Treatment of symptoms of the menopause: an endocrine society clinical practice guideline

Objective: The objective of this document is to generate a practice guideline for the management and treatment of symptoms of the menopause. Participants: The Treatment of Symptoms of the Menopause Task Force included six experts, a methodologist, and a medical writer, all appointed by The Endocrine Society. Evidence: The Task Force developed this evidenced-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned three systematic reviews of published data and considered several other existing meta-analyses and trials. Consensus Process: Multiple e-mail communications, conference calls, and one face-to-face meeting determined consensus. Committees of The Endocrine Society, representatives from endorsing societies, and members of The Endocrine Society reviewed and commented on the drafts of the guidelines. The Australasian Menopause Society, the British Menopause Society, European Menopause and Andropause Society, the European Society of Endocrinology, and the International Menopause Society (co-sponsors of the guideline) reviewed and commented on the draft. Conclusions: Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms and other symptoms of the climacteric. Benefits may exceed risks for the majority of symptomatic postmenopausal women who are under age 60 or under 10 years since the onset of menopause. Health care professionals should individualize therapy based on clinical factors and patient preference. They should screen women before initiating MHT for cardiovascular and breast cancer risk and recommend the most appropriate therapy depending on risk/benefit considerations. Current evidence does not justify the use of MHT to prevent coronary heart disease, breast cancer, or dementia. Other options are available for those with vasomotor symptoms who prefer not to use MHT or who have contraindications because these patients should not use MHT. Low-dose vaginal estrogen and ospemifene provide effective therapy for the genitourinary syndrome of menopause, and vaginal moisturizers and lubricants are available for those not choosing hormonal therapy. All postmenopausal women should embrace appropriate lifestyle measures

The menopausal age and associated factors in Gorgan, Iran

Background: Considering the physical, emotional and psychological complications of early or delayed menopause on women's life, it is necessary to determine associated factors of menopause age. This study designed to determine menopausal age and associated factors in women of Gorgan, i.e. the capital of Golestan province in the north-east of Iran. Methods: In this cross-sectional study, 804 menopausal women in Gorgan were selected via two-stage sampling method in 2009. The study included only women who had undergone natural menopause and had their last menstrual bleeding at least one year before. Data were gathered through structured questionnaire that included individual characteristics, socioeconomic characteristics, menstrual and fertility characteristics and climacteric complaints. Socioeconomic status was defined using principal component analysis. Data were analyzed with Tstudent's and ANOVA tests using SPSS version 16 (SPSS Inc, Chicago, IL, USA) for Windows. Results: The mean menopause age was 47.6±4.45 years with the median age of 48 years. The mean menopause age in women with first pregnancy before 30 years (47.58±4.47years), without pregnancy (46.26±4.90years) and without delivery (46.30±4.47years) was significantly lower than others (p 0.05). Socioeconomic status was not associated significantly with menopause age (p>0.05). Conclusion: This study illustrated that menstrual and fertility factors have influence on menopausal age while socioeconomic factors were not effective

Surgical menopause and frailty risk in older community dwelling women: the study of osteoporotic fractures

BACKGROUND: Low testosterone levels in older women have been shown to be associated with frailty. Whether older postmenopausal women with a history of bilateral oophorectomy before natural menopause resulting in lower testosterone levels (surgical menopause) have higher risk for frailty is not known. This prospective study investigated whether women who had surgically-induced menopause had a greater risk of frailty than naturally menopausal women. Furthermore, we also determined whether lower serum testosterone levels would be associated with frailty in our study population of older postmenopausal women. METHODS: The sample included 7699 community-dwelling white women aged ≥ 65 years from the Study of Osteoporotic Fractures (SOF). Participants were determined to have undergone surgical versus natural menopause based on whether or not they reported retrospectively having undergone a bilateral oophorectomy before or after menopause. Frailty status was classified as not frail, somewhat frail (hereafter referred to as Intermediate stage), frail or death at four interviews, conducted 6-18 years post-baseline. Baseline serum total testosterone concentrations were available on a subset of 541 participants. RESULTS: Approximately 12.6% of the participants reported surgical menopause. A total of 39.7% were classified as somewhat frail (intermediate stage) and 10.1% as frail. Twenty-two (22.0%) of the participants died during the interview period when frailty was assessed. Mean age at baseline was 71.2 years. Total serum testosterone levels were significantly lower among surgically menopausal women compared to naturally menopausal women (p<0.01). Surgical menopause was not significantly associated with an increased risk of frailty (Odds Ratio=0.94; 95% CI=0.72-1.22), intermediate stage frailty (Odds Ratio=0.96; 95% CI=0.80-1.10) or death (Odds Ratio=1.17 ; 95% CI=0.97-1.42) after adjusting for age, BMI and number of IADL impairments. Stratified analyses showed that oral estrogen use did not modify these associations. CONCLUSION: Among postmenopausal women, surgical menopause was not associated with a higher risk for frailty compared to naturally menopausal women, even in the absence of estrogen therapy. Future prospective studies are needed to investigate hormonal mechanisms involved in the development of frailty in older postmenopausal women.2017-11-05T00:00:00

The use of complementary and alternative medications by menopausal women living in South East Queensland

Complementary and alternative medication (CAM) use during menopause is a growing public and women's health issue. The use of CAMs is increasing and evidence of CAM use in the general population suggests that women in the menopausal age range are more likely to use CAMs. In the context of menopause, preliminary research has indicated that women are using a number of CAMs to address symptoms. In a study of American women aged 45 to 65 years, 22% of women used CAMs during menopause, specifically herbal or naturopathic remedies (13%), relaxation techniques (9%) and dietary soy supplements (7%). Fourteen percent (14%) of women strongly agreed with the proposition that approaches such as nutrition and vitamins were better than hormones (Newton et al., 2002). The term 'menopause' is a concept of varying perceptions and perspectives. From the biological perspective, menopause is constant, however from the individual perspective, menopause is a unique experience shaped by cultural, emotional, psychological and physical characteristics. Symptoms commonly cited during menopause include hot flushes, night sweats palpitations, irregular menses and muscle and bone pain. The use of CAMs during menopause has the potential to address current symptoms and promote long term health and wellness. The reviewed literature indicated that while a preliminary understanding of CAM use during menopause is evident, further research is needed to clarify and contextualise current prevalence rates and types used. In addition, an understanding of the reasons and factors that influence women to use CAMs during this transition is crucial to understanding women's menopausal experience. This project aimed to explore the prevalence of CAM use during menopause and to identify the reasons that influence women to use these therapies during the transition. To address this question, a two phase study was designed to incorporate both quantitative and qualitative research methods. For Phase 1, a secondary data analysis was undertaken on a dataset that explored women's menopausal experiences and therapies used to address symptoms and for phase 2, focus groups were used to explore women's personal experiences and perceptions of CAM use during menopause. The secondary data analysis was undertaken on a population based sample of 886 women aged 47-67 years. Women were randomly selected from the electoral roll on the basis of gender, age and postcode, which were selected to ensure representation of urban and rural and varying socioeconomic status. From this analysis, the findings indicated that 80% of women used at least one type of CAM with therapeutic techniques (activities such as walking and swimming) the most commonly used (83.0%), followed by nutrition (66.8%), phytoestrogens (55.8%), herbal therapies (41.3%) and CAM medications (25.1%). Women who used CAMs were more likely to experience anxiety and vasomotor (hot flushes and night sweats) symptoms, have higher education levels, be low to middle income earners, be aged under 55 years, be previous users of hormone therapy (HT) and have participated in self breast examinations. CAM users were 40 to 90% less likely to be currently using HT or to smoke more than 20 cigarettes per day. The results of the secondary data analysis indicated the prevalence and factors associated with CAM use, however the factors that influence women to use CAMs during the menopause were unclear. A series of three focus groups and two telephone interviews were undertaken with a group of 15 women, who were current users of CAMs, aged 47-67 years and fluent in English. Women were recruited through an advertisement placed in a newsletter distributed by a large metropolitan hospital; a flyer displayed on noticeboards of libraries and shopping centres; and a media release through the local community newspaper and on a state wide radio station. Analysis of the transcripts indicated that a number of factors interact to influence a woman's decision to use CAMs. Influences included relationships with family, friends and health practitioners, effects of symptoms, information on CAMs and menopause, current menopause research, personal perceptions of health, wellness and effectiveness of CAM therapies to alleviate symptoms. Taken together, the results of the Phase 1 and 2 combined with the literature indicated that women were using multiple forms of CAMs. A post hoc analysis was undertaken and the CAM questions analysed in Phase 1 were critiqued within this new knowledge of CAM use. As a consequence, CAMs were redefined into four groups to enhance current understandings. After reclassification, the use of at least one CAM was 71.6%, with the most commonly used dietary phytoestrogens (60.0%), followed by dietary supplements (47.0%), herbal therapies (35.9%) and phytoestrogen supplements (33.0%). Sociodemographic, health and symptom characteristics were further profiled against the redefined categories of dietary phytoestrogens, dietary supplements, herbal therapies, phytoestrogen supplements and users of multiple CAMs. The consistency of associations varied according to the CAM category with no significant association present across all four CAM categories. This post hoc analysis clarified CAM categorisation and highlighted the high prevalence of women who were using multiple forms of CAMs. Additionally, multivariable analysis validated and confirmed the results of Phase 1 as similar profiles of a CAM user were found. This research has identified the prevalence of CAM use during menopause in Queensland women and has begun to elucidate the reasons that influence women to use these therapies during this transition. The utilisation of both quantitative and qualitative methods has provided a comprehensive and holistic depiction of women's use of CAMs during menopause. The results and conclusions drawn from this research have highlighted areas that need addressing within the research and health service domain. For future research, development of a comprehensive CAM survey instrument is required and clarification of the definition of CAMs is also needed. Multiple definitions are currently used to describe CAM use, creating confusion in classifying types of CAMs and comparing prevalence rates between studies. With regard to health service recommendations, there is a need for increased access to information on menopause and alternative therapies for women. Open, active and participatory relationships between health practitioners and menopausal women are essential and health practitioners need to be aware women are using a variety of CAMs during the menopause and are likely to continue to do so even if health practitioner support is not apparent

Ovarian reserve and anti-Mullerian hormone (AMH) in mothers of dizygotic twins

This study aimed to explore if natural dizygotic (DZ) twinning is associated with earlier menopause and lower anti-Mullerian hormone (AMH) values. We investigated if advanced biological reproductive aging, which can be responsible for the multiple follicle growth in familial twinning, is similar to mechanisms that occur in normal ovarian aging, reflected by earlier menopause in mothers of DZ twins and lower levels of AMH. A total of 16 mothers of DZ twins enrolled with the Netherlands Twin Register (average age at first assessment: 35.9 +/- 3.0 years) and 14 control mothers (35.1 +/- 3 years) took part in a prospective study. Fifteen years after entry into the study, which included follicle-stimulating hormone (FSH) assessment, AMH was measured in stored serum samples and menopause status was evaluated. Average AMH levels were not significantly different between DZ twin mothers and controls (2.1 +/- 2.4 mu g/L vs. 1.9 +/- 1.9 mu g/L). Among the 16 mothers of twins, 7 had an elevated (FSH) value over 10 U/L at first assessment. Their AMH levels were lower than the nine twin mothers with normal FSH values: 0.6 +/- 0.4 versus 3.4 +/- 2.6 mu g/L (p = .01). Of the mothers of twins, eight mothers had entered menopause at the second assessment compared with only one control mother (p = .07). Thus, slightly more DZ mothers were in menopause than the control mothers, although this difference was not significant. The subgroup of DZ twin mothers who had an increased FSH concentration 15 years ago had a limited ovarian reserve as reflected by lower AMH levels. These data indicate that advanced ovarian aging can be a feature in familial DZ twinning, particularly with elevated early follicular phase FSH

Women, work and the menopause: releasing the potential of older professional women

Explores the experiences of menopause for professional women as part of a broader appreciation of&nbsp;health and well-being in later life. Executive summary This report presents the key findings and recommendations of a research project entitled Women, Work and the Menopause: Releasing the Potential of Older Professional Women. Menopause is a ‘silent issue’ for most organisations, and older women represent a group whose working lives, experiences and aspirations are poorly understood by employers, national governments and academic researchers alike. This is highly unfortunate given that women aged 45 years and over comprise 17% of the ageing Australian workforce, meaning that over one million working women are currently going through, or have already gone through, the menopause. The broad aim of this project was therefore to examine the occupational health and well-being of older women, with a particular emphasis on understanding women’s experiences of menopause at work. More specifically, the project set out to generate insights on five key areas: 1. Older women’s health and well-being; 2. The relationship between menopause-related symptoms and four specific work outcomes (work engagement, job satisfaction, organisational commitment, intention to quit); 3. Actual and desired levels of organisational support for women experiencing menopause; 4. Work-related and organisational factors that exacerbate or ameliorate women’s experiences of menopause in the workplace; and 5. Women’s first-hand experiences, beliefs and attitudes towards menopause at work. Data collection took place between November 2013 and March 2014 via two parallel research studies. The first study consisted of an online survey (herein referred to as WAW – Women at Work Survey) of 839 women (age range 40-75 years; average age 51.3 years) employed in academic, administrative and executive roles at three Australian universities. The second study (herein referred to as Prime – The Prime Project) involved 48 qualitative interviews with academic and administrative staff members at two Australian universities. The study identified the following key findings: All age groups reported average to good mental and physical health. While self-reported physical health deteriorated with age, mental health appeared to improve with age (60+ year olds reported better mental health than 40-49 and 50-59 year olds). Among administrative and executive staff, women aged 40-49 years reported greater intention to quit their jobs than their older colleagues (50-59 years and 60+ years old). The interview study was marked by an overwhelming sense that ‘women just get on with it’. This theme captured many inter-related aspects of women’s experiences of mid-life in general (e.g., of juggling demanding and multiple work and care-giving roles) and underlined the considerable, and often unacknowledged, resilience of older professional women. Peri-women currently experiencing the menopause most frequently experienced the following symptoms associated with menopause (in descending order of prevalence): sleep disturbance, headaches, weakness or fatigue, loss of sexual desire, anxiety, memory loss, pain in bone joints, and hot flushes. None of the measured work outcomes differed by menstrual status. However, the more frequently women reported experiencing menopause-related symptoms and the more bothersome the symptoms were, the less engaged they felt at work, less satisfied with their job, the greater their intention to quit their job and the lower their commitment to the organisation. The interview findings, however, suggested that it is difficult to attribute many symptoms simply to menopause. Symptoms can also be associated with ageing and ‘the time of life’ more generally, or the occupational impact of the working environment, such as stress (notably associated with organisational change and work intensification). Negative organisational and managerial messages about older women had a significant impact on how engaged, and how included, women felt at work. There was evidence of gendered ageism, with many women only feeling able to talk informally to other close female colleagues and friends about their menopausal experiences. Organisational sub-cultures were also found to have a significant influence on women’s experience of menopause at work, creating particular demands on women to ‘fit in’ and to manage expectations and workplace identities that assumed an ‘unproblematic body’. Work-related and organisational factors played important roles in ameliorating or exacerbating women’s experience of menopause at work. Temperature control over their immediate environment was important, as was the exacerbating impact of the increasingly sedentary nature of work that might intensify menopausal-related symptoms. However, paid employment also held positive benefits for some women, ameliorating their symptoms and providing an environment in which to develop and blossom as strong, independent and energetic employees. The flexibility of working arrangements (notably in respect of work time) was a particular characteristic that benefited (menopausal) women. Both the survey and the interviews pointed to a lack of menopause-specific support or information in their organisational settings. Many were unsure whether line managers were given training in awareness of the menopause in the workplace. While organisations should provide information, there were varying views about whether organisations should or could introduce menopause-specific policies, or whether that would only serve to marginalise or problematise older workers. While women did not want formal management or ‘intervention’ of the menopause, organisational understanding and support was deemed to be important and part of a broader message as to whether older women were welcome in the workplace or not. This report proposes a number of recommendations related to Occupational Health and Safety (OH&amp;S) and Human Resources (HR) Management, and emphasises the role of general organisational processes, policies and professional bodies in initiating change. To plan for improved working conditions for older women now, is to ensure that organisations will reap future rewards by acknowledging and investing in this reliable, loyal, committed and resilient segment of the workforce. &nbsp

Wage Work for Women: The Menstrual Cycle and the Power of Water

We hypothesise that women's participation in wage (off-farm) work is reduced when their greater water needs due to the menstrual cycle are not met because their household has poor access to water. For testing, we use the data from rural villages in China. Controlling for village fixed effects, poor access to water is found to decrease the probability of wage work participation of affected (pre-menopause) women by about 10 percentage points, a large effect. As expected, there is no adverse causal impact of poor household access to water for women post-menopause, or for men, ceteris paribus.wage work, women, menopause, water engineering, rural development, China

Can the menopause really be reversed?

Scientists in Greece claimed recently to have “reversed the menopause”. They did this by injecting blood plasma that contains platelets into the ovaries of eight women who had not menstruated for around five months in order to stimulate ovarian regeneration. The scientists later recovered eggs from the ovaries. The eggs were able to mature and reach the stage at which they could be fertilised. Does this mean the end of menopause? At this time, the answer would almost certainly be “no”

The relationship between anti-mullerian hormone in women receiving fertility assessments and age at menopause in subfertile women: evidence from large population studies

&lt;p&gt;Context: Anti-Müllerian hormone (AMH) concentration reflects ovarian aging and is argued to be a useful predictor of age at menopause (AMP). It is hypothesized that AMH falling below a critical threshold corresponds to follicle depletion, which results in menopause. With this threshold, theoretical predictions of AMP can be made. Comparisons of such predictions with observed AMP from population studies support the role for AMH as a forecaster of menopause.&lt;/p&gt; &lt;p&gt;Objective: The objective of the study was to investigate whether previous relationships between AMH and AMP are valid using a much larger data set.&lt;/p&gt; &lt;p&gt;Setting: AMH was measured in 27 563 women attending fertility clinics.&lt;/p&gt; &lt;p&gt;Study Design: From these data a model of age-related AMH change was constructed using a robust regression analysis. Data on AMP from subfertile women were obtained from the population-based Prospect-European Prospective Investigation into Cancer and Nutrition (Prospect-EPIC) cohort (n = 2249). By constructing a probability distribution of age at which AMH falls below a critical threshold and fitting this to Prospect-EPIC menopausal age data using maximum likelihood, such a threshold was estimated.&lt;/p&gt; &lt;p&gt;Main Outcome: The main outcome was conformity between observed and predicted AMP.&lt;/p&gt; &lt;p&gt;Results: To get a distribution of AMH-predicted AMP that fit the Prospect-EPIC data, we found the critical AMH threshold should vary among women in such a way that women with low age-specific AMH would have lower thresholds, whereas women with high age-specific AMH would have higher thresholds (mean 0.075 ng/mL; interquartile range 0.038–0.15 ng/mL). Such a varying AMH threshold for menopause is a novel and biologically plausible finding. AMH became undetectable (&#60;0.2 ng/mL) approximately 5 years before the occurrence of menopause, in line with a previous report.&lt;/p&gt; &lt;p&gt;Conclusions: The conformity of the observed and predicted distributions of AMP supports the hypothesis that declining population averages of AMH are associated with menopause, making AMH an excellent candidate biomarker for AMP prediction. Further research will help establish the accuracy of AMH levels to predict AMP within individuals.&lt;/p&gt

The role of Phytoestrogens in the management of menopausal symptoms

Menopause reflects a change in the woman’s physiological hormonal status and is regarded as a pivotal point in a woman’s life. The commonest symptoms experienced by women during the menopause are hot flushes and night sweats. Although HRT remains the gold standard for the treatment of menopausal symptoms, certain controversial studies have led to a shift against the regular use of HRT. Many physicians and women have turned to alternative ‘natural’ products, hoping that these can substitute the need for HRT. The evidence base for the efficacy and safety of phytoestrogens, in particular isoflavones, will be discussed.peer-reviewe