Effect of Vitamin D on the Vaginal Health of Menopausal Women: A Systematic Review

Menopause is associated with the onset of climacteric symptoms due to low estradiol levels, which may cause insufficient maturation of the vaginal mucosa. Vitamin D may regulate the growth and differentiation of cells that are adversely affected due to low estradiol levels, thereby restoring vaginal health. The objective of this systematic review, the first on this subject, was to investigate the effect of vitamin D on the vaginal health of menopausal women. PubMed, Embase, Scopus, Web of Science, and Google Scholar databases and reference lists of hand-searched articles were searched for published studies from February 2000 to November 2018. The selection criteria were as follows: randomized or quasi-randomized trials that compared the effects of vitamin D or related compounds, alone or with calcium, on vaginal health (growth and differentiation of epithelial cells, dryness, acidity [pH]) outcomes in menopausal women. The methodological quality of these studies was examined using the Cochrane tool checklist by two independent investigators, following which the data were extracted. Of six examined studies, two showed that vitamin D administration improved the growth and differentiation of vaginal epithelial cells, improved vaginal pH, and decreased vaginal dryness in menopausal women. Although the level of evidence for the effects of vitamin D on vaginal health is low in our study, we concluded that vitamin D may improve the vaginal health of women, especially during menopause.

Effect of Isoflavones and Genistein on Glucose Metabolism in Peri- and Post-Menopausal Women: An Overview of Meta-Analysis

The purpose of the present overview of meta-analysis is to summarize and critically assess the effect of isoflavones and genistein on glucose metabolism among the peri- and post-menopausal women. Two independent authors searched the databases of MEDLINE, Scopus and Cochrane Library for meta-analysis. Three databases were searched from inception to January 2018. Methodological quality of each meta-analysis of randomized controlled trials was evaluated using the AMSTAR (a measurement tool used to assess systematic reviews). Four meta-analyses were included to the current overview. Fasting insulin levels and homeostatic model assessment of insulin resistance (HOMA-IR) values were significantly lower in peri-menopausal and postmenopausal. Two meta-analyses showed that treatment with isoflavones could not alter fasting blood glucose. However, one meta-analysis depicted that isoflavones significantly improved blood glucose levels in non-Asian postmenopausal women. Treatment with genistein could have significant beneficial effects on fasting insulin, blood glucose and HOMA-IR in comparison to the control group. Regardless of the population, the treatment with genistein is effective in improving fasting insulin, HOMA-IR and glucose levels. Nevertheless, the high heterogeneity among studies and poor methodology of reviews made it difficult to draw a definite conclusion on the positive impacts of soy on glucose metabolism.

Effect of Lavender on Sleep, Sexual Desire, Vasomotor, Psychological and Physical Symptom among Menopausal and Elderly Women: A Systematic Review

OBJECTIVES: The present systematic review was conducted to compare the effect of lavender on the quality of sleep, sexual desire, and vasomotor, psychological and physical symptoms among menopausal and elderly women. METHODS: There were five electronic databases which selected to search respective articles which included were Scopus, PubMed, Web of Science, Google Scholar, and the Cochrane Library without any language restriction since the study inception to March 10, 2018. The quality of studies was assessed in accordance with a jaded scale. RESULTS: According to three trials, the lavender as utilized in a capsule form or aromatherapy could significantly improve the measured Pittsburgh Sleep Quality Index score (P < 0.05) in the menopausal and elderly women. The aromatherapy with lavender improved sexual function (P < 0.001), depression (P < 0.001), anxiety (P < 0.001), and physical (P < 0.001) symptoms. Based on a trial, 66.7%, 70.0%, and 53.3% of subjects reported feelings of relaxation, happiness, and cleanness effects of having used lavender respectively. CONCLUSIONS: The results suggested the effectiveness of the use of lavender either in capsule form or aromatherapy on the improved quality of sleep, depression, anxiety, sexual desire, and psychological and physical symptoms. These results, however, should be interpreted with caution considering the limitations of the study.

The Beneficial and Adverse Effects of Raloxifene in Menopausal Women: A Mini Review

OBJECTIVES: The present mini review aimed to summarize the existing knowledge regarding the beneficial and adverse effects of raloxifene in menopausal women. METHODS: This study is a review of relevant publications about the effects of raloxifene on sleep disorder, depression, venous thromboembolism, the plasma concentration of lipoprotein, breast cancer, and cognitive function among menopausal women. RESULTS: Raloxifene showed no significant effect on depression and sleep disorder. Verbal memory improved with administration of 60 mg/day of raloxifene while a mild cognitive impairment risk reduction by 33% was observed with administration of 120 mg/day of raloxifene. Raloxifene was associated with a 50% decrease in the need for prolapse surgery. The result of a meta-analysis showed a significant decline in the plasma concentration of lipoprotein in the raloxifene group compared to placebo (standardized mean difference, −0.43; 10 trials). A network meta-analysis showed that raloxifene significantly decreased the risk of breast cancer (relative risk, 0.572; 95% confidence interval, 0.327–0.881; P = 0.01). In terms of adverse effects of raloxifene, the odds ratio (OR) was observed to be 1.54 (P = 0.006), indicating 54% increase in the risk of deep vein thrombosis (DVT) while the OR for pulmonary embolism (PE) was 1.05, suggesting a 91% increase in the risk of PE alone (P = 0.03). CONCLUSIONS: Raloxifene had no significant effect on depression and sleep disorder but decreased the concentration of lipoprotein. Raloxifene administration was associated with an increased risk of DVT and PE and a decreased risk of breast cancer and pelvic organ prolapse in postmenopausal women.

Effect of Foeniculum Vulgare (Fennel) on Sleep Quality of Menopausal Women: A Double-blinded, Randomized Placebo-controlled Trial

OBJECTIVES: Aim of present study was designed to investigate the soporific effect of fennel among menopausal women. METHODS: The present double-blinded and placebo-controlled trial examined the fennel effect on Pittsburgh Sleep Quality Index (PSQI). Total score and relevant 7 components, including sleep duration, sleep latency, use of sleeping medication, subjective sleep quality, sleep disturbances, daytime dysfunction and habitual sleep efficiency among 50 menopausal women compared to control group within a 12-week follow-up. RESULTS: The patients in both groups reported no certain side effects and all subjects completed the study. The mean actual sleep duration was 5 hours and 66 minutes. Intergroup comparison revealed no statistically significant differences in the mean total PSQI score (P = 0.439), subjective sleep quality (P = 0.826), habitual sleep efficiency (P = 0.127), sleep disturbances (P = 0.130), use of sleeping medication (P = 0.52) and daytime dysfunction (P = 0.439). A tendency toward significant between 2 groups was seen concerning the sleep duration (P = 0.059). Intergroup comparison showed significantly borderline levels (P = 0.059). CONCLUSIONS: The treatment of 12 weeks with fennel caused a slight effect that did not reach to significant. These findings should be considered cautiously because of small sample size, short-term follow-up and subjective measure of sleep quality.

Cultural Barriers Influencing Midwives' Sexual Conversation with Menopausal Women

OBJECTIVES: The present study aimed to determine the barriers influencing the sexual conversation. METHODS: In this descriptive cross-sectional study, 200 midwives were selected through convenience sampling method from private and public clinics in Mashhad, North East of Iran. A self-structured questionnaire was used to collect the study data. RESULTS: The mean age of subjects was 39.58 ± 8.12 years with 13.49 ± 7.59 years of work experience. A number of cultural conditions act as an inhibitory force for the midwives to address sexual issues with menopausal women. Menopausal women visit a doctor at the acute stage when emotional and physical problems make sexual discussion difficult for the midwives (86.5%). Other related causes for not having proper sexual conversation were insufficient knowledge (51.4%), inadequate education provided via public media through health providers (83.5%), midwives or their patient's shame (51.5%), and attempt to get help from traditional healers, friends, relatives and supplicants instead of midwifery staff (78.5%). Also, we found that sexual workshops, communication workshops, and work experiences had a significant influence in changing the views of midwives. CONCLUSIONS: Cultural barriers prevent the patients and providers from communicating effectively with each other, thus highlighting the need for sexual and communication workshops for the health care providers.

A Systematic Review and Meta-analysis on the Effect of Herbal Medicine to Manage Sleep Dysfunction in Peri- and Postmenopause

OBJECTIVES: Some conventional medications used to treat insomnia, such as benzodiazepine, non-benzodiazepine, and hormone therapy, are associated with side effects. Therefore, there is a growing interest in the use of herbal medicine. The aim of this systematic review is to assess the effects herbal medicines have on sleep disorders of peri- and postmenopausal women. METHODS: Three databases were searched including MEDLINE, Scopus, and the Cochrane Library from inception to March 2018. RESULTS: Six trials assessed the effect of soy on sleep disorders. Forrest plot for 2 studies showed that the standardized mean difference (SMD) of the sleep problems was lower in the soy group than the placebo group (SMD = −0.996; P < 0.001; 95% confidence interval, −1.42 to −0.563). Three trials showed soy had no significant effect on sleep disorders and one study showed a positive effect on sleep disorders. Accordingly, it is difficult to reach a definite conclusion regarding the effects of soy on sleep disorders based on these findings. According to a trial, significant beneficial effect associated with taking Schisandra chinensis. Findings suggested that some herbal medicines like red clover, lavender combined with bitter orange and pin bark extract had attenuating effects on sleep disorders. After intake of 530 mg of valerian twice a day for one month, statistically significant effects were observed regarding the quality of sleep of postmenopausal women. CONCLUSIONS: The present systematic review and meta-analysis found inadequate evidence to draw conclusions regarding the effectiveness of herbal medications, especially soy.

Overview of the Effect of Herbal Medicines and Isoflavones on the Treatment of Cognitive Function

OBJECTIVES: The current overview aimed to present the effect of herbal medicines on cognitive function among menopausal women. METHODS: Two separate authors performed systematic search of the 3 databases of (the MEDLINE Scopus and the Cochrane Central Register Trials) from inception to January 2018. Methodological quality of each study was assessed using the AMSTAR. RESULTS: According to 2 reviews, soy seems to be effective in enhancing summary cognitive function and visual memory. The effect of isoflavones on cognition was affected by treatment duration as six weeks of treatment improved some dimensions of cognitive parameters, including mental flexibility and planning, and longer treatment period (6 months) improved category digit span test, digit symbol test, and visual scanning test score. The effect of phytoestrogen on cognitive function of menopausal women might be altered age, gender, ethnicity, menopausal status, dosage, and length of treatment, types of cognitive test, location, types of soy, and types of phytoestrogen. Combination of Gingko with ginseng could not improve sustained attention, episode memory, category generation or frontal lobe function. Gingko biloba had no significant effect on planning, memory and sustained attention, except for its limited effect on mental flexibility in late menopause. In addition, other herbal medicines like black cohosh showed no effective beneficial. CONCLUSIONS: Phytoestrogen, soy and isoflavones might have a limited beneficial effect on some aspects of cognition. The phytoestrogens affecting cognition might be modified by age, gender, ethnicity, menopausal status, dosage, and length of treatment, types of cognitive test, location, types of soy, and types of phytoestrogen.

Effect of Aromatherapy on the Treatment of Psychological Symptoms in Postmenopausal and Elderly Women: A Systematic Review and Meta-analysis

OBJECTIVES: To critically assess the effect of aromatherapy on the psychological symptoms as noted in the postmenopausal and elderly women. METHODS: Three following databases were systematically searched: MEDLINE, Scopus and Cochrane Library (Cochrane Central Register of Controlled Trials) from inception to January 2018. The search keywords included ‘menopause’ AND (aromatherapy), without language restrictions. RESULTS: In this study, 4 trials were included which fit into our systematic review. The findings demonstrated that the aromatherapy massage have significantly improved psychological symptoms in menopausal and elderly women as compared to the control group (standardized mean difference [SMD] = −1.24; 95% confidence interval, −0.188 to −0.606; P < 0.001 random effect model; 3 trials, moderate to high heterogeneity, I2 = 0.76; P = 0.028). According to 1 of the trials, the aromatherapy oil massage was no more effective than the untreated group regarding their experience of symptoms such as nervousness. CONCLUSIONS: The aromatherapy may be beneficial in attenuating the psychological symptoms that these women may experience, such as anxiety and depression, but it is not considered as an effective treatment to manage nervousness symptom among menopausal women. This finding should be observed in light of study limitations.

Erratum to: Sexual Disharmony in Menopausal Women and Their Husband: A Qualitative Study of Reasons, Strategies, and Ramifications

Title and Abstract correction. The title and abstract should be corrected as ‘Sexual Disharmony in Menopausal Women and Their Husband: A Qualitative Study of Reasons and Strategies’.

The Effect of Short-term Treatment with Fennel on Lipid Profile in Postmenopausal Women: A Randomized Controlled Trial

OBJECTIVES: The present trial aimed to assess the effects of Fennel (Foeniculum vulgare Mill.) on lipid profiles. METHODS: In this double blind, randomized and placebo-controlled trial, sixty eligible postmenopausal women were randomly assigned into the fennel and placebo groups. Total blood cholesterol, cholesterol fractions, and triglycerides were tested at the baseline, and after three-month follow-up. RESULTS: There was no significant difference in triglyceride (P = 0.679), total cholesterol (P = 0.103), low-density lipoprotein cholesterol (LDL-C; P = 0.146) and high-density lipoprotein cholesterol (HDL-C; P = 0.266) levels between the two groups. In addition, in both groups, a paired t.test showed no significant difference in all mentioned parameters, except for HDL-C, indicating significant borderline improvement (P = 0.052) in the fennel group. CONCLUSIONS: The fennel group revealed a very slight positive change in LDL-C, triglyceride and HDL-C. Further studies with longer durations, higher doses, and larger sample sizes are recommended to validate the results.

Sexual Disharmony in Menopausal Women and Their Husband: A Qualitative Study of Reasons, Strategies, and Ramifications

OBJECTIVES: The goal of this study was to explore perceptions and experiences of general practitioners and midwives during sexual dialogue with menopausal women. METHODS: In a descriptive exploratory qualitative study, 13 midwives and 12 general practitioners were selected using a semi-structured interview and purposive sampling method. Data analysis was conducted using qualitative content analysis adopted by Graneheim and Lundman. RESULTS: Through data analysis “sexual disharmony” emerged as a central theme, which included three categories of reasons, strategies, and ramifications of sexual disharmony. Reasons for sexual disharmony included subcategories of aging and health related-problems, marital problems, and stereotypical perceptions regarding menopause and sexuality and daily concerns. Strategies used by couples to address sexual disharmony consisted of changing roles and values, pretending to reach orgasm, suppressing sexual desire, meeting sexual needs of husbands in accordance with religious rules, seeking help of peers, seeking friends or traditional medicine and health providers, seeking a help charmer, engaging in sex with other women to fulfill sexual needs, pretending to be moody to alleviate sexual tension. Sexual disharmony may lead to spending money on a prostitute instead of engaging in sex out of wedlock or a surge in social pathologies such as sexually transmitted disease. CONCLUSIONS: Healthcare providers must be aware of various sexual behavior of menopausal women and their husbands when they detect sexual disharmony in their patients. Results of this study can facilitate development of restricted guidelines for sexual discussion with menopausal women.

Aromatherapy for Sexual Problems in Menopausal Women: A Systematic Review and Meta-analysis

OBJECTIVES: The aim of the present systematic review and meta-analysis is the exploration of the potential evidence of the effectiveness of aromatherapy products on the sexual function of menopausal women. METHODS: From inception to December 2017, the search process was performed using the MEDLINE and Scopus databases and the Cochrane Library regarding the trials on the effectiveness of herbal-medicine aromatherapy on the sexual function of menopausal women. RESULTS: Three of the trials comprise suitable data for inclusion in the meta-analysis. According to the meta-analysis, it is possible to improve the standardized mean difference (SMD) of the sexual desire up to 0.56 in the aromatherapy group compared with the control group (SMD = 0.56; P < 0.001; heterogeneity; I² = 42%; P = 0.141). According to one of the trials, the serum-estrogen level of two different doses did not change in the neroli oil inhalation group compared with the almond-oil group. CONCLUSIONS: Both aromatherapy with neroli oil or lavender (monopreparation) and combined-oil aromatherapy with lavender, fennel, geranium, and rose significantly improved human sexual function; however, a significant change of the serum-estrogen level was not detected. The findings of the present review should be presented cautiously because of the corresponding limitations such as the lack of a standardized tool, the lack of intention-to-treat reporting, the low study amount, and the short-term follow-up.

Effect of Fennel on the Health Status of Menopausal Women: A Systematic and Meta-analysis

OBJECTIVES: The aim of the present study is the systematic and critical investigation of the effectiveness of fennel on the climacteric symptoms among menopausal females. METHODS: A search of the trials studying the effect of fennel on menopausal females was conducted in 2017 using the MEDLINE and Scopus databases and the Cochrane Library with the following keywords: fennel, Foeniculum vulgare, and menopause. RESULTS: Fennel combined with officinalis is more effective in the attenuating of sleep disorders compared to Citalopram. The comparison of these two groups regarding the mean bone mineral density and bone mineral content (P = 0.14, P = 0.504); the total hip femoral (P = 0.42, P = 0.66); the trochanter (P = 0.075, P = 0.07); the intertrochanter (P = 0.84, P = 0.93); and the femoral neck (P = 0.43, P = 0.64) did not show any significant statistical differences; however, a statistically significant difference regarding the vasomotor symptoms (P < 0.01) was found. The other significant differences are related to the values of the total cholesterol (P = 0.103); low-density lipoprotein cholesterol, or LDL-C (P = 0.104); high-density lipoprotein cholesterol, or HDL-C (P = 0.266); triglyceride (P = 0.679); body weight (P = 0.212); body mass index (P = 0.041); waist and hip circumferences (P = 0.365); and fat distribution (P = 0.337) between the two groups. The standardized mean difference (SMD) values of sexual activity (SMD = 0.638; P < 0.001), and maturation value (SMD = 0.601; P = 0.003) are highly significant among the fennel-treated women compared with the placebo group. CONCLUSIONS: According to the findings of the present study, fennel is important in the relieving of vasomotor symptoms, vaginal itching, dryness, dyspareunia, sexual function, sexual satisfaction, and sleep distribution.

Prognostic importance of C-KIT mutations in core binding factor acute myeloid leukemia: a systematic review

Acute myeloid leukemia [AML] is defined as leukemic blast reproduction in bone marrow. Chromosomal abnormalities form different subgroups with joint clinical specifications and results. t[8;21][q22;q22] and inv[16][p13;q22] form core binding factor- AML [CBF-AML]. c-kit mutation activation occurs in 12.8-46.1% of adults with CBF leukemia. These mutations occur in 20-25% of t[8;21] and 30% of inv[16] cases

Methods: In this systematic review, we searched different databases, including PubMed, Scopus, and Embase. Selected articles were measured based on the inclusion criteria of this study and initially compared in terms of titles or abstracts. Finally, articles relevant to the subject of this review were retrieved in full text. Twenty-two articles matched the inclusion criteria and were selected for this review

Results: In this study, c-kit mutations were associated with poor prognosis in AML patients with t[8;21] and inv[16]. In addition, these mutations had better prognostic effects on AML patients with inv[16] compared with those with t[8;21]

Conclusion: According to the results of this study, c-kit mutations have intense, harmful effects on the relapse and white blood cell increase in CBF-AML adults. However, these mutations have no significant prognostic effects on patients

The Effect of Foeniculum Vulgare (Fennel) on Body Composition in Postmenopausal Women with Excess Weight: A Double-blind Randomized Placebo-controlled Trial

OBJECTIVES: The goal of this study was to evaluate the effect of fennel on body composition. METHODS: This study is a secondary analysis of a double-blind, randomized, placebo-controlled trial. Fifty-four out of 60 patients were able to successfully complete the original study. Seven out of 54 patients were excluded because they were not overweight and obese. Thus, 47 women were included in this secondary analysis. Of these 47 women, 22 were in the fennel group and 25 were in placebo group. Body weight, body mass index (BMI) as well as fat distribution was measured at the baseline and after a three-month follow-up. RESULTS: Comparison of fennel and placebo groups did not reveal any significant effect in terms of body weight, BMI, waist and hip circumferences and fat distribution. Also, the results of paired t-test did not variation of these parameters across groups before and after 12-week treatment. CONCLUSIONS: Menopausal women in fennel group experienced a slight increase in body weight and fat distribution, which was not significant. Further studies with larger sample sizes are recommended to validate the results of this study.

The Effect of Short-term Treatment with Fennel on Bone Density in Postmenopausal Women: A Randomized Controlled Trial

OBJECTIVES: The goal of this study is to assess the effect of fennel on bone density. METHODS: This was a double-blind, randomized, placebo-controlled trial, which studied sixty eligible postmenopausal women, who were randomly assigned to fennel and placebo groups. Then, the dual energy X-ray absorptiometry was utilized to measure bone mineral density (BMD) and bone mineral content (BMC) of the spine, femoral neck, intertrochanter, and trochanter at the baseline and after three-month follow-up. RESULTS: The mean BMD and BMC at lumbar spine (P = 0.14, P = 0.504), total hip femoral (P = 0.427, P = 0.471), trochanter (P = 0.075, P = 0.07), intertrochanter, (P = 0.864, P = 0.932) and femoral neck (P = 0.439, P = 0.641) was not significantly different between the fennel and placebo groups. CONCLUSIONS: The results of this study did not approve the effect of fennel on bone density in post-menopausal women. However, to gain deeper insights, further studies with longer durations and larger sample sizes are recommended.

efficacy of Iranian herbal medicines in alleviating hot flashes: a systematic review

Background: Hot flashes are the most common symptoms experienced by women around the time of menopause. Many women are interested in herbal medicines because of fear of side effects of hormone therapy

Objective: The aim of this systematic review was to assess the effectiveness of Iranian herbal medicines in alleviating hot flashes

Materials and Methods: MEDLINE [1966 to January 2015], Scopus [1996 to January 2015], and Cochrane Central Register of Controlled Trials [The Cochrane Library, issue 1, 2015] were searched along with, SID, Iran Medex, Magiran, Medlib and Irandoc. Nineteen randomized controlled trials met the inclusion criteria

Results: Overall, studies showed that Anise [Pimpinella anisum], 60Tlicorice [Glycyrrhizaglabra]60T, Soy, Black cohosh, Red clover, Evening primrose, Flaxseed, Salvia officinalis, Passiflora ¡itex Agnus Castus, Piascledine [Avacado plus soybean oil], 60TSt. John's wort [Hypericum perforatum]60T, and valerian can alleviate the side effects of hot flashes

Conclusion: This research demonstrated the efficacy of herbal medicines in alleviating hot flashes, which are embraced both with people and health providers of Iran Therefore, herbal medicine can be seen as an alternative treatment for women experiencing hot flashes

Evaluation of menopausal women's attitudes towards menopause in Shiraz

To evaluate the attitudes of menopausal women towards the menopause and its relation with demographic characteristics. This was a cross-sectional study that evaluated 378 menopausal women attending primary health care centers in Shiraz. Five health centers in different parts of the city were chosen and the participants were selected from these women attending the above-mentioned health care centers randomly. Then, they were interviewed and a questionnaire was filled in. The mean age of the participants was 54.9 [ +/- 5.5] years. Nine women [2.4%] were single and 306 [81%] were married. One hundred sixty [42.3%] were illiterate and nine [2.4%] had a college degree. Seventy [18.5%] of them were smoker. One hundred twenty five [33.1%] suffered from hypertension, 64 [16.9%] had diabetes, 206 [54.5%] musculoskeletal problems, 43 [11.4%] pulmonary diseases, and 75 [19.8%] heart diseases. The mean and standard deviation of the total score of attitude was 102.7 +/- 11.8 [Rang:71-135]. Statistically significant relation was observed between physical menopausal symptoms and total score of attitude in multiple regression analysis. According to the results of the study, there are some differences in various countries and cultures and these differences lead to different attitudes among in women. Physical symptoms are very important in attitudes towards menopause in women and such bothering symptoms can lead to negative attitude. Therefore, it is very important to make some plans for evaluating menopausal symptoms and controlling them