Objectives: This cross-sectional study assessed the association between body composition characteristics and bone mineral density (BMD) across different menopausal transition stages. Methods: In total, 320 rural women aged 45–60 years were recruited. Body composition and BMD at different skeletal sites were evaluated by dual energy X-ray absorptiometry. Results: The BMD and bone mineral content of the entire hip, lumbar region, and left arm significantly decreased across most of the menopausal transition stages, which was confirmed by Tukey post hoc analysis. Multiple linear regression analysis revealed that BMD at the hip, lumbar region, and left arm were strongly and positively associated with weight. However, BMD was negatively associated with % total body fat (TBF) across all the four menopausal stages except for lumbar BMD at the late postmenopausal stage (Model 1). Lean mass was positively and significantly associated with BMD at all the skeletal sites evaluated except for some fluctuations in lumbar BMD (Model 2). Furthermore, waist circumference was significantly associated with BMD in the late postmenopausal stage (Model 3) . Conclusions Weight and lean mass are significant predictors of BMD during the menopausal transition and beyond. Furthermore, %TBF may be a negative indicator of BMD.

Sleep disturbances are common among women during menopause. Hormone replacement therapy (HRT) using micronized progesterone (MP) may improve sleep, owing to its neurosteroid effects. Studies on the impact of oral MP on sleep quality in Japanese women are limited, given the recent introduction of MP in Japan. We conducted a single-arm, open-label study to examine the effects of HRT with estradiol (E2) and oral MP on sleep quality in 15 peri- and postmenopausal Japanese women who chose HRT to address their menopausal symptoms. The participants completed the Pittsburgh Sleep Quality Index (PSQI) and menopausal symptoms questionnaires at baseline, 1 month, and 3 months after HRT. The changes in PSQI scores were evaluated. Responders were defined as those with a ≥ 25% reduction in the PSQI global score at 1 month. The PSQI components and menopausal symptoms at baseline were compared between responders and non-responders. Initially, 86.7% of the participants were categorized as poor sleepers. The PSQI global score and sleep quality significantly improved at 1 and 3 months after HRT (baseline to 3rd month mean scores: from 7.8 to 6.1 to 6.5 and from 1.7 to 1.0 to 1.2, respectively). Responders (n = 5) exhibited poorer habitual sleep efficiency before treatment than the non-responders.However, menopausal symptoms did not differ significantly between the groups at baseline. The results indicate that HRT with E2 and MP is a promising treatment option for peri- and postmenopausal Japanese women experiencing sleep disturbances, especially those with poor sleep efficiency.

Objectives: This study aimed to achieve expert consensus on menopause management in the Asia-Pacific region, taking into account patient diversity, the latest evidence, and current treatment options. Methods: A focused literature search was performed to identify clinical practice statements on menopause management. Menopause experts were nominated by members of the Asia-Pacific Menopause Federation (APMF) society. A modified Delphi methodology, involving iterative rounds of anonymous surveys, was employed until consensus was reached for each statement. Consensus was defined as ≥ 70% of experts voting ‘agree’ or ‘strongly agree’ for a given clinical practice statement. Results: A total of 39 participants from 14 different APMF member societies were involved. Eighty-five clinical practice statements reached a consensus. Based on the clinical practice statements, an algorithm was created as a tool to guide clinicians on menopause management. APMF experts agreed that, in addition to vasomotor symptoms, Asian women experiencing somatic or psychological symptoms may also benefit from treatment with menopausal hormone therapy (MHT). MHT should also be considered for the prevention of osteoporosis in asymptomatic peri- and postmenopausal women. Conclusions This APMF consensus statement supersedes the previous one published in 2008. It provides guidance to gynecologists, endocrinologists, family physicians, and other healthcare professionals in delivering optimal care to menopausal women in the ethnically and culturally diverse Asia-Pacific region.

Objectives: In this study, we investigate the effects of dietary supplementation with standardized aqueous extracts of shatavari (Asparagus racemosus, Ar), ashwagandha (Withania somnifera, Ws), or their combination on menopausal symptoms, vascular dysfunction, bone turnover, and serum concentrations of inflammatory and oxidative stress markers in postmenopausal women. Methods: Postmenopausal women aged 40–55 were enrolled in a double-blind randomized study to receive one of six treatments:placebo, Ar 250 mg/500 mg, Ws 250 mg/500 mg, or 500 mg extract combining Ar 250 mg and Ws 250 mg. Primary outcomes were changes in the menopause-specific quality of life (MENQOL) questionnaire, bone mineral density/bone turnover markers (BTMs), and reflection index (RI) after 24 weeks. Secondary outcomes included changes in serum inflammatory and oxidative stress markers, and evaluation of supplement safety and tolerability. Results: Supplemented groups showed significant dose-dependent decrease MENQOL and RI compared with placebo (P < 0.0001).Women supplemented with Ws or Ar extracts had significantly decreased levels of the BTMs C-terminal telopeptide of type I collagen, bone alkaline phosphatase, and receptor activator of nuclear factor kappa-B ligand, and increased osteoprotegerin levels (P < 0.0001).Significantly decreased levels of inflammatory and oxidative stress markers high-sensitivity C-reactive protein and malondialdehyde, and increased glutathione and nitric oxide levels (P < 0.0001) were also observed. Conclusions Daily supplementation with Ws or Ar extracts dose-dependently reduces menopausal symptoms, vascular dysfunction, bone turnover/resorption, and estrogen deficiency-related inflammation and oxidative stress in postmenopausal women.

Objectives: Vulvovaginal atrophy (VVA) presents significant challenges in postmenopausal women. VVA is typically managed either with hormonal-estrogenic therapy or nonpharmacologically with hyaluronic acid (HA) treatments. This study has investigated an advanced formulation, Ubigel Donna TM , consisting of an spermidine hyaluronate (Spd-HA) complex formed by combining spermidine and HA. Initial clinical trials have demonstrated promising outcomes for this formulation. Methods: Local administrations of Spd-HA gel, HA gel, and 17β-estradiol (E2) gel were evaluated under a pulsatile regimen in ovariectomized Wistar female rats for assessing therapeutic efficacy. Results: While E2 treatment demonstrated robust tissue revitalization through restored endometrial thickness and estrus-like vaginal epithelia, the HA gel yielded contradicting atrophic conditions (metestrus). The Spd-HA gel demonstrated an intermediate mucosal status with enhanced differentiation. All three treatments demonstrated similar regulation of the vaginal pH. Conclusions This study reaffirmed the efficacy of the estrogen replacement therapy. More importantly, the Spd-HA approach can be considered as a promising alternative for patients unable to use hormonal treatments. Thus, Ubigel Donna TM can be considered as an enhanced nonpharmacological solution for the widespread burden of postmenopausal VVA.

Objectives: This cross-sectional study assessed the association between body composition characteristics and bone mineral density (BMD) across different menopausal transition stages. Methods: In total, 320 rural women aged 45–60 years were recruited. Body composition and BMD at different skeletal sites were evaluated by dual energy X-ray absorptiometry. Results: The BMD and bone mineral content of the entire hip, lumbar region, and left arm significantly decreased across most of the menopausal transition stages, which was confirmed by Tukey post hoc analysis. Multiple linear regression analysis revealed that BMD at the hip, lumbar region, and left arm were strongly and positively associated with weight. However, BMD was negatively associated with % total body fat (TBF) across all the four menopausal stages except for lumbar BMD at the late postmenopausal stage (Model 1). Lean mass was positively and significantly associated with BMD at all the skeletal sites evaluated except for some fluctuations in lumbar BMD (Model 2). Furthermore, waist circumference was significantly associated with BMD in the late postmenopausal stage (Model 3) . Conclusions Weight and lean mass are significant predictors of BMD during the menopausal transition and beyond. Furthermore, %TBF may be a negative indicator of BMD.

Sleep disturbances are common among women during menopause. Hormone replacement therapy (HRT) using micronized progesterone (MP) may improve sleep, owing to its neurosteroid effects. Studies on the impact of oral MP on sleep quality in Japanese women are limited, given the recent introduction of MP in Japan. We conducted a single-arm, open-label study to examine the effects of HRT with estradiol (E2) and oral MP on sleep quality in 15 peri- and postmenopausal Japanese women who chose HRT to address their menopausal symptoms. The participants completed the Pittsburgh Sleep Quality Index (PSQI) and menopausal symptoms questionnaires at baseline, 1 month, and 3 months after HRT. The changes in PSQI scores were evaluated. Responders were defined as those with a ≥ 25% reduction in the PSQI global score at 1 month. The PSQI components and menopausal symptoms at baseline were compared between responders and non-responders. Initially, 86.7% of the participants were categorized as poor sleepers. The PSQI global score and sleep quality significantly improved at 1 and 3 months after HRT (baseline to 3rd month mean scores: from 7.8 to 6.1 to 6.5 and from 1.7 to 1.0 to 1.2, respectively). Responders (n = 5) exhibited poorer habitual sleep efficiency before treatment than the non-responders.However, menopausal symptoms did not differ significantly between the groups at baseline. The results indicate that HRT with E2 and MP is a promising treatment option for peri- and postmenopausal Japanese women experiencing sleep disturbances, especially those with poor sleep efficiency.

Objectives: This study aimed to achieve expert consensus on menopause management in the Asia-Pacific region, taking into account patient diversity, the latest evidence, and current treatment options. Methods: A focused literature search was performed to identify clinical practice statements on menopause management. Menopause experts were nominated by members of the Asia-Pacific Menopause Federation (APMF) society. A modified Delphi methodology, involving iterative rounds of anonymous surveys, was employed until consensus was reached for each statement. Consensus was defined as ≥ 70% of experts voting ‘agree’ or ‘strongly agree’ for a given clinical practice statement. Results: A total of 39 participants from 14 different APMF member societies were involved. Eighty-five clinical practice statements reached a consensus. Based on the clinical practice statements, an algorithm was created as a tool to guide clinicians on menopause management. APMF experts agreed that, in addition to vasomotor symptoms, Asian women experiencing somatic or psychological symptoms may also benefit from treatment with menopausal hormone therapy (MHT). MHT should also be considered for the prevention of osteoporosis in asymptomatic peri- and postmenopausal women. Conclusions This APMF consensus statement supersedes the previous one published in 2008. It provides guidance to gynecologists, endocrinologists, family physicians, and other healthcare professionals in delivering optimal care to menopausal women in the ethnically and culturally diverse Asia-Pacific region.

Objectives: In this study, we investigate the effects of dietary supplementation with standardized aqueous extracts of shatavari (Asparagus racemosus, Ar), ashwagandha (Withania somnifera, Ws), or their combination on menopausal symptoms, vascular dysfunction, bone turnover, and serum concentrations of inflammatory and oxidative stress markers in postmenopausal women. Methods: Postmenopausal women aged 40–55 were enrolled in a double-blind randomized study to receive one of six treatments:placebo, Ar 250 mg/500 mg, Ws 250 mg/500 mg, or 500 mg extract combining Ar 250 mg and Ws 250 mg. Primary outcomes were changes in the menopause-specific quality of life (MENQOL) questionnaire, bone mineral density/bone turnover markers (BTMs), and reflection index (RI) after 24 weeks. Secondary outcomes included changes in serum inflammatory and oxidative stress markers, and evaluation of supplement safety and tolerability. Results: Supplemented groups showed significant dose-dependent decrease MENQOL and RI compared with placebo (P < 0.0001).Women supplemented with Ws or Ar extracts had significantly decreased levels of the BTMs C-terminal telopeptide of type I collagen, bone alkaline phosphatase, and receptor activator of nuclear factor kappa-B ligand, and increased osteoprotegerin levels (P < 0.0001).Significantly decreased levels of inflammatory and oxidative stress markers high-sensitivity C-reactive protein and malondialdehyde, and increased glutathione and nitric oxide levels (P < 0.0001) were also observed. Conclusions Daily supplementation with Ws or Ar extracts dose-dependently reduces menopausal symptoms, vascular dysfunction, bone turnover/resorption, and estrogen deficiency-related inflammation and oxidative stress in postmenopausal women.