Bakgrund: Klimakteriet är en period på ett antal år före och efter menopaus, kvinnans sista mens. Menopausen inträffar i genomsnitt vid 51-52 års ålder. Symptom som kan uppkomma under klimakteriet beror till stor del på sjunkande östrogennivåer som kan ge värmevallningar, svettningar samt tunna och sköra slemhinnor i underlivet. Klimakteriet innebär för kvinnan en tid av förändringar och hur hon upplever det kan variera. Syfte: Att beskriva kvinnors upplevelser av klimakteriet.Metod: Den valda metoden är en litteraturstudie och tio vetenskapliga studier med kvalitativ ansats inkluderades. Sökningarna efter vetenskapliga studier utfördes i PubMed och CINAHL. Resultat: Fem olika teman identifierades efter att resultaten i studierna analyserats: ”Behov av information”, ”En ny fas i livet”, ”Symptom i den nya livsfasen”, ”Kontakt med vården” och ”Att hantera klimakteriet”.Slutsats: Det finns en stor variation i hur klimakteriet upplevs. För vissa kvinnor påverkas det dagliga livet stort medan andra upplever det som en enkel passage. Flera kvinnor har obesvarade frågor och efterfrågar mer kunskap för att bättre kunna hantera de förändringar som klimakteriet medför. Därmed är det angeläget för sjuksköterskan att ha kunskaper om klimakteriet och de förändringar som det innebär för kvinnorna. / Background: Menopause is a period of several years before and after a woman's last menstrual period. The menopause occurs on average at the age of 51-52. Symptoms that may occur during menopause is due in large part to decreasing estrogen levels that may cause hot flashes, sweating and thin and fragile vaginal mucosa. For women, menopause is a time of change and the experiences can vary. Aim: To describe women’s experiences of menopause.Method: The chosen method is a literature review and ten qualitative research studies were included. The search for scientific studies was performed in PubMed and CINAHL. Results: Five different themes were identified following the analysis of the results: “Need for information”, “A new phase in life”, “Symptoms in the new life phase”, “Contact with health care” and “To manage menopause”.Conclusion: There is great variation in how women experience menopause. Some women’s daily life is affected while others experience it as an easy passage. Several women have unanswered questions and are in need for more knowledge to better manage the changes that menopause causes. It is therefore of great importance for the nurse to have knowledge about menopause and the changes it causes.

The nanoscale dimension known as D-spacing describes the staggering of collagen molecules, which are fundamental to the biphasic makeup of bone tissue. This dimension was long assumed to be constant, but recent studies have shown that the periodicity of collagen is variable. Given that the arrangement of collagen molecules is closely related to the degree of bone mineralization, recent studies have begun to look at D-spacing as a potential factor in the ongoing effort to battle postmenopausal osteoporosis. The theoretical models presented by previous studies have only opted to model a single collagen-hydroxyapatite period, so the creation of an intricate computational approach that more exhaustively models a network of collagen and mineral is well-warranted. Sheep present an excellent opportunity to examine metabolic disorders, as their bone structure similar to that of the human skeleton. Six Rambouillet-cross ewes were used for the purpose of gathering experimental data. Three ewes underwent a sham surgery (controls), while an ovariectomy (OVX) was performed on the remaining three sheep. Each sheep was sacrificed after 12 months and their radius and ulna were harvested for atomic force microscopy and mechanical testing. Each sheep bone produced up to 25 beam samples that were available for analysis, and two were randomly selected from each test sheep. The cranial anatomical sector was selected for testing as it replicates the tensile loading condition characteristically experienced by collagen molecules and its exclusive examination removes any unintended variation due to bone section. Experimental D-spacing measurements were used in a finite element software, Abaqus, to create the ``Complex Model'': a large-scale, 2-D staggered array representation of collagen and hydroxyapatite periodicity. D-spacings intrinsic variability was mimicked through a Gaussian distribution that randomly determined periodic lengths based on provided experimental data. The model was generated with these random conditions for 2 x 100 units. Safeguards were implemented to ensure appropriate ratios of collagen to hydroxyapatite throughout the randomization. Collagen was assigned viscoelastic material properties originally developed by Dr. Frank Richter and modified by Miguel Mendoza. Hydroxyapatite was modeled as an elastic isotropic material. Four models were created using randomized D-spacings from control sheep and four separate models were created based on OVX sheep. Tangent delta--a damping characteristic--was recorded to evaluate bone viscoelasticity across four test frequencies: 1, 3, 9, and 15 Hz. Results strongly suggest that the Complex Model matches experimental findings more accurately than previous computational approaches. These results indicate the complicated network of many collagen units is an essential parameter of adequate modeling. A repeated measures analysis of variance was performed to examine the differences between control and OVX sheep. After adjusting for all other predictors, at the 1% significance level, after adjusting for all other variables, there is not enough evidence to convince this study that the Surgical Treatment alone has a significant impact on output tangent delta. This finding leads this study to conclude that OVX is fully accounted for within the Complex Model through the inclusion of its D-spacing, and the answers to bone's complicated mechanical properties during estrogen loss may lie in how OVX changes collagen viscoelasticity. Significant interactions were found between the Model Type and the Test Frequency. A Tukey-Kramer pairwise comparison was performed between Complex and Experimental data, which determined the Complex Model did not behave statistically differently from experimental findings at 15 Hz. This result suggests the Complex Model may begin to be validated to experimental results in a statistically meaningfully way that is a first for this style of FEA approach. The flexibility implemented in the randomization of the Complex Model welcomes refinement primarily in modeling viscoelasticity and fine-tuning the representation of mineralization. Through adjusting these material characteristics, the Complex Model may become an even more powerful tool in examining bone viscoelasticity and metabolic disorders.

Background: Menopause is a natural part of life which can affect a woman's physical and mental health. Women's experience and knowledge of menopause varies globally, and insufficient knowledge can lead to unnecessary suffering. Knowledge of the menopause is important, both for the women themselves and for the healthcare system in order to guide the women to appropriate self-care methods, which can be crucial to health in this new phase of life. Purpose: The aim was to account for the effect health education, has on health and quality of life onwomen in menopause. Method: A general literature study consisting of quantitative studies which included four randomized controlled studies, five quasi and one semi-experimental study, without a control group. Results: The results showed that the knowledge that the women acquired during the educational interventions had a positive effect by improving the women's awareness and attitude towards the menopause, which empowered them to improve their lifestyles, and through this develop an increased health and thus a better quality of life. Conclusion: Knowledge is the key to an improved quality of life. Through a structured education, the nursing care can increase the awareness and knowledge of women regarding their self-care during the menopause. This strengthens women's autonomy and is cost-effective for healthcare.

In females, menopause-related reductions in estrogen may cause declines in cardiovascular health and increase the risk for stroke. In the event of stroke, cardiovascular health of postmenopausal females may be further worsened. It is well established that physical activity and exercise improves cardiovascular health in the general population and in those with chronic conditions, including stroke. However, the nature and extent of the associations between physical activity and cardiovascular health of pre- and post-menopausal females with, and without, stroke are unclear. This thesis is comprised of two studies to address this knowledge gap. The first study was a systematic review to examine the effect of aerobic exercise on cardiovascular health of postmenopausal females, and the association with different exercise intensities. Five electronic databases from inception to May 6th, 2022, were searched for randomized-controlled trials of aerobic exercise interventions reporting cardiovascular outcomes in postmenopausal females. Data was synthesized qualitatively, and random-effects meta-analyses and subgroup analyses (for light, moderate, vigorous intensity) were performed. Fifty-six studies (4134 participants;45-78 years of age) were identified. Aerobic exercise interventions varied in frequency (3-21x/week), intensity, type, time (8-60 min/session), and duration (3-52 weeks). Fifty studies (n=3730) were included in the quantitative synthesis. Aerobic exercise improved systolic blood pressure (SBP) (Mean difference(MD)=-3.67mmHg, 95%CI[-6.88,-0.46],p=0.03), resting heart rate (MD=-5.76bpm, 95%CI[-5.76,-1.61],p<0.01), body mass index (BMI)(MD=-0.65kg/m2, 95%CI[-0.99,-0.31],p<0.01), waist circumference (WC) (MD=-2.03cm, 95%CI[-2.65,-1.41],p<0.01), body fat (MD=-2.57kg, 95%CI[-3.65,-1.49],p<0.01), low-density lipoprotein cholesterol (MD=-10.46mg/dL, 95%CI[-16.31,-4.61],p<0.01), high-density lipoprotein cholesterol (MD=3.28mg/dL, 95%CI[0.20,6.36],p=0.04) and cardiorespiratory fitness (Standardized MD=1.43, 95%CI[1.17,1.70],p<0.01). Subgroup differences in exercise intensity were only present for BMI where light- and vigorous-intensities were beneficial, and moderate intensity had no effect (X2=9.79, df=2,p<0.01), and for blood triglycerides and blood glucose where light intensity showed a beneficial effect and there was no effect of moderate and vigorous intensities (triglycerides X2=7.70, df=2, p=0.02; glucose X2=20.98, df=2, p<0.01). The second study was a cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging that examined the association between physical activity and cardiovascular health in females with stroke, and the interaction with menopause. Generalized linear models with applied sampling weights were used to examine the associations between cardiovascular health, and self-reported physical activity, while controlling for age and smoking history. Subsequent models included an interaction between physical activity and menopausal status. The sample included 1468 females with stroke (103 premenopausal). Physical activity was beneficially associated with SBP (ß = -0.02 (SE=0.01), p=0.04, 95% CI: -0.42 to -0.0005), WC (ß = -0.03 (SE=0.008), p<0.01, 95% CI: -0.05 to -0.02), waist-to-hip ratio (ß = -0.00009 (SE=0.00004), p=0.03, 95% CI: -0.0002 to -0.0000007), C-Reactive protein (ß = -0.007 (SE=0.003), p<0.02, 95% CI: -0.013 to -0.001). There were no interactions between physical activity and menopausal status for all outcomes. Together, these studies contribute to the development of future guidelines and research to improve cardiovascular health in underrepresented and high-risk populations of postmenopausal females and females with stroke. / Thesis / Master of Science Rehabilitation Science (MSc) / Exercise and physical activity are good for the health of the heart and blood vessels. We do not know how physical activity also benefits females after menopause and females with stroke. This thesis examined the association between physical activity and the health of the heart and blood vessels in females before and after menopause, with and without stroke. The first study reviewed other studies that looked at the effect of aerobic exercise on the health of the heart and blood vessels in females after menopause. We found that after menopause females might benefit from aerobic exercise. We also found that different intensities of exercise may affect the health of the heart and blood vessels better than others, but more research is needed. The second study found that physical activity is related to better health of the heart and blood vessels in females after stroke, and whether a female has undergone menopause does not change this relationship. These studies show that exercise and physical activity may help the health of heart and blood vessels in females after menopause and females with stroke. Together they may help inform future exercise and physical activity guidelines and research to improve the health of the heart and blood vessels in these populations.

As women age and transition into menopause they face a higher risk of developing osteoarthritis leading to total joint replacements. Estrogen is the primary female reproductive hormone. As a woman approaches menopause, estrogen production decreases by 100-fold. Previous research has shown that Estrogen Replacement Therapy (ERT) reduced joint replacements in post-menopausal women. However, there is a lack of research surrounding ERT's effect on chondrocyte proliferation and extracellular matrix production, particularly 3D culture extracellular matrix production. Chondrogenesis is a process of skeletal development resulting in the formation of cartilage. Chondrocytes, derived from mesenchymal progenitors, serve as the fundamental cellular component in the development of articular cartilage, facilitating smooth joint movement. This thesis examines female articular cartilage in both 2D growth assessment and using 3D aggregates with and without arthritis-like inflammatory conditions. Estrogen seems to have minimal effect on growth, metabolic activity, and extracellular matrix production. Healthy and pre-exposed osteoarthritic cartilage donors indicate some variability within the data. Overall, this project allowed us to further elucidate the mechanism of estrogen hormone replacement therapy utilizing healthy and osteoarthritic samples.

No description available.

Osteoarthritis (OA) is a prevalent and progressive musculoskeletal condition characterized by the degradation of the cartilage and bone and is often comorbid with cardiovascular disease (CVD), with both disease prevalence’s increasing with age. Several factors, such as the site of OA and the menopause transition, are known to independently influence both conditions. OA and CVD share overlapping risk factors and proposed mechanisms, though it is not well understood how these mechanisms influence the risk of comorbidity. This thesis examines the relationship of CVD risk factors, sites of OA, and menopausal variables on CVD risk in individuals with OA. The first aim of this thesis was to examine preclinical markers of CVD risk, namely the carotid intima-media thickness (cIMT) and cardiovascular risk scores, the Framingham risk score (FRS) and the InterHeart risk score (IHRS), in individuals with and without OA to examine differences in CVD risk profiles. Additional considerations were given to the site of OA, as well as non-specific CVD risk factors (such as social disadvantage and frailty). Risk factors were compared between age- and sex-matched individuals with and without OA and between weight-bearing and non-weight bearing OA. Individuals with OA had significantly greater cIMT, FRS, and IHRS, though no differences were found when comparing the site of OA. Unadjusted and multivariate adjusted odds ratios (OR) calculated odds of CVD at 3-year follow-up in the same cohorts. There was a significantly unadjusted (p<0.001, OR:1.70) and adjusted (p<0.001, OR ranging from 1.67-1.70) influence of OA diagnosis on odds of CVD at 3-year follow-up. There was no significant unadjusted or adjusted difference in odds of CVD at 3-year follow-up when comparing different sites of OA (p ranging from 0.24-0.75, OR ranging from 0.69-0.71). The second aim of this thesis was to study CVD risk in post-menopausal women. CVD risk factors and the IHRS were used to calculate differences between age-matched post-menopausal women. Unadjusted and multivariable adjusted ORs calculated odds of CVD at 3-year follow-up. There was a significant unadjusted influence of OA diagnosis (p=0.03, OR:1.34) on CVD outcomes, though the effect of OA diagnosis became non-significant after adjusting for the IHRS (p=0.25, OR:1.36) and the IHRS with menopausal variables (p=0.22, OR:1.40). Although OA is a multifaceted condition, it has often been viewed as a joint-centric disease. The elevated risk of CVD individuals with OA suggests that additional aspects of the OA pathology, such as inflammation and frailty, may drive the increase in risk of CVD independent of age, sex, or menopausal status. / Thesis / Master of Science (MSc) / Osteoarthritis (OA) and cardiovascular disease (CVD) are two of the most prevalent comorbidities that affect the aging population. Surrogate measures of CVD, such as CVD risk scores and carotid intima-media thickness, have rarely been examined in individuals with OA despite studies showing elevated CVD risk in individuals with OA. We used baseline and 3-year follow-up data collected by the Canadian Longitudinal Study on Aging to study CVD risk factors in older individuals with and without OA, with considerations given to the site of OA and to menopause, which are additional non-modifiable factors known to influence vascular outcomes. We hypothesized that individuals with OA have greater CVD risk and odds of developing CVD compared to individuals without OA. We found that individuals with OA have greater CVD risk and odds of developing CVD at 3-year follow-up, with no influence of OA site on CVD outcomes, and post-menopausal women with OA have greater odds of developing CVD than post-menopausal women without OA. Our findings suggests that aspects of the OA pathology play a role in increasing CVD risk, which are partially explained through shared risk factors and etiology.

The purpose of this paper is to examine the female hormonal cycle throughout a woman's life and its effects on the singing voice. Dealing with vocal issues brought on by hormonal fluctuations can be extremely frustrating for the professional singer, as these issues can wreak havoc on performance and practice schedules. The best weapon of defense against its unpredictability is information. Unfortunately, data on the female hormonal cycle and its effects on the voice is not covered in most standard vocal pedagogy books. Information on the subject is often relegated to a small section of a chapter, and even then usually describes only the symptoms: edema, hoarseness, and loss of high notes and power. The question as to why these symptoms happen every month and during menopause, and whether there is anything that can be done to alleviate them, remains largely unanswered. A candid discourse on the subject of hormones and the female voice has begun, but now must brought into the open. It is a subject that needs to be broached in voice studios everywhere. Can the effects of hormonal fluctuations on the voice be managed? What treatments are there for the symptoms; are they safe; are they effective? How can we further the dissemination of information on this subject? This paper will attempt to answer these questions by compiling data from the studies and research of esteemed doctors and scientists on this subject into one document, making it easy for young students and interested voice teachers to access this important information. It is my goal with this monograph to help and inform my readers. The human larynx is directly influenced by lifelong cyclical hormonal fluctuations. A woman's monthly cycle, which lasts from puberty to menopause, causes changes in hormone concentrations. These changes can affect a woman's physical and emotional states, causing bloating, and temporary abnormalities in sleep, mood, concentration levels, and energy. These effects are also seen in the vocal tract, where edema, vocal fatigue, decreased range, and lowering of the fundamental frequency can occur. The monthly symptoms of hormonal change are called premenstrual syndrome, or PMS. Similarly, the symptoms manifested in the larynx are called premenstrual vocal syndrome, or PMVS. This paper is an examination and exploration of the effects of PMS and PMVS on the singing voice. To do so, it provides a brief overview of the steroid hormones: estrogen, progestogen, and androgen. These three hormones are responsible for the development and maturation of primary and secondary sexual characteristics. It is only through studying the specific functions of each of the steroid hormones that it is made clear why some women suffer so profoundly each month from PMS and PMVS. Additionally, this paper provides information regarding the benefits and drawbacks of oral contraceptives, or OCPs. OCPs contain synthetic hormones that mimic the body's own natural hormones, and they regulate the body's levels of estrogen and progesterone, which prevents ovulation. In addition to their contraceptive use, OCPs are used to treat endometriosis, acne, and irregular periods. By preventing the body's hormonal levels from fluctuating, OCPs have proven highly effective as a treatment of PMS and PMVS. Further, the changes to the voice during pregnancy will be examined. The increased hormonal concentrations associated with pregnancy act upon the reproductive organs, muscles, bone, cerebral cortex, and mucosa, as well as the larynx. This paper also explores what happens to the voice throughout the stages of menopause, the symptoms of which can range from moderate to quite severe. Treatment options are discussed, including both hormone replacement therapy and alternative methods. Lastly, this paper shares information gathered from a survey of singers regarding their own experiences with PMS and PMVS, OCPs, pregnancy, and menopause. / Music Performance

To determine the effect of estrogen on weight changes in women, eight adult females were followed for a period of six months subsequent to hysterectomy or ovariohysterectomy. Three groups comprised the study: 1) a hysterectomy or control group, 2) an ovariohysterectomy group with estrogen replacement therapy, and 3) an ovariohysterectomy without estrogen treatment group. Body weight, caloric intake, and activity level were recorded for the eight prospective subjects over the six month period. Weight data were gathered from past medical records on an additional 19 patients meeting the treatment criteria. Weight changes between groups were not statistically significant. A trend in weight changes among the groups was noted. The hysterectomy group lost five pounds, ovariohysterectomy treated group lost one pound and the untreated group, 0.2 pound. The same trend in weight changes was noted when data from prospective and retrospective subjects were combined. Caloric intake and activity levels did not explain all changes noted. Detailed information on subjects was presented as case studies. The results supported the concept that endogenous estrogen protects against weight gain; evidence did not support the comparable action of exogenous estrogen. Subjects having ovariohysterectomy stated that they experienced appetite changes such as cravings for sweets, undesirable muscle tone and body contour changes, and difficulty in ability to control weight. Further research with a larger sample size is needed to determine direct relationships between female hormones and suppression of weight gain in women. / Master of Science

Yes / Objective To assess the quality, readability and coverage of website information about herbal remedies for menopausal symptoms. Study design A purposive sample of commercial and non-commercial websites was assessed for quality (DISCERN), readability (SMOG) and information coverage. Main outcome measures Non-parametric and parametric tests were used to explain the variability of these factors across types of websites and to assess associations between website quality and information coverage. Results 39 sites were assessed. Median quality and information coverage scores were 44/80 and 11/30 respectively. The median readability score was 18.7, similar to UK broadsheets. Commercial websites scored significantly lower on quality (p = 0.014), but there were no statistical differences for information coverage or readability. There was a significant positive correlation between information quality and coverage scores irrespective of website provider (r = 0.69, p < 0.001, n = 39). Conclusion Overall website quality and information coverage are poor and the required reading level high.