Phytoestrogens, which consist mainly of isoflavones, lignans and coumestans have estrogenic and anti-inflammatory properties. Prior research suggests that higher dietary or supplemental intakes of isoflavones and lignans are related to better cognitive performance in middle aged and older women.
We conducted longitudinal analysis of dietary phytoestrogens and cognitive performance in a cohort of African-American, white, Chinese and Japanese women undergoing the menopause transition (MT). Tests were: Symbol Digit Modalities, East Boston Memory and Digits Span Backward. Phytoestrogens were assessed by Food Frequency Questionnaire. We modeled each cognitive score as a function of concurrent value of the primary predictors (highest tertile of isoflavones, lignans or coumestrol) and covariates including MT stage.
Coumestrol and isoflavone intakes were 10 and 25 times greater, respectively, in Asian versus non-Asian participants. During late perimenopause and postmenopause, Asian women with high isoflavone intakes did better on processing speed, but during early perimenopause and postmenopause, high isoflavone Asian consumers performed worse on verbal memory. The highest isoflavone consumers among non-Asians likewise posted lower verbal memory scores during early perimenopause. A verbal memory benefit of higher dietary lignan consumption was apparent only during late perimenopause, when women from all ethnic/racial groups who were in the highest tertile of intake demonstrated a small advantage. Coumestrol was unrelated to cognitive performance.
Cognitive effects of dietary phytoestrogens are small, appear to be class-specific, vary by menopause stage and cognitive domain and differ among ethic/racial groups (but whether this is related to dose or to host factors cannot be discerned).
menopause transition; cognitive function; phytoestrogen; isoflavone; lignan; coumestrol
Cancer-related fatigue afflicts up to one-third of breast cancer survivors, yet there are no empirically-validated treatments for this symptom.
We performed a two-group RCT to determine the feasibility and efficacy of an Iyengar yoga intervention for breast cancer survivors with persistent post-treatment fatigue. Participants were breast cancer patients who had completed cancer treatments (other than endocrine therapy) at least 6 months prior to enrollment, reported significant cancer-related fatigue, and had no other medical conditions that would account for fatigue symptoms or interfere with yoga practice. Block randomization was used to assign participants to a 12-week Iyengar-based yoga intervention or to 12 weeks of health education (control). The primary outcome was change in fatigue measured at baseline, immediately post-treatment, and 3 months after treatment completion. Additional outcomes included changes in vigor, depressive symptoms, sleep, perceived stress, and physical performance. Intent to treat analyses were conducted with all randomized participants using linear mixed models.
Thirty-one women were randomly assigned to yoga (n = 16) or health education (n = 15). Fatigue severity declined significantly from baseline to post-treatment and over a 3 month follow-up in the yoga group relative to controls (P = .032). In addition, the yoga group showed significant increases in vigor relative to controls (P = .011). Both groups showed positive changes in depressive symptoms and perceived stress (P < .05). No significant changes in sleep or physical performance were observed.
A targeted yoga intervention led to significant improvements in fatigue and vigor among breast cancer survivors with persistent fatigue symptoms.
To assess whether a specifically designed Yoga intervention can reduce hyperkyphosis.
A 6-month, 2 group, randomized, controlled, single masked trial.
Community research unit.
118 women and men aged >60 years with kyphosis angle >40 degrees. Major exclusions were: serious medical comorbidity; use of assistive device; unable to hear or see adequately for participation; or unable to pass a physical safety screen.
The active treatment group attended hour-long Yoga classes, 3 days per week, for 24 weeks. The control group attended a monthly luncheon/seminar and received mailings.
Primary outcomes were change (baseline to 6 months) in Debrunner kyphometer-assessed kyphosis angle, standing height, timed chair stands, functional reach and walking speed. Secondary outcomes were change in: kyphosis index, flexicurve kyphosis angle, the Rancho Bernardo Blocks posture assessment and health-related quality of life (HRQOL).
Compared to control participants, those randomized to Yoga experienced a 4.4% improvement in flexicurve kyphosis angle (p=0.006) and a 5% improvement in kyphosis index (p=0.004). The intervention did not result in statistically significant improvement in Debrunner kyphometer angle, measured physical performance or in self-assessed HRQOL (each p>0.1).
The decrease in flexicurve kyphosis angle in the Yoga treatment group shows that hyperkyphosis is remediable, a critical first step in the pathway to treating or preventing this condition. Larger, more definitive studies of Yoga or other interventions for hyperkyphosis should be considered. Targeting individuals with more malleable spines and using longitudinally precise measures of kyphosis could strengthen the treatment effect.
kyphosis; hyperkyphosis; yoga; randomized controlled clinical trial
Adult bone mass depends on acquisition in childhood and decline in adulthood, and may be influenced by socioeconomic conditions over the entire life course.
We examined associations of bone mineral density (BMD) in adulthood with life course socioeconomic status in 729 participants in the Midlife in the United States Biomarker Project, adjusting for age, menopausal transition stage, race, gender, body weight, smoking, physical activity in several life stages, and research site. Primary predictors were a) childhood socioeconomic advantage score (including parental education, self-rated financial status relative to others, not being on welfare), b) adult education level (no college vs. some college vs. college graduate), and c) adult current financial advantage score (including family-adjusted poverty to income ratio, self-assessed current financial situation, having enough money to meet needs, ease in paying bills).
Mean age was 56.9 (range 34–85) years. After adjustment for covariates, childhood socioeconomic advantage and adult education level were positively associated with lumbar spine BMD: 0.27 standard deviations (SD) higher at 90th compared to 10th percentile of childhood advantage score (P = 0.009), and 0.24 SD higher in college graduates compared to participants without college education (P = 0.01). Adult current financial advantage was not associated with lumbar spine BMD. None of the three socioeconomic indicators was significantly associated with femoral neck BMD.
Childhood socioeconomic advantage and adult education level were associated with higher adult lumbar spine BMD. Current financial advantage was not associated with BMD. Childhood socioeconomic factors may influence acquisition of lumbar BMD.
bone mineral density; socioeconomic status; poverty; education; income
Phytoestrogens, heterocyclic phenols found in plants, may benefit several health outcomes. However, epidemiologic studies of the health effects of dietary phytoestrogens have yielded mixed results, in part due to challenges inherent in estimating dietary intakes. The goal of this study was to improve the estimates of dietary phytoestrogen consumption using a modified Block Food Frequency Questionnaire (FFQ), a 137-item FFQ created for the Study of Women’s Health Across the Nation (SWAN) in 1994. To expand the database of sources from which phytonutrient intakes were computed, we conducted a comprehensive PubMed/Medline search covering January, 1994 through September, 2008. The expanded database included 4 isoflavones, coumestrol and 4 lignans. The new database estimated isoflavone content of 105 food items (76.6%) versus 14 (10.2%) in the 1994 version and computed coumestrol content of 52 food items (38.0%), compared to 1 (0.7%) in the original version. Newly added were lignans; values for 104 FFQ food items (75.9%) were calculated. In addition, we report here the phytonutrient intakes for each racial and language group in the SWAN sample and present major food sources from which the phytonutrients came. This enhanced ascertainment of phytoestrogens will permit improved studies of their health effects.
To determine socioeconomic status (SES) and race differences in levels of bone turnover.
Using data from the Biomarker Substudy of the Midlife in the U.S. (MIDUS) study (491 men, 449 women), we examined cross-sectional associations of SES and race with serum levels of bone turnover markers (bone-specific alkaline phosphatase [BSAP], procollagen type I N-terminal propeptide [PINP], and N-telopeptide [Ntx]) separately in men and women. Linear multivariable regression was used to control for body weight, menopausal transition stage, and age.
Among men, low family poverty-to-income ratio (FPIR) was associated with higher turnover, but neither education nor race was associated with turnover. Men with FPIR <3 had 1.808 nM BCE higher Ntx (P = 0.05), 3.366 U/L higher BSAP (P = 0.02), and 7.066 higher PINP (P = 0.02). Among women, neither education nor FPIR was associated with bone turnover, but Black women had 3.688 nM BCE higher Ntx (P = 0.001), 5.267 U/L higher BSAP (P=0.005), and 11.906 μg/L higher PINP (P=0.008) compared to non-Black women.
Economic adversity was associated with higher bone turnover in men, and minority race status was associated with higher bone turnover in women, consistent with the hypothesis that higher levels of social stresses cause increased bone turnover. The magnitude of these associations was comparable to the effects of some osteoporosis medications on levels of turnover.
bone turnover; bone resorption; socioeconomic status; SES; N-telopeptide; bone-specific alkaline phosphatase; procollagen type I N-terminal propeptide; poverty; income; Ntx; PINP; BSAP
The metabolic syndrome (MetS) is associated with an increase in breast cancer risk. In this study, we evaluated whether the MetS was associated with an increase in percent mammographic density (MD), a breast cancer risk factor. We used linear regression and mixed models to examine the cross-sectional and longitudinal associations of the MetS and components of the MetS to percent MD in 790 pre- and early perimenopausal women enrolled in the Study of Women’s Health Across the Nation (SWAN). In cross-sectional analyses adjusted for body mass index (BMI), modest inverse associations were observed between percent MD and the MetS (β = −2.5, SE = 1.9, p = 0.19), abdominal adiposity (β = −4.8, SE = 1.9, p = 0.01) and raised glucose (β = −3.7, SE = 2.4, p = 0.12). In longitudinal models adjusted for covariates including age and BMI, abdominal adiposity (β = 0.34, SE = 0.17, p = 0.05) was significantly positively associated with slower annual decline in percent MD with time. In conclusion, our results do not support the hypothesis that the MetS increases breast cancer risk via a mechanism reflected by an increase in percent MD.
adiposity; body mass index; breast cancer risk factor; mammographic density; metabolic syndrome
To evaluate whether the menopausal transition is associated with worsening of urinary incontinence symptoms over 6 years in mid-life women.
We analyzed data from 2415 women who reported monthly or more incontinence in self-administered questionnaires at baseline and during the first 6 annual follow-up visits (1995–2002) of the prospective cohort Study of Women’s Health Across the Nation. We defined worsening as a reported increase and improving as a reported decrease in frequency of incontinence between annual visits. We classified the menopausal status of women not taking hormone therapy annually from reported menstrual bleeding patterns and hormone therapy use by interviewer questionnaire. We used Generalized Estimating Equations (GEE) methodology to evaluate factors associated with improving and worsening incontinence from year to year.
Over 6 years, 14.7% of incontinent women reported worsening, 32.4% reported improvement, and 52.9% reported no change in the frequency of incontinence symptoms. Compared with pre-menopause, peri- and post menopause were not associated with worsening incontinence; for example, early peri-menopause was associated with improvement (OR 1.19; 95% CI 1.06, 1.35) and post-menopause reduced odds of worsening (OR 0.80; 95% CI 0.66, 0.95). Meanwhile, each pound of weight gain increased odds of worsening (OR 1.04; 95% CI 1.03, 1.05) and reduced odds of improving (OR 0.97; 95% CI 0.96, 0.98) incontinence.
In mid-life incontinent women, worsening of incontinence symptoms was not attributable to the menopausal transition. Modifiable factors such as weight gain account for worsening of incontinence during this life stage.
The objective of this study was to describe: the time of onset and offset of bone mineral density (BMD) loss relative to the date of the final menstrual period (FMP); the rate and amount of BMD decline during the 5 years before and the 5 years after the FMP; and the independent associations between age at final menstrual period (FMP), body mass index (BMI) and race/ethnicity with rates of BMD loss during this time interval. The sample included 242 African-American, 384 Caucasian, 117 Chinese and 119 Japanese women, pre- or early perimenopausal at baseline, who had experienced their FMP and for whom an FMP date could be determined. Loess-smoothed curves showed that BMD loss began 1 year before the FMP and decelerated (but did not cease) 2 years after the FMP, at both the lumbar spine (LS) and femoral neck (FN) sites. Piece-wise, linear, mixed effects regression models demonstrated that during the 10-year observation period, at each bone site, the rates and cumulative amounts of bone loss were greatest from 1 year before through 2 years after the FMP, termed the transmenopause. Postmenopausal loss rates, those occurring between 2 and 5 years after the FMP, were less than those observed during transmenopause. Cumulative, 10-year LS BMD loss was 10.6%; 7.38% was lost during the transmenopause. Cumulative FN loss was 9.1%; 5.8% was lost during the transmenopause. Greater BMI and African American heritage were related to slower loss rates, while the opposite was true of Japanese and Chinese ancestry.
Menopause; perimenopause; bone mineral density; ethnic differences; longitudinal cohort
The number of older adults participating in yoga has increased dramatically in recent years; yet, the physical demands associated with yoga performance have not been reported. The primary aim of the Yoga Empowers Seniors Study (YESS) was to use biomechanical methods to quantify the physical demands associated with the performance of 7 commonly-practiced standing yoga poses in older adults.
20 ambulatory older adults (70.7 + − 3.8 yrs) attended 2 weekly 60-minute Hatha yoga classes for 32 weeks. The lower-extremity net joint moments of force (JMOFs), were obtained during the performance of the following poses: Chair, Wall Plank, Tree, Warrior II, Side Stretch, Crescent, and One-Legged Balance. Repeated-measure ANOVA and Tukey’s post-hoc tests were used to identify differences in JMOFs among the poses. Electromyographic analysis was used to support the JMOF findings.
There was a significant main effect for pose, at the ankle, knee and hip, in the frontal and sagittal planes (p = 0.00 – 0.03). The Crescent, Chair, Warrior II, and One-legged Balance poses generated the greatest average support moments. Side Stretch generated the greatest average hip extensor and knee flexor JMOFs. Crescent placed the highest demands on the hip flexors and knee extensors. All of the poses produced ankle plantar-flexor JMOFs. In the frontal plane, the Tree generated the greatest average hip and knee abductor JMOFs; whereas Warrior II generated the greatest average hip and knee adductor JMOFs. Warrior II and One-legged Balance induced the largest average ankle evertor and invertor JMOFs, respectively. The electromyographic findings were consistent with the JMOF results.
Musculoskeletal demand varied significantly across the different poses. These findings may be used to guide the design of evidence-based yoga interventions that address individual-specific training and rehabilitation goals in seniors.
Clinical trial registration
This study is registered with NIH Clinicaltrials.gov #NCT 01411059
Intervention; Lower-extremity; Biomechanics; Moment; EMG; Older adult
We evaluated the relationship between annually measured serum endogenous estradiol and the development or worsening of stress and urge incontinence symptoms over 8 years in women transitioning through menopause.
This is a longitudinal analysis of women with incontinence in the Study of Women’s Health Across the Nation (SWAN), a multi-center, multi-racial/ethnic prospective cohort study of community-dwelling women transitioning through menopause. At baseline and each of 8 annual visits, SWAN elicited frequency and type of incontinence in a self-administered questionnaire and drew a blood sample on days 2-5 of the menstrual cycle. All endocrine assays were performed using a double-antibody chemiluminescent immunoassay. We analyzed data using discrete Cox survival models and generalized estimating equations with time dependent covariates.
Estradiol levels drawn at either the annual visit concurrent with or previous to the first report of incontinence were not associated with the development of any (hazard ratio (HR) = 0.99, 95% CI 0.99, 1.01), stress, or urge incontinence in previously continent women. Similarly, estradiol levels were not associated with worsening of any (odds ratio (OR) = 1.00, 95% CI 0.99, 1.01), stress, or urge incontinence in incontinent women. Change in estradiol levels from one year to the next was also not associated with the development (HR = 0.98, 95% confidence interval 0.97, 1.00) or worsening (OR = 1.03, 95% CI 0.99, 1.05) of incontinence.
We found that annually measured values and year-to-year changes in endogenous estradiol levels had no effect on the development or worsening of incontinence in women transitioning through menopause.
Urinary incontinence; Estradiol; Reproductive hormones; Menopause transition; Epidemiology; Prospective cohort study
To investigate the relationships among hip joint moments produced during functional activities and hip bone mass in sedentary older adults.
Eight male and eight female older adults (70–85 yr) performed functional activities including walking, chair sit–stand–sit, and stair stepping at a self-selected pace while instrumented for biomechanical analysis. Bone mass at proximal femur, femoral neck, and greater trochanter were measured by dual-energy X-ray absorptiometry. Three-dimensional hip moments were obtained using a six-camera motion analysis system, force platforms, and inverse dynamics techniques. Pearson’s correlation coefficients were employed to assess the relationships among hip bone mass, height, weight, age, and joint moments. Stepwise regression analyses were performed to determine the factors that significantly predicted bone mass using all significant variables identified in the correlation analysis.
Hip bone mass was not significantly correlated with moments during activities in men. Conversely, in women bone mass at all sites were significantly correlated with weight, moments generated with stepping, and moments generated with walking (p < 0.05 to p < 0.001). Regression analysis results further indicated that the overall moments during stepping independently predicted up to 93% of the variability in bone mass at femoral neck and proximal femur; whereas weight independently predicted up to 92% of the variability in bone mass at greater trochanter.
Submaximal loading events produced during functional activities were highly correlated with hip bone mass in sedentary older women, but not men. The findings may ultimately be used to modify exercise prescription for the preservation of bone mass.
Bone mineral density; Functional activity; Hip; Joint moment; Submaximal loads
Squatting activities may be used, within exercise programs, to preserve physical function in older adults. This study characterized the lower-extremity peak joint angles, peak moments, powers, work, impulse, and muscle recruitment patterns (electromyographic; EMG) associated with two types of squatting activities in elders.
Twenty-two healthy, older adults (ages 70–85) performed three trials each of: 1) a squat to a self-selected depth (normal squat; SQ) and 2) a squat onto a chair with a standardized height of 43.8 cm (chair squat; CSQ). Descending and ascending phase joint kinematics and kinetics were obtained using a motion analysis system and inverse dynamics techniques. Results were averaged across the three trials. A 2 × 2 (activity × phase) ANOVA with repeated measures was used to examine the biomechanical differences among the two activities and phases. EMG temporal characteristics were qualitatively examined.
CSQ generated greater hip flexion angles, peak moments, power, and work, whereas SQ generated greater knee and ankle flexion angles, peak moments, power, and work. SQ generated a greater knee extensor impulse, a greater plantar flexor impulse and a greater total support impulse. The EMG temporal patterns were consistent with the kinetic data.
The results suggest that, with older adults, CSQ places greater demand on the hip extensors, whereas SQ places greater demand on the knee extensors and ankle plantar flexors. Clinicians may use these discriminate findings to more effectively target specific lower-extremity muscle groups when prescribing exercise for older adults.
AGING; BIOMECHANICS; JOINT MOMENT; JOINT POWER; EMG; CHAIR SQUAT; BOX SQUAT
The purpose of this study was to characterize the mechanical demands of the lower-extremity musculature during the standing forward lunge (FL) and the standing lateral lunge (LL) exercises performed by older adults. Twenty healthy older adults (9 men, 11 women, mean age 75.0 ± 4.4 years) performed FL and LL while instrumented for biomechanical analysis. Low-er-extremity net joint moments, powers, impulse, and mechanical energy expenditure were determined using standard inverse dynamics techniques. The FL preferentially targeted the hip extensors, producing a greater flexion angle (12.8%), peak joint moment (13.6%), joint power (56.5%), and mechanical energy expenditure (25.1%). Conversely, LL targeted the ankle plantar flexors, producing greater dorsiflexion angles (19.3%), joint moments (40.9%), impulse (87.0%), and mechanical energy expenditure (61.1%). Kinetic differences at the knee were less consistent. Fitness professionals may use this information to better match the biomechanical attributes of FL and LL activities with the needs of the trainee.
strength training; functional exercise; mechanical energy expenditure; impulse
To characterize the lower-extremity biomechanics associated with stepping activities in older adults.
Repeated-measures comparison of kinematics and kinetics associated with forward step-up and lateral step-up activities.
Biomechanical analysis may be used to assess the effectiveness of various ‘in-home activities’ in targeting appropriate muscle groups and preserving functional strength and power in elders.
Data were analyzed from 21 participants (mean 74.7 yr (standard deviation, 4.4 yr)) who performed the forward and lateral step-up activities while instrumented for biomechanical analysis. Motion analysis equipment, inverse dynamics equations, and repeated measures anovas were used to contrast the maximum joint angles, peak net joint moments, angular impulse, work, and power associated with the activities.
The lateral step-up resulted in greater maximum knee flexion (P < 0.001) and ankle dorsiflexion angles (P < 0.01). Peak joint moments were similar between exercises. The forward step-up generated greater peak hip power (P < 0.05) and total work (P < 0.001); whereas, the lateral step-up generated greater impulse (P < 0.05), work (P < 0.01), and power (P < 0.05) at the knee and ankle.
In older adults, the forward step-up places greater demand on the hip extensors, while lateral step-up places greater demand on the knee extensors and ankle plantar flexors.
Resistance exercise; Kinetics; Kinematics; Older adults
Perimenopause; menopause; estrogen; follicle stimulating hormone; cognitive function; cardiovascular risk factors; ovariectomy; cognitive function
Yoga is considered especially suitable for seniors because poses can be modified to accommodate practitioners' capabilities and limitations. In this study, biomechanical assessments on healthy seniors (n = 20; 70.1 ± 3.8 yr) were used to quantify the physical demands, (net joint moments of force [JMOFs] and muscular activation in the lower extremities) associated with the performance of 3 variations (introductory, intermediate, advanced) of 2 classical Hatha yoga poses – Tree and One-Leg Balance (OLB). ANOVA and Cohen's-d were used to contrast the postural variations statistically. The advanced (single-limb, without additional support) versions were hypothesized to generate the greatest demands, followed by the intermediate (single-limb [Tree] and bilateral-limb [OLB] with support) and introductory (bilateral-limb) versions. Our findings, however, suggest that common, long-held conceptions about pose modifications can be counter-intuitive. There was no difference between the intermediate and advanced Tree variations regarding hip and knee JMOFs in both the sagittal
and frontal planes (P = 0.13–0.98). Similarly, OLB introductory and intermediate variations induced sagittal JMOFs that were in the opposite direction of the classic advanced pose version at the hip and knee (P < .001; d = 0.98–2.36). These biomechanical insights provide evidence that may be used by instructors, clinicians and therapists when selecting pose modifications for their yoga participants.
A rise in circulating dehydroepiandrosterone sulfate (DHEAS) concentration occurs during the menopausal transition (MT) that is ovarian-stage but not age-related. The objective of this study was to determine the source of the rise in circulating DHEAS.
Circulating DS concentrations in women that had undergone bilateral salpingo-oophorectomy (BSO) were compared to the pattern of circulating DHEAS in women that progressed through the MT naturally. Annual serum samples from the Study of Women's Health Across the Nation (SWAN) over a ten year study period were used. From1272 women in the SWAN cohort that were eligible for longitudinal evaluation of DHEAS annual samples, eighty one underwent BSO during the pre- or early-perimenopause stage of the menopausal transition and were potentially available for study. Of these eighty one BSO participants, twenty had sufficient annual samples for evaluation of the post-BSO trajectory of circulating DHEAS. SWAN women not having previous hormone replacement therapy those with intact ovaries were compared to women that underwent a BSO immediately after a pre- or early perimenopausal annual visit. There were no intervention and circulating concentrations of DHEAS was the main outcome.
A detectable rise in DHEAS was observed in fourteen (70%) of the twenty BSO women which is similar to the proportion (85%) of women with intact ovaries that had a detectable DHEAS rise. The mean rise in DHEAS (5-8%) was similar in both BSO and non-BSO women.
The MT rise in DHEAS (5-8%) occurring in the absence of ovaries is largely of adrenal origin.
Dehydroepiandrosterone sulfate; menopause; adrenal; ovary
The purpose of this study was to determine the longitudinal association between menopausal vasomotor symptoms (VMS) and urinary N-telopeptide level (NTX) according to menopausal stage. We analyzed data from 2283 participants of the Study of Women's Health Across the Nation, a longitudinal community-based cohort study of women aged 42 to 52 years at baseline. At baseline and annually through follow-up visit 8, participants provided questionnaire data, urine samples, serum samples, and anthropometric measurements. Using multivariable repeated-measures mixed models, we examined associations between annually assessed VMS frequency and annual NTX measurements. Our results show that mean adjusted NTX was 1.94 nM of bone collagen equivalents (BCE)/mM of creatinine higher among early perimenopausal women with any VMS than among early perimenopausal women with no VMS (p < .0001). Mean adjusted NTX was 2.44 nM BCE/mM of creatinine higher among late perimenopausal women with any VMS than among late perimenopausal women with no VMS (p = .03). Among premenopausal women, VMS frequency was not significantly associated with NTX level. When NTX values among women with frequent VMS (≥6 days in past 2 weeks) were expressed as percentages of NTX values among women without frequent VMS, the differences were 3% for premenopausal women, 9% for early perimenopausal women, 7% for late perimenopausal women, and 4% for postmenopausal women. Adjustment for serum follicle-stimulating hormone (FSH) level greatly reduced the magnitudes of associations between VMS and NTX level. We conclude that among early perimenopausal and late perimenopausal women, those with VMS had higher bone turnover than those without VMS. Prior to the final menstrual period, VMS may be a marker for risk of adverse bone health. © 2011 American Society for Bone and Mineral Research.
HOT FLASHES; VASOMOTOR SYMPTOMS; BONE TURNOVER; URINARY N-TELOPEPTIDE; NTX
This NIA-sponsored workshop was aimed at understanding the impact of the menopausal transition on mood symptoms and cognitive disorders during the menopausal transition and identifying research priorities for further investigation. Longitudinal studies provide insights into the frequency of these problems in representative samples of midlife women. The majority of women do not experience serious depressive symptoms during the transition, but a subgroup of women is at increased risk. Slight changes in memory function and processing speed are evident during the transition, and physiological factors associated with hot flashes may contribute to memory problems. Clinical trial evidence indicates that estradiol therapy can be effective in treating perimenopausal depression. There is some limited evidence of a cognitive benefit with estrogen alone therapy in younger postmenopausal women, and stronger evidence that certain forms of combination hormone therapy produce modest deficits in verbal memory in younger and older women. Identifying a cognitively neutral or beneficial combination therapy for the treatment of menopausal symptoms in naturally menopausal women is an important goal for future research. Pharmacological challenge studies bridge the basic science and clinical literatures to provide insights into the extent to which changes in endogenous and exogenous hormones and other neurotransmitter systems contribute to cognitive and mood problems. Routine evaluation of depressive symptoms in perimenopausal women is warranted by the literature. Quick and valid screening tools for assessing depression in the clinic are available on-line and free of charge.
Menopause; Cognition; Mood; Perimenopause; Depression
To estimate whether menopause transition stage is independently associated with the development of incontinence symptoms.
We conducted a longitudinal analysis, using discrete proportional hazards models, of women who were continent at baseline in the Study of Women’s Health Across the Nation (SWAN), a multi-center, multi-racial/ethnic prospective cohort study of community-dwelling mid-life women transitioning through menopause. At baseline and each of the 6 annual visits, SWAN elicited frequency and type of incontinence in a self-administered questionnaire and classified menopausal stage from menstrual bleeding patterns.
Compared to being in premenopause, being in the early peri-menopause (incidence 17.8 per 100 woman years) made it 1.34 times and being in the late peri-menopause (incidence 14.5 per 100 woman years) made it 1.52 times more likely for women to develop monthly or more frequent incontinence. In contrast, women in postmenopause (incidence 8.2 per 100 woman years) were approximately half as likely to develop this degree of incontinence. This pattern of association across the menopausal transition was similar for stress and urge incontinence. However, menopausal stage was not associated with developing more frequent incontinence (leaking several times per week or more). Worsening anxiety symptoms, a high baseline BMI, weight gain and new onset diabetes were associated with developing more frequent incontinence.
Menopausal transition stage was associated with developing monthly or more frequent but not weekly or more frequent incontinence, suggesting that only infrequent incontinence symptoms were attributable to the peri-menopause. Since modifiable factors such as anxiety, weight gain, and diabetes were associated with developing more frequent incontinence, determining whether healthy life changes and treating medical problems can prevent incontinence is a priority.
A long-standing, but unproven hypothesis is that menopause symptoms cause cognitive difficulties during the menopause transition. This 6-year longitudinal cohort study of 1,903 midlife US women (2000–2006) asked whether symptoms negatively affect cognitive performance during the menopause transition and whether they are responsible for the negative effect of perimenopause on cognitive processing speed. Major exposures were depressive, anxiety, sleep disturbance, and vasomotor symptoms and menopause transition stages. Outcomes were longitudinal performance in 3 domains: processing speed (Symbol Digit Modalities Test (SDMT)), verbal memory (East Boston Memory Test), and working memory (Digit Span Backward). Adjustment for demographics showed that women with concurrent depressive symptoms scored 1 point lower on the SDMT (P < 0.05). On the East Boston Memory Test, the rate of learning among women with anxiety symptoms tested previously was 0.09 smaller per occasion (P = 0.03), 53% of the mean learning rate. The SDMT learning rate was 1.00 point smaller during late perimenopause than during premenopause (P = 0.04); further adjustment for symptoms did not attenuate this negative effect. Depressive and anxiety symptoms had a small, negative effect on processing speed. The authors found that depressive, anxiety, sleep disturbance, and vasomotor symptoms did not account for the transient decrement in SDMT learning observed during late perimenopause.
cohort studies; longitudinal studies; memory; menopause
To study the determinants of breast discomfort among postmenopausal women initiating menopausal hormone therapy (HT).
We analyzed questionnaire, anthropometric, and serum estrone data from the Postmenopausal Estrogen/Progestin Interventions Trial (PEPI), a randomized trial comparing placebo, conjugated equine estrogen (CEE) alone, or CEE with a progestogen (continuous or cyclical medroxyprogesterone acetate or cyclical micronized progesterone) among postmenopausal women. HT users could join PEPI after stopping HT for 2 months. We modeled the relation between smoking, body weight, alcohol consumption, age, quitting HT to join PEPI, physical activity and alpha-tocopherol consumption and new-onset breast discomfort at 12-month follow-up among 662 participants without baseline breast discomfort.
The associations of new-onset breast discomfort with weight and with strenuous exercise varied by treatment assignment. Among women assigned to CEE + progestogen, strenuous exercise was associated with a 49% lower odds of new-onset breast discomfort (OR 0.51, 95% CI 0.29–0.89, P = 0.02), whereas among women assigned to placebo or CEE alone, strenuous exercise was not significantly associated with new-onset breast discomfort. Surprisingly, among women taking CEE alone, each kilogram higher weight was associated with 6% lower odds of new-onset breast discomfort (P=0.04), whereas among women taking placebo, the association was in the opposite direction (P=0.04). Adjustment for estrone level had neglible effects on odds ratios. Alpha-tocopherol intake, age, smoking, and alcohol intake were not significantly associated with new-onset breast discomfort in adjusted analyses.
Strenuous exercise and higher body weight may decrease the odds of new-onset breast discomfort among postmenopausal women initiating HT.
mastodynia; mastalgia; menopausal hormone therapy; estrogen therapy; breast pain
One potential mechanism by which physical activity may protect against breast cancer is by decreasing mammographic density. Percent mammographic density, the proportion of dense breast tissue area to total breast area, declines with age and is a strong risk factor for breast cancer. The authors hypothesized that women who were more physically active would have a greater decline in percent mammographic density with age, compared with less physically active women. The authors tested this hypothesis using longitudinal data (1996–2004) from 722 participants in the Study of Women's Health Across the Nation (SWAN), a multiethnic cohort of women who were pre- and early perimenopausal at baseline, with multivariable, repeated-measures linear regression analyses. During an average of 5.6 years, the mean annual decline in percent mammographic density was 1.1% (standard deviation = 0.1). A 1-unit increase in total physical activity score was associated with a weaker annual decline in percent mammographic density by 0.09% (standard error = 0.03; P = 0.01). Physical activity was inversely associated with the change in nondense breast area (P < 0.01) and not associated with the change in dense breast area (P = 0.17). Study results do not support the hypothesis that physical activity reduces breast cancer through a mechanism that includes reduced mammographic density.
breast neoplasms; exercise; longitudinal studies; mammography; physical fitness; risk factors
Studies have reported declines with age in cognitive or physical functioning, but rarely identify whether these are parallel or linked events in the same study. Furthermore, most research in this area has focused on persons in late life rather than midlife. Objective: The objective of the study was to determine (1) if cognitive functioning was related to physical functioning and whether this relationship persisted after adjustment for age, menopause status, metabolic status, depression and socioeconomic resources, and (2) if changes in physical functioning were associated with changes in cognitive functioning over a 4-year follow-up period.
Data were from the Study of Women's Health Across the Nation (SWAN), a multi-site, longitudinal study of women aged 46–56 years at follow-up examination 4. Three follow-up examinations (study years 04, 06 and 08) included measures of physical functioning perception (MOS SF-36) and cognitive functioning [Symbol Digit Modality Test (SDMT), Digit Span Backward Test (DSBT), and East Boston Memory Test (EBMT)] (n = 2,405).
Women with lower cognitive functioning scores also had lower perceived physical functioning scores. While adjustment for covariates attenuated the association between perceived physical functioning and both the SDMT and EBMT cognitive measures, these associations remained statistically significant. Additionally, the 4-year change in perceived physical functioning was significantly associated with the 4-year change in the EBMT.
At midlife, there were associated declines in cognitive and perceived physical functioning scores, commencing at midlife in women.
Physical functioning; Cognitive functioning; Menopause; Metabolic syndrome; MOS SF-36