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Objective: To compare the outcomes of open versus laparoscopic hysterectomy in women at a tertiary care military hospital. Study Design: Prospective comparative study. Place and Duration of Study: Department of Gynecology, Combined Military Hospital, Lahore Pakistan, from Jul 2021 to Jun 2023. Methodology: All patients who were advised to undergo hysterectomy for any gynecological reason at our teaching unit were recruited for this study. They were divided into two groups via block randomization. Group I underwent laparoscopic hysterectomy, while Group II underwent open hysterectomy. Clinical parameters such as operative time, blood loss, and fall in hemoglobin, postoperative pain, and hospital stay were compared between the two groups. Results: Out of 618 women recruited, 64(10.4%) were premenopausal, 242(39.2%) were peri menopausal, and 312(50.5%) were postmenopausal. The mean age of the study participants was 50.14±8.48 years. Mean blood loss (p-value =0.011), mean fall in hemoglobin (p-value <0.001), mean pain score (p-value <0.001), and mean duration of hospital stay (p-value <0.001) were all statistically significantly less in women who underwent laparoscopic hysterectomy compared to those who underwent open hysterectomy. Conclusion: Laparoscopic hysterectomy was found to be the superior procedure in terms of blood loss during surgery, postoperative pain, and duration of hospital stay.

Background Postmenopausal osteoporosis (PMOP) has high morbidity and devastating complications. However, few studies explored the modifying role of different types of physical activity (PA) in the associations between the number of pregnancies as well as livebirths and the odds of PMOP. This study aimed to investigate the associations of the number of pregnancies and livebirths with PMOP odds. Methods This study used the baseline of the China Multi-Ethnic Cohort study, and a total of 27,459 postmenopausal women were recruited. Bone mineral density and quantitative ultrasound index were measured by quantitative ultrasound bone densitometer. Number of pregnancies and number of livebirths were collected by questionnaires. PA was classified into occupational, transportation, housework, and leisure PA. Logistic regression and multiple linear regression were used to analyze the associations between the number of pregnancies and livebirths and PMOP odds. The modifying effects of PA and its domain-specific types in the associations were analyzed by interaction analysis. Results A total of 1,539 (5.6%) participants had PMOP. Each additional pregnancy and each additional livebirth were associated with a 5% (OR [95% CI]: 1.05 [1.02, 1.09]) and 21% (1.21 [1.15, 1.28]) higher odds of PMOP, respectively. High levels of housework PA attenuated the adverse effect of livebirths on the PMOP odds ( P for interaction < 0.05, q  < 0.05). Associations between the number of pregnancies and livebirths and the odds of PMOP were observed among women of older age, with earlier age at menopause, later age at menarche, and longer total breastfeeding duration. Conclusions An increased number of pregnancies and livebirths was positively associated with the odds of PMOP. However, high levels of housework PA attenuated the adverse effect of livebirths on the PMOP odds, suggesting that an active lifestyle is associated with more favorable bone health status.

Background Several abdominal obesity indices including waist circumference (WC), waist–hip ratio (WHR), visceral adiposity index (VAI), lipid accumulation product (LAP), and Chinese visceral adiposity index (CVAI) were considered effective and useful predictive markers for cardiovascular disease (CVD) in general populations or diabetic populations. However, studies investigating the associations between these indices among postmenopausal women are limited. Our study aimed to investigate the associations of the five indices with incident CVD and compare the predictive performance of CVAI with other abdominal obesity indices among postmenopausal women. Methods A total of 1252 postmenopausal women without CVD at baseline were analyzed in our investigation based on a 10-year follow-up prospective cohort study. Link of each abdominal obesity index with CVD were assessed by the Cox regression analysis and the Kaplan–Meier curve. The receiver operating characteristic (ROC) curves were drawn to compare the predictive ability for CVD. Results During the median follow-up of 120.53 months, 121 participants newly developed CVD. Compared to quartile 1 of LAP and CVAI, quartile 4 had increased risk to develop CVD after fully adjusted among postmenopausal women. When WC, VAI and CVAI considered as continuous variables, significant increased hazard ratios (HRs) for developing CVD were observed. The areas under the curve (AUC) of CVAI (0.632) was greatly higher than other indices (WC: 0.580, WHR: 0.538, LAP: 0.573, VAI: 0.540 respectively). Conclusions This study suggested that the abdominal obesity indices were associated with the risk of CVD excluded WHR and highlighted that CVAI might be the most valuable abdominal obesity indicator for identifying the high risk of CVD in Chinese postmenopausal women.

Background Whether DCIS is associated with higher breast cancer-specific and all-cause mortality is unclear with few studies in older women. Therefore, we examined DCIS and breast cancer-specific, cardiovascular (CVD)-specific, and all-cause mortality among Women’s Health Initiative (WHI) Clinical Trial participants overall and by age (< 70 versus ≥ 70 years). Methods Of 68,132 WHI participants, included were 781 postmenopausal women with incident DCIS and 781 matched controls. Serial screening mammography was mandated with high adherence. DCIS cases were confirmed by central medical record review. Adjusted multivariable Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI). Kaplan Meier (KM) plots were used to assess 10-year and 20-year mortality rates. Results After 20.3 years total, and 13.2 years median post-diagnosis follow-up, compared to controls, DCIS was associated with higher breast cancer-specific mortality (HR 3.29; CI = 1.32–8.22, P  = 0.01). The absolute difference in 20-year breast cancer mortality was 1.2% without DCIS and 3.4% after DCIS, log-rank P  = 0.026. Findings were similar by age (< 70 versus ≥ 70 years) with no interaction (P interaction = 0.80). Incident DCIS was not associated with CVD-specific mortality (HR 0.77; CI-0.54-1.09, P  = 0.14) or with all-cause mortality (HR 0.96; CI = 0.80–1.16, P  = 0.68) with similar findings by age. Conclusions In postmenopausal women, incident DCIS was associated with over three-fold higher breast cancer-specific mortality, with similar findings in younger and older postmenopausal women. These finding suggest caution in using age to adjust DCIS clinical management or research strategies.

Background The prediction of bone mineral density (BMD) response to osteoporosis treatment remains challenging as current prediction models rely on complex clinical data or sequential BMD measurements. This study aims to research the association between baseline 24-hour urinary creatinine excretion (24 h Ucr) and the change of BMD after treatment with zoledronic acid (ZOL) and develop an effective model for BMD improvement prediction in older postmenopausal women with osteoporosis. Methods A total of 135 postmenopausal women (aged ≥ 60 years) with osteoporosis receiving ZOL treatment were included. Correlation analysis was performed to assess the association of baseline 24 h Ucr with BMD change after one year of ZOL treatment. The prediction model for the changes in BMD was established by multivariable binary logistic regression analysis with backward selection. Bootstrap resampling was used to internally validate the final model. Results Higher baseline 24 h Ucr was negatively correlated with lumbar BMD changes ( r  =－0.230, p  = 0.007). After adjusting for confounding factors, baseline 24 h Ucr was found to be an independent predictor of changes in lumbar BMD after ZOL treatment (odds ratio 0.694, 95% confidence interval 0.530–0.908, p  = 0.008). The new model logit (P) developed achieved a strong area under the curve (AUC) of 0.831 for discriminating treatment responders. The model was internally validated using the bootstrap re-sampling procedure that calculated small AUC optimisms of 0.018 (95% CI－0.060–0.085). Conclusion Our study identifies baseline 24 h Ucr as a promising, readily available and independent predictor for the response to ZOL therapy. This finding offers a potential tool for personalising geriatric osteoporosis management by identifying patients most likely to achieve significant BMD improvement.

Background Previous studies have yielded inconsistent findings regarding the association between age at menopause and bone health, with limited exploration of potential mediating factors, particularly in the less-developed muti-ethnic regions of China. Our objective was to analyze the association between age at menopause and bone health among postmenopausal women in southwest China, while also examining the mediating effect of body mass index (BMI) and the moderating effect of years since menopause on this association. Methods and results The analysis included a total of 15,352 naturally postmenopausal women obtained from the baseline data of the China Multi-Ethnic Cohort (CMEC) Study. Multiple linear regression was used for multivariate analysis. Mediation analysis was conducted to examine the mediating role of BMI in the association between age at menopause and bone health. A significant positive association was observed between age at menopause and bone health index (Quantitative ultrasound index, QUI). Specifically, with each year’s delay in age at menopause, there was an increase of 0.260 (95% confidence interval (CI): 0.152–0.368) in QUI. Notably, women with later menopause (menopausal age ≥ 53 years) exhibited a higher QUI ( β : 2.684, 95%CI: 1.503–3.865). Additionally, BMI partially mediated the relationship between age at menopause and QUI, accounting for 9.0% of the total effect, with an indirect effect coefficient β (95%CI) was 0.023(0.014, 0.032). Besides, it is worth mentioning that years since menopause moderated the association between age at menopause and bone health as well as the mediating effect of BMI. Conclusion Naturally postmenopausal women with a later age at menopause demonstrate enhanced bone health. Maintaining a moderately high BMI, without progressing to overweight or obesity, may provide health benefits for postmenopausal women, especially for those with a longer duration since menopause.

Background Bacterial vaginosis (BV) is the most common cause of vaginal discharge in reproductive age women; however, little is known about it after menopause. We aimed to learn more about BV in Australian postmenopausal women. Methods We conducted an online survey (July-September 2021). Participants were recruited via social media and professional networks and asked about demographic characteristics, sexual history and BV experiences. Outcomes of interest were the proportion who had heard of BV, had BV ever, or had BV after menopause. Factors associated with these outcomes were assessed using logistic regression. Results Of 906 participants, 83% were included in the analysis. Overall, 37.9% had heard of BV, 11.0% reported having a BV diagnosis ever, 6.3% reported having a BV diagnosis after menopause and 4.4% reported having a BV diagnosis only after menopause. Multivariable analysis found that among all women the odds of having a BV diagnosis after menopause were increased for those who had BV before menopause, had douched in the past 12months, or had a previous STI diagnosis. Among those in a sexual relationship, a BV diagnosis after menopause was associated with a BV diagnosis before menopause, or being in a sexual relationship of 5years or less in duration. About half who reported BV after menopause described recurrences, distress, and a detrimental effect on sexual relationships. Conclusions BV in postmenopausal women is associated with sexual activity, and impacts negatively on their lives. Research into BV should not be limited to reproductive age women.

Objective The aim of this study is to evaluate the findings of existing systematic reviews (SRs) and provide scientific evidence on the efficacy and safety of whole-body vibration (WBV) in improving bone mineral density (BMD) in postmenopausal women, to provide recommendations and guidance for future high-quality clinical research and SRs. Methods We conducted searches in six databases (SinoMed, CNKI, Cochrane Library, Embase, PubMed, Web of Science) from the inception of the databases until July 31, 2023. The language was limited to Chinese or English. The methodological quality, risk of bias, and evidence grade of outcomes were evaluated using AMSTAR-2, ROBIS, and GRADE, respectively. Additionally, the degree of overlap in randomized controlled trials (RCTs) among the SRs was calculated using corrected covered area (CCA). Furthermore, we performed quantitative synthesis or descriptive analysis of the relevant data. All relevant operations were independently conducted by two individuals. Results A total of 15 SRs were included in the analysis, out of which three were qualitative descriptions and 12 were meta-analyses. According to AMSTAR-2, only two SRs were rated as low or moderate, while the remaining 13 SRs were rated as critically low quality. The ROBIS assessment indicated that seven SRs had a low risk of bias, while 8 SRs had a high risk of bias. The overall findings suggest that WBV does not have a significant advantage in improving BMD in postmenopausal women. Furthermore, the CCA results revealed a high overlap in RCTs across five outcomes among the 15 SRs. Only five SRs reported specific adverse reactions/events experienced by participants after WBV interventions, and none of the SRs reported any severe adverse events. Conclusion The existing evidence cannot establish definitive advantages of WBV in improving BMD in postmenopausal women. Therefore, we do not recommend the use of WBV for improving BMD in postmenopausal women. However, WBV may have potential value in maintaining BMD in postmenopausal women, further research is needed to confirm these findings.

After menopause, the incidence of cardiovascular disease in women rises sharply, especially coronary artery disease (CAD), which has become a major health concern for women worldwide. Previous perspectives have held that decreased estrogen levels are the main cause of the elevated risk among postmenopausal women. In recent years, increasing evidence has suggested that follicle-stimulating hormone (FSH), whose levels surge postmenopausally, may play a pivotal role in this process. This review aims to systematically summarize current evidence from clinical and animal studies to evaluate the relationship between FSH and CAD risk in postmenopausal women, exploring the conflicting evidence and examining its potential effects in both the pathogenesis of atherosclerosis and the regulation of cardiometabolic risk factors. It has been confirmed by multiple studies that elevated FSH, by engaging follicle-stimulating hormone receptor (FSHR) in the liver and inflammatory cells, disrupts lipid metabolism and exacerbates vascular inflammation, thereby promoting the progression of CAD. Epidemiological evidence also supports this point. However, some clinical studies show contrasting evidence, indicating that FSH might exert a protective effect in certain contexts, possibly by influencing various metabolic pathways. In conclusion, there is increasing evidence suggesting that FSH levels play a role in the development of CAD in postmenopausal women, yet the current body of evidence is characterized by predominantly observational study designs and inconsistent findings. Therefore, it is particularly important for future research to further verify this association and clarify the causal relationship. By synthesizing the proposed mechanistic pathways, this review highlights implications for future research, which can explore the potential of FSH and FSHR as biomarkers and therapeutic targets for coronary atherosclerosis risk stratification, assessment, and intervention in this postmenopausal population.

Background Low back pain (LBP) in perimenopause and postmenopausal women is an important public health concern because of its high prevalence and associated social and economic burden. Dietary patterns and physical activity have attracted increasing attention as modifiable determinants of LBP, but the impact of their interaction, particularly across menopausal stages, has not been well characterized. Methods This cross-sectional analysis included 1530 adult women from the Ordos Resident Health White Paper Program. Dietary patterns were derived using principal components analysis of food frequency questionnaire data. Physical activity was assessed using the International Physical Activity Questionnair. LBP was defined as self-reported pain, ache or discomfort in the lumbosacral region (Verbal Rating Scale score 1–3). Logistic regression models were used to examine associations between dietary patterns, physical activity and LBP. Interaction between dietary patterns and physical activity was assessed overall and stratified by menopausal status. Results The prevalence of LBP was 12.6%. Three major dietary patterns were identified: a plant-based dietary pattern (PBDP), a northern pastoral dietary pattern (NPDP) and a northern traditional dietary pattern (NTDP). Only PBDP was significantly associated with LBP. Compared with women in the highest quartile of adherence to PBDP (Q4), those in the lowest quartile (Q1) had higher odds of LBP (adjusted OR = 2.879, 95% CI: 1.749–4.739). No significant association with LBP was observed for NPDP. In joint analyses, the highest odds of LBP were observed among women with higher-intensity physical activity and non-adherence to PBDP (Q1) (adjusted OR = 3.777, 95% CI: 1.991–7.166). In analyses stratified by menopausal status, the risk associated with higher-intensity physical activity and non-adherence to PBDP increased from perimenopausal to postmenopausal women, with adjusted ORs of 3.600 (95% CI: 1.029–12.592) and 5.752 (95% CI: 2.189–15.114), respectively. Conclusions In this population of midlife women, higher-intensity physical activity was associated with increased risk of LBP, and this risk rose from perimenopause to postmenopause. Adherence to PBDP attenuated the LBP risk associated with higher-intensity physical activity, with the beneficial effect becoming more pronounced after menopause. These findings suggest that menopause-specific combinations of dietary improvement and appropriate physical activity may help mitigate the burden of LBP in perimenopausal and postmenopausal women. Contributions to the literature Low back pain (LBP) is a leading cause of disability worldwide and is particularly common in midlife and older women. Most existing studies have examined diet and physical activity separately, and evi-dence on their joint effects on LBP—especially in perimenopausal and postmeno-pausal women—is scarce. The joint effects of diet and physical activity on LBP among perimenopausal and postmenopausal women in Ordos City necessitates the development of personalized and well- supervised public health policies.