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Objective : To evaluate the effects of hormone therapy ( HT ) on cognition and subjective quality of life ( QoL ) in recently postmenopausal women with cognitive complaints . Methods : Cognitive Complaints in Early Menopause Trial ( COGENT ) was a r and omized , double-blind , placebo-controlled , multicenter , pilot study of 180 healthy postmenopausal women aged 45 to 55 years , r and omly assigned to receive either placebo or conjugated equine estrogen 0.625 mg/medroxyprogesterone acetate 2.5 mg for 4 months . Outcome measures included memory , subjective cognition , QoL , sexuality , and sleep , which were assessed at baseline and month 4 . Results : The study was terminated before the expected final sample size of 275 due to a decrease in enrollment coinciding with the publication of findings from the Women ’s Health Initiative . There were no differences between groups on any cognitive or QoL measures , except for an increase in sexual interest and thoughts with HT . Modest negative effects on short- and long-term verbal memory approached significance ( p < 0.10 ) . Women with baseline vasomotor symptoms ( VMS ) showed a decrease in VMS and an improvement in general QoL , but no cognitive benefit vs placebo . Conclusions : With the power to detect an effect size of ≥0.45 , this study suggests potential modest negative effects on verbal memory that are consistent with previous hormone therapy trials in older women . GLOSSARY : BTA = Brief Test of Attention ; BVRT = Benton Visual Retention Test ; COGENT = Cognitive Complaints in Early Menopause Trial ; CRT = Educational Testing Service Card Rotation Test ; CVLT = California Verbal Learning ; FAS = Letter Fluency Test ; HERS = Heart and Estrogen/progestin Replacement Study ; HT = hormone therapy ; MFSQ = McCoy Female Sexuality Scale Question naire ; MFQ = The Memory Functioning Question naire ; PANAS = Positive and Negative Affect Scale ; PSQI = The Pittsburgh Sleep Quality Index ; QoL = subjective quality of life ; SWAN = Study of Women ’s Health Across the Nation ; UQoL = Utian Quality of Life ; VMS = vasomotor symptoms Test ; WHI = Women ’s Health Initiative ; WHISCA = WHI Study of Cognitive Aging ; WMS-R/DGT-F , MS-R/DGT-B = Digit Span Forward and Backward Subtests of the Wechsler Memory Scale – Revised Women experience somatic , mood , energy , and libido changes during menopause .  Testosterone replacement therapy is being prescribed in conjunction with estrogen replacement therapy ( ERT ) for these symptoms . Little is known about women ’s perceptions of the benefits and risks of testosterone , so an Internet survey was conducted to elicit women ’s perceptions of the effects on mood , energy , sexuality , and somatic symptoms .  A sample of 61 women primarily from the United States and Canada participated in the survey ; one woman from Germany and one from Sweden also took part in the survey . Participants reported significantly improved sexuality and improved mood and vigor , with a decline in fatigue . Of the 7 somatic complaints assessed , improvements were noted in 5 ( sleep disturbances , hot flashes , night sweats , vaginal dryness , and appetite ) . A prospect i ve clinical trial is needed to confirm these results OBJECTIVE To provide up date d guidelines for health care providers on the management of menopause in asymptomatic healthy women as well as in women presenting with vasomotor or urogenital symptoms and on considerations related to cardiovascular disease , breast cancer , urogynaecology , and sexuality . OUTCOMES Lifestyle interventions , prescription medications , and complementary and alternative therapies are presented according to their efficacy in the treatment of menopausal symptoms . Counselling and therapeutic strategies for sexuality concerns in the peri- and postmenopausal years are review ed . Approaches to the identification and evaluation of women at high risk of osteoporosis , along with options for prevention and treatment , are presented in the companion osteoporosis guideline . EVIDENCE Published literature was retrieved through search es of PubMed and The Cochrane Library in August and September 2012 with the use of appropriate controlled vocabulary ( e.g. , hormone therapy , menopause , cardiovascular diseases , and sexual function ) and key words ( e.g. , hormone therapy , perimenopause , heart disease , and sexuality ) . Results were restricted to clinical practice guidelines , systematic review s , r and omized control trials/controlled clinical trials , and observational studies . Results were limited to publication date s of 2009 onwards and to material in English or French . Search es were up date d on a regular basis and incorporated in the guideline until January 5 , 2013 . Grey ( unpublished ) literature was identified through search ing the websites of health technology assessment and health technology assessment -related agencies , national and international medical specialty societies , and clinical practice guideline collection INTRODUCTION Sexual dysfunction is more prevalent in postmenopausal women . AIMS To prospect ively evaluate and compare the effects of hormone therapy ( HT ) regimens , oral and vaginal estradiol , estradiol + drospirenone and tibolone , on  sexual function in healthy postmenopausal women . METHODS The study included 169 consecutive healthy postmenopausal women , and the women were divided into two groups : 111 women received HT , and 58 women received no treatment and served as a control group . As an HT , 23 women with surgically induced menopause received oral 17-beta estradiol . The rest of the women with natural menopause were prospect ively r and omized : 22 received oral 17-beta estradiol + drospirenone daily , 42 received oral tibolone , and 24 received vaginal 17-beta estradiol .  Sexual function was evaluated with a detailed 19-item question naire , the female sexual function index , including sexual desire , arousal , lubrication , orgasm , satisfaction , and pain . MAIN OUTCOME MEASURES The differences in sexual function were compared before and 6 months after the treatment in all women . RESULTS Total sexual function score increased from 19.81 + /- 7.15 to 22.9 + /- 6.44 in the HT group and decreased from 21.6 + /- 8.69 to 17.6 + /- 5.7 in the control group , revealing a significant difference from baseline to post-treatment between the two groups ( P = 0.000 ) . The highest improvement in total score and arousal was achieved with the oral 17-beta estradiol ( P = 0.000 and P = 0.000 , respectively ) . The highest improvement in lubrication was achieved with the oral and vaginal 17-beta estradiol groups ( P = 0.000 ) . The highest improvement in orgasm was achieved with the tibolone group ( P = 0.000 ) . The highest improvement in pain was achieved with the oral and vaginal 17-beta estradiol groups ( P = 0.000 ) . CONCLUSIONS HT provided significant improvement in sexual function compared to women receiving no treatment , and therefore , HT regimens should be suggested for improvement in sexual functioning of postmenopausal women BACKGROUND Evidence suggests that a high proportion of perimenopausal and postmenopausal women experience vasomotor symptoms ( hot flushes/night sweats ) that can be severe and disruptive and which are the principal reason for seeking medical intervention . Hormone therapy ( HT ) is known to be an effective treatment for troublesome hot flushes/night sweats but research has raised questions about the safety of HT and there have been negative high profile media reports about its use . Consequently many women are seeking alternatives and exercise might be one such option but there is a lack of high quality evidence on its effectiveness . AIMS This RCT initially aims to investigate the feasibility/acceptability of two exercise interventions identified from our previous preference study in 165 women , and if found to be feasible/acceptable , continue to recruit sufficient women ( n=261 ) to examine the effect of these interventions on hot flushes/night sweats and other outcomes relevant to menopausal women . METHOD We aim to recruit inactive perimenopausal and menopausal symptomatic women not using HT and r and omise them to one of two exercise interventions or usual care for six months . RESULTS We will assess outcomes at baseline and 6 and 12 months from r and omisation . CONCLUSION We hope this RCT will contribute towards increasing the evidence regarding the question of whether exercise is an effective treatment for vasomotor symptoms in women not taking HT OBJECTIVE : To estimate the effect of the selective serotonin reuptake inhibitor sertraline on hot flush frequency and severity in perimenopausal and postmenopausal women . METHODS : We performed a r and omized , blinded , placebo-controlled trial in women aged 40 to 60 years with 14 or more hot flushes per week ( N=99 ) . Women were r and omly assigned initially to daily oral sertraline ( 50 mg ) or identical placebo for 2 weeks . If no substantial side effects were noted , the dose was increased to two tablets daily ( 100 mg sertraline or placebo ) and continued for an additional 4 weeks . Hot flush frequency and severity were recorded on a daily diary . Hot flush score was calculated as frequency multiplied by severity . Participants also completed question naires addressing quality of life , menopausal symptoms , sleep quality , sexual function , mood , and side effects . RESULTS : After 6 weeks of treatment , hot flush frequency decreased similarly in both the placebo ( 38 % ) and sertraline ( 39 % ) groups ( P=.94 ) . Mean hot flush scores also decreased similarly in both groups ( 41 % and 42 % , respectively , P=.86 ) . Compared with placebo , women in the sertraline group were more likely to report gastrointestinal complaints , dry mouth , and dizziness . Treatment with sertraline also result ed in greater worsening of scores on the Medical Outcomes Study ( MOS ) Short Form 36 st and ardized physical component and the global Female Sexual Function Index . Results were similar in women at least 80 % adherent to study medication . CONCLUSION : Treatment with sertraline did not improve hot flush frequency or severity in generally healthy perimenopausal and postmenopausal women , but was associated with bothersome side effects . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00283192 LEVEL OF EVIDENCE : Background For postmenopausal women , the main reason to start hormone therapy ( HT ) is to reduce menopausal symptoms and to improve quality of life ( QOL ) . The aim of this study was to analyse the impact of HT on different aspects of symptom experience and QOL during a r and omised trial . A total of 1823 postmenopausal women were recruited into the Estonian Postmenopausal Hormone Therapy ( EPHT ) trial in 1999–2001 . Women were r and omised to blind HT , open-label HT , placebo or non-treatment arm . After one year in the trial , a question naire was mailed and 1359 women ( 75 % ) responded , 686 in the HT arms and 673 in the non-HT arms . Mean age at filling in the question naire was 59.8years . The question naire included Women 's Health Question naire ( WHQ ) to assess menopause specific QOL of middle-aged women together with a 17-item question naire on symptoms related to menopause , a question about painful intercourse , and a question about women 's self-rated health . Results After one year in the trial , fewer women in the HT arms reported hot flashes , trouble sleeping , and sweating on the symptom question naire . According to WHQ , women in the HT arms had fewer vasomotor symptoms , sleep problems , and problems with sexual behaviour , but more menstrual symptoms ;  HT had no effect on depression , somatic symptoms , memory , attractiveness , or anxiety . A smaller proportion of women reported painful intercourse in the HT arms . There were no significant differences between the trial arms in women ’s self-rated subjective health . Conclusions The results from the EPHT trial confirm that HT is not justified for treating symptoms , other than vasomotor symptoms , among postmenopausal women . WHQ proved to be a useful and sensitive tool to assess QOL in this age group of women OBJECTIVE To determine whether oophorectomy during the perimenopause , with the associated decline in ovarian and rogens , affects sexual function and psychological well-being negatively . DESIGN Prospect i ve , observational study comparing sexuality and psychological well-being in women after hysterectomy only ( HYST ) vs. hysterectomy and concomitant oophorectomy ( HYST+BSO ) .  SETTING University hospital and district general hospital . PATIENT(S ) Three hundred sixty-two perimenopausal women scheduled for elective hysterectomy on benign indication were recruited and 323 ( 89 % ) completed the 1-year follow-up ( 217 in the HYST group and 106 in the HYST+BSO group ) . INTERVENTION(S ) The patients were evaluated preoperatively and 1 year after surgery . Postoperatively , estrogen replacement therapy was recommended to all women in the HYST+BSO group and to HYST group subjects with climacteric symptoms . MAIN OUTCOME MEASURE(S ) Sex steroids ( T , and rostenedione , DHEA-S , and E(2 ) ) and sex hormone-binding globulin ( SHBG ) were measured . Free and rogen index and free E(2 ) index were calculated . Sexuality ( McCoy 's Female Sex Question naire ) and psychological well-being ( Psychological General Well-Being Index ) were evaluated . RESULTS ( S ) Preoperatively , no hormonal differences were found between the two groups . At 1-year follow-up , all sex steroid levels and indices were decreased and SHBG was increased in the HYST+BSO group . Ovarian sex steroids were decreased in the HYST group , whereas DHEA-S and SHBG were unaltered . Sexuality was unaltered in the HYST+BSO group , whereas decreased scores were found in 3 of 14 sexual variables in the HYST group . Psychological well-being was improved in both groups . There were no correlations between the observed changes ( data 1 year after surgery , compared with preoperative data ) in and rogen levels and index and the observed changes in any aspect of sexuality or psychological well-being . CONCLUSION ( S ) Hormonal changes after oophorectomy in conjunction with perimenopausal hysterectomy do not significantly change postoperative ( 1-year ) sexual or psychological well-being Background With the exception of sexual functioning and weight , social and behavioural effects of postmenopausal hormone therapy ( HT ) have not been reported from trials . This paper reports such results from the EPHT-trial in Estonia . Methods A r and omized trial , with a blind and non-blind sub-trial in Estonia . From 1999–2001 , 1778 women were recruited . The mean follow-up was 3.6 years . Women 's experiences were asked in the first and final study year by mailed question naires ( 74 and 81 % response rates ) . Comparisons of the groups were made by cross-tabulation and logistic regression , adjusting for age . Results There were no differences between the HT and non-HT groups in regard to being employed , the extent of social involvement or marital status or opinions on aging . There was no difference in the frequency of free-time exercise , or overweight . Some of the indicators suggested less sexual inactivity , but the differences were small . Conclusion In a trial setting , postmenopausal hormone therapy did not influence work or social involvement or health behaviour . Trial registration IS RCT BACKGROUND In perimenopause many women complain of psychogenic and organic disorders often connected with initial and increasing levels of hypoestrogenism . In this study we evaluated the effects of hormone replacement therapy ( HRT ) in symptomatic women in perimenopause . METHODS We enrolled 100 healthy and symptomatic women who were r and omly distributed to two groups for a 12-month study . Group A : 50 patients received HRT with estradiol valerate and cyproterone acetate ( Pausene(R ) ) ; Group B : 50 patients were used as a control group ( treated with Cacit Vitamin D30(R ) ) . A number of clinical and instrumental tests were performed at 0 , 6 and 12 months to evaluate any changes in vasomotor and urogenital symptoms , bone and serum homeostasis and possible sexual disorders . The statistical analysis was performed using the c2 test . RESULTS The group of women receiving HRT showed a significant reduction in vasomotor clinical symptoms ( p<0.001 ) and sexual disorders ( p<0.002 ) ; this was not reflected in the control group where libido decreased steadily with apparent slight improvements only at the end of the study . The urogenital disorders disappeared almost completely in Group A , whereas they diminished in Group B. HRT patients also showed a slight increase ( p<0.001 ) in the initial value of BMD ( bone mineral density ) , a reduction in the marker for bone turnover and an improved lipid profile ( p<0.05 ) . These changes were unfortunately not noted in Group B. CONCLUSIONS On the basis of these results we conclude that HRT appeared to have a beneficial effect on perimenopausal clinical symptoms over the 12-month period , leading to marked improvements in the psychophysical wellbeing of symptomatic women in perimenopause In this report we evaluated the action of conjugated equine estrogens ( CEE ) on vaginal symptoms , cytology , pH , and flora in late postmenopausal women without any previous hormone therapy . The study was a r and omized , double-blind , placebo-controlled trial with 48 late postmenopausal women who received placebo or unopposed CEE ( 0.625mg/day of CEE orally ) during three months of treatment .  Vaginal and sexual complaints were evaluated through daily diary cards . We analyzed vaginal changes through cytology and pH measurements . After three months of treatment , 20 % of placebo-treated patients and 80 % of the CEE-treated patients reported improvement in vaginal dryness and irritation . In the latter group , the vaginal cells and Lactobacillus increased and the vaginal pH decreased , without other changes in sexual complaints . We concluded that estrogen ameliorated the genital tract of late postmenopausal women without any previous hormone therapy Objective To assess the effects of raloxifene , estrogen , and placebo on quality of life in healthy , asymptomatic , postmenopausal women . Methods In a multicenter , double-blind , 12-month study , 398 women were assigned r and omly to one of four groups : raloxifene HCl , 60 ( n = 97 ) or 150 mg/day ( n = 100 ) ; conjugated equine estrogens , 0.625 mg/day ( n = 96 ) ; or placebo ( n = 105 ) . The Women 's Health Question naire , a vali date d quality -of-life instrument for perimenopausal and postmenopausal women , was administered at baseline and 3-month intervals . Results Overall , quality of life from baseline to end point was preserved equally in all treatment groups . Six domains ( depressed mood , somatic symptoms , memory/ concentration , sexual behavior , sleep problems , and perceived attractiveness ) were unchanged in all groups . Three domains ( menstrual symptoms , vasomotor symptoms , and anxiety/fears ) were statistically significantly different among groups . Mean scores for menstrual symptoms significantly worsened and vasomotor symptoms significantly improved from baseline to end point in the estrogen group . Mean scores for vasomotor symptoms did not worsen at any point in the raloxifene 60 mg/day group . Mean anxiety/fears scores improved significantly during raloxifene 60 mg/day administration throughout treatment ( P < .05 ) , irrespective of previous hormone replacement therapy , baseline estradiol ( E2 ) levels , or years postmenopause . Conclusion Most quality -of-life domains were not affected by treatment with estrogen or raloxifene . Estrogen provided relief from vasomotor symptoms but caused menstrual symptoms . Raloxifene 60 mg/day improved anxiety levels in postmenopausal women Background Adding testosterone to hormonal therapy could improve sexual function and general well-being among women during climacteric . We evaluated the effectiveness of testosterone undecanoate on sexual function in postmenopausal women utilizing the st and ardized question naire FSFI score . Methods Postmenopausal women with sexual complaints and Female Sexual Function Index ( FSFI ) ≤ 26.5 were enrolled in to this r and omized , double-blinded , placebo-controlled trial . Participants were r and omly assigned to 8-week treatment with either oral testosterone undecanoate 40 mg or placebo twice weekly with daily oral estrogen .  The FSFI scores before and after treatment were compared to assess any improvement of sexual function . Results Seventy women were recruited of which each group had 35 participants . The baseline characteristics and baseline FSFI scores were comparable between both groups . After 8 weeks of treatment , the FSFI scores significantly improved in both groups when compared to the baseline but the FSFI scores from the testosterone group were significantly higher than in the placebo group post-treatment ( 28.6 ± 3.6 , 25.3 ± 6.7 , respectively , p = 0.04 ) . There was no difference in adverse effect between the two groups Conclusions The twice weekly addition of testosterone undecanoate to daily oral estrogen was associated with a significant improvement in sexual function  among postmenopausal women than the use of the estrogen alone . Trial registration Clinical Trials.gov Identifier NCT01724658 ( February 17 , 2012 ) From a longitudinal prospect i ve study , 160 women with spontaneous menopause and without steroid medication were followed during the transition from pre- to  postmenopause  . After 12 years 152 women were still participating in the study . Blood sample s were drawn every 6 months until 1 year after the menopause and every 12 months thereafter . Measurements of bone mineral density ( BMD ) on the forearm were performed every second year . All women routinely completed a question naire concerning symptoms frequently attributed to the climacteric period . All data were grouped around the onset of the menopause , thereby allowing longitudinal evaluation of the changes in the variables from the premenopausal to the postmenopausal period . The beginning of the perimenopausal period was characterized by transitory elevations of follicle-stimulating hormone ( FSH ) . A significant increase in serum levels of gonadotropins was observed for both FSH and luteinizing hormone ( LH ) from about 5 years before the menopause . Within the 6 month period around the menopause there was a further increase which culminated within the first postmenopausal year for LH and 2 - 3 years postmenopause for FSH . Thereafter , a continuous decrease in LH occurred over the following 8 years . With respect to FSH , there was a slight decline starting about 4 years postmenopause . During the premenopausal period an increasing frequency of inadequate luteal function or anovulation occurred and , in the postmenopausal years , the serum levels of progesterone ( P ) were invariably low . Gradually , the ratio between estrone ( E1 ) and 17-beta-estradiol ( E2 ) increased , reflecting the declining follicular steroidogenesis . A marked decrease in estrogen levels occurred during the 6 month period around the menopause , most pronounced in E2 . During the next 3 years , the levels of E2 and E1 showed an essentially parallel , moderate decline . Around the menopause , serum levels of testosterone ( T ) , delta 4- and rostenedione ( A ) and sex hormone-binding globulin ( SHBG ) showed small but significant decreases . From about 3 years postmenopause , the levels were relatively constant over the following 5 years . A decrease in BMD was observed in the postmenopause , and from about 3 years postmenopause , estradiol correlated positively with BMD . Before , as well as after the menopause , body mass index ( BMI ) showed an inverse correlation with SHBG . Postmenopausal and rostenedione correlated positively with E1 , E2 and T. BMI correlated positively with E1 and E2 . The concentrations of the free fraction of E2 and T are dependent on the levels of SHBG , which in turn has a negative correlation with BMI . The impact of this will influence the severity of symptoms , the degree of bone loss and the need for supplementary therapy Objective To compare the effect of different formulations of continuous combined hormone therapy on sexual performance in naturally postmenopausal women . Material and methods A total of 158 postmenopausal women were enrolled and prospect ively r and omized to the single-blind study . Fifty-four women received tibolone 2.5 mg , 53 received 2 mg estradiol and 2 mg dienogest ( E2/dienogest ) , and 51 did not receive any menopausal therapy . The patients were monitored after 6 months . Attitudes of sexuality were evaluated by using the Rosen 's female sexual function index . Results Compared with E2/dienogest and the control group , tibolone treatment was associated with more improvement of sexual performance , including sexual desire , sexual arousal and satisfaction . Both of the hormone therapies decreased frequencies of vaginal dryness and painful intercourse . Conclusions Tibolone has more positive effects on the sexual dysfunction of postmenopausal women and may be an alternative to the E2/dienogest preparation in postmenopausal women with sexual dysfunction Objective : To determine the difference , if any , in the placebo response when both perimenopausal and postmenopausal women are enrolled , compared with postmenopausal women alone , in a study assessing the efficacy of synthetic conjugated estrogen tablets on moderate-to-severe vasomotor symptoms ( MSVS ) . Methods : A total of 120 healthy women ( 72 active ; 48 placebo ) complaining of moderate-to-severe vasomotor symptoms were enrolled in a r and omized , placebo-controlled , double-blind , multicenter clinical trial . In all , 109 patients completed treatment to week 12 . Women were enrolled using minimal inclusion and exclusion criteria , and included perimenopausal women ( n = 34 ; 0 to 6 months since last menses ) as well as menopausal women ( n = 79 ; > 12 months since last menses ) . Results : Changes in MSVS in the intent-to-treat ( ITT ) population showed differences between the active and placebo treatments at weeks 4 ( p < 0.022 ) , 8 ( p < 0.010 ) and 12 ( p < 0.010 ) . At week 12 , the mean percentage reduction in MSVS was 81 % for the active treatment group and 58 % in the placebo treatment group . To examine the placebo response , the ITT population was broken down into groups defined by the time since their last menses . The perimenopausal group ( 0 to 6 months since last menses ) demonstrated a consistently higher placebo response than that of the postmenopausal groups ( > 12 months since last menses ) . Conclusions : Perimenopausal women contributed to a higher placebo response , compared with the rate of response previously reported in clinical studies of estrogen replacement in postmenopausal women . Including perimenopausal women in future vasomotor symptom trials will require study population s of sufficient size to maintain the statistical power to demonstrate a difference between therapeutic response to active or placebo treatment Background Awareness of the risks associated with hormone therapy for menopausal symptoms has sparked a global decline in this treatment . Alternative treatments to relieve menopausal symptoms are therefore required . The applied relaxation ( AR ) technique has proven to be successful for symptom amelioration , but requires participation in 12 weekly classes . The purpose of this study was to determine the effectiveness of a modified relaxation version ( MR ) of AR for treatment of hot flashes , night sweats , and sleep disturbances . Methods We conducted a12-week , r and omized , parallel , open-label , controlled trial in perimenopausal and postmenopausal women visiting the menopausal clinic . Participants were r and omly assigned to an MR or AR group . The MR group ( n=36 ) received a single session of ( MR ) training and the AR group ( n=35 ) received conventional 12-week training . Participants were instructed to practice the techniques daily at home for 12 weeks . The main outcome was the measure on the severity scale and frequency of hot flashes , night sweats , and sleep disturbances . Results All participants completed the study .  Total severity scores in both groups decreased after 12 weeks , but there was no difference between the groups ( P=0.93 ) . The severity score for hot flashes in the MR group decreased more than in the AR group ( P=0.02 ) . The severity scores for night sweats and sleep disturbances decreased in both groups . The frequency of hot flashes , night sweats , and sleep disturbances were also decreased in both groups . Conclusion A shorter , modified version of the AR was equally effective or slightly better than the conventional AR for the relief of hot flashes , night sweats , and sleep disturbances in perimenopausal and postmenopausal women . Recommendations for future research include confirmatory studies and trials with larger sample OBJECTIVE To evaluate the benefits and risks of hormone replacement therapy ( HRT ) combined with methyltestosterone ( MT ) in postmenopausal women with sexual dysfunction .  DESIGN This study was a r and omized , double-blind , placebo-controlled and crossover trial . Eighty-five women using HRT  were divided into four treatment groups : GI-HRT plus placebo for 4 months ; GII-HRT plus MT 2.5mg/day for 4 months ; GIII-HRT plus placebo for 2 months and then replaced with HRT plus MT 2.5mg/day for 2 months ; GIV-HRT plus MT 2.5mg/day and then replaced with HRT plus placebo for 2 months . Blood was collected at baseline , after 2 months ( T1 ) and 4 months ( T2 ) of treatment for hormone determinations of estradiol , FSH , total and free testosterone , GOT , GPT , glucose , total and fractions of cholesterol and triglycerides . All participants answered clinical questions and a vali date d question naire of modified McCoy 's sex scale . RESULTS The association of HRT with MT 2.5mg/day did not significantly change liver enzymes or increase cardiovascular risk factors . The patients of GII , GIIII and GIV when using MT presented amelioration of sex symptoms , mainly satisfaction and desire ( p<0.01 ) ; however , GIII at T1 ( 1.3+/-0.3 ) presented similar problem score results as compared to GIII at T2 ( 1.5+/-0.6 ) . CONCLUSION All data suggest that combined HRT- and rogen therapy may be beneficial for postmenopausal women receiving HRT who continue to complain of sexual difficulties or for postmenopausal women with sexual complaints who are not undergoing estrogen therapy We conducted a double-blind , placebo-controlled study to determine the role of dietary supplementation on sexual function in women of differing menopausal status . One hundred eight ( 108 ) women , age 22–73 years , who reported a lack of sexual desire , enrolled as participants . Of these , 55 received ArginMax for women and 53 received placebo . ArginMax for women contains L-arginine , ginseng , ginkgo , damiana , multivitamins , and minerals . The 108 women , given definitions , self-reported as 59 premenopausal ( PRE ) ; 20 perimenopausal ( PERI ) , and 29 postmenopausal ( POST ) . After 4 weeks , PRE women on ArginMax primarily reported significant improvement in level of sexual desire ( 72 % ; p = 0.03 ) and satisfaction with overall sex life ( 68 % ; p = 0.007 ) , compared with placebo group , according to the Female Sexual Function Index ( FSFI ; Kaplan et al. , 1999 ) scales . Frequency of sexual desire ( 60 % ; p = 0.05 ) and frequency of intercourse ( 56 % p = 0.01 ) also increased among the PRE women . In contrast , among PERI women , primary improvements were reported for frequency of intercourse ( 86 % ; p = 0.002 ) , satisfaction with sexual relationship ( 79 % ; p = 0.03 ) , and vaginal dryness ( 64 % ; p = 0.03 ) compared with placebo group . POST women primarily showed an increased in level of sexual desire , with 51 % showing improvement , compared with only 8 % in the placebo group ( p = 0.008 ) . Nutritional intervention plays an important role in women 's sexual health , but issues and areas of greatest improvement differ among women of different menopausal states . The largest number of attribute improvements were seen in PRE and PERI women , although attribute types vary among these groups . Level of desire was shown to increase significantly in POST women . Since ArginMax for women has been shown to exhibit no estrogen activity , it may be desirable alternative to hormone therapy for sexual concerns Objective To evaluate the effect of the addition of methyltestosterone to estrogen and progestogen therapy on postmenopausal sexual energy and orgasm . Methods Sixty postmenopausal women in a stable relationship with a partner capable of intercourse , and presenting sexual complaints that appeared after menopause , were r and omly divided into two groups : EP ( n = 29 ) received one tablet of equine estrogens ( CEE ) 0.625 mg plus medroxyprogesterone acetate ( MPA ) 2.5 mg and one capsule of placebo ; EP + A ( n = 31 ) received one tablet of CEE 0.625 mg plus MPA 2.5 mg and one capsule of methyltestosterone 2.0 mg ; The treatment period was 12 months . The effects of treatment on sexual energy were assessed using the Sexual Energy Change Scale . The ability to reach orgasm in sexual relations with the partner was verified through monthly calendars and by calculating the ratio between monthly frequency of orgasms in sexual relations and monthly sexual frequency . Results There was a significant relationship between improvement in level of sexual energy and the addition of methyltestosterone to CEE/MPA treatment ( p = 0.021 ) . No significant effect on orgasmic capacity was noted after the treatment period . Conclusion Addition of methyltestosterone to CEE/MPA therapy may increase sexual energy , but might not affect the ability to obtain orgasm in sexual relations OBJECTIVE The aim of this study was to screen for disorders and to histologically classify endometrial biopsy specimens from 2964 perimenopausal and postmenopausal women who were c and i date s for hormonal replacement therapy .  STUDY DESIGN Endometrial biopsy specimens were obtained with a Vabra aspiration curette , processed by st and ard methods , and stained by hematoxylin and eosin and special methods to reveal subtle features of the endometrium . RESULTS Of the endometrial biopsy specimens , 68.7 % were atrophic , 23.5 % were proliferative , 0.5 % were secretory , 0.6 % were hyperplastic , 0.07 % were adenocarcinoma , and 6.6 % were insufficient for classification . Three independent senior microscopists agreed on the classification of each biopsy specimen . CONCLUSION The number of patients is the largest ever screened for a single hormone replacement therapy study . The low yield of endometrial cancer indicates that biopsies are unnecessary before hormone replacement therapy is initiated in asymptomatic women OBJECTIVE To investigate the efficacy of esterified estrogens alone and combined with oral and rogen on sexual function and menopausal symptoms in postmenopausal women . STUDY DESIGN Twenty postmenopausal women dissatisfied with their estrogen or estrogen-progestin therapy volunteered to enter a double-blind , r and omized trial in which they received either oral esterified estrogens or esterified estrogens + and rogen for eight weeks after a single-blind , placebo , lead-in period . Sexual function was assessed with a question naire used in the Yale midlife survey , and plasma levels of estradiol , estrone , sex hormone binding globulin ( SHBG ) and beta-endorphin were measured at two- to four-week intervals . RESULTS Estrogen- and rogen therapy significantly improved sexual sensation and desire after four and eight weeks of double-blind treatment in comparison to previous estrogen therapy and postplacebo baseline assessment s. Plasma levels of estradiol and estrone increased significantly in all patients as compared to the postplacebo baseline and decreased in comparison to circulating estrogen concentrations on previous therapy . Relative proportions of free and bound steroid hormone exhibited contrasting shifts during estrogen and estrogen- and rogen therapy .  SHBG increased in the estrogen group and decreased in the estrogen- and rogen group , leading to lower amounts of free and rogens during estrogen therapy and increased free and rogen levels during estrogen- and rogen therapy . Since proportions of free ( bioavailable ) ovarian steroids would correlate inversely with plasma protein binding capacity , the beneficial effects of oral estrogen- and rogen therapy on sexual sensation and desire may be due either to the administered and rogen or to the increased availability of endogenous and exogenous and rogens , particularly in the central nervous system . CONCLUSION Sexual desire , satisfaction and frequency in postmenopausal women taking hormonal therapy were improved significantly by combined estrogen- and rogen therapy but not by estrogen or estrogen-progestin therapy .  Sexual function improved with estrogen- and rogen therapy even though circulating estrogen levels were lower than those measured during previous estrogen therapy . This leads to the conclusion that and rogens play a pivotal role in sexual function but that estrogens are not a significant factor determining levels of sexual drive and enjoyment Summary In this prospect i ve study in 2,137 perimenopausal and early postmenopausal women who were followed over a 13.1-year period of time , we observed no association between bone mineral density measured at the beginning of menopause and the subsequent risk of breast cancer . Introduction This study aim ed to investigate the relationship between BMD and the risk of breast cancer ( BC ) in young postmenopausal women . Methods As part of a clinical research program , 2,137 women who were perimenopausal or within their 5 first postmenopausal years were scanned  between 1988–1990 and review ed on average 13.1 years after their initial examination . Ninety-eight incident BC cases were recorded throughout the follow-up . Results Women with incident BC significantly differed from those who had never had BC with regard to age at menarche , age of birth of 1st child , familial history of BC and postmenopausal hormone therapy ( PHT ) use . There was no significant difference between the two groups for baseline DXA of the spine . There was a trend for BC cases for having lower femoral neck BMD compared to women without BC . However , women with low BMD were more likely to have taken PHT by the end of the study . In Cox multivariate analyses the relationship between BC risk and femoral neck BMD no longer existed . Conclusions There was no relationship between BMD measured within the first postmenopausal years and the risk of BC , which makes unlikely the possibility of using BMD as a predictor factor for BC in early postmenopausal women OBJECTIVE In a prospect i ve study , the 1-year psychological well-being outcome after  oophorectomy-hysterectomy  , compared to hysterectomy-only and the correlations between the changes in psychological well-being and the changes in sexuality were evaluated . STUDY POPULATION Perimenopausal sexually active women ( n=362 ) , scheduled for hysterectomy on benign indication , were recruited . Three hundred and twenty-three women ( 89 % ) completed the 1-year follow-up ; 217 women spared their ovaries and 106 underwent concomitant oophorectomy .  METHODS Psychological well-being was studied by the psychological general well-being index ( PGWB ) and sexuality by the McCoy 's sex question naire . The prevalence of climacteric symptoms was reported by the modified Kupperman 's index . Hormone-replacement therapy was recorded . Postoperative , all oophorectomized and the hysterectomy-only women with climacteric symptoms were recommended estrogen-replacement therapy . RESULTS The two groups did not differ in PGWB , neither before surgery nor at 1-year follow-up . Postoperative , both groups showed increased well-being regarding depressed mood , general health and total score . Besides , the hysterectomy-only group had increased vitality and the hysterectomy-oophorectomy group showed increased positive well-being and decreased anxiety . Most of the sexual parameters showed positive correlation to the PGWB parameters . The correlations were strong regarding parameters of overall sexual satisfaction , weak , regarding sexual motivation and relationship to partner , while absent regarding coital frequency . CONCLUSION Concomitant prophylactic oophorectomy , at elective hysterectomy , does not negatively affect psychological well-being in adequately estrogenized perimenopausal women . Indeed , both hysterectomy-only and hysterectomy-oophorectomy have a positive effect on psychological well-being . Most aspects of sexuality are correlated to aspects of psychological well-being ABSTRACT Background Sexual desire is affected by endocrine and psychosocial factors . Menopausal hormonal changes are relevant to the causes of sexual dysfunction during reproductive aging . Aim To evaluate the effects of different types of hormonal replacement therapy ( HRT ) on sexual function , frequency of sexual intercourse , and quality of relationship in early postmenopausal women . We recruited 48 healthy postmenopausal women aged 50–60 years ( mean age 54.5 ± 3.3 years ) . Women with climacteric symptoms were uniformly r and omized into three groups receiving either dehydroepi and rosterone ( DHEA 10 mg ) daily , or daily oral estradiol ( 1 mg ) plus dihydrogesterone ( 5 mg ) , or daily oral tibolone ( 2.5 mg ) for 12 months . Women who refused hormonal therapy were treated with oral vitamin D ( 400 IU ) . Efficacy was evaluated using the McCoy Female Sexuality Question naire before treatment and after 12 months . We evaluated the hormonal profile before treatment and after 3 , 6 and 12 months . Results The groups receiving DHEA or HRT reported a significant improvement in sexual function compared to baseline ( p < 0.001 and p < 0.01 , respectively ) using the McCoy total score . The quality of relationship was similar at baseline and after 3 , 6 and 12 months of treatment . There were significant increases in the numbers of episodes of sexual intercourse in the previous 4 weeks in women treated with DHEA , HRT and tibolone in comparison with the baseline value ( p < 0.01 , p < 0.05 , p < 0.01 , respectively ) . No changes in the McCoy score occurred in women receiving vitamin D. Conclusions Daily oral DHEA therapy at the dose of 10 mg , HRT and tibolone all provided a significant improvement in comparison with vitamin D  in sexual function and in frequency of sexual intercourse in early postmenopausal women OBJECTIVES The aim of this study was to evaluate the effects of local thermal therapy with far-infrared rays ( FIR ) on menopausal symptoms and bone mineral density ( BMD ) in postmenopausal women . SUBJECTS AND METHODS A prospect i ve r and omized , controlled trial was conducted in female volunteers from communities in Northern Taiwan . The intervention group ( n=22 ) received local thermal therapy with the help of FIR from an FIR emitter , for approximately 20 minutes per day , twice a week , for 20 sessions . They received the therapy on their backs while lying in a supine position . The control group ( n=21 ) received no treatment . The primary outcome was the change in the Perceived Perimenopausal Disturbances Scale , design ed for the measurement of menopause-related symptoms ( MRS ) before and after completion of treatment in a 10-week period . Secondary outcome parameters included serum levels of estradiol ( E2 ) with osteocalcin ( OC ) , and calcaneal BMD by quantitative ultrasound . RESULTS After 10 weeks of intervention , MRS determined by the scale decreased in mean total scores and mean scores for vasomotor , musculoskeletal , urologic , reproductive , and psychologic domains ( p<0.05 ) , except for reproductive ( sexuality-related ) symptoms . In the control group , mean total scores and scores of each domain had no significant difference between baseline and follow-up examination after 10 weeks . There was no significant difference between the quantitative ultrasound parameters in the calcaneus , serum E2 , and OC levels either at the baseline or in the changes from the baseline between the intervention and control groups of women ( p>0.05 ) . CONCLUSIONS Local thermal therapy with FIR results in a significant reduction of MRS in  postmenopausal women . Serum E2 , OC levels , and calcaneal BMD showed no significant changes between the two groups . These results suggest that FIR local thermal therapy may be a potential alternative for the management of postmenopausal symptoms BACKGROUND AND AIM OF THE STUDY The aim of this study is to report the prevalence of menopausal symptoms by severity among the Finnish female population and the association of their symptoms with lifestyle ( smoking , use of alcohol , physical activity ) and body mass index ( BMI ) . MATERIAL AND METHODS Health 2000 is a nationally representative population -based study of Finnish adults . Data were collected by home interview , three self-administered question naires and a clinical examination by a physician . This study included women aged 45 - 64 years ( n=1427 ) . All symptoms included menopause-specific symptoms . Both univariate analysis and a factor analysis based on symptom factors were performed by menopausal group . Multiple regression analysis included each symptom factor as a dependent variable and confounding and lifestyle factors ( age , education , smoking , alcohol use , physical activity , BMI , use of hormonal replacement therapy ( HRT ) and chronic disease status ) . RESULTS Over one-third ( 38 % ) of the premenopausal , half of the perimenopausal , and 54 % of both postmenopausal and hysterectomized women reported bothersome symptoms . The difference between pre- and perimenopausal women was largest and statistically most significant in the case of back pain and hot flushes . Physically active women reported fewer somatic symptoms than did women with a sedentary lifestyle . Smoking was not related to vasomotor symptoms . CONCLUSION Bothersome symptoms are common in midlife , regardless of menopausal status . Inverse association between physical activity and menopausal symptoms needs to be confirmed in r and omized trials OBJECTIVE To evaluate the effect of a soy-rich diet on urogenital symptoms , vaginal health index , and vaginal cytology in perimenopausal and postmenopausal women . MATERIAL S AND METHODS Thirty-six perimenopausal and postmenopausal women ( mean age 52.5+/-5.1 years ) participated in a r and omized , cross-over trial with two 12-week diet periods and two 4-week washout periods before and between treatments . The study diet consisted of a control diet ( soy-free diet ) and an isocaloric soy-rich diet ( 25 g soy protein in various forms of soy food containing more than 50 mg/day of isoflavones substituted for an equivalent amount of animal protein ) . Subjects were assessed for urogenital symptoms , vaginal health index , vaginal pH and vaginal cytology . The single physician and the single cytopathologist were blinded with regard to onset , period and r and omization number . Statistical analyses were performed using paired t-test or Wilcoxon Signed Ranks Test , significance was set as P<0.05 . RESULTS Good compliance to the diet was shown by the significant elevation of serum levels of daidzein and genistein during the soy-rich diet period . The symptoms of urge incontinence and vaginal dryness had significantly increased after 12-week of soy-free diet . All other urogenital symptoms did not change in both periods . The vaginal health index , the vaginal pH , the karyopyknotic index , and the maturation value were not significantly changed in both periods . CONCLUSION A soy-rich diet did not relieve the urogenital symptoms or restore the vaginal epithelium or improve the vaginal health in perimenopausal and postmenopausal Thai women Background —The Women ’s Healthy Lifestyle Project Clinical Trial tested the hypothesis that reducing saturated fat and cholesterol consumption and preventing weight gain by decreased caloric and fat intake and increased physical activity would prevent the rise in LDL cholesterol and weight gain in women during perimenopause to postmenopause . Methods and Results —There were 275 premenopausal women r and omized into the assessment only group and 260 women into the intervention group . The mean age of participants at baseline was 47 years , and 92 % of the women were white . The mean LDL cholesterol was 115 mg/dL at baseline , and mean body mass index was 25 kg/m2 . The follow-up through 54 months was excellent . By 54 months , 35 % of the women had become postmenopausal . At the 54-month examination , there was a 3.5-mg/dL increase in LDL cholesterol in the intervention group and an 8.9-mg/dL increase in the assessment -only group ( P = 0.009 ) . Weight decreased 0.2 lb in the intervention and increased 5.2 lb in the assessment -only group ( P = 0.000 ) . Triglycerides and glucose also increased significantly more in the assessment -only group than in the intervention group . Waist circumference decreased 2.9 cm in the intervention compared with 0.5 cm in the assessment -only group ( P = 0.000 ) . Conclusions —The trial was successful in reducing the rise in LDL cholesterol during perimenopause to postmenopause but could not completely eliminate the rise in LDL cholesterol . The trial was also successful in preventing the increase in weight from premenopause to perimenopause to postmenopause . The difference in LDL cholesterol between the assessment and intervention groups was most pronounced among postmenopausal women and occurred among hormone users and nonusers The objective of this study was to determine if 6 months of the aromatase inhibitor letrozole , administered to postmenopausal women taking a stable dose of hormone replacement remedy , would be safe and would modulate biomarkers of breast cancer risk . The intent was to reduce the proliferation marker Ki-67 while maintaining adequate systemic levels of estradiol so as to avoid perimenopausal symptoms . Postmenopausal women at high risk for development of breast cancer and taking a stable dose of estrogen or estrogen plus progestin were screened by r and om periareolar fine needle aspiration ( RPFNA ) . To be eligible , the acquired breast epithelial cells had to be characterized as cytologic atypia or borderline atypia with ≥1,000 epithelial cells on the cytomorphology slide ; plus ≥500 epithelial cells on a slide processed for Ki-67 immunocytochemistry . Forty-two women were enrolled in the one arm study and received 2.5 mg letrozole per day for 6 months , followed by repeat assessment of biomarkers . Ki-67 was reduced by a median relative value of 66 % . There was no significant change in breast cell cytomorphology ; ER weighted index score ; serum estradiol , testosterone , or IGF-1:IGFBP-3 ratio ; mammographic breast density , or frequency or severity of perimenopausal symptoms . Given the dramatic reduction in proliferation , the effect of letrozole on risk and response biomarkers should be explored further in a r and omized , placebo-controlled Phase IIB breast cancer chemoprevention trial Objective : The aim of this study was to evaluate the effectiveness of acupuncture plus usual care for relief of hot flashes and menopause-related symptoms compared with usual care alone in perimenopausal or postmenopausal women . Methods : A multicenter , r and omized , controlled trial was conducted . Perimenopausal or postmenopausal women with average hot flash scores of 10 or higher during the week before the screening visit were enrolled and r and omly divided into two groups . The treatment group received 12 sessions of acupuncture and maintained usual care for 4 weeks , whereas the control group underwent usual care alone .  Hot flash scores were calculated by multiplying frequency by severity of hot flashes recorded in a daily diary . The primary outcome was the mean change in the average 24-hour hot flash score at week 4 from baseline . The secondary outcome was the mean change in menopause-related symptoms as estimated by the Menopause Rating Scale question naire at week 4 . Follow-up assessment at week 8 was conducted in the treatment group only . Results : The mean change in the average 24-hour hot flash score was −16.57 in the treatment group ( n = 116 ) and −6.93 in the control group ( n = 59 ) , a difference of 9.64 ( P < 0.0001 ) . The total Menopause Rating Scale score , as well as the subscale scores for the psychological , somatic , and urogenital dimensions of menopause , showed significant improvement in the acupuncture group compared with the control group ( P < 0.001 ) . The mean change in the treatment group in the primary outcome was −17.58 at week 8 . Conclusions : Our results suggest that acupuncture in addition to usual care is associated with marked clinical improvement in hot flashes and menopause-related symptoms in perimenopausal or postmenopausal women OBJECTIVE This study compared the effects of a continuous-combined regimen of low-dose hormone therapy ( LD-HT ) versus tibolone and supplemental calcium/vitamin D3 ( control ) on quality of life ( QoL ) in symptomatic postmenopausal women . DESIGN This study was a prospect i ve , r and omised , double-blind , comparative trial with a control group . SETTING The study was conducted in a climacteric outpatient clinic in the University Hospital of Federal University of Juiz de Fora , Brazil . POPULATION A total of 174 postmenopausal women under 60 years of age who attended the climacteric outpatient clinic between June 2009 and June 2011 were recruited . These women complained of moderate or intense vasomotor symptoms and exhibited no contraindications for the use of hormone therapy . INTERVENTIONS The patients were r and omised into three groups : ( 1 ) daily treatment with 2.5 mg tibolone ( n=64 ) , ( 2 ) 50 mg calcium carbonate+200 IU vitamin D3 ( Ca/Vit D3 , n=54 ) or ( 3 ) 1 mg oestradiol+0.5 mg norethindrone acetate ( E2/NETA , n=56 ) for 12 weeks . PRIMARY OUTCOME MEASURES The primary outcome was the evaluation of QoL using the Women 's Health Question naire ( WHQ ) in all subjects at baseline and after 4 , 8 and 12 weeks of treatment . RESULTS A total of 130 women in the following groups completed the study : tibolone ( n=42 ) , Ca/Vit D3 ( n=44 ) and E2/NETA ( n=44 ) . An improved QoL based on the WHQ was observed at T0 ( 80.12±14.04 , 77.73±15.3 , 77.45±15.4 ) and T12 ( 57.0±15.5 , 55.7±16.7 , 58.4±12.6 ) for the tibolone , E2+NETA and Ca/Vit D3 groups , respectively ( p values < 0.05 ) . The three groups exhibited significantly different scores at T12 for sexual behaviour and vasomotor symptoms . The tibolone group exhibited better sexual function compared with the E2/NETA and Ca/Vit D3 groups ( 4.2±26 , 5.6±2.8 , 5.4±2.8 , respectively , p values < 0.05 ) . LD-HT was superior to tibolone and Ca/Vit D3 treatment for improvements in vasomotor symptoms ( 3.2±1.5 , 4.0±1.8 , 4.3±2.0 , respectively , p values < 0.05 ) . Adverse effects were few and mild . CONCLUSIONS An improved QoL was observed in the three study groups . Tibolone primarily improved sexual function , and E2/NETA exhibited a superior response for vasomotor symptoms INTRODUCTION Dehydroepi and rosterone ( DHEA ) and its sulfate DHEAS , which are the most abundant steroids in women , decline with age . We have shown association between low sexual function and low circulating DHEAS levels in women . AIM The aim of this study was to evaluate whether restoration of circulating DHEA levels in postmenopausal women to the levels seen in young individuals improves sexual function . METHODS Ninety-three postmenopausal women not using concurrent estrogen therapy were enrolled in a 52-week r and omized , double-blind , placebo controlled trial and received either DHEA 50 mg or placebo ( PL ) daily . MAIN OUTCOME MEASURES Efficacy was assessed through 26 weeks . The main outcome measures were the change in total satisfying sexual events ( SSE ) and the change in the Sabbatsberg Sexual Self-Rating Scale ( SSS ) total score . Secondary measures were the Psychological General Well-Being Question naire ( PGWB ) , and the Menopause-Specific Quality of Life Question naire ( MENQOL ) . Hormonal levels , adverse events ( AEs ) , serious adverse events ( SAEs ) and clinical labs were evaluated over 52 weeks . RESULTS Eighty-five participants ( 91 % ) were included in the 26-week efficacy analysis . There were no significant differences between the DHEA and PL groups in the change in total SSE per month or the SSS , PGWB , and MENQOL change scores . Overall AE reports and number of withdrawals as a result of AEs were similar in both groups ; however more women in the DHEA group experienced and rogenic effects of acne and increased hair growth . CONCLUSIONS In this study treatment of postmenopausal women with low sexual desire with 50 mg/day DHEA result ed in no significant improvements in sexual function over PL therapy over 26 weeks BACKGROUND Sexual dysfunction may significantly affect quality of life and marital relations in the postmenopausal period . The aim of the study was to assess the effect of tibolone on climacteric symptoms and sexuality in late postmenopausal but still symptomatic women . PATIENTS AND METHODS A six-month prospect i ve study was conducted of two groups of clinical ly healthy postmenopausal women : a control group ( n = 18 ; mean age 57.8 + /- 4.1 yrs ; menopause at 49.7 + /- 2.5 ; years of amenorrhea 8.1 + /- 4.0 yrs ) and a tibolone group ( n = 22 ; mean age 57 + /- 4.5 yrs ; menopause at 47.7 + /- 3.9 ; years of amenorrhea 9.2 + /- 4.6 yrs ) , who received 2.5 mg tibolone daily for six months . The Kupperman menopausal index ( KI ) was calculated for both groups at baseline and at six months . Sexual function was assessed by the Female Sexual Function Index ( FSFI ) question naire at the beginning and at the end of the study . The FSFI comprised five main domains : desire , arousal , lubrication , orgasm and pain . Satisfaction and a total score were also recorded . RESULTS The results showed that during the observation period KI decreased significantly in the tibolone group ( 15.7 + /- 9.2 vs 11.3 + /- 6.8 , p < 0.001 ) , while in the control group no difference was observed . There was a significant improvement of sexual function in the tibolone group in all domains : desire -- from 2.6 + /- 1.0 to 3.1 + /- 1.0 ( p < 0.001 ) ; arousal -- from 2.3 + /- 1.8 to 3.4 + /- 1.1 ( p < 0.001 ) ; lubrication - 2.6 + /- 2.1 and 3.5 + /- 1.4 ( p < 0.05 ) . The ability to reach orgasm increased ( p < 0.001 ) and pain and discomfort during and after sexual intercourse significantly decreased ( p < 0.01 ) . The overall satisfaction and the total score in the treated group changed favourably in a statistically significant manner , while these parameters did not change in the control group . CONCLUSIONS Treatment with tibolone had a beneficial effect on the climacteric symptoms and sexual function of late postmenopausal women . Moreover , tibolone seems to have an advantage over conventional hormone replacement therapy ( HRT ) in improving desire and arousal Objective : Estrogen therapy ( ET ) seems to differentially effect cognitive processes in younger versus older postmenopausal women , suggesting a window of opportunity when ET is most beneficial . Cognitive improvement in younger postmenopausal women has been attributed to ET 's influence on hot flushes and sleep , but empiric examination of the mediating role of menopause symptoms versus direct effects of ET on the brain is limited . Design : In a double-blind trial , 52 women were r and omly assigned to estradiol 0.05 mg/day  ( n = 26 )  or placebo transdermal patches ( n = 26 ) for 12 weeks . Women completed tests of memory , learning , and executive functioning , and hot flush and sleep assessment s at baseline and study end . A subset of women ( five ET treated , six placebo treated ) also underwent blood oxygenation level-dependent ( BOLD ) functional magnetic resonance imaging ( fMRI ) studies . Results : Nondepressed perimenopausal and postmenopausal women were studied . The majority had hot flushes and sleep impairment . Compared with placebo , ET selectively reduced errors of perseveration during verbal recall ( P = 0.03 ) , a frontal system-mediated function , but did not influence other cognitive processes .  Women with baseline hot flushes had greater cognitive benefit with ET ( P < 0.05 ) . Cognitive benefit was not associated with sleep problems or its improvement . Measures of fMRI BOLD activation during tests of verbal and spatial working memory showed significant increases in frontal system activity with ET ( P < 0.001 ) . Conclusions : Estrogen therapy selectively improves executive functioning as demonstrated by reduced perseverative errors and prefrontal cortex activation during verbal recall tasks . Cognitive improvement with ET is associated with hot flushes , but not with sleep , suggesting that ET has a direct central nervous system effect , rather than an indirect effect mediated through improvement of sleep OBJECTIVES ( 1 ) To assess the prevalence of risk factors for osteoporosis and cardiovascular disease and the prevalence and severity of the appearance of menopausal symptoms among Spanish menopausal women . ( 2 ) To identify the main factors responsible for this severity . ( 3 ) To detect symptom differences between perimenopausal and postmenopausal women . METHODS Cross-sectional descriptive study encompassing women aged 45 - 65 years in the whole Spanish territory . The study population sample was collected through r and om sampling . A total of 10,514 women were included . The sociodemographic , medical history and lifestyle data were assessed by means of a survey . The Kupperman scale was used to assess the severity of menopausal symptoms . RESULTS The prevalence of risk factors for osteoporosis and cardiovascular disease were 67.6 % and 74.8 % , respectively . The most common risk factors were physical inactivity ( 53.6 % ) , obesity ( 44.3 % ) , arterial hypertension ( 36.6 % ) , hypercholesterolemia ( 31.4 % ) , low calcium intake ( 30.1 % ) and smoking ( 28.7 % ) . The predominant symptoms experienced by menopausal women were hot flushes ( 51.4 % ) , insomnia ( 45.7 % ) and irritability ( 42.2 % ) . These were severe in 3.3 % of the sample , moderate in 27.3 % , mild in 24.6 % while 44.8 % had no symptoms . The prevalence of joint pain ( 40.1 % ) and depressive mood ( 40 % ) was higher in perimenopausal than in postmenopausal women . Logistic regression analysis showed that there were differences for age , BMI , smoking , social class and poor consumption of dairy products in the severity of menopausal symptoms . CONCLUSIONS A high prevalence of risk factors for osteoporosis and cardiovascular disease was observed in our study . The main factors contributing to more severe menopausal symptoms were age , BMI , smoking social class and poor consumption of dairy products . In general , postmenopausal women presented significantly higher rates of menopausal symptoms when compared to perimenopausal women Summary . Forty postmenopausal women , referred for hormone replacement therapy and all of whom reported a significant concern about a decline in their sexual interest , were r and omly allocated to one of two hormone implant  treatment groups : either oestradiol ( 50 mg ) alone , or oestradiol ( 50 mg ) and testosterone ( l00 mg ) . Comparison between the two groups as a whole revealed no significant differences on any measure , both treatments being associated with a significant reduction in the severity of psychological , somatic and vasomotor symptoms , and with a significant improvement in sexual interest and responsiveness . Similar effects were also observed in patients who denied , pretreatment , any concurrent dyspareunia .  Although it is not possible to identify the reasons for change , the results indicate no advantages of supplementary testosterone administration over oestradiol alone for sexually unresponsive postmenopausal women Objective : The aim of this study was to examine changes in health-related quality of life ( HRQL ) during the menopausal transition , controlling for chronological aging , symptoms , and other covariates . Methods : This was a prospect i ve , longitudinal study of women aged 42 to 52 years at baseline recruited at seven US sites ( N = 3,302 ) in the multiethnic Study of Women 's Health Across the Nation . Women eligible for the cohort had an intact uterus , had at least one ovary , were not currently using exogenous hormones , were either premenopausal or early perimenopausal , and were self-identified as one of the study 's design ated racial/ethnic groups . Data from the baseline interview and six annual follow-up visits are reported . HRQL was assessed with five subscales from the Medical Outcomes Study Short-Form Health Survey , with reduced functioning defined as being in the lowest 25 % on a subscale . Covariates included symptoms , medical conditions , sociodemographics variables , physical activity , and psychological factors . Results : With adjustment for baseline age , chronological aging , and relevant covariates , the odds of reduced role-physical functioning were significantly greater at late perimenopause ( odds ratio , 1.46 ; 95 % CI , 1.08 - 1.99 ) and postmenopause ( odds ratio , 1.49 ; 95 % CI , 1.09 - 2.04 ) compared with premenopause . Menopause status was unrelated to bodily pain , vitality , role-emotional , or social functioning .  Hormone therapy users were more likely to report reduced functioning . Other variables significantly related to HRQL across all domains included vasomotor symptoms , urine leakage , poor sleep , arthritis , depressed mood , perceived stress , and stressful life events . Conclusions : The menopausal transition showed little impact on HRQL when adjusted for symptoms , medical conditions , and stress BACKGROUND The risk for major depressive disorder ( MDD ) increases during the menopausal transition . Nonetheless , no large , placebo-controlled studies have prospect ively assessed the efficacy of antidepressants in perimenopausal or postmenopausal women . This r and omized , double-blind , placebo-controlled trial evaluated the short-term efficacy and safety of desvenlafaxine ( administered as desvenlafaxine succinate ) in perimenopausal and postmenopausal women with DSM-IV-defined MDD . METHOD 387 depressed perimenopausal and postmenopausal women aged 40 to 70 years were r and omly assigned to placebo or desvenlafaxine ( 100 or 200 mg/d at the discretion of the investigator ) in an 8-week , flexible-dose trial conducted from September 2006 to June 2008 . The primary efficacy variable was change from baseline in 17-item Hamilton Depression Rating Scale ( HDRS(17 ) ) total score , analyzed using a mixed-effects model for repeated- measures analysis . Safety data were collected throughout the trial . RESULTS The reduction in adjusted HDRS17 total scores from baseline to week 8 ( mean daily dose after titration , 162 to 176 mg/d ) was significantly greater for desvenlafaxine ( -12.64 ) compared with placebo ( -8.33 ; P < .001 ) . Statistical separation from placebo was observed at week 1 and was sustained through week 8 . Both the perimenopausal and postmenopausal subgroups achieved significant reductions in HDRS(17 ) total scores with desvenlafaxine treatment ( perimenopausal , P = .003 ; postmenopausal , P < .001 ) . Response ( 58.6 % ) and remission ( 38.2 % ) rates were significantly higher for desvenlafaxine compared with placebo ( 31.6 % [ P < .001 ] and 22.4 % [ P = .008 ] , respectively ) . In all , 19/256 ( 7.4 % ) desvenlafaxine-treated patients and 4/125 ( 3.2 % ) placebo-treated patients discontinued due to adverse events . Treatment-emergent adverse events were reported by 94/125 ( 75.2 % ) placebo-treated patients and 218/256 ( 85.2 % ) desvenlafaxine-treated patients . CONCLUSIONS Short-term treatment with desvenlafaxine was effective and generally well tolerated in perimenopausal and postmenopausal women with MDD . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00369343 INTRODUCTION A significant number of postmenopausal women suffer from distressing problems because of urogenital atrophy secondary to the decline in circulating estrogen levels . Treatment with topical hormones may provide relief in such women when used judiciously . AIM To study the effects of local estrogen with or without local testosterone on urogenital and sexual health in postmenopausal women . METHODS Seventy-five postmenopausal women symptomatic for urogenital atrophy and sexual dysfunction were r and omly divided into two study groups and one control group . The women in study group 1 received local estrogen cream ; study group 2 received local estrogen and testosterone cream ; the control group received nonhormonal lubricant KY gel for 12 weeks . The urogenital and sexuality score , along with the vaginal health index and the vaginal maturation index ( VMI ) , was calculated at the beginning of therapy and 12 weeks later . MAIN OUTCOME MEASURES Changes in the urogenital and sexuality score along with vaginal health index and VMI . RESULTS After 12 weeks of therapy , there was a significant improvement in all the four study parameters , which correlated well with the improvement in symptoms of urogenital atrophy and sexual dysfunction in both the study groups as compared with the control group . Improvement in sexuality score was greatest with combined estrogen- and rogen therapy . There were no adverse effects and the therapies were well accepted without any compliance issue . CONCLUSION Local estrogen either alone or with and rogen is highly effective in relieving symptoms of urogenital atrophy and in improving sexual function in symptomatic postmenopausal women BACKGROUND The decision to take hormone replacement therapy ( HRT ) is a choice many women encounter when entering menopause . The purpose of this study was to examine the choice to take HRT while participating in a lifestyle intervention to reduce cardiovascular risk through the menopause . METHODS The Women 's Healthy Lifestyle Project is a r and omized clinical trial design ed to examine whether a behavioral lifestyle intervention can decrease the expected rise in cardiovascular risk through the menopause . Participants ( N = 535 ) completed question naires and were interviewed regarding menopausal symptoms , menopausal status , hot flashes , and  HRT  use at baseline and 54 months . RESULTS The intervention was successful in preventing risk elevation through the 54-month visit . At the final visit , there was no difference between the intervention and control groups in the percentage who had become postmenopausal ( 32.9 % vs 35.0 % , respectively ) , there was no difference between control and intervention with  HRT  use , with 31.2 % reporting use of HRT , and there was no difference between groups with menopausal symptoms . The women started HRT an average of 6 months after they missed a period . Baseline risk factors did not predict HRT use at the 54-month visit . CONCLUSIONS A sizable number of women reported HRT use . The decision to use HRT was not influenced by the lifestyle intervention or their baseline cardiovascular risk , and these women started HRT very early in the peri- to postmenopause . Further , weight loss in the perimenopause did not affect menopausal symptoms OBJECTIVES this paper aims to report the prevalence of symptoms in the Hong Kong Chinese perimenopausal women ; to construct reported symptoms into symptom groupings ; and to clarify whether the symptom groups are associated with menopausal status . METHODS a r and om telephone survey of perimenopausal women aged 44 - 55 years was conducted in 1996 . Eligible subjects were identified through telephone dialing of a r and om sample of the numbers listed in the residents ' telephone directory . St and ardized question naire , including a 22-item symptom check list , was administered over the telephone . The principal component analysis method followed by varimax rotation was used to examine the relations among the symptoms . RESULTS differences in the prevalence of menstrual problems across the menopausal status were noted with perimenopausal women having the most complaints . Musculoskeletal conditions were the top complaints reported by the respondents , followed by headaches and psychological symptoms . About 10 % of the women complained of hot flushes , and less than 5 % of cold sweats . Five symptom clusters , namely psychological , musculoskeletal/gastrointestinal , non-specific somatic , respiratory , and vasomotor , have been identified . After adjustment for age , the analysis of variance showed that psychological , non-specific somatic and vasomotor symptoms were significantly associated with menopausal status , while musculoskeletal and respiratory were of borderline statistical significance . CONCLUSIONS compared with pre- and post-menopausal women , perimenopausal women had the highest reports of symptom complaints . Musculoskeletal complaints were the most prevalent complaints , followed by psychological symptoms . While vasomotor symptoms were significantly associated with menopausal status , their prevalence was comparatively lower than that reported in Caucasian population Objective : This study examined whether use of complementary and alternative ( CAM ) therapies during the menopause transition varied by ethnicity . Design : The Study of Women 's Health Across the Nation is a prospect i ve cohort study following a group of 3,302 women from five racial/ethnic groups at seven clinical sites nationwide . Using longitudinal data encompassing 6 years of follow-up , we examined trends in use of five categories of CAM ( nutritional , physical , psychological , herbal , and folk ) by menopause status and ethnicity . To account for potential secular trends in CAM use or availability , we also evaluated the trends in CAM use over calendar time . Results : Approximately 80 % of all participants had used some form of CAM at some time during the 6-year study period . White and Japanese women had the highest rates of use ( 60 % ) , followed by Chinese ( 46 % ) , African American ( 40 % ) , and Hispanic ( 20 % ) women . Overall use of CAM therapy  remained relatively stable over the study period . In general ,  CAM  use did not seem to be strongly associated with change in menopause transition status . Use of CAM  among white women did not change with transition status . Among Chinese and African American participants , we observed an increase in  CAM use as women transitioned to perimenopause and a decrease in use of CAM  with transition to postmenopause . Among Hispanic and Japanese women , we observed a decrease in use of CAM  in early perimenopause , followed by an increase as women entered late perimenopause and a decrease as they progressed to postmenopause . Patterns of use for the five individual types of CAM varied . White women had relatively stable use of all  CAM therapies  through the transition . Japanese women decreased use of nutritional and psychological remedies and increased use of physical remedies as they transitioned into late perimenopause . Among African American women , use of psychological remedies increased as they progressed through menopause . Conclusions : Although CAM use did vary in some ethnic groups in relation to advancing menopause status , there was no evidence of influence of calendar time on CAM use . Patterns of CAM use during menopause are likely to be driven by personal experience , menopausal health , and access to therapies . Women 's personal preferences should be taken into consideration by healthcare providers for medical decision making during menopause and throughout the aging process Objective : The onset of climacteric symptoms ( hot flashes and night sweats ) is the primary reason for perimenopausal women to start hormone therapy . The association of a lower incidence of postmenopausal symptoms with high intake of soybeans in Asian women suggests that phytoestrogens are an alternative to estrogen therapy . The main effective compounds in soybean are isoflavones , which have a higher binding affinity to estrogen receptor & bgr ; than to estrogen receptor & agr;. The aim of present study was to evaluate the effects of isoflavone treatment in postmenopausal women . Design : This was a double-blind prospect i ve study . Sixty healthy postmenopausal women were r and omly assigned by computer into two groups to receive 60 mg isoflavones or placebo daily for 3 months . Before and after treatment , climacteric symptoms were recorded ; serum was collected to measure the levels of lipoprotein lipids , estradiol , and follicle-stimulating hormone ; and biopsy specimens from endometrium and breast were analyzed to investigate the expression level of steroid receptors and proliferation . Endometrial thickness was measured by ultrasound . Results : Fifty-one women finished the 12-week study . In women receiving 60 mg isoflavones daily , hot flashes and night sweats were reduced by 57 % and 43 % , respectively . The treatment did not change the levels of circulating estradiol or follicle-stimulating hormone . Immunohistochemical staining of endometrial and breast biopsy specimens revealed that isoflavones did not affect expression levels of steroid receptors ; estrogen receptors & agr ; , & bgr ; , and & bgr;cx ; progesterone receptors A and B ; or the proliferation marker Ki67 . No side effects on body weight or lipoprotein lipids were observed . Conclusions : This short-term prospect i ve study implies that isoflavones could be used to relieve acute menopausal symptoms Objective : The extent to which aromatization of testosterone ( T ) to estradiol is required for the observed effects of testosterone therapy on sexual function and well-being are not known . Therefore , the authors investigated the effects of aromatase enzyme inhibition on sexual function , well-being , and mood in estrogen- and T-replete postmenopausal women in a double-blind , r and omized , placebo-controlled study . Design : Postmenopausal women using transdermal estrogen therapy for at least 8 weeks and reporting low sexual satisfaction ( score < 42 for the Sabbatsberg Sexual Self-rating Scale [ SSS ] ) with a total T value of less than 1.2 nmol/L were treated with 400 μL of a 0.5 % T gel ( total dose 2 mg ) and were r and omly assigned to receive treatment with either 2.5 mg/day of letrozole or an identical placebo tablet . Women were assessed at baseline ( week −2 ) and at 0 , 4 , 8 , and 16 weeks . Sexual function was assessed with the SSS , well-being was assessed with the Psychological General Well-being Index , and mood was assessed with the Beck Depression Inventory at 0 and 16 weeks . Eighty-one women were screened , 76 were r and omly assigned to a treatment group , and 30 in each group completed the study . Because this was a mechanistic study , only the 60 women who completed the study per protocol were included in the final analysis . Results : Total T and calculated free T increased from baseline in both groups , with no difference between groups . At 16 weeks , estradiol , sex hormone-binding globulin , fasting lipids , lipoprotein(a ) , and C-reactive protein did not differ from baseline or between groups . Significant increases in total Sabbatsberg Sexual Self-rating Scale scores , total Psychological General Well-being Index scores , and a reduction in Beck Depression Inventory scores from baseline to 16 weeks was seen for both treatment groups , with no effect of treatment allocation . No adverse treatment effects were reported . Conclusions : Increases in total and free T in the physiologic range in postmenopausal women were associated with improved sexual satisfaction , well-being , and mood . In this study , aromatase inhibition did not influence any of these outcomes . Short-term transdermal T therapy did not modify fasting lipids , lipoprotein(a ) , or C-reactive protein OBJECTIVE To investigate prospect ively changes in weight , skin-fold measurements , waist circumference and waist/hip ratio in relation to changes in menopausal status , hormone therapy use and life-style factors . METHOD The study was a 5-year follow-up of volunteers from a population -based cohort of Australian-born women aged 46 - 57 years at baseline : 106 premenopausal , 106 perimenopausal and 21 hormone therapy users .  RESULTS Mean ( SD ) weight gain of the entire cohort over 5 years was 2.1 ( 5.1 ) kg . Baseline age was negatively associated with weight change ( regression coefficient = -0.4 , SE 0.1 , p < 0.05 ) . After 5 years , 20 women remained premenopausal , 80 were perimenopausal , 112 had become naturally postmenopausal and 21 remained on hormone therapy .  Changes in weight were greater than zero ( p < 0.05 ) in all groups except for the women who remained on hormone therapy . There was no significant difference in weight gain between women who remained premenopausal and those who had a natural menopause . Increases in suprailiac skin-fold measurements ( p < 0.05 ) and in waist circumference and waist/hip ratio occurred in women who experienced the menopausal transition but not in those who took hormone therapy continuously . There was no association between weight change and baseline weight , exercise , alcohol intake or smoking . CONCLUSION Weight gain was not related to change in menopausal status nor to any life-style factors measured . Women who were older at baseline gained less weight than the younger members .  Suprailiac skin-fold measurements , waist circumference and waist/hip ratio all increased during the menopausal transition . Continuous hormone therapy users showed no gain in mean weight , suprailiac skin-fold measurements or waist measurements over the follow-up period INTRODUCTION Women in the menopausal stage of life usually have climacteric symptoms of  hot flashes ,  back pain , sleeplessness , night sweats and increased risk of cardiovascular disorders . Although physical exercises have been documented to favourably alleviate some of these problems , there 's a paucity of knowledge of their effects on menopausal women in Nigeria . OBJECTIVES This study investigated the effect of a twelve-week Endurance Exercise Programme ( EEP ) on quality of life(QOL ) and menopausal symptoms in these women . METHODS Participants were purposively recruited and assigned into perimenopausal and postmenopausal groups based on history of thier last menstrual period and from each of these groups r and omized into : perimenopausal exercise group ( PEMEG ) , postmenopausal exercise group ( POMEG ) , perimenopausal control group ( PEMCG ) postmenopausal control group ( POMCG ) .  Quality of life ( QOL ) , Menopausal symptoms - Back Pain ( BP ) and hot flashes ( HF ) among other variables , were evaluated at baseline and 4 weekly intervals . EEP consisted of a 10-station circuit of muscular and cardiovascular endurance , flexibility , coordination , abdominal and pelvic floor muscle exercises . RESULTS One hundred and seventy five menopausal women , mean age 52.3 + /- 4.1 years . Significant changes occurred between baseline and end of 12th week mean values of PEMEG for QOL : 565.9 + /- 108.8 vs 725.0 + /- 42.9 and BP 4.42 + /- 1.7 vs 1.00 + /- 0.0 . ( p= 0.000 ) . Also , in POMEG : QOL 558.3 + /- 127.7 vs 736.5 + /- 44.8 ; and BP 5.37 + /- 1.48 vs 1.88 + /- 1.18 ( p=0.000 ) . Significant changes in QOL and BP did not occur in the control groups . CONCLUSION Routine participation in endurance exercise programme is recommended for menopausal women for improved QOL Abstract Objective : This study aim ed to evaluate the effects of monophasic estrogen-progestogen therapy on the sexuality and climacteric symptoms of postmenopausal women . Patients and methods : A prospect i ve , r and omised , double-blind , crossover , placebo-controlled , single-centre study was carried out over a total of 12 consecutive months in 40 postmenopausal women with an intact uterus who had no contraindications to hormone therapy . Patients received 17β-estradiol 2 mg in combination with norethisterone acetate 1 mg ( Cliane ® ) daily for 6 months or one placebo tablet daily for 6 months . The tablets were identical in appearance . After 6 months , the groups were crossed over and the patients were followed up for another 6 months . The groups were homogenous with respect to age , height , bodyweight , body mass index and race . For the statistical analysis , the group receiving hormone therapy was referred to as group A and the placebo group was design ated group B , irrespective of the placebo/hormone therapy sequence . Results : In group A there were fewer hot flashes ( F = 22.85 , p < 0.01 ) and an improvement in sexual interest ( F = 5.55 , p < 0.05 ) . The sequence in which the medication was received result ed in a statistically significant difference with respect to dyspareunia ( F = 9.65 , p < 0.01 ) and satisfaction with the duration of penetration ( F = 6.58 , p < 0.05 ) . In the intrapatient analysis of variation with respect to orgasmic capability and the presence of dialogue with partner regarding the couple ’s sexual life , whether the placebo was taken prior to or following hormone therapy was significant ( F = 17.12 , p < 0.001 and F = 7.10 , p < 0.05 , respectively ) . Conclusions : Monophasic estrogen-progestogen therapy has a beneficial effect on sexuality and on hot flashes in postmenopausal women Studies were conducted on the effect of estrogen on the mental and psychosomatic disorders and mental performance in 27 patients with climacteric symptoms and 25 postmenopausal women who had been amenorrheic for at least 1 year . Both groups were treated with estrogen and a progestogen cyclically for 6 months . A group of 21 postmenopausal women were divided into 2 subgroups 11 were treated with estrogen and 10 received placebo in a double-blind procedure . Social status parity education and occupation were similar in all groups . All patients received a general physical and gynecological examination and metabolic screening . Each patient was examined by means of a series of psychological tests inventories and rating scales for degree of neuroticism distress depression sexual function information-processing capacity and psychosomatic complaints . There was a decrease of follicle stimulating hormone and luteinizing hormone in the estrogen-treated postmenopausal women at 3 and 6 months of treatment ; levels in estrogen-treated premenopausal women and in the placebo group were unchanged . Climacteric and postmenopausal patients initially showed a higher than st and ard degree of neuroticism as measured by the Eysenck Personality Inventory .  Estrogen-treated patients showed a statistically significant decrease in contrast to an increase in placebo patients . In the Hamilton Rating Scale for Depression and Sabbatsberg Distress Self-Rating Scale  estrogen-treated groups improved significantly while the placebo group showed a deterioration . Performance tests of estrogen-treated patients particularly in complex tasks showed improved information-processing capacity . An improvement was noted on the Sabbatsberg General Symptoms Rating Scale and Sabbatsberg Sexual Self Rating Scale . In self-report estrogen-treated patients considered themselves improved while placebo patients reported the opposite . These findings suggest that estrogen deficiency should be treated to restore somatic mental and social well-being OBJECTIVES To evaluate the preliminary efficacy and safety of Pueraria mirifica in the treatment of vasomotor symptoms . DESIGN Open-label study . SETTING Hat Yai Regional Hospital , Thail and . SUBJECTS Pre and postmenopausal women with vasomotor symptoms , such as hot flushes and night sweats . Other unpleasant symptoms , urogenital and psychological symptoms , were also evaluated . MATERIAL AND METHOD Patients were enrolled voluntarily and r and omly received 50 mg or 100 mg of Pueraria mirifica in capsules , once daily for six months . RESULTS Of the 48 enrolled patients , 11 cases were excluded for failing to complete the initial work-up . Thirty-seven cases were evaluated . 20 of 37 ( 54.1 % ) r and omly received a dose of 50 mg/day of Pueraria mirifica ( Group A ) , and 17 of 37 ( 45.9 % ) received 100 mg/day of Pueraria mirifica ( Group B ) . The mean of the modified Greene climacteric scale decreased from 35.6 to 26.6 , 17.2 and 15.1 in group A , while group B , declined from 32.6 to 21.0 , 14.8 and 13.6 at 1- , 3- and 6-month respectively . The mean serum estradiol , fluctuated from the baseline of 76.6 to 55.4 , 56.7 , 72.5 , 69.2 , 114.2 and 74.5 pg/ml at 1- , 2- , 3- , 4- , 5- and 6-month respectively . Whereas the mean serum follicle-stimulating hormone (FSH)/luteinizing hormone ( LH ) was stable in the range of ; 27.1/12.6 , 28.3/12.9 and 22.5/11.4 mIU/ml at baseline , 3- and 6-month respectively . CONCLUSIONS Pueraria mirifica , containing phytoestrogens , relatively alleviated the climacteric symptoms in perimenopausal women . The transient negative profiles occurred in a small number of subjects that included anemia , and liver profiles . While there was a slight decrease in lipoproteins and an increase in hormonal profiles , Pueraria mirifica demonstrates great promise in the treatment of climacteric symptoms among perimenopausal women . However , optimal doses should be clinical ly assessed , to meet appropriate individual responses Abstract : This prospect i ve population -based cohort study investigated factors predicting  distal forearm fracture ( DFF ) in perimenopausal women . The study population consisted of 11 798 women from the Kuopio Osteoporosis Risk Factor and Prevention ( OSTPRE ) Study in Finl and . Mean baseline age of these women was 52.3 ( SD 2.9 ) years ( range 47–56 years ) and 68 % were postmenopausal . Three hundred and sixty-eight women ( 3.1 % ) had a vali date d DFF during the 5-year follow-up . Previous wrist fracture , postmenopausal state , age and nulliparity were independent predictors of DFF , while hormone replacement therapy ( HRT ) , dairy calcium and overweight protected against it in multivariate Cox regression analysis : previous wrist fracture increased the DFF risk by 158 % ( p<0.0001 ) , menopause by 69 % ( p= 0.002 ) and age by 6 % per year ( p= 0.010 ) , whereas the continuous use of HRT decreased the risk by 63 % ( p= 0.0001 ) , the use of dairy calcium at 1000–1499 mg/day ( vs < 500 mg/day ) by 39 % ( p= 0.004 ) , overweight ( BMI > 25 kg/m2 ) by 36 % ( p= 0.0002 ) and parity by 29 % ( p= 0.031 ) . Combining dichotomous low weight , low use of calcium , non-use of HRT and previous wrist fracture into a risk score gave a dose – response effect by score level : the presence ( vs absence ) of all four risk factors result ed in a 12-fold DFF risk . Nevertheless , the sensitivity and specificity of the score for detecting DFF remained low . It was concluded that HRT , high nutritional calcium intake and overweight protect against but a history of wrist fracture predisposes to perimenopausal distal forearm fracture . A simple risk factor inquiry would help to identify perimenopausal women at high risk of distal forearm fracture BACKGROUND Results of previous studies suggest that estrogen improves somatic and mild depressive symptoms experienced by perimenopausal women . This study investigated the efficacy of 17beta-estradiol for the treatment of clinical ly significant depressive disorders in endocrinologically confirmed perimenopausal women . METHODS Perimenopausal women ( aged 40 - 55 years , with irregular menstrual periods and serum concentrations of follicle-stimulating hormone > 25 IU/L ) , meeting criteria for major depressive disorder , dysthymic disorder , or minor depressive disorder , according to DSM-IV , were r and omized to receive transdermal patches of 17beta-estradiol ( 100 microgram ) or placebo in a 12-week , double-blind , placebo-controlled study . A 4-week washout period followed the 12-week treatment phase . Outcome measures were the Montgomery-Asberg Depression Rating Scale and Blatt-Kupperman Menopausal Index scores . RESULTS Fifty women were enrolled in the study ; 26 met DSM-IV criteria for major depressive disorder , 11 for dysthymic disorder , and 13 for minor depressive disorder .  Remission of depression was observed in 17 ( 68 % ) women treated with 17beta-estradiol compared with 5 ( 20 % ) in the placebo group ( P = .001 ) . Subjects responded similarly to estradiol treatment , regardless of DSM-IV diagnosis . Patients treated with estradiol sustained antidepressant benefit of treatment after the 4-week washout period , although somatic complaints increased in frequency and intensity . Treatment was well tolerated and adverse events were rare in both groups . CONCLUSION Transdermal estradiol replacement is an effective treatment of depression for perimenopausal women Objectives To determine the effect of acupuncture in treating hot flushes in perimenopausal or postmenopausal women . Methods The study was a r and omised single-blind sham-controlled clinical trial . Perimenopausal or postmenopausal women with moderate or severe hot flushes were r and omised to receive real or sham acupuncture . Both groups underwent a 4-week run-in period before the treatment . The real acupuncture group received 11 acupuncture treatments for 7 weeks , and the control group underwent sham acupuncture on non-acupuncture points during the same period . Both groups were followed for 8 weeks after the end of treatment period . Changes from baseline in the hot flush scores at week 7 , measured by multiplying the hot flush frequency and severity , were the primary outcome . Hot flush frequency , severity and menopause-related symptoms measured with the Menopause Rating Scale Question naire were regarded as secondary outcomes . Results 54 participants were r and omised into the  real acupuncture group ( n=27 ) and the sham acupuncture group ( n=27 ) . The mean change in hot flush scores was −6.4±5.2 in the real acupuncture group and −5.6±9.2 in the sham group at week 7 from values at the start of the acupuncture treatment ( 10.0±8.1 vs 11.7±12.6 ) , respectively ( p=0.0810 ) . No serious adverse events were observed during the whole study period . Conclusions Compared to sham acupuncture , acupuncture failed to show significantly different effects on the hot flush scores but showed partial benefits on the hot flush severity . Further consideration is needed to develop appropriate strategies for distinguishing non-specific effects from observed overall effectiveness of acupuncture for hot flushes . Whether acupuncture has point-specific effects for hot flushes should be also considered in design ing future research es OBJECTIVES To describe the effects of low dose hormonal replacement therapy ( LD-HRT ) on quality of life in early postmenopausal women , since the postmenopausal estrogen deprivation in mid age women often brings along a series of changes and symptoms , which may greatly affect quality of life . METHODS Fifty normal postmenopausal women were recruited and r and omly treated with LD-HRT , 17beta-estradiol ( 1 mg/day ) and norethisterone acetate ( 0.5 mg/day ) ( LD-HRT ) or calcium supplement ( controls ) . No significant differences in age , age at menopause , the presence of chronic diseases and socio-economic status were present in the two groups . The Women 's Health Question naire ( WHQ ) , a vali date d quality -of-life instrument for perimenopausal and postmenopausal women , was administered at baseline and after 6 and 12 weeks of treatment in both groups . RESULTS At baseline no significant differences in WHQ scores were present in the two groups . In the control group the scores in all different areas showed no significant modification either after 6 and 12 weeks of observation . Conversely , the LD-HRT group showed a significant decrease in the scores of vasomotor symptoms , somatic symptoms , anxiety/fear , depressed mood and sleep problem items . No effects on memory/concentration and menstrual symptoms areas were evident . CONCLUSION Although quality of life is also and may be mainly influenced by socio-economic and cultural factors , LD-HRT definitively can improve not only vasomotor symptoms , but also more general aspects of physical and psychological well-being of symptomatic postmenopausal women AIMS The use of hormone therapy ( HT ) is a relevant and topical issue in the treatment of menopausal symptoms in women . Information regarding the effects of combination treatment with estrogen and progesterone as well as treatment timing on cognitive function is lacking and was evaluated in healthy pre- and postmenopausal women . METHODS Sixteen premenopausal ( 45 - 51 years ) and 16 postmenopausal ( 58 - 70 years ) women were r and omly assigned to receive either estrogen + progestin therapy ( HT ) or placebo ( PL ) for six months . The study was double-blind . Cognitive performance was measured at baseline and follow up with tests of verbal and visuomotor functions , verbal and visual memory , and attention . RESULTS In premenopausal women , cognitive attention , when compared to baseline , improved with HT but declined slightly with PL in the two-choice reaction time task ( P = 0.049 ) , while PL was associated with better performance in tests of shared attention ( P = 0.024 ) and auditory attention ( P < 0.05 ) . In postmenopausal women , HT was associated with improved performance in verbal episodic memory ( P = 0.024 ) and a minor decline in auditory attention ( P = 0.025 ) . CONCLUSIONS HT , with estradiol valerate and norethisterone , in healthy women showed only minor effects on attention around the menopausal transition and on memory in postmenopause Objective To evaluate the efficacy and safety of Heyan Kuntai Capsule ( 和颜坤泰胶囊 , HYKT ) and hormone therapy ( HT ) on perimenopausal syndromes ( PMSs ) . Methods From 2005 to 2008 , 390 women with PMSs were recruited from 4 clinic centers . The inclusion criteria included ages 40 to 60 years , estradiol ( E2 ) below 30 ng/L , and follicle stimulating hormone ( FSH ) above 40 IU/L , etc . The patients were r and omly assigned to HYKT group or HT group by r and om number table method , administrated HYKT or conjugated estrogen with/without medroxyprogesterone acetate tablets for 12 months . During treatment , the patients were interviewed quarterly , Kupperman Menopausal Index ( KMI ) scores , hot flush scores , insomnia scores , Menopause-Specific Quality of Life ( MENQOL ) scores and adverse effects were used for evaluating drug efficacy and safety respectively . The last interview was made at the end of 12-month treatment Results After treatment , KMI scores of HYKT group and HT group were both significantly decreased compared with baseline ( P < 0.01 ) and there was no significant difference between groups ( P > 0.05 ) , except that KMI of HYKT group was higher after 3-month treatment ( P < 0.05 ) . After treatment , hot flush and insomnia scores were both improved significantly in two groups ( P < 0.01 ) ; and HT had a better performance than HYKT in improving hot flush ( P < 0.05 ) . MENQOL were significantly improved in both groups after treatment ( P < 0.01 ) ; but there was no significant difference between two groups ( P > 0.05 ) . The incidence of adverse event in the HYKT group was much lower than that in the HT group ( P < 0.01 ) . Conclusions HYKT could effectively relieve PMSs and improve patients quality of life without severe adverse reactions . Although HYKT exerted curative effects more slowly than hormone , it possessed better safety profile than hormone Objective : To determine the effects of raloxifene on sexual function in postmenopausal women with pre-existing vaginal atrophy treated with vaginal estrogen cream . Methods : A total of 187 naturally postmenopausal women , 42 - 80 years of age , with signs of genitourinary atrophy were enrolled in this 6-month , multicenter , parallel-group study . Subjects were r and omized to oral raloxifene HCl 60 mg daily or matching placebo ; the same subjects were also r and omized to receive one application of either vaginal conjugated estrogen cream 0.5 g twice weekly for 6 months or non-hormonal vaginal moisturizer twice weekly for 3 months , followed by conjugated estrogen cream for 3 months . Both investigators and subjects were masked to the identity of the oral medication . The vaginal preparations were administered in an open-label fashion . The Sexual Activity Question naire ( SAQ ) was administered at baseline and at 3 and 6 months . Safety was assessed throughout the study . Results : A total of 102 women were sexually active at baseline and , of these , 82 were also sexually active at the 6-month end-point . At 6 months , raloxifene and placebo , in the presence of vaginal conjugated estrogen cream , were both associated with improvement from baseline in vaginal dryness and reduced discomfort during sexual activity . There were no significant differences between raloxifene and placebo groups in any SAQ item . Enjoyment of sexual activity significantly increased from baseline with raloxifene but not with placebo . No difference in adverse events was observed between groups . Conclusion : Raloxifene had no negative effects on sexual function in postmenopausal women with vaginal atrophy who were treated concomitantly with vaginal estrogen cream BACKGROUND When genital atrophy exists , systemic hormone therapy ( HT ) has a timing until to induce vaginal proliferation and symptomatic relieve . Thus , in order to obtain a prompt improvement , the association of local therapy acting on the genital epithelium to the systemic treatment should be considered . OBJECTIVE To evaluate the effects of a combined therapy consisting of vaginal estriol with transdermal 17-beta-estradiol ( 50 microg/day ) plus medroxyprogesterone acetate ( 5 mg/day ) per os in shortening the period of uro-genital symptoms . SUBJECTS AND METHODS In a r and omized , double blind , controlled with placebo study , 27 women with climacteric symptoms and atrophic vaginitis were treated for 4 months with HT plus vaginal estriol 0.5 mg/day ( group E ) or placebo ( group P ) . Patients use the local medication daily for the first 3 weeks and twice-weekly thereafter . Before entering in the study , patients were asked about HT and selected for inclusion . In the first visit , electible patients after written informed consent were r and omized to receive HT plus local estriol or placebo . All the subjects had baseline studies , including medical history , physical examination , blood and urine analysis . In order to evaluate the effect of local treatment on urinary and genital symptoms , a score for genital , urinary and colposcopic complaints ( 0 minimum-100 maximum ) was developed . This score and Blatt-Kuperman were recorded and performed in every control . RESULTS There were no differences on climacteric symptoms relief between the two groups . Additionally , the improvement in urinary symptoms at the end of the study was similar for both groups ( from 16.5 + /- 6.1 to 8.5 + /- 2.4 for E group and from 15.8 + /- 7.8 to 8.8 + /- 2.7 for P group ; P < 0.01 versus basal ) ; however , those women in group E reached significant improvement on urinary complaints since the first month of treatment . Additionally , a significant difference between E and P was observed at months 2 and 3 , although no differences were detected at the end of the study . Papanicolaou smear showed reactive or reparative changes and karyopyknotic index exhibited a significant increase in superficial cells in both groups and at the end of the study . CONCLUSIONS Adding vaginal estriol to HRT may shorten the latency period for urinary symptoms Aims : To compare the effects of 3 months ' tibolone treatment with the effects of placebo on sexual function ( in particular , vaginal blood flow , and sexual desire and arousability ) and climacteric symptoms in postmenopausal women . Methods : A r and omized , double-blind , cross-over study was conducted in 38 postmenopausal women who received tibolone 2.5 mg/day and placebo .  Vaginal blood flow during erotic stimulation by fantasy and film was measured using a vaginal photoplethysmograph and subjects completed sexual function question naires and daily diaries . Results : Tibolone significantly increased baseline vaginal pulse amplitude ( VPA ) levels compared with placebo . There were significant treatment differences in VPA in favor of tibolone during fantasy periods but not during erotic film stimulation . Tibolone was associated with significant increases in sexual desire , and the frequency of arousability and of sexual fantasies compared with those with placebo .  Vaginal lubrication was significantly improved on tibolone . Twenty-five of 38 ( 66 % ) subjects correctly guessed when they were on active treatment . Tibolone was well tolerated . Conclusions : Tibolone was associated with significant improvements in sexual function  in postmenopausal women , reflecting both its estrogenic and and rogenic properties . There were significantly greater increases in vaginal blood flow with tibolone in response to erotic fantasy but not film , suggesting two possible pathways of female sexual response Objective : The aim of this study was to determine the patterns and predictors of sexual activity in the Hormone Therapy ( HT )  Trials of the Women 's Health Initiative ( WHI ) . Methods : Sexual activity questions were administered to 27,347 women ages 50 to 79 years at baseline and at year 1 and to a r and om 8.6 % sub sample at years 3 and 6 . The associations with demographic and health characteristics were determined . Results : Sexual activity at baseline was 60.7 % , 44.9 % , and 28.2 % in the 50- to 59- , 60- to 69- , and 70- to 79-year-old age groups , respectively . Most of the participants were satisfied with their current sexual activity ( 63.2 % ) . Of those dissatisfied , 57 % preferred more sexual activity . Vaginal atrophy correlated with sexual inactivity at baseline ( P < 0.001 ) . The correlates associated with stopping sexual activity at year 1 included poor/fair self-rated health , lack of satisfaction with quality of life , depression , and loss of partner ( P < 0.001 ) . The strongest predictor of sexual activity at year 1 was sexual activity at baseline ( odds ratio , 96.71 ; 95 % CI , 81.90 - 114.20 ) . A subset analysis of women adherent with HT or placebo at years 3 and 6 suggested that HT was associated with a higher percentage of participants reporting sexual activity ( P = 0.01 ) . Conclusions : Most women in the WHI HT Trials were satisfied with their sexual activity . Of those who were dissatisfied , the majority preferred more , rather than less , sexual activity . Vaginal atrophy at baseline correlated with sexual inactivity , and sexual activity at baseline was the strongest identified predictor of sexual activity at year 1 . HT use was not predictive of ongoing sexual activity in the intent-to-treat analysis . This report further characterizes the participants in the WHI HT trials and reveals the complexity of factors related to the prevalence of sexual activity and satisfaction Few data are available regarding endometrial histologic features in asymptomatic perimenopausal and postmenopausal women . This study encompasses  endometrial biopsy specimens obtained from 801 such women before enrollment in a multicenter study of estrogen-progestin replacement .  One endometrial cancer was found ( 0.13 % ) ; four additional biopsy specimens showed atypia ( total 0.63 % ) . The endometrium was atrophic in 373 ( 46.9 % ) , proliferative in 133 ( 16.7 % ) , secretory in 54 ( 6.8 % ) , and hyperplastic in 41 ( 5.2 % ) . Insufficient tissue for diagnosis was obtained in 195 ( 24.5 % ) . We conclude that the yield for neoplasia is so low that screening endometrial biopsy is not justified in asymptomatic perimenopausal and postmenopausal women AIM The effect of hormone replacement therapy ( HRT ) on the quality of life in women with hypertension is still not clear . Thus , the aim of the study was to assess the effect of hormone replacement therapy on quality of life in postmenopausal women with essential hypertension by using a battery of st and ardized question naires . MATERIAL AND METHODS The study population consisted of 53 women ( mean age 50.9 + /- 6.3 years ) with mild and moderate essential hypertension ( mean duration 6.4 + /- 6.4 years ) . The postmenopausal status was defined as the absence of menstrual blood loss during > 6 months and blood estradiol concentration < 50 pg/ml , accompanied by follicle-stimulating hormone ( FSH ) levels > 21 U/I. Twenty seven women were blindly r and omised to transdermal hormone replacement therapy ( HRT ) and received 17-beta-estradiol and noretisterone acetate , TTS .  Twenty six women were r and omly selected as controls . The subjects were evaluated at baseline ( after 2 weeks ' wash-out from hypotensive drug period ) and after three months of HRT using self-administered st and ardized quality of life question naires : the Psychological General Well-being Index ( PGWB ) and the Subjective Symptoms Assessment Profile ( SSA-P ) . RESULTS No differences were found in blood pressure values , heart rate , body mass index and distribution of body fat tissue between women receiving HRT and controls at baseline and after 3 months of follow-up . There were no significant differences in the baseline total PGWB score as well as in its subscale between two groups . Similarly , the frequency and intensity of subjective symptoms assessed by SSA-profile were the same in both groups at baseline . After 3 months , a significant improvement in PGWB total score was observed in women receiving HRT . This effect was due to improvement in anxiety , positive well-being and vitality . Moreover , emotional distress , symptoms of flushing , sweating and trembling h and s also diminished and sexual capacity improved in women treated with HRT . CONCLUSION A three-month hormone replacement therapy in hypertensive postmenopausal women slightly improves the general well-being , seems to decrease emotional tension , increase sexual capacity and markedly relieves some vasomotor symptoms Objective : The study aims to evaluate the effectiveness and safety of Chinese herbal medicine granules Danzhi Qing’e formula ( DZQE ) , Erzhi formula ( EZ ) , and their combination ( Combined formula ) in the treatment of menopausal symptoms at different stages of menopause . Methods : Women between the ages of 40 to 60 years , who met menopausal symptoms diagnostic criteria and experienced hot flushes at least 14 times/week in the last 4 weeks , were recruited to participate in a stratified r and omized , double-blind , placebo-controlled  clinical trial ( n = 389 ) . They received a treatment period of 8 weeks and were followed up for 4 weeks . Participants were categorized into two subgroups : 197 in the perimenopausal subgroup ( menstrual disorder to 1 y after amenorrhea ) and 192 in the early postmenopausal subgroup ( 1 - 5 y after amenorrhea ) . Participants were r and omly assigned to placebo or one of the three herbal formula treatments . The primary outcome instrument was the Menopause-Specific Quality of Life ( MENQOL ) question naire . Results : When analyzing the two subgroups together , DZQE markedly decreased the MENQOL total score at the end of 12th week with statistical significance ( P = 0.02 ) and improved vasomotor symptoms after 8 weeks treatment and 4 weeks follow-up ( P < 0.05 ) . What is more , the combined formula also greatly improved the participants ’ vasomotor symptoms compared with placebo after the 4 weeks follow-up . No statistically meaningful difference was observed in any other outcomes among the groups . The results of subgroup analysis showed that DZQE and Combined formula were more effective than placebo in improving MENQOL total score for perimenopausal women at the end of week 12 . For typical menopausal symptoms such as hot flushes and night sweats , DZQE displayed more favorable effects on early postmenopausal participants . Compared to placebo , the DZQE both showed statistically significant differences after 8 weeks treatment and 4 weeks follow-up . Although at the end of 12th week , DZQE also had better effects than placebo in the perimenopausal subgroup on vasomotor symptoms . Participants in the EZ group did not show a significant difference of any domains in MENQOL compared with participants in the placebo group . Conclusions : The DZQE formula improves the quality of life for menopausal women , especially for those with vasomotor symptoms during the whole menopausal period . The DZQE and EZ combination formula is effective only on perimenopausal symptoms The objective of this study was to examine the effects of estrogen-based hormone therapy ( HT ) on regional cerebral metabolism in postmenopausal women ( mean age = 58 , SD = 5 ) at risk for development of dementia . The prospect i ve clinical trial design included pre- and post-intervention neuroimaging of women r and omized to continue ( HT+ ) or discontinue ( HT− ) therapy following an average of 10 years of use . The primary outcome measure was change in brain metabolism during the subsequent two years , as assessed with  fluorodeoxyglucose-18 positron emission tomography ( FDG-PET ) . Longitudinal FDG-PET data were available for 45 study completers . Results showed that women r and omized to continue HT experienced relative preservation of frontal and parietal cortical metabolism , compared with women r and omized to discontinue HT . Women who discontinued 17-β estradiol (17βE)-based HT , as well as women who continued conjugated equine estrogen (CEE)-based HT , exhibited significant decline in metabolism of the precuneus/posterior cingulate cortical ( PCC ) area . Significant decline in PCC metabolism was additionally seen in women taking concurrent progestins ( with either 17βE or CEE ) . Together , these findings suggest that among postmenopausal subjects at risk for developing dementia , regional cerebral cortical metabolism is relatively preserved for at least two years in women r and omized to continue HT , compared with women r and omized to discontinue HT . In addition , continuing unopposed 17βE therapy is associated specifically with preservation of metabolism in PCC , known to undergo the most significant decline in the earliest stages of Alzheimer 's disease . Trial Registration Clinical Trials.gov OBJECTIVE Evaluate the 8-week efficacy and safety of desvenlafaxine at the recommended dose of 50 mg/d in perimenopausal and postmenopausal women with major depressive disorder ( MDD ) based on the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , Text Revision . METHOD This phase 4 , multicenter , parallel-group , r and omized , double-blind , placebo-controlled  study was conducted from June 30 , 2010 , to June 8 , 2011 . Patients received placebo or desvenlafaxine 50 mg/d ( 1:1 ratio ; n = 217 in each group ) . The primary outcome measure was the change at week 8 in the 17-item Hamilton Depression Rating Scale ( HDRS17 ) total score . Secondary outcome measures included change in the Sheehan Disability Scale ( SDS ) , the Clinical Global Impressions-Improvement scale ( CGI-I ) , the Montgomery-Asberg Depression Rating Scale ( MADRS ) , and the Visual Analog Scale-Pain Intensity ( VAS-PI ) . RESULTS At end point , compared to placebo , desvenlafaxine was associated with a significantly greater decrease in HDRS17 total scores ( last-observation-carried-forward analysis ; adjusted mean change from baseline -9.9 vs -8.1 , respectively ; P = .004 ) and significant improvements on the CGI-I ( P < .001 ) , MADRS ( P = .002 ) , SDS ( P = .038 ) , and VAS-PI ( P < .001 ) . Improvements on the SDS and VAS-PI reached significance by week 2 . Desvenlafaxine was generally safe and well tolerated . CONCLUSIONS Short-term treatment with desvenlafaxine 50 mg/d was effective for the treatment of MDD in perimenopausal and postmenopausal women , with significant benefits on pain and functional outcomes evident as early as week 2 . The safety and tolerability of desvenlafaxine were consistent with data in other population s. TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01121484 INTRODUCTION Physical exercise including pelvic floor muscle ( PFM ) training seems to improve the sexual function of women with urinary incontinence . This effect in postmenopausal women who are continent has not yet been determined . AIM The aim of this study was to assess the effect of a 3-month physical exercise protocol ( PEP ) on the sexual function and mood of postmenopausal women . METHODS Thirty-two sedentary , continent , sexually active women who had undergone menopause no more than 5 years earlier and who had follicle stimulating hormone levels of at least 40 mIU/mL were enrolled into this longitudinal study . All women had the ability to contract their PFMs , as assessed by vaginal bimanual palpation .  Muscle strength was grade d according to the Oxford Modified Grading Scale ( OMGS ) . A PEP was performed under the guidance of a physiotherapist ( M.M.F. ) twice weekly for 3 months and at home three times per week . All women completed the Sexual Quotient-Female Version ( SQ-F ) and the Hospital Anxiety and Depression Scale ( HADS ) before and after the PEP . MAIN OUTCOME MEASURES SQ-F to assess sexual function , HASDS to assess mood , and OMGS to grade pelvic floor muscle strength . RESULTS Thirty-two women ( 24 married women , eight women in consensual unions ) completed the PEP . Following the PEP , there was a significant increase in OMGS score ( 2.59 ± 1.24 vs. 3.40 ± 1.32 , P < 0.0001 ) and a significant decrease in the number of women suffering from anxiety ( P < 0.01 ) , but there was no effect on sexual function . CONCLUSION Implementation of our PEP seemed to reduce anxiety and improve pelvic floor muscular strength in sedentary and continent postmenopausal women . However , our PEP did not improve sexual function . Uncontrolled variables , such as participation in a long-term relationship and menopause status , may have affected our results . We suggest that a r and omized controlled trial be performed to confirm our results OBJECTIVE In some women , a decline in sexual interest accompanies a relative and rogen insufficiency after menopause . We sought to characterize the hormonal effects of the combination of oral esterified estrogens and methyltestosterone and to investigate whether this regimen improves hypoactive sexual desire . DESIGN Double-blind r and omized trial . SETTING Healthy volunteers in a multicenter research environment . PATIENT(S ) Postmenopausal women taking estrogen therapy who were experiencing hypoactive sexual desire . INTERVENTION(S ) 4 months of treatment with 0.625 mg of esterified estrogens ( n = 111 ) or the combination of 0.625 mg of esterified estrogens and 1.25 mg of methyltestosterone ( n = 107 ) . MAIN OUTCOME MEASURES Baseline and end-of- study measurements of total and bioavailable testosterone and sex hormone-binding globulin ( SHBG ) , and mean change in level of sexual interest or desire as rated on the Sexual Interest Question naire . RESULT ( S ) Treatment with the combination of esterified estrogens and methyltestosterone significantly increased the concentration of bioavailable testosterone and suppressed SHBG . Scores measuring sexual interest or desire and frequency of desire increased from baseline with combination treatment and were significantly greater than those achieved with esterified estrogens alone . Treatment with the combination was well tolerated . CONCLUSION ( S ) Increased circulating levels of unbound testosterone and suppression of SHBG provide a plausible hormonal explanation for the significantly improved sexual functioning in women receiving the combination of esterified estrogen and methyltestosterone OBJECTIVE To investigate the effects of hormone therapy ( HT ) administered to postmenopausal women on pulmonary function tests ( PFT ) . METHODS Eighty-two postmenopausal women who were having natural or surgically initiated menopause and had no risk factor that could affect the respiratory system were included into this prospect i ve , r and omized study . Twenty-five women who refused to use HT were assessed as the control group ( Group I ) . Nineteen women who accepted using HT and who were having surgically initiated menopause were given continuous estrogen ( Group II ) , 23 were given continuous estrogen and progesterone in combination ( Group III ) and 15 were given cyclic estrogen and progesterone combination ( Group IV ) . Forced expiratory volume ( FEV1 ) , forced vital capacity ( FVC ) , FEV1/FVC , forced expiratory flow rate over 25 - 75 % of the forced vital capacity volume and peak expiratory flow rate were assessed at the beginning of the treatment and in the third month in order to evaluate the effects of HT regimens on the women 's PFT . RESULTS A statistically significant increase was observed only in the FEV1 and FVC parameters of Group III after three months of therapy ( P<0.05 ) . The comparison between pre- and posttherapy FEV1 and FVC values showed an increase in the Group IV , but the difference was not statistically significant , while there was no difference between basal and third month FEV1 and FVC values of the group receiving estrogen only . CONCLUSIONS It was seen that particularly continuous combined HT regimen positively affected the FEV1 and FVC parameters of the postmenopausal women Dehydroepi and rosterone ( DHEA ) , an and rogenic steroid hormone , exhibits an age-related decline . Perimenopausal women have only approximately 50 % of peak DHEA levels . Despite limited scientific data , DHEA has gained recognition as a dietary supplement to reduce the symptoms of aging and improve well-being . This r and omized , double-blind placebo-controlled trial examined the effects of 50 mg/day of oral DHEA supplementation , for 3 months , on 60 perimenopausal women with complaints of altered mood and well-being .  Changes in the serum endocrine profile of women in the DHEA group were significantly greater than the placebo group , including a 242 % [ 95 % confidence interval ( CI ) + 60.1 , + 423.9 ] increase in DHEAS , a 94.8 % ( 95 % CI + 34.2 , + 155.4 ) increase in testosterone , and a 13.2 % ( 95 % CI -27.88 , + 0.5 ) decline in cortisol compared to baseline . Women receiving DHEA had a 10.1 % ( 95 % CI -15.0 , -5.1 ) decline in high-density lipoprotein and an 18.1 % ( 95 % CI -32.2 , -3.9 ) decline in Lp(a ) from baseline , but these declines did not significantly differ from women who received placebo . Women receiving DHEA did not have any improvements significantly greater than placebo in the severity of perimenopausal symptoms , mood , dysphoria , libido , cognition , memory , or well-being .  DHEA supplementation significantly effects the endocrine profile , may affect the lipid profile , but does not improve perimenopausal symptoms or well-being compared to placebo Objective To investigate the long term effect of hormone replacement therapy on cardiovascular outcomes in recently postmenopausal women . Design Open label , r and omised controlled trial . Setting Denmark , 1990 - 93 . Participants 1006 healthy women aged 45 - 58 who were recently postmenopausal or had perimenopausal symptoms in combination with recorded postmenopausal serum follicle stimulating hormone values . 502 women were r and omly allocated to receive hormone replacement therapy and 504 to receive no treatment ( control ) .  Women who had undergone hysterectomy were included if they were aged 45 - 52 and had recorded values for postmenopausal serum follicle stimulating hormone . Interventions In the treatment group , women with an intact uterus were treated with triphasic estradiol and norethisterone acetate and women who had undergone hysterectomy received 2 mg estradiol a day . Intervention was stopped after about 11 years owing to adverse reports from other trials , but participants were followed for death , cardiovascular disease , and cancer for up to 16 years . Sensitivity analyses were carried out on women who took more than 80 % of the prescribed treatment for five years . Main outcome measure The primary endpoint was a composite of death , admission to hospital for heart failure , and myocardial infa rct ion . Results At inclusion the women on average were aged 50 and had been postmenopausal for seven months . After 10 years of intervention , 16 women in the treatment group experienced the primary composite endpoint compared with 33 in the control group ( hazard ratio 0.48 , 95 % confidence interval 0.26 to 0.87 ; P=0.015 ) and 15 died compared with 26 ( 0.57 , 0.30 to 1.08 ; P=0.084 ) . The reduction in cardiovascular events was not associated with an increase in any cancer ( 36 in treated group v 39 in control group , 0.92 , 0.58 to 1.45 ; P=0.71 ) or in breast cancer ( 10 in treated group v 17 in control group , 0.58 , 0.27 to 1.27 ; P=0.17 ) . The hazard ratio for deep vein thrombosis ( 2 in treated group v 1 in control group ) was 2.01 ( 0.18 to 22.16 ) and for stroke ( 11 in treated group v 14 in control group ) was 0.77 ( 0.35 to 1.70 ) . After 16 years the reduction in the primary composite outcome was still present and not associated with an increase in any cancer . Conclusions After 10 years of r and omised treatment , women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality , heart failure , or myocardial infa rct ion , without any apparent increase in risk of cancer , venous thromboembolism , or stroke . Trial registration Clinical Trials.gov NCT00252408 Background Abnormal uterine bleeding ( AUB ) is one of the most common debilitating menstrual problems and has remained one of the most frequent indications for hysterectomy in developing countries . Approximately in 40 % of hysterectomy specimens , no definite organic pathology could be established . The problem is common worldwide but causes may vary from one region to another . This study may help gynecologists in our population to improve their therapeutic strategies by promoting minimally invasive uterus sparing modalities such as endometrial ablation and hysteroscopic resection of early proliferative lesions . Methods It was a prospect i ve , cross-sectional study conducted at Liaquat National Hospital from 15th January 2010 till 14th July 2011 over a period of 18 months . Women who underwent dilatation and curettage for endometrial sampling with complaints of AUB were included in the study and histopathologic spectrum was determined . Results Polymenorrhea was the most common presenting pattern ( 30 % , 72/241 ) with reproductive age women being the most susceptible ( 49.3%,119/241 ) . The commonest histopathological spectrum was normal menstrual pattern ( 34 % , 82/241 ) and the commonest pathology was hormonal imbalance ( 27 % , 65/241 ) , followed by endometrial polyp ( 14 % , 34/241 ) , chronic endometritis ( 12 % , 28/241 ) , atrophic endometrium ( 6 % , 15/241 ) , endometrial hyperplasia ( 5 % , 12/241 ) , and endometrial carcinoma ( 2 % , 5/241 ) . Chronic endometritis was commonly seen in reproductive age ( 18 % , 21/119 ) ; hormonal imbalance ( 45 % , 35/77 ) and endometrial hyperplasia ( 6.5 % , 5/77 ) in perimenopausal age ; endometrial polyp ( 35.5 % , 16/45 ) and endometrial carcinoma ( 9 % , 4/45 ) in postmenopausal age . Conclusion Frequency of benign endometrial pathology is quite high in AUB , 236 participants ( 98 % , 236/241 ) . Histopathological spectrum in patients with AUB is quite variable with respect to age . The most common pattern of AUB was polymenorrhea . The most common pathology was hormonal imbalance . It is suggested that age was associated with more progressive lesions found in peri and postmenopausal age group such as endometrial hyperplasia and endometrial carcinoma . Yet endometrial polyp was the most common pathology found in postmenopausal women . Therefore , the management strategy should be individualized , as in most cases a restrictive approach is appropriate in order to avoid unnecessary hysterectomies The effects of physical training and hormone replacement therapy ( HRT ) on bone mineral density in perimenopausal women were studied . Sixty perimenopausal women were r and omized to either physical training ( n=20 ) , HRT ( n=20 ) , or control group ( n=20 ) . The study period was 18 months . Bone mineral density ( BMD ) in the femoral neck and lumbar spine was measured using dual-energy X-ray absorptiometry ( DXA ) . DXA was performed before treatment and after 6 and 18 months . Blood sample s for analysis of the bone markers U-deoxypyridinoline and osteocalcin were collected at the same time points . After 18 months , BMD in the spine had not decreased in either the training group or in the HRT group . In the control group , spine BMD had significantly decreased ( p=0.0014 ) . U-Deoxypyridinoline and osteocalcin were increased significantly in the control group ( p=0.0198 , p=0.0295 , respectively ) . No significant changes in bone marker levels were found in the training group or the HRT group . We found that both HRT and physical training can prevent loss of spine BMD in perimenopausal women over a period of 18 months . HRT remains a cornerstone in the treatment of vasomotor symptoms and preservation of BMD . However , HRT can only be used for limited periods of time due to the potential serious adverse effects . This study indicates a beneficial effect of physical activity on spine BMD in the perimenopausal period , and highlights its potential as an alternative to HRT during this period Objectives : Equol , a metabolite of the isoflavone daidzein , is hypothesized to play a major role in the health benefits of soy . We examined the effect of a new S-equol supplement on  menopausal symptoms and mood states . Design : We conducted a r and omized , double-blind , placebo-controlled trial with our new equol supplement for 12 weeks with 134 Japanese women ( aged 40 - 59 years ) . They were r and omly assigned to three groups : placebo ( n = 44 ) , 10 mg of equol per day ( EQ-1 ; n = 44 ) , and 10 mg of equol three times per day ( EQ-3 ; n = 46 ) . Habitual isoflavone intake was limited to 20 mg/d . Participants completed menopausal symptom and Profile of Mood States question naires at baseline and postintervention . Physical examination and blood and 24-hour urine collection were performed at baseline and postintervention . Results : At baseline , total menopausal symptom score varied by menopausal and equol producer status ( 34.3 % producers ) . A total of 127 participants ( 94.8 % ) completed the trial . No adverse effects were reported , except for a systemic rash in one EQ-3 woman . The anxiety scores of equol producers were lower than those of nonproducers ( P < 0.05 ) . Significant differences between premenopausal and perimenopausal/postmenopausal symptom scores were observed for anxiety , somatic , and total scores . After the EQ-3 intervention , perimenopausal/postmenopausal equol nonproducers showed significant decreases from baseline in all menopausal symptom scores except depression ( P < 0.01 ) . Compared with placebo , the EQ-3 group showed significant decreases in depression scores ( P < 0.05 ) , as well as significant decreases in Tension-Anxiety ( P < 0.05 ) , Depression-Dejection ( P < 0.05 ) and Fatigue ( P < 0.01 ) and increases in Vigor ( P < 0.05 ) of the Profile of Mood States . Conclusion : S-equol supplement improved mood-related symptoms in perimenopausal/postmenopausal equol nonproducers Objective : This study aims to evaluate the effectiveness and safety of Gua sha therapy on perimenopausal symptoms , quality of life , and serum female hormones in participants with perimenopausal syndrome . Methods : A prospect i ve , r and omized , controlled clinical trial was conducted at the First Affiliated Hospital of Nanjing University of Chinese Medicine in China . Eighty women with perimenopausal syndrome were recruited and r and omized into an intervention group or a control group . Participants in the intervention group received 15-minute Gua sha treatment sessions once a week plus conventional treatment for 8 weeks , whereas participants in the control group received conventional treatment alone . The primary outcome was the change in perimenopausal symptoms and quality of life as obtained through the modified Kupperman Index ( KI ) and the Menopause-Specific Quality of Life . The secondary outcome was the change of serum female hormones including estrogen , follicle-stimulating hormone , and luteinizing hormone . Results : Seventy-five out of 80 participants ( 93.8 % ) completed the study —38 in the intervention group and 37 in the control group . The baseline levels of demographic and outcome measurements were comparable between the two groups . After eight sessions of intervention , the reduction in the total modified KI score was , however , 16.32 ± 4.38 in the intervention group and 11.46 ± 5.96 in the control group , with a difference of 4.86 ± 6.15 ( P < 0.01 ) between the two groups . Also the reductions of hot flash/sweating , paresthesia , insomnia , nervousness , melancholia , fatigue , and headache were greater in the intervention group than in the control group ( P < 0.05 ) . The reduction in the total Menopause-Specific Quality of Life score was 17.87 ± 3.84 in the intervention group and 13.62 ± 7.40 in the control group , with a difference of 4.46 ± 7.52 ( P < 0.01 ) between the two groups . And the scores for vasomotor , psychosocial , and physical domains in the intervention group were significantly lower than those in the control group ( P < 0.05 ) . There were no significant differences in serum estrogen , follicle-stimulating hormone , and luteinizing hormone between the two groups . Conclusions : The results of this study suggest that Gua sha therapy was effective and safe in relieving perimenopausal symptoms and improving the quality of life in participants with perimenopausal syndrome . The therapy may serve as a promising , effective , nondrug treatment for perimenopausal syndrome in clinical work . Additional research is needed to better underst and its effectiveness and examine its mechanism for treating perimenopausal syndrome Background The adverse effects of menopause on sexual function could be mitigated by pelvic floor muscle ( PFM ) training . This study aim ed to investigate the effects of PFM exercises on sexual function in postmenopausal women . METHODS A r and omised clinical trial was conducted among 97 Iranian postmenopausal women , aged 40 to 60 years . The participants ' baseline sexual functions were assessed using the Female Sexual Function Index ( FSFI ) question naire . They were then r and omly design ated to two groups : ( 1 ) the intervention group , which received specific instructions on PFM exercises and was followed up on a weekly basis ; and ( 2 ) the control group , which received general information on menopause . After 12 weeks , the sexual functions of the participants were reassessed . RESULTS No significant difference was initially observed between the two groups in terms of demographic and socioeconomic characteristics and total scores of FSFI . After the intervention , however , the scores of arousal , orgasm and satisfaction were significantly higher in the intervention group ( 3.10 , 4.36 , and 4.84 vs 2.75 , 3.89 , and 4.36 respectively ; P<0.05 ) . CONCLUSION PFM exercises have the potential to improve the sexual function of postmenopausal women and are thus suggested to be included in healthcare packages design ed for postmenopausal women Objective : The relationship between vulvovaginal atrophy and female sexual dysfunction is unclear . We investigated this association among sexually active postmenopausal women . Design : The Menopause Epidemiology Study is a cross-sectional , population -based study of women 40 to 65 years old in the United States chosen from a source population selected by r and om digit dialing and probability sampling . We focused on sexually active postmenopausal women ( N = 1,480 ) for our analyses . Vulvovaginal atrophy was defined as one or more of the following : vaginal dryness , itching , irritation ; pain on urination ; or pain or bleeding on intercourse . The Arizona Sexual Experience Survey was used to define female sexual dysfunction . Sexual dysfunction subtypes for desire , arousal , and orgasm difficulties were individually scored . We evaluated demographic , behavioral , reproductive history , and medication covariates for effect modification and confounding . Multivariate logistic regression was used to assess the relationship between vulvovaginal atrophy and female sexual dysfunction . Results : The prevalence of vulvovaginal atrophy ( 57 % ) and female sexual dysfunction ( 55 % ) was high . Women with female sexual dysfunction were 3.84 times more likely to have vulvovaginal atrophy than women without female sexual dysfunction ( 95 % CI : 2.99 - 4.94 ) . Hot flashes modified the association between vulvovaginal atrophy and desire difficulty . Educational level modified the association between vulvovaginal atrophy and arousal difficulty . Parity modified the association between vulvovaginal atrophy and orgasm difficulty . Conclusions : This large population -based study provides evidence of an association between vulvovaginal atrophy and overall female sexual dysfunction and its subtypes . Therapies aim ing to reduce symptoms of one condition may also relieve symptoms of the other OBJECTIVE To assess the effect of raloxifene compared with placebo on sexual function in older postmenopausal women undergoing therapy for the treatment of osteoporosis . METHODS A subset ( 12 % ) of English-speaking women in the United States and Canada participating in the Multiple Outcomes of Raloxifene Evaluation Trial were asked to complete a sexual function question naire at baseline and after 36 months of treatment . The Multiple Outcomes of Raloxifene Evaluation Trial is a multicenter , r and omized , blinded , placebo-controlled clinical trial , in which 7705 postmenopausal women with osteoporosis were r and omly assigned to one of three groups : raloxifene hydrochloride 60 mg per day or 120 mg per day or placebo . In this sub study , 943 women completed the sexual function question naire at both visits . Because preliminary analyses showed no differences by raloxifene dose ( n = 302 for 60 mg per day ; n = 322 for 120 mg/day ) , the two groups were combined and compared with the placebo group ( n = 319 ) . For the given sample size , we had 80 % power ( & agr ; = .05 , two-sided , ratio of raloxifene to placebo = 2:1 ) to detect a 10%–16 % difference in the proportion of women experiencing no change in sexual function between placebo and treatment groups . RESULTS Overall , sexual function and changes in sexual function from baseline to study end between the raloxifene and placebo groups did not differ . In particular , there were no differences in sexual desire or frequency of sexual activity between the groups . Among sexually active women , there were no differences in enjoyment , satisfaction , orgasm , or reported sexual problems . CONCLUSION Sexual function in older postmenopausal women with osteoporosis is not affected by treatment with raloxifene INTRODUCTION Female libido is multifactorial and complex . Declining estrogen levels in postmenopausal women affects vaginal function . AIM The aim of this study was to evaluate female sexual function after using topical estrogen , testosterone , or polyacrylic acid as vaginal lubricants with K-Y jelly as a placebo lubricant . METHODS This was a r and omized controlled clinical trial on 80 postmenopausal women between 40 and 70 years of age with follow-up at the Menopause Clinic of the CAISM Unicamp . The women were r and omized to treatment with topical vaginal estrogen , testosterone , polyacrylic acid , or oil lubricant alone , three times a week for a period of 12 weeks from November 2011 to January 2013 . MAIN OUTCOME MEASURE We used the Female Sexual Function Index ( FSFI ) to assess changes in sexual response at baseline , and after 6 and 12 weeks . RESULTS After 12 weeks of treatment , polyacrylic acid and topical testosterone produced improvements in the FSFI domains of sexual desire , lubrication , satisfaction , reduced pain during intercourse , and total score compared with lubricant alone . Treatment with topical estrogen in comparison with lubricant alone showed an improvement in the FSFI field of desire . The intragroup analysis over the time of the treatment showed improvements in the fields of desire , lubrication , and reduced pain for polyacrylic acid , testosterone , and estrogen . Furthermore , women who used testosterone showed improvements over time in the fields of arousal , orgasm , and satisfaction . CONCLUSIONS Treatment of postmenopausal women with symptoms of vaginal atrophy with polyacrylic acid , testosterone , and estrogen for 12 weeks produced improvements in self-reported female sexual function when compared with a placebo lubricant BACKGROUND The efficacy and safety of testosterone treatment for hypoactive sexual desire disorder in postmenopausal women not receiving estrogen therapy  are unknown . METHODS We conducted a double-blind , placebo-controlled , 52-week trial in which 814 women with hypoactive sexual desire disorder were r and omly assigned to receive a patch delivering 150 or 300 microg of testosterone per day or placebo .  Efficacy was measured to week 24 ; safety was evaluated over a period of 52 weeks , with a subgroup of participants followed for an additional year . The primary end point was the change from baseline to week 24 in the 4-week frequency of satisfying sexual episodes . RESULTS At 24 weeks , the increase in the 4-week frequency of satisfying sexual episodes was significantly greater in the group receiving 300 microg of testosterone per day than in the placebo group ( an increase of 2.1 episodes vs. 0.7 , P<0.001 ) but not in the group receiving 150 microg per day ( 1.2 episodes , P=0.11 ) . As compared with placebo , both doses of testosterone were associated with significant increases in desire ( 300 microg per day , P<0.001 ; 150 microg per day , P=0.04 ) and decreases in distress ( 300 microg per day , P<0.001 ; 150 microg per day , P=0.04 ) . The rate of and rogenic adverse events - primarily unwanted hair growth - was higher in the group receiving 300 microg of testosterone per day than in the placebo group ( 30.0 % vs. 23.1 % ) . Breast cancer was diagnosed in four women who received testosterone ( as compared with none who received placebo ) ; one of the four received the diagnosis in the first 4 months of the study period , and one , in retrospect , had symptoms before undergoing r and omization . CONCLUSIONS In postmenopausal women not receiving estrogen therapy  , treatment with a patch delivering 300 microg of testosterone per day result ed in a modest but meaningful improvement in sexual function . The long-term effects of testosterone , including effects on the breast , remain uncertain . ( Clinical Trials.gov number , NCT00131495 . Objective : Although observational studies showed an apparent lower ischemic coronary disease risk in postmenopausal women receiving hormone therapy ( HT )  , r and omized clinical trials in postmenopausal women showed an increase in ischemic cardiovascular events . Soluble cell adhesion molecules have been associated with cardiovascular risk factors and events . HT reduces circulating levels of soluble cell adhesion molecules in healthy postmenopausal women , but its effects in postmenopausal women with coronary artery disease are less clear . We assessed the effect of HT on soluble cell adhesion molecules in the Estrogen Replacement and Atherosclerosis trial . Design : The Estrogen Replacement and Atherosclerosis trial was a double-blind , placebo-controlled study that r and omized 309 postmenopausal women ( mean age , 65.8 y ) to daily unopposed estrogen ( conjugated estrogens 0.625 mg ) , estrogen plus 2.5 mg of medroxyprogesterone acetate , or placebo  , with a mean follow-up period of 3.2 years . Soluble intercellular adhesion molecule-1 , vascular cell adhesion molecule-1 , and E-selectin were measured in serum obtained from participants at baseline and after 12 months of follow-up . Results : Of the 265 women with complete data , 87 women were assigned to unopposed estrogen , 88 women to estrogen plus medroxyprogesterone acetate , and 90 women to placebo . Compared with placebo , 12 months of HT ( n = 175 ) was associated with reductions in soluble intercellular adhesion molecule-1 ( 25.6 ± 4.7 vs 10.6 ± 6.4ng/mL , P = 0.06 ) , soluble vascular cell adhesion molecule-1 ( 80.2± 10.6 vs 28.8 ± 14.7 ng/mL , P = 0.005 ) , and E-selectin ( 8.8 ± 0.9 vs −1.1 ± 1.2 ng/mL , P < 0.001 ) . Conclusions : Twelve months of HT in postmenopausal women with established coronary artery disease was associated with reductions in serum markers of endothelial cell activation/injury such as soluble intercellular adhesion molecule-1 , vascular cell adhesion molecule-1 , and E-selectin Objective To evaluate the effects of the tissue selective estrogen complex ( TSEC ) pairing bazedoxifene ( BZA ) with conjugated estrogens ( CE ) on sexual function and quality of life in postmenopausal women . Methods In this 12-week , double-blind , placebo-controlled study , postmenopausal , non-hysterectomized women ( n = 652 ) with symptoms of moderate to severe vulvar/vaginal atrophy were r and omized to once-daily treatment with BZA 20 mg/CE 0.45 or 0.625 mg , BZA 20 mg , or placebo . The Arizona Sexual Experiences ( ASEX ) Scale , Menopause-Specific Quality of Life ( MENQOL ) question naire , and Menopause Symptoms Treatment Satisfaction Question naire ( MS-TSQ ) were secondary measures used to assess the effects of BZA/CE on sexual function , menopausal symptoms , and satisfaction with treatment , respectively . Results At week 12 , both BZA/CE doses were associated with significant improvement in ease of lubrication score from baseline compared with placebo ( p < 0.05 ) on the ASEX scale , although there was no difference in the change in total score . The MENQOL question naire results at week 12 showed significant improvements in vasomotor function , sexual function and total scores with both BZA/CE doses vs. placebo or BZA 20 mg ( p < 0.001 ) . The MS-TSQ results showed that BZA/CE-treated subjects reported significantly greater overall satisfaction with treatment , as well as satisfaction with control of hot flushes during the day and night , effect on quality of sleep , and effect on mood or emotions , compared with subjects treated with placebo or BZA 20 mg ( all p < 0.05 ) . Conclusion Treatment with BZA/CE for 12 weeks was shown to significantly improve sexual function and quality -of-life measures in symptomatic postmenopausal women Summary This 30-month study investigating bone change and its determinants in 438 perimenopausal Chinese women revealed that the fastest bone loss occurred in women undergoing menopausal transition but maintenance of body weight and physical fitness were beneficial for bone health . Soy protein intake also seemed to exert a protective effect . Introduction This 30-month follow-up study aims to investigate change in bone mineral density and its determinants in Hong Kong Chinese perimenopausal women . Methods Four hundred and thirty-eight women aged 45 to 55 years were recruited through r and om telephone dialing and primary care clinic .  Bone mass , body composition , lifestyle measurements were obtained at baseline and at 9- , 18- and 30-month follow-ups . Univariate and stepwise multiple regression analyses were performed with the regression coefficients of BMD/C ( derived from baseline and follow-up measurements ) as the outcome variables . Menopausal status was classified as pre- or postmenopausal or transitional . Results Menopausal status was the strongest determinant of bone changes . An annual bone loss of about 0.5 % was observed among premenopausal , 2 % to 2.5 % among transitional , and about 1.5 % in postmenopausal women . Multiple regression analyses , revealed that a positive regression slope of body weight was protective for follow-up bone loss at all sites . Number of pregnancy , soy protein intake  and walking were protective for total body BMC . Higher baseline LM was also protective for neck of femur BMD . Conclusion Maintenance of body weight and physical fitness were observed to have a protective effect on for bone loss in Chinese perimenopausal women Objective : To compare the effects of oral and vaginal estrogen therapy ( ET ) on the vaginal blood flow and sexual function in postmenopausal women with previous hysterectomy . Design : Fifty-seven women were r and omized to receive either oral ( 0.625 mg of conjugated equine estrogens per tablet ; n = 27 ) or topical ( 0.625 mg conjugated equine estrogens per 1 g vaginal cream ; n = 30 ) estrogen administered once daily . All women underwent estradiol measurements , urinalysis , pelvic examination , introital color Doppler ultrasonographies , and personal interviews for sexual symptoms using a vali date d question naire before and 3 months after ET . Results : A higher serum level of estradiol was noted in the oral group compared with the topical group after 3 months of ET . There were significant increases in the number of vaginal vessels and the minimum diastole ( P < 0.01 ) , and marked decreases of pulsatility index values ( P < 0.01 ) in both groups after ET . Regarding the systolic peak , we found a significant decrease only in the topical group ( P < 0.05 ) . Although the post-ET prevalence of anorgasmia decreased significantly in both groups ( P < 0.05 ) , changes in other domains , including the rates of low libido and coital frequency , were not statistically significant ( P > 0.05 ) . In the topical group , ET  improved sexual function on the vaginal dryness and dyspareunia domains in a statistically significant manner ( P < 0.05 ) , but this was not the case in the oral group ( P > 0.05 ) . However , the efficacy of oral ET for vaginal dryness and dyspareunia reached 80 % and 70.6 % , respectively . The corresponding figures of the topical ET were 79.2 % and 75 % . Conclusions : The results of our study suggest that ET alone in hysterectomized postmenopausal women increases the vaginal blood flow and improves some domains of sexual function , but it may not have an impact on diminished sexual desire or activity . Compared with systemic therapy , topical vaginal preparations are found to correlate with better symptom relief despite the lower serum level of estradiol Two hundred and forty‐two postmenopausal women between 35 and 65 years of age requiring hormone replacement therapy for climacteric symptoms were blindly and r and omly allocated to treatment either with transdermal estradiol therapy ( Estraderm * 50 μg/24 h ) ( E ) or placebo ( P ) . The patches were changed twice a week and treatment continued for 12 weeks . No progestogen supplement therapy was given during the study . No previous hormone replacement therapy had been given for the last six months and the women had had their last menstruation more than sin months ago . As a part of a larger study assessing women 's quality of life , a Swedish version of ‘ McCoy 's Sex Scale Question naire ’ was administered at the start of treatment and after 12 weeks . This question naire contains nine items regarding different aspects of sexual life . The difference between the scorings at the start of treatment and after 12 weeks were calculated for each item and the values of the E and the P groups were compared . Items regarding ‘ satisfaction with frequency of sexual activity , sexual fantasies . degree of enjoyment . vaginal lubrication and pain during intercourse ’ were positively influenced in the E group compared to the P group . Items not affected were ‘ frequency of orgasm and sexual arousal ’ . A correlation between improved sexual life and quality of life was also found when the results from the McCoy scale were compared with a battery of quality of life question naires Current st and ard-dose calcium supplements ( eg , 1000 mg/d ) may increase the risk for cardiovascular events . Effectiveness of lower-dose supplements in preventing bone loss should thus be considered . This study aim ed to assess whether calcium supplements of 500 or 250 mg/d effectively prevent bone loss in perimenopausal and postmenopausal Japanese women . We recruited 450 Japanese women between 50 and 75 years of age . They were r and omly assigned to receive 500 mg of calcium ( as calcium carbonate ) , 250 mg of calcium , or placebo daily . Medical examinations conducted three times over a 2-year follow-up period assessed bone mineral density ( BMD ) of the lumbar spine and femoral neck . One-factor repeated measures ANOVA was used for statistical tests . Subgroup analyses were also conducted . Average  total daily calcium intake at baseline for the 418 subjects who underwent follow-up examinations was 493 mg/d . Intention-to-treat analysis showed less dramatic decreases in spinal BMD for the 500-mg/d calcium supplement group compared to the placebo group ( 1.2 % difference over 2 years , p = 0.027 ) . Per- protocol analysis ( ≥80 % compliance ) revealed that spinal BMD for the 500-mg/d and 250-mg/d calcium supplement groups decreased less than the placebo group ( 1.6 % , p = 0.010 and 1.0 % , p = 0.078 , respectively ) , and that femoral neck BMD for the 500-mg/d calcium supplement group decreased less relative to the placebo group ( 1.0 % , p = 0.077 ) . A low-dose calcium supplement of 500 mg/d can effectively slow lumbar spine bone loss  in perimenopausal and postmenopausal women with habitually low calcium intake , but its effect on the femoral neck is less certain . Calcium supplementation dosage should thus be reassessed . ( Clinical Trials Registry number : UMIN000001176 ) Sexual dysfunction is present the most important problem among menopausal women and thus counseling may have a major role for improving menopausal sexual state in this population . We aim ed to assess effects of counseling on sexual function of menopause women and their spouses . An interventional trial study was performed on 120 consecutive Iranian couples ( menopause women and their spouses ) who were resident in Hamadan , Iran in 2015 . The subjects were r and omly assigned to  receive counseling service ( n = 60 ) or did not receive this service ( n = 60 ) . Couples were asked to complete a st and ardized vali date d question naire assessing sexual function and behaviors . The frequency of sexual intercourse was considerably increased following first and second counseling sessions compared with the time before counseling in former group , while sexually state was remained unchanged in those who not received these counseling . Furthermore , dyspareunia in interventional women with counseling was significantly reduced after the first and second counseling , whereas this complaint was not significantly removed in the control group within the study period . Also , unsuccessful intercourse was significantly decreased in men who received counseling sessions , while this parameter was remained unchanged in other men . In addition , talking with the partner about sexually and Satisfaction degree of wife ’s love was significantly improved in both men and women in interventional groups compared with the control groups . Active and structured counseling effectively improve sexual functions and behaviors in menopausal women and their spouses Background —Despite diffuse effects of sex hormones on the cardiovascular system , few prospect i ve studies have examined the relationship of plasma and rogens and estrogens with risk of cardiovascular disease ( CVD ) in postmenopausal women . Methods and Results —A nested case-control study was performed among women in the Women ’s Health Study . Two hundred women who developed CVD were matched 1:1 by age , smoking , and postmenopausal hormone therapy ( HT ) to controls who remained free of CVD . We measured testosterone , estradiol , and sex hormone binding globulin ( SHBG ) levels and calculated free and rogen index ( FAI ) , free estradiol index , and the FAI/free estradiol index ratio .  Results were stratified by HT use . Among HT nonusers , cases had significantly higher and rogen profiles ( higher median FAI and lower SHBG levels ) than controls . After adjustment for age , smoking , use of aspirin , vitamin E , and alcohol , family history of myocardial infa rct ion , and physical activity , nonusers in the lowest SHBG quartile had an OR of 2.25 ( 95 % CI , 1.03 to 4.91 ) for CVD , and there were significant trends across FAI quartiles ( P for trend=0.03 ) . Additional adjustment for body mass index , hypertension , diabetes , and elevated cholesterol eliminated associations with SHBG and FAI . Among women using HT , no significant differences in hormones or SHBG were observed among women who developed CVD and controls . Conclusions —Among HT nonusers , lower SHBG and higher FAI levels were noted among postmenopausal women who developed CVD events , but this was not independent of body mass index and other cardiovascular risk factors . Estradiol levels were not associated with risk of CVD in  HT  users or nonusers Objective The aim of this study is to investigate the effectiveness and safety of a Chinese herbal formula , Er-Xian decoction ( EXD ) , in the treatment of menopausal symptoms among Hong Kong perimenopausal women . Methods A r and omized , double-blind , controlled trial was conducted for 12 weeks among 108 Hong Kong perimenopausal women who reported Menopause Rating Scale ( MRS ) total scores of 28 or higher . Posttreatment follow-up was performed 3 months after the intervention . The primary outcome measure was the frequency and severity of hot flushes . The secondary outcome measures included the MRS , the Menopause-Specific Quality of Life question naire , and serum hormone levels . Results Among 108 participants , 101 participants finished the study . EXD significantly reduced the mean ( SD ) frequency of hot flushes from 5.8 ( 5.0 ) to 2.2 ( 3.0 ) in the treatment group and from 5.0 ( 3.8 ) to 2.4 ( 2.5 ) in the placebo group ( P = 0.04 ) . The mean ( SD ) hot flush score was also reduced from 19.6 ( 6.6 ) to 4.9 ( 7.8 ) in the treatment group and from 16.6 ( 5.4 ) to 7.0 ( 6.4 ) in the placebo group ( P = 0.02 ) . The superiority of EXD to placebo was also observed with greater improvement in the total scores for the MRS ( P = 0.03 ) and the Menopause-Specific Quality of Life question naire ( P < 0.01 ) . There were no differences in serum hormone levels between the EXD group and the placebo group . There were no serious adverse events , and the safety indices of whole blood counts , renal function , and liver function were within the normal range before and after treatment . Conclusions The Chinese herbal formula EXD is superior to placebo in reducing the frequency and severity of hot flushes and in improving menopausal symptoms in Hong Kong perimenopausal women . It is well tolerated , with no serious adverse events noted during the study period OBJECTIVE The aim of this study is to investigate the effectiveness and safety of a Chinese herbal formula , Er-Xian decoction ( EXD ) , in the treatment of menopausal symptoms among Hong Kong perimenopausal women . METHODS A r and omized , double-blind , controlled trial was conducted for 12 weeks among 108 Hong Kong perimenopausal women who reported Menopause Rating Scale ( MRS ) total scores of 28 or higher . Posttreatment follow-up was performed 3 months after the intervention . The primary outcome measure was the frequency and severity of hot flushes . The secondary outcome measures included the MRS , the Menopause-Specific Quality of Life question naire , and serum hormone levels . RESULTS Among 108 participants , 101 participants finished the study . EXD significantly reduced the mean ( SD ) frequency of hot flushes from 5.8 ( 5.0 ) to 2.2 ( 3.0 ) in the treatment group and from 5.0 ( 3.8 ) to 2.4 ( 2.5 ) in the placebo group ( P = 0.04 ) . The mean ( SD ) hot flush score was also reduced from 19.6 ( 6.6 ) to 4.9 ( 7.8 ) in the treatment group and from 16.6 ( 5.4 ) to 7.0 ( 6.4 ) in the placebo group ( P = 0.02 ) . The superiority of EXD to placebo was also observed with greater improvement in the total scores for the MRS ( P = 0.03 ) and the Menopause-Specific Quality of Life question naire ( P < 0.01 ) . There were no differences in serum hormone levels between the EXD group and the placebo group . There were no serious adverse events , and the safety indices of whole blood counts , renal function , and liver function were within the normal range before and after treatment . CONCLUSIONS The Chinese herbal formula EXD is superior to placebo in reducing the frequency and severity of hot flushes and in improving menopausal symptoms in Hong Kong perimenopausal women . It is well tolerated , with no serious adverse events noted during the study period BACKGROUND The sex lives of women are strongly affected by menopause . Non-pharmacologic approaches to improving the sexual function of postmenopausal women might prove effective . AIM To compare two methods of intervention ( formal sex education and Kegel exercises ) with routine postmenopausal care services in a r and omized clinical trial . METHODS A r and omized clinical trial was conducted of 145 postmenopausal women residing in Chalus and Noshahr , Iran . Their sexual function statuses were assessed using the Female Sexual Function Index ( FSFI ) question naire . After obtaining written informed consents , they were r and omly assigned to one of three groups : ( i ) formal sex education , ( ii ) Kegel exercises , or ( iii ) routine postmenopausal care . After 12 weeks , all participants completed the FSFI again . Analysis of covariance was used to compare the participants ' sexual function before and after the interventions , and multiple linear regression analysis was used to determine the predictive factors for variation in FSFI scores in the postintervention stage . OUTCOMES Sexual function was assessed using the FSFI . RESULTS There were no statistically significant differences in demographic and socioeconomic characteristics and FSFI total scores among the three study groups at the outset of the study . After 12 weeks , the scores of arousal in the formal sex education and Kegel groups were significantly higher compared with the control group ( 3.38 and 3.15 vs 2.77 , respectively ) . The scores of orgasm and satisfaction in the Kegel group were significantly higher compared with the control group ( 4.43 and 4.88 vs 3.95 and 4.39 , respectively ) . CLINICAL IMPLICATION S Formal sex education and Kegel exercises were used as two non-pharmacologic approaches to improve the sexual function of women after menopause . STRENGTHS AND LIMITATIONS The main strength of this study was its design : a well-organized r and omized trial using precise eligibility criteria with a small sample loss . The second strength was the methods of intervention used , namely non-pharmacologic approaches that are simple , easily accessible , and fairly inexpensive . The main limitation of the study was our inability to objective ly assess the participants ' commitment to exercise and the sexual function of their partners . CONCLUSION Sex education programs and Kegel exercises could cause improvements in some domains of sexual function-specifically arousal , orgasm , and satisfaction-in postmenopausal women . Nazarpour S , Simbar M , Tehrani FR , Majd HA . Effects of Sex Education and Kegel Exercises on the Sexual Function of Postmenopausal Women : A R and omized Clinical Trial . J Sex Med 2017;14:959 - 967 STUDY OBJECTIVE To compare 2-dimensional ( 2D ) sonohysterography ( SHG ) and 3D-SHG with saline solution infusion vs diagnostic hysteroscopy for investigation of intrauterine lesions in perimenopausal and postmenopausal women with abnormal uterine bleeding . DESIGN Comparative observational cross-sectional study ( Canadian Task Force classification II-1 ) . SETTING University hospital . PATIENTS Fifty perimenopausal and 20 postmenopausal women with abnormal intrauterine bleeding with clinical ly or ultrasonically suspected intrauterine lesions . INTERVENTIONS Conventional 2D- and 3D ultrasonography and 2D- and 3D-SHG with saline solution infusion followed by diagnostic hysteroscopy , and endometrial curettage or subsequent operative treatment ( e.g. , hysterectomy , myomectomy , or polypectomy ) . Ultrasonographic and hysteroscopic findings were compared with histopathologic findings . MEASUREMENTS AND MAIN RESULTS For 2D-SHG , sensitivity , specificity , positive predictive value , negative predictive value , overall accuracy , likelihood ratio for a positive result , and likelihood ratio for a negative result were 79 % , 72 % , 89 % , 54 % , 76 % , 2.82 , and 0.29 , respectively , and for 3D-SHG , were 92 % , 89 % , 96 % , 80 % , 91 % , 8.36 , and 0.09 , respectively ; and for diagnostic hysteroscopy , were 94 % , 89 % , 96 % , 84 % , 93 % , 8.55 , and 0.07 , respectively . Thus , 3D-SHG was superior to 2D SHG ( p = .02 ) and comparable to diagnostic hysteroscopy ( p = .75 ) for diagnosis of intrauterine lesions . CONCLUSION 3D-SHG can be used in the initial investigation of intrauterine lesions in perimenopausal and postmenopausal women with abnormal uterine bleeding before resorting to invasive procedures such as diagnostic hysteroscopy . Further studies of computer-reconstructed 3D-SHG virtual hysteroscopy are recommended Objective : The aim of this study was to evaluate the efficacy of citalopram for climacteric symptoms and to assess the combined effect of citalopram and hormone therapy ( HT ) on climacteric symptoms in women inadequately responsive to HT alone . Design : The study included 100 postmenopausal women who were allocated into one of four groups : ( 1 ) citalopram , ( 2 ) placebo , ( 3 ) citalopram + HT , or ( 4 ) placebo + HT . The women who were unable or unwilling to take HT  were r and omly placed in groups 1 and 2 . The women who were inadequately responsive to HT  were r and omly placed in groups 3 and 4 . The initial dose of citalopram was 10 mg/day in groups 1 and 3 . After 1 week , the dose was increased to 20 mg/day . After starting the medication , follow-up visits took place during the fourth and eighth weeks of treatment . During the first and eighth weeks , women completed two question naires : a modified Kupperman index and the Menopause-Specific Quality of Life Question naire . Results : Mean hot flash scores significantly improved in all groups ( P < 0.05 ) . The reduction rates were 37 % in group 1 , 13 % in group 2 , 50 % in group 3 , and 14 % in group 4 . Psychosocial complaints and mean values on the Kupperman index significantly decreased in all groups ( P < 0.05 ) . Physical well-being significantly improved in groups 1 , 3 , and 4 ( P < 0.05 ) . The decrease in all scores was significantly greater in groups 1 and 3 compared to groups 2 and 4 ( P < 0.01 ) . Conclusion : Citalopram is an effective alternative treatment option for patients who do not want to take HT for the alleviation of climacteric symptoms . Adjuvant treatment with a selective serotonin reuptake inhibitor increases the effectiveness of HT  for the treatment of climacteric symptoms in women who had responded inadequately to HT OBJECTIVES To describe Australian-born women 's experience of symptoms during the natural menopause transition and the relative contribution of menopausal and health status , social factors and lifestyle behaviours . DESIGN A community based cross-sectional survey by telephone interview was carried out on a r and omly derived sample of Melbourne women . PARTICIPANTS The participants were 2000 Australian-born women , aged between 45 and 55 years . OUTCOME MEASURES A list of 22 symptoms was used . Explanatory variables were : sociodemographic variables ; menopausal and health status ; lifestyle behaviours ; attitudes to ageing and to menopause . RESULTS A 70 % response rate was achieved for eligible women who could be contacted during the study . Premenopausal women were the least symptomatic and perimenopausal women the most symptomatic . Factor analysis found seven common factors from the 22 symptoms studied . Menopausal status based on menstrual history was significantly related to two groups of symptoms : vasomotor symptoms , which increased through the menopausal transition ; and general somatic symptoms which were more frequent in the perimenopause . Analysis of variance of factor scores found fewer symptoms with increasing years of education , better self-rated health , the use of fewer non-prescription medications , the absence of chronic health conditions , a low level of interpersonal stress , the absence of premenstrual complaints , not currently smoking , exercise at least once a week , and positive attitudes to ageing and menopause . CONCLUSIONS Many factors unrelated to hormonal changes contributed to the symptoms . Longitudinal investigation is needed to determine the relative importance of hormonal , psychosocial and lifestyle variables in the aetiology of mid-life symptoms OBJECTIVES The object of this study was to assess the effects of menopause and a diet/exercise intervention on sub clinical atherosclerosis progression . BACKGROUND Sub clinical atherosclerosis has been linked to higher coronary heart disease and stroke rates and is greater among postmenopausal women according to cross-sectional analyses . Whether menopause is associated with an accelerated progression of sub clinical disease is unknown , as is the extent to which lifestyle intervention can alter the course of progression . METHODS Intima-media thickness ( IMT ) measures of the common carotid artery ( CCA ) , internal carotid artery ( ICA ) , and bulb segments of the carotid arteries were measured twice during the course of 4 years in 353 women from the Women 's Healthy Lifestyle Project , a dietary and exercise clinical trial design ed to prevent adverse risk factor changes through the menopause . A third measure was obtained 2.5 years later for 113 women . RESULTS The progression of IMT was observed for the average of all segments ( AVG ) , the CCA , and the bulb ( 0.007 mm/year , 0.008 mm/year , and 0.012 mm/year ; p < 0.01 for all ) , but not for the ICA . Among controls , menopause was associated with accelerated IMT progression ( 0.003 mm/year for premenopausal women vs. 0.008 mm/year for perimenopausal/postmenopausal women for AVG IMT ; p = 0.049 ) . Additionally , among the 160 perimenopausal/postmenopausal women , the intervention slowed IMT progression ( 0.008 mm/year for the control group vs. 0.004 mm/year for the intervention group for AVG IMT ; p = 0.02 ) . Similar results were found for the CCA and bulb segments . CONCLUSIONS These data demonstrate that the menopause transition is associated with accelerated sub clinical atherosclerosis progression and that a diet/exercise intervention slows menopause-related atherosclerosis progression Previous studies have indicated that the addition of progestins during sequential  hormonal replacement therapy ( HRT ) causes negative mood and physical symptoms . History of premenstrual syndrome , type of progestin , and dose of progestin have thus far been shown to influence the progestin-induced adverse mood symptoms during HRT . The aim of this study was to compare adverse mood effects of two different doses of estradiol , in combination with a progestin , during postmenopausal HRT . Twenty-eight perimenopausal women were included in this r and omized , double-blind , crossover study comparing 2- or 3-mg continuous estradiol , with an addition of 10 mg medroxyprogesterone acetate on d 17 - 28 during each treatment cycle . The main outcome measures were mood and physical symptoms kept on a daily rating scale . Together with the progestin , the higher dose of estrogen caused significantly more negative mood symptoms than the lower dose . Tension , irritability , and depressed mood were all significantly augmented during the progestin phase of cycles with 3 mg estradiol ( P < 0.001 ) . Physical symptoms also increased during the progestin phase of 3-mg estradiol cycles ( P < 0.001 ) , whereas positive mood symptoms were less affected . The only positive mood that changed with estrogen dose was friendliness , which decreased during the progestin phase of high estradiol cycles compared with cycles with lower estradiol ( P < 0.05 ) . Our conclusion is that an increase of the estrogen dose accentuates negative mood and physical symptoms during the progestin phase of sequential hormonal therapy Risk factors that are associated with lower bone mineral density ( BMD ) may not necessarily be associated with increased bone loss among premenopausal and perimenopausal women . We determined risk factors for lower premenopausal and perimenopausal BMD while simultaneously determining risk factors for increased 6-year rate of bone loss  among women aged 24–50 years within a population -based prospect i ve cohort study .  BMD of the lumbar spine and femoral neck , reported as t scores , were measured five times within the 6-year study among 614 women who were between the ages of 24 and 44 in 1992/1993 .  Rates of bone loss were calculated from the repeated BMD measurements . Risk factors for lower BMD over time at the lumbar spine included history of any fracture ( P=0.005 ) . The major risk factor for lower BMD over time at the femoral neck was family history of osteoporosis ( P<0.002 ) . The major protective factor for greater BMD over time at both skeletal sites was additional body weight ( P<0.0001 ) . Other protective factors for greater BMD over time at the femoral neck were modest alcohol consumption ( P=0.0002 ) and high-school sports participation ( P=0.002 ) . Risk factors for greater bone loss at either skeletal site included postmenopausal status ( P<0.0001 at the lumbar spine ; P=0.01 at the femoral neck ) , and the reporting of a reproductive cancer ( P<0.0001 at the lumbar spine ; P=0.0008 at the femoral neck ) . Body weight was protective against bone loss at both skeletal sites ( P<0.0001 ) . Baseline age , calcium intake , smoking , and current physical activity were not associated with BMD or bone loss . The underst and ing of the relative importance of risk factors for both low BMD and bone loss may assist in the identification of women at greater risk for subsequent low postmenopausal BMD In a double-blind trial oestradiol , oestradiol/testosterone , or placebo implants were assessed for their effects on psychological symptoms in women attending a menopause clinic . After two months , women receiving active treatment scored better than the placebo group on a self-rating scale of distress , on anxiety , and on depression ( p less than 0.05 ) . Postmenopausal but not perimenopausal women improved after placebo , and at 4 months the scores in the three groups no longer differed significantly OBJECTIVE This study examined the effect of hormone therapy ( HT ) on the plasma concentration of remnant lipoprotein cholesterol ( RLP-C ) and high-density lipoprotein ( HDL ) sub population s and the contribution of HT-related changes in these lipoproteins to the progression of coronary heart disease ( CHD ) in postmenopausal women . METHODS Study participants were 256 women who completed the Estrogen Replacement and Atherosclerosis ( ERA ) trial , a placebo-controlled , r and omized trial that examined the effects of 3.2 years of conjugated equine estrogen ( CEE , 0.625 mg/day ) or CEE ( 0.625 mg/day ) plus medroxyprogesterone acetate ( MPA , 2.5mg/day ) on postmenopausal women with established coronary atherosclerosis . Quantitative coronary angiography and plasma RLP-C and HDL sub population s were assessed at baseline and at follow-up . RESULTS Relative to placebo , both CEE and CEE+MPA caused a significant reduction in plasma RLP-C concentrations and a significant increase in alpha1 and alpha2 HDL sub population s. However , in the HT-treated subjects , faster progression of coronary atherosclerosis was observed in women who experienced the greatest reductions in RLP-C and in prebeta1 HDL sub population s. CONCLUSIONS Our data suggest that individual variability in RLP-C and HDL sub population response to HT is a predictor of CHD progression . Lipoprotein response to HT may be an indirect marker of susceptibility to other harmful effect of HT in postmenopausal women with established CHD or an indication of formation of dysfunctional lipoproteins PURPOSE To up date the ASCO clinical practice guideline on adjuvant endocrine therapy on the basis of emerging data on the optimal duration of treatment , particularly adjuvant tamoxifen . METHODS ASCO convened the Up date Committee and conducted a systematic review of r and omized clinical trials from January 2009 to June 2013 and analyzed three historical trials . Guideline recommendations were based on the Up date Committee 's review of the evidence . Outcomes of interest included survival , disease recurrence , and adverse events . RESULTS This guideline up date reflects emerging data on duration of tamoxifen treatment . There have been five studies of tamoxifen treatment beyond 5 years of therapy . The two largest studies with longest reported follow-up show a breast cancer survival advantage with 10-year duration s of tamoxifen use . In addition to modest gains in survival , extended therapy with tamoxifen for 10 years compared with 5 years was associated with lower risks of breast cancer recurrence and contralateral breast cancer . RECOMMENDATIONS Previous ASCO guidelines recommended treatment of women who have hormone receptor-positive breast cancer and are premenopausal with 5 years of tamoxifen , and those who are postmenopausal a minimum of 5 years of adjuvant therapy with an aromatase inhibitor or tamoxifen followed by an aromatase inhibitor ( in sequence ) . If women are pre- or perimenopausal and have received 5 years of adjuvant tamoxifen , they should be offered 10 years total duration of tamoxifen . If women are postmenopausal and have received 5 years of adjuvant tamoxifen  , they should be offered the choice of continuing tamoxifen or switching to an aromatase inhibitor for 10 years total adjuvant endocrine therapy The possibility that the heightened cardiovascular risk associated with the menopause , which is said to be ameliorated by soybeans , can be reduced with soy isoflavones was tested in 21 women . Although several were perimenopausal , all have been included . A placebo-controlled crossover trial tested the effects of 80-mg daily isoflavones ( 45 mg genistein ) over 5- to 10-week periods . Systemic arterial compliance ( arterial elasticity ) , which declined with age in this group , improved 26 % ( P < .001 ) compared with placebo .  Arterial pressure and plasma lipids were unaffected . The vasodilatory capacity of the microcirculation was measured in nine women ; high acetylcholine-mediated dilation in the forearm vasculature was similar with active and placebo treatments . LDL oxidizability measured in vitro was unchanged . Thus , one important measure of arterial health , systemic arterial compliance , was significantly improved in perimenopausal and menopausal women taking soy isoflavones to about the same extent as is achieved with conventional hormone replacement therapy Objective : To evaluate vaginal , endometrial , and reproductive hormone effects of three herbal regimens compared with placebo and hormone therapy ( HT ) . Design : This was a 1-year , r and omized , double-blind , placebo-controlled trial of 351 women , ages 45 to 55 , with two or more vasomotor symptoms per day . Women were r and omly assigned to ( 1 ) black cohosh , ( 2 ) a multibotanical containing black cohosh , ( 3 ) the same multibotanical plus dietary soy counseling , ( 4 ) HT , or ( 5 ) placebo .  Women were ineligible if they had used HT in the previous 3 months or menopausal herbal therapies in the previous month . Data on vaginal cytology and dryness were collected ( at baseline and 3 and 12 mo ) . Daily menstrual diaries were maintained by 313 women with a uterus , and abnormal bleeding was evaluated . Serum estradiol , follicle-stimulating hormone , luteinizing hormone , and steroid hormone-binding globulin were assessed ( baseline and 12 mo ) among 133 postmenopausal women . Gynecologic outcomes of the five groups were compared . Results : The five groups did not vary in baseline vaginal cytology profiles , vaginal dryness , menstrual cyclicity , or hormone profiles . The HT group had a lower percentage of parabasal cells and vaginal dryness than the placebo group at 3 and 12 months ( P < 0.05 ) . Abnormal bleeding occurred in 53 of 313 ( 16.9 % ) women . There were no differences in frequency of abnormal bleeding between any of the herbal and placebo groups , whereas women in the HT group had a greater risk than those in the placebo group ( P < 0.001 ) . Among postmenopausal women , HT significantly decreased follicle-stimulating hormone and increased estradiol ; none of the herbal interventions showed significant effects on any outcomes at any time point . Conclusion : Black cohosh , used alone or as part of a multibotanical product with or without soy dietary changes , had no effects on vaginal epithelium , endometrium , or reproductive hormones Objective : Nonhormonal treatment of postmenopausal symptoms is a subject of great interest today . The results of studies on selective serotonin reuptake inhibitors ( SSRIs ) are promising , but long-term results do not exist . The objective of this study was to evaluate the efficacy of citalopram and fluoxetine in the treatment of physical and psychological menopausal symptoms and their effects on psychosocial and sexual well being in symptomatic postmenopausal women . Design : One hundred fifty healthy women suffering from menopausal symptoms were recruited to this placebo-controlled double-blind study with a follow-up period of 9 months . They were r and omized into three groups receiving placebo , fluoxetine , or citalopram . The initial dose was 10 mg of both fluoxetine and citalopram , and it was increased to 20 mg at 1 month and to 30 mg at the 6-month visit . The main outcome measures were hot flushes and Kupperman index . The R AND -36 Quality of Life question naire , Beck 's Depression Scale , and the McCoy Female Sexuality Question naire were used at every control visit . Results : There were no statistically significant differences between the groups in respect to number of hot flushes , Kupperman index , or Beck 's Depression Scale , although there was a tendency in all these parameters in favor of SSRIs versus placebo . Insomnia improved significantly in the citalopram group versus placebo .  Discontinuation rates at nine months were 40 % in the placebo group , 34 % in the fluoxetine group and 34 % in the citalopram group . Conclusions : Compared with placebo , citalopram and fluoxetine have little effect on hot flushes and can not therefore be recommended for the treatment of menopausal symptoms , if vasomotor symptoms are the main complaint . Whether the improvement of insomnia by means of citalopram affects the quality of sleep needs further investigation Menopause impacts 25 million women world wide each year , and the World Health Organization estimates 1.2 billion women will be postmenopausal by 2030 . Menopause has been associated with symptoms of hot flashes , night sweats , dysphoric mood , sleep disturbance , and conditions of cardiovascular disease , depression , osteoporosis , osteoarthritis , depression , dementia , and frailty . Conventional hormone replacement therapy results in increased thrombotic events , and an increased risk of breast cancer and dementia as evidence d in large prospect i ve clinical trials including Heart and Estrogen/Progestin Replacement Study I and the Women 's Health Initiative . A possible mechanism for these adverse events is the unfavorable net effects of conjugated equine estrogens and medroxyprogesterone acetate on the hemostatic balance and inflammatory and immune factors . Physiologic sex steroid therapy with transdermal delivery for peri/postmenopausal women may offer a different risk/benefit profile , yet long-term studies of this treatment model are lacking . The objective of this study was to examine the long-term effects of compounded bioidentical transdermal sex steroid therapy including estriol , estradiol , progesterone , DHEA , and testosterone on cardiovascular biomarkers , hemostatic , inflammatory , immune signaling factors ; quality -of-life measures ; and health outcomes in peri/postmenopausal women within the context of a hormone restoration model of care . A prospect i ve , cohort , closed-label study received approval from the Human Subjects Committee . Recruitment from outpatient clinics at an academic medical center and the community at large result ed in three hundred women giving signed consent . Seventy-five women who met strict inclusion /exclusion criteria were enrolled .  Baseline hormone evaluation was performed along with baseline experimental measures . Following this , women received compounded transdermal bioidentical hormone therapy of BiEst ( 80%Estriol/20%Estradiol ) , and /or Progesterone for eight weeks to meet established physiologic reference ranges for the luteal phase in premenopausal women . The luteal phase hormone ratios were selected based on animal and epidemiologic studies demonstrating favorable outcomes related to traumatic , ischemic , or neuronal injury . Follow-up testing was performed at eight weeks and adjustment to hormone regimens were made including addition of and rogens of DHEA and Testosterone if indicated . Experimental subjects were monitored for 36 months . Baseline , 2-month , and annual values were obtained for : blood pressure , body mass index , fasting glucose , Homeostasis Metabolic Assessment of Insulin Resistance ( HOMA-IR ) , fasting triglycerides , total Factor VII , Factor VIII , fibrinogen , Antithrombin III , Plasminogen Activator Inhibitor1(PAL-1 ) , C-reactive protein ( CRP ) , Interleukin-6 ( IL-6 ) , Matrix Metalloproteinase-9 ( MMP-9 ) , Tumor Necrosis Factor-alpha ( TNF ) , Insulin-like Growth Factor ( IGF-1 ) , and sex steroid levels . Psychosocial measures included : Greene Climacteric Scale , Visual Analog Pain Scale , Hamilton Anxiety Scale , Hamilton Depression Scale , Holmes Rahe Stress Scale , Job Strain , and Home Strain . Health outcome measures included the number of prescribed medications used , number of co-morbidities , and endometrial thickness in postmenopausal women with intact uteri . Subjects receiving  compounded transdermal bioidentical hormone therapy showed significant favorable changes in : Greene Climacteric Scale scores , Hamilton Anxiety Scale , Hamilton Depression Scale , Visual Analog Pain Scale , fasting glucose , fasting triglycerides , MMP-9 , C-reactive Protein , fibrinogen , Factor VII , Factor VIII , Insulin-Like Growth Factor 1 , and health outcomes of co-morbidities and a number of prescribed medications . Antithrombin III levels were significantly decreased at 36 months . All other measures did not exhibit significant effects . Administration of compounded transdermal bioidentical hormone therapy in doses targeted to physiologic reference ranges administered in a daily dose significantly relieved menopausal symptoms in peri/postmenopausal women . Cardiovascular biomarkers , inflammatory factors , immune signaling factors , and health outcomes were favorably impacted , despite very high life stress , and home and work strain in study subjects . The therapy did not adversely alter the net prothrombotic potential , and there were no associated adverse events . This model of care warrants consideration as an effective and safe clinical therapy for peri/postmenopausal women especially in population s with high perceived stress and a history of stressful life events prior to , or during the menopausal transition Objective : To investigate the efficacy and safety of the special extract ERr 731 from the roots of Rheum rhaponticum compared to placebo in perimenopausal women with climacteric complaints . Design : A multicenter , prospect i ve , r and omized , double-blind , placebo-controlled , clinical trial in which 109 women with climacteric complaints received either one enteric-coated tablet of ERr 731 ( n = 54 ) or placebo ( n = 55 ) daily for 12 weeks . Primary outcome criterion for efficacy was the change in Menopause Rating Scale II ( MRS II ) total score after 12 weeks . Other efficacy assessment s analyzed number and severity of hot flushes , menopause-specific quality of life , number of bleeding/spotting days , and treatment outcome . Results : By 12 weeks , the MRS II total score and each MRS II symptom significantly decreased in the ERr 731 group compared to the placebo group ( P < 0.0001 ) . After 4 weeks , ERr 731 also significantly decreased the number and severity of hot flushes ( P < 0.0001 ) . After 12 weeks , the overall menopause-specific quality of life was significantly better in women treated with ERr 731 compared with placebo ( P < 0.05 ) . Treatment outcome assessed by investigators and participants was better in the ERr 731 group , and ERr 731 was better tolerated than placebo . There were no differences in gynecological findings including endometrial biopsies , bleeding , weight , blood pressure , pulse , and laboratory safety parameters between the treatment groups . No adverse events were classified as being related to the investigational medication . Conclusions : Compared to placebo , ERr 731 significantly reduces the occurrence and severity of climacteric complaints in perimenopause . It is also safe and well tolerated UNLABELLED The increase in bone fragility after menopause results from reduced periosteal bone formation and increased endocortical resorption . Women with highest remodeling had greatest loss of bone mass and estimated bone strength , whereas those with low remodeling lost less bone and maintained estimated bone strength . INTRODUCTION Bone loss from the inner ( endocortical ) surface contributes to bone fragility , whereas deposition of bone on the outer ( periosteal ) surface is believed to be an adaptive response to maintain resistance to bending . MATERIAL S AND METHODS To test this hypothesis , changes in bone mass and estimated indices of bone geometry and strength of the one-third distal radius , bone turnover markers , and fracture incidence were measured annually in 821 women 30 - 89 years of age for 7.1 + /- 2.5 years . The analyses were made in 151 premenopausal women , 33 perimenopausal women , 279 postmenopausal women , and 72 postmenopausal women receiving hormone replacement therapy ( HRT ) .  RESULTS In premenopausal women , periosteal apposition increased the radius width , partly off setting endocortical resorption ; therefore , the estimated cortical thickness decreased . Outward displacement of the thinner cortex maintained bone mass and cortical area and increased estimated bending strength . Estimated endocortical resorption accelerated during perimenopause , whereas periosteal apposition decreased . Further cortical thinning occurred , but estimated bending strength was maintained by modest outward cortical displacement . Endocortical resorption accelerated further during the postmenopausal years , whereas periosteal apposition declined further ; cortices thinned , but because outward displacement was minimal , estimated cortical area and bending strength now decreased . Women with highest remodeling had the greatest loss of bone mass and strength . Women with low remodeling lost less bone and maintained estimated bone strength . In  HRT-treated women , loss of bone strength was partly prevented . These structural indices predicted incident fractures ; a 1 SD lower section modulus doubled fracture risk . CONCLUSIONS Periosteal apposition does not increase after menopause to compensate for bone loss ; it decreases . Bone fragility of osteoporosis is a consequence of reduced periosteal bone formation and increased endocortical resorption . Underst and ing the mechanisms of the age-related decline in periosteal apposition will identify new therapeutic targets . On the basis of our results , it may be speculated that the stimulation of periosteal apposition will increase bone width and improve skeletal strength Abstract Dyspareunia negatively affects women´s quality of life , and is a frequent complaint during the peri- and postmenopausal period . A r and omized trial evaluated sexual function , quality of life , pain , and pelvic floor muscle function of climacteric women aged between 40 and 60 years old who were sexually active and had complaints of dyspareunia for at least six months . They were assessed before and after their r and omization in one of the following interventions : the first group ( n = 21 ) received five one-hour sessions of thermotherapy for relaxation of pelvic floor muscles , myofascial release , and pelvic training ( pelvic floor muscle training — PFMT group ) . The second group ( n = 21 ) received five one-hour sessions during which heat was applied to the lower back with myofascial release of abdominal diaphragm , piriformis , and iliopsoas muscles , with no involvement of pelvic training ( lower back — LB group ) . Forty-two climacteric women with dyspareunia ( mean ± SD , PFMT group : 51.9 ± 5.3 years , LB group : 50.6 ± 4.7 years , Student ’s t-test , p = 0.397 ) were  studied . Pain scores ( mean ± SEM ) in the PFMT group decreased from 7.77 ± 0.38 to 2.25 ± 0.30 ; and in the LB group from 7.62 ± 0.29 to 5.58 ± 0.49 ( generalized estimating equation — GEE model , p ≤ 0.001 for group , time , and interaction pairwise comparisons ) . Conclusion : The proposed pelvic floor muscle training protocol was effective to improve pain , quality of life , sexual function , and pelvic floor muscle function in climacteric women with dyspareunia OBJECTIVES Treatments for genitourinary syndrome of menopause ( GSM ) may not be suitable for all women , may not be completely effective , and may cause adverse effects . Therefore , there is a need to explore new treatment approaches . The objectives were to evaluate the feasibility of using a pelvic floor muscle training ( PFMT ) program in postmenopausal women with GSM , and to investigate its effect on symptoms , signs , activities of daily living ( ADL ) , quality of life ( QoL ) and sexual function . STUDY DESIGN Postmenopausal women with GSM participated in a single-arm feasibility study embedded in a r and omized controlled trial ( RCT ) on PFMT for urinary incontinence . This sub study was composed of two pre-intervention evaluations , a 12-week PFMT program and a post-intervention evaluation . MAIN OUTCOME MEASURES Feasibility was defined as study completion and participation in physiotherapy sessions and in-home exercises . The effects of the PFMT program were assessed by measuring GSM symptoms ( ' Most Bothersome Symptom ' approach , ICIQ-UI SF ) , GSM signs ( Vaginal Health assessment scale ) , GSM 's impact on ADL ( Atrophy Symptom question naire ) , QoL and sexual function ( ICIQ-VS , ICIQ-FLUTSsex ) and leakage episodes . RESULTS Thirty-two women participated . The study completion rate was high ( 91 % ) , as was participation in treatment sessions ( 96 % ) and in-home exercises ( 95 % ) . Post-intervention , there were significant reductions in GSM symptoms and signs ( p < 0.01 ) as well as in its impacts on ADL , QoL and sexual function ( p < 0.05 ) . CONCLUSIONS A study including a PFMT program is feasible , and the outcomes indicate PFMT to be an effective treatment approach for postmenopausal women with GSM and urinary incontinence . This intervention should be assessed through a RCT Estrogen-only  menopausal hormone therapy ( HT ) increases the risk of endometrial cancer , but less is known about the association with other types of HT . Using Cox proportional hazards regression , the authors examined the association of various types of HT with the risk of endometrial cancer among 115,474 postmenopausal women recruited into the European Prospect i ve Investigation into Cancer and Nutrition between 1992 and 2000 . After a mean follow-up period of 9 years , 601 incident cases of endometrial cancer were identified . In comparison with never users of  HT  , risk of endometrial cancer was increased among current users of estrogen-only HT ( hazard ratio ( HR ) = 2.52 , 95 % confidence interval ( CI ) : 1.77 , 3.57 ) , tibolone ( HR = 2.96 , 95 % CI : 1.67 , 5.26 ) , and , to a lesser extent , estrogen-plus-progestin HT ( HR = 1.41 , 95 % CI : 1.08 , 1.83 ) , although risks differed according to regimen and type of progestin constituent . The association of HT use with risk was stronger among women who were older , leaner , or had ever smoked cigarettes . The finding of a strong increased risk of endometrial cancer with estrogen-only HT and a weaker association with combined HT supports the hypothesis that progestins have an attenuating effect on endometrial cancer risk . The increased risk associated with tibolone use requires further investigation Objective : The objective of this study was to provide evidence that the transformation of DHEA into both and rogens and /or estrogens locally in cells of the three layers of the vagina ( epithelium , lamina propria , and muscularis ) would have effects of greater impact , including effects on sexual function , than only effects on superficial epithelial cells as achieved with estrogens . Methods : This prospect i ve , r and omized , double-blind , and placebo-controlled phase III clinical trial has evaluated the effect of daily local intravaginal application of Prasterone ( dehydroepi and rosterone ; DHEA ) for 12 weeks on the domains of sexual dysfunction , namely , desire/interest , arousal , orgasm , and pain at sexual activity , in 216 postmenopausal women with moderate to severe symptoms of vaginal atrophy . Results : A time- and dose-dependent improvement of the four domains of sexual function was observed . At the 12-week time interval , the 1.0 % DHEA dose led , compared with placebo , to 49 % ( P = 0.0061 ) and 23 % ( P = 0.0257 ) improvements of the desire domains in the Menopause Specific Quality of Life and Abbreviated Sex Function question naires , respectively . Compared with placebo , the Abbreviated Sex Function arousal/sensation domain was improved by 68 % ( P = 0.006 ) , the arousal/lubrication domain by 39 % ( P = 0.0014 ) , orgasm by 75 % ( P = 0.047 ) , and dryness during intercourse by 57 % ( P = 0.0001 ) . Conclusions : By a local action in the vagina , DHEA applied daily at doses at which serum steroids remain well within normal postmenopausal values exerts relatively potent beneficial effects on all four aspects of sexual dysfunction . Such data indicate that combined and rogenic/estrogenic stimulation in the three layers of the vagina exerts important beneficial effects on sexual function in women without systemic action on the brain and other extravaginal tissues BACKGROUND The antidepressant effect of estrogen in women undergoing the menopause transition is hypothesized to be mediated by central nervous system effects of increasing estradiol on mood or through a pathway involving suppression of hot flashes and associated sleep disturbance . Estrogen therapy ( ET ) and the hypnotic agent zolpidem were selected as interventions in a three-arm , double-blind , placebo-controlled trial to distinguish the effects of estradiol , sleep , and hot flashes on depression . METHODS Women with depressive disorders , hot flashes , and sleep disturbance were r and omly assigned to transdermal 17β-estradiol 0.05 mg/d , zolpidem 10 mg/d , or placebo for 8 wk . Changes in serum estradiol , perceived sleep quality , objective ly measured sleep , and hot flashes were examined as predictors of depression improvement [ Montgomery-Åsberg Depression Rating Scale ( MADRS ) ] using multivariate linear regression . RESULTS Seventy-two peri/postmenopausal women with depression disorders were r and omized to 17β-estradiol ( n = 27 ) , zolpidem ( n = 31 ) , or placebo ( n = 14 ) . There was no significant difference between groups in depression improvement ( overall MADRS decrease 11.8 ± 8.6 ) . Increasing estradiol ( P = 0.009 ) and improved sleep quality ( P < 0.001 ) predicted improved mood in adjusted models but reduced hot flashes ( P = 0.99 ) did not . Post hoc subgroup analyses revealed that the therapeutic effect of increasing estradiol levels on mood was seen in perimenopausal ( P = 0.009 ) , but not postmenopausal , women . CONCLUSIONS For women with menopause-associated depression , improvement in depression is predicted by improved sleep , and among perimenopausal women , by increasing estradiol levels . These results suggest that changes in estradiol and sleep quality , rather than hot flashes , mediate depression during the menopause transition . Therapies targeting insomnia may be valuable in treating menopause-associated depression
HT treatment with estrogens alone or in combination with progestogens was associated with a small to moderate improvement in sexual function , particularly in pain , when used in women with menopausal symptoms or in early postmenopause ( within five years of amenorrhoea ) , but not in unselected postmenopausal women .
The current evidence does not suggest an important effect of tibolone or of SERMs alone or combined with estrogens on sexual function .
BACKGROUND The perimenopausal and postmenopausal periods are associated with many symptoms , including sexual complaints .
OBJECTIVES To assess the effect of hormone therapy ( HT ) on  sexual function in perimenopausal and postmenopausal women .