BACKGROUND:Human milk is a dynamic biofluid influenced by maternal health, diet, and environmental exposures, including cannabis consumption. OBJECTIVE:To synthesize current evidence on whether maternal cannabis consumption is directly associated with alterations in the macronutrient and immunological composition of breastmilk, and to identify dietary patterns and social adversity as key confounding variables requiring methodological consideration in future research. METHODS:A narrative review of the peer-reviewed literature was conducted. Relevant studies were identified using selected keywords searched individually and in combination. Search was not restricted by date but prioritized recent literature, with seminal studies included where relevant. Studies were selected based on relevance to the review questions; no formal inclusion or exclusion criteria were applied, consistent with the narrative review methodology. RESULTS:Maternal diet is a key determinant of breastmilk composition, particularly for fatty acids. Emerging evidence suggests that cannabis consumption may be associated with alterations in fat and protein concentrations, and may affect immune components such as Secretory Immunoglobulin A (SIgA). However, these associations may be confounded by cannabis-related changes in dietary patterns and by socioeconomic disadvantages that influence maternal nutrition and health. Findings remain limited and inconsistent, and underlying biological mechanisms remain poorly understood. CONCLUSIONS:Current evidence on the impact of maternal cannabis use on breastmilk composition is sparse and inconclusive. Further research is needed to disentangle the direct effects of cannabis exposure from related dietary and social determinants to clarify implications for infant growth, immune development, and long-term health outcomes.

The present study utilized a randomized crossover design to compare the short-term effects of time-restricted feeding (TRF) and alternate-day fasting (ADF) on the subjective experiences of young females. Twenty-three females ( M age = 18.3 ± 0.4 years) participated in this study. Participants were asked to complete three days of TRF and three days of ADF, separated by a four-day washout period. On the day before fasting and on each fasting day, the participants completed an online questionnaire at noon. The questionnaire collected information on mood, hunger, diet satisfaction and subjective sleep quality. Total mood disturbance increased following ADF compared to TRF [condition x time interaction: F (3, 57) = 3.35, p = .03, η²ₚ = .15], but this effect disappeared by the second fasting day. Hunger increased on fasting days following both TRF and ADF [main effect of time: F (3, 57) = 19.82, p < .001, η²ₚ = .51, and a condition x time interaction: F (3, 57) = 10.08, p < .001, η²ₚ = .35]. Diet satisfaction was significantly higher during TRF than ADF [main effect of condition: F (1, 19) = 5.21, p = .03, η²ₚ = .22]. Neither fasting protocol significantly affected subjective sleep quality. Together, these findings suggest that TRF may offer a more tolerable fasting strategy than ADF, particularly in terms of mood and diet satisfaction, without adverse effects on subjective sleep quality.

OBJECTIVE:To examine whether ultra-processed food (UPF) intake and adherence to the Prospective Urban Rural Epidemiological (PURE) Healthy Diet Score are associated with age at natural menopause (ANM) among Canadian participants. METHODS:This longitudinal cohort study used data from 1972 biological females aged ≥45 years who were premenopausal at baseline in the Canadian Longitudinal Study on Aging (CLSA). Dietary intake was assessed using the Short Diet Questionnaire (SDQ). UPF intake was estimated using the Nova framework and expressed as times/day, while diet quality was assessed using the PURE Healthy Diet Score (0-28). Cox proportional hazards models estimated associations between dietary exposures and time to natural menopause, adjusting for sociodemographic, lifestyle, and reproductive covariates. RESULTS:Over a mean follow-up of 4.08 ± 1.93 years, 1148 participants experienced natural menopause. In unadjusted analyses, a higher PURE Healthy Diet Score was associated with a shorter time to menopause (hazard ratio [HR] 1.013; 95% confidence interval [CI] 1.001, 1.025), whereas UPF intake was not significantly associated with menopause timing. After adjustment for sociodemographic, lifestyle, and reproductive factors, neither UPF intake (HR 1.024; 95% CI 0.977, 1.073) nor the PURE Healthy Diet Score (HR 1.006; 95% CI 0.986, 1.025) was independently associated with time to natural menopause. Results were consistent in sensitivity analyses. CONCLUSIONS:In this longitudinal cohort, UPF intake and the PURE Healthy Diet Score were not independently associated with menopause timing. These findings suggest that menopause timing may reflect cumulative life-course influences more strongly than dietary exposures measured in midlife.

Background:The prevalence and characterization of specific types of musculoskeletal (MSK) conditions associated with menopausal transition remains unclear and is often underreported. Our objectives were twofold: (1) to systematically review, and conduct meta-analysis whenever appropriate, to compare the prevalence of MSK symptoms across the different stages of menopause and (2) to characterize the specific MSK conditions associated with transition to menopause. Methods:We searched Medline, EMBASE, CENTRAL, and PubMed from inception to May 2024. Articles were eligible for inclusion if they included perimenopausal women and reported any primary data on MSK symptoms or pathology. The outcomes we aimed to find included muscle and joint pain, back pain, and the prevalence of various MSK conditions. A pairwise meta-analysis was performed using a DerSimonian-Laird random-effects model for all comparative data, and subgroup analyses were used to explore heterogeneity. Results:After screening 5,556 relevant records, 37 observational studies across 22 countries enrolling 93,021 women were included in the quantitative analysis. Four in 10 women experienced muscle or joint pain during the premenopausal phase (40% [95% confidence interval {CI}: 32%-49%]). Whereas over half of perimenopausal women (57% [95% CI: 48%-65%]) and postmenopausal women (59% [95% CI: 50%-67%]) experienced muscle or joint pain, representing a 1.35-fold increased risk (risk ratio [RR] 1.35, 95% CI: 1.25-1.46, p < 0.001, I2 = 88.6%; absolute risk difference 130 more per 1,000 [95% CI: 93-171]) and a 1.40-fold increased risk (RR 1.40, 95% CI: 1.28-1.53, p < 0.001, I2 = 95.0%; absolute risk difference 148 more per 1,000 [95% CI: 104-197]) on pairwise comparison with premenopausal women, respectively. Geographic study location nor measurement scale explained the considerable heterogeneity in the pooled analyses. There was underreporting of specific MSK conditions beyond the generic descriptors of muscle and/or joint pain. Conclusion:Women transitioning to menopause appear to be at increased risk of developing muscle or joint pain. However, as these findings are based on observational studies, specific causes of MSK pain are underreported, and there is significant heterogeneity. Further high-quality research is needed to confirm and clarify this association. Level of Evidence:Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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.

Cannabis consumption among reproductive aged women is increasing in Canada, especially after its legalization. Despite its growing prevalence, limited empirical data exists to guide evidence-based clinical recommendations. The objective of this study is to examine how maternal cannabis consumption characteristics such as timing of use (pregnancy, lactation, or both), frequency, and mode of use are associated with cannabinoids concentrations in breastmilk. A cohort of 181 lactating individuals self-reporting cannabis consumption or not during pregnancy and/or lactation were recruited. Concentrations of Δ⁹-tetrahydrocannabinol (Δ⁹-THC), 11-hydroxy-THC (11-OH-THC), 11-nor-9-carboxy-THC (THC-COOH), cannabidiol (CBD), and cannabinol (CBN) were measured in their breastmilk samples collected between 4 and 16 weeks postpartum. Participants completed a baseline survey assessing their sociodemographic characteristics, pregnancy information, and patterns of cannabis consumption. Δ⁹-THC showed the strongest and most consistent associations: frequency of consumption during lactation was associated with higher breastmilk Δ⁹-THC (frequent use, 58-fold higher; infrequent use, 6-fold higher), as was consumption during both pregnancy and lactation (34-fold higher) and inhalation-based or combined modes during lactation (smoking, vaping, and combined use). Frequent consumption during pregnancy was also associated with higher Δ⁹-THC, whereas timing within pregnancy and mode of use during pregnancy were not. THC-COOH was associated with frequent consumption and use across both pregnancy and lactation, and CBN with frequent consumption during lactation. No pattern of consumption was significantly associated with 11-OH-THC or CBD concentrations after correction for multiple comparisons. All comparisons are expressed relative to no cannabis consumption in the corresponding period, except those involving period of use, which are relative to consumption during pregnancy only. This study found that frequent cannabis consumption during lactation, particularly via inhalation-based or combined modes, and continued use across both pregnancy and lactation were most strongly associated with higher breastmilk Δ⁹-THC concentrations. These findings highlight the relevance of postnatal, not only prenatal, cannabis consumption to infant exposure and support a cautious, person-centered approach to cannabis consumption during pregnancy and lactation; larger studies are needed to determine the implications for infant development.

Mammary gland development is a complex process that begins in utero and continues to evolve after birth and throughout life. During and after pregnancy, this gland responds to stimuli to prepare for reproduction, undergoing several cycles of growth, maturation, milk production and secretion, and finally involution. Lactation is a high-energy-consuming process that, over a limited period, becomes one of the major energy expenditures for mothers, which is essential for the offspring's survival. The mammary epithelium produces and secretes the different milk constituents, consisting of protein, lipids, and carbohydrates (lactose). Lactose represents one of the most abundant nutrients present in milk, being of the utmost importance for newborns. Here, we present a new methodology to perform quantitative measurement of lactose by gas chromatography - mass spectrometry. The method is simple and allows high recovery of lactose (>95%), along with a high reproducibility between batches at physiologically relevant concentrations. It thus represents a new tool to further study milk biology.•A novel protocol to measure lactose by mass spectrometry in milk is described.

Objective: To describe the prevalence of multimorbidity among individuals with primary ovarian insufficiency (POI) and early menopause compared with those with the average age of menopause. Design: Prospective cohort. Subjects: This prospective cohort encompassed female postmenopausal individuals from the Canadian Longitudinal Study on Aging. The Canadian Longitudinal Study on Aging collected cross-sectional data from 50,000 community-dwelling Canadians aged 45-85 years between 2010 and 2015. Exposure: The primary exposure was POI (defined by onset of menopause at the age of <40 years). Comparators included average age of menopause (age, 46-55 years), early menopause (40-45 years), and late-onset menopause (56-65 years) and those who underwent hysterectomy. Main Outcome Measure(s): The primary outcome was multimorbidity, which was defined as two or more chronic conditions. The secondary outcomes were severe multimorbidity (defined as 3 or more chronic conditions) and frequencies of specific chronic conditions among a comprehensive list of 15 individual conditions. We assessed the association between multimorbidity and age at menopause using logistic regression and odds ratios (ORs), with confidence intervals (CIs) set at 95%. The ORs were adjusted for known predictors of multimorbidity, including age, menopausal hormone therapy, education, ethnicity, self-reported loneliness, living alone, body mass index, smoking habits, nutritional risk, social participation, and physical activity. Result(s): A total of 12,339 postmenopausal participants were included, of whom 374 (3.0%) experienced POI and 1,396 (11.3%) experienced early menopause. The prevalence rates of multimorbidity were 64.8% and 51.1% among those with POI and early menopause, respectively. In contrast, only 43.9% of individuals with average age of menopause (age, 46-55 years) had multimorbidity. The OR for multimorbidity in the POI population was 2.5 (95% CI, 2.0-3.1) compared with that in individuals who had the average age of menopause. This relationship was maintained after adjustment for confounders (adjusted OR [aOR], 2.0; 95% CI, 1.5-2.5). The prevalence of severe multimorbidity was also double in the POI group compared with that in the average age group (39.2% vs. 21.1%). There were significantly increased risks of ischemic heart disease (aOR, 2.8; 95% CI, 1.7-4.7), gastric ulcers (aOR, 1.6; 95% CI, 1.1-2.3), and osteoporosis (aOR, 1.6; 95% CI, 1.2-2.1) in the POI group. Conclusion(s): Individuals with POI and early menopause experience increased multimorbidity compared with those undergoing menopause at an average age. This trend persists even after adjusting for significant multimorbidity risk factors. (Fertil Steril (R) 2025;123:289-99. (c) 2024 by American Society for Reproductive Medicine.) El resumen est & aacute; disponible en Espa & ntilde;ol al final del art & iacute;culo.

BACKGROUND:Sexual concerns are reported by 43%-82.5% of peri- and post-menopausal women and negatively impact physical and emotional well-being. Despite the high prevalence and negative impact, treatment options are limited, particularly those which are non-pharmacological. AIM:The primary objective of this pilot trial was to evaluate the effectiveness of a novel four-session individual Cognitive Behavioural Therapy protocol for improving sexual functioning (CBT-SC-Meno) during peri- and post-menopause. Secondary objectives included assessing body image, relationship satisfaction, and common menopause symptoms (eg, vasomotor), depression, anxiety, and self-reported health. METHODS:Participants (n = 32) were peri- or post-menopausal women experiencing primary sexual concerns and reporting a score of 26.55 or lower on the Female Sexual Function Index (FSFI), indicating impaired sexual functioning. Eligible participants were assigned to a waitlist control condition for 4 weeks, after which they were reassessed and then completed the CBT protocol. OUTCOMES:Measures assessing sexual functioning, satisfaction, distress, and desire, as well as body image, relationship satisfaction, common menopause symptoms (eg, vasomotor), depression, anxiety, and self-reported health were completed at baseline, post-waitlist, and post-treatment. Treatment satisfaction was captured with the Client Satisfaction Questionnaire along with qualitative data. RESULTS:During the waitlist period, no significant changes were observed across measures, apart from the FSDQ concern subscale and GCS physical subscale. Following CBT-SC-Meno, participants experienced a significant improvement in overall sexual functioning (eg, desire, arousal, reduced pain, satisfaction), a decrease in symptoms of sexual distress, concern, and resistance, menopausal symptoms, symptoms of depression and anxiety, as well as improved body image, couple satisfaction, and overall health (P < 0.001). All participants endorsed high treatment satisfaction and indicated that treatment helped them better cope with their symptoms more effectively. CLINICAL IMPLICATIONS:To our knowledge, this is the first study examining the effectiveness of a CBT protocol specifically designed to target sexual concerns experienced during peri- and post-menopause. Results suggest that CBT-SC-Meno leads to significant improvements in sexual functioning across several important sexual concern domains and related areas (eg, body image), in addition to several other commonly comorbid menopausal symptoms (eg, vasomotor), depression, anxiety, and self-reported overall health. STRENGTHS AND LIMITATIONS:Although CBT-SC-Meno appears to be a promising treatment for sexual concerns, the sample was small and homogeneous. CONCLUSIONS:This study provides preliminary evidence of CBT as a non-pharmacological treatment for peri- and post-menopausal women experiencing sexual concerns and offers the basis for a larger randomized clinical trial. CLINICAL TRIAL REGISTRATION:Trial # NCT04922385 and Accessible at: https://clinicaltrials.gov/ct2/show/NCT04922385?term=NCT04922385&draw=2&rank=1.

Mood disorders during perimenopause and menopause are very common but often underdiagnosed, significantly affecting quality of life and well-being. Women face higher risks of depression and anxiety, with depressive symptoms typically more severe during the transition than before or after menopause. Menopausal depression has a complex etiology, and this review aims to explore the etiology and pathogenesis of depression during this vulnerable stage of life while focusing on the latest evidence. Fluctuations in estrogens and progesterone, dysregulation of the hypothalamic-pituitary-adrenal axis, changes in neurochemical systems, alterations in circadian rhythm, and endogenous opioid dysregulation are key disease mechanisms that have been traditionally described. Genetic predisposition and life stressors are additional contributing factors. Recent research points toward structural brain changes, neuroinflammatory processes and oxidative stress mechanisms as possible causes. Including biomarkers such as neuroinflammatory markers and oxidative stress indices could aid in risk stratification and guide personalized treatment plans. This review summarizes current understanding of the etiopathogenesis of menopausal depression, emphasizing hormonal, neurobiological, inflammatory, and psychosocial factors, along with promising evidence-based treatments including pharmacologic, hormonal, and non-pharmacologic therapies.

Genitourinary syndrome of menopause affects most postmenopausal women and gender-diverse persons. Many will notice symptoms before the cessation of menstruation, related to declining hormone levels. Our aim was to assess genitourinary syndrome of menopause incidence among those referred to a specialised Canadian menopause clinic and identify potential gaps in care. Among 529 participants, 74% reported bothersome vaginal dryness; however, only 10.9% had been prescribed a local vaginal hormone before referral. With long wait times for menopause clinics, our results highlight an important area for education for all providers caring for women and gender-diverse persons in midlife and menopause.

Objective Sexual dysfunction is very common among middle-aged females. Several factors are considered to influence sexual functioning, including reproductive aging and associated physiological changes as well as life stressors, mental health, and other socioeconomic influences. The objectives of this study are to evaluate the effect of current depressive symptoms on sexual functioning during menopause and to further analyze whether socioeconomic status, age, and antidepressant usage impact this association. Methods Perimenopausal and postmenopausal women aged 40 to 65 years seeking treatment from a specialized menopause clinic completed a self-report survey with the main outcome measure being the 19-item Female Sexual Function Index quantifying sexual dysfunction. We used the 10-item Center for Epidemiological Studies Depression Scale to estimate a major depressive episode. Statistical analyses were completed to assess the potential associations of socioeconomic factors, age, and antidepressant usage. Results Of the 269 participants, 61.3% met criteria for a major depressive episode and 67.0% had low sexual function. As predicted, women currently experiencing depressive symptoms had a greater risk of low sexual function during perimenopause and postmenopause. Antidepressant usage, low household income, being postmenopausal, and age also predicted low sexual function. Conclusions Among perimenopausal and postmenopausal women, current depressive symptoms were associated with low sexual function. A biopsychosocial approach should be considered when exploring effective treatment strategies for sexual concerns among midlife women.

Objective To describe the prevalence of multimorbidity among individuals with premature ovarian insufficiency (POI) and early menopause, in comparison to average age of menopause. Design Prospective cohort Subjects This prospective cohort encompassed female postmenopausal individuals from the Canadian Longitudinal Study on Aging (CLSA). The CLSA collected cross-sectional data from 50,000 community-dwelling Canadians aged 45 to 85 between 2010 and 2015. Exposure The primary exposure was primary ovarian insufficiency (defined by onset of menopause younger than 40 years). Comparators included average age of menopause (age 46 to 55 years), early menopause (40-45 years), late onset menopause (56-65 years), and those who underwent a hysterectomy. Main outcome measures The primary outcome was multimorbidity, which was defined as two or more chronic conditions. The secondary outcome was severe multimorbidity (defined as three or more chronic conditions) as well as frequencies of specific chronic conditions among a comprehensive list of 15 individual conditions. We assessed the association between multimorbidity and age at menopause using logistic regression and odds ratios, with confidence intervals set at 95%. Odds ratios were adjusted for known predictors of multimorbidity, including age, menopause hormone therapy (MHT), education, ethnicity, self-reported loneliness, living alone, BMI, smoking habits, nutritional risk, social participation, and physical activity. Results A total of 12,339 postmenopausal participants were included, of which 374 (3.0%) experienced POI and 1396 (11.3%) experienced early menopause. The prevalence of multimorbidity was 64.8% and 51.1% among those with POI and early menopause respectively. In contrast, only 43.9% of individuals with average age of menopause (age 46 to 55 years) had multimorbidity. The OR for multimorbidity in the POI population was 2.5 (95% CI 2.0-3.1) in comparison to those who underwent the average age of menopause. This relationship was maintained after adjustment for confounders (aOR 2.0, 95% CI: 1.5-2.5). The prevalence of severe multimorbidity was also double in the POI group in comparison in the average age group (39.2% versus 21.1%). There was significantly increased risk of ischemic heart disease (aOR 2.8, 95% CI: 1.7-4.7), gastric ulcers (aOR 1.6, 95% CI: 1.1-2.3) and osteoporosis (aOR 1.6, 95% CI: 1.2-2.1) in the POI group. Conclusions Individuals with POI and early menopause experience increased multimorbidity in comparison to those undergoing menopause at an average age. This trend persists even after adjusting for significant multimorbidity risk factors.

[Voir la version anglaise de l'article ici: www.cmaj.ca/lookup/doi/10.1503/cmaj.231066][1] La perte de la fonction ovarienne à la suite du traitement de cancers gynécologiques peut entraîner la manifestation de symptômes vasomoteurs graves et soudains de même qu'un accroissement du risque

OBJECTIVE:Depressive symptoms are commonly reported during the perimenopause and in the early postmenopausal years. Although menopausal hormone therapy (MHT) is considered the most effective treatment option for vasomotor symptoms, its effect on mood-related symptoms is less established. This study aims to assess interval change in depressive symptoms after initiation of MHT treatment in women seeking care at a Canadian specialized menopause clinic.METHODS:Women and female-presenting people attending the St. Joseph's Healthcare Menopause Clinic in Hamilton, Ontario, were invited to participate in this study. Participants (n = 170) completed a self-report questionnaire, which included their medical history as well as validated tools for bothersome symptoms at their initial visit. A shortened version was administered at the follow-up visit 3 to 12 months later with the same validated tools. We sought to examine interval changes on the Center for Epidemiological Studies Depression Scale based on type of treatment used and MHT dose, while controlling for relevant demographic variables (smoking, education level, age).RESULTS:There was a high rate of depressive symptoms in those seeking specialized menopause care (62%). MHT use was associated with significantly improved depressive symptoms, both alone and in addition to an antidepressant medication ( P < 0.001). Younger age, lower education attainment, and smoking were all associated with higher depression scores.CONCLUSION:This study supports the use of MHT to improve depressive symptoms experienced by those seeking specialized menopause care. Further investigation into timing of treatment initiation may facilitate a personalized treatment approach to improve quality of life of women in the peri- and postmenopausal years.