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Impact of Time Since Last Childbirth on Survival of Women with Premenopausal and Postmenopausal Breast Cancers

Balakrishnan N, Teo SH, Sinnadurai S, Bhoo Pathy NT, See MH, Taib NA, et al.

World J Surg, 2017 11;41(11):2735-2745.
PMID: 28653143 DOI: 10.1007/s00268-017-4081-9

BACKGROUND: Reproductive factors are associated with risk of breast cancer, but the association with breast cancer survival is less well known. Previous studies have reported conflicting results on the association between time since last childbirth and breast cancer survival. We determined the association between time since last childbirth (LCB) and survival of women with premenopausal and postmenopausal breast cancers in Malaysia.
METHOD: A historical cohort of 986 premenopausal, and 1123 postmenopausal, parous breast cancer patients diagnosed from 2001 to 2012 in University Malaya Medical Centre were included in the analyses. Time since LCB was categorized into quintiles. Multivariable Cox regression was used to determine whether time since LCB was associated with survival following breast cancer, adjusting for demographic, tumor, and treatment characteristics.
RESULTS: Premenopausal breast cancer patients with the most recent childbirth (LCB quintile 1) were younger, more likely to present with unfavorable prognostic profiles and had the lowest 5-year overall survival (OS) (66.9; 95% CI 60.2-73.6%), compared to women with longer duration since LCB (quintile 2 thru 5). In univariable analysis, time since LCB was inversely associated with risk of mortality and the hazard ratio for LCB quintile 2, 3, 4, and 5 versus quintile 1 were 0.53 (95% CI 0.36-0.77), 0.49 (95% CI 0.33-0.75), 0.61 (95% CI 0.43-0.85), and 0.64 (95% CI 0.44-0.93), respectively; P trend = 0.016. However, this association was attenuated substantially following adjustment for age at diagnosis and other prognostic factors. Similarly, postmenopausal breast cancer patients with the most recent childbirth were also more likely to present with unfavorable disease profiles. Compared to postmenopausal breast cancer patients in LCB quintile 1, patients in quintile 5 had a higher risk of mortality. This association was not significant following multivariable adjustment.
CONCLUSION: Time since LCB is not independently associated with survival in premenopausal or postmenopausal breast cancers. The apparent increase in risks of mortality in premenopausal breast cancer patients with a recent childbirth, and postmenopausal patients with longer duration since LCB, appear to be largely explained by their age at diagnosis.

Matched MeSH terms: Postmenopause*
Reproductive factors influencing bone mineral density in postmenopausal women

Mohammadi F, Amirzadeh Iranagh J, Motalebi SA, Hamid TA

Women Health, 2019 02;59(2):145-154.
PMID: 29400628 DOI: 10.1080/03630242.2018.1434592

This study examined the relationship between reproductive characteristics and bone mineral density (BMD) in postmenopausal women who had been referred to the menopause clinics of the National Population and Family Development Board and of the Hospital Kuala Lumpur from July 2011 to January 2012. The participants of this study were 201 postmenopausal Malaysian women aged 45-71 years. Some socio-demographic, lifestyle, and reproductive factors were recorded. Calcaneal BMD was measured by quantitative ultra-sonography. Correlations of reproductive factors with BMD were assessed by Pearson's correlation test and multiple regression analysis. Age at menopause was not significantly correlated with BMD, while the years after menopause, age at the first menstrual period, number of pregnancies, and total lactation periods were inversely correlated with it. Among reproductive factors, only the association between lactation duration and BMD remained significant after adjusting for age, body mass index, activity, and calcium intake. The results indicated that except for prolonged total time of lactation, other reproductive factors were not significantly associated with BMD in postmenopausal women.

Matched MeSH terms: Postmenopause/physiology*
Fulltext Beneficial Properties of Probiotics

Shi LH, Balakrishnan K, Thiagarajah K, Mohd Ismail NI, Yin OS

Trop Life Sci Res, 2016 Aug;27(2):73-90.
PMID: 27688852 MyJurnal DOI: 10.21315/tlsr2016.27.2.6

Probiotics are live microorganisms that can be found in fermented foods and cultured milk, and are widely used for the preparation of infant food. They are well-known as "health friendly bacteria", which exhibit various health beneficial properties such as prevention of bowel diseases, improving the immune system, for lactose intolerance and intestinal microbial balance, exhibiting antihypercholesterolemic and antihypertensive effects, alleviation of postmenopausal disorders, and reducing traveller's diarrhoea. Recent studies have also been focused on their uses in treating skin and oral diseases. In addition to that, modulation of the gut-brain by probiotics has been suggested as a novel therapeutic solution for anxiety and depression. Thus, this review discusses on the current probiotics-based products in Malaysia, criteria for selection of probiotics, and evidences obtained from past studies on how probiotics have been used in preventing intestinal disorders via improving the immune system, acting as an antihypercholesterolemic factor, improving oral and dermal health, and performing as anti-anxiety and anti-depressive agents.

Matched MeSH terms: Postmenopause
Fulltext Pregnancy, Primary Aldosteronism, and Adrenal CTNNB1 Mutations

Teo AE, Garg S, Shaikh LH, Zhou J, Karet Frankl FE, Gurnell M, et al.

N Engl J Med, 2015 Oct 08;373(15):1429-36.
PMID: 26397949 DOI: 10.1056/NEJMoa1504869

Recent discoveries of somatic mutations permit the recognition of subtypes of aldosterone-producing adenomas with distinct clinical presentations and pathological features. Here we describe three women with hyperaldosteronism, two who presented in pregnancy and one who presented after menopause. Their aldosterone-producing adenomas harbored activating mutations of CTNNB1, encoding β-catenin in the Wnt cell-differentiation pathway, and expressed LHCGR and GNRHR, encoding gonadal receptors, at levels that were more than 100 times as high as the levels in other aldosterone-producing adenomas. The mutations stimulate Wnt activation and cause adrenocortical cells to de-differentiate toward their common adrenal-gonadal precursor cell type. (Funded by grants from the National Institute for Health Research Cambridge Biomedical Research Centre and others.).

Matched MeSH terms: Postmenopause
Fulltext Effects of exercise training on postmenopausal hypertension: implications on nitric oxide levels

Khalid T, Nesreen E, Ramadhan O

Med J Malaysia, 2013 Dec;68(6):459-64.
PMID: 24632913

BACKGROUND: Postmenopausal hypertension is one of the leading causes of morbidity and mortality in women. Exercise training has been proved to decrease its risk factors and cardiovascular events. Aerobic exercise training stimulates endothelial nitric oxide release that acts as an antithrombotic and is cardiovascular protective. The effect of aerobic exercise training on postmenopausal hypertension is not fully elucidated.

THE PURPOSE OF THE STUDY: to investigate the effects of moderate exercise training on nitric oxide levels in postmenopausal hypertension.

METHODS: A prospective, randomized, controlled trial was conducted on 30 postmenopausal women involved in this study. The participants had at least one year's history of postmenopausal hypertension. Their ages ranged (40-50) years. Their body mass index ranged (30-36 Kg/m(2)). They were divided into two equal groups (treatment and control). Nitric oxide levels and blood pressure were measured in both groups in the initial examination at the beginning of the study, and at the end of the study. The treatment group received moderate aerobic exercise training. This ranged from 60-70% of maximum heart rate by walking on a treadmill at an average speed of 4km/hour for at least 20 minutes, three sessions a week, for 8 weeks.

RESULTS: Body mass index, systolic and diastolic blood pressures were statistically significantly decreased. Nitric oxide levels were significantly increased in the treatment group. In this group the level of NO increased by 30.4% and systolic blood pressure decreased by 16.2%. Diastolic blood pressure decreased by 9.5% and body mass index decreased by 6%. In the control group the NO level increased by 8%. Systolic blood pressure decreased by 3% and diastolic blood pressure decreased by 3%.

CONCLUSION: Exercise performed at moderate intensity for two months had obvious benefits in improving NO levels and controlling the hypertension in obese postmenopausal women.

Matched MeSH terms: Postmenopause
Fulltext Bone Mineral Density Assessment in Pre- and Postmenopausal Women: Comparison Between T-Scores by Heel QUS and DXA in HRPZII

Zaini WM, Md Ariff A

Med J Malaysia, 2012 Oct;67(5):487-90.
PMID: 23770864 MyJurnal

This short-term study which was carried out in a small group of pre- and postmenopausal women at Hospital Raja Perempuan Zainab II (HRPZII) aims to compare between Tscores detected by heel Quantitative Ultrasound (QUS) and by Dual X-ray Absorptiometry (DXA) of the hip and spine. The prevalence of osteoporosis by heel QUS was 63.3% and up to 16.7% by DXA. Insufficient or weak agreement exists between T-score measurements by heel QUS and axial DXA. Significant correlations were found between measurements of T-scores by both methods, with r values from 0.364 to 0.91. Although some correlation was found, significant discrepancy in the frequency of osteoporosis using different methods and sites is substantial.

Matched MeSH terms: Postmenopause
Fulltext Pilot study of formestane in postmenopausal women with breast cancer

Joseph JK, Lim AKH

Med J Malaysia, 1998 Mar;53(1):37-41.
PMID: 10968135

A pilot study of Formestane or 4-Hydroxyandrostenedione (Lentaron), a new endocrine agent, was conducted on 18 postmenopausal patients with locally advanced and metastatic breast cancer. 16 patients were evaluable for response and objective responses were seen in 4 patients (25%). Stabilisation of disease was seen in 5 patients (32%). Out of 17 patients evaluable for toxicity, 3 (18%) reported adverse effects including hot flushes, lethargy and myalgia. Adverse effects were mild, transient and no patient required discontinuation of drug. Our study confirms that Formestane is a well tolerated endocrine agent with low toxicity and reasonable efficacy in postmenopausal patients with locally advanced and metastatic breast cancer.

Matched MeSH terms: Postmenopause
Isolation of Neissseria meningitidis from an unusual site

Karunakaran R, Ngeow YF, Mashor M

Malays J Pathol, 2002 Dec;24(2):103-5.
PMID: 12887169

A 59-year-old post-menopausal lady who had returned from a pilgrimage to Mecca about a month earlier presented with a three days' history of profuse vaginal discharge. Neissseria meningitidis was isolated from high vaginal swab specimens taken from her on 2 occasions, five days apart. Her symptoms disappeared without treatment after two weeks. We conclude that although the organism may have been a colonizer, it is possible that it was responsible for the self-limiting genital infection in this patient.

Matched MeSH terms: Postmenopause
Fulltext Malignant mixed mullerian tumour, heterologous in a 66-year-old malay lady - a case report

Rahman MT, Naik VR, Noor SR, Mahmud NM, Isa M

Malays J Med Sci, 2003 Jul;10(2):93-5.
PMID: 23386805

A 66-year-old Malay woman, known hypertensive, presented with post menopausal bleeding associated with clot for three months. She was postmenopausal for last ten years. She also complaints of developing a mass in the abdomen which was growing in size also for last three months. Abdominal examination revealed a twenty week size mass, movable from side to side but unable to get below the mass. Vaginal examination revealed a fleshy fungating mass arising from the uterus coming out through the vagina. Cervix could not be visualized properly. Subsequent histopathology of the removed mass was reported as a Malignant Mixed Mullerian Tumour - Heterologous.

Matched MeSH terms: Postmenopause
Fulltext Beta-human Chorionic Gonadotropin-secreting Lung Adenocarcinoma

Wong YP, Tan GC, Aziz S, Pongprakyun S, Ismail F

Malays J Med Sci, 2015 Jul-Aug;22(4):76-80.
PMID: 26715912 MyJurnal

Overexpression of beta-human chorionic gonadotropin (β-hCG) is frequently associated with germ cell tumours, especially choriocarcinoma. Ectopic secretion of β-hCG by non-small cell lung cancer is exceptional. We present an exceedingly rare case of pulmonary adenocarcinoma that secretes β-hCG. Our patient is a 62-year-old postmenopausal woman, a nonsmoker, who presented with a six-month history of progressive dyspnoea, associated with decreased appetite and significant weight loss. Her serum β-hCG was very high (11211.9 mIU/ml), which prompted investigations to exclude germ cell tumour. Radiological imaging revealed a 10-cm right lung mass with adrenal metastasis. No other focal lesions were detected. Microscopy of the lung biopsy specimen showed replacement of normal lung tissue by sheets of malignant cells, forming vague glands in some areas. Immunohistochemically, the malignant cells showed focal immunopositivity for thyroid transcription factor 1 (TTF-1), napsin A, cytokeratin 7 (CK7) and β-hCG. A diagnosis of β-hCG-secreting pulmonary poorly differentiated adenocarcinoma was rendered. Serum β-hCG level decreased significantly to 168.6 mIU/ml after the first cycle of chemotherapy. In conclusion, β-hCG expression in lung cancer should be recognised to facilitate prompt diagnosis and initiation of appropriate intervention.

Matched MeSH terms: Postmenopause
Efficacy and safety of raloxifene 60 milligrams/day in postmenopausal Asian women

Kung AW, Chao HT, Huang KE, Need AG, Taechakraichana N, Loh FH, et al.

J Clin Endocrinol Metab, 2003 Jul;88(7):3130-6.
PMID: 12843154

In healthy Caucasian postmenopausal women, raloxifene increases bone mineral density (BMD), decreases biochemical markers of bone turnover, and lowers low-density lipoprotein (LDL) cholesterol, without effects on high-density lipoprotein (HDL) cholesterol and triglycerides. This randomized, double-blind study examines the effects of raloxifene 60 mg/d (n = 483) or placebo (n = 485) in healthy postmenopausal Asian women (mean age 57 yr) from Australia, Hong Kong, India, Indonesia, Malaysia, Pakistan, Philippines, Singapore, Taiwan, and Thailand. Serum osteocalcin, serum N-telopeptide, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides were assessed at baseline and 6 months. Lumbar spine BMD was measured at baseline and 1 yr in 309 women from 4 countries. Clinical adverse events were recorded at each interim visit. At 6 months, raloxifene 60 mg/d significantly decreased osteocalcin, N-telopeptide, total cholesterol, and LDL cholesterol by medians of 15.9%, 14.6%, 5.3%, and 7.7%, respectively, from placebo. Changes in HDL cholesterol and triglycerides were similar between raloxifene and placebo. Raloxifene 60 mg/d increased mean lumbar spine BMD (1.9%) from placebo at 1 yr (P = 0.0003). The incidences of hot flashes (placebo 3.5%, raloxifene 5.6%, P = 0.12), and leg cramps (placebo 2.7%, raloxifene 4.3%, P = 0.16) were not different between groups. No case of venous thromboembolism was reported. The effects of raloxifene 60 mg/d on bone turnover, BMD, and serum lipids in healthy postmenopausal Asian women were similar to that previously reported in Caucasian women.

Matched MeSH terms: Postmenopause
Fulltext Long-term hormone therapy for perimenopausal and postmenopausal women

Marjoribanks J, Farquhar C, Roberts H, Lethaby A, Lee J

Cochrane Database Syst Rev, 2017 Jan 17;1(1):CD004143.
PMID: 28093732 DOI: 10.1002/14651858.CD004143.pub5

BACKGROUND: Hormone therapy (HT) is widely provided for control of menopausal symptoms and has been used for the management and prevention of cardiovascular disease, osteoporosis and dementia in older women. This is an updated version of a Cochrane review first published in 2005. OBJECTIVES: To assess effects of long-term HT (at least 1 year's duration) on mortality, cardiovascular outcomes, cancer, gallbladder disease, fracture and cognition in perimenopausal and postmenopausal women during and after cessation of treatment. SEARCH METHODS: We searched the following databases to September 2016: Cochrane Gynaecology and Fertility Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and PsycINFO. We searched the registers of ongoing trials and reference lists provided in previous studies and systematic reviews. SELECTION CRITERIA: We included randomised double-blinded studies of HT versus placebo, taken for at least 1 year by perimenopausal or postmenopausal women. HT included oestrogens, with or without progestogens, via the oral, transdermal, subcutaneous or intranasal route. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed risk of bias and extracted data. We calculated risk ratios (RRs) for dichotomous data and mean differences (MDs) for continuous data, along with 95% confidence intervals (CIs). We assessed the quality of the evidence by using GRADE methods. MAIN RESULTS: We included 22 studies involving 43,637 women. We derived nearly 70% of the data from two well-conducted studies (HERS 1998; WHI 1998). Most participants were postmenopausal American women with at least some degree of comorbidity, and mean participant age in most studies was over 60 years. None of the studies focused on perimenopausal women.In relatively healthy postmenopausal women (i.e. generally fit, without overt disease), combined continuous HT increased the risk of a coronary event (after 1 year's use: from 2 per 1000 to between 3 and 7 per 1000), venous thromboembolism (after 1 year's use: from 2 per 1000 to between 4 and 11 per 1000), stroke (after 3 years' use: from 6 per 1000 to between 6 and 12 per 1000), breast cancer (after 5.6 years' use: from 19 per 1000 to between 20 and 30 per 1000), gallbladder disease (after 5.6 years' use: from 27 per 1000 to between 38 and 60 per 1000) and death from lung cancer (after 5.6 years' use plus 2.4 years' additional follow-up: from 5 per 1000 to between 6 and 13 per 1000).Oestrogen-only HT increased the risk of venous thromboembolism (after 1 to 2 years' use: from 2 per 1000 to 2 to 10 per 1000; after 7 years' use: from 16 per 1000 to 16 to 28 per 1000), stroke (after 7 years' use: from 24 per 1000 to between 25 and 40 per 1000) and gallbladder disease (after 7 years' use: from 27 per 1000 to between 38 and 60 per 1000) but reduced the risk of breast cancer (after 7 years' use: from 25 per 1000 to between 15 and 25 per 1000) and clinical fracture (after 7 years' use: from 141 per 1000 to between 92 and 113 per 1000) and did not increase the risk of coronary events at any follow-up time.Women over 65 years of age who were relatively healthy and taking continuous combined HT showed an increase in the incidence of dementia (after 4 years' use: from 9 per 1000 to 11 to 30 per 1000). Among women with cardiovascular disease, use of combined continuous HT significantly increased the risk of venous thromboembolism (at 1 year's use: from 3 per 1000 to between 3 and 29 per 1000). Women taking HT had a significantly decreased incidence of fracture with long-term use.Risk of fracture was the only outcome for which strong evidence showed clinical benefit derived from HT (after 5.6 years' use of combined HT: from 111 per 1000 to between 79 and 96 per 1000; after 7.1 years' use of oestrogen-only HT: from 141 per 1000 to between 92 and 113 per 1000). Researchers found no strong evidence that HT has a clinically meaningful impact on the incidence of colorectal cancer.One trial analysed subgroups of 2839 relatively healthy women 50 to 59 years of age who were taking combined continuous HT and 1637 who were taking oestrogen-only HT versus similar-sized placebo groups. The only significantly increased risk reported was for venous thromboembolism in women taking combined continuous HT: Their absolute risk remained low, at less than 1/500. However, other differences in risk cannot be excluded, as this study was not designed to have the power to detect differences between groups of women within 10 years of menopause.For most studies, risk of bias was low in most domains. The overall quality of evidence for the main comparisons was moderate. The main limitation in the quality of evidence was that only about 30% of women were 50 to 59 years old at baseline, which is the age at which women are most likely to consider HT for vasomotor symptoms. AUTHORS' CONCLUSIONS: Women with intolerable menopausal symptoms may wish to weigh the benefits of symptom relief against the small absolute risk of harm arising from short-term use of low-dose HT, provided they do not have specific contraindications. HT may be unsuitable for some women, including those at increased risk of cardiovascular disease, increased risk of thromboembolic disease (such as those with obesity or a history of venous thrombosis) or increased risk of some types of cancer (such as breast cancer, in women with a uterus). The risk of endometrial cancer among women with a uterus taking oestrogen-only HT is well documented.HT is not indicated for primary or secondary prevention of cardiovascular disease or dementia, nor for prevention of deterioration of cognitive function in postmenopausal women. Although HT is considered effective for the prevention of postmenopausal osteoporosis, it is generally recommended as an option only for women at significant risk for whom non-oestrogen therapies are unsuitable. Data are insufficient for assessment of the risk of long-term HT use in perimenopausal women and in postmenopausal women younger than 50 years of age.

Matched MeSH terms: Postmenopause*
Fulltext Plasma carotenoids, vitamin C, tocopherols, and retinol and the risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition cohort

Bakker MF, Peeters PH, Klaasen VM, Bueno-de-Mesquita HB, Jansen EH, Ros MM, et al.

Am J Clin Nutr, 2016 Feb;103(2):454-64.
PMID: 26791185 DOI: 10.3945/ajcn.114.101659

BACKGROUND: Carotenoids and vitamin C are thought to be associated with reduced cancer risk because of their antioxidative capacity.
OBJECTIVE: This study evaluated the associations of plasma carotenoid, retinol, tocopherol, and vitamin C concentrations and risk of breast cancer.
DESIGN: In a nested case-control study within the European Prospective Investigation into Cancer and Nutrition cohort, 1502 female incident breast cancer cases were included, with an oversampling of premenopausal (n = 582) and estrogen receptor-negative (ER-) cases (n = 462). Controls (n = 1502) were individually matched to cases by using incidence density sampling. Prediagnostic samples were analyzed for α-carotene, β-carotene, lycopene, lutein, zeaxanthin, β-cryptoxanthin, retinol, α-tocopherol, γ-tocopherol, and vitamin C. Breast cancer risk was computed according to hormone receptor status and age at diagnosis (proxy for menopausal status) by using conditional logistic regression and was further stratified by smoking status, alcohol consumption, and body mass index (BMI). All statistical tests were 2-sided.
RESULTS: In quintile 5 compared with quintile 1, α-carotene (OR: 0.61; 95% CI: 0.39, 0.98) and β-carotene (OR: 0.41; 95% CI: 0.26, 0.65) were inversely associated with risk of ER- breast tumors. The other analytes were not statistically associated with ER- breast cancer. For estrogen receptor-positive (ER+) tumors, no statistically significant associations were found. The test for heterogeneity between ER- and ER+ tumors was statistically significant only for β-carotene (P-heterogeneity = 0.03). A higher risk of breast cancer was found for retinol in relation to ER-/progesterone receptor-negative tumors (OR: 2.37; 95% CI: 1.20, 4.67; P-heterogeneity with ER+/progesterone receptor positive = 0.06). We observed no statistically significant interaction between smoking, alcohol, or BMI and all investigated plasma analytes (based on tertile distribution).
CONCLUSION: Our results indicate that higher concentrations of plasma β-carotene and α-carotene are associated with lower breast cancer risk of ER- tumors.

Matched MeSH terms: Postmenopause
Fulltext Serum sex hormone levels in pre- and postmenopausal breast cancer patients

Ho CC, Rohaizak M, Zulkifli SZ, Siti-Aishah MA, Nor-Aini U, Sharifah-Noor-Akmal SH

Singapore Med J, 2009 May;50(5):513-8.
PMID: 19495523

This study was conducted to determine the association between serum sex hormone levels and breast cancer.

Matched MeSH terms: Postmenopause*
Bone resorption marker status of pre and postmenopausal Malay women in Kelantan and its corresponding risk factors

Hermizi Hapidin, Hawa Mahmood, Sakinah Harith

Sains Malaysiana, 2013;42:1191-1200.

Menopause is the most prevalent cause of accelerated bone loss in women. Biochemical markers of bone resorption can be used clinically to predict future bone loss. This study aimed to determine the level of bone resorption markers in healthy pre and postmenopausal Malay women and determine their association with the risk. A total of 150 healthy women were recruited for this study (51 pre and 99 postmenopausal subjects). Data on socioeconomic, lifestyle habit and clinical were gained by personal interview. Fasting serum was collected to measure both C-telopeptide (CTx) and N-telopeptide (NTx) of type 1 collagen. Both markers were highly correlated with each other (r=0.568, p<0.001). Both intra- and inter-assay coefficient of variations (CV) of NTx were higher than those of CTx (8% and 12% vs 6% and 5%). The mean CTx values of pre and postmenopausal subjects were comparable with the expected values (0.2833 (0.1769) ng/mL and 0.4323 (1.851) ng/mL compared with 0.287 and 0.438 ng/mL, respectively). The NTx value for premenopausal subjects were higher than the expected values (15.2 (8.10) compared to 12.6 (3.20) nM BCE). The median was 19.929 nM BCE. The mean CTx and NTx levels of postmenopausal subjects were significantly lower than premenopausal subjects (p<0.05). The risk factors for bone resorption in this population were duration of menopause, marital status, body mass index (BMI), physical activity and education level. In conclusion, postmenopausal women showed a higher bone resorption, indicating higher bone loss. Increasing education and physical activity intervention might be effective to ensure better health in Malaysian older population.

Matched MeSH terms: Postmenopause
A review on the performance of osteoporosis self-assessment tool for Asians in determining osteoporosis and fracture risk

Chin KY

Postgrad Med, 2017 Sep;129(7):734-746.
PMID: 28695762 DOI: 10.1080/00325481.2017.1353394

The prevalence of osteoporosis in Asian countries is growing. An effective screening method will enable patients at risk for osteoporosis to receive early diagnosis and treatment, and avoid overcrowding the limited dual-energy x-ray absorptiometry (DXA) machines available in Asian countries. Many simple osteoporosis screening algorithms have been developed but they are not validated for use in Asian populations. osteoporosis self-assessment tools for Asians (OSTA), established using a multinational Asian cohort, is the first screening algorithm that caters for the Asian populations. It considers only body weight and age in the algorithm. It shows consistently high performance and sensitivity in identifying postmenopausal women at risk for osteoporosis in many Asian countries. Its usage has been expanded for identifying osteoporosis in men, as well as determining fracture risk for both sexes. However, the performance of OSTA is influenced by age, sex, ethnicity and site of BMD measurement to define osteoporosis. Its usage is also limited in individuals without apparent risk factors. These limitations should be noted by physicians considering the use of OSTA in clinical setting. As a conclusion, OSTA is a cost-effective measure for osteoporosis screening in primary healthcare setting.

Matched MeSH terms: Postmenopause
An overview of the phytoestrogen effect on vaginal health and dyspareunia in peri- and post-menopausal women

Dizavandi FR, Ghazanfarpour M, Roozbeh N, Kargarfard L, Khadivzadeh T, Dashti S

Post Reprod Health, 2019 Mar;25(1):11-20.
PMID: 30786797 DOI: 10.1177/2053369118823365

OBJECTIVE: The aim of this overview was to evaluate the effectiveness of phytoestrogens on vaginal health and dyspareunia in peri- and post-menopausal women.
MATERIAL AND METHODS: Three databases including MEDLINE, Scopus and the Cochrane Central Register of Controlled Trials were from inception to August 2017.
RESULT: Two systematic reviews and 11 RCTs were included in the overview. According to the findings, isoflavones increased the maturation value and attenuated the vaginal atrophy in the post-menopausal women. Topical isoflavones had beneficial effects on the vaginal atrophy. Similar efficacy was found in Pueraria mirifica and conjugated estrogen cream on dryness ( p = 0.277), soreness ( p = 0.124) and irritation ( p = 0.469), as well as discharge ( p = 0.225) and dyspareunia ( p = 0.089). However, the conjugated estrogen cream was more effective compared to Pueraria mirifica ( p > 0.005) regarding maturation index improvement. Comparison of fennel 5% vaginal cream and placebo gel showed significant difference in superficial cells ( p

Matched MeSH terms: Postmenopause
Effect of menstrual status on lipid profile: A cross-sectional study in a tertiary care hospital in Nepal

Adhikaree J, Shrestha R, Bomjan P, Shrestha A, Pokharel S, Acharya R, et al.

Post Reprod Health, 2023 Dec;29(4):195-200.
PMID: 37907067 DOI: 10.1177/20533691231213301

Background: The ovarian follicular cell's degradation and subsequent decrease in the synthesis of estrogen results in the decreased cardiovascular protection. As a result, the incidence of cardiovascular disease (CVD) increases in postmenopausal women and is characterized by change in lipid profile. This study sought to ascertain the extent of the impact that menstrual status might have on lipid profiles among premenopausal and postmenopausal women. Methods: A cross-sectional study was conducted with 260 premenopausal and postmenopausal women (1: 1) and serum lipid component concentrations (high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), and total cholesterol (TC)) were measured. A comparison between two groups was made between premenopausal and postmenopausal women, and regression was carried out to estimate the effect of menstrual status on lipid components. Results: Compared with premenopausal women, the concentrations of the lipid components (HDL-C, LDL-C, TG, and TC) were found to be significantly higher in postmenopausal women. Using the linear regression, menstruation status was able to predict 11.7%-13.3% of the lipid components (TG and TC) when age and weight were adjusted. Conclusion: The difference in lipid components between premenopausal women and postmenopausal women exists, with menstrual status explaining 11.7%-13.3% variance for the observed lipid level. The factors influencing the lipid profile beside the menstrual status should also be explored. External intervention such as estrogen replacement therapy is also recommended in case of deviation of lipid profile from the suggested normal clinical range.

Matched MeSH terms: Postmenopause*
Fulltext Influence of lifestyle factors on mammographic density in postmenopausal women

Brand JS, Czene K, Eriksson L, Trinh T, Bhoo-Pathy N, Hall P, et al.

PLoS One, 2013;8(12):e81876.
PMID: 24349146 DOI: 10.1371/journal.pone.0081876

BACKGROUND: Mammographic density is a strong risk factor for breast cancer. Apart from hormone replacement therapy (HRT), little is known about lifestyle factors that influence breast density.
METHODS: We examined the effect of smoking, alcohol and physical activity on mammographic density in a population-based sample of postmenopausal women without breast cancer. Lifestyle factors were assessed by a questionnaire and percentage and area measures of mammographic density were measured using computer-assisted software. General linear models were used to assess the association between lifestyle factors and mammographic density and effect modification by body mass index (BMI) and HRT was studied.
RESULTS: Overall, alcohol intake was positively associated with percent mammographic density (P trend = 0.07). This association was modified by HRT use (P interaction = 0.06): increasing alcohol intake was associated with increasing percent density in current HRT users (P trend = 0.01) but not in non-current users (P trend = 0.82). A similar interaction between alcohol and HRT was found for the absolute dense area, with a positive association being present in current HRT users only (P interaction = 0.04). No differences in mammographic density were observed across categories of smoking and physical activity, neither overall nor in stratified analyses by BMI and HRT use.
CONCLUSIONS: Increasing alcohol intake is associated with an increase in mammography density, whereas smoking and physical activity do not seem to influence density. The observed interaction between alcohol and HRT may pose an opportunity for HRT users to lower their mammographic density and breast cancer risk.

Matched MeSH terms: Postmenopause
Fulltext Haematological reference intervals in a multiethnic population

Ambayya A, Su AT, Osman NH, Nik-Samsudin NR, Khalid K, Chang KM, et al.

PLoS One, 2014;9(3):e91968.
PMID: 24642526 DOI: 10.1371/journal.pone.0091968

INTRODUCTION: Similar to other populations, full blood count reference (FBC) intervals in Malaysia are generally derived from non-Malaysian subjects. However, numerous studies have shown significant differences between and within populations supporting the need for population specific intervals.
METHODS: Two thousand seven hundred twenty five apparently healthy adults comprising all ages, both genders and three principal races were recruited through voluntary participation. FBC was performed on two analysers, Sysmex XE-5000 and Unicel DxH 800, in addition to blood smears and haemoglobin analysis. Serum ferritin, soluble transferrin receptor and C-reactive protein assays were performed in selected subjects. All parameters of qualified subjects were tested for normality followed by determination of reference intervals, measures of central tendency and dispersion along with point estimates for each subgroup.
RESULTS: Complete data was available in 2440 subjects of whom 56% (907 women and 469 men) were included in reference interval calculation. Compared to other populations there were significant differences for haemoglobin, red blood cell count, platelet count and haematocrit in Malaysians. There were differences between men and women, and between younger and older men; unlike in other populations, haemoglobin was similar in younger and older women. However ethnicity and smoking had little impact. 70% of anemia in premenopausal women, 24% in postmenopausal women and 20% of males is attributable to iron deficiency. There was excellent correlation between Sysmex XE-5000 and Unicel DxH 800.
CONCLUSION: Our data confirms the importance of population specific haematological parameters and supports the need for local guidelines rather than adoption of generalised reference intervals and cut-offs.

Matched MeSH terms: Postmenopause/blood*; Postmenopause/ethnology

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