BACKGROUND:Studies have shown that aromatherapy improve health problems related to anxiety, depression, heart rate variability (HRV), and sleep. However, the effect of aromatherapy in women who suffer from menopausal syndrome and its specific effects on HRV and sleep quality are unknown.

PURPOSE:This study designed an aromatherapy intervention and evaluated its effect on menopausal syndrome, HRV, and sleep quality in women.

METHODS:This double-blinded randomized controlled trial was conducted at a medical center hospital. A total of 84 participants who met the study criteria were randomly assigned using permuted block randomization. The experimental group received a 20-min inhalation of essential oil and the control group received a 20-min inhalation of sweet almond oil every night for 4 weeks. Posttest data was collected at 2 weeks after completion of the intervention. Data were collected using the Green Menopausal Symptom Scale, HRV device, and Pittsburgh Sleep Quality Index.

RESULTS:After adjusting for age, the results of the generalized estimation equations (GEE) showed that all outcomes were significantly different in both the experimental group and the control group (p<.05) for the interaction effect of group and time, and that the outcome of sleep quality on the 2nd week in the control group was not significantly different (p<.066).

CONCLUSIONS / IMPLICATIONS FOR PRACTICE:This study supports that the 4-week aromatherapy intervention improves menopausal symptoms, the activity of autonomic nervous systems, and sleep quality in women with no adverse side effects. In the future, this intervention may be applied in outpatient departments to promote the health of menopausal women.

OBJECTIVES:To observe the effect of yoga on menopausal symptoms using a prospective, randomized, controlled and interventional study. Main outcome measures Total Menopause Rating Scale (MRS) score and three subscale scores (somatovegetative, psychological and urogenital) were measured on day 1 and day 90 in the study group which performed yoga (asana, pranayam and meditation) under supervision for three months, and were compared with the control group that did not perform yoga. MRS has been designed to measure health-related quality of life of ageing women. It consists of 11 symptoms and three subscales.

RESULTS:It was observed that on day 1 the scores in both the groups were comparable. On day 90, the scores in the yoga group showed a reduction in score on all the subscales, which was statistically significant. No significant difference was noted in the control group.

CONCLUSION:Yoga is effective in reducing menopausal symptoms and should be considered as alternative therapy for the management of menopausal symptoms.

The purposes of this study were to analyze the impact of 24 weeks of vibratory and multicomponent training (MT) and to determine what type of training creates greater adaptations on body composition and isokinetic strength of the knee and ankle joints in postmenopausal women. Thirty-eight women (60.0 ± 6.3 years) were randomly assigned to whole body vibration group (WBVG), multicomponent training group (MTG), or a control group. A significant decrease in total fat mass was observed in experimental groups. There were no changes in total lean mass and total bone mineral density in both groups. WBVG and MTG showed significant increases in isokinetic strength for knee extensors at 60°/s and at 270°/s. Regarding the ankle joint, there were significant increments in strength for plantar flexion at 60°/s in WBVG and at 120°/s in the two trainings groups. MTG showed a significant increase in strength for dorsiflexion at 60°/s. With respect to eversion and inversion, WBVG and MTG improved strength at 60°/s. Also, the WBVG showed increased strength in the ankle evertors at 120°/s and both groups showed increased strength in the ankle invertors at 120°/s. Twenty-four weeks of whole body vibration or MTs result in positive modifications in total fat mass. These trainings are effective in improving knee extension and stabilizer muscles of the ankle joint strength.

The aim of this study was to investigate the effects of an 8-week Pilates exercise program on menopausal symptoms and lumbar strength and flexibility in postmenopausal women. In total, 74 postmenopausal women were recruited and randomly allocated to a Pilates exercise group (n=45) and a control group (n=29). Menopausal symptoms were measured through a questionnaire, while lumbar strength was measured through a lumbar extension machine, and lumbar flexibility was measured through sit-and-reach and trunk lift tests performed before and after the Pilates exercise program, respectively. The Pilates exercises consisted of 7-10 min for warm-up, 35-40 min for the main program modified from Pilates Academy International, and 5-7 min for the cool-down, and were performed 3 times a week for 8 weeks. The results showed a significant decrease in menopausal symptoms except urogenital symptoms. Also, the results presented a significant increase in lumbar strength and flexibility after 8 weeks of the Pilates exercise program. We concluded that an 8-week Pilates exercise program is effective in decreasing menopausal symptoms and increasing lumbar strength and flexibility.

Context• During the postmenopausal stage, women go through many remarkable changes, including physical, emotional, and hormonal. They also experience some unwanted effects, such as vasomotor symptoms, anxiety, and insomnia. The use of Bach flower remedies has been described as a supporting therapy for those symptoms. Objectives • The investigation aimed to evaluate the effects of the supplement on sleep pattern (ie, sleep perception and objective sleep) and on menopausal symptoms. Design • The research team created a case report. Setting • The study was conducted at the Menopause Transition and Postmenopause Sleep Disorder Clinic at the Department of Gynecology of the Federal University of São Paulo in São Paulo, Brazil. Participant • The participant was a 53-y-old, single woman, at the postmenopausal stage, who had been diagnosed with insomnia according to the criteria of the American Academy of Sleep Medicine and complained of climacteric symptoms. Intervention • The patient underwent treatment with a blend of the supplement for 4 mo. Outcome Measures • Sleep questionnaires were given and polysomnography was performed before and after treatment. Results • Both sleep perception and objective sleep were improved. The patient's anxiety and menopausal symptoms were reduced after the treatment with the supplement. Conclusion • The use of Bach flower remedies as a therapeutic strategy to relieve menopausal symptoms, such as anxiety, mood changes, and insomnia, seemsworthy of further investigation.

OBJECTIVE:To observe the differences in the clinical efficacy on menopausal irritability between acupuncture and medication.

METHODS:Sixty cases of menopausal irritability were randomized into an acupuncture group (31 cases) and a medication group (29 cases). In the acupuncture group, the warming needling manipulation was applied at the key acupoints such as Hegu (LI 4) and Taichong (LR 3), once a day, 10 treatments made one session. Totally, 2 sessions were required. In the medication group, 2.5 mg diazepam tablets were prescribed, three times a day, for 23 days totally. The clinical efficacy, the modified Kupperman score and self-rated health measurement scale (SRHMS) were compared before and after treatment in the two groups. RESULTS The total effective rate was 87. 1% (27/31) in the acupuncture group and 82.8% (24/29) in the medication group. The difference in the clinical efficacy was not significant between the two groups (P>0.05). The modified Kupperman score and SRHMS score were both reduced obviously after treatment in the two groups, indicating the significant difference (all P<0.05). The reduction of two scores in the acupuncture group was more obvious than those in the medication group (Kupperman: 15.23 +/- 6.19 vs 18.45 +/- 5.37; SRHMS: 116.29 +/- 38.24 vs 140.34 +/- 42.15, both P<0.05).

CONCLUSION:The acupuncture and medication are effective in the treatment of menopausal irritability, but the efficacy of warming needling manipulation is better than that of diazepam tablets.

OBJECTIVE:To observe the differences in the clinical efficacy on menopausal irritability between acupuncture and medication.

METHODS:Sixty cases of menopausal irritability were randomized into an acupuncture group (31 cases) and a medication group (29 cases). In the acupuncture group, the warming needling manipulation was applied at the key acupoints such as Hegu (LI 4) and Taichong (LR 3), once a day, 10 treatments made one session. Totally, 2 sessions were required. In the medication group, 2.5 mg diazepam tablets were prescribed, three times a day, for 23 days totally. The clinical efficacy, the modified Kupperman score and self-rated health measurement scale (SRHMS) were compared before and after treatment in the two groups. RESULTS The total effective rate was 87. 1% (27/31) in the acupuncture group and 82.8% (24/29) in the medication group. The difference in the clinical efficacy was not significant between the two groups (P>0.05). The modified Kupperman score and SRHMS score were both reduced obviously after treatment in the two groups, indicating the significant difference (all P<0.05). The reduction of two scores in the acupuncture group was more obvious than those in the medication group (Kupperman: 15.23 +/- 6.19 vs 18.45 +/- 5.37; SRHMS: 116.29 +/- 38.24 vs 140.34 +/- 42.15, both P<0.05).

CONCLUSION:The acupuncture and medication are effective in the treatment of menopausal irritability, but the efficacy of warming needling manipulation is better than that of diazepam tablets.

OBJECTIVES:Yoga practice includes a group of specific psychophysical techniques. Although previous studies showed beneficial effects of yoga for health and rehabilitation, improving quality of life, there are few studies on the possible therapeutic application of yoga during the climacteric period. The purpose of this study was to investigate the psychophysiological effects of Hatha Yoga regular practice in post-menopausal women.

METHODS:Eighty-eight post-menopausal women volunteered for this 12-week trial. They were randomly assigned to one of three groups: control (no intervention), exercise, and yoga. Questionnaires were applied in order to evaluate climacteric syndrome (Menopause Rating Scale), stress (Lipp Stress Symptom Inventory), quality of life (Brief World Health Organization Quality of Life), depression (Beck Depression Inventory) and anxiety (State/Trait Anxiety Inventories). Physiological changes were evaluated through hormone levels (cortisol, FSH, LH, progesterone and estradiol).

RESULTS:At 12 weeks, yoga practitioners showed statistically lower scores for menopausal symptoms, stress levels and depression symptoms, as well as significantly higher scores in quality of life when compared to control and exercise groups. Only control group presented a significant increase in cortisol levels. The yoga and exercise groups showed decreased levels of FSH and LH when compared to control group.

CONCLUSIONS:These results suggest that yoga promotes positive psychophysiological changes in post-menopausal women and may be applied as a complementary therapy towards this population.

OBJECTIVES:To carry out a preliminary trial evaluating the effectiveness of two types of homeopathy for the treatment of menopausal symptoms in breast cancer survivors.

DESIGN:Randomized, double-blinded, placebo-controlled.

SETTINGS/LOCATION:Private medical clinic, Seattle, WA.

SUBJECTS:Women with a history of breast cancer who had completed all surgery, chemotherapy, and radiation treatment and who had an average of at least three hot flashes per day for the previous month.

INTERVENTIONS:Subjects were randomized to receive either an individualized homeopathic single remedy, a homeopathic combination medicine, or placebo. Patients were seen by homeopathic providers every 2 months for 1 year.

OUTCOME MEASURES:Hot flash frequency and severity, Kupperman Menopausal Index (KMI), Short Form 36 (SF-36).

RESULTS:There was no significant difference found in the primary outcome measure, the hot flash severity score, although there was a positive trend in the single remedy group during the first 3 months of the study (p = 0.1). A statistically significant improvement in general health score in both homeopathy groups (p<0.05) on the SF-36 after 1 year was found. Evidence of a homeopathic "drug proving" in the subjects receiving the homeopathic combination medicine who were not taking tamoxifen also was found.

CONCLUSIONS:Small sample size precludes definitive answers, but results from this preliminary trial suggest that homeopathy may be of value in the treatment of menopausal symptoms and improving quality of life, especially in those women not on tamoxifen. Larger studies should be carried out that also include healthy women who want to avoid hormone replacement therapy.

It is now well established that after menopause cardiometabolic disorders become more common. Recently, resistance exercise has been recommended as a complement to aerobic (combined training, CT) for the treatment of cardiometabolic diseases. The aim of this study was to evaluate the effects of CT in hypertensive ovariectomized rats undergoing fructose overload in blood pressure variability (BPV), inflammation, and oxidative stress parameters. Female rats were divided into the following groups (n = 8/group): sedentary normotensive Wistar rats (C), and sedentary (FHO) or trained (FHOT) ovariectomized spontaneously hypertensive rats undergoing and fructose overload. CT was performed on a treadmill and ladder adapted to rats in alternate days (8 wk; 40-60% maximal capacity). Arterial pressure (AP) was directly measured. Oxidative stress and inflammation were measured on cardiac and renal tissues. The association of risk factors (hypertension + ovariectomy + fructose) promoted increase in insulin resistance, mean AP (FHO: 174± 4 vs. C: 108 ± 1 mmHg), heart rate (FHO: 403 ± 12 vs. C: 352 ± 11 beats/min), BPV, cardiac inflammation (tumor necrosis factor-α-FHO: 65.8 ± 9.9 vs. C: 23.3 ± 4.3 pg/mg protein), and oxidative stress cardiac and renal tissues. However, CT was able to reduce mean AP (FHOT: 158 ± 4 mmHg), heart rate (FHOT: 303 ± 5 beats/min), insulin resistance, and sympathetic modulation. Moreover, the trained rats presented increased nitric oxide bioavailability, reduced tumor necrosis factor-α (FHOT: 33.1 ± 4.9 pg/mg protein), increased IL-10 in cardiac tissue and reduced lipoperoxidation, and increased antioxidant defenses in cardiac and renal tissues. In conclusion, the association of risk factors promoted an additional impairment in metabolic, cardiovascular, autonomic, inflammatory, and oxidative stress parameters and combined exercise training was able to attenuate these dysfunctions.

OBJECTIVE:The aim of this study was to evaluate predictors of the placebo response in a randomized, placebo-controlled, double-blind trial of a phytotherapeutic combination for the treatment of menopausal symptoms.

METHODS:A post hoc analysis was conducted on data from 46 placebo participants completing the study. Variables at baseline were investigated for prediction of improvement on any of the endpoints of flushing, depression measured on the Hamilton Depression Inventory, and menopausal symptoms measured on the Greene Climacteric Scale. Hierarchical linear regression analyses were carried out on the individual endpoints, controlling for baseline scores. Multivariate linear regression analysis was also conducted on these three endpoints in combination.

RESULTS:Higher anxiety at study entry predicted placebo response on all three outcome measures individually (flushing: R = 0.33, P = 0.03; depression: R = 0.34, P<0.001; and Greene Climacteric score: R = 0.24, P = 0.04); and in combination (P = 0.002), as did total Greene Climacteric scores at study entry (R = 0.24, P = 0.005). Improvement during nontreatment run-in predicted placebo response for depression (P = 0.005), menopausal symptoms (R = 0.28, P = 0.013), and the three combined endpoints (P = 0.015). Severity of scores at baseline predicted subsequent improvement on the Greene Climacteric scores only (r = 0.038, P = 0.009).

CONCLUSIONS:These findings may facilitate identification of potential placebo responders in future randomized controlled trials on menopausal symptoms and have relevance to study design in this context. Further research is required.

Background:We examined the effect of antioxidant supplementation and exercise on irisin within postmenopausal women.

Methods:Forty-eight participants (age: 55.7 ± 4.9 years; weight: 68.0 ± 6.3 kg; BMI 27.0 ± 2.7; mean ± SD) were randomized into four groups for the eight week intervention: control group (CG; = 12), resistance training group (RTG; = 12), supplementation withgroup (ZG; = 12), or supplementation withand resistance training group (ZRTG; = 12). RTG and ZRTG performed circuit resistance training, and both ZG and ZRTG consumed 500 mg ofevery day during the intervention. Blood samples were taken 48 hours before and after the intervention.

Results:There was a significant difference in irisin at post-training, with greater levels in ZRTG compared to CG. A significant increase was noted for irisin at post-training compared to pre-training for ZG, RTG, and ZRTG. Moreover, we identified a significant decrease in malondialdehyde in the RTG and ZRTG groups and increase in glutathione in the ZG, RTG, and ZRTG groups when compared to CG.

Conclusion:These findings showed that exercise,supplementation or their combination led to an increase in irisin.

BACKGROUND:Menopausal symptoms experienced by women vary widely, and while many women transition through menopause with manageable symptoms, others experience severe symptoms, which may impair their quality of life.

OBJECTIVES:A randomized clinical trial was conducted to determine the effect of aromatherapy massage on psychological symptoms during menopause.

METHODS:The study population comprised 90 women. Each subject in the aromatherapy massage group received 30 min aromatherapy sessions with aroma oil, twice a week, for four weeks; each subject in the massage therapy group received the same treatment with odorless oil, while no treatment was provided to subjects in the control group. The outcome measures were psychological symptoms, as obtained through the psychological subscale of the Menopause Rating Scale.

RESULTS:A total of 87 women were evaluated. A statistically significant difference was found between the participants' pre- and post-application psychological score in intervention groups, whereas the score in the control group did not differ significantly. Aromatherapy massage decreased the psychological score MD: -3.49 (95% Confidence Interval of Difference: -4.52 to -2.47). Massage therapy also decreased the psychological score MD: -1.20 (95% Confidence Interval of Difference: -2.19 to -0.08). To distinguish the effect of aromatherapy from massage separately, we compared the reduction in the psychological score. Aromatherapy massage decreased the psychological score more than massage therapy MD: -2.29 (95% Confidence Interval of Difference: -3.01 to -0.47).

CONCLUSION:Both aromatherapy massage and massage were effective in reducing psychological symptoms, but, the effect of aromatherapy massage was higher than massage.

INTRODUCTION:Menopause is the termination of menstruation and fertility. Women commonly experience sleeping problems during the menopausal period. Aromatherapy is among the complementary therapies used to remedy sleeping problems.

METHODS:This study aims to investigate the effects of lavender oil on sleep and quality of life of menopausal women through steam inhalation. This study was quasi-experimental with pre-test/post-test placebo control groups. It was conducted with 57 women, 27 of whom were subject to aromatherapy and 30 to a placebo. Data were collected using the Questionnaire Form, the Pittsburgh Sleep Quality Index (PSQI) and the Menopause-Specific Quality of Life Questionnaire (MENQOL).

RESULTS:For the intervention group, the PSQI median scores after the administration of aromatherapy were found to be significantly lower than those before the administration (p<0.001) and those of the placebo group (p<0.001). Similarly, for the intervention group, the total median MENQOL scores after the administration of the aromatherapy were found to be significantly lower than the scores prior to the administration (p<0.001) as well as the scores of the placebo group (p<0.001).

CONCLUSION:It was found that aromatherapy involving lavender-scented steam inhalation increased sleep quality and quality of life in women with sleep deprivation problems during menopause.

OBJECTIVES:The menopause is a natural biological process that is happened by a permanent regal stop due to the loss of performance. The aim of this research is to evaluate the effect of lavender aromatherapy on the menopause symptoms.

STUDY DESIGN:This double-blind cross over clinical trial carried out on 100 menopause women (between 45 and 155 years old) referring to health centers in Ardabil in 2013-14. The samples blocked randomly, placed in two experimental (Lavender) and control (diluted milk) groups. Lavender aroma is smelled two times daily for 20 min during 12 weeks by research subjects. Data were collected by Green questionnaire and the analysis of data carried out in SPSS v.16 by paired t-test.

MAIN OUTCOME MEASURES:The level of the symptoms has been decreased significantly after using lavender.

RESULTS:Comparing the level of the symptoms before and after using lavender in experimental group suggested that the rate of the menopause symptoms has been decreased significantly (P = 0.000). The comparison of the mean of the menopause symptoms after intervention between two groups suggested that the menopause symptoms in the experimental group had a significant decrease comparing the control group (P = 0.000).

CONCLUSION:Using the lavender aromatherapy decreases menopause symptoms. According to the undesirable effect of the menopause symptoms on the quality of life of the menopausal women, these interventions may be instructed by midwives in the treatment and care centers as a health activity.

OBJECTIVES:Previous research has found that yoga can enhance quality of life and ease menopausal symptoms of breast cancer survivors. The study examined whether self-esteem mediated the effects of yoga on quality of life, fatigue and menopausal symptoms, utilizing validated outcome measures.

STUDY DESIGN:This is a secondary analysis of a randomized controlled trial comparing the effects of yoga with those of usual care in 40 breast cancer survivors who suffered from menopausal symptoms. All participants completed all 3 assessments (week 0, week 12, and week 24) and provided full data.

MAIN OUTCOME MEASURES:Outcomes were measured using self-rating instruments. Mediation analyses were performed using SPSS.

RESULTS:Self-esteem mediated the effect of yoga on total menopausal symptoms (B=-2.11, 95% BCI [-5.40 to -0.37]), psychological menopausal symptoms (B=-0.94, 95% BCI [-2.30 to -0.01]), and urogenital menopausal symptoms (B=-0.66, 95% BCI [-1.65 to -0.15]), quality of life (B=8.04, 95% BCI [3.15-17.03]), social well-being (B=1.80, 95% BCI [0.54-4.21]), emotional well-being (B=1.62, 95% BCI [0.70-3.34]), functional well-being (B=1.84, 95% BCI [0.59-4.13]), and fatigue (B=4.34, 95% BCI [1.28-9.55]). Self-esteem had no effect on somatovegetative menopausal symptoms (B=-0.50, 95% BCI n.s.) or on physical well-being (B=0.79, 95% BCI n.s.).

CONCLUSIONS:Findings support the assumption that self-esteem plays a vital role in the beneficial effect of yoga and that yoga can have long-term benefits for women diagnosed with breast cancer and undergoing menopausal transition.

OBJECTIVES:The purpose of this research was to investigate the effect of Urtica dioica in comparison with placebo, acupuncture and combined therapy on hot flashes and quality of life in postmenopausal women.

METHODS:In a double-blinded randomized controlled trial, patients were treated for 7 weeks then followed up 4 weeks. Seventy-two postmenopausal women who reported at least 20 hot flashes attacks per week were randomly allocated into one of the 4 groups of Urtica dioica 450 mg/day and acupuncture 11 sessions (A), acupuncture and placebo (B), sham acupuncture and Urtica dioica (C), and sham acupuncture and placebo (D). The primary outcomes were the change in hot flashes score from baseline to the end of treatment and follow up; and the change in the quality of life (MENQOL) from baseline to the end of treatment. Secondary outcomes included changes in FSH, LH, and ESTRADIOL levels from baseline to the end of treatment. The trial was conducted from October 2017 to July 2018 in Acupuncture clinic of a teaching hospital in Iran.

RESULTS:A total of 72 women 45-60 years old were enrolled, and 68 were included in the analyses. The median (IQR) hot flashes score decreased in the A group by 20.2 (31.7) and 21.1 (25.1), B group by 19 (18) and 17.3 (27), C group by 14.6 (25.4) and 20.8 (13), and D group by 1.6 (11.6) and 1 (13.3) at the end of treatment and follow up (P < 0.0001, P < 0.0001); no significant difference between A, B and C groups. The mean (SD) of MENQOL score decreased in the A group by 42.6 (21.1), B group by 40.7 (29.8), C group by 37.8 (26.8) and D group by 9.8 (14.3) at the end of treatment (P = 0.001); no significant difference between A, B and C groups.

CONCLUSIONS:Urtica dioica can decrease menopausal hot flashes and increase the quality of life of postmenopausal women better than placebo-sham control but same as acupuncture. The combination of Urtica dioica and acupuncture did not add to the effects of those therapies.