Menopause and its management: A review

Menopausal transition (premenopause) is the phase in the ageing process of women representing the transition from the reproductive stage of life to the non-reproductive stage. With improvements in average life expectancy, women live an increased proportion of their lives in the postmenopause. The consequences of oestrogen loss are the early symptoms (psychological and vasomotor), the genitourinary syndrome (intermediate), as well as postmenopausal osteoporosis with increased risk of fractures and cardiovascular diseases (late). The diagnosis of climacteric syndrome is based on typical clinical symptoms. Perimenopausal women should understand physiological changes occurring in menopausal transition. They should be encouraged to live a healthy lifestyle. Menopausal hormone therapy is indicated for relief of the acute symptoms of menopause and for treatment of urogenital atrophy. It should be administered in the lowest effective dose for the shortest period of time. The treatment should be initiated before the age of 60 years or within 10 years after menopause in order to decrease its risks. The benefit/risk profile needs to be individually re-assessed every year.

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.

Association of bilateral salpingo-oophorectomy with all cause and cause specific mortality: population based cohort study

Objectives To determine if bilateral salpingo-oophorectomy, compared with ovarian conservation, is associated with all cause or cause specific death in women undergoing hysterectomy for non-malignant disease, and to determine how this association varies with age at surgery. Design Population based cohort study. Setting Ontario, Canada from 1 January 1996 to 31 December 2015, and follow-up to 31 December 2017. Participants 200 549 women (aged 30-70 years) undergoing non-malignant hysterectomy, stratified into premenopausal (<45 years), menopausal transition (45-49 years), early menopausal (50-54 years), and late menopausal (≥55 years) groups according to age at surgery; median follow-up was 12 years (interquartile range 7-17). Exposures Bilateral salpingo-oophorectomy versus ovarian conservation. Main outcomes measures The primary outcome was all cause death. Secondary outcomes were non-cancer and cancer death. Within each age group, overlap propensity score weighted survival models were used to examine the association between bilateral salpingo-oophorectomy and mortality outcomes, while adjusting for demographic characteristics, gynaecological conditions, and comorbidities. To account for comparisons in four age groups, P<0.0125 was considered statistically significant. Results Bilateral salpingo-oophorectomy was performed in 19%, 41%, 69%, and 81% of women aged <45, 45-49, 50-54, and ≥55 years, respectively. The procedure was associated with increased rates of all cause death in women aged <45 years (hazard ratio 1.31, 95% confidence interval 1.18 to 1.45, P<0.001; number needed to harm 71 at 20 years) and 45-49 years (1.16, 1.04 to 1.30, P=0.007; 152 at 20 years), but not in women aged 50-54 years (0.83, 0.72 to 0.97, P=0.018) or ≥55 years (0.92, 0.82 to 1.03, P=0.16). Findings in women aged <50 years were driven largely by increased non-cancer death. In secondary analyses identifying a possible change in the association between bilateral salpingo-oophorectomy and all cause death with advancing age at surgery, the hazard ratio gradually decreased during the menopausal transition and remained around 1 at all ages thereafter. Conclusion In this observational study, bilateral salpingo-oophorectomy at non-malignant hysterectomy appeared to be associated with increased all cause mortality in women aged <50 years, but not in those aged ≥50 years. While caution is warranted when considering bilateral salpingo-oophorectomy in premenopausal women without indication, this strategy for ovarian cancer risk reduction does not appear to be detrimental to survival in postmenopausal women.

Management of sleep disorders in the menopausal transition

The menopausal transition is associated with increasing sleep disorders including sleep apnoea and restless leg syndrome. Insomnia is the most common and is recognised as a core symptom of the menopause. Guidelines to support decision making for women with sleep problems during the menopausal transition are lacking. Sleep problems are associated with negative impacts on healthcare utilisation, quality of life and work productivity. Sleep deprivation is a risk factor for cardiovascular disease, diabetes, obesity and neurobehavioral dysfunction. Declining oestrogen is implicated as a cause of menopausal sleep disruption. Vasomotor symptoms (VMS) and menopausal mood disturbance are also factors in the complex aetiology. VMS commonly precipitate insomnia and, due to their prolonged duration, they often perpetuate the condition. Insomnia in the general population is most effectively treated with cognitive behavioural therapy (CBT) (also effective in the menopausal transition.) The associations of menopausal sleep disturbance with VMS and depression mean that other treatment options must be considered. Existing guidelines outline effectiveness of hormone replacement therapy (HRT), CBT and antidepressants. HRT may indirectly help with sleep disturbance by treating VMS and also via beneficial effect on mood symptoms. The evidence base underpinning menopausal insomnia often references risks associated with HRT that are not in line with current international menopause guidelines. This may influence clinicians managing sleep disorders, leading to hesitation in offering HRT, despite evidence of effectiveness. Viewing sleep symptoms on an axis of menopausal symptoms – towards vasomotor symptoms or towards mood symptoms may help tailor treatment options towards the symptom profile.

A Novel Hypothesis: A Role for Follicle Stimulating Hormone in Abdominal Aortic Aneurysm Development in Postmenopausal Women

An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta, which can potentially be fatal due to exsanguination following rupture. Although AAA is less prevalent in women, women with AAA have a more severe AAA progression compared to men as reflected by enhanced aneurysm growth rates and a higher rupture risk. Women are diagnosed with AAA at an older age than men, and in line with increased osteoporosis and cardiovascular events, the delayed AAA onset has been attributed to the reduction of the protective effect of oestrogens during the menopausal transition. However, new insights have shown that a high follicle stimulating hormone (FSH) level during menopause may also play a key role in those diseases. In this report we hypothesize that FSH may aggravate AAA development and progression in postmenopausal women via a direct and/or indirect role, promoting aorta pathology. Since FSH receptors (FSHR) are reported on many other cell types than granulosa cells in the ovaries, it is feasible that FSH stimulation of FSHR-bearing cells such as aortic endothelial cells or inflammatory cells, could promote AAA formation directly. Indirectly, AAA progression may be influenced by an FSH-mediated increase in osteoporosis, which is associated with aortic calcification. Also, an FSH-mediated decrease in cholesterol uptake by the liver and an increase in cholesterol biosynthesis will increase the cholesterol level in the circulation, and subsequently promote aortic atherosclerosis and inflammation. Lastly, FSH-induced adipogenesis may lead to obesity-mediated dysfunction of the microvasculature of the aorta and/or modulation of the periaortic adipose tissue. Thus the long term increased plasma FSH levels during the menopausal transition may contribute to enhanced AAA disease in menopausal women and could be a potential novel target for treatment to lower AAA-related events in women.

High plant-based diet and physical activity in women during menopausal transition

Purpose The menopausal transition (MT) is a period when there may be an increase in visceral fat mass and a worsening of cardiometabolic risk factors. Few studies have evaluated the efficacy of plant-based low-calorie diets on groups of women at different stages of MT. The purpose of this study is to compare the effectiveness of a high plant-to-animal protein ratio diet in women of similar age but with different fertility statuses. Design/methodology/approach Subjects were divided into three groups according to their fertility status at the baseline: “premenopausal” (n = 11), “perimenopause” (n = 14) and “postmenopause” (n = 18). Body composition (BC) was measured at the beginning and after eight months of treatment. Individualised lifestyle treatment included a strong component of plant-based foods. Findings Forty-three overweight or obese Caucasian women (age 52.3 ± 4.5 years, body mass index 30.6 ± 5.4 kg/m2, fat mass 33.1 ± 9.3 kg data presented as means ± SD) were included in the study. Mean physical activity was 8.4 ± 7.6 metabolic equivalent of tasks/week. Subjects had an improvement in BC (fat mass −5.6 ± 4.0 kg, p < 0.001 protein −0.3 ± 0.5 kg, p < 0.001), HDL-C and systolic blood pressure values. Waist circumference and hip circumference decreased by 4.1 ± 3.1 cm and −6.0 ± 4.3 cm, respectively. Weight loss resulted in a significant improvement in some blood lipid values, such as total and high-density lipoprotein cholesterol. Adherence to a high plant protein diet helps adult women with different fertility statuses to improve BC and reduce cardiovascular risk factors. Long-term studies with larger sample sizes are needed to confirm these findings. Originality/value In pre-peri- and post-menopausal adult women, a diet high in plant proteins improves body composition and reduces cardiovascular risk factors.