OBJECTIVE:Menopause symptoms and experiences vary considerably between women and can be influenced by multiple biopsychosocial and cultural factors, age and ethnicity. This study investigated the symptoms and attitudes of perimenopausal women in Singapore. METHOD:Women aged 40-60 years attending women's health talks and forums in Singapore completed an anonymized, voluntary online questionnaire in English. The study collected demographic information, and assessed menopause status and attitudes toward menopause and hormone therapy. Participants reporting menopause symptoms completed the Menopause Rating Scale (MRS) questionnaire. RESULTS:A total of 147 perimenopausal women reported at least one moderate to very severe symptom of menopause. The most common menopause symptoms reported were joint and muscular discomfort (44.2%), followed by sleep problems (43.5%) and physical and mental exhaustion (39.5%). Common terms for attitudes toward menopause included natural (51.3%), old age (45.0%), and threatening, dreading, causing symptoms and health problems (40.0%). CONCLUSION:This study sheds light on common symptoms of perimenopausal women and their attitudes toward menopause and hormone therapy.
OBJECTIVE:This study aimed to identify lifestyle, reproductive and socioeconomic correlates of early menopause (age <45 years) in a cross-sectional analysis of a population-based cohort of Japanese women. METHOD:The study analyzed data from 6313 naturally menopausal women in the Yamagata Cohort Study (2009-2015). Women were classified as having early menopause (age <45 years; n = 239) or menopause at age 45-54 years (n = 6074). Data included age at menarche, menstrual pattern at age 20 years, educational attainment, marital status, parity, breastfeeding, smoking and body mass index (BMI). Multivariable logistic regression estimated odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS:Lower educational attainment (OR 1.84, 95% CI 1.32-2.57) and never-married status (OR 2.52, 95% CI 1.24-5.11) were associated with early menopause. Low BMI was associated with early menopause in univariate analysis but not after multivariable adjustment. An interaction was observed between menstrual pattern at age 20 years and BMI: among women with menstrual irregularity, obesity (BMI ≥25 kg/m2) was associated with higher odds of early menopause (OR 3.49, 95% CI 1.91-6.37). CONCLUSION:In this cross-sectional analysis of a population-based cohort of Japanese women, lower educational attainment and never-married status were associated with early menopause. Women with menstrual irregularity and obesity may be at increased risk of early menopause.
OBJECTIVE:This study aimed to evaluate the effects of photobiomodulation (PBM) alone and in combination with pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) function, sexual and urinary function, and quality of life in women with genitourinary syndrome of menopause. METHOD:The three-arm clinical trial included women aged 45-65 years who had experienced natural menopause for at least 1 year. Participants were randomized into three groups: PFMT + active PBM, PFMT + sham PBM and isolated PFMT. Interventions lasted 8 weeks, with participants attending two 50-min sessions per week. Outcomes were assessed before and after the 16th session. RESULTS:Although manometry showed no significant differences between groups, the intervention group demonstrated greater numerical improvement. The Female Sexual Function Index (FSFI) total score differed significantly between the PFMT + active PBM and PFMT + sham PBM groups (mean difference = 4.55; 95% confidence interval: 0.57, 8.52; d = 1.05). Significant between-group differences were also observed in the orgasm subdomain in favor of the PFMT + active PBM group compared to the PFMT + sham PBM group. The International Consultation on Incontinence Questionnaire - short form (ICIQ-SF) indicated a clinically significant improvement of 3.06 points in the PFMT + active PBM group compared to the PFMT + sham PBM group following the intervention. CONCLUSION:Active PBM combined with PFMT showed greater but non-significant improvements in PFM pressure, urinary function and quality of life, while significantly improving only sexual function.
OBJECTIVE:This study aimed to investigate the associations of menarche age, menopause age and reproductive life span with menopausal symptoms in Chinese women. METHODS:The prospective, longitudinal study included 557 midlife Chinese women. Menopausal symptoms were evaluated through the Menopause-Specific Quality of Life (MENQOL) questionnaire, covering vasomotor symptoms (VMS), psychosocial, physical and sexual domains. Generalized estimating equation models were used to estimate the crude and adjusted mean differences (β) and 95% confidence intervals (CI). RESULTS:Mean menarche and menopause ages were 13.92 ± 1.62 and 50.56 ± 3.20 years, with a mean reproductive life span of 36.64 ± 3.56 years. Age at menarche was not associated with MENQOL domain scores. Earlier menopause and shorter reproductive life span were associated with higher adjusted sexual-domain scores, with significant differences for menopause before age 45 years (β = 0.83, 95% CI: 0.21, 1.44) and reproductive life span <30 years (β = 0.98, 95% CI: 0.21, 1.74). These sexual-domain associations were attenuated after adjustment for time since menopause, whereas associations with higher VMS scores became apparent in postmenopausal analyses. No significant associations were observed for psychosocial or physical-domain scores. CONCLUSION:Earlier menopause and shorter reproductive life span were associated with MENQOL-assessed sexual-domain discomfort, partly explained by time since menopause. Additional postmenopausal analyses also linked these factors to greater VMS burden.
Osteoarthritis (OA) is the most common form of arthritis. OA becomes more prevalent in women around the age of menopause, and it has been suggested that the decrease in estrogen at menopause may be important in the pathophysiology of OA development. The association between estrogen exposure and OA is complex; a recent meta-analysis suggested that menopause hormone therapy use may be associated with an increased risk of joint replacement, bringing this research area back into focus. This narrative review used a systematic process, adopting a life-course approach to consider relationships between reproductive factors and OA, identifying 15 papers published over a 26-year period. Increased parity, use of the oral contraceptive pill, abortion, breastfeeding and inter-menstrual years were all considered but findings varied widely between studies. We note that progesterone is rarely considered, despite animal work suggesting its importance. These data highlight the need for further research with careful measurements of confounding variables, and consideration of the role for progesterone in OA etiology.
OBJECTIVE:Estrogen deficiency promotes metabolic dysfunction and bone loss. This study thus evaluated the effects of biomass-derived humic acid (HA) on ovariectomy-induced metabolic and bone alterations in mice. METHOD:Female C57BL/6 mice (n = 6/group) were assigned to Sham, Sham + HA, ovariectomized (OVX) or OVX + HA groups. Estrogen deprivation was induced by bilateral ovariectomy. After a 14-day recovery period, HA (80 mg/kg/day) was administered orally for 28 days. Body mass, food intake, serum glucose, lipid profile, creatinine, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured. Tibial calcium and phosphorus content and bone surface topography were assessed by scanning electron microscopy coupled with energy dispersive X-ray spectroscopy, and receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) staining intensity in the femoral head was evaluated by immunohistochemistry. Data were analyzed using two-way analysis of variance with the Bonferroni post hoc test. RESULTS:OVX animals presented increased body mass gain, fasting glucose, dyslipidemia, creatinine and AST compared with Sham animals (p < 0.05). HA attenuated these alterations (p < 0.05) and reduced body weight gain. OVX-induced reductions in tibial mineral content and increased bone porosity were partially reversed by HA (p < 0.05), with a descriptive shift toward a less pro-resorptive RANKL/OPG staining profile. CONCLUSION:Biomass-derived HA mitigates metabolic dysfunction and bone loss from estrogen deficiency, supporting its potential as adjunct therapy.
OBJECTIVE:Menopause can affect women's quality of life through vasomotor, psychological and urogenital symptoms. This study assessed the prevalence and correlates of impaired quality of life across menopausal stages in Bangladeshi women. METHOD:This cross-sectional study included 3000 women aged 45-55 years attending outpatient gynecology clinics in Dhaka between December 2022 and June 2024. Menopausal stage was classified using Stages of Reproductive Aging Workshop +10 (STRAW +10) criteria. Symptoms and quality of life were assessed using the Menopause Rating Scale (MRS), with impaired quality of life defined as MRS >16. Multivariable logistic regression identified factors associated with impaired quality of life. RESULTS:Overall, 825 women (27.5%) had impaired quality of life. Symptom severity increased across menopausal stages, and hot flush prevalence rose from 22.1% in premenopause to 47.8% in late postmenopause. Hot flushes showed the strongest association with impaired quality of life (adjusted odds ratio [aOR] 10.28, 95% confidence interval [CI]: 8.84-11.95). Psychotropic medication use (odds ratio [OR] 2.00) and vaginal dryness (OR 1.28) were also associated with impairment, whereas sexual activity (OR 0.75), hormone therapy use (OR 0.70) and good self-rated health (OR 0.58) were associated with lower odds. Early postmenopause had the highest risk (aOR 2.14, 95% CI: 1.71-2.69). CONCLUSION:Early postmenopause is a vulnerable period for impaired quality of life among Bangladeshi women. Vasomotor and urogenital symptoms were important correlates of poorer well-being, supporting routine symptom assessment and culturally appropriate menopausal care.
Menopause is the biological process that occurs with the end of the menstrual cycle, not only involving hormonal changes but also leading to significant epigenetic transformations at the genomic level. Alterations in estrogen, progesterone and androgen levels positively or negatively influence epigenetic mechanisms such as DNA methylation, histone modifications, genome methylation and microRNA expression. These changes can alter the aging process by altering cell gene expression, and immunosenescence can increase susceptibility to osteoporosis, cardiovascular disease and some cancers. Furthermore, altering epigenetic mechanisms through environmental factors (such as nutrition, exercise and stress management) and lifestyle offers promising strategies for maintaining health during menopause and reducing the risk of chronic disease. Menopause-associated epigenetic alterations are not only linked to accelerated biological aging but also play a critical role in the pathogenesis of major chronic diseases, including cardiovascular disease, osteoporosis and hormone-related cancers. These epigenetic changes, particularly DNA methylation patterns and microRNA profiles, have emerged as promising biomarkers for early detection and risk stratification, as well as potential targets for personalized therapeutic interventions. This review aims to review the literature on epigenetic changes associated with menopause.
OBJECTIVE:Perimenopause is the time leading up to and including the first 12 months after the final menstrual period. This study examined how social determinants of health (SDOH) including race/ethnicity, income, education and healthcare access influence perimenopause symptom burden. METHOD:A cross-sectional survey was distributed to English, Spanish, Portuguese and French-speaking Flo app users aged 35 years and above. Participants completed the validated Menopause Rating Scale (MRS) and provided data on key SDOH. Associations between SDOH and total MRS and domain scores (psychological, somatic, urogenital) were evaluated using multivariable linear regression. RESULTS:A total of 12,382 women completed the survey. All examined SDOH were significantly associated with total and domain MRS scores (p < 0.001). Healthcare access had the strongest association, followed by income sufficiency and education level. Asian, Black and Hispanic/Latino race/ethnicities were significantly associated with MRS scores (p < 0.001) compared with White race/ethnicity. In a subset of 2618 women who reported being in perimenopause, SDOH remained significantly associated with MRS scores, with income sufficiency showing the strongest association (p < 0.001). CONCLUSIONS:SDOH, particularly healthcare access and income, are strongly associated with perimenopause symptom burden. Addressing health inequities is essential to improve perimenopause care and reduce symptom burden.
Pelvic organ prolapse affects millions of postmenopausal women worldwide, frequently requiring surgical intervention when conservative treatments fail. This systematic review and meta-analysis evaluated the effectiveness and safety of perioperative vaginal estrogen therapy in postmenopausal women undergoing prolapse surgery. Nine randomized controlled trials including 764 women (383 estrogen, 381 controls) were analyzed through December 2024. Meta-analyses demonstrated significant tissue quality improvement (standardized mean difference 0.73, 95% confidence interval [CI] 0.16-1.30, p = 0.012) with substantial heterogeneity (I2 = 86.7%). However, urinary tract infection effects were inconclusive and contradictory (risk ratio [RR] 0.75, 95% CI 0.27-2.04, p = 0.570, I2 = 67.2%), with one study showing harm and two studies showing benefit. Composite surgical success showed no difference (RR 0.94, 95% CI 0.83-1.06, p = 0.297), with trends toward lower success in estrogen groups. Patient satisfaction was universally high (>95%) regardless of treatment. Vaginal atrophy symptoms improved significantly with estrogen. Safety profiles were excellent. Current evidence supports perioperative vaginal estrogen for tissue quality optimization and atrophy symptom management, but not for preventing complications or enhancing surgical success.
Menopause is a natural life stage with substantial impacts on women's quality of life and long-term health. Education on menopause for healthcare professionals (HCPs) remains limited and inconsistently embedded across health disciplines. This scoping review mapped current evidence on menopause education, including available programs, delivery approaches and extent of curricular integration. Following the Joanna Briggs Institute methodology and PRISMA-ScR guidelines, a search of six databases and gray literature (last searched May 2025) identified original research evaluating menopause-specific education for undergraduate and postgraduate HCPs. Data were synthesized using deductive and inductive analyses. Of 5034 records identified, 14 studies met the inclusion criteria: nine evaluated educational interventions and five examined curricular provision. Most studies originated from the USA and focused on medical residents. Education formats varied widely, including structured curricula, case-based learning, online modules, telemedicine encounters and peer-supported platforms. Core content commonly addressed menopause physiology, symptom management and hormone therapy, while long-term health implications and equity-focused content were infrequently included. Interventions consistently improved knowledge, confidence and preparedness for menopause care. Despite widespread recognition of its importance, menopause education remains inadequately integrated across healthcare training. Standardized, multidisciplinary and equity-focused menopause education frameworks are urgently required to strengthen clinical competence and improve care for midlife women.
OBJECTIVE:This study aimed to examine Portuguese osteopaths' perceptions, confidence and approaches to managing musculoskeletal conditions in menopausal women. METHOD:A nationwide cross-sectional online survey was conducted among osteopaths registered with the Portuguese Central Administration of the Health System. A 36-item questionnaire, adapted from validated osteopathic instruments, assessed demographics, attitudes, clinical confidence, therapeutic strategies and barriers to menopause-related musculoskeletal management. The primary outcome measures were osteopaths' attitudes, confidence and therapeutic strategies regarding the relevance of menopause to musculoskeletal health. RESULTS:Data from 258 osteopaths were analyzed. Most respondents recognized menopause as relevant to musculoskeletal health (95%) and reported frequent clinical contact with menopausal women (58%). Mobilization, fascial and soft-tissue techniques were commonly used, whereas high-velocity low-amplitude thrusts were less frequent. Confidence in treatment and patient education was moderate to high, although 36% felt under-informed about menopause and musculoskeletal interactions. Lack of clinical guidelines (59%) and limited research availability (75%) were the main barriers. Most participants (81%) reported a need for advanced training in menopause management. Female osteopaths scored significantly higher than males in perceptions of menopause and musculoskeletal conditions (p = 0.015), clinical experience and therapeutic approaches (p = 0.001), and competences in osteopathic practice (p = 0.001). CONCLUSION:Portuguese osteopaths, particularly women, appear aware of and engaged in managing menopause-related musculoskeletal conditions, adapting manual therapy and educational approaches to patients' needs. However, limited knowledge and the absence of structured clinical guidance may hinder consistent, evidence-informed care. Targeted education and clinical protocols may strengthen osteopathic support for women's musculoskeletal health during midlife.
Migraine is a highly prevalent primary headache disorder that disproportionately affects women owing to the effects of sex hormones, particularly estrogen. Hyperestrogenism during early perimenopause, coupled with anovulatory cycles, is associated with an increased frequency and severity of migraine attacks and an increased prevalence of perimenstrual migraine. The natural decline in estrogen levels after menopause is generally associated with migraine improvement; however, this is variable and often complicated by chronic migraine, vasomotor symptoms, cardiovascular risk and use of menopause hormone therapy (MHT). Although there is a trend toward increasing the use of MHT during perimenopause, there are no research trials regarding migraine in this population, although it appears to have a negative clinical effect. This could be explained by the addition of MHT to the already high and fluctuating endogenous estrogen levels. More appropriate during perimenopause is hormone cycle control. This can be achieved using continuous combined hormonal contraception for women with migraine without aura, whereas progestogen-only regimens, with the option of additional transdermal estrogen, can be used in women with migraine with and without aura. For women choosing to use MHT postmenopause, continuous transdermal regimens are better tolerated than cyclical preparations.
OBJECTIVE:This study aimed to develop and evaluate a culturally adapted, group-based eight-session cognitive behavioral therapy (CBT) program for perimenopausal/postmenopausal Korean women to reduce vasomotor symptoms (VMS) and improve psychological well-being and quality of life. METHOD:In a non-blinded, parallel-group randomized controlled trial, 50 postmenopausal women were randomly assigned to a group-based CBT intervention group or a wait-list control group. Assessments were conducted at baseline, post intervention and at 4-week follow-up. Primary outcomes were VMS frequency and distress assessed using the Hot Flush Rating Scale (HFRS) and daily interference measured by the Hot Flash Related Daily Interference Scale (HFRDIS). Secondary outcomes included menopause-specific quality of life assessed using the Menopause-Specific Quality of Life Questionnaire (MENQOL), anxiety and depressive symptoms measured by the Hospital Anxiety and Depression Scale, and sleep quality assessed using the Pittsburgh Sleep Quality Index (PSQI). RESULTS:Compared with the control group, the CBT group showed significant improvements in VMS frequency, distress and daily interference. Quality of life improved across all MENQOL domains. Anxiety decreased significantly with sustained effects at follow-up. Depressive symptoms did not change significantly, and sleep improvements were not sustained. CONCLUSIONS:Group-based CBT effectively reduced VMS and improved quality of life and anxiety, supporting its use as a safe non-hormonal intervention for perimenopausal/postmenopausal Korean women.
OBJECTIVE:Borderline ovarian tumors (BOTs) are heterogeneous primary epithelial lesions defined by atypical epithelial proliferation without stromal invasion, accounting for approximately 15% of primary ovarian neoplasms. Menopausal hormone therapy (MHT) treats vasomotor and genitourinary symptoms in postmenopausal women, yet its relationship with ovarian neoplasia, especially BOTs, remains uncertain. This systematic review evaluates the association between MHT and BOT outcomes. METHOD:Five databases were searched from inception to August 2025. Included studies were assessed for type of MHT, duration, and recurrences where reported. Risk of bias was assessed with the Newcastle-Ottawa Scale and certainty of evidence with GRADE. RESULTS:A search identified 469 studies; eleven met the inclusion criteria (four cohort, seven case-control). Six reported a statistically significant association between MHT and increased odds of BOTs; five did not. Combined estrogen-progestin therapy showed a stronger, more consistent positive association (odds ratio 1.426, 95% confidence interval 1.083-1.877), whereas estrogen-only therapy showed a nonsignificant association. Post-diagnosis evidence is extremely limited: no study addressed BOT recurrence, and only one observational study evaluated BOT survival, finding no adverse association. CONCLUSION:Evidence on the MHT-BOT association is heterogeneous and inconsistent. Although a statistical association was observed between combined MHT and increased odds of BOTs, postsurgical safety data are limited and overall certainty of evidence is very low; findings warrant considerable caution. Current literature is insufficient to confirm or exclude an association between MHT and BOT recurrence or survival. Indications for MHT after BOT surgery require individualized, multidisciplinary discussion involving oncology and menopause specialists, balancing quality-of-life benefits against unquantified theoretical risks.
OBJECTIVE:This systematic review investigated the impact of conjugated estrogens/bazedoxifene (CE/BZA) for treating perimenopausal and menopausal symptoms in patients with a history of endometriosis. METHOD:The review followed PRISMA guidelines and was prospectively registered with PROSPERO (CRD42024617174). Without randomized controlled trials (RCTs), the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports and Case Series assessed methodology and risk of bias. An information specialist completed the search in June 2025 using Ovid MEDLINE, PubMed, Ovid EMBASE, and Web of Science, combining controlled vocabularies and keywords for dysmenorrhea, dyspareunia, endometriosis, perimenopausal, postmenopausal, menopause hormone therapy, Duavive, and CE/BZA. Eligible studies included RCTs, cohort studies, case reports, and case-control studies evaluating CE/BZA for vasomotor symptoms in premenopausal and menopausal endometriosis patients. RESULTS:Of 1540 retrieved studies, two coauthors (J.C.M.-G., E.S.) independently screened titles and abstracts, selecting 20 for full-text review. Only two publications met inclusion criteria, one case report and one case series, representing nine patients (four detailed, five additional). No RCTs, cohort, or case-control studies directly addressed CE/BZA in endometriosis. Preliminary narrative evidence suggests pain and vasomotor symptom relief, though findings carry high risk of bias. CONCLUSION:Because bazedoxifene antagonizes estrogen receptors and endometriosis is estrogen-dependent, CE/BZA may alter systemic inflammation or endothelial function. Although preclinical models show reduced lesion size, human evidence remains extremely limited and biased, insufficient to assess lesion recurrence or vascular safety. CE/BZA is currently indicated only for postmenopausal vasomotor symptoms; preliminary anecdotal evidence suggests symptom improvement, but large-scale comparative trials are urgently needed to establish safety and efficacy in endometriosis.
OBJECTIVE:The relationship between early menopause and the risk of cardiovascular disease (CVD) is understudied in Asian women. This study aimed to investigate this association and its potential causality among East Asian women. METHOD:A seven-year observational study involving 1929 postmenopausal women from the China Health and Retirement Longitudinal Study was combined with two-sample Mendelian randomization (MR) analyses utilizing genetic data from the China Kadoorie Biobank and Biobank Japan. Time-varying Cox proportional hazards models were employed for observational analysis. For MR analyses, the inverse variance-weighted method was used as the primary approach to investigate potential causality between genetically proxied age at natural menopause and CVD. RESULTS:In the multivariable-adjusted Cox regression model, early menopause was significantly associated with an increased CVD risk (hazard ratio 1.43, 95% confidence interval 1.05-1.97). However, MR analyses did not yield significant associations. Additionally, a dose-response relationship was observed between menopausal age and incident CVD risk (p-value for non-linearity = 0.022). CONCLUSIONS:Early menopause was associated with a higher risk of incident CVD in the observational study, while MR findings suggested this association may not be causal. This study unravels the importance of early menopause in CVD risk assessment and informs CVD primary prevention for Asian women.
