Navigating menopause at work: a preliminary study about challenges and support systems.

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.

The mortality toll of estrogen avoidance: an analysis of excess deaths among hysterectomized women aged 50 to 59 years.

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.

Hormone replacement therapy in young women with surgical primary ovarian insufficiency.

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.

Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause.

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.

Decline in physical performance among women with a recent transient ischemic attack or ischemic stroke: opportunities for functional preservation a report of the Women's Estrogen Stroke Trial.

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.

Striatal dopamine transporter availability with [123I]beta-CIT SPECT is unrelated to gender or menstrual cycle.

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.

Sexual dysfunction: treat or refer.

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.

Clinical assessment of function among women with a recent cerebrovascular event: a self-reported versus performance-based measure.

BACKGROUND: Self-reported functional status is a commonly used health measure in clinical settings, yet the optimal approach for assessing function is often debated. OBJECTIVE: To examine the agreement between a self-reported and a performance-based measure of function and the relative ability of each measure to predict long-term health outcomes. DESIGN: Prospective cohort study. SETTING: 20 hospitals in Connecticut and Massachusetts. PARTICIPANTS: 620 postmenopausal women (46 to 91 years of age) who had experienced a stroke or transient ischemic attack. MEASUREMENTS: A self-reported and a performance-based measure of function were assessed at baseline (before intervention) by using the Barthel index and the Physical Performance Test. RESULTS: Disagreement between the self-reported and performance-based measure of function was common (slight disagreement, 55.0%; substantial disagreement, 19.3%). Most women (95.4%) overreported their level of function. Women who were more clinically impaired (risk ratio [RR] for more comorbid conditions, 1.52 [95% CI, 1.17 to 1.97]; RR for recent stroke, 2.33 [CI, 1.45 to 3.73]; and RR for cognitive impairment, 1.76 [CI, 1.34 to 2.32]); who were less educated (RR = 1.30 [CI, 1.02 to 1.67]); and who were of nonwhite ethnicity (RR 1.43 [CI, 1.07 to 1.91]) were more likely to overreport their level of function. An impaired performance-based measure of function predicted subsequent stroke or death (hazard ratio, 1.50, [CI, 1.06 to 2.11]); however, an impaired self-reported measure of function was not likely to predict these outcomes. CONCLUSIONS: Clinicians should be aware that results of self-reported and performance-based measures of function can differ in women who have experienced a recent cerebrovascular event. Although more difficult to collect, results of a performance-based measure may provide information about long-term health outcomes that is not available from a self-reported measure.

Androgen deficiency: menopause and estrogen-related factors.

OBJECTIVE: To describe the changes in ovarian hormones caused by natural menopause and hormone replacement therapy that have effects on androgen bioavailability and to describe indications for androgen replacement in postmenopausal women. DESIGN: Review of English language-published research over the last 35 years from January 1, 1966 to June 30, 2001 using MEDLINE. SETTING: Academic medical center. INTERVENTION(S): None. RESULT(S): In menopausal women, the effects of estradiol depletion and replacement on sex hormone-binding globulin appear to have clinically significant effects on bioavailable endogenous androgens. Many women whose menopause-related symptoms and bone loss responded inadequately to estrogen replacement were found to benefit from the addition of androgens. Most studies have focused on the sexual benefits of prescribing androgens to postmenopausal women. New studies have begun exploring the effects of androgens in other body systems, including the brain and the cardiovascular system. CONCLUSION(S): Estrogen depletion and replacement therapy at menopause can have clinically significant effects on bioavailability of endogenous androgens. Androgens complement the actions of estrogens in symptom control and disease prevention in postmenopausal women. Although androgen effects on sexual function are important, effects of androgens in many body systems should be considered in future research to determine optimal postmenopausal hormone replacement therapy.

Estrogen therapy and risk of cognitive decline: results from the Women's Estrogen for Stroke Trial (WEST).

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.

Vaginal laser Doppler flowmetry pre- and posthysterectomy.

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.