What Physicians Should Advise their Mature Patients Concerning Gender Transition
Clearly, the issue of gender being a binary characteristic of humans is a societal norm of western culture [1]. Many cultures such as the Hijra of Nepal, Bangladesh, Pakistan and India, the Muxes of Mexico and the Bugis Tribe of Indonesia recognize more than two genders. However, over the past five years, western society is breaking down gender silos and with this the number of individuals describing themselves as transgender has increased. As transgender individuals work their way into healthcare systems, clinicians in many different specialties are being called on to help facilitate both affirmation of gender and mainten...
Source: Maturitas - June 12, 2019 Category: Primary Care Authors: Anne Koch Source Type: research

Effectiveness of occupational therapy interventions in acute geriatric wards: a systematic review
Scientific advances, together with economic and social growth, have contributed to substantially improving the quality of life in developed countries, thus increasing life expectancy. It is estimated that the average life expectancy in Spain is 80.3 years for men and 85.7 years for women 1. Coupled with a decrease in birth rate, this has led to an exponential aging of the population. Currently, 18.8% of the Spanish population is over the age of 65 and this is estimated to reach 34.6% in 2066, making Spain one of the oldest countries in the world. (Source: Maturitas)
Source: Maturitas - June 10, 2019 Category: Primary Care Authors: C ésar Cuevas-Lara, Mikel Izquierdo, Marta Gutiérrez-Valencia, Itxaso Marín-Epelde, Fabricio Zambom-Ferrasi, Beatriz Contreras-Escámez, Nicolás Martínez-Velilla Source Type: research

Shoe design for older adults: evidence from a systematic review on the elements of optimal footwear
The world is ageing rapidly. By 2050, the world ’s population aged ≥60 is expected to total 2 billion, up from 900 million in 2015, and the population aged ≥80 is projected to triple from 137 million in 2017 to 425 million in 2050 [1]. (Source: Maturitas)
Source: Maturitas - June 6, 2019 Category: Primary Care Authors: Anton Jellema, Toon Huysmans, Klaas Hartholt, Tischa van der Cammen Source Type: research

Co-designing with people with dementia: a scoping review of involving people with dementia in design research
Fifty million people worldwide were living with dementia in 2018 and the numbers are expected to triple to 152 million by 2050 [1]. Dementia is the loss of cognitive functioning in a way that, most of the time, compromises the person ’s daily-life activities and social interactions [2]. Some of the main functions affected in people with dementia (PwD) are memory, verbal skills, visual perception, and attention span [3]. These cognitive impairments hinder PwD from expressing what they want and how they feel, which makes caring for PwD different from caring for older adults who can communicate their needs and preferenc...
Source: Maturitas - June 5, 2019 Category: Primary Care Authors: Gubing Wang, Chiara Marradi, Armagan Albayrak, Tischa J.M. van der Cammen Source Type: research

Long-term consequences of androgen insensitivity syndrome
Androgen insensitivity syndrome (AIS) is a rare X-linked disorder characterized by mutations of the androgen receptor (AR) gene, causing variable degrees of androgen resistance in individuals with the XY karyotype. AIS is one of the most common XY disorders of sexual development [1,2], with an estimated prevalence between 2 and 5 per 100.000 [3]. (Source: Maturitas)
Source: Maturitas - June 5, 2019 Category: Primary Care Authors: Konstantia Kosti, Loukas Athanasiadis, Dimitrios G. Goulis Source Type: research

What indicators have been used to evaluate the impact of music on the health and wellbeing of people with dementia? A review using meta-narrative methods
The value of music to people with dementia is widely acknowledged [1,2]. However, research into music and dementia is still a relatively new and developing field, and appears to have evolved fairly independently within different disciplines such as music therapy, psychology and nursing. Systematic reviews synthesise evidence about the effects of music, but tend to focus on one type of intervention or outcome variable, such as music therapy [3] or anxiety [4], and include only certain types of studies [5]. (Source: Maturitas)
Source: Maturitas - June 4, 2019 Category: Primary Care Authors: Becky Dowson, Orii McDermott, Justine Schneider Source Type: research

Depressive disorders, anxiety disorders and subjective mental health in common musculoskeletal diseases: a review
Poor mental health, musculoskeletal diseases (MSDs) and their comorbidities are major threats to work and functional ability [1 –2]. In 2017, mental disorders and MSDs were estimated to account for over 30% of the global years lived with disability (YLDs) [3]. The relationship between mental health and the common MSDs has not received enough attention, despite the research on several specific associations between depressio n and other somatic diseases [4–9]. (Source: Maturitas)
Source: Maturitas - May 29, 2019 Category: Primary Care Authors: Jeremi Heikkinen, Risto Honkanen, Lana Williams, Janni Leung, P äivi Rauma, Shae Quirk, Heli Koivumaa-Honkanen Source Type: research

Editorial board
(Source: Maturitas)
Source: Maturitas - May 26, 2019 Category: Primary Care Source Type: research

Inertial wearables as pragmatic tools in dementia
Dementia is a common disorder in older adults where the major subtypes include Alzheimer ’s disease and vascular dementia [1]. Traditional tests designed to diagnose neurodegenerative disorders are often delayed in detecting abnormalities in cognitive decline in the earliest stages of the disease [2]. Hence, there is a need for robust pragmatic and objective tools to aid clinical deci sions. (Source: Maturitas)
Source: Maturitas - May 24, 2019 Category: Primary Care Authors: A Godfrey, M Brodie, KS van Schooten, M Nouredanesh, S Stuart, L Robinson Source Type: research

Effects of high-protein, high-calorie oral nutritional supplementation in malnourished older people in nursing homes: an observational, multi-center, prospective study (PROT-e-GER). Protocol and baseline population characteristics
The prevalence of malnutrition increases with age, due to factors such as comorbidity, loss of appetite (anorexia), a reduction in physical activity, poor oral health, loss of the ability to eat autonomously and cognitive impairment [1,2]. (Source: Maturitas)
Source: Maturitas - May 23, 2019 Category: Primary Care Authors: Vincenzo Malafarina, Jos é Antonio Serra Rexach, Ferran Masanes, Alfonso J. Cruz-Jentoft Source Type: research

The effect of occupation type on risk of Alzheimer ’s disease in men and women
The high incidence rate of Alzheimer's disease (AD) is a major public health problem [1], even though recent reports show that the age-specific incidence of dementia may be declining [2]. At present, there is no cure for AD. Therefore, it is essential to identify risk factors to prevent or slow down the progress of this disease. (Source: Maturitas)
Source: Maturitas - May 20, 2019 Category: Primary Care Authors: Javier Santab árbara, Ana Cristina Gracia-Rebled, Raúl López-Antón, Concepción Tomás, Elena Lobo, Guillermo Marcos, Antonio Lobo Source Type: research

Identification of five frailty profiles in community-dwelling individuals aged 50 to 75: a latent class analysis of the SUCCEED survey data
Frailty is commonly used to assess the health status of older people. It is a multidimensional syndrome in which decreased physiological reserve capacity leads to impaired stress adaptation mechanisms. Frailty corresponds to a deceptive, precarious state of equilibrium that can decompensate when a stressful event occurs (e.g. when a close friend dies or a relative moves away) and increases the likelihood of adverse health outcomes such as falls, disability, hospitalization and death [1]. It is a progressive but reversible condition that begins with a preclinical stage; hence, early detection of frailty and the application ...
Source: Maturitas - May 20, 2019 Category: Primary Care Authors: Lauriane Segaux, Nadia Oubaya, Amaury Broussier, Marjolaine Baude, Florence Canoui-Poitrine, Henri Naga, Marie Laurent, Claire Leissing-Desprez, Etienne Audureau, Emilie Ferrat, Christophe Chailloleau, Isabelle Fromentin, Jean-Philippe David, Sylvie Bastu Source Type: research

Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults ≥65 years
The European population is estimated at 515 million inhabitants, of which 19% is currently aged 65 years and older. This is expected to increase to 29% in 2060 [1,2]. Longevity is one of the main causes for the increasing number of people aged 65 years and older in Europe. Ageing is both wonderful and problematic, the latter because increased longevity often brings health-related issues [3], among which protein-energy malnutrition (PEM) is frequently observed [4,5]. PEM is associated with delayed recovery from disease, poorer quality of life and increased risk of morbidity and mortality [6]. (Source: Maturitas)
Source: Maturitas - May 17, 2019 Category: Primary Care Authors: Susanne Leij-Halfwerk, Marije H. Verwijs, Sofie van Houdt, Jos W. Borkent, Patr ícia Realino Guaitoli, Thomas Pelgrim, Martijn W. Heymans, Lauren Power, Marjolein Visser, Clare A. Corish, Marian A.E. de van der Schueren, the MaNuEL Consortium Source Type: research

Tech world and medicine come together to harness digital medicine
Chances are you own a smartphone. There is also a chance you use only a fraction of the functionality your smartphone offers. Most people use the core communication functionality their smartphone provides, without comprehending the power that resides in the palm of their hand. The technology is 120 million times more powerful than that of the 1971 Apollo spacecraft [1]. True, the ability to stay connected via speech or short text-based messages is a 21  st century phenomenon that allows humans to engage and relay information like never before but more impressive and perhaps, more important options exist. (Source: Maturitas)
Source: Maturitas - May 16, 2019 Category: Primary Care Authors: A Godfrey, S Stuart, P Tenaerts Source Type: research

Frailty and multimorbidity in the elderly
The sustained increase in life expectancy determines a higher number of individuals presenting aging-related traits, specifically a rise in the prevalence of frailty and in vulnerability to chronic diseases. The changes imposed by aging in cells and systems are at the base of those phenotypic profiles. Advances in the science of aging are revealing pathways involved in the deceleration of that otherwise relentless process. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Antonio Cano Tags: INV1 Source Type: research

Effect of programmed exercise on depressive/anxiety symptoms, sleep quality, and perceived stress in postmenopausal women: evidence from meta-analyses
Depressive symptoms are common yet potentially serious in mid-aged women, particularly during the menopausal transition, when hormonal fluctuations occur. Different drug treatments have been recommended; although many women do not follow them. There are conflicting results from observational studies concerning the effect of exercise on depressive/anxiety symptoms, sleep and perceived stress in postmenopausal women. Meta-analyses of randomized clinical trials (RCTs) provide a global approach to obtain recommendations. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Faustino Perez-Lopez Tags: INV2 Source Type: research

Impact of diet and lifestyle on frailty prevention
An appropriate diet and a healthy lifestyle including non-smoking, a normal weight and regular physical activity can reduce the risk for cancer and cardiovascular disease effectively. According to epidemiological data women who were least adherent to nutrition and lifestyle recommendation are characterized by a 3fold higher hazard of dying from cancer and a 4fold increase with regard to cardiovascular death. Evidently the impact of diet and lifestyle on cancer and cardiovascular disease goes beyond the effects of classical risk factors and may target inflammatory processes, epigenetic modification and the intestinal microb...
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Birgit-Christiane Zyriax Tags: INV3 Source Type: research

Short and long term effects of menopause
The average of the menopause is 50 and with increasing longevity could be considered to be a midlife event. Hot flushes and night sweats are the most common symptoms of the menopause and affect up to 85% of women. Starting in the perimenopause, they usually are present for less than five years, but some women will continue to flush beyond the age of 60 years. Genitourinary Syndrome of Menopause (GSM) is a chronic condition and has been estimated to affect 1 in 2 women. The major chronic systemic diseases are: cardiovascular disease, osteoporosis, sarcopenia, dementia and cognitive decline. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Margaret Rees Tags: INV4 Source Type: research

Improving sex at menopause - is testosterone the answer?
There has been much controversy as to the precise role of endogenous androgens in women and the place of testosterone replacement in women with distressing low sexual desire. Healthy young women produce approximately 100 - 400 mcg per day. This represents three to four times the amount of estrogen produced by the ovaries. Approximately half the endogenous testosterone and precursors are derived from the ovaries and half from the adrenal glands. Testosterone contributes to sexual desire, arousal and orgasm; clearly there are other factors involved including psychosexual, physical, iatrogenic and environmental. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Nick Panay Tags: INV5 Source Type: research

Chronic inflammation and its consequences during female midlife
During the menopausal transition there is a gradual decrease in the secretion of ovarian estrogens, which has been correlated to female bio, psycho- and social changes. Estrogens play an important role in maintaining many female systems in appropriate functioning. As a direct or indirect consequence of this progressive estrogenic decrease, women tend to increase their weight as they age. Obesity has been related to an increase of insulin resistance, type 2 diabetes, hypertension, increased cardiovascular risk and the development of other chronic disorders, via inflammation as a consequence of the enhanced secretion of pro-...
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Peter Chedraui Tags: INV6 Source Type: research

Lipid and glucose metabolism during the menopausal transition & beyond
Transition to menopause, characterized by estrogen decline, is associated with increase in body weight and central adiposity. Moreover, energy expenditure is decreased, as a result of mood changes, comorbidity and inactivity. Insulin secretion and action may also be affected. All these metabolic alterations increase the risk of Type 2 diabetes mellitus. LDL-cholesterol and triglyceride levels increase, while HDL-cholesterol levels decrease during the transition to menopause. Oral estrogens have a decreasing effect on LDL-cholesterol, however, they may increase triglyceride levels. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Irene Lambrinoudaki Tags: INV7 Source Type: research

Eating patterns, body composition and cardiometabolic health in menopause
Menopausal transition is associated with hormonal changes, which contribute to the increase in visceral fat mass and the development of abdominal obesity in postmenopausal women. Additionally, postmenopausal period is characterized by several lifestyle changes resulting in decrease in energy expenditure, mainly as a result of the reduction in physical activity, as well as changes in food choices. Some of these changes have been depicted in the relevant research, examining nutrient intake and dietary adequacy. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Mary Yannakoulia Tags: INV8 Source Type: research

Longterm consequences of diet styles (vegetarian, vegan, low-carb …)
Dietary pattern such as the Mediterranean Diet, the Dietary Approaches to Stop Hypertension (DASH), the Healthy Eating Index or a vegan diet have shown some impact on the development of chronic diseases and mortality. The DASH-diet is considered evidence-based and established for reducing elevated blood pressure and prevention of coronary heart disease. A Mediterranean diet has been shown to reduce cardiovascular events in patients with a metabolic syndrome, whereas a vegan diet together with physical activity, and stress management can induce regression of coronary stenoses and reduce angina pectoris even in clinically ov...
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Birgit-Christiane Zyriax Tags: INV9 Source Type: research

Benefits of exercise during peri-and postmenopause
Menopause is associated with an increasing risk to develop the so called metabolic syndrome. A major reason is the decrease of circulating estrogen, a sex steroid which is involved in a variety of metabolic processes. Estrogens affect fat metabolism, bone metabolism and protein metabolism. Declining estrogen levels are associated with adverse lipid profiles, a reduced ability o to metabolize fatty acids, reduced bone mass and density and with a decrease in skeletal muscle mass. All this has implications for the development of diseases like cardiovascular disease, sarcopenia, osteoporosis and diabetes type II. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Patrick Diel, Anja Wacker, Katharina Br ück, Georg Predel, Birna Bjarnason-Wehrents Tags: INV10 Source Type: research

Impact of diet on menopausal symptoms
Women and health professionals have been exploring the effects of diet and weight loss on menopausal symptoms for many years but the evidence is conflicting and limited to hot flushes. There is observational and interventional evidence to suggest that adherence to dietary guidelines (low fat and sugar), and a high consumption of plant-based foods in particular, is associated with decreased severity of hot flushes. This may be independent of weight loss. This suggests that dietary components are important. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Margaret Rees Tags: INV11 Source Type: research

Diagnostics and fracture risk prediction
Diagnostics in osteoporosis and fracture risk prediction should never rely on bone mineral density (BMD) measurements alone. Data from the National Osteoporosis Risk Assessment (NORA) in the USA revealed some 15 years ago that only 6.4% of postmenopausal women with new fragility fractures had T-scores of −2.5 or less (WHO definition of osteoporosis) in BMD tests performed one year before the event. The majority of fractures occurs in patients with osteopenia or normal BMD. Many of them are middle-aged women, 40 to 65 years old, an age group not much attended to in most studies on osteoporosis. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Ewald Boschitsch Tags: INV12 Source Type: research

Bone health care in breast cancer survivors
Breast cancer is the most common type of cancer affecting women, while the majority are treated for cure nowadays. Therefore, monitoring of long-term consequences is necessary and important, with bone heath representing a very essential parameter. Anti-hormonal therapies are often used to reduce the risk of breast cancer recurrence. Aromatase inhibitors (AIs) reduce the peripheral conversion of androgens to estrogens. Both the steroidal (exemestane) and non-steroidal AIs (letrozole and anastrazole) have been associated with bone loss and increased risk of fractures. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Stavroula A. Paschou Tags: INV13 Source Type: research

Bone health care in hypogonadal men with prostate cancer
Osteoporosis is one of the most frequent diseases in postmenopausal women leading to an increased fracture risk due to the physiologic loss of the bone protective effects of estrogen. Hereby, several risk factors for fracture such as prevalent fracture, low BMD, age, low BMI, family history, tendency to falls, smoking, use of SSRIs, glucocorticoid use etc. have been identified. Additionally, the further reduction of endogenous hormones with chemotherapy (CHT) or GnRH-analoga continuously increases fracture risk. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Peyman Hadji Tags: INV14 Source Type: research

Management of urinary incontinence
Menopause, a natural biological process in women's aging, leads to a large number of adaptive changes of the female pelvic floor, related to life and endocrine events. Genitourinary syndrome of menopause (GSM) is a neologism that describes several menopausal symptoms and signs, associated with changes of the vulva, vagina, and lower urinary tract, such as dyspareunia, dysuria, frequency, nocturia, incontinence, and recurrent infections. The management of these complex patients should consider the connection between menopause and aging bladder dysfunction: these women need a multidisciplinary approach. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Tommaso Simoncini Tags: INV15 Source Type: research

Vaginal laser therapy - hype or established treatment?
Noninvasive treatment is recommended as first line for urinary incontinence (UI) in women. However, surgical procedures are more likely to be implemented to cure UI but are associated with more adverse events. Less invasive operative mesh techniques are relatively effective, but not immune to complications such as bleeding, bladder perforation, urethral injury, infection, and the retention requiring mesh resection. In patients for whom the risks of anesthesia and surgery are too high, a minimally invasive approach is recommended and further research is needed in terms of more compliant, less invasive and low-cost methods f...
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Ivan Fistonic Tags: INV16 Source Type: research

Historical development of menopausal issues. Have we delivered what we promised?
The history of the female menopause is one riddled with mythology, misogyny, ignorance, false promises made and unfulfilled, graft, corruption, extortion, and just a little fulfillment and hope. Perhaps this is the story of the world. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Wulf Utian Tags: INV17 Source Type: research

Testosterone: the known knowns, the known unknowns and the unknown unknowns
Testosterone has long been recognised as a critical hormone for women. Known knowns are that the ovaries and adrenals are the primary sources of circulating testosterone, that iatrogenic suppression, removal of both ovaries or both adrenals, or spontaneous ovarian/adrenal failure will result in low testosterone, and that exogenous testosterone treatment will improve sexual function in women presenting with low libido. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Susan R. Davis, Marina A. Skiba, Penelope J. Robinson, Rakibul M. Islam, Robin J. Bell Tags: INV18 Source Type: research

Changing demands at the workplace - now and in future
In all EU countries, women's labour participation is lower than men's. However, times are changing and the gender employment gap is slowly closing. There is a rise in dual-income households during the child-rearing years, as women continue to work after the birth of their children. Furthermore, the employment rate for women aged 50 and above is increasing throughout all Europe. This is partly explained by demographic ageing and the increase in retirement age, a trend that will continue to have an effect in the coming decade. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Marije Geukes Tags: INV19 Source Type: research

Elderly employees - burden or benefit
Recent data show that today 60% or more of women participate in labour force. The number of women age 51 years or older on the workplace are expected to increase during the next decade. To lessen the impact of an aging population elderly people are encouraged to continue working. The supply of workers aged 50 and above has risen rapidly since 2011. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: H. Oosterhof Tags: INV20 Source Type: research

Menopausal women's needs at the workplace
Menopausal women's needs at work will be described drawing upon a recent qualitative study addressing the question: ‘What do working menopausal women want?’ (Hardy, Griffiths, Hunter 2017 Maturitas). Following this the development and evaluation of two interventions, that aim to meet the needs of working menopausal women, will be described: (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Myra Hunter Tags: INV21 Source Type: research

Why CVD in women is killer number 1
The proportion of total deaths attributable to CVD in Europe is greater for women (51%) than for men (42%). Classic manifestations of cardiovascular diseases (CVD) develop on average 7 –10 years later in women than in men. The risk in women is systematically underestimated (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Angela H.E.M. Maas Tags: INV22 Source Type: research

Cardiovascular health management: preventive assessment
Cardiovascular disease (CVD), the leading cause of death among men and women, represents a significant women's health concern. While the majority of cardiovascular prevention guidelines are similar for men and women, there is growing appreciation that there may be sex differences in the magnitude of relative and absolute benefits and harms of preventive interventions. For instance, while aspirin is associated with a reduction in the risk of CVD events in both men and women, the specific types of benefit appear to differ by sex, with some evidence that aspirin therapy lowers myocardial infarction risk in men (but not women)...
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Maria Grazia Modena, Elisa Lodi, Alberto Scavone, Alberto Carollo Tags: INV23 Source Type: research

Statins for the treatment of hypercholesterolaemia in post menopausal women - solution or problem?
Studies have demonstrated that statins reduce cardiovascular risk in men and women, but the effectiveness of statins among low-risk women continues to be contentious. One reason is that the number of women enrolled in statin trials has been small relative to men, limiting statistical inferences. Also, for any given age women have a lower absolute risk of cardiovascular disease when compared to men. When absolute benefit is low, the risk of adverse effects becomes more important. Myopathy and rhabdomyolysis are rare but established side-effects of statin therapy, and concern is growing that statins could increase the risk o...
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Peter Collins Tags: INV24 Source Type: research

MHT in myocardial infarction and stroke survivors
30 years ago, it was believed that there is a clear cut protective effect of estrogen in women with coronary artery disease. This was based on studies that monitored the outcomes of postmenopausal hormone therapy (MHT) in women with various basal clinical scenarios, such as myocardial infarction, coronary angiography or coronary artery bypass. These studies were observational, and treatment usually comprised of conjugated equine estrogen alone or combined with medroxyprogesterone acetate. However, results of randomized, placebo-controlled trials (secondary prevention, but mainly primary prevention) pointed at neutrality or...
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Amos Pines Tags: INV25 Source Type: research

Osteoporosis and breast cancer: pathogenesis, diagnosis and treatment
Osteoporosis is one of the most frequent diseases in postmenopausal women leading to an increased fracture risk due to the physiologic loss of the bone protective effects of estrogen. Hereby, several risk factors for fracture such as prevalent fracture, low BMD, age, low BMI, family history, tendency to falls, smoking, use of SSRIs, glucocorticoid use etc. have been identified. Additionally, the further reduction of endogenous estrogens with chemotherapy (CHT), GnRH-analoga or aromatase inhibitors (AI) continuously increases fracture risk. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Peyman Hadji Tags: INV26 Source Type: research

MHT in menopausal women at risk: comorbidity endometriosis
The observation that disease recurrence was not substantially increased among women with endometriosis who had hysterectomy and bilateral oophorectomy and subsequently receive low-dose hormone therapy for bone protection and symptom relief after surgical menopause would imply that various tissues differ in their sensitivity to estrogen. A dose of estrogen sufficient to provide bone protection would not necessarily be high enough to reactivate endometriosis. This concept forms the basis of the ‘estrogen threshold theory’. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Tevfik Yoldemir Tags: INV27 Source Type: research

Progestogen Intolerance (in MHT): what are the options?
Progestogens have a variety of effects apart from the one for which their use was intended, that of secretory transformation of the endometrium. Symptoms of fluid retention are produced by the sodium retaining effect of the renin-aldosterone system which is triggered by stimulation of mineralocorticoid receptors. Androgenic side effects such as acne and hirsuitism are a problem of the testosterone derived progestogens due to stimulation of the androgen receptors. Mood swings and PMS-like side effects result from stimulation of the central nervous system progesterone receptors. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Nick Panay Tags: INV28 Source Type: research

Estrogen on the breast Yin or Yan?
The normal breast and most of breast cancers are influenced by hormones. Estradiol is responsible of the rapid proliferation of the breast at puberty. Breast cancers belong to different histological types defined by their content in hormone receptors (estradiol and progesterone receptors (ER,PR)), the amplification of HER2 or the lack of these markers. The prognosis of these types is different the best one beeing the ER+,PR+ breast cancers (luminal A type), the worse the triple negative ones, devoided of ER, PR and HER2. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Anne Gompel Tags: INV29 Source Type: research

Impact of combined MHT on breast cancer risk (incl Mirena ®)
Both estrogen postmenopausal therapy and estrogen-progestogen postmenopausal therapy are listed as ‘group one carcinogenic to human’ by the International Agency for Research on Cancer (American Cancer Society). The use of equine estrogen (CEE) combined with medroxy progesterone acetate (MPA) is associated with an increase in breast cancer. Using CEE-only entails a reduction of breast cancer r isk in the WHI-E study. Well-designed experimental studies indicate that some progestagens, including MPA, might interfere with apoptosis induced by estrogen. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Herman Depypere Tags: INV30 Source Type: research

Hormone-based strategies for management of BrCa1 and 2 carriers
Women found to have mutations of the BrCa 1 or 2 genes face many therapeutic decisions with respect to prevention of ovarian and breast cancer and management of menopausal symptoms after natural or surgical menopause. The first issue is whether these women should undergo breast cancer prevention with an antiestrogen. This issue predominantly affects pre-menopausal women. The majority of data suggest that tamoxifen reduces the risk of breast cancer by approximately 50% of women with these two mutations (RR 0.38 –0.50 for BrCa1 and 0.42–0.63 for BrCa2). (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Richard Santen Tags: INV31 Source Type: research

Modern evaluation of abnormal uterine bleeding
Abnormal uterine bleeding in women older than age 40 years, and certainly in menopausal patients, mandates evaluation, mainly to exclude cancer and hyperplasia, but also to better diagnose the source of the bleeding to appropriately manage the patient. In the past, dilation and curettage was the mainstay of diagnosis. This gave way to in-office suction pump-generated biopsies. Most recently, disposable biopsy instruments with their own internal piston to generate suction have become the standard of care. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Steven Goldstein Tags: INV32 Source Type: research

Surveillance and treatment of endometrial hyperplasia
Endometrial hyperplasia is a relatively common condition to encounter occurring more often in women over the age of 30 years. Histopathology is pivotal in guiding the best clinical advise, which will also be influenced by other factors, in particular, the patients age and parity. In post-menopausal women where atypia is found in the histological specimen, the probability of an underlying carcinoma been present is in the region of 40 –50%, and thus in such women the standard care is to advice a hysterectomy. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Sean Kehoe Tags: INV33 Source Type: research

MHT in menopausal women at risk: comorbidity cerebrovascular disease
Because stroke incidence increases with age, the absolute risk of stroke associated with standard-dose hormone therapy will be less among women close to the time of menopause, the group of women more likely to consider hormone therapy for vasomotor symptoms. These risks, which are rare but not negligible, should be considered by mid-life women and their physicians when discussing hormone therapy initiation and maintenance for treatment of vasomotor symptoms. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Tevfik Yoldemir Tags: INV34 Source Type: research

Osteoporosis and sarcopenia
are among the most dangerous conditions for postmenopausal women, with potential reduction of quality of life and life expectancy. Osteoporosis is a decreased bone strength, with subsequent increased susceptibility to fracture. Sarcopenia is an age-related decrease of muscle mass, with subsequent functional alterations and loss of strength, increased risk of falls, and decreased personal autonomy. In women, menopausal period is linked to a significant decrease in estrogen levels and an accelerated decline in bone/muscle mass and strength. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Stefano Lello, Anna Capozzi, Giovanni Scambia Tags: INV35 Source Type: research

Systemic lupus erythematosus
SLE is an autoimmune and inflammatory disease. It is much frequent in women than men (9/1). In general women have more susceptibility to auto-immune diseases and this is interpreted by the effects of estrogens on auto-immunity at different levels and including the AIRE gene. (Source: Maturitas)
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Anne Gompel Tags: INV36 Source Type: research