What we know about managing menopausal hot flashes: navigating without a compass

Hot flashes and night sweats are frequently experienced as the cardinal symptoms of menopause. However, their physiological basis has not been explained; nor have any potential risks been explored. Current knowledge and theoretical perspectives regarding hot flashes will be presented and contrasted with evidence for an emerging hypothesis of altered brain glucose availability as the hot flash trigger. Perspectives regarding hormone therapy and alternative therapies for treatment of hot flashes will be presented and directions for future research reviewed.     

Unfavorable lipid profile and higher frequency of hot flashes during perimenopausal years after fallopian tube ligation

Abstract

Aim: We sought to study the effect of tubal ligation on lipid profile, ovarian reserve and hot flashes during perimenopausal years.

Methods: A total of 210 perimenopausal women complaining of abnormal vaginal bleeding were enrolled for the study. Subjects’ menstrual, reproductive and medical histories were recorded. Serum FSH, LH and estradiol levels were screened in all women to determine menopausal status. In order to rule out any gynecologic pathology, all subjects underwent transvaginal sonography. Women were divided into two groups according to presence (study group, n?=?68) or absence (control group, n?=?142) of tubal ligation history. Lipid profiles and ovarian reserve tests were compared between groups.

Results: Mean age, parity, serum hemoglobin (Hb), high density lipoprotein (HDL-C), triglyceride, estradiol levels, endometrial thickness and frequency of hot flashes were significantly different between groups (p?<?0.05). Mean age was 42.8?±?1.9 years in women with tubal ligation and 45.9?±?3.5 years in control group. Mean serum estradiol level was lower in group with tubal ligation (41.4 versus 92.5?pg/ml). Mean endometrial thickness was higher in control group (10.2 versus 7.5?mm). Age-adjusted serum Hb, HDL-C, triglyceride, estradiol, FSH level, endometrial thickness and frequency of hot flashes remained significantly different between groups (p?<?0.05).

Conclusion: Tubal ligation is associated with unfavorable lipid profile and higher frequency of hot flashes during perimenopausal years.     

Pregnancy outcome of women exposed to bupropion during pregnancy: a prospective comparative study

OBJECTIVE: Bupropion was developed for the treatment of depression, but subsequently was found to be effective for smoking cessation. To date, there are no prospective comparative studies examining its safety in pregnancy. The primary objective was to determine whether bupropion increases the risks for major malformations above baseline. The secondary objective was to examine the rates of live births, stillbirths, spontaneous and therapeutic abortions, mean birth weight, and gestational age at birth. STUDY DESIGN: Women who were pregnant or planning a pregnancy and taking bupropion were enrolled in the study. Follow-up of pregnancy outcome was carried out between 4 months and 1 year after delivery. Three comparisons were carried out: 1) women exposed to bupropion vs a nonteratogen group; 2) those taking for depression vs other antidepressants, vs a nonteratogen group; 3) spontaneous abortions were compared between those taking for depression, vs another antidepressant group vs a nonteratogen group. RESULTS: We completed follow-up on 136 women exposed to bupropion during the first trimester of pregnancy. There were (105) live births, no major malformations, the mean birth weight was (3450g), the mean gestational age at delivery was (40 weeks), the number of spontaneous abortions was 20, there were 10 therapeutic abortions, there was 1 stillbirth, and 1 neonatal death. There were no statistically significant differences between any of the end points we examined between the exposed and comparison groups, with the exception of significantly more spontaneous abortions in the bupropion group (P = .009). CONCLUSION: These results suggest that bupropion does not increase the rates of major malformation above baseline. The higher rates of spontaneous abortions are similar to other studies examining the safety of antidepressants during pregnancy.     

甘肃省绝经过渡期和绝经后期女性潮热症状发生率及其相关因素

目的：分析甘肃地区绝经过渡期和绝经后期妇女潮热症状的发生率，探讨潮热相关影响因素。方法：2016年7—10月按照多阶段整群随机抽样的方法对甘肃13个市/州54个区/县162个乡/镇40～55岁妇女进行横断面研究，采用问卷调查的方式进行潮热症状的相关信息收集，并分析其可能影响因素。结果：本研究获得有效问卷2 807份，其中绝经过渡期妇女1 393例、绝经后期妇女1 414例。存在潮热症状者1 758例（62.6%），其中轻度潮热880例（50.1%），中度潮热624例（35.5%），重度潮热254例（14.4%）。Logistic回归分析显示，年龄增加（OR=1.070，P=0.000）、高血压（OR=1.547，P=0.000）、痛经（OR=1.422，P=0.000）是潮热发生的危险因素。相较于正常体质量妇女，超重（OR=1.293，P=0.001）、肥胖（OR=2.056，P=0.000）妇女更易发生潮热。另外，回族妇女比汉族妇女更易发生潮热（OR=1.802，P=0.000），体力劳动者较脑力劳动者更易发生潮热（OR=1.392，P=0.013）。结论：甘肃地区62.6%的绝经过渡期和绝经后期女性受潮热问题困扰。年龄增加、BMI增高、高血压、痛经是潮热发生的危险因素，民族差异也与潮热的发生相关，体力劳动者比脑力劳动者更易发生潮热。     

Impact of hot flashes and night sweats on carotid intima-media thickness and bone mineral density among postmenopausal women

Objective

To determine whether postmenopausal women with vasomotor symptoms have a lower bone mineral density (BMD) and a higher carotid intima-media thickness (CIMT) than those without vasomotor symptoms.

Methods

Postmenopausal women with (n = 87) or without (n = 117) vasomotor symptoms who did not receive hormone therapy were included. The CIMT and BMD were determined and the relationship with vasomotor symptoms evaluated.

Results

The presence of both hot flashes and night sweats was associated with a CIMT of more than 0.80 mm after adjusting for age, time since menopause, and body mass index (adjusted odds ratio 3.2; 95% confidence interval [CI], 2.3-4.5; P < 0.001). The adjusted odds ratio for a CIMT higher than 0.80 mm in women with night sweats was 3.6 (95% CI 1.5-8.9; P = 0.006); the adjusted odds ratio in women with hot flashes was 23.1 (95% CI 9.1-58.4; P < 0.001). The mean CIMT was 0.65 ± 0.08 mm in the asymptomatic group and 0.81 ± 0.06 mm in the symptomatic group (P < 0.001). The mean lumbar (L1, L2, and L3) and total hip BMD values were lower in the symptomatic group (P < 0.05).

Conclusion

Hot flashes and night sweats in postmenopausal women are associated with a higher CIMT and a lower BMD.     

Understanding the association between teenage pregnancy and inter-generational factors: a comparative and analytical study

Objectives

(1) to identify the number of teenage pregnant women who also have mothers who became pregnant when they were in their teenage years and (2) to explore the importance of this intergenerational experience on the teenagers themselves, their significant family, friends and society as a whole.

Design

semi-structured interviews with the subjects allowed for both breadth and depth exploration.

Sample

the total research sample was 95 teenage women, which included 48 pregnant (51%) and 47 non-pregnant (49%) women. Stage 1 reports on the findings relating to the intergenerational phenomena and stage 2 focuses on related historical experiences of a further 8 interviews with subjects who had experienced this intergenerational phenomenon. The subjects in both stages of this study came from two contrasting demographic areas of the UK: North West and South East.

Measurements

data were analysed using an appropriate qualitative software package. The specific categories of experience were constructed using a grounded theory approach.

Findings

the findings of stage 1 of the study showed that the number of teenage women who reported that they had a mother who's first baby was born to her when she was under 20 years of age was 33 (69%) for the pregnant group and 12 (26%) for the non-pregnant group. This was found to be statistically significant (χ²=6.51, df=1, p=<0.011). In this study (from a sub-set of 19 themes) three major themes emerged: (a) reflection, (b) peer group pressure and (c) intergenerational factors.

Conclusions

reflection, peer group pressure and intergenerational factors were the major thematic findings of this study. Midwives working collaboratively with other health, social and educational colleagues have a pivotal role to work with families in addressing the complexities of intergenerational teenage pregnancy. A national multi-method research study is now required to explore the breadth of intergenerational teenage pregnancy and the experiences of those families where this social construct is prevalent.     

Esophageal carcinoma during pregnancy: a case report

Association of pregnancy with esophageal cancer is an extremely rare event. The symptoms are frequently masked by factors related to normal pregnancy and diagnostic approaches are restricted by physical and psychological clinical events. Hence, the cancer stage is usually advanced at the time of diagnosis. The approach to cancer surgery and chemotherapy must be modified in pregnant patients to minimize fetal and maternal risks. We present an extremely rare case of carcinoma esophagus during pregnancy     

Serial changes in cardiac output during normal pregnancy: a Doppler ultrasound study

Objectives: To determine the direction and magnitude of change in cardiac output (CO) during pregnancy. Study design: We performed serial measurements of CO on five occasions from 24 weeks gestation to term and once during the puerperium in 26 normal pregnancies (156 measurements) using Doppler ultrasound measurement of flow velocity profiles and aortic root cross sectional area. Result: CO increased to 7.0 l/min by 32 weeks gestation, 49% above baseline values. It fell to 5.7 l/min by term. 21% above baseline. The peak in CO corresponded with an increase in heart rate to 91 beats/min, 32% above baseline. Stroke volume peaked at 36 weeks gestation, by which time CO had already begun to decline. Conclusions: CO increased in a linear fashion until 32 weeks gestation and then declined to term, but to a value still greater than the postpartum baseline. These findings have obvious management implications for patients with serious heart disease complicating pregnancy.     

Nonweightbearing exercise during pregnancy on land and during immersion: a comparative study

Seven women at 25 weeks' gestation exercised on land and in the water at 70% maximum oxygen capacity (VO2max) on a bicycle ergometer. Women had significantly lower heart rates and lower systolic blood pressures during immersion exercise. Women had a mean diuresis of 207 ml (6.5 ml/min) during water exercise compared with 98 ml. (2.4 ml/min) during land exercise. Fetal heart rates showed a tendency toward being higher after land exercise compared with water exercise. Six of seven fetuses displayed tachycardia after land exercise compared to one of seven after water exercise. Exercise on land and during immersion at 70% VO2max was well tolerated. However, exercise during immersion offers several physiologic advantages during pregnancy.     

Pheochromocytoma diagnosed during pregnancy: a case report

Abstract

Pheochromocytoma is a rare catecholamine producing tumor. During pregnancy, this tumor can mimic gestational hypertension, preeclampsia or eclampsia. We present a case of a 38-year-old, multiparous woman admitted at 36?weeks of gestation due to hypertension. After cesarean section, she developed an unexplainable worsening of her hypertension that was resistant to the traditional therapy. Additional investigation lead to the diagnosis of pheochromocytoma. This case highlights the importance of an early diagnosis and the need of a multidisciplinary approach for the improvement of pregnancy outcomes in patients with pheochromocytoma.     

妊娠间隔对经产妇妊娠结局的影响多中心回顾性研究

目的:探讨不同妊娠间隔（IPI）对经产妇妊娠结局的影响。方法:基于全国14个省区市共21家医院开展多中心回顾性研究,通过查阅病历收集2011—2018年间两次妊娠均在同一家医院分娩的经产妇的年龄、身高、孕前体重、IPI、既往史、妊娠合并症和并发症、分娩孕周、分娩方式、妊娠结局等资料。根据不同IPI分为4组：<18个月组...     

Associations of life events during pregnancy with longitudinal change in symptoms of antenatal anxiety and depression

Objective

to investigate the association of life events during pregnancy with change in antenatal anxiety and depression symptoms. We distinguished pregnancy related and non-pregnancy related events and assessed specificity of these associations for depressive or anxious symptoms. In addition, we investigated whether the associations were affected by personality or childhood adversities.

Design

observational prospective cohort study

Setting

primary and secondary obstetric care centres in the Netherlands

Participants

1603 women during their first trimester of pregnancy between May 2010 and May 2012

Measurements and findings

we performed linear regression analyses to test the associations of pregnancy related, non-pregnancy related life events, childhood adversities and the personality traits neuroticism and extraversion with the change in symptoms of anxiety (State Trait Anxiety Inventory) and depression (Edinburgh Postnatal Depression Scale) from week 12 to week 36.Life events during pregnancy were associated with increasing antenatal symptoms of anxiety and depression. Effect sizes associated with the highest numbers of events observed ranged from 0.59 to 1.31. Pregnancy related events were specifically associated with increasing symptoms of anxiety (p=0.009), whereas non-pregnancy related events were merely associated with an increase in symptoms of depression (p<0.001). Neither personality traits nor childhood trauma influenced the associations under study.

Key conclusions

the most important finding is that pregnancy related life events during pregnancy increase levels of antenatal anxiety, whereas depression levels increase when women experience life events that are unrelated to pregnancy. Furthermore, non-pregnancy related events show stronger associations with increases in symptoms of anxiety or depression compared to pregnancy related events.

Implications for practice

our findings may help midwives to tailor psychosocial care to the specific risks of the pregnant woman which may eventually have a positive impact on the health of mother and child.     

Aspirin use during early pregnancy and the risk of congenital abnormalities: a population-based case-control study

It is still controversial whether aspirin use during pregnancy increases the risk of certain congenital abnormalities (in particular, neural tube defects, gastroschisis, and cleft lip +/- palate). We examined the risk of selected congenital abnormalities in a large case-control dataset from Hungary and found no increased risk of such congenital abnormalities.