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1.
Menopause ; 31(4): 258-265, 2024 Apr 01.
Article in English | MEDLINE | ID: mdl-38442310

ABSTRACT

OBJECTIVE: Women's increasing workforce participation necessitates understanding unique life phases like menopause for enhanced workplace inclusivity. This research investigates the challenges and needs of peri-menopausal women in work settings, using the Job Demands-Resources model as a foundation. METHODS: A cross-sectional survey was administered to 351 working women aged 40 to 65 years in the United States. Hierarchical multiple regression models were employed to assess the relationship between the severity of menopausal symptoms, emotional exhaustion, work engagement, and turnover intentions. RESULTS: Most of the respondents reported moderate (38.46%) to severe (35.9%) menopausal symptoms. Notably, 54% of the women were caregivers for children or adults. About 77.7% of participants reported work-related challenges due to menopause, with a perceived reduction in productivity (56.8%) being the most common issue. The severity of menopausal symptoms was found to significantly predict more emotional exhaustion ( P < 0.001), less work engagement ( P < 0.001), and greater turnover intentions ( P = 0.03). Concerns about being perceived as less capable in the workplace due to menopausal symptoms were reported by 51.2% of respondents. A striking gap exists between the workplace measures desired by women, such as formal menopause policies and managerial training (65.4%-68%), and their actual implementation (2%-6.3%). CONCLUSIONS: This study reveals an exigent need for increased awareness and structural changes to support working women going through menopause. The findings have far-reaching implications for not just promoting gender equity and well-being but are also pivotal for maintaining a diversified, engaged, and effective workforce.


Subject(s)
Menopause , Workplace , Adult , Child , Female , Humans , Cross-Sectional Studies , Menopause/psychology , Workplace/psychology , Surveys and Questionnaires
6.
Fertil Steril ; 106(7): 1588-1599, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27912889

ABSTRACT

Primary ovarian insufficiency (POI) is a rare but important cause of ovarian hormone deficiency and infertility in women. In addition to causing infertility, POI is associated with multiple health risks, including bothersome menopausal symptoms, decreased bone density and increased risk of fractures, early progression of cardiovascular disease, psychologic impact that may include depression, anxiety, and decreased perceived psychosocial support, potential early decline in cognition, and dry eye syndrome. Appropriate hormone replacement therapy (HRT) to replace premenopausal levels of ovarian sex steroids is paramount to increasing quality of life for women with POI and ameliorating associated health risks. In this review, we discuss POI and complications associated with this disorder, as well as safe and effective HRT options. To decrease morbidity associated with POI, we recommend using HRT formulations that most closely mimic normal ovarian hormone production and continuing HRT until the normal age of natural menopause, ∼50 years. We address special populations of women with POI, including women with Turner syndrome, women with increased risk of breast or ovarian cancer, women approaching the age of natural menopause, and breastfeeding women.


Subject(s)
Estrogen Replacement Therapy/methods , Fertility Agents, Female/therapeutic use , Infertility, Female/drug therapy , Menopause, Premature/drug effects , Primary Ovarian Insufficiency/drug therapy , Adult , Estrogen Replacement Therapy/adverse effects , Female , Fertility Agents, Female/adverse effects , Humans , Infertility, Female/diagnosis , Infertility, Female/etiology , Infertility, Female/physiopathology , Middle Aged , Patient Selection , Primary Ovarian Insufficiency/complications , Primary Ovarian Insufficiency/diagnosis , Primary Ovarian Insufficiency/physiopathology , Risk Assessment , Risk Factors , Treatment Outcome
7.
Fertil Steril ; 106(7): 1580-1587, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27793381

ABSTRACT

Bilateral oophorectomy performed in women before they are menopausal induces surgical primary ovarian insufficiency, an acute and chronic deficiency of the hormones normally produced by the ovaries. Without hormone replacement therapy (HRT) most of these women develop severe symptoms of estrogen (E) deficiency and are at increased risk for osteoporosis, cardiovascular disease, cognitive decline, dementia, and the associated increases in morbidity and mortality. In cases in which a hysterectomy has been performed at the time of bilateral oophorectomy transdermal or transvaginal E2 replacement therapy without cyclic progestin replacement is the optimum hormonal management for these women. There is substantial evidence this approach even reduces the risk for breast cancer. Unfortunately, unwarranted fear of all menopausal HRTs has become widespread following the reports of the Women's Health Initiative studies. This fear has led to a steep decline in use of E therapy, even in women in whom HRT is clearly indicated. Discussion of possible ovarian conservation in women who are premenopausal is an integral part of the preoperative planning for any women undergoing hysterectomy. Timely and effective HRT for women who will experience surgical primary ovarian insufficiency is clearly indicated.


Subject(s)
Estrogen Replacement Therapy/methods , Ovariectomy/adverse effects , Primary Ovarian Insufficiency/drug therapy , Age Factors , Estrogen Replacement Therapy/adverse effects , Female , Humans , Primary Ovarian Insufficiency/diagnosis , Primary Ovarian Insufficiency/etiology , Primary Ovarian Insufficiency/physiopathology , Risk Assessment , Risk Factors , Treatment Outcome
11.
Am J Public Health ; 103(9): 1583-8, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23865654

ABSTRACT

OBJECTIVES: We examined the effect of estrogen avoidance on mortality rates among hysterectomized women aged 50 to 59 years. METHODS: We derived a formula to relate the excess mortality among hysterectomized women aged 50 to 59 years assigned to placebo in the Women's Health Initiative randomized controlled trial to the entire population of comparable women in the United States, incorporating the decline in estrogen use observed between 2002 and 2011. RESULTS: Over a 10-year span, starting in 2002, a minimum of 18 601 and as many as 91 610 postmenopausal women died prematurely because of the avoidance of estrogen therapy (ET). CONCLUSIONS: ET in younger postmenopausal women is associated with a decisive reduction in all-cause mortality, but estrogen use in this population is low and continuing to fall. Our data indicate an associated annual mortality toll in the thousands of women aged 50 to 59 years. Informed discussion between these women and their health care providers about the effects of ET is a matter of considerable urgency.


Subject(s)
Estrogens/therapeutic use , Hysterectomy/mortality , Estrogens/adverse effects , Female , Humans , Hysterectomy/methods , Middle Aged , Ovariectomy/mortality , Risk Assessment , United States/epidemiology
12.
Menopause ; 19(3): 250-2, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22228323
14.
Obstet Gynecol ; 106(4): 834-9, 2005 Oct.
Article in English | MEDLINE | ID: mdl-16199644

ABSTRACT

Sexual dysfunction is common in postmenopausal women, but because this problem may be caused by several factors, the primary need for these patients is an initial assessment and accurate diagnosis by the primary care provider. Listening to the patient and clarifying her concerns are important for defining the nature of the problem, its severity and duration, and her motivation for treatment. A complete physical evaluation, including a pelvic examination and measurement of postmenopausal hormone levels, may provide important information for structuring a treatment plan to address the patient's concerns. Providing postmenopausal women with reassuring reading materials and focusing on their specific concerns about sexual dysfunction will help reduce anxiety, as will physician suggestions keyed to the patient's individual needs. Alleviation of some menopause-related sexual function difficulties with prescription medications may be warranted, and referral to a specialist for further treatment and counseling may often be the best course of action for a primary care provider. Sexual problems in postmenopausal women are usually amenable to fairly simple interventions that are within the competence of primary care professionals. This paper provides the primary care provider with a perspective on the appropriateness of treatment compared with referral for women experiencing postmenopausal sexual dysfunction.


Subject(s)
Postmenopause , Primary Health Care , Referral and Consultation , Sexual Dysfunction, Physiological/therapy , Aged , Female , Humans , Middle Aged , Sexual Dysfunction, Physiological/etiology , Sexual Dysfunction, Physiological/psychology
15.
Psychopharmacology (Berl) ; 183(2): 181-9, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16175405

ABSTRACT

OBJECTIVES: The effect of gender and female menstrual cycle on human striatal dopamine transporters (DATs) was investigated with single-photon emission computed tomography (SPECT) using the ligand 2beta-carbomethoxy-3beta-(4-[(123)I]iodophenyl)tropane. METHODS: Ten female subjects aged 18-40 years (25.3+/-7.3 years) were scanned twice during the early follicular and the mid-luteal phases to detect any hormone-mediated changes in DAT availability in the striatum or serotonin transporter (SERT) availability in brainstem-diencephalon. Plasma estradiol and progesterone levels were obtained at the time of SPECT and confirmed the expected increases from the follicular to the luteal phases. Finally, in a post hoc analysis of a previously published healthy-subject sample, striatal DAT availability was compared between 70 male and 52 female subjects who ranged in age from 18 to 88 years. RESULTS: In the ten menstrual cycle subjects, DAT availability (V(3)'') in striatum and SERT availability in brainstem-diencephalon did not differ between follicular and luteal phases. Moreover, change in V(3)'' for striatum or brainstem-diencephalon was uncorrelated with change in plasma estradiol or progesterone from the follicular to the luteal phase. In the larger healthy-subject sample, there was no significant effect of gender or the interaction of age and gender on striatal V(3)''. CONCLUSIONS: These findings suggest that in using DAT or SERT ligands in the study of neuropsychiatric disorders, matching of female subjects according to a menstrual cycle phase is unnecessary. Although the present investigation did not confirm previous reports of gender differences in striatal DAT availability, controlling for gender in such studies still seems advisable.


Subject(s)
Cocaine/analogs & derivatives , Corpus Striatum/metabolism , Dopamine Plasma Membrane Transport Proteins/metabolism , Gender Identity , Iodine Radioisotopes/pharmacokinetics , Menstrual Cycle/metabolism , Adolescent , Adult , Analysis of Variance , Cocaine/pharmacokinetics , Corpus Striatum/diagnostic imaging , Demography , Female , Humans , Male , Tomography, Emission-Computed, Single-Photon/methods
16.
Am J Obstet Gynecol ; 192(2): 387-93, 2005 Feb.
Article in English | MEDLINE | ID: mdl-15695976

ABSTRACT

OBJECTIVE: This study was undertaken to assess whether estrogen therapy (ET) reduces the risk of cognitive decline in women with cerebrovascular disease. STUDY DESIGN: We conducted a randomized, double-blind trial of estradiol 17beta versus placebo for secondary stroke prevention in 664 postmenopausal women with a recent stroke or transient ischemic attack. The Mini-Mental State Examination (MMSE) and 5 domain measures were obtained at baseline and exit. RESULTS: Among 461 women withdrawn alive without stroke, ET did not have a significant effect on cognitive measures after an average of 3 years (relative risk of MMSE decline: 0.74, 95% CI, 0.49-1.13). In women with normal MMSE at entry, estrogen was associated with less decline (relative risk, 0.46, 95% CI, 0.24-0.87). CONCLUSION: In this study, estradiol did not have significant effects on cognitive measures. However, in women with normal function at baseline, there may be a benefit for ET in reducing the risk for cognitive decline.


Subject(s)
Cognition/drug effects , Estradiol/therapeutic use , Stroke/prevention & control , Aged , Aged, 80 and over , Double-Blind Method , Female , Humans , Middle Aged , Postmenopause
17.
Stroke ; 36(3): 630-4, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15677573

ABSTRACT

BACKGROUND AND PURPOSE: Physical performance for walking, reaching, turning, and other common tasks is a major determinant of functional independence after stroke. Current strategies to preserve physical performance focus on prevention of recurrent stroke. Loss of physical performance, however, may occur in the absence of recurrence. To examine this possibility, we measured change in physical performance, independent of subsequent stroke, among women with a recent ischemic stroke or transient ischemic attack (TIA). METHODS: Among 664 postmenopausal women who participated in a clinical trial of estrogen therapy after stroke or TIA, we administered the Physical Performance Test (PPT) at baseline (mean 58 days from the cerebrovascular event) and annually. Women who died or had a stroke during follow-up were censored. Decline or improvement in physical performance was defined as a change in the PPT score from baseline of at least 3 points. Sustained decline or improvement was defined as 2 consecutive years during which the score had declined or improved, respectively, relative to the baseline score. RESULTS: With each year of follow-up, a smaller proportion of the cohort demonstrated improvement (16% in year 1, 6% in year 5) and a larger proportion demonstrated decline (15% in year 1, 35% in year 5). In an analysis restricted to 259 women with 3 years of follow-up, 46 (18%) experienced a nonsustained decline in physical performance, and 39 (15%) experienced a sustained decline. CONCLUSIONS: Decline in physical performance is common after an ischemic stroke or TIA even in the absence of a recurrent neurological event. Our findings suggest that specific interventions to maintain and improve physical performance may be important for reducing long-term disability.


Subject(s)
Estrogens/therapeutic use , Ischemic Attack, Transient/physiopathology , Recovery of Function/physiology , Stroke/physiopathology , Aged , Brain Ischemia/physiopathology , Brain Ischemia/prevention & control , Double-Blind Method , Female , Humans , Ischemic Attack, Transient/prevention & control , Postmenopause/physiology , Psychomotor Performance/drug effects , Psychomotor Performance/physiology , Recovery of Function/drug effects , Risk Factors , Secondary Prevention , Stroke/prevention & control , Walking/physiology , Women's Health
18.
J Am Coll Nutr ; 23(5): 397-403, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15466946

ABSTRACT

OBJECTIVE: To determine effects of oat and antioxidant vitamin (C 500 mg, E 400 IU) ingestion on endothelial function in overweight, dyslipidemic adults. DESIGN: Randomized, blinded, placebo-controlled, crossover trial Intervention(s): Subjects (16 males > or = age 35; 14 postmenopausal females) were assigned, in random order, to oats (60 g oatmeal), vitamin E (400 IU) plus vitamin C (500 mg), the combination of oats and vitamins, or placebo, and underwent brachial artery reactivity scans (BARS) following a single dose of each treatment, and again following 6 weeks of daily ingestion, with 2-week washout periods. At each test, a provocation high-fat meal (50 g, predominantly saturated) was administered and subjects were scanned pre, and 3 hours post-ingestion. RESULTS: Mean flow-mediated vasodilation (FMD; measured as percent diameter change before and after treatments) at baseline was 6.35 +/- 3.37. Oats increased FMD non-significantly (p > 0.05) with both single acute dose (from 6.07 +/- 6.25 to 9.22 +/- 8.82) and six weeks of sustained treatment (from 6.01 +/- 10.07 to 8.69 +/- 8.42). The direction of effect was negative for vitamins and the oat/vitamin combination with both acute and sustained treatment. There were no significant differences in FMD change among the treatments in either phase of the study, however when acute and sustained effects were pooled, oat treatment significantly augmented FMD (p < 0.05). CONCLUSIONS: This trial suggests but does not confirm a beneficial influence of oat ingestion on endothelial function in overweight, dyslipidemic adults. Further study of this potential association is warranted.


Subject(s)
Antioxidants/pharmacology , Ascorbic Acid/pharmacology , Avena , Dietary Fats/pharmacology , Endothelium, Vascular/drug effects , Vasodilation/drug effects , Vitamin E/pharmacology , Adult , Aged , Antioxidants/administration & dosage , Ascorbic Acid/administration & dosage , Blood Flow Velocity , Brachial Artery/drug effects , Brachial Artery/physiology , Cross-Over Studies , Dietary Fats/administration & dosage , Dietary Supplements , Double-Blind Method , Endothelium, Vascular/physiology , Female , Humans , Hyperlipidemias/blood , Hyperlipidemias/physiopathology , Male , Middle Aged , Obesity/blood , Obesity/physiopathology , Postprandial Period , Vasodilation/physiology , Vitamin E/administration & dosage
19.
J Sex Marital Ther ; 30(1): 43-7, 2004.
Article in English | MEDLINE | ID: mdl-14660293

ABSTRACT

The objective of this study was to demonstrate the applicability of laser doppler flowmetry to pre- and posthysterectomy vaginal blood flow assessment. We used laser Doppler flowmetry to measure pre-and postoperational vaginal blood flow in 8 premenopausal women undergoing benign hysterectomies; we also measured serum E2, FSH, FT and administered a brief sexual function questionnaire. We analyzed data using two tailed t-test for paired samples. We found no significant differences at the P <.05 level of significance for vaginal blood flow. Accompanying values of estradiol, FSH, and free testosterone remained unchanged as well. A brief sexual function assessment revealed improvement or stability of libido, arousal, orgasm, and partner relatedness. Laser doppler flowmetry is an objective, reproducible measure of vaginal blood flow and may be used to investigate posthysterectomy sexual function.


Subject(s)
Coitus , Hysterectomy , Laser-Doppler Flowmetry , Libido , Vagina/blood supply , Adult , Coitus/psychology , Female , Humans , Middle Aged , Pilot Projects , Premenopause , Reproducibility of Results , Statistics, Nonparametric , Time Factors
20.
Am J Obstet Gynecol ; 188(2): 304-9, 2003 Feb.
Article in English | MEDLINE | ID: mdl-12592230

ABSTRACT

OBJECTIVE: The purpose of this study was to determine the effects of raloxifene on endothelial function in healthy, postmenopausal women. STUDY DESIGN: This was a randomized, double-blind, placebo-controlled crossover trial. Subjects (n = 19; mean age, 61 years) underwent endothelial function testing at baseline and after treatment with placebo or raloxifene (60 mg per day for 6 weeks). RESULTS: Brachial artery diameter change (flow-mediated dilation) increased 5.0% with placebo and 8.56% with raloxifene (SE = 1.83, P =.03) in response to a hyperemic stimulus; an adjustment of this response for a variation in stimulus intensity resulted in greater discrimination (P =.009). The ratio of area under the curve response to area under the curve reference with the use of laser Doppler measures was 1.18 for placebo and 1.28 for raloxifene (P =.05). Flow-mediated dilation and area under the curve ratio correlated significantly (r = 0.33, P =.04). CONCLUSION: Treatment with raloxifene enhanced endothelial-mediated dilation in brachial arteries and digital vessels in healthy, postmenopausal women. A potential mechanism for a cardioprotective effect of raloxifene is suggested and warrants further study.


Subject(s)
Endothelium, Vascular/drug effects , Endothelium, Vascular/physiology , Postmenopause/physiology , Raloxifene Hydrochloride/pharmacology , Selective Estrogen Receptor Modulators/pharmacology , Brachial Artery/physiology , Cross-Over Studies , Double-Blind Method , Female , Humans , Laser-Doppler Flowmetry , Microcirculation/drug effects , Middle Aged , Raloxifene Hydrochloride/adverse effects , Regional Blood Flow/physiology , Selective Estrogen Receptor Modulators/adverse effects , Vasodilation/drug effects , Vasomotor System/drug effects
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