Special Issue "Treatments and Clinical Management of Menopausal Symptoms: Current Approaches and Future Perspectives"

A special issue of Medicina (ISSN 1010-660X).

Deadline for manuscript submissions: closed (31 December 2019).

Special Issue Editors

Dr. Antonio Simone Laganà
Website SciProfiles
Guest Editor
Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
Interests: endometriosis; reproductive immunology; infertility; minimally invasive surgery; in vitro fertilization
Special Issues and Collections in MDPI journals
Dr. Valentina Lucia La Rosa
Website
Guest Editor

Special Issue Information

Dear Colleagues,

Menopause is defined as the point in time when menstrual cycles permanently cease because of the natural depletion of ovarian oocytes from aging. These elements reflect important changes in hormonal and metabolic homeostasis: in particular, low estrogen can result in vasomotor instability (such as hot flushes and night sweats), psychological changes (such as mood swings, depression, and difficulty concentrating), insomnia, genital tract atrophy (such as vaginal dryness, painful intercourse, and urinary incontinence), skin changes (such as thinning and decreased elasticity). In addition, lower androgen levels (male hormones) can contribute to the loss of sex drive.

Menopausal symptoms have a negative impact on quality of life, social relationships, and sexual activity. More specifically, the sexual sphere is particularly affected by the clinical manifestations of menopause, and it is common to observe menopausal women suffering from female sexual dysfunctions. The risk of sexual dysfunction for menopausal women grows with the decrease in estrogen levels and the ageing process. Women usually report diminished vaginal lubrication, pain and discomfort during intercourse, decreased arousal, and difficulty in achieving orgasm. Therefore, a multidisciplinary approach is needed in order to improve the clinical management of menopause.

The first line of treatment for menopausal symptoms includes non-hormonal vaginal lubricants, moisturizers, and regular sexual function. For women with moderate to severe vulvovaginal symptoms who do not benefit from the use of lubricants and moisturizers, estrogen therapy (topic or systemic) is generally recommended as a therapeutic standard. However, not all women want to use hormonal therapy, preferring treatments with nutraceuticals which have been shown to have positive effects in the treatment of menopausal disorders. Indeed, it has been underlined that selected nutrients and nutraceuticals may significantly ameliorate the symptoms and signs of menopause. On one hand, these compounds improve the quality of life, whereas on the other hand, they may also increase life expectancy by modifying known risk factors for comorbidities.

Considering these elements, this Special Issue aims to publish updated and groundbreaking original researches as well as comprehensive reviews about clinical management and treatment options for menopausal symptoms. Space will also be given to multidisciplinary contributions in order to better understand the impact of the different treatments on sexual function, couple relationship, and psychological wellbeing.

Potential topics include but are not limited to the following:

  • Menopause and vulvovaginal atrophy symptoms
  • Topical treatments for menopausal symptoms
  • Systemic treatments for menopausal symptoms
  • Nutrition and symptoms/signs of menopause
  • The role of nutraceuticals during menopause
  • Menopause and sexual dysfunctions
  • Menopause and psycological symptoms
  • Treatments of menopausal symptoms and quality of life

Dr. Antonio Simone Laganà
Dr. Valentina Lucia La Rosa
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Menopause
  • Menopausal symptoms
  • Genitourinary syndrome of menopause
  • Non-hormonal treatments
  • Hormone therapy
  • Vulvovaginal atrophy
  • Quality of life
  • Sexuality

Published Papers (4 papers)

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Editorial

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Open AccessEditorial
Risk-Reducing Bilateral Salpingo-Oophorectomy for BRCA Mutation Carriers and Hormonal Replacement Therapy: If It Should Rain, Better a Drizzle than a Storm
Medicina 2019, 55(8), 415; https://doi.org/10.3390/medicina55080415 - 29 Jul 2019
Cited by 1
Abstract
Women carrying a BRCA mutation have an increased risk of developing breast and ovarian cancer. The most effective strategy to reduce this risk is the bilateral salpingo-oophorectomy, with or without additional risk-reducing mastectomy. Risk-reducing bilateral salpingo-oophorectomy (RRBSO) is recommended between age 35 and [...] Read more.
Women carrying a BRCA mutation have an increased risk of developing breast and ovarian cancer. The most effective strategy to reduce this risk is the bilateral salpingo-oophorectomy, with or without additional risk-reducing mastectomy. Risk-reducing bilateral salpingo-oophorectomy (RRBSO) is recommended between age 35 and 40 and between age 40 and 45 years for women carriers of BRCA1 and BRCA2 mutations, respectively. Consequently, most BRCA mutation carriers undergo this procedure prior to a natural menopause and develop an anticipated lack of hormones. This condition has a detrimental impact on various systems, affecting both the quality of life and longevity; in particular, women carrying BRCA1 mutation, who are likely to have surgery earlier as compared to BRCA2. Hormonal replacement therapy (HRT) is the only effective strategy able to significantly compensate the hormonal deprivation and counteract menopausal symptoms, both in spontaneous and surgical menopause. Although recent evidence suggests that HRT does not diminish the protective effect of RRBSO in BRCA mutation carriers, concerns regarding the safety of estrogen and progesterone intake reduce the use in this setting. Furthermore, there is strong data demonstrating that the use of estrogen alone after RRBSO does not increase the risk of breast cancer among women with a BRCA1 mutation. The additional progesterone intake, mandatory for the protection of the endometrium during HRT, warrants further studies. However, when hysterectomy is performed at the time of RRBSO, the indication of progesterone addition decays and consequently its potential effect on breast cancer risk. Similarly, in patients conserving the uterus but undergoing risk-reducing mastectomy, the addition of progesterone should not raise significant concerns for breast cancer risk anymore. Therefore, BRCA mutation carriers require careful counselling about the scenarios following their RRBSO, menopausal symptoms or the fear associated with HRT use. Full article

Review

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Open AccessReview
Efficacy of Low-Dose Paroxetine for the Treatment of Hot Flushes in Surgical and Physiological Postmenopausal Women: Systematic Review and Meta-Analysis of Randomized Trials
Medicina 2019, 55(9), 554; https://doi.org/10.3390/medicina55090554 - 31 Aug 2019
Cited by 1
Abstract
Background and Objectives: Hot flushes and sleep disturbances are the most common vasomotor symptoms (VMS) reported by postmenopausal women. Hormonal treatment is to date referred to as the gold standard approach but not suitable for all the patients. Alternative treatments are needed in [...] Read more.
Background and Objectives: Hot flushes and sleep disturbances are the most common vasomotor symptoms (VMS) reported by postmenopausal women. Hormonal treatment is to date referred to as the gold standard approach but not suitable for all the patients. Alternative treatments are needed in case of a contraindication to menopausal hormone therapy (MHT), adverse side effects, and poor compliance. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS. Nonetheless, few trials with low consensus are available about this topic. In this review, we aimed to evaluate the efficacy of low-dose paroxetine therapy in the treatment of vasomotor hot flushes and night sleep disturbances in postmenopausal women. Materials and Methods: We performed an electronic search from the beginning of all databases to July 2019. All results were then limited to a randomized trial. Restrictions for language or geographic location were not utilized. Inclusion criteria were randomized clinical trials of physiological or surgical postmenopausal women experiencing hot flushes and sleep disturbances who were randomized to either low-dose paroxetine or placebo (i.e., formulations without active ingredients). The primary outcome evaluated was the mean weekly reduction of hot flushes. Results: Five randomized clinical trials, including 1482 postmenopausal women, were analyzed. Significant heterogeneity (I2 = 90%) between studies was noted. Hot flushes episodes were significantly reduced in the treatment arm compared to placebo (mean difference (MD) −7.97 [−10.51, −5.92] episodes/week). Results on the improvement on sleep were limited by being reported in only two studies; however, no significant reduction of night-time awakenings was observed (MD, −0.40 awakenings/night [−1.38, 0.58 CI]). Conclusions: Low-dose paroxetine is an effective treatment for vasomotor menopause symptoms, including hot flushes. Full article
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Open AccessReview
A Nutraceutical Approach to Menopausal Complaints
Medicina 2019, 55(9), 544; https://doi.org/10.3390/medicina55090544 - 28 Aug 2019
Cited by 7
Abstract
The menopausal transition, or perimenopause, is characterized by menstrual irregularities, vasomotor symptoms, sleep disturbances, mood symptoms, and urogenital tract atrophy. These changes can also affect the quality of life and one’s self-esteem. Hormone replacement therapy (HRT) is considered the best option to achieve [...] Read more.
The menopausal transition, or perimenopause, is characterized by menstrual irregularities, vasomotor symptoms, sleep disturbances, mood symptoms, and urogenital tract atrophy. These changes can also affect the quality of life and one’s self-esteem. Hormone replacement therapy (HRT) is considered the best option to achieve therapeutic relief of different menopausal symptoms but is usually restricted to moderate or severe symptoms. Moreover, many women refuse HRT for a variety of reasons concerning the fear of cancer and other adverse effects. According to these considerations, new topics are emerging: Dissatisfaction with drug costs and conventional healthcare, desire for personalized medicines, and the public perception that “natural is good”. In this context, nonhormonal therapies are mostly evolving, and it is not unusual that women often request a “natural” approach for their symptoms. The aim of this study is to investigate nonhormonal therapies that have been identified to reduce the menopausal symptoms. Full article
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Open AccessReview
Surgically Induced Menopause—A Practical Review of Literature
Medicina 2019, 55(8), 482; https://doi.org/10.3390/medicina55080482 - 14 Aug 2019
Cited by 1
Abstract
Menopause can occur spontaneously (natural menopause) or it can be surgically induced by oophorectomy. The symptoms and complications related to menopause differ from one patient to another. We aimed to review the similarities and differences between natural and surgically induced menopause by analyzing [...] Read more.
Menopause can occur spontaneously (natural menopause) or it can be surgically induced by oophorectomy. The symptoms and complications related to menopause differ from one patient to another. We aimed to review the similarities and differences between natural and surgically induced menopause by analyzing the available data in literature regarding surgically induced menopause and the current guidelines and recommendations, the advantages of bilateral salpingo-oophorectomy in low and high risk patients, the effects of surgically induced menopause and to analyze the factors involved in decision making. Full article
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