Transition to menopause and its changing hormonal milieu are strongly associated with new onset of depressed mood among women with no history of depression.

Medtronic. Dr. Nead has received personal fees from Medtronic. Dr. Bowling has received personal fees from Medtronic. Dr. Murgu has received personal fees from Medtronic, Boston Scientific, Pinnacle Biologics, Olympus, Cook, Auris Robotics, and Elsevier; and has stock ownership in Concordia, Boston Scientific, and Merck. Dr. Krimsky has received personal fees from Medtronic, Innovital Systems, Gala Therapeutic, SOC, and Peytant; has stock ownership with Innovital Systems and CSA Medical; and has patents pending with Medtronic and Merit. Dr. Murillo has received support from Medtronic. Dr. LeMense has received personal fees from Medtronic. Dr. Minnich has received personal fees from Medtronic. Dr. Bansal has received personal fees from Medtronic, Pinnacle Biologics, Sunovion, and Veran Medical. Dr. Ellis has received support from Medtronic. Dr. Mahajan has received personal fees from Medtronic. Dr. Gildea has received personal fees from Medtronic. Dr. Bechara has received support from Medtronic. Dr. Sztejman has received support from Medtronic. Dr. Flandes has received grants from BTG-PneumRx and Ambu; and personal fees from Medtronic, BTG-PneumRx, Olympus, Ambu, PulmonX, and Boston Scientific. Dr. Rickman has received personal fees from Medtronic, Veran Medical, BD, Olympus, and Abbvie. Dr. Benzaquen has received support from Medtronic. Dr. Hogarth has received personal fees from Medtronic, Auris Surgical Robotics, Boston Scientific, Grifols, Shire, and CSL; and has stock ownership with Auris Surgical Robotics. Dr. Linden has received support from Medtronic. Dr. Wahidi has received personal fees from Medtronic and Veran Medical. Dr. Mattingley has received personal fees from Medtronic and is current employee of Medtronic (employment began after completion of enrollment). Dr. Hood is an employee with stock ownership at Medtronic; and has stock ownership with Boston Scientific. Ms. Lin and Ms. Wolvers are employees with stock ownership at Medtronic. Dr. Khandar has received personal fees from Medtronic.

No abstract

II.

Objective To estimate associations of obesity with reproductive hormone levels as women progress from premenopausal to postmenopausal status. Methods This is a longitudinal study conducted in the population-based Penn Ovarian Aging Cohort (N=436). At cohort enrollment, the women were premenopausal, ages 35–47 years, with equal numbers of African Americans and Caucasians. Anthropometric measures, menopausal status and reproductive hormone measures were evaluated for 12 years. Associations of the anthropometric measures with estradiol, FSH and inhibin b in the menopausal transition were estimated using generalized linear regression models for repeated measures. Results Associations between obesity and hormone levels differed by menopausal status as indicated by significant interactions between each hormone and menopausal stage. Premenopausal obese and overweight women had significantly lower estradiol levels compared to non-obese women, independent of age, race and smoking (obese: 32.8 pg/mL; 95% CI: 30.6. 35.2 versus non-obese: 39.8 pg/mL; 95% CI: 37.0, 42.8, P<0.001). The associations reversed postmenopause, with obese women having the highest estradiol levels (obese: 20.6 pg/mL; 95% CI: 17.2, 24.7 versus non-obese: 12.2 pg/mL; 95% CI: 10.1, 14.8, P<0.001). Inhibin b levels were significantly lower in premenopausal obese compared to non-obese women but reversed in the late transition stage. FSH levels were lowest in postmenopausal obese compared to non-obese women (P<0.001). Measures of waist circumference (central adiposity) and waist/hip ratio paralleled the BMI results. Conclusion Obesity is an important factor in hormone dynamics independent of age, race and smoking in mid-life women, although the mechanisms remain unclear.

No abstract

Subtle changes in menstrual cycle length reflect significant changes in inhibin B and FSH levels during the menopausal transition. Therefore, it appears that subtle changes in bleeding pattern may be helpful in identifying the earliest hormonal changes during menopausal transition.

OBJECTIVE To estimate the duration of moderate-to-severe menopausal hot flushes and identify potential risk factors for hot flush duration. METHODS The Penn Ovarian Aging Study cohort was followed for 13 years. Hot flushes were evaluated at 9-month to 12-month intervals through in-person interviews. The primary outcome was the duration of moderate to severe hot flushes, estimated by survival analysis (N=259). Potential risk factors included menopausal stage, age, race, reproductive hormone levels, body mass index (BMI) and current smoking. A secondary analysis included women who reported any hot flushes (N=349). RESULTS The median duration of moderate to severe hot flushes was 10.2 years and was strongly associated with menopausal stage at onset. Hot flushes that commenced near entry into the menopause transition had a median duration >greater than 11.57 years; onset in the early transition stage had a median duration of 7.35 years (95% CI 4.94, 8.89), P<0.001); and onset in the late transition to postmenopausal stages had a median duration of 3.84 years (95% CI: 1.77, 5.52), P<0.001. The most common ages at onset of moderate-to-severe hot flushes were 45–49 years (median duration 8.1 years; 95% CI 5.12, 9.28). African American women had a longer duration of hot flushes than white women in adjusted analysis. CONCLUSIONS The median duration of hot flushes considerably exceeded the time frame that is generally accepted in clinical practice. The identified risk factors, particularly menopausal stage, race, and BMI, are important to consider in individualizing treatment and evaluating the risk to benefit ratio of hormones and other therapies.