitamins and minerals against the background of lifestyle modification. The algorithm of dynamic clinical and laboratory examination of women with menopausal disorders of mild and moderate severity and metabolic syndrome in the period of menopausal transition has been developed, including a general clinical examination, assessment of alimentary, thyroid, psycho-emotional, gynecological, urological statuses, the state of the intestinal microbiota, the function of the hypothalamic-pituitary complex, biochemical blood profile, hemostasis, levels of markers of inflammation, assessment of the state of the musculoskeletal system, sexual function, allowing to get an idea of the state of mental and physical health of patients, evaluate the effectiveness of the complex of measures, optimize therapeutic tactics. It is addressed to a wide range of readers interested in women's health. It can be useful for students, postgraduates, teachers of medical universities, obstetricians, gynecologists, endocrinologists, cardiologists, specialists of restorative medicine.

Efficacy and Safety of Acupuncture Vs. Hormone Therapy for Menopausal Syndrome: A Systematic Review and Meta-Analysis

Menopausal syndrome (MPS) is a common gynecological disorder around the time of menopause, and hormone therapy (HT) is the first-line treatment for it. However, HT is prone to cause adverse reactions in MPS patients treated with HT. Acupuncture is a popular non-pharmaceutical therapy for MPS, but the differences in the efficacy and safety between acupuncture and HT remain unclear. The purpose of this evidence-based study is to address this issue. Five databases were searched for potentially eligible RCTs. All RCTs comparing acupuncture with HT in the treatment of MPS were included in this study. The clinical effective rate was the primary outcome. Kupperman index, serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E[Formula: see text], and side effects were the secondary outcomes. A total of 15 RCTs recruiting 1376 MPS patients were included. Results of meta-analysis showed that compared with HT, acupuncture significantly improved clinical effective rate (RR = 1.09, 95% CI 1.03 to 1.16, [Formula: see text] = 0.005), decreased the Kupperman index (WMD = −2.55, 95% CI = −2.93 to −2.17, [Formula: see text] < 0.00001) and the incidence of side effects (RR = 0.14, 95% CI = 0.06–0.32, [Formula: see text] < 0.00001). There were no statistically significant differences in serum FSH (WMD = −1.36, 95% CI = −3.25–0.53, [Formula: see text] = 0.16), E2(WMD = −1.11, 95% CI = −2.59–0.37, [Formula: see text] = 0.14), or LH (WMD = −1.87, 95% CI = −4.58–0.83, [Formula: see text] = 0.17) between the acupuncture and HT groups. Based on the current evidence, manual acupuncture is safer and more effective than HT and is recommended for the treatment of MPS, but the evidence for the efficacy of other types of acupuncture is inconclusive.

HUBUNGAN OBESITAS DAN PEMAKAIAN KONTRASEPSI HORMONAL TERHADAP KEJADIAN MENOPAUSE LAMBAT PADA WANITA USIA 55-65 TAHUN

WHO estimates that 25 million women worldwide enter menopause, data by 2018 around 500 million menopausal women worldwide, then by 2030 an estimated 1.2 billion women experience menopausal syndrome almost worldwide. Late menopause increases the risk of breast cancer, cervical cancer, and ovarian cancer in women. This study aims to analyze Determinants Affecting Menopause Slow Events in Women Age 55-65 Years. This research is an observational analytic research with case control design that case group experiencing menopause slowly amount to 49 responden and control group not experiencing menopause slow amounted 49 respondents. Data collection by interview using questionnaire. Method of data analysis by univariate analysis, bivariate analysis with simple logistic regression test and multivariate analysis with multiple logistic regression test.The results showed that there was an effect of obesity (p = 0,015 and hormonal contraceptive use (p = 0,027), with menopausal incidence in women aged 55-65 years at Bromo Puskesmas Medan. The results of multiple logistic regression test showed that dominant variables that influence the incidence of menopause slowly in women aged 55-65 years is obesity (OR = 2,504).Based on the results of research is expected for health workers to be able to improve services optimally, especially in providing various knowledge about menopause slow and set healthy lifestyle such as balanced diet, and maintain ideal body weight

HORMONE LEVEL CHANGES IN ENDOMETRIAL ABNORMALITIES IN THE POSTMENOPAUSAL PERIOD

Background. In recent decades, the increase in life expectancy has led to a significant increase in the duration of the postmenopausal period. Prolonged estrogen deficiency contributes to an increase in the incidence of chronic somatic diseases, including neurovegetative, metabolic-endocrine, and psycho-emotional disorders that define the menopausal syndrome. Aim. To study the prognostic and diagnostic significance of hormone parameters in endometrial abnormalities in the postmenopausal period. Material and methods. Forty-seven women with various clinical manifestations of endometrial pathology in the postmenopausal period were examined. The mean age of the examined women was (58,43±1,1) years. All the patients had luteinizing hormone, follicle-stimulating hormone, progesterone, testosterone, estradiol, dehydroepiandrosterone sulfate, and serum sex hormone-binding globulin measured by enzyme immunoassay. The results obtained were subjected to statistical processing using standard computer programs «Statgraph» designed for parametric and nonparametric methods of calculating mean values. We calculated mean and standard deviation (M±Se), as well as minimum-maximum values for the sample. Differences were considered significant at p<0,05. Results and discussion. As a result of the study the abnormality of the endometrium in the postmenopausal period was determined. Endometritis was observed in 4 (8,5%) of 47 patients, atrophic endometrium in 7 (14,9%) patients, diffuse endometrial hyperplasia in 3 (6,4%) cases, endometrial polyp in 29 (61,7%) cases, and endometrial carcinoma in 3 (6,4%) cases. A significant increase in follicle-stimulating hormone [(65,39±1,27) mmE/ mL], luteinizing hormone [(34,85±0,15] mmE/mL), estradiol [(88,73±2,1) pg/mL], and testosterone [(2,29±0,08) ng/mL] values was registered in the postmenopausal patients, which is an important prognostic and diagnostic criterion in this patient population. Conclusion. The study of hormone parameters in the postmenopausal period is one of the most important methods of early detection of various endometrial abnormalities, allowing timely implementation of appropriate therapeutic and preventive measures.