Early menopause, the cessation of ovarian function prior to age 45, affects 5-10% of Western women and is associated with an increased risk of adverse health outcomes, including premature mortality and cardiovascular disease. Recent literature suggests that high vegetable protein intake may prolong female reproductive function, but no study has evaluated the association between this exposure and early menopause. Therefore, we evaluated the relationship between cumulative vegetable protein intake as a percentage of total calories and early menopause in the Nurses’ Health Study II cohort. Women included in analyses were premenopausal at baseline (1991) and followed for up to 20 years. Cases (n=2,077) were defined as women experiencing natural menopause before age 45; women were excluded if early menopause was a result of hysterectomy, oophorectomy or radiation treatment. Non-cases were women whose age at menopause was 45 or greater or who were older than 45 and still premenopausal in 2011 (n=51,007). Intake of vegetable and animal protein was assessed every four years via food frequency questionnaires. In Cox proportional hazard models adjusting for age, smoking, diet, and behavioral factors, women in the highest quintile of cumulatively averaged vegetable protein intake (median=6.5%) had a significant 18% lower likelihood of experiencing early menopause as compared to women in the lowest quintile (3.9%) (95% CI: 0.71-0.94; P-trend=0.004). In contrast, animal and total protein was unrelated to risk. Results were similar in analyses limited to never smokers and never oral contraceptive users. Our findings suggest vegetable protein intake may be inversely associated with early menopause.

Although many women find relief from menopause through hormone therapy (HT), current guidelines recommend that HT be used only for short-term relief of symptoms. Women who attempt to stop HT often encounter troublesome recurrent symptoms leading to a diminished quality of life (QoL); 25% of women who discontinue eventually resume HT. Unfortunately, there is little information for women and their health care providers as to the best way to discontinue HT or how to prepare and guide women through this process. An in-depth description of women‘s experiences during HT discontinuation and the factors influencing recurrent symptoms, QoL and discontinuation outcome would provide knowledge to develop much needed counseling and support interventions. The purpose of this study was to explore women‘s experiences discontinuing hormone therapy for menopause. This Internet-based mixed-methods study used a dominant Qualitative Descriptive design with embedded quantitative QoL measurements. Participants completed the quantitative questionnaires online while open-ended questions were completed either online or by telephone. Interview data were analyzed through Qualitative Content Analysis; descriptive statistics were used to explore the quantitative measures. Participants were stratified by discontinuation status for comparison of variations in discontinuation experiences, QoL and influencing factors. Thirty-four women (20 stopped, 9 resumed, 4 tapering) were enrolled. One overarching theme--'a solitary journey'--emerged: although all women embarked on this journey, each woman traveled her own path. Two subthemes--'burden and interference' and 'appraising risk'--encompassed the symptom factors (severity, interference and sensitivity) that influenced women's experiences and the manner in which women evaluated their options. Other influencing factors included: readiness viii and reasons for stopping HT, beliefs about menopause and roles. QoL was strongly connected to symptoms for many but not all women. Information from health care providers was inconsistent; women desired more support from providers and other women. The rich description of women's experiences stopping HT highlights the need for providers to assess women's sensitivity to symptoms and readiness to discontinue to determine which women might benefit from more support. Greater health literacy would enhance women's understanding of HT risks. More research is needed on symptom clusters and interference and strategies for minimizing their impact.

abstract: Progestogens, such as progesterone (P4), medroxyprogesterone acetate (MPA), and micronized progesterone (mP4), are given to ovary-intact women during the transition to menopause to attenuate heavy uterine bleeding and other symptoms. Both progesterone and MPA administration have been shown to impair cognition in ovariectomized (Ovx) rats compared to vehicle-treated controls. mP4, however, has yet to be investigated for cognitive effects in a preclinical setting. Further, progestogens affect the GABA (-aminobutyric acid) ergic system, specifically glutamic acid decarboxylase (GAD) the rate limiting enzyme necessary for synthesizing GABA. The goal of this experiment was to investigate the cognitive impact of P4, MPA, and mP4, in an ovary-intact transitional menopause model using 4-vinylcyclohexene diepoxide (VCD) and assess whether these potential changes were related to the GABAergic system. One group of rats received vehicle injections, and the remainder of the groups received VCD to induce follicular depletion, modeling transitional menopause in women. Vehicle or hormone administration began during perimenopause to model the time period when women often take progestogens alone. Rats then underwent testing to assess spatial working and reference memory in the water radial-arm maze (WRAM) and spatial reference memory in the Morris water maze (MWM). Results indicate that P4 and MPA improved learning for working memory measure, but only MPA impaired memory retention in the WRAM. For the WRAM reference memory measure, VCD only treated rats showed impaired learning and memory retention compared to vehicle controls; progestogens did not impact this impairment. Although GAD expression did not differ between treatment groups, in general, there was a relationship between GAD expression and WRAM performance such that rats that tended to have higher GAD levels also tended to make more WRAM working memory errors. Thus, while P4 and MPA have been previously shown to impair cognition in an Ovx model, giving these hormones early in an ovary-intact perimenopause model elicits divergent effects, such that these progestogens can improve cognition. Additionally, these findings suggest that the cognitive changes seen herein are related to the interaction between progestogens and the GABAergic system. Further investigation into progestogens is warranted to fully understand their impact on cognition given the importance of utilizing progestogens in the clinic. / Dissertation/Thesis / Masters Thesis Psychology 2019

The doctrine of informed consent, defined as respect for autonomy, is the tool used to govern the relationship between physicians and patients. Its framework relies on rights and duties that mark these relationships. The main purpose of informed consent is to promote human rights and dignity. Some researchers claim that informed consent has successfully replaced patients' historical predispositions to accept physicians' advice without much explicit resistance. Although the doctrine of informed consent promotes ideals worth pursuing, a successful implementation of these ideals in practice has yet to occur. What has happened in practice is that attorneys, physicians, and hospital administrators often use consent forms mainly to protect physicians and medical facilities from liability. Consequently, ethicists, legal theorists, and physicians need to do much more to explain how human rights and human dignity relate to the practice of medicine and how the professionals can promote them in practice. This is especially important because patients' vulnerability has increased just as the complexity and power of medical science and technology have increased. Certain health care practices can shed light on the difficulties of implementing the doctrine of informed consent and explain why it is insufficient to protect patients' rights and dignity. Defining a normal biological event as a disease, and routinely prescribing hormone drug therapy to menopausal women for all health conditions related to menopause, does not meet the standards of free informed consent. Clinicians provide insufficient disclosure about risks related to long-term use of hormone therapies and about the absence of solid evidence to support their bias toward hormone therapies as a treatment of choice for menopause related health conditions. The contributing problem is women's failure to act as autonomous agents because they either choose not to take an active part in their own therapy or because they fear to question physicians' medical authority. To insure that patients' autonomy and free choice are a part of every physician-patient interaction, physicians and patients need actively to promote them as values that are absolutely indispensable in physicians' offices, clinics, and hospitals.

Cardiovascular Disease (CVD) accounts for the leading number of deaths worldwide. Prior to menopause, women exhibit lower rates of CVD compared to age-matched men, however, risks for women increase with menopause. Studies show estrogen loss and age exacerbating cardiac β-adrenergic receptor (β-AR) signaling and contractile function. We therefore hypothesized that prolonged estrogen deficiency and chronic β-adrenergic stimulation cause decreases in cardiac function and increases in fibrosis in aged female hearts. Female mice underwent either an ovariectomy (OVX) or a control SHAM surgery at 10 weeks old and were infused with Isoproterenol for three days via mini osmotic pumps in order to induce chronic β-adrenergic stimulation 12-months post-surgery. Our results show prolonged estrogen deficiency from the OVX exacerbates cardiac function and fibrosis compared to SHAM. These differences highlight the importance of continued research on cardiac estrogen deficiency mechanisms to understand the long-term effects in the heart during both CVD and menopause.

abstract: Reproductive hormones are recognized for their diverse functions beyond reproduction itself, including a vital role in brain organization, structure, and function throughout the lifespan. From puberty to reproductive senescence, the female is characterized by inherent responsiveness to hormonal cyclicity. For most women, a natural transition to menopause occurs in midlife, wherein the endogenous hormonal milieu undergoes significant changes and marks the end of the reproductive life stage. Although most women experience natural menopause, many women will undergo gynecological surgery during their lifetime, which can lead to an abrupt surgical menopause. It is of critical importance to better understand how endogenous and exogenous reproductive hormone exposures across the lifespan influence cognitive and brain aging, as women are at a greater risk for developing a variety of diseases after menopause, including dementia. Using rodent models, this dissertation explores how the etiology of reproductive senescence, that is, whether it is transitional or surgical, influences the female phenotype to result in divergent cognitive outcomes dependent upon a variety of factors, with an emphasis on age at the time of intervention playing a key role in brain outcomes. Furthermore, the impact of exogenous hormone therapy on cognition is evaluated in the context of surgical menopause. A novel rat model of hysterectomy is also presented, with results demonstrating for the first time that the nonpregnant uterus, which is typically considered to be a quiescent organ, may play a unique, direct role in modulating cognitive outcomes. Neurobiological mechanisms associated with reproductive hormones and aging are assessed to better recognize neural correlates underlying the observed behavior changes. The overarching goal of this dissertation was to elucidate novel factors contributing to cognitive aging outcomes in females. Collectively, the data presented herein indicate that the age at the onset of reproductive senescence has significant implications for learning and memory outcomes, and that variations in gynecological surgery can have unique, long-lasting effects on the brain and cognition. Translationally, this series of experiments moves the field forward toward the goal of improving the health and quality of life for women throughout the lifespan. / Dissertation/Thesis / Doctoral Dissertation Psychology 2019

The purpose of this study was to explore the needs of women experiencing menopause. Since women at this time experience physical, social and emotional changes, they may have a special need for services. Doctors were selected as the population for study because they treat so many women at this age and because they are powerful transmitters of our culture. This exploratory study was designed to provide descriptive information about the doctors' perceptions. Results are reported from interviews with seventeen gynecologists from the Portland metropolitan area in Oregon. Attempts were made to interview all female gynecologists in the area. Male gynecologists were randomly sampled and the sample was stratified to ensure representation of doctors from a pre-paid medical plan. Doctors were questioned about definitions of menopause, treatment, and use of community resources. Overall, it was found that doctors hesitated to make generalizations about patients. This seemed especially true in regard to questions about the effects of menopause or the problems women experience. When speaking about both their definition of menopause and the types of problems associated with it, female physicians tended to limit responses to the biological aspects of menopause. Generally, it was the male doctors who stressed the social or emotional aspects. The major forms of primary treatment used by doctors were: hormone replacement therapy; talking to the patient (i.e. providing education or reassurance about menopause); or some combination of the two depending upon the individual patient's problem. Degree of hormone use varied among doctors. Yet, at some time, with some patients - all doctors used some form of hormone treatment. Generally, Kaiser doctors appeared to use a lower rate of hormone therapy than doctors in private practice. Most doctors were aware of the existence of community resources. Kaiser doctors tend to most frequently use their own social service department or mental health clinic to handle the other-than-medical problems patients might experience. The community resources which received the highest mention overall were mental health clinics and members of the clergy. The next most frequent category was other mental health professionals. Six of the seventeen doctors interviewed named services, not now in existence, which they would use if available. Those most frequently mentioned were groups and information & referral services. Most doctors believed that the needs of women at the time of menopause were different from the needs of other women. Most frequently mentioned were changes in the women's family structure, changes in her activities, and feelings of being no longer needed. Several doctors who were interviewed echoed researchers such as Bernice Neugarten and Pauline Bart in stressing the negative attitudes which our society has towards women at the age of menopause. In addition, many of the gynecologists expressed awareness of social needs. The results of the study indicate that doctors' services are primarily involved with treatment of medical or biological concerns, and referrals are generally to mental health resources. Several doctors mentioned social needs of the women; and as has been noted, the need for attitudinal change. Social workers can play important roles to bring about these changes. Two possible approaches are suggested: education to increase awareness of medical and social work professionals and the establishment of new resources to advocate for women at the time of menopause. Suggestions for further research are also given.

The central thesis of this paper is that the social work profession needs to know much more about menopause and its concomitants in order to enhance diagnosis and treatment. Unfortunately, the woeful lack of research and consequent paucity of data on the subject require a heavy reliance upon intuitively plausible statements in support of larger propositions about many of the strategic relationships advanced in the course of the argument. When these propositions and statements are taken as a whole, the paper is also an outline of essential research topics.

No description available.

Bakgrund: Sexualiteten är en integrerad del av människans hälsa och kan variera i upplevelse och uttryck. Klimakteriet inträder som en naturlig del av åldrandet och kan ge upphov till olika kroppsliga förändringar. Primärvården ansvarar för att hjälpa kvinnor med klimakteriebesvär och i distriktssköterskans roll ingår att vårda hälsofrämjande, personcentrerat och förebyggande med ett holistiskt och hälsopedagogiskt förhållningssätt. Syfte: Syftet var att belysa kvinnors erfarenheter av sexualitet vid klimakteriet. Metod: En litteraturöversikt med systematisk ansats genomfördes och baserades på 15 artiklar av kvalitativ metod. Artiklarna inhämtades från Ageline, CinahlComplete och Pubmed. Använda sökord var sexuality, sexual health, menopause, climacteric, experience, perception och perspective. Tematisk analys utfördes utifrån Thomas och Hardens (2008) metodbeskrivning. Resultat: De huvudteman som framkom var Fysiska förändringar och Förändrad parrelation. Det första handlade om olika känslor som kvinnorna upplevde till följd av de fysiska förändringarna såsom vaginal torrhet och värmevallningar vilket påverkade deras sexuella lust. Det andra temat visade att kvinnor upplevde förändringar i parrelationen vilket främst orsakades av en obalans i sexuell lust och kvinnors förändrade behov. De hade olika sätt att hantera detta på i syfte att främja samlaget. Slutsats: Klimakteriet kunde påverka kvinnors sexualitet med olika symtom och förändring av sexuell lust. Det orsakade en känslomässig påverkan och kunde även influera parrelationen på olika sätt. Förändringarna hanterades olika där vissa sökte stöd via samtal, medan andra valde att inte diskutera det. / Background: Sexuality is an integral aspect of human well-being and can vary in experience and expression. Menopause occurs as a natural part of aging and can lead to various physical changes. Primary care providers are responsible for helping women with menopausal symptoms. The nurse’s role includes provision of person-centered care, that is preventive with an educational approach. Aim: The aim was to explore women’s experiences of sexuality during menopause. Method: A systematic literature review was conducted based on 15 articles of qualitative method. The articles were obtained from Ageline, CinahlComplete and Pubmed. The search terms used were sexuality, sexualhealth, menopause, climacteric, experience, perception and perspective. Thematic analysis was performed using Thomas and Harden’s (2008) method description. Results: Main themes emerging were Physical changes and Changed partner relationship. The first included different feelings experienced as a result of physical changes such as vaginal dryness and hot flushes which in turn affected their sexual desire. The second theme showed that women experienced changes in their relationship with their partner, mainly caused by an imbalance in sexual desire and women’s changed needs. They had different ways of handling this using various approaches to maintain sexual intercourse. Conclusion: Menopause impacted women’s sexuality through various symptoms and changes in sexual desire. It caused emotional effects and could also influence the dynamics of intimate relationships differently. The management of these changes varied, with some seeking support through conversations with others, while others chose not to discuss it.