Trajectories of Blood Pressure in Midlife Women: Does Menopause Matter?

Background: Whether changes in blood pressure (BP) over women's midlife are more driven by chronological aging or the menopause transition (MT) has been debated. We sought to determine whether women can be classified into distinct trajectory groups based on pattern and level of systolic (SBP), diastolic blood pressure, pulse pressure (PP), and mean arterial pressure (MAP) over the MT, and to assess whether menopause-related factors predict the group and/or level of BP measures. Methods: Participants were from the Study of Women's Health Across the Nation (SWAN). Group-based trajectory modeling was used to identify women who shared distinct BP trajectories over time relative to menopause onset and to assess associations of menopause-related factors with trajectory group and/or level of BP measures. An accelerated rise relative to menopause onset suggests a menopause contribution. Results: The study included 3,302 multi-racial/ethnic women with BP measures over 17 follow-up visits (baseline age[SD]: 46.3[2.7]). Women were classified into either low, medium, or high trajectory group in each BP measure. The low SBP, PP, and MAP trajectories (in 35%, 53%, and 28% of the cohort, respectively) were rising slowly before menopause but showed a significant accelerated rise 1 year after menopause, indicating a menopause contribution. The remaining BP trajectories were rising up until menopause and either continued with the same rise or declined after menopause. A younger menopause age predicted the low SBP, PP, and MAP trajectories. A greater follicle-stimulating hormone level predicted lower SBP and PP levels, while vasomotor symptoms occurrence predicted higher SBP, PP, and MAP levels over time. Estradiol did not predict trajectory or level of any BP measure. Conclusions: Distinct BP trajectories over the MT exist that revealed a group of women whose SBP, PP, and MAP trajectories are consistent with a menopause contribution. Our findings support frequent monitoring of BP during the MT.

Menopause as a well-being strategy: Organizational effectiveness, gendered ageism and racism

Objective This study considers the example of one council who deliberately implemented menopause considerations into their well-being strategy instead of instituting a menopause policy. This example is used to explore whether such a strategy is a more viable and effective alternative. Study Design An online survey was distributed amongst council workers and completed by 189 individuals. The questions covered respondents’ own experiences of menopause transition at work (where applicable) and the availability of information and support for menopause at work, as well as a range of contextual factors. Main outcome measures Experiences of workplace environments and relationships by those experiencing menopause. Results Results on menopause experiences in this council are comparable to those in organizations who have implemented menopause policies or guidelines. Contextual factors, including gendered vertical segregation and racism, are highlighted as important factors influencing the experience of menopause transition in the workplace. Conclusions Early indications suggest that integrating menopause support into a health and well-being strategy helps mainstream menopause issues amongst staff. Long-term assessment is required to consider whether it is more effective than introducing a menopause policy or guidelines.

Arterial hypertension in women: Menopause as a risk window

Objectives Cardiovascular diseases (CVD) exert a heavy toll on health of women, mainly due to hypertension said to cluster around the period of transition to menopause. This makes this period a good window to target for prevention and control. We therefore sought to determine if this period really heralds arterial hypertension and CVD in women in our environment. Study design We secondarily analysed our population data on CVD risk factors in free living rural residents. Main outcome variables The data considered were blood pressure, anthropometric and biochemical variables in women stratified based on menstruation status. Results There were 488 females, with 218 still menstruating. They were younger ( p = .000), had lower systolic and diastolic blood pressures ( p = .000), lower anthropometric indices attaining significance only with waist circumference ( p = .001) and lower total cholesterol ( p = .001). Controlling for age, statistically significant differences remained for systolic and diastolic blood pressures, body mass index, waist and hip circumferences, and total cholesterol. Conclusion The menopause transition comes with a worse CVD profile. Blood pressure rises and so are the anthropometric variables and some biochemical parameters that fuel CVD. This could be ascribed to age which is higher with those post-menopausal. Controlling for age in this cohort still showed that transiting from pre- to post-menopause still came with CVD burden. Clinicians should take the opportunity presented by menopause transition to screen for CVD risk factors and initiate either preventive or control measures to mitigate morbi-mortality consequences.

‘Menopause affects us all . . .’: menopause transition experiences of female ambulance staff from a UK ambulance service

Background: There is limited research regarding the menopause transition in the emergency services; however, all women will experience this life phase, which can have a significant impact on personal well-being, workplace attendance and performance. The aim of this survey was to explore personal and work impacts of the menopause for all female staff in the ambulance setting.Methods: A purpose-designed, 20-question survey, based on the Menopause Rating Scale and British Menopause Survey, was developed to understand menopausal symptoms and their impact on female staff in one UK ambulance service. Disseminated during 1‐31 July 2019, it resulted in a convenience sample of 522 responses, which were analysed using descriptive statistics and thematic approaches.Results: Typically, respondents were either pre-menopausal or peri-menopausal, with approximately a third being menopausal or post-menopausal. Over half worked in emergency operational delivery, and typically worked shifts or unsocial hours. For those who had experienced menopause symptoms, the most commonly reported were tiredness or low energy levels, difficulty sleeping (including insomnia) and mood changes (including anxiety or depression). Symptoms impacted respondents’ well-being, work and home life. Most had not expected the symptoms they experienced. The majority of respondents did not feel supported at work, with lack of menopausal symptom awareness and personal impact, working times and patterns, and sense of embarrassment of most concern. Other issues included lack of managerial and peer support, inadequate working environment and uniform, lack of dignity and choice, and no dedicated menopause policy.Conclusions: It is understood that this is the first survey to explore female ambulance staff menopause experiences. The impact of menopausal symptoms can be significant. Menopause awareness in this ambulance service is lacking and there is clear scope for initiatives for improved staff support and well-being. Further research is warranted to explore how best to support ambulance staff with the menopause transition.

Biopsychosocial risk factors of depression during menopause transition in southeast China

Objective More than 2 billion women experiencing menopause transition in China and some of them suffered depression; while the risk factors of depression are still unclearin China. We aimed to investigate the risk factors in mid-life women in Southeast China. Method This study included 1748 Chinese women aged 40 to 65 years who visit gynecology outpatient department of Women’s hospital School of Medicine, Zhejiang University during 2010 to 2018. Demographic information was collected, and the modified Kupperman Menopausal Index (mKMI) and Hamilton Rating Scale for Depression were assessed. Circulating levels of sex hormones were obtained. Ordinal logistic regression analysis was performed to identify risk factors for depression. Results The prevalence of depression symptoms was 47.43%. The majority of women had mild (38.56%) or moderate depression symptoms (8.00%); only 0.86% had severe depression. Compared with perimenopausal women, postmenopausal women had increased risks of depression. The associations between menopausal syndromes and depression were strongly positive (OR 6.69, 95% CI 5.39–8.29). Women with older age, higher follicle stimulating hormone levels, lower estradiol levels, and fewer parity had increased risk of depression. Among postmenopausal women, underweight, mKMI > 14, earlier age at menopause, shorter reproductive period, and longer duration after menopause were risk factors for depression. Conclusions The results demonstrated a high proportion of depression in women complaining of menopause. Menopausal symptoms were strongly related to the risk of depression. In postmenopausal women, estrogen related events are associated with depression. Gynecological endocrinologists in China should consider screening for depression in high-risk women.