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Item Cognitive Complaints Are Associated with Smaller Right Medial Temporal Gray-Matter Volume in Younger Postmenopausal Women(Wolters Kluwer, 2020-11) Conley, Alexander C.; Albert, Kimberly M.; Boyd, Brian D.; Kim, Shin-Gyeom; Shokouhi, Sepideh; McDonald, Brenna C.; Saykin, Andrew J.; Dumas, Julie A.; Newhouse, Paul A.; Radiology and Imaging Sciences, School of MedicineObjective: Menopause is associated with increasing cognitive complaints and older women are at increased risk of developing Alzheimer disease compared to men. However, there is difficulty in early markers of risk using objective performance measures. We investigated the impact of subjective cognitive complaints on the cortical structure in a sample of younger postmenopausal women. Methods: Data for this cross-sectional study were drawn from the baseline visit of a longer double-blind study examining estrogen-cholinergic interactions in normal postmenopausal women. Structural Magnetic Resonance Imaging was acquired on 44 women, aged 50-60 years and gray-matter volume was defined by voxel-based morphometry. Subjective measures of cognitive complaints and postmenopausal symptoms were obtained as well as tests of verbal episodic and working memory performance. Results: Increased levels of cognitive complaints were associated with lower gray-matter volume in the right medial temporal lobe (r = −0.445, P < 0.002, R2 = 0.2). Increased depressive symptoms and somatic complaints were also related to increased cognitive complaints and smaller medial temporal volumes but did not mediate the effect of cognitive complaints. In contrast, there was no association between performance on the memory tasks and subjective cognitive ratings, or medial temporal lobe volume. Conclusions: The findings of the present study indicate that the level of reported cognitive complaints in postmenopausal women may be associated with reduced gray-matter volume which may be associated with cortical changes that may increase risk of future cognitive decline.Item Confirmatory factor analysis of the Insomnia Severity Index (ISI) and invariance across race: a pooled analysis of MsFLASH data(Wolters Kluwer, 2019-08-01) Otte, Julie L.; Bakoyannis, Giorgos; Rand, Kevin L.; Ensrud, Kristine E.; Guthrie, Katherine A.; Joffe, Hadine; McCurry, Susan M.; Newton, Kathrine M.; Carpenter, Janet S.; School of NursingObjective: Women's sleep at menopause is widely reported to be problematic. The Insomnia Severity Index is a commonly used tool for quantifying sleep problems in clinical and research settings, but psychometric properties in menopausal women have not been reported. Our study aim was to examine the factor structure of the Insomnia Severity Index in a large and diverse sample of midlife women with hot flashes. Methods: Baseline data were from 899 women enrolled in one of the three clinical trials using similar entry criteria conducted by the Menopause Strategies Finding Lasting Answers to Symptoms and Health (MsFLASH) research network. We conducted confirmatory factor analyses for the total sample and within strata defined by race/ethnicity (Black and White women). Results: The Insomnia Severity Index had two factors in the total sample. The 2-factor structure was consistent across Black and White women, with the exception of one item “Difficulty falling asleep”. Conclusions: The Insomnia Severity Index in midlife women with hot flashes is composed of two factors that capture dimensions of the insomnia severity and daytime impact. The instrument is a psychometrically sound scale appropriate for use in research and clinical practice to capture the severity and daytime impact of insomnia symptoms in diverse samples of midlife women with hot flashes. An abbreviated screening of two items could be considered to determine if further evaluation is needed of sleep complaints.Item Elevated Mechanical Loading When Young Provides Lifelong Benefits to Cortical Bone Properties in Female Rats Independent of a Surgically Induced Menopause(2013-09) Warden, Stuart J.; Galley, Matthew R.; Hurd, Andrea L.; Wallace, Joseph M.; Gallant, Maxime A.; Richard, Jeffrey S.; George, Lydia A.Exercise that mechanically loads the skeleton is advocated when young to enhance lifelong bone health. Whether the skeletal benefits of elevated loading when young persist into adulthood and after menopause are important questions. This study investigated the influence of a surgically induced menopause in female Sprague-Dawley rats on the lifelong maintenance of the cortical bone benefits of skeletal loading when young. Animals had their right forearm extrinsically loaded 3 d/wk between 4 and 10 weeks of age using the forearm axial compression loading model. Left forearms were internal controls and not loaded. Animals were subsequently detrained (restricted to cage activities) for 94 weeks (until age 2 years), with ovariectomy (OVX) or sham-OVX surgery being performed at 24 weeks of age. Loading enhanced midshaft ulna cortical bone mass, structure, and estimated strength. These benefits persisted lifelong and contributed to loaded ulnas having greater strength after detraining. Loading also had effects on cortical bone quality. The benefits of loading when young were not influenced by a surgically induced menopause because there were no interactions between loading and surgery. However, OVX had independent effects on cortical bone mass, structure, and estimated strength at early postsurgery time points (up to age 58 weeks) and bone quality measures. These data indicate skeletal loading when young had lifelong benefits on cortical bone properties that persisted independent of a surgically induced menopause. This suggests that skeletal loading associated with exercise when young may provide lifelong antifracture benefits by priming the skeleton to offset the cortical bone changes associated with aging and menopause.Item Fezolinetant findings can fuel future instrumentation inquiries(Wolters Kluwer, 2020-12) Carpenter, Janet S.; School of NursingItem MsFLASH Participants’ Priorities for Alleviating Menopausal Symptoms(Taylor and Francis, 2015) Carpenter, Janet S.; Woods, Nancy Fugate; Otte, Julie L.; Guthrie, Katherine A.; Hohensee, Chancellor; Newton, Katherine M.; Joffe, Hadine; Cohen, Lee; Sternfeld, Barbara; Lau, R. Jane; Reed, Susan D.; LaCroix, Andrea Z.; Department of Nursing, IU School of NursingObjective To describe self-reported menopausal symptom priorities and their association with demographics and other symptoms among participants in an intervention trial for vasomotor symptoms (VMS). Methods Cross-sectional study embedded in the MsFLASH 02 trial, a three-by-two factorial design of yoga vs. exercise vs. usual activity and omega-3-fatty acid vs. placebo. At baseline, women (n = 354) completed hot flush diaries, a card sort task to prioritize symptoms they would most like to alleviate, and standardized questionnaires. Results The most common symptom priorities were: VMS (n = 322), sleep (n = 191), concentration (n = 140), and fatigue (n = 116). In multivariate models, women who chose VMS as their top priority symptom (n = 210) reported significantly greater VMS severity (p = 0.004) and never smoking (p = 0.012), and women who chose sleep as their top priority symptom (n = 100) were more educated (p ≤ 0.001) and had worse sleep quality (p < 0.001). ROC curves identified sleep scale scores that were highly predictive of ranking sleep as a top priority symptom. Conclusions Among women entering an intervention trial for VMS and with relatively low prevalence of depression and anxiety, VMS was the priority symptom for treatment. A card sort may be a valid tool for quickly assessing symptom priorities in clinical practice and research.Item Somatosensory Amplification And Hot Flashes In Breast Cancer Survivors And Healthy Menopausal Women(Office of the Vice Chancellor for Research, 2014-04-11) Igega, Christele M.; Carpenter, Janet S.Somatosensory amplification is a cognitive explanation of the tendency to sense normal somatic and visceral sensations as intense, noxious, and disturbing. An individual with somatosensory amplification takes existing physical sensations and/or conditions and focuses on them to the point that the perception of these often-normal sensations becomes overly bothersome and intense. The goal of this study is to describe the concept of somatosensory amplification and its role in the menopausal symptom experience of two target groups: menopausal breast cancer survivors and healthy midlife women. This is a cross-sectional, descriptive, correlational study. This study looked at baseline data containing the demographics, somatosensory amplification data, and mood, sleep and hot flash data (frequency, bother, control, interference, and perceived control) of 98 breast cancer survivors and 135 midlife women. Each item on the Somatosensory Amplification Scale (SSAS) was looked at in order to determine if there is a significant difference between healthy menopausal women and menopausal breast cancer survivors. The total SSAS scores were also analyzed to determine if there was a difference between the two groups. Midlife women had a higher total SSAS score than breast cancer survivors, but the group differences in total scores and individual items were not significant. Somatosensory amplification was significantly correlated with hot flash interference, perceived control of hot flashes, mood and sleep. The outcomes offer more insight into how somatosensory amplification can affect the every day lives of menopausal women and the perceived control they have over their hot flashes. Findings may prove to be useful in selecting more appropriate and relevant interventions that have the potential of improving quality of life of menopausal women.Item A Systematic Review of Palpitations Prevalence by Menopausal Status(Springer, 2021-03) Carpenter, Janet S.; Sheng, Ying; Elomba, Charles D.; Alwine, Jennifer S.; Yue, Min; Pike, Caitlin A.; Chen, Chen X.; Tisdale, James E.; School of NursingPurpose of the Review The purpose was to systematically review evidence on the prevalence of palpitations by menopausal stage. Palpitations are a feeling of missed, irregular, or exaggerated heart beats. Recent Findings Carefully delineated search, screening, and data extraction strategies resulted in five articles for review. Articles offered cross-sectional findings from menopausal symptom surveys from five countries between 1974 and 2011 with clinic- and community-based samples of premenopausal, perimenopausal, and postmenopausal women. Reported studies were good (n = 2) to fair (n = 3) quality with low (n = 2) to moderate (n = 3) bias. Menopausal palpitations were not the focus of any study but were assessed as a single item of heart racing, pounding, or discomfort over the past 2 weeks, month, or year. Palpitations prevalence rates by menopausal stage were 3.7 to 40.2% premenopausal, 20.1 to 40.2% perimenopausal, and 15.7 to 54.1% postmenopausal. Three of five articles showed that compared with premenopausal and postmenopausal women, palpitation prevalence was significantly higher among perimenopausal and surgically postmenopausal women. Summary Good-quality evidence on palpitation prevalence by menopausal stage is limited but suggests that physiological changes of menopause may play a role in this symptom. Measurement varied, suggesting a need to standardize the assessment of menopausal palpitations. The review findings suggest a strong need for clinicians and researchers to collaborate to standardize documentation of menopausal palpitations across the menopause transition.Item Using an FSDS-R Item to Screen for Sexually Related Distress: A MsFLASH Analysis(2015) Carpenter, Janet S.; Reed, Susan D.; Guthrie, Katherine A.; Larson, Joseph C.; Newton, Katherine M.; Lau, R. Jane; Learman, Lee A.; Shifren, Jan L.Introduction The Female Sexual Distress Scale-Revised (FSDS-R) was created and validated to assess distress associated with impaired sexual function, but it is lengthy for use in clinical practice and research when assessing sexual function is not a primary objective. Aim The study aims to evaluate whether a single item from the FSDS-R could be identified to use to screen midlife women for bothersome diminution in sexual function based on three criteria: (i) highly correlated with total scores; (ii) correlated with commonly assessed domains of female sexual functioning; and (iii) able to differentiate between women reporting high and low sexual concerns during the prior month. Methods Data from 93 midlife women were collected by the Menopause Strategies Finding Lasting Answers to Symptoms and Health (MsFLASH) research network. Main Outcome Measures Women completed the FSDS-R, Female Sexual Function Index (FSFI), and Menopausal Quality of Life Scale (MENQOL). Those who reported a change in the past month on the MENQOL sexual were categorized into a high sexual concerns group, while all others were categorized into a low sexual concerns group. Results Women were an average of 54.6 years old (SD 3.1) and mostly Caucasian (77.4%), college educated (60.2%), married/living as married (64.5%), and postmenopausal (79.6%). The FSDS-R item number 1 “Distressed about sex life” was: (i) highly correlated with FSDS-R total scores (r = 0.90); (ii) moderately correlated with FSFI total scores (r = −0.38) and FSFI desire (r = −0.37) and satisfaction domains (r = −0.40); and (iii) showed one of the largest mean differences between high and low sexual concerns groups (P < 0.001). Other FSDS-R items met one or two, but not all three of the prespecified criteria (i, ii, iii). Conclusions A single FSDS-R item may be a useful screening tool to quickly identify midlife women with sexually related distress when it is not feasible to administer the entire scale, though further validation is warranted.Item Vitamin D levels and menopause-related symptoms.(Wolters Kluwer Health, 2014-11) LeBlanc, Erin S.; Desai, Manisha; Perrin, Nancy; Wactawski-Wende, Jean; Manson, JoAnn E.; Cauley, Jane A.; Michael, Yvonne L.; Tang, Jean; Womack, Catherine; Song, Yiqing; Johnson, Karen C.; O’Sullivan, Mary J.; Woods, Nancy; Stefanick, Marcia L.; Department of Epidemiology, Richard M. Fairbanks School of Public HealthObjective: To determine whether vitamin D levels are associated with menopause-related symptoms in older women. Methods: A randomly selected subset of 1,407 women, among 26,104 potentially eligible participants of the Women’s Health Initiative Calcium and Vitamin D (CaD) trial of postmenopausal women aged 51-80 years, had 25-hydroxyvitamin D [25(OH)D] levels measured at the CaD trial baseline visit. Information about menopause-related symptoms at baseline was obtained by questionnaire and included overall number of symptoms and composite measures of sleep disturbance, emotional well-being, and energy/fatigue, as well as individual symptoms. After exclusions for missing data, 530 women [mean age 66.2 years (SD 6.8)] were included in these analyses. Results: There were borderline significant associations between 25(OH)D levels and total number of menopausal symptoms (p values ranging from 0.05 to 0.06 for fully adjusted models); however, the effect was clinically insignificant and disappeared with correction for multiple testing. There were no associations between 25(OH)D levels and composite measures of sleep disturbance, emotional well-being, or energy/fatigue (p’s > 0.10 for fully adjusted models). Conclusions: There was no evidence of a clinically important association between serum 25(OH)D levels and menopause-related symptoms in postmenopausal women.