The intensity of temporomandibular disorder-induced pain was linked to menopausal symptom intensity, with the strongest correlation observed in the late menopausal transition, according to a cross-sectional study in Menopause.
“There is some inconclusive evidence pointing to the interference of hypoestrogenism in [temporomandibular disorder (TMD)]-induced pain and the influence of menopausal symptoms on the disorder,” Alessandra Pucci Mantelli Galhardo, PhD,an OB/GYN at the University of São Paulo Faculty of Medicine Clinics Hospital in Brazil, and colleagues wrote. “However, in these studies, women were not separated according to the different stages, namely, (early and late) menopausal transition and (early and late) postmenopause.”
Menopausal symptoms were linked to the intensity of pain caused by temporomandibular disorder, particularly during the late menopausal transition. Source: Adobe Stock
Galhardo and colleagues enrolled 74 women with TMD symptoms who were being treated at their institution and divided them by menopausal stage: late menopausal transition (n = 25), early postmenopause (n = 30) and late postmenopause (n = 19).
The researchers found statistically significant differences between the groups for two menopause symptoms — tingling (P = .0397) and heart palpitations (P = .0085) — but not TMD-induced pain.
Overall, menopausal symptoms and the intensity of TMD pain were significantly associated with each other (P = .0004). This association was stronger during the late menopausal transition (P = .0267), with women in this group having more intense TMD pain compared with those in late postmenopause (P = .0426).
Analyses of sociodemographic factors revealed no statistically significant differences between groups for menopausal symptoms. However, early postmenopausal women with less than 4 years of schooling and who were white were significantly more likely to have symptoms compared with their counterparts (P =.02 and P = .008, respectively).
Additionally, the sociodemographic analysis showed there were no significant differences in TMD pain between groups, but less schooling within the early postmenopause group was significantly associated with a higher craniomandibular index score (P = .02).
“This should be a wake-up call for health professionals treating menopausal women,” Galhardo and colleagues wrote. “TMD may end up hindering and limiting vital actions, such as mastication and phonation, leading to negative social, professional and health consequences, as well as unsuccessful treatment outcomes for both [TMD and menopausal symptoms].”
Women who participated in music therapy had lower levels of depression and reduced menopausal symptoms compared with those who did not, according to findings in Menopause.
“Evidence suggests that the prevalence of depression increases during the menopausal transition and postmenopausal period, including middle age,” DeryaYükselKoçak, PhD, assistant professor in the department of nursing at Hitit University Faculty of Health Sciences in Çorum, Turkey, and colleagues wrote.
Listening to music for 15 minutes every day reduces depression and menopausal symptoms. Source: Adobe Stock.
They noted that studies have shown music’s effect on depression and menopausal symptoms separately, though “it is noteworthy that there is no study investigating the effects of … music therapy on [both] menopausal symptoms and the risk of depression in menopausal women.”
Koçak and colleagues enrolled 48 postmenopausal women with no history of depression in a randomized controlled study from July 2019 to December 2020. At the beginning of the study, participants completed a form detailing sociodemographic information, as well as the Menopause Rating Scale (MRS) questionnaire — which assessed somatic, psychological and urogenital symptoms of menopause — and the Beck Depression Inventory (BDI). They completed the MRS and BDI again at the end of 6 weeks.
The researchers played three pieces of Turkish classical music — a genre that had “comforted and calmed” participants in a pilot study — for 21 participants (mean age, 59.1 years; mean age of menopause, 44.2 years). Participants assigned to the music therapy intervention chose their favorite song and were instructed to use headphones to listen to their chosen song for at least 15 minutes every day when they were alone in a quiet environment for 6 weeks. The 27 control participants (mean age, 56.5 years; mean age of menopause, 46.8 years) did not have any intervention.
There were no statistically significant differences in menopausal symptoms between the control and intervention groups at baseline.
MRS posttest scores of the women in the control group were higher than those in the music group, but the difference was not significant, the researchers said.
In the intervention group, MRS posttest scores overall and for three components — somatic, psychological and urogenital subscales — were 99% lower than pretest scores (P < .01), which constituted a significant decrease in menopausal symptoms. There were no significant differences between pretest and posttest median scores in the control group, however.
BDI scores showed depression was significantly decreased in the intervention group (pretest mean value, 15.38; posttest mean value, 11.81; P = .003). In the control group, there was no significant change in BDI scores.
“Although menopause is a natural process, the management of symptoms that occur during this period bears significant importance for women,” Koçak and colleagues wrote.
“The present study on music therapy and depression suggests a significant and permanent reduction in patients’ symptoms and improvement in their quality of life,” they added.
Study limitations included women’s refusal to participate, non-generalizability of findings and self-reported data.
Koçak and colleagues suggested more research on music’s effect on menopausal symptoms to validate their findings for future clinical application.
This study highlights the potential benefits of a simple, easy-to-implement, low-cost, low-risk intervention for common symptoms women experience during the menopause transition, including depressed mood. Although this study is small, music therapy can be added to our armamentarium of non-medication strategies for management of menopause symptoms. Additional study is needed to confirm these findings in larger and more diverse groups of women. It is also important to note that for those women who do not experience adequate relief of symptoms with this and other non-medication treatments, there are safe and effective medications for treatment of menopause symptoms, including menopausal hormone therapy.
Stephanie Faubion, MD, MBA
Director, Mayo Clinic Center for Women’s Health
Medical Director, the North American Menopause Society
The cognitive performance of women was sensitive to the severity of their menopausal symptoms, particularly depression and sexual dysfunction, according to a cross-sectional study published in Menopause.
The study included 404 women aged 40 to 65 years (mean age, 50.78 years) living in the rural areas of district Rupnagar, Punjab, India, according to Mankamal Kaur, MSc, a research scholar, and Maninder Kaur, PhD, chair and assistant professor, both of the department of anthropology at Panjab University in Chandigarh, India.
Kaur M, et al. Menopause. 2021;doi:10.1097/GME.0000000000001910.
With a mean age at menarche of 14.89 ± 0.08 years and at menopause of 47.24 ± 0.32 years, 107 of the participants were premenopausal, 90 were perimenopausal, 92 were early menopausal and 115 were late menopausal according to WHO criteria.
Also, 83.4% were married, and 93.8% did not have any kind of private or government job. In terms of education, 22.5% were illiterate, 37.6% had primary to middle school education, 32.2% had a high school degree and 7.7% were graduates or postgraduates.
The women were evaluated according to the Greene Climacteric Scale, which evaluates 21 menopausal symptoms across psychological, somatic, vasomotor and sexual interest classifications.
Depression (67%), somatic (63.5%) and sexual dysfunction (67.8%) were highest among late postmenopausal women. Anxiety (58.7%) and vasomotor symptoms (59.8%) were highest among early postmenopausal women.
Also, the women completed a 30-point Hindi version of the Mini-Mental State Examination (MMSE) to gauge their global cognitive performance across its orientation to time and place, registration, attention and calculation, recall, and language and visuo-spatial ability subdomains.
Women with severe menopausal symptoms had significantly lower mean values for orientation (8.11 vs. 8.9; P < .001), registration (2.77 vs. 2.91; P < .001), attention (4.31 vs. 4.48; P < .01), recall (2.26 vs. 2.53, P < .05) and language/visio-spatial skills (7.13 vs. 7.91, P < .001) than women with mild symptoms.
In a univariate linear regression analysis, the severity of each menopausal symptom was negatively and significantly associated with global cognitive scores, the researchers said.
In the multivariate linear regression analysis, though, only severe depression and greater intensity of sexual dysfunction had a negative and significant association with MMSE scores.
After adjusting for age and marital and educational status, the researchers found that severe depression and sexual dysfunction were the only symptoms with a significant association with overall cognitive performance.
Severe vasomotor symptoms were not predictors of cognitive performance in all the cognitive domains on the MMSE scale except for attention, and once the researchers adjusted for covariates in the model, its significance was lost as well. No significant association was observed between somatic symptoms and cognitive performance either.
Although more longitudinal and cross-sectional studies of large population-based samples could clarify these associations, the researchers said, they believe their results can help rural services address these issues and help many women.
The study showed a link between cognitive performance and the severity of menopause symptoms in a cohort of midlife women in rural India. The finding of cognitive changes in women during the menopause transition is not new.
Many women describe “brain fog” during the menopause transition, and this may relate to a number of factors, including sleep disruption related to menopause (insomnia, night sweats), mood disorders and life stressors.
Sleep disorders unrelated to menopause are also more prevalent in midlife and include restless leg syndrome and obstructive sleep apnea, which can contribute to daytime fatigue and cognitive changes.
Life stressors potentially resulting in sleep disruption and contributing to poorer cognitive performance include caretaking, relationship discord, financial stressors and other factors.
We also know that the menopause transition is a period of vulnerability in terms of mood, and mood disorders can certainly result in poorer cognitive performance.
Whether cognitive changes that occur in midlife are transient remains unclear. In contrast to findings of the Study of Women’s Health Across the Nation (SWAN), a recent study by Maki et al showed that cognitive declines in menopause may be persistent in women with multiple risk factors for cognitive dysfunction, including those with low income, low education, mental health disorders and high trauma exposure — factors that may be more prevalent in rural populations in India.
The study by Kaur and Kaur, however, highlights the importance of screening for potentially modifiable factors in individual women, such as sleep issues, mood disorders and bothersome menopause symptoms. But it also underscores the importance of addressing the more difficult societal level issues of the effects of poverty and trauma on health and quality of life.Stephanie Faubion, MD, MBADirector, Mayo Clinic Center for Womens HealthMedical Director, the North American Menopause Society
Many women have horrible PMS or menopausal symptoms, and others suffer from infertility. More often than not these hormone imbalances are cause from dysfunctions in the endocrine system which for those of you unfamiliar with this, it is your glandular system. Here are a few natural herbs you can use to get your imbalanced hormones under control.
When it comes to hormones natural therapy is always better, so rather than jumping straight to conventional hormone therapy why not give these a try first. There are many herbs that can assist in hormone function but these are all time favorites. Here are 5 herbs that have been quite successful in my practice:
1. Maca:
Maca has been used for centuries by the Peruvian people for fertility, hormonal balance, libido, and endurance. It does not produce hormones but rather works as an adaptogenic herb which means that it adapts to each body’s circumstances and balances hormones depending on that person’s needs. So if a person is producing too much or too little of a hormone, it will act in the opposite direction either increasing the deficient hormone or decreasing the body’s production of the over abundant hormone. I like to call it a regulator. It regulates hormones and keeps them in check not allowing them to get out of control in either way.
Maca stimulates and nourishes the pituitary and hypothalamus glands of your endocrine system which are known as the “master glands”. These two glands are responsible for regulating all the other hormone producing glands. With these “master glands” in balance it has the ability to naturally bring all other glands into balance as well.
This herb is not just for women! Men benefit greatly from this herb and it can often times increase libido and endurance. It is a natural “Viagra” of all sorts. Also because 40-50 percent of infertility cases are due in part to the man, taking this herb may help with sperm motility, volume, and quality.
2. Red Raspberry Leaf:
It has a pleasant taste as a tea and is a nutrient dense power packed herb for women. This herb is best known for its uterine strengthening properties. This wonderful herb is a rich source of vitamins and minerals particularly vitamin C.
Red Raspberry Leaf has many benefits besides that of a uterine tonic. It has been known to help increase fertility in both men and women, prevent miscarriage and hemorrhage, and help decrease heavy blood flow and painful menstrual cramps. It can ease the nausea associated with pregnancy, reduce pain during and after labor, and help stimulate milk production.
3. Vitex Or (Chaste Tree Berry):
This herb has a long extensive history of use for hormone regulation. It is often used for treating endometriosis, infertility, PMS, preventing miscarriage in first trimester, and menopausal symptoms particularly hot flashes. Vitex or chaste tree berry. I have had success using this herb in my clinic to help regulate menstrual cycle and even help initiate a period in women who have had absent periods for some time.
Vitex does not contain actual hormones but rather works to help naturally balance the body’s hormones by way of regulating the pituitary which we talked about earlier and that it was one of the body’s “master glands”. By regulating the pituitary it has an effect on the function of the other glands involved in this system. The pituitary sends out the signal to the other glands to tell them when and how much hormone to produce. This communication system is called a hormonal feedback loop. If the pituitary is not balanced properly this will effectively throw off the balance of the other glands.
4. Milk Thistle:
This is one of my all-time favorite herbs for a multitude of health conditions. Milk Thistle is one of the best liver cleansing herbs and a healthy liver is vital for hormone balance. Many women have an excess of estrogen and a deficiency of progesterone because of it. What many people don’t know is that excess estrogens get filtered out of the body through the liver.
If the liver is congested and stagnant the body cannot eliminate these excess estrogens and they re-enter the body. The liver is also the processing plant for our body’s toxic wastes such as chemicals, heavy metals, fungus and other toxins. Many of these toxins can act to mimic hormones in our body and lead to further hormonal imbalance and disruption.
5. Oatstraw:
Oatstraw may not be the typical herb that comes to mind when people think of herbs for hormones. I have found oatstraw to strengthen the nerves, calm the body, strengthen the blood, stabilize moods, strengthen digestion, sooth stomach, balance the endocrine system or those hormone producing glands, support the skeletal system due to its abundance of bio-available calcium, magnesium, and silica, and calm the central nervous system.
Other benefits of this beautiful herb are great supportive benefits to the hair, skin, and nails, diuretic, cholesterol lowering, and heart health. This herb is great on its own or as a base mixed with other herbs.
The first large prospective cohort study to examine the relationship between menopausal symptoms and bone health in postmenopausal women has found that those who experience moderate to severe hot flashes and night sweats during menopause tend to have lower bone mineral density and higher rates of hip fracture than peers with no menopausal symptoms.
The study followed thousands of women for eight years. After adjusting for age, body mass index and demographic factors, it found that women who reported moderate to severe hot flashes at baseline enrollment showed a significant reduction in the bone density in the femoral neck region of their hips over time and were nearly twice as likely to have a hip fracture during the follow-up period.
This study employed data and study participants from the Women’s Health Initiative (WHI) initiated by the U.S. National Institutes of Health (NIH) in 1991 to address major health issues causing morbidity and mortality in postmenopausal women.
The WHI consisted of three clinical trials and an observational study undertaken at 40 clinical centers throughout the US, including the University at Buffalo Clinical Center directed by Wactawski-Wende.
She says the research team examined data from 23,573 clinical trial participants, aged 50 to 79, who were not then using menopausal hormone therapy nor assigned to use it during the trial. They conducted baseline and follow-up bone density examinations in 4,867 of these women.
Wactawski-Wende says, “We knew that during menopause, about 60 percent of women experience vasomotor symptoms (VMS), such as hot flashes and night sweats. They are among the most bothersome symptoms of menopause and can last for many years.
“It also was known that osteoporosis, a condition in which bones become structurally weak and more likely to break, afflicts 30 percent of all postmenopausal women in the United States and Europe, and that at least 40 percent of that group will sustain one or more fragility fractures in their remaining lifetime,” she says.
“What we did not know,” says Wactawski-Wende, “was whether VMS are associated with reductions in bone mineral density or increased fracture incidence.
“Women who experience vasomotor menopausal symptoms will lose bone density at a faster rate and nearly double their risk of hip fracture,” she says, “and the serious public health risk this poses is underscored by previous research that found an initial fracture poses an 86 percent risk for a second new fracture.”
Wactawski-Wende says, “Clearly more research is needed to understand the relationship between menopausal symptoms and bone health. In the meantime, women at risk of fracture may want to engage in behaviors that protect their bones including increasing their physical activity and ensuring they have adequate intakes of calcium and vitamin D.”
Middle-aged women who exercise regularly report a higher quality of life and reduced symptoms of menopause, according to a population-based study published in the January 2015 issue of Maturitas.
“Women with the recommended level of physical activity had a higher self-perceived health level, better relative health, and better global quality of life in relation to other women their age,” write Kirsi Mansikkamäki, MSc, from the UKK Institute for Health Promotion, Tampere, Finland, and colleagues.
The investigators surveyed 2606 women from Finland’s population registry, representing a 52% response rate from an original random sample of 5000 women. All were born in 1963, making them 49 years old at the time of the study. Of those, 28% were still menstruating regularly, 31% were perimenopausal, and 23% had not menstruated in the past 12 months. The menopausal status of the other 18% could not be determined because they were taking hormone replacement therapy.
The questionnaire, delivered by mail, included a shortened form of the Women’s Health Questionnaire with questions about quality of life and perceived health, body mass index, education, and physical activity. Half had a body mass index below 25 kg/m2 and were considered to be of normal weight.
The researchers considered women to be physically active if they met the recommended 2.5 hours per week of moderate activity (eg, fast-paced walking) or 1.25 hours of vigorous activity (such as jogging or running), and if they also did any strength or balance training at least twice a week. Just more than half of the participants (51%) met the definition of being physically active.
The less-active women were more likely to score highly for anxiety or depressed mood (proportional odds ratio [POR], 1.44; 95% confidence interval [CI], 1.26 – 1.65), somatic symptoms not counting vasomotor symptoms (POR, 1.61; 95% CI, 1.40 – 1.85), and memory and concentration problems (POR, 1.48; 95% CI, 1.29 – 1.70). Vasomotor symptoms, or hot flashes, were more common in less-active women before adjusting for body mass index and education, but after these calculations, they were not statistically significant.
Overall, the more active women had greater self-perceived health (adjusted POR, 3.22; 95% CI, 2.76 – 3.74) and global quality of life (adjusted POR, 1.91; 95% CI, 1.65 – 2.20) compared with other women their age.
Writing in an accompanying editorial, Debra Anderson, PhD, and Charlotte Seib, PhD, both from the Institute of Health and Biomedical Innovation at the Queensland University of Technology in Brisbane, Australia, note that studies on the effects of exercise on symptoms of menopause have been inconsistent. They suggest several possibilities. One is that some women who engage in less than the recommended amount of exercise may still see some benefits, causing the observed effect of exercise to be smaller than it really is. Another is that women experiencing more severe symptoms, whether physical or mental, may be less likely to engage in exercise.
Still, they write, “[t]he emerging evidence that exercise may now be seen as a useful intervention strategy for the alleviation of menopausal symptoms provides health professionals, with a new intervention for use in the care of menopausal women.”
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