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J Obstet Gynaecol Can ; 42(3): 301-303, 2020 Mar.
Article in English | MEDLINE | ID: covidwho-1291550


Vulvovaginal atrophy (VVA) resulting from estrogen deprivation at menopause often results in distressing vaginal dryness and dyspareunia. Fewer than 25% of affected women seek help for this condition citing embarrassment, cultural values, an aging or unavailable partner and concerns about use of estrogens following the Women's Health Initiative. Available non-hormonal treatments, such as moisturizers, while affording some relief can be messy to apply and do not prevent disease progression. A new oral selective estrogen receptor modulator, ospemifene, has been found to have strong estrogenic activity in vaginal tissues without adverse estrogenic effects at other sites.

Atrophy/drug therapy , Menopause , Selective Estrogen Receptor Modulators/administration & dosage , Tamoxifen/analogs & derivatives , Vagina/drug effects , Vulva/drug effects , Aged , Atrophy/pathology , COVID-19/drug therapy , Dyspareunia/drug therapy , Female , Humans , Menopause/physiology , Middle Aged , Postmenopause , Selective Estrogen Receptor Modulators/therapeutic use , Tamoxifen/administration & dosage , Tamoxifen/therapeutic use , Vagina/pathology , Vulva/pathology
Maturitas ; 150: 14-21, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1253363


Governments, employers, and trade unions are increasingly developing "menopause at work" policies for female staff. Many of the world's most marginalised women work, however, in more informal or insecure jobs, beyond the scope of such employment protections. This narrative review focuses upon the health impact of such casual work upon menopausal women, and specifically upon the menopausal symptoms they experience. Casual work, even in less-then-ideal conditions, is not inherently detrimental to the wellbeing of menopausal women; for many, work helps manage the social and emotional challenges of the menopause transition. Whereas women in higher status work tend to regard vasomotor symptoms as their main physical symptom, women in casual work report musculoskeletal pain as more problematic. Menopausal women in casual work describe high levels of anxiety, though tend to attribute this not to their work as much as their broader life stresses of lifelong poverty and ill-health, increasing caring responsibilities, and the intersectionally gendered ageism of the social gaze. Health and wellbeing at menopause is determined less by current working conditions than by the early life experiences (adverse childhood experiences, poor educational opportunities) predisposing women to poverty and casual work in adulthood. Approaches to supporting menopausal women in casual work must therefore also address the lifelong structural and systemic inequalities such women will have faced. In the era of COVID-19, with its devastating economic, social and health effects upon women and vulnerable groups, menopausal women in casual work are likely to face increased marginalisation and stress. Further research is need.

Employment/psychology , Menopause/physiology , Menopause/psychology , Occupational Health/standards , Workplace/standards , Female , Humans , Workplace/organization & administration , Workplace/psychology
Obstet Gynecol ; 137(3): 423-429, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1066430


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), uses two primary receptors, type II transmembrane serine protease and angiotensin-converting enzyme-2, for priming and cellular invasion, respectively. Both proteins have been demonstrated to be present in different concentrations in females and males, which may explain a mechanism for the reported higher case-fatality rate in males. Despite the known sex difference in COVID-19 disease mortality, preliminary data suggest there are certain female populations, including pregnant and menopausal women and possibly polycystic ovarian syndrome patients who are more susceptible to COVID-19-related morbidity. This commentary analyzes the interplay between sex differences, hormones, and the immune function in each of these populations with respect to the risk and severity of COVID-19 and proposes biological rationales to explain these differences.

COVID-19/epidemiology , COVID-19/genetics , Genetic Predisposition to Disease , Angiotensin-Converting Enzyme 2/genetics , Chromosomes, Human, X , Disease Susceptibility , Female , Humans , Male , Menopause/physiology , Morbidity , Polycystic Ovary Syndrome/epidemiology , Pregnancy , SARS-CoV-2/physiology , Serine Endopeptidases/genetics , Sex Factors