Age at menarche and risk of vasomotor menopausal symptoms: a pooled analysis of six studies.

OBJECTIVE: To examine the association between age at menarche and risk of vasomotor menopausal symptoms (VMS) and whether midlife body mass index (BMI) modified the association. DESIGN: A pooled analysis of six cohort studies. SETTING: The International collaboration on the Life course Approach to reproductive health and Chronic disease Events (InterLACE). POPULATION: 18 555 women from the UK, USA and Australia. METHODS: VMS frequency data (never, rarely, sometimes and often) were harmonised from two studies (n = 13 602); severity data (never, mild, moderate and severe) from the other four studies (n = 4953). Multinominal logistic regression models were used to estimate relative risk ratios (RRRs) and 95% CIs adjusted for confounders and incorporated study as random effects. MAIN OUTCOME MEASURES: Hot flushes and night sweats. RESULTS: Frequency data showed that early menarche ≤11 years was associated with an increased risk of 'often' hot flushes (RRR 1.48, 95% CI 1.24-1.76) and night sweats (RRR 1.59, 95% CI 1.49-1.70) compared with menarche at ≥14 years. Severity data showed similar results, but appeared less conclusive, with RRRs of 1.16 (95% CI 0.94-1.42) and 1.27 (95% CI 1.01-1.58) for 'severe' hot flushes and night sweats, respectively. BMI significantly modified the association as the risk associated with early menarche and 'often' VMS was stronger among women who were overweight or obese than those of normal weight, while this gradient across BMI categories was not as strong with the risk of 'severe' VMS. CONCLUSIONS: Early age at menarche is a risk factor for VMS, particularly for frequent VMS, but midlife BMI may play an important role in modifying this risk. TWEETABLE ABSTRACT: Overweight and obesity exacerbate the risk of vasomotor symptoms associated with early menarche.

Hot flush severity during the menopausal transition and early postmenopause: beyond hormones.

BACKGROUND: Understanding factors promoting symptom severity is essential to developing innovative symptom management models. AIM: To investigate hot flush severity during the menopausal transition (MT) and early postmenopause and effects of age, MT stages, age of onset of late stage and final menstrual period (FMP), estrogen, follicle stimulating hormone (FSH), cortisol, anxiety, perceived stress, body mass index, smoking, alcohol use and exercise. METHODS: A subset of participants in the Seattle Midlife Women's Health Study (n = 291 with up to 6973 observations) provided data during the late reproductive, early and late MT stages and early postmenopause, including menstrual calendars, annual health questionnaires, and symptom diaries and urine specimens assayed for hormones several times per year. Multilevel modeling with an R program was used to test models accounting for hot flush severity. RESULTS: Hot flush severity persisted through the MT stages and peaked during the late MT stage, diminishing after the second year postmenopause. In individual analyses, hot flush severity was associated with being older, being in the late MT stage or early postmenopause, beginning the late MT stage at a younger age and reporting greater anxiety. In a model including only endocrine factors, hot flush severity was significantly associated with higher FSH and lower estrone levels. An integrated model revealed dominant effects of late MT stage and early postmenopause, with anxiety contributing to hot flush severity. CONCLUSIONS AND IMPLICATIONS: Hot flush severity was affected largely by reproductive aging and anxiety, suggesting symptom management models that modulate anxiety and enhance women's experience of the menopausal transition and early postmenopause.

Effects of herbal preparations on symptom clusters during the menopausal transition.

AIMS: To determine the effects of herbal therapies on hot flushes and at least one other symptom including, sleep, mood, cognition, and pain that women experience during the menopausal transition and early postmenopause. METHODS: An extensive search of PubMed/Medline, CINAHL Plus, PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, AMED, and Alt-Health Watch for randomized, controlled trials reported in English between January 2004 and July was conducted by an experienced reference librarian. There were 1193 abstracts identified but only 58 trials examined effectiveness of therapies for hot flushes and at least one additional co-occurring symptom. RESULTS: Seventeen studies used herbal preparation including seven studies of black cohosh, two studies of black cohosh mixed with other herbals, and eight studies of other herbals. Of these, one study of black cohosh, two studies of black cohosh mixed with other herbals, and four other herbal studies had significant effects on hot flushes and at least one additional co-occurring symptom. The adverse events of herbal therapies were various, ranging from mild to moderate and women were generally tolerant of the preparations. CONCLUSIONS: Black cohosh mixed with other herbals, Rheum rhaponticum, and French maritime pine bark had significant effects on hot flushes and at least one other symptom. These herbal therapies may be a promising alternative treatment to hormonal treatment. Future studies should classify women based on their menopausal stages, report each symptom separately, have adequate sample size, focus on multiple co-occurring symptoms, and target symptom management of menopausal symptoms.

Effects of traditional Chinese medicine on symptom clusters during the menopausal transition.

AIMS: To review controlled clinical trials of traditional Chinese medicine (TCM) therapies for hot flushes and at least one other co-occurring symptom among sleep, cognitive function, mood, and pain. METHODS: An experienced reference librarian performed an extensive search of PubMed/Medline, CINAHL Plus, PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, AMED, and Alt-Health Watch for randomized, controlled trials reported in English between 2004 and July 2011. Of 1193 abstracts identified, 58 trials examined effectiveness of therapies for hot flushes and at least one additional co-occurring symptom. RESULTS: Eleven trials (13 publications) examined TCM therapeutics of acupuncture, Chinese herbal medicine (CHM) or moxibustion. Acupuncture trials (eight) yielded mixed results; five trials significantly reduced hot flushes. Of those five trials, one also showed benefit for sleep and pain and two trials found benefit for mood symptoms. Of three CHM trials, three trials had significant findings: one for hot flushes and mood, one for hot flushes and pain, and one for hot flushes, sleep, mood symptoms and pain. Moxibustion and counseling (one trial) significantly reduced hot flushes, mood symptoms and pain. None of the trials reported any serious adverse events. CONCLUSIONS: TCM therapeutics of acupuncture, CHM and moxibustion show promising results for the treatment of mood and pain symptoms co-occurring with hot flushes. Although the controlled clinical trials of TCM therapeutics reviewed here measured multiple symptom outcomes, few report treatment effects in ways that allow clinicians to consider symptom clusters when prescribing therapies. Future studies need to measure and report results for individual symptoms or group like symptoms together into subscales. Controlled clinical trials with larger numbers of participants are essential to allow evaluation of these therapies on hot flushes and multiple co-occurring symptoms.

Effects of mind-body therapies on symptom clusters during the menopausal transition.

AIMS: Although most women experience symptom clusters during the menopausal transition and early postmenopause, investigators reporting clinical trial effects for hot flushes often omit co-occurring symptoms. Our aim was to review controlled clinical trials of mind-body therapies for hot flushes and at least one other co-occurring symptom from these groups: sleep, cognitive function, mood, and pain. METHODS: An experienced reference librarian performed an extensive search of PubMed/Medline, CINAHL Plus, PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, AMED, and Alt-Health Watch for randomized controlled trials reported in English between 2004 and July 2011. Of 1193 abstracts identified, 58 trials examining effectiveness of therapies for hot flushes and at least one additional co-occurring symptom of interest were identified. RESULTS: Eight trials (ten publications) examined relaxation, yoga, or exercise. Physical activity/exercise trials (six) yielded mixed results; only one significantly reduced hot flushes and mood symptoms. Of two relaxation therapy trials, only mindfulness-based stress reduction training reduced sleep and mood symptoms and had within-group treatment effects on hot flushes. Yoga (one trial) significantly reduced hot flushes and improved cognitive symptoms more than exercise, and also had within-group effects on sleep and pain symptoms. CONCLUSIONS: Studies of mind-body therapies for hot flushes increasingly measure multiple symptom outcomes, but few report treatment effects in ways that allow clinicians to consider symptom clusters when prescribing therapies. Future studies need to measure and report results for individual symptoms or group like symptoms together into subscales rather than use subscales with mixed dimensions. Trials with larger numbers of participants are essential to allow evaluation of these therapies on multiple co-occurring symptoms.

Correlates of urinary incontinence during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study.

BACKGROUND: Urinary incontinence (UI) becomes more prevalent as women age, but little is known about UI in midlife, including stress incontinence (SUI) and urge incontinence (UUI) and their relationship to reproductive aging, reproductive history, health-related factors, and personal and social factors associated with midlife. OBJECTIVES: To determine the influence of age and reproductive aging factors (menopausal transition stages, follicle stimulating hormone (FSH), estrone glucoronide), reproductive history (number of live births), health-related factors (perceived health, body mass index (BMI), exercise, diabetes) and personal and social factors (race/ethnicity, education) on the experience of UI among midlife women during the menopausal transition and early postmenopause. METHODS: A subset of the Seattle Midlife Women's Health Study participants (n = 298 with up to 2249 observations) provided data during the late reproductive, early and late menopausal transition stages and early postmenopause, including menstrual calendars, annual health questionnaire and provided health diaries since 1990. Generalized estimating equation analysis was used to test models accounting for SUI and UUI that included age as a measure of time with predictors. RESULTS: Stress urinary incontinence was associated significantly with individual predictors of: worse perceived health (odds ratio (OR) 0.89, p = 0.025), history of ≥ three live births (OR 3.00, p = 0.002), being in the early menopausal transition stage (OR 1.53, p = 0.06), having less formal education (OR 0.33, p = 0.02), and being White/not Black (OR 0.32, p = 0.04). The most parsimonious model for SUI included: worse perceived health, ≥ three live births, and being White. Urge incontinence was associated significantly with individual predictors of: increasing age (OR 1.06, p = 0.001), worse perceived health (OR 0.78, p < 0.001), BMI ≥ 30 kg/m(2) (OR 2.96, p = 0.001), history of ≥ three live births (OR 2.81, p = 0.01), and lower FSH levels (OR 0.59, p = 0.08). The most parsimonious model for UUI included: being older, having worse perceived health, and having a high BMI. CONCLUSIONS: SUI risk was a function of reproductive history, poor health, and being White. UUI risk was a function of aging, having worse health, and higher BMI. Further exploration of UI during the menopausal transition is needed to articulate a lifespan view of UI and its typology.

Identifying symptom clusters during the menopausal transition: observations from the Seattle Midlife Women's Health Study.

OBJECTIVES: First, to explore the variability in how symptoms clustered together over the late reproductive stage, early and late menopausal transition (MT) stages, and early postmenopause; second, to determine whether the symptom factor structure of the preceding MT stage would predict the symptom factor structure of the MT stage immediately following. METHODS: The sample consisted of a subset of Seattle Midlife Women's Health Study participants who were in late reproductive or early or late menopausal transition stages or early postmenopause and provided self-reported data on symptoms experienced between 1990 and 2005. Principal components analysis was used to determine how symptoms clustered together across the stages. Variables predicting the symptom factor structure were analyzed by multiple regression. RESULTS: Principal components analysis with varimax rotation revealed different factor structures for each of the four stages. The three-factor solution in the late reproductive stage explained a total of 54.9% of the variance. The four-factor solutions in the early and late menopausal transition stages and postmenopause explained a total of 56.5%, 59.3%, and 60.7%, respectively. CONCLUSIONS: This analysis revealed similar factor structures across the four stages in that each stage revealed a mood component, a vasomotor component, and a pain component. However, the symptoms differed somewhat in how they grouped from stage to stage. Regression analysis demonstrated that a relationship exists between the symptom factor structures across stages. Controlling for demographic and lifestyle variables, it was revealed that the symptom clusters at the early and late menopausal transition stages and early postmenopause were best predicted by the symptom factor structure of the previous stage.

Clinical features of psoroptic mange in cattle in England and Wales.

The clinical signs, treatments used and spread of psoroptic mange in cattle from October 2007 until March 2011 are described. The disease was first diagnosed in South West Wales, having not been reported in Great Britain since the 1980s. The likely source was identified as a farm that had imported two animals from mainland Europe in the summer of 2006. Since that time, disease has been diagnosed on a further 22 premises, the majority in South West Wales but also in South East and Mid Wales and on one farm in England. Bought in animals harbouring the Psoroptes species mite but not showing clinical signs were considered the greatest risk of introducing the infestation into a herd. This, together with the difficulties of treatment to eliminate the parasite, means that it is unlikely that this outbreak has been controlled. There is also a continuing threat of importing the disease from abroad. The disease is not notifiable in the UK.

Husbandry risk factors associated with subclinical coccidiosis in young cattle.

This paper describes an observational longitudinal study of cattle farms in England and Wales, which aimed to identify management practices associated with the presence of Eimeria spp. infection in young cattle. Thirty cattle farms situated in England and Wales were selected and one group of more than 20 young cattle aged 5-18 months of age was monitored on each farm. Three variables were identified as significantly associated with status in a multivariable model. The odds of finding Eimeria spp. were lower on farms that kept sheep on the same premises as the cattle, as was an increase in the maximum age within the sampled group. The latter probably reflects the development of post-infection immunity within the sampled animals. Good water-trough hygiene protected against Eimeria spp. oocyst excretion, with the odds of detection being higher on farms where it was reported that the water troughs were not cleaned and emptied more than once per month. The value of frequent emptying and cleaning of water troughs in reducing the exposure of calves to Eimeria spp. and thus lowering the impact of coccidiosis, both clinical and subclinical should be communicated to cattle farmers.

Differential contributions of theobromine and caffeine on mood, psychomotor performance and blood pressure.

The combination of theobromine and caffeine, methylxanthines found in chocolate, has previously been shown to improve mood and cognition. However, it is unknown whether these molecules act synergistically. This study tested the hypothesis that a combination of caffeine and theobromine has synergistic effects on cognition, mood and blood pressure in 24 healthy female subjects. The effects of theobromine (700 mg), caffeine (120 mg) or the combination of both, or placebo were tested on mood (the Bond-Lader visual analog scale), psychomotor performance (the Digit Symbol Substitution Test (DSST)) and blood pressure before and at 1, 2 and 3 h after administration. Theobromine alone decreased self-reported calmness 3h after ingestion and lowered blood pressure relative to placebo 1 h after ingestion. Caffeine increased self-reported alertness 1, 2 and 3h after ingestion and contentedness 1 and 2 h after ingestion, and increased blood pressure relative to placebo (at 1 h). The combination of caffeine+theobromine had similar effects as caffeine alone on mood, but with no effect on blood pressure. There was no treatment effect on DSST performance. Together these results suggest that theobromine and caffeine could have differential effects on mood and blood pressure. It was tentatively concluded that caffeine may have more CNS-mediated effects on alertness, while theobromine may be acting primarily via peripheral physiological changes.

Cognitive symptoms during the menopausal transition and early postmenopause.

PURPOSES: To describe changes in levels of cognitive symptoms (forgetting and difficulty concentrating) during the menopausal transition (MT) stages and early postmenopause, including effects of age, MT-related factors(MT stages, estrone, follicle stimulating hormone (FSH), testosterone), symptoms (hot flush, sleep, mood), health-related factors (alcohol use, smoking, exercise, perceived health), stress-related factors (perceived stress, history of sexual abuse, cortisol, catecholamines) and social factors (partner and parenting status, education, employment). METHODS: A subset was studied of Seattle Midlife Women's Health Study participants who provided data during the late reproductive, early and late MT stages or postmenopause (n=292) including menstrual calendars for staging the MT, annual health questionnaires for social factors, morning urine samples assayed for estrone glucuronide (E1G), testosterone, FSH, cortisol and catecholamines and health diaries for rating symptoms several times each year. Multilevel modeling (R program) was used to test patterns of cognitive symptoms related to age, MT-related factors, symptoms, health-related, stress-related and social factors with as many as 6811 observations. RESULTS: As individual covariates and in the multivariate model, age, anxiety, depressed mood, night-time awakening, perceived stress, perceived health, and employment were each significantly related to difficulty concentrating. Hot flushes, amount of exercise and history of sexual abuse had a significant effect as individual covariates but not in the final multivariate model. The best predictors of forgetfulness when analyzed as individual covariates and in the multivariate model were age, hot flushes, anxiety, depressed mood, perceived stress, perceived health and history of sexual abuse. Awakening during the night, although significant as an individual covariate, had no significant effect on forgetfulness in the final multivariate model. CONCLUSIONS: Menopausal transition-related factors were not significantly associated with difficulty concentrating or forgetfulness. Consideration of women's ages and the context in which they experience the menopausal transition may be helpful in understanding women's experiences of cognitive symptoms.

Age dependent incorporation of 14C-DHA into rat brain and body tissues after dosing various 14C-DHA-esters.

INTRODUCTION: The omega-3 fatty acid docosahexaenoic acid (DHA) accounts for 10% of fatty acids in human brain and is critical for neuronal function and brain development. Mechanisms of transport, accumulation and conservation of DHA in the brain are unclear. The objective of the study was to quantify the age dependent DHA incorporation into the brain of 2-, 4- or 10-week-old rats after a bolus dose of different DHA-esters. METHODS: Rats were gavaged with (14)C-DHA-TAG, (14)C-DHA-PL or (14)C-DHA-TAG+PL at 2 mg DHA/kg BW. After 24h the distribution of radioactivity in body and brain regions was determined using quantitative whole body autoradiography (QWBA). Radiolabeled compounds were extracted from the brains to determine the identity of the radiolabeled compounds. RESULTS: Accumulation of orally ingested (14)C-DHA in rat brain was less than 1% of the dose and decreased with age. Ester specific differences were seen only in 10-week-old rats, where oral (14)C-DHA-PL delivered a 2-fold higher accretion of radioactivity in the brain. CONCLUSIONS: Less than 1% of a dietary achievable DHA dose reached the rat brain within 24h. Optimal efficacy of DHA-PL may occur in older age groups.

Pain symptoms during the menopausal transition and early postmenopause.

AIM: The aim of this study was to describe changes in levels of back pain and joint pain during the stages of menopausal transition stages and early postmenopause, including the effects of age, menopausal transition-related factors (estrone, follicle stimulating hormone (FSH), testosterone), menopausal transition stages, symptoms (hot flush, sleep, mood, cognitive), health-related factors (body mass index, alcohol use, smoking, well-being), stress-related factors (perceived stress, history of sexual abuse, cortisol, catecholamines) and social factors (partner and parenting status, education). METHODS: A subset was studied of the participants in the Seattle Midlife Women's Health Study who provided data during the late reproductive, early and late menopausal transition stages or postmenopause (n = 292) including menstrual calendars for staging the menopausal transition, annual health reports completed between 1990 and 2006, and morning urine samples assayed for estrone glucuronide (E(1)G), testosterone, FSH, cortisol and catecholamines, and symptom diary ratings several times each year. Multilevel modeling with an R program was used to test patterns of pain symptoms related to age, menopausal transition-related factors, symptoms, health-related, stress-related and social factors, with as many as 6812 observations. Age was centered at 47.4 years. RESULTS: Women experienced a slight, non-significant rise in back pain with age and a significant increase in back pain during the early (p = 0.003) and late menopausal transition stages (p = 0.002) and early postmenopause (p = 0.02), but urinary E(1)G, FSH and testosterone levels were unrelated. Of the stress-related factors, perceived stress (p = 0.01) and lower overnight urinary cortisol levels were associated with more severe back pain (p = 0.03); history of sexual abuse and catecholamines did not have a significant effect. Those most troubled by symptoms of hot flushes, depressed mood, anxiety, night-time awakening, and difficulty concentrating reported significantly greater back pain (all p < 0.0001). Of the health-related factors, having worse perceived health (p < 0.0001), exercising more (p = 0.005), using analgesics (p < 0.0001), and having a higher body mass index (p < 0.0001) were associated with more back pain, but alcohol use and smoking did not have significant effects. Of the social factors, only having a more formal education (p = 0.004) was associated with less back pain; parenting, having a partner, and employment were not significant. Factors associated with joint pain included age (p < 0.0001), but not menopausal transition-related factors. Symptoms of hot flushes, night-time awakening, depressed mood, and difficulty concentrating were each significantly associated with joint pain (p < 0.0001). Poorer perceived health, more exercise, higher body mass index, and greater analgesic use were all associated similarly with joint pain. History of sexual abuse was the only stress-related factor significantly related to joint pain severity (p = 0.024). IMPLICATIONS: Clinicians working with women traversing the menopausal transition should be aware that managing back and joint pain symptoms among mid-life women requires consideration of their changing biology as well as their ongoing life challenges and health-related behaviors.

Ulcerative vulvitis and balanitis in sheep flocks.

Outbreaks of ulcerative vulvitis and balanitis occurred in three commercial sheep flocks in England and Wales. Between 29 and 44 per cent of the ewes were affected; most of the lesions resolved in three weeks. Pathogens such as mycoplasmas, which have previously been associated with these conditions, were not detected despite using improved laboratory techniques. In one of the flocks, ovine herpesvirus type 2 was detected by pcr in the blood of two acutely affected ewes, from the vulval ulcers of one of them, and from the penis of an affected ram.