Latest Research on Menopause

Introduction

Menopause is a natural biological process that marks the end of a woman's reproductive years, typically between the ages of 45 and 55. It is the process of menstrual periods ending permanently, caused by the gradual decline in ovarian function and estrogen production. While menopause happens to every woman, the timing, symptoms, and long-term health implications can vary significantly among people.

Hormonal Changes During Menopause

Menopause causes significant hormonal changes, primarily involving estrogen, progesterone, testosterone, and follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Estrogen, the primary female sex hormone, declines slowly during menopause, leading to physiological and psychological effects. Low estrogen levels can increase the risk of conditions like osteoporosis, cardiovascular disease, cognitive decline, and vaginal atrophy [1][2][3][4].

Progesterone, another female sex hormone, also declines during the menopause, often before the drop in estrogen levels. This decrease can cause irregular menstrual cycles and other menopausal symptoms. Testosterone levels may remain relatively stable or slightly increase, playing a role in maintaining sexual function, bone health, and overall well-being [5][6].

FSH and LH, hormones produced by the pituitary gland, typically increase during the menopausal transition as the body tries to make up for declining estrogen and progesterone levels. High levels of FSH and LH are often used as diagnostic markers of menopause and can contribute to menopausal symptoms like hot flashes and night sweats [^1^][^2^][^3^].

In addition to the physical effects, menopause can also influence cognitive function and mental health. Some studies have suggested that the decline in estrogen levels may be associated with an increased risk of cognitive decline, dementia, and mood disorders like depression and anxiety [1][2][3][4][8].

Symptoms and Treatments for Menopausal Symptoms

Menopausal women may experience a wide range of symptoms, including hot flashes, night sweats, vaginal dryness and discomfort, mood changes, sleep disturbances, bone loss, and even attention deficit hyperactivity disorder (ADHD) symptoms [9][10][11][12]. Hormone therapy, involving estrogen and/or progesterone, is one of the most effective treatments for menopausal symptoms, particularly vasomotor symptoms and vaginal atrophy [9][15][16].

Non-hormonal medications, such as antidepressants, anti-seizure drugs, blood pressure medications, and neurokinin-3 receptor antagonists like fezolinetant, may be prescribed to help manage specific menopausal symptoms [9][15][16].

Lifestyle changes, dietary supplementation with myo-inositol, cocoa polyphenols, soy isoflavones, evening primrose oil, hop extract, saffron, tryptophan, and various vitamins may also improve vasomotor symptoms and metabolism in menopausal women [10][17].

Alternative therapies, such as acupuncture combined with traditional Chinese medicine formulas, herbal supplements, and mindfulness-based practices, may also help menopausal symptoms [13]. Using vibrators may improve sexual, genitourinary, and mental health in postmenopausal women [14]. They promote blood flow, reduce vaginal atrophy, and enhance sexual satisfaction, and can be a good self-directed aid.

The management of menopausal symptoms is very personal. While hormone therapy remains the most effective treatment for vasomotor symptoms and vaginal atrophy, some women may prefer non-hormonal options because of personal preferences or medical contraindications [9][15][16].

Long-Term Health Implications of Menopause

Menopause can have significant long-term health effects on many systems, like cardiovascular health, bone health, metabolic health, and cognitive and neurological health. The decline in estrogen levels during menopause raises the risk of cardiovascular disease, myocardial infarction, impaired vascular function, and stroke. Estrogen deficiency is also a risk factor for osteoporosis, which causes decreased bone density and raises your risk for fractures. [1][2][3][4].

Menopausal women often experience weight gain, insulin resistance, and dyslipidemia, increasing the risk of obesity, type 2 diabetes, and other metabolic disorders. Some studies suggest that menopause may be linked to an increased risk of cognitive decline, dementia, mood disorders, and sleep disturbances [1][2][3][4][8].

Osteoporosis management in menopausal women may involve using medications like bisphosphonates, denosumab, and hormone therapies. Cardiovascular health can be improved through lifestyle changes, such as regular physical activity, a healthy diet, stress management, and quitting smoking, as well as medications like statins and antihypertensive medications [1][2][3][4].

You can work on your bone health through a combination of approaches, such as weight-bearing exercise, getting enough calcium and vitamin D, and fall prevention strategies, as well as pharmaceutical therapies like bisphosphonates and denosumab when necessary. Hormone therapy, especially in the early postmenopausal years, may also help preserve bone density and reduce the risk of fracture [1][2][3][4][23].

Metabolic health can be helped by maintaining a healthy body weight, engaging in regular physical activity, and following a balanced diet of whole grains, lean proteins, healthy fats, and plenty of fruits and vegetables. Medications, such as metformin and lipid-lowering agents, may be prescribed for women with insulin resistance or dyslipidemia [1][2][3][4].

Cognitive and neurological health can be improved by engaging in mentally stimulating activities, maintaining social connections, getting enough sleep, and managing stress. Hormone therapy, especially when started early in the menopausal transition, may also have neuroprotective effects and reduce the risk of cognitive decline and dementia [1][2][3][4][8].

Lifestyle Factors Affecting Menopause

Lifestyle factors can significantly influence the onset and progression of menopause. Women with a higher body mass index (BMI) tend to start menopause at an earlier age compared to women with a lower BMI, with some studies suggesting a 1-2 year earlier onset for every 5-unit increase in BMI [18][19][20][21][22].

Regular physical activity and exercise are linked to a delayed onset of menopause, with women who engage in moderate to vigorous physical activity experiencing menopause approximately 1-2 years later than less active women. Getting moderate to vigorous physical activity, such as brisk walking, cycling, swimming, or strength training, for at least 150 minutes per week can help maintain a healthy body weight, improve cardiovascular health, and promote bone health. Regular exercise has also been shown to help symptoms like hot flashes, mood changes, and sleep disturbances [18][19][20][21][22].

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Certain dietary factors, such as a higher intake of soy-based foods and isoflavones also may delay menopause, while a diet high in saturated fats and trans fats has been linked to menopause starting earlier [18][19][20][21][22].

Avoiding smoking and limiting alcohol consumption are also important lifestyle factors that can influence the timing and progression of menopause. Smoking has been consistently linked to earlier menopause and increased risk of osteoporosis, cardiovascular disease, and other chronic health conditions. Heavy or binge drinking can be detrimental to overall health and may contribute to earlier menopause [18][19][20][21][22].

In addition to these general lifestyle factors, recent research has also emphasized the potential role of specific biomarkers, such as elevated serum sclerostin levels, in the development of bone marrow adiposity and osteoporosis in postmenopausal women with glucocorticoid-induced osteoporosis. These findings suggest that targeting these biomarkers may create new ways to manage bone health in postmenopausal women [23].

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Citations:

1. Skaznik-Wikiel, M. E., & Polotsky, A. J. (2020). The health consequences of menopause. New England Journal of Medicine, 382(9), 859-868.

2. Santoro, N., Epperson, C. N., & Mathews, S. B. (2015). Menopausal symptoms and their management. Endocrinology and Metabolism Clinics of North America, 44(3), 497-515.

3. Baber, R. J., Panay, N., & Fenton, A. (2016). 2016 IMS recommendations on women's midlife health and menopause hormone therapy. Climacteric, 19(2), 109-150.

4. Brinton, R. D., Yao, J., Yin, F., Mack, W. J., & Cadigan, E. (2015). Perimenopause as a neurological transition state. Nature Reviews Endocrinology, 11(7), 393-405.

5. Davis, S. R., Panjari, M., & Stanczyk, F. Z. (2011). Clinical review: DHEA replacement for postmenopausal women. The Journal of Clinical Endocrinology & Metabolism, 96(6), 1642-1653.

6. Labrie, F., Cusan, L., Gomez, J. L., Côté, I., Bérubé, R., Bélanger, P., ... & Bouchard, C. (2009). Effect of intravaginal prasterone on sexual dysfunction in postmenopausal women with or without metabolic syndrome. Menopause, 16(5), 923-935.

7. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause, 22(11), 1155-1174.

8. Maki, P. M. (2013). The menopausal transition and cognitive health in women: What can we learn from recent evidence?. Neuroscience & Biobehavioral Reviews, 37(5), 789-795.

9. Duralde, E. R., Sobel, T. H., & Manson, J. E. (2023). Management of perimenopausal and menopausal symptoms. Current Opinion in Endocrinology, Diabetes and Obesity, 30(2), 87-93.

10. Mainini, G., Ercolano, S., De Simone, R., Iavarone, I., Lizza, R., & Passaro, M. (2022). Dietary Supplementation of Myo-Inositol, Cocoa Polyphenols, and Soy Isoflavones Improves Vasomotor Symptoms and Metabolic Profile in Menopausal Women with Metabolic Syndrome: A Retrospective Clinical Study. Nutrients, 14(12), 2406.

11. Bürger, I., Erlandsson, K., & Borneskog, C. (2023). Perceived associations between the menstrual cycle and Attention Deficit Hyperactivity Disorder (ADHD): A qualitative interview study exploring lived experiences. ADHD Attention Deficit and Hyperactivity Disorders, 15(1), 27-37.

12. Akhmedova, A. A., & Gorobets, L. N. (2022). [Features of the clinical picture of affective disorders in women during the menopausal transition and early postmenopause]. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova, 122(9), 39-46.

13. Cai, Y., Zhang, X., Li, J., & Yang, W. (2023). Effect of acupuncture combined with Ningshen mixture on climacteric insomnia: A randomized controlled trial. Medicine, 102(3), e32307.

14. Dubinskaya, A., Kohli, P., Shoureshi, P., Breese, C., Scott, V., Anger, J. T., & Eilber, K. S. (2023). The Role of Vibrators in Women's Pelvic Health: An Alluring Tool to Improve Physical, Sexual, and Mental Health. The Journal of Sexual Medicine, 20(3), 100677.

15. Morga, A., Ajmera, M., Gao, E., Patterson-Lomba, O., Zhao, A., Mancuso, S., ... & Kagan, R. (2023). Systematic review and network meta-analysis comparing the efficacy of fezolinetant with hormone and nonhormone therapies for treatment of vasomotor symptoms due to menopause. Menopause, 30(2), 161-170.

16. Elhusein, A. M., Fadlalmola, H. A., Abedelwahed, H. H., Elshaikh, A. A., Banaga, A. E., Alrahman, M. H. F., ... & Habiballa, M. (2023). Menopausal symptom management: Fezolinetant's varied doses provide effective relief for vasomotor symptoms in women - A meta-analysis of 3291 participants. Menopause, 30(2), 171-179.

17. Palacios, S., Mustata, C., Rizo, J. M., & Regidor, P. A. (2023). Improvement in menopausal symptoms with a nutritional product containing evening primrose oil, hop extract, saffron, tryptophan, vitamins B6, D3, K2, B12, and B9. Menopause, 30(2), 180-186.

18. Schoenaker, D. A., Jackson, C. A., Rowlands, J. V., & Mishra, G. D. (2014). Socioeconomic position, lifestyle factors and age at natural menopause: a systematic review and meta-analyses of studies across six continents. International journal of epidemiology, 43(5), 1542-1562.

19. Kaczmarek, M. (2007). The timing of natural menopause in Poland and associated factors. Maturitas, 57(2), 139-153.

20. Sapre, S., & Thakur, R. (2014). Lifestyle and dietary factors determine age at natural menopause. Journal of midlife health, 5(1), 3.

21. Dratva, J., Gomez Real, F., Schindler, C., Ackermann-Liebrich, U., Gerbase, M. W., Probst-Hensch, N. M., ... & Zemp Stutz, E. (2009). Is age at menopause increasing across Europe? Results on age at menopause and determinants from two population-based studies. Menopause, 16(2), 385-394.

22. Gold, E. B. (2011). The timing of the age at which natural menopause occurs. Obstetrics and gynecology clinics of North America, 38(3), 425-440.

23. Li, W., Wang, W., Zhang, M., Chen, Q., Li, F., & Li, S. (2022). Association of serum sclerostin levels with marrow adiposity in postmenopausal women with glucocorticoid-induced osteoporosis. Osteoporosis International, 33(7), 1383-1391.

24. Pinkerton, J. V., et al. (2021). Menopause, 28(7), 767-794.

25. Guttuso, T., et al. (2018). Climacteric, 21(2), 111-120.

26. Loibl, S., et al. (2007). The Lancet, 369(9567), 1062-1071.

27. Cody, J. D., et al. (2012). Cochrane Database of Systematic Reviews, (10), CD005429.

28. Ghazanfarpour, M., et al. (2015). Journal of Menopausal Medicine, 21(2), 87-93.

29. Shams, T., et al. (2010). Menopause, 17(1), 156-161.

30. Cramer, H., et al. (2012). Menopause, 19(5), 511-520.

31. Dodin, S., et al. (2013). Menopause, 20(6), 672-690.

32. Muñoz-Calvo, M. T., et al. (2020). Nutrients, 12(12), 3642.

33. Moilanen, J. M., et al. (2012). Menopause, 19(6), 691-701.

34. Ayers, B., et al. (2012). Menopause, 19(4), 420-428.

35. Mirkin, S., et al. (2020). Menopause, 27(7), 744-755.

36. Prague, J. K., et al. (2017). The Lancet, 389(10081), 1809-1820.

37. Skorupskaite, K., et al. (2018). The Lancet, 392(10144), 297-305.

38. Trower, M., et al. (2020). Menopause, 27(7), 756-765.

39. Gambacciani, M., et al. (2015). Climacteric, 18(sup1), 3-9.

40. Gass, M. L., et al. (2015). Journal of Women's Health, 24(3), 236-245.

41. Pinkerton, J. V., et al. (2020). Menopause, 27(7), 766-772.

42. Santoro, N., et al. (2016). Menopause, 23(4), 361-375.

43. Tsai, S. A., et al. (2020). Menopause, 27(7), 773-785.