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.

Efficacy of cognitive therapy and behavior therapy for menopausal symptoms: a systematic review and meta-analysis

Background T long-term effects of cognitive therapy and behavior therapy (CTBT) for menopausal symptoms are unknown, and whether the effects are different between natural menopause and treatment-induced menopause are currently unclear. Therefore, we sought to conduct an accurate estimate of the efficacy of CTBT for menopausal symptoms. Methods We conducted searches of Cochrane Library, EMBASE, PsycINFO, PubMed, and Web of Science databases for studies from 1 January 1977 to 1 November 2021. Randomized controlled trials (RCTs) comparing intervention groups to control groups for menopausal symptoms were included. Hedge's g was used as the standardized between-group effect size with a random-effects model. Results We included 14 RCTs comprising 1618 patients with a mean sample size of 116. CTBT significantly outperformed control groups in terms of reducing hot flushes [g = 0.39, 95% confidence interval (CI) 0.23–0.55, I2 = 45], night sweats, depression (g = 0.50, 95% CI 0.34–0.66, I2 = 51), anxiety (g = 0.38, 95% CI 0.23–0.54, I2 = 49), fatigue, and quality of life. Egger's test indicated no publication bias. Conclusions CTBT is an effective psychological treatment for menopausal symptoms, with predominantly small to moderate effects. The efficacy is sustained long-term, although it declines somewhat over time. The efficacy was stronger for natural menopause symptoms, such as vasomotor symptoms, than for treatment-induced menopause symptoms. These findings provide support for treatment guidelines recommending CTBT as a treatment option for menopausal symptoms.

Duration of Reproductive Period and Risk of Transitioning to Mild Cognitive Impairment and Dementia

Decreasing estrogen levels have been hypothesized to be associated with increased risk of dementia, yet the current literature reveals conflicting results. This study aimed to determine whether a longer reproductive period, as an indicator of longer exposure to endogenous estrogens, is associated with risk of transitioning to MCI and dementia. Women 65 and over (N=1507) from the Rush Memory and Aging Project met eligibility for the current analysis. The average length of reproductive period (menopause age minus menarche age) was 35 years (range=16-68 years), and 64% had natural menopause. Multistate survival modeling (MSM) was used to estimate the influence of reproductive period on risk of transitioning through cognitive states including mild cognitive impairment (MCI) and clinically diagnosed dementia, as well as death. Multinomial regression models estimated total and cognitively unimpaired life expectancies based on the transition probabilities estimated by the MSM. Results suggest that women with more reproductive years were less likely to transition from no cognitive impairment (NCI) to MCI, and were more likely to return to NCI from MCI. Analyses also suggest two additional years free of cognitive impairment for women with 45 vs 25 years of reproduction, though reproduction period did not significantly impact overall life expectancy. This study suggests that the number of years of reproductive duration is not associated with the transition to dementia, but is possibly associated with delayed cognitive decline, reduced risk of MCI, increased likelihood of returning to NCI from MCI, and increased lifespan free of cognitive impairment.

The predictive role of monocyte-lymphocyte ratio and plateletlymphocyte ratio in postmenopausal osteoporosis

Objective. To investigate the relationship between neutrophil to lymphocyte ratio (NEU/LY), monocyte to lymphocyte ratio (MO/LY), platelet to lymphocyte ratio (PLT/LY), mean platelet volume to lymphocyte ratio (MPV/LY), mean platelet volume to platelet ratio (MPV/PLT), plateletcrit to platelet ratio (PCT/PLT) and postmenopausal osteoporosis. Materials and Methods. The data of the patients who were admitted to Ümraniye Training and Research Hospital between January 2017 and July 2020 and had both bone mineral densitometry and hemogram tests on the same day were retrospectively scanned. A number of 177 patients who had been in natural menopause for at least one year and did not have any chronic disease nor used any medication were first divided into 3 groups: a number of 48 patients with osteoporosis, 103 with osteopenia and 26 patients included in the control group. Later on, 177 patients were divided into two groups: 151 patients with low bone mineral density and 26 patients were included in the control group. Results. There was no difference between the three groups in terms of NEU/LY, MPV/LY, MPV/PLT and PCT/PLT. The MO/LY ratio and PLT/LY ratio were statistically significantly higher in the osteoporosis group (p = 0.002, p <0.001, respectively). The MO/LY ratio was significantly higher in the group with low bone mineral density compared to the control group (p = 0.011), while there was no statistical difference between the two groups in terms of PLT/LY ratio (p = 0.281). Conclusions. This study shows that MO/LY and PLT/LY are quite simple and cheap markers that can be used in the diagnosis of postmenopausal osteoporosis and MO/LY in the diagnosis of postmenopausal low bone mineral density.

Surgical menopause: A toolkit for healthcare professionals

Surgical menopause (bilateral oophorectomy) is commonly undertaken during a hysterectomy to treat various medical conditions. Menopausal symptoms can be particularly severe due to the sudden loss of ovarian function. This clinical toolkit is intended to guide healthcare professionals caring for women undergoing surgical menopause. Women commonly experience vasomotor symptoms, sexual dysfunction and an increased risk of cardiovascular and osteoporotic disease. Compared with a natural menopause, loss of libido can be more pronounced following a surgical menopause. Hormone Replacement Therapy (HRT) plays a significant role in managing surgical menopause, especially in women aged under 45 years old. All women undergoing surgical menopause should have adequate counselling regarding the hormonal consequences of surgery and the role of HRT with a view to provide individualised, patient-centred care.