title: Efficacy of yoga for vasomotor symptoms: a randomized controlled trial Effect of aerobic training on menopausal symptoms—a randomized controlled trial Yoga decreases insomnia in postmenopausal women: a randomized clinical trial A 12-week structured education and exercise program improved climacteric symptoms in middle-aged women. Are menopausal symptoms associated with bone mineral density and changes in bone mineral density in premenopausal women? HABITS (hormonal replacement therapy after breast cancer—is it safe?), a randomised comparison: trial stopped Physical activity and mental health outcomes during menopause: A randomized controlled trial Endurance exercise effect on quality of life and menopausal symptoms in Nigerian women. Effect of aerobic training on hot flushes and quality of life—a randomized controlled trial Feasibility and acceptability of restorative yoga for treatment of hot flushes: a pilot trial. Preparation for menopause: prospective evaluation of a health education intervention for mid-aged women. A clinical trial of estrogen-replacement therapy after ischemic stroke. A randomized, placebo-controlled trial on the effects of soy protein containing isoflavones on quality of life in postmenopausal women Vasomotor symptoms and quality of life in previously sedentary postmenopausal women randomised to physical activity or estrogen therapy. Applied relaxation and oral estradiol treatment of vasomotor symptoms in postmenopausal women. Effect of a yearlong, moderate-intensity exercise intervention on the occurrence and severity of menopause symptoms in postmenopausal women Efficacy of exercise for menopausal symptoms: a randomized controlled trial Dose–response effects of exercise training on the subjective sleep quality of postmenopausal women: exploratory analyses of a randomised controlled trial Aerobic exercise training in healthy postmenopausal women: effects of hormone therapy Quality of life of rural menopausal women in response to a customized exercise programme. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. National use of postmenopausal hormone therapy: annual trends and response to recent evidence A comparison of acupuncture and oral estradiol treatment of vasomotor symptoms in postmenopausal women Exercise participation, body mass index, and health-related quality of life in women of menopausal age. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial Soy isoflavones, diet and physical exercise modify serum cytokines in healthy obese postmenopausal women. A randomized, placebo-controlled trial of the effects of physical exercises and estrogen therapy on health-related quality of life in postmenopausal women Menopausal Status, Moderate-Intensity Walking, and Symptoms in Midlife Women Training or EPT in perimenopause on balance and flushes Cognitive-behavioral intervention among women with slight menopausal symptoms: a pilot study. Physical training and hormone replacement therapy reduce the decrease in bone mineral density in perimenopausal women: a pilot study A pilot study of a Hatha yoga treatment for menopausal symptoms. Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese postmenopausal women. Menopausal symptoms and symptom clustering in Chinese women. The psychosocial outcomes of total and subtotal hysterectomy: A randomized controlled trial. Effects of soy protein and resistance exercise on body composition and blood lipids in postmenopausal women. Hormone replacement therapy use and menopausal symptoms among women participating in a behavioral lifestyle intervention. Treating the climacteric symptoms in Indian women with an integrated approach to yoga therapy: a randomized control study An intensive behavioral weight loss intervention and hot flushes in women. Effect of yoga on menopausal symptoms Effect of exercise combined with phytoestrogens on quality of life in postmenopausal women Influence of exercise on mood in postmenopausal women. Do physical leisure time activities prevent fatigue? A 15 month prospective study of nurses’ aides Menopausal symptoms in Australian women. Physical activity, menopause, and quality of life: the role of affect and self-worth across time Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. Sleep quality and aerobic training among menopausal women--a randomized controlled trial. Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. An evaluation of a health education intervention for mid-aged women: five year follow-up of effects upon knowledge, impact of menopause and health. Effect of exercise training combined with phytoestrogens on adipokines and C-reactive protein in postmenopausal women: a randomized trial. Physical activity and the menopause experience: a cross-sectional study. Hot flushes during the menopause transition: a longitudinal study in Australian-born women When, why and for whom there is a relationship between physical activity and menopause symptoms. Changes in physical activity and health outcomes in a population–based cohort of mid–life Australian–born women The importance of continued exercise participation in quality of life and psychological well-being in previously inactive postmenopausal women: a pilot study Aerobic exercise as a treatment for vasomotor menopausal symptoms: randomised controlled trial protocol. The association between soy nut consumption and decreased menopausal symptoms. Habitual physical activity and menopausal symptoms: a case-control study.
abstract: Objective This study aims to determine the efficacy of yoga in alleviating vasomotor symptoms ( VMS ) frequency and bother . Methods This study was a three-by-two factorial , r and omized controlled trial . Eligible women were r and omized to yoga ( n = 107 ) , exercise ( n = 106 ) , or usual activity ( n = 142 ) , and were simultaneously r and omized to a double-blind comparison of & ohgr;-3 fatty acid ( n = 177 ) or placebo ( n = 178 ) capsules .  Yoga intervention consisted of 12 weekly 90-minute yoga classes with daily home practice . Primary outcomes were VMS frequency and bother assessed by daily diaries at baseline , 6 weeks , and 12 weeks . Secondary outcomes included insomnia symptoms ( Insomnia Severity Index ) at baseline and 12 weeks . Results Among 249 r and omized women , 237 ( 95 % ) completed 12-week assessment s. The mean baseline VMS frequency was 7.4 per day ( 95 % CI , 6.6 to 8.1 ) in the yoga group and 8.0 per day ( 95 % CI , 7.3 to 8.7 ) in the usual activity group . Intent-to-treat analyses included all participants with response data ( n = 237 ) . There was no difference between intervention groups in the change in VMS frequency from baseline to 6 and 12 weeks ( mean difference [ yoga − usual activity ] from baseline at 6 wk , −0.3 [ 95 % CI , −1.1 to 0.5 ] ; mean difference [ yoga − usual activity ] from baseline at 12 wk , −0.3 [ 95 % CI , −1.2 to 0.6 ] ; P = 0.119 across both time points ) . Results were similar for VMS bother . At week 12 , yoga was associated with an improvement in insomnia symptoms ( mean difference [ yoga − usual activity ] in the change in Insomnia Severity Index , 1.3 [ 95 % CI , −2.5 to −0.1 ] ; P = 0.007 ) . Conclusions Among healthy women , 12 weeks of yoga class plus home practice , compared with usual activity , do not improve VMS frequency or bother but reduce insomnia symptoms Objective The aim of this study was to assess whether aerobic training affects menopausal symptoms in recently postmenopausal sedentary women . Methods Symptomatic women aged 45 to 63 years ( N = 176 ; 3 - 36 months since last menstruation ) were r and omly assigned to an aerobic training or a control group . The intervention included unsupervised aerobic training for 50 minutes four times weekly for 24 weeks , whereas the control group attended health lectures twice a month . Symptoms were reported twice a day using a mobile phone . The perceived disturbance of menopausal symptoms ( night sweats , mood swings , irritability , depressive mood , headache , vaginal dryness , and urinary symptoms ) was evaluated on a scale from 1 ( low ) to 5 ( high ) . Multilevel mixed-effect ordinal regression models were based on 17,000 responses during 24 weeks . Results One hundred fifty-four women continued until the end of the study ( 88 % compliance rate ) . Baseline prevalence was as follows : night sweats , 50 % to 60 % ; irritability and depression , 20 % to 25 % ; mood swings , 25 % to 30 % ; headache and urinary problems , 15 % to 20 % ; and vaginal dryness , 10 % to 15 % . The prevalence of all symptoms except vaginal dryness decreased among intervention groups . According to multilevel mixed-effect ordinal regression analysis , night sweats and mood swings ( P < 0.001 ) and disturbance of the mood swings ( P < 0.001 ) and irritability ( P < 0.001 ) were reduced more among the women in the intervention group than in the control group . Conclusions In sedentary women , aerobic training for 6 months may decrease the typical menopausal symptoms , especially night sweats , mood swings , and irritability Objective The practice of yoga has been proven to have positive effects on reducing  insomnia . Studies have also shown its effects on reducing climacteric symptoms . To date , however , no studies that evaluate the effects of yoga on postmenopausal women with a diagnosis of insomnia in a r and omized clinical trial have been conducted . The aim of this study was to evaluate the effect of yoga practice on the physical and mental health and climacteric symptoms of postmenopausal women with a diagnosis of insomnia . Methods Postmenopausal women not undergoing hormone therapy , who were 50 to 65 years old , who had an apnea-hypopnea index less than 15 , and who had a diagnosis of insomnia were r and omly assigned to one of three groups , as follows : control , passive stretching , and yoga . Question naires were administered before and 4 months after the intervention to evaluate quality of life , anxiety and depression symptoms , climacteric symptoms , insomnia severity , daytime sleepiness , and stress . The volunteers also underwent polysomnography .  The study lasted 4 months . Results There were 44 volunteers at the end of the study . When compared with the control group , the yoga group had significantly lower posttreatment scores for climacteric symptoms and insomnia severity and higher scores for quality of life and resistance phase of stress . The reduction in insomnia severity in the yoga group was significantly higher than that in the control and passive-stretching groups . Conclusions This study showed that a specific sequence of yoga might be effective in reducing insomnia and menopausal symptoms as well as improving quality of life in postmenopausal women with insomnia In the present study , 40- to 60-year-old women with climacteric symptoms were placed on a 12-week structured education and exercise program to ascertain the effects of this program on climacteric symptoms , quality of life ( QOL ) , and attitude towards exercise .  A total of 35 women served as subjects . Twenty women were enrolled in an educational and exercise program that involved learning about menopause and participating in physical activity at least three times a week ( Group E ) . For comparison , the other 15 women did not participate in this program and were instructed to refrain from exercising during study period ( Group C ) . The effects of the 12-week interventional program on climacteric symptoms , QOL , and attitude towards exercise were thereby investigated . The program demonstrated significant effects on climacteric symptoms in terms of Kupperman index and psychosomatic symptoms , especially paresthesia and nervousness . In other words , climacteric symptoms improved significantly in Group E. Furthermore , scores for QOL and attitude towards exercise improved in Group E after the 12-week program ; however , these trends did not reach statistical significance . Hence , the 12-week structured education and exercise program was shown to be effective in alleviating climacteric symptoms BACKGROUND The relationship between menopausal symptoms and bone mineral density ( BMD ) was examined in 290 premenopausal women , ages 44 - 50 years , participating in a r and omized clinical trial of a dietary and exercise intervention : The Women 's Healthy Lifestyle Project . METHODS Information on hot flashes ( presence , absence ) , menstrual cycles ( irregular , regular ) and menstrual flow per period ( variable , same ) over the past 6 months was collected at entry . Participants reporting at least one menopausal symptom were classified as symptomatic and compared to those having no symptoms . Bone mineral density ( BMD ) at the lumbar spine ( L1-L4 ) , total hip and whole-body were made at baseline and at 30 months using a dual-energy X-ray absorptiometer ( Hologic QDR 2000 densitometer ) . RESULTS Baseline BMD at the spine , hip and whole-body were significantly reduced in women reporting menopausal symptoms compared to asymptomatic women , after adjustment for age , weight and intervention status ( all p < 0.05 ) . Women with irregular menstrual cycles had greater annualized rates of bone loss at the spine and hip than asymptomatic women ( spine , -0.77 (1.6)% per year vs. -0.19 (1.0)% per year , p = 0.0043 ; hip , -0.37 (1.1)% per year vs. -0.04 (1.0)% per year , p = 0.061 ) , after adjustments for age , percent change in weight , intervention status , and baseline BMD . Similar findings were not found for whole-body BMD . CONCLUSIONS These results suggest that menopausal symptoms are useful for the effective identification of premenopausal women at higher risk of low BMD and perhaps , of osteoporosis In the 1990s , two r and omised clinical trials started in Sc and inavia addressing whether hormone replacement therapy ( HRT ) is safe for women with previous breast cancer . We report the findings of the safety analysis in HABITS ( hormonal replacement therapy after breast cancer -- is it safe ? ) , an open r and omised clinical trial with allocation to either HRT or best treatment without hormones . The main endpoint was any new breast cancer event . All analyses were done according to intention-to-treat . Until September , 2003 , 434 women were r and omised ; 345 had at least one follow-up report . After a median follow-up of 2.1 years , 26 women in the HRT group and seven in the non-HRT group had a new breast-cancer event . All women with an event in the HRT group and two of those in the non-HRT group were exposed to HRT and most women had their event when on treatment . We decided that these findings indicated an unacceptable risk for women exposed to HRT in the HABITS trial , and the trial was terminated on Dec 17 , 2003 Background : Many women experience detriments in mental health during the menopausal transition . Physical activity may attenuate these adverse outcomes but few studies investigating such effects exist . Purpose : This study examined the effects of a 4-month r and omized controlled exercise trial on mental health outcomes in 164 previously low-active middle-aged women ( M age=49.9 ; SD=3.6 ) . Methods and Results : Participants completed body composition and fitness assessment and a battery of psychological measures at the beginning and end of a 4-month r and omized controlled exercise trial with three arms : walking , yoga , control . The results indicated that walking and yoga were effective in enhancing positive affect and menopause-related QOL and reducing negative affect . Women who experienced decreases in menopausal symptoms across the trial also experienced improvements in all positive mental health and QOL outcomes and reductions in negative mental health outcomes . Whether menopausal symptoms increased or decreased across the trial appeared to be determined in part by whether there were increases or decreases in cardiorespiratory fitness . Conclusions : Physical activity appears to enhance mood and menopause-related QOL during menopause , however , other aspects of mental health may be affected only as a result of reduction in menopausal symptoms . Increasing cardiorespiratory fitness could be one way to reduce menopausal symptoms INTRODUCTION Women in the menopausal stage of life usually have climacteric symptoms of  hot flashes ,  back pain , sleeplessness , night sweats and increased risk of cardiovascular disorders . Although physical exercises have been documented to favourably alleviate some of these problems , there 's a paucity of knowledge of their effects on menopausal women in Nigeria . OBJECTIVES This study investigated the effect of a twelve-week Endurance Exercise Programme ( EEP ) on quality of life(QOL ) and menopausal symptoms in these women . METHODS Participants were purposively recruited and assigned into perimenopausal and postmenopausal groups based on history of thier last menstrual period and from each of these groups r and omized into : perimenopausal exercise group ( PEMEG ) , postmenopausal exercise group ( POMEG ) , perimenopausal control group ( PEMCG ) postmenopausal control group ( POMCG ) .  Quality of life ( QOL ) , Menopausal symptoms - Back Pain ( BP ) and hot flashes ( HF ) among other variables , were evaluated at baseline and 4 weekly intervals . EEP consisted of a 10-station circuit of muscular and cardiovascular endurance , flexibility , coordination , abdominal and pelvic floor muscle exercises . RESULTS One hundred and seventy five menopausal women , mean age 52.3 + /- 4.1 years . Significant changes occurred between baseline and end of 12th week mean values of PEMEG for QOL : 565.9 + /- 108.8 vs 725.0 + /- 42.9 and BP 4.42 + /- 1.7 vs 1.00 + /- 0.0 . ( p= 0.000 ) . Also , in POMEG : QOL 558.3 + /- 127.7 vs 736.5 + /- 44.8 ; and BP 5.37 + /- 1.48 vs 1.88 + /- 1.18 ( p=0.000 ) . Significant changes in QOL and BP did not occur in the control groups . CONCLUSION Routine participation in endurance exercise programme is recommended for menopausal women for improved QOL Abstract Background and objective . To estimate whether aerobic training has an effect on frequency of hot flushes or quality of life . Design . A r and omized controlled trial . Participants and setting . Symptomatic , sedentary women ( n = 176 ) , 43–63 years , no current use of hormone therapy . Intervention . Unsupervised aerobic training for 50 minutes four times per week during 6 months . Outcomes . Hot flushes as measured with Women 's Health Question naire ( WHQ ) and Health-Related Quality of Life ( HRQoL , SF-36 ) , daily reported hot flushes on phone-based diary , cardiorespiratory fitness ( CRF ) , and body composition . Results . Intervention group had larger decrease in the frequency of night-time hot flushes based on phone diary ( P for month × group = 0.012 ) , but not on WHQ scale . Intervention group had less depressed mood ( P = 0.01 ) than control women according to change in WHQ score . Changes in WHQ score in depressed mood ( P = 0.03 ) and menstrual symptoms ( P = 0.01 ) in the intervention group were significantly dependent on frequency of training sessions . HRQoL was improved among the intervention group women in physical functioning ( P = 0.049 ) and physical role limitation ( P = 0.017 ) . CRF improved ( P = 0.008 ) , and lean muscle mass increased ( P = 0.046 ) significantly in the intervention group as compared to controls . Conclusions . Aerobic training may decrease the frequency of hot flushes and improve quality of life among slightly overweight women OBJECTIVE To determine the feasibility and acceptability of a restorative yoga intervention for the treatment of hot flushes in postmenopausal women . METHODS A pilot trial in 14 postmenopausal women experiencing > or = 4 moderate to severe hot flushes per day or > or = 30 moderate to severe hot flushes per week . The intervention consisted of eight restorative yoga poses taught in a 3-h introductory session and 8 weekly 90-min sessions .  Feasibility was measured by recruitment rates , subject retention and adherence . Acceptability was assessed by subject interview and question naires . Efficacy measures included change in frequency and severity of hot flushes as recorded on a 7-day diary . RESULTS Recruitment was accomplished as planned . The majority of study subjects ( 93 % ) completed the trial . Of those who completed the trial , 92 % attended seven or more of the eight yoga sessions . The majority of the subjects were satisfied with the study and 75 % continued to practice yoga 3 months after the study . Mean number of hot flushes per week decreased by 30.8 % ( 95 % CI 15.6 - 45.9 % ) and mean hot flush score decreased 34.2 % ( 95 % CI 16.0 - 52.5 % ) from baseline to week 8 . No adverse events were observed . CONCLUSIONS This pilot trial demonstrates that it is feasible to teach restorative yoga to middle-aged women without prior yoga experience . The high rates of subject retention and satisfaction suggest that yoga is an acceptable intervention in this population . Our results indicate that a larger , r and omized controlled trial to explore the efficacy of restorative yoga for treatment of menopausal symptoms would be safe and feasible Many women approach menopause with uncertainty about what will happen and how to deal with changes that occur . The current study aim ed to evaluate the short-term outcome of a health education intervention devised to prepare 45-year old women in general practice s. One hundred and seventy-eight 45-year old women registered at five general practice s in south London were targeted for the research ; 106 of the women responded and 86 of these women formed a usable pre-menopausal sample which was r and omly allocated to the preparation intervention and control conditions . Preparation involved two health education sessions carried out in small groups and covering information and discussion of the normal menopause transition in the context of mid-life . The women completed pre- and post-intervention ( 3 and 15 months ) question naires which assessed knowledge and beliefs about menopause and a number of health-related behaviours . Knowledge improved significantly at the follow-up assessment s for the preparation group but not for the control group . On the whole , the prepared women 's beliefs about menopause became less negative following the intervention , although there were also some changes reported by the control group . The proportion of smokers decreased from 25 to 20 % for the prepared women although this did not reach statistical significance . There was no change in the prevalence of regular exercise . There was also a decrease in the intention to take hormonal treatments following the intervention . Suggestions for further development of health promotion services for mid-aged women and more holistic health care practice s are proposed BACKGROUND Observational studies have suggested that estrogen-replacement therapy may reduce a woman 's risk of stroke and death . METHODS We conducted a r and omized , double-blind , placebo-controlled trial of estrogen therapy ( 1 mg of estradiol-17beta per day ) in 664 postmenopausal women ( mean age , 71 years ) who had recently had an ischemic stroke or transient ischemic attack . Women were recruited from 21 hospitals in the United States and were followed for the occurrence of stroke or death . RESULTS During a mean follow-up period of 2.8 years , there were 99 strokes or deaths among the women in the estradiol group , and 93 among those in the placebo group ( relative risk in the estradiol group , 1.1 ; 95 percent confidence interval , 0.8 to 1.4 ) . Estrogen therapy did not reduce the risk of death alone ( relative risk , 1.2 ; 95 percent confidence interval , 0.8 to 1.8 ) or the risk of nonfatal stroke ( relative risk , 1.0 ; 95 percent confidence interval , 0.7 to 1.4 ) . The women who were r and omly assigned to receive estrogen therapy had a higher risk of fatal stroke ( relative risk , 2.9 ; 95 percent confidence interval , 0.9 to 9.0 ) , and their nonfatal strokes were associated with slightly worse neurologic and functional deficits . CONCLUSIONS Estradiol does not reduce mortality orthe recurrence of stroke in postmenopausal women with cerebrovascular disease . This therapy should not be prescribed for the secondary prevention of cerebrovascular disease Objective : Postmenopausal estrogen decline is implicated in several age-related physical and psychological changes in women , including decreases in perceived quality of life ( QoL ) . A number of trials with hormone therapy showed beneficial effects of the intervention on parameters of quality of life . However , because of known or suspected serious side-effects of conventional hormone therapy there is a need for alternatives . Design : We conducted a double-blind r and omized placebo-controlled trial with soy protein , containing 52 mg genistein , 41 mg daidzein , and 6 mg glycitein ( aglycone weights ) , or milk protein ( placebo ) daily for 1 year . For this trial , we recruited 202 postmenopausal women aged 60 to 75 years . Results : At baseline and at final visit , participants filled in the Short Form of 36 questions ( SF-36 ) , the Question naire on Life Satisfaction Modules ( QLSM ) , and the Geriatric Depression Scale ( GDS ) . For the placebo group scores on all dimensions of the SF-36 and the QLSM decreased during the intervention year , except for the dimension " role limitations caused by physical problems . " The soy group showed increases on two dimensions of the SF-36 ( " social functioning " and " role limitations caused by physical problems " ) and on one dimension of the QLSM . There were however no statistically significant differences in changes of scores between the two intervention groups . For the GDS similarly , no significant differences were found between the groups . Conclusions : In conclusion , the findings in this r and omized trial do not support the presence of a marked effect of soy protein substitution on quality of life ( health status , life satisfaction , and depression ) in elderly postmenopausal women OBJECTIVE To assess if regular physical exercise or oral oestradiol therapy decreased vasomotor symptoms and increased quality of life in previously sedentary postmenopausal women . SETTING A prospect i ve , r and omised trial at a University Hospital . METHODS 75 postmenopausal , sedentary women with vasomotor symptoms were r and omised to : exercise three-times weekly over 12 weeks ( 15 women ) , oral oestradiol therapy for 12 weeks ( 15 women ) and 45 women to three other treatment arms . Results from the exercise and oestradiol groups are presented here . The effects on vasomotor symptoms and wellbeing were assessed with logbooks and vali date d question naires . RESULTS Ten women fulfilled 12 weeks of exercise . The number of flushes was rather unchanged in five women and decreased to 28 % ( range 18 - 42 % ) of baseline in the other five women . Five of the ten women continued to exercise another 24 weeks , thus in all 36 weeks . The mean number of flushes decreased by about 50 % in these five women ( from 6.2/24 to 3.2 flushes/24 h at 36 weeks ) . In the same group a score made as the product of reduction in number and severity of flushes decreased by 92 % at 12 weeks , 75 % at 24 weeks and 72 % at 36 weeks compared with baseline . In the estrogen group flushes decreased from 8.4 to 0.8 ( P<0.001 ) after 12 weeks of therapy and remained at this level after 36 weeks . Well-being according to different measurements improved significantly in both groups , albeit more markedly in the estrogen group . CONCLUSIONS Apart from many other health benefits regular physical exercise may decrease vasomotor symptoms and increase quality of life in postmenopausal women , but this has to be further evaluated scientifically . Exercise should be introduced gradually to ensure compliance OBJECTIVE The aim was to evaluate and compare the effects of applied relaxation and oral estradiol treatment on hot flushes , mood and psychological wellbeing in postmenopausal women . PATIENTS AND METHODS In a prospect i ve study , 30 postmenopausal women with vasomotor symptoms were r and omized to applied relaxation or oral estradiol treatment during 12 weeks with 6 months follow-up . Number and severity of flushes were registered daily and Kupperman 's Index and a general estimate of climacteric symptoms , Mood Scale and Symptom Check List were completed at baseline , 4 , 8 and 12 weeks of treatment , and 3 and 6 months after therapy . RESULTS After 12 weeks of treatment , the number of flushes/24 h decreased significantly over time in both treatment groups . In the group receiving applied relaxation , the mean number of flushes/24 h decreased from 6.0 ( 95 % CI 4.5 - 7.6 ) to 3.0 ( 95 % CI 2.1 - 3.9 ) after 12 weeks of treatment . The mean number of flushes/24 h was 1.7 ( 95 % CI 0.7 - 2.5 ) at 6 months follow-up ; i.e. a 72 % decrease . In the estrogen group , the mean number of flushes/24h decreased from 8.4 to 0.8 ; i.e a 90 % decrease in the number of flushes after 12 weeks of treatment . The significant change in flushes reached after 12 weeks of treatment and remained to 6 months after end of treatment in both groups . Estrogen therapy reduced flushes significantly faster than applied relaxation .  General climacteric symptoms according to the Visual Analogue Scale and the Kupperman 's Index decreased significantly over time in both groups . General mood ( Mood Scale ) increased significantly in the estrogen group , but not in the group receiving applied relaxation .  Psychological wellbeing according to Symptom Checklist , increased significantly from baseline to 12 weeks in both groups . CONCLUSIONS We suggest that applied relaxation may be used as an alternative treatment of vasomotor symptoms for postmenopausal women but should be further evaluated Objective : To evaluate the effect of moderate-intensity exercise on the occurrence and severity of  menopause symptoms . Design : A yearlong , r and omized , clinical trial , conducted in Seattle , WA , with 173 overweight , postmenopausal women not taking hormone therapy in the previous 6 months . The intervention was a moderate-intensity exercise intervention ( n = 87 ) versus stretching control group ( n = 86 ) . Using logistic regression , odds ratios comparing exercise with controls were calculated at 3 , 6 , 9 , and 12 months for menopause symptoms and their severity . Results : There was a significant increase in hot flash severity and decreased risk of memory problems in exercisers versus controls over 12 months , although the numbers affected were small . No other significant changes in symptoms were observed . Conclusions : Exercise does not seem to decrease the risk of having menopause symptoms in overweight , postmenopausal women not taking hormone therapy and may increase the severity of some symptoms in a small number of women Objective This study aims to determine the efficacy of exercise training for alleviating vasomotor and other menopausal symptoms . Methods Late perimenopausal and postmenopausal sedentary women with frequent vasomotor symptoms ( VMS ) participated in a r and omized controlled trial conducted in three sites : 106 women r and omized to exercise and 142 women r and omized to usual activity . The exercise intervention consisted of individual facility-based aerobic exercise training three times per week for 12 weeks . VMS frequency and bother were recorded on daily diaries at baseline and on weeks 6 and 12 . Intent-to-treat analyses compared between-group differences in changes in VMS frequency and bother , sleep symptoms ( Insomnia Severity Index and Pittsburgh Sleep Quality Index ) , and mood ( Patient Health Question naire-8 and Generalized Anxiety Disorder-7 question naire ) . Results At the end of week 12 , changes in VMS frequency in the exercise group ( mean change , −2.4 VMS/d ; 95 % CI , −3.0 to −1.7 ) and VMS bother ( mean change on a four-point scale , −0.5 ; 95 % CI , −0.6 to −0.4 ) were not significantly different from those in the control group ( −2.6 VMS/d ; 95 % CI , −3.2 to −2.0 ; P = 0.43 ; −0.5 points ; 95 % CI , −0.6 to −0.4 ; P = 0.75 ) . The exercise group reported greater improvement in insomnia symptoms ( P = 0.03 ) , subjective sleep quality ( P = 0.01 ) , and depressive symptoms ( P = 0.04 ) , but differences were small and not statistically significant when P values were adjusted for multiple comparisons . Results were similar when considering treatment-adherent women only . Conclusions These findings provide strong evidence that 12 weeks of moderate-intensity aerobic exercise do not alleviate VMS but may result in small improvements in sleep quality , insomnia , and depression in midlife sedentary women Objective To investigate whether a dose – response relationship existed between exercise and subjective sleep quality in postmenopausal women . This objective represents a post hoc assessment that was not previously considered . Design Parallel-group r and omised controlled trial . Setting Clinical exercise physiology laboratory in Dallas , Texas . Participants 437 sedentary overweight/obese postmenopausal women . Intervention Participants were r and omised to one of four treatments , each of 6 months of duration : a non-exercise control treatment ( n=92 ) or one of three dosages of moderate-intensity exercise ( 50 % of VO2peak ) , design ed to meet 50 % ( n=151 ) , 100 % ( n=99 ) or 150 % ( n=95 ) of the National Institutes of Health Consensus Development Panel physical activity recommendations . Exercise dosages were structured to elicit energy expenditures of 4 , 8 or 12 kilocalories per kilogram of body weight per week ( KKW ) , respectively . Analyses were intent to treat . Primary outcome measures Continuous scores and odds of having significant sleep disturbance , as assessed by the Sleep Problems Index from the 6-item Medical Outcomes Study Sleep Scale . Outcome assessors were blinded to participant r and omisation assignment . Results Change in the Medical Outcomes Study Sleep Problems Index score at 6 months significantly differed by treatment group ( control : −2.09 ( 95 % CI −4.58 to 0.40 ) , 4 KKW : −3.93 ( −5.87 to −1.99 ) , 8 KKW : −4.06 ( −6.45 to −1.67 ) , 12 KKW : −6.22 ( −8.68 to −3.77 ) ; p=0.04 ) , with a significant dose – response trend observed ( p=0.02 ) . Exercise training participants had lower odds of having significant sleep disturbance at postintervention compared with control ( 4 KKW : OR 0.37 ( 95 % CI 0.19 to 0.73 ) , 8 KKW : 0.36 ( 0.17 to 0.77 ) , 12 KKW : 0.34 ( 0.16 to 0.72 ) ) . The magnitude of weight loss did not differ between treatment conditions . Improvements in sleep quality were not related to changes in body weight , resting parasympathetic control or cardiorespiratory fitness . Conclusion Exercise training induced significant improvement in subjective sleep quality  in postmenopausal women , with even a low dose of exercise result ing in greatly reduced odds of having significant sleep disturbance . Trial registration number clinical trials.gov identifier : NCT00011193 Objective : We investigated the influence of hormone therapy ( HT ) on submaximal central and peripheral function in healthy postmenopausal women after 12 weeks of endurance training . Methods : A r and omized , double-blind , placebo-controlled study in a research and clinical facility was conducted . All participants ( N = 23 ) underwent 12 weeks of aerobic exercise training ( walking 5 d/wk at 70%-80 % peak heart rate [ HR ] ) . Eleven participants received HT ; 12 received placebo . HT consisted of daily 17&bgr;-estradiol ( 1 mg ) with cyclic micronized progesterone ( 200 mg ) or placebo for 10 days per month . Participants were tested before and after exercise training . Primary outcome measures were submaximal stroke volume , cardiac output , and total peripheral resistance measured during cycling at 30W , 45W , and 60W . Secondary outcome measures were ventilatory threshold , peak oxygen uptake ( VO2 peak ) , and resting and peak-ischemic calf blood flow . Results : At baseline , HT and placebo groups were similar ( P > 0.05 ) in age ( mean ± SEM , 57 ± 1 y ) , height ( 162 ± 2 cm ) , weight ( 72 ± 4 kg ) , VO2 peak ( 21.5 ± 1.4 mL · kg−1 · min−1 ) , and all cardiovascular measures . Posttraining oxygen consumption and HR decreased ( P < 0.05 ) within groups during each submaximal exercise workload . Stroke volume , cardiac output , and total peripheral resistance remained unaltered ( P > 0.05 ) . VO2 peak and oxygen consumption at the ventilatory threshold increased ( P < 0.05 ) within groups . Resting and postischemic blood flow were unaltered . HT did not influence any of the cardiovascular responses . Conclusions : These findings suggest that in healthy postmenopausal women , 12 weeks of aerobic training is effective in eliciting favorable cardiovascular adaptations , regardless of the presence of short-term HT AIM This paper reports a study examining the effects of physical exercise on the quality of life of menopausal women . BACKGROUND People who perform no type of physical activity have poorer physical and mental health . Despite the well-documented benefits of exercise , ageing women remain largely sedentary , and interventions design ed to help them to maintain exercise programmes may prove particularly valuable . Measures should focus on increasing women 's confidence so that they can overcome barriers to exercise . Conflicting results have been reported in intervention studies to promote exercise in postmenopausal women . METHODS Forty-eight menopausal women aged 55 - 72 years were recruited at a primary care centre as voluntary participants in a quasi-experimental study . They were r and omly assigned to one of two groups : control ( n = 24 ) and experimental ( n = 24 ) . The experimental group participated in a 12-month programme of cardiorespiratory , stretching , muscle-strengthening and relaxation exercises carried out during two fully supervised exercise sessions per week ( total of 3 hours weekly ) . Health-related quality of life was assessed by using the Quality of Life Profile for Chronically Ill Patients , a generic question naire widely used in epidemiological and clinical studies to measure well-being and function , incorporating as an optional module the Kupperman Index of Menopausal Symptomatology . RESULTS There was a statistically significant improvement in the health-related quality of life of the experimental group , whereas the health-related quality of life of the control group significantly worsened . Menopausal symptoms also significantly improved in the experimental group and significantly worsened in the control group over the 12-month study period . CONCLUSIONS A customized exercise programme is valuable for improving the health-related quality of life of menopausal women CONTEXT The timing of initiation of hormone therapy may influence its effect on  cardiovascular disease .  OBJECTIVE To explore whether the effects of hormone therapy on risk of cardiovascular disease vary by age or years since menopause began . DESIGN , SETTING , AND PARTICIPANTS Secondary analysis of the Women 's Health Initiative ( WHI ) r and omized controlled trials of hormone therapy in which 10,739 postmenopausal women who had undergone a hysterectomy were r and omized to conjugated equine estrogens ( CEE ) or placebo and  16,608 postmenopausal women who had not had a hysterectomy  were r and omized to CEE plus medroxyprogesterone acetate ( CEE + MPA ) or placebo .  Women aged 50 to 79 years were recruited to the study from 40 US clinical centers between September 1993 and October 1998 . MAIN OUTCOME MEASURES Statistical test for trend of the effect of hormone therapy on coronary heart disease ( CHD ) and stroke across categories of age and years since menopause in the combined trials . RESULTS In the combined trials , there were 396 cases of CHD and 327 cases of stroke in the hormone therapy group vs 370 [ corrected ] cases of CHD and 239 cases of stroke in the placebo group . For women with less than 10 years since menopause began , the hazard ratio ( HR ) for CHD was 0.76 ( 95 % confidence interval [ CI ] , 0.50 - 1.16 ) ; 10 to 19 years , 1.10 ( 95 % CI , 0.84 - 1.45 ) ; and 20 or more years , 1.28 ( 95 % CI , 1.03 - 1.58 ) ( P for trend = .02 ) . The estimated absolute excess risk for CHD for women within 10 years of menopause was -6 per 10,000 person-years ; for women 10 to 19 years since menopause began , 4 per 10,000 person-years ; and for women 20 or more years from menopause onset , 17 per 10,000 person-years . For the age group of 50 to 59 years , the HR for CHD was 0.93 ( 95 % CI , 0.65 - 1.33 ) and the absolute excess risk was -2 per 10,000 person-years ; 60 to 69 years , 0.98 ( 95 % CI , 0.79 - 1.21 ) and -1 per 10,000 person-years ; and 70 to 79 years , 1.26 ( 95 % CI , 1.00 - 1.59 ) and 19 per 10,000 person-years ( P for trend = .16 ) . Hormone therapy increased the risk of stroke ( HR , 1.32 ; 95 % CI , 1.12 - 1.56 ) . Risk did not vary significantly by age or time since menopause . There was a nonsignificant tendency for the effects of hormone therapy on total mortality to be more favorable in younger than older women ( HR of 0.70 for 50 - 59 years ; 1.05 for 60 - 69 years , and 1.14 for 70 - 79 years ; P for trend = .06 ) . CONCLUSIONS Women who initiated hormone therapy closer to menopause tended to have reduced CHD risk compared with the increase in CHD risk among women more distant from menopause , but this trend test did not meet our criterion for statistical significance . A similar nonsignificant trend was observed for total mortality but the risk of stroke was elevated regardless of years since menopause . These data should be considered in regard to the short-term treatment of menopausal symptoms . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00000611 CONTEXT  Postmenopausal hormone therapy use increased dramatically during the past 2 decades because of a prevailing belief in its health benefits . Recent evidence from r and omized trials published in July 2002 demonstrated adverse cardiovascular disease events and other risks with hormone therapy in the form of oral estrogen combined with progestin . OBJECTIVE To describe patterns of hormone therapy use from 1995 until July 2003 , including the impact of recent evidence . DESIGN , SETTING , AND POPULATION Two data bases were used to describe national trends in  hormone therapy use from January 1995 to July 2003 . The National Prescription Audit data base provided data on the number of hormone therapy prescriptions filled by retail pharmacies and the National Disease and Therapeutic Index data base provided data on patient visits to office-based physicians during which hormone therapy was prescribed . MAIN OUTCOME MEASURES Annual number of hormone therapy prescriptions and characteristics of visits to physicians during which hormone therapy was prescribed . RESULTS Annual hormone therapy prescriptions increased from 58 million in 1995 to 90 million in 1999 , representing approximately 15 million women per year , then remained stable through June 2002 . Adoption of new oral estrogen/progestin combinations , primarily Prempro , accounted for most of this growth . Obstetrician/gynecologists provided more than 70 % of hormone therapy prescriptions , and more than one third of patients were older than 60 years . Following the publication of trial results in July 2002 ,  hormone therapy prescriptions declined in successive months . Relative to January-June 2002 , prescriptions from January-June 2003 declined by 66 % for Prempro and 33 % for Premarin . Small increases were observed in vaginal formulations and in new prescriptions for low-dose Premarin . If prescription rates observed through July 2003 remain stable , a decline to 57 million prescriptions for 2003 , similar to the rate in 1995 , is projected . CONCLUSIONS Clinical practice responded rapidly to recent evidence of harms associated with hormone therapy . Since July 2002 , many patients have discontinued hormone therapy or are tapering to lower doses Objective To compare the effects of electro-acupuncture with oral estradiol and superficial needle insertion on hot flushes in postmenopausal women . Material and methods Forty-five postmenopausal women with vasomotor symptoms were r and omized to electro-acupuncture , superficial needle insertion or oral estradiol treatment during 12 weeks , with 6 months ' follow-up . The number and severity of flushes were registered daily and the Kupperman index and a general estimate of climacteric symptoms were completed before , during and after therapy . Results In the electro-acupuncture group , the mean number of flushes/24 h decreased from 7.3 to 3.5 ( ANOVA , p < 0.001 ) . Eleven of the 15 women had at least a 50 % decrease in number of flushes ( with a mean decrease of 82 % ) . Superficial needle insertion decreased the number of flushes/24 h from 8.1 to 3.8 ( p < 0.001 ) . In seven out of 13 women , the number of flushes decreased by at least 50 % ( mean decrease 83 % ) . In the estrogen group , the number of flushes decreased from 8.4 to 0.8 ( p < 0.001 ) . The decrease in number of flushes persisted during the 24-week follow-up period in all treatment groups . The Kupperman index and the general climacteric symptom score decreased , and remained unchanged 24 weeks after treatment in all groups ( p < 0.001 ) . Electro-acupuncture decreased the number of flushes/24 h significantly over time , but not to the same extent as the estrogen treatment . No significant difference in effect was found between electro-acupuncture and the superficial needle insertion . Conclusion We suggest that acupuncture is a viable alternative treatment of vasomotor symptoms in postmenopausal women and can not recommend superficial needle insertion as an inactive control treatment BACKGROUND Menopausal symptoms can affect women 's health and wellbeing . It is important to develop interventions to alleviate symptoms , especially given recent evidence result ing in many women no longer choosing to take hormone replacement therapy . Exercise may prove useful in alleviating symptoms , although evidence on its effectiveness has been conflicting . AIM To examine the association between exercise participation , body mass index ( BMI ) , and health-related quality of life in women of menopausal-age . DESIGN OF STUDY Survey of women of menopausal age . SETTING West Midl and s , Engl and . METHOD Women aged 46 - 55 years ( n = 2399 ) registered with six general practice s in the West Midl and s were sent a question naire containing items relating to demographics , lifestyle factors , weight , height , exercise participation , menopausal bleeding patterns , and health-related quality of life ( including vasomotor symptoms ) . RESULTS One thous and two hundred and six ( 50.3 % ) women replied . Women who were regularly active reported better health-related quality of life scores than women who were not regularly active ( P<0.01 for all significant subscales ) . No difference in vasomotor symptoms was recorded for exercise status . Women who were obese reported significantly higher vasomotor symptom scores than women of normal weight ( P<0.01 ) . Women who were obese reported significantly higher somatic symptoms ( P<0.001 ) and attractiveness concern scores ( P<0.001 ) than women of normal weight or those who were overweight . CONCLUSION The data suggest a positive association between somatic and psychological dimensions of health-related quality of life and participation in regular exercise .  Women with BMI scores in the normal range reported lower vasomotor symptom scores and better health-related quality of life scores than heavier women . Further evidence from high- quality r and omised controlled trials is required to assess whether exercise interventions are effective for management of menopausal symptoms CONTEXT Despite decades of accumulated observational evidence , the balance of risks and benefits for hormone use in healthy postmenopausal women remains uncertain . OBJECTIVE To assess the major health benefits and risks of the most commonly used combined hormone preparation in the United States . DESIGN Estrogen plus progestin component of the Women 's Health Initiative , a r and omized controlled primary prevention trial ( planned duration , 8.5 years ) in which 16608 postmenopausal women aged 50 - 79 years with an intact uterus at baseline were recruited by 40 US clinical centers in 1993 - 1998 . INTERVENTIONS Participants received conjugated equine estrogens , 0.625 mg/d , plus medroxyprogesterone acetate , 2.5 mg/d , in 1 tablet ( n = 8506 ) or placebo ( n = 8102 ) . MAIN OUTCOMES MEASURES The primary outcome was coronary heart disease ( CHD ) ( nonfatal myocardial infa rct ion and CHD death ) , with invasive breast cancer as the primary adverse outcome . A global index summarizing the balance of risks and benefits included the 2 primary outcomes plus stroke , pulmonary embolism ( PE ) , endometrial cancer , colorectal cancer , hip fracture , and death due to other causes . RESULTS On May 31 , 2002 , after a mean of 5.2 years of follow-up , the data and safety monitoring board recommended stopping the trial of estrogen plus progestin vs placebo because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits . This report includes data on the major clinical outcomes through April 30 , 2002 . Estimated hazard ratios ( HRs ) ( nominal 95 % confidence intervals [ CIs ] ) were as follows : CHD , 1.29 ( 1.02 - 1.63 ) with 286 cases ; breast cancer , 1.26 ( 1.00 - 1.59 ) with 290 cases ; stroke , 1.41 ( 1.07 - 1.85 ) with 212 cases ; PE , 2.13 ( 1.39 - 3.25 ) with 101 cases ; colorectal cancer , 0.63 ( 0.43 - 0.92 ) with 112 cases ; endometrial cancer , 0.83 ( 0.47 - 1.47 ) with 47 cases ; hip fracture , 0.66 ( 0.45 - 0.98 ) with 106 cases ; and death due to other causes , 0.92 ( 0.74 - 1.14 ) with 331 cases . Corresponding HRs ( nominal 95 % CIs ) for composite outcomes were 1.22 ( 1.09 - 1.36 ) for total cardiovascular disease ( arterial and venous disease ) , 1.03 ( 0.90 - 1.17 ) for total cancer , 0.76 ( 0.69 - 0.85 ) for combined fractures , 0.98 ( 0.82 - 1.18 ) for total mortality , and 1.15 ( 1.03 - 1.28 ) for the global index . Absolute excess risks per 10 000 person-years attributable to estrogen plus progestin were 7 more CHD events , 8 more strokes , 8 more PEs , and 8 more invasive breast cancers , while absolute risk reductions per 10 000 person-years were 6 fewer colorectal cancers and 5 fewer hip fractures . The absolute excess risk of events included in the global index was 19 per 10 000 person-years . CONCLUSIONS Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2-year follow-up among healthy postmenopausal US women .  All-cause mortality was not affected during the trial . The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases , and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD OBJECTIVES Evaluate the effect of diet , physical exercise , and a daily oral intake of a soy isoflavones extract ( Fisiogen ( ® ) ) contained 200 mg of Glycine max , which corresponded to 80 mg of isoflavone ( 60.8 mg of genistein , 16 mg of daidzein and 3.2 mg of glicitein ) on leptin and other adipokines plasma levels in healthy obese postmenopausal women . METHODS A multicentric r and omized longitudinal prospect i ve cohort study was conducted in a sample of 87 healthy obese postmenopausal women . Patients were r and omly assigned to a 1200 kcal diet and exercise group ( control group ) or a group of 1200 kcal diet , exercise , and daily oral intake of daily oral intake of a soy isoflavones extract ( Fisiogen ( ® ) ) contained 200 mg of Glycine max , which corresponded to 80 mg of isoflavone ( 60.8 mg of genistein , 16 mg of daidzein and 3.2 mg of glicitein ) ( soy isoflavones group ) along 6 months . Main outcome measures were : anthropometric measures , body composition , leptin , adiponectin , TNF-alpha , homocysteine , C-reactive protein , glucose , insulin , lipid profile and oestradiol serum levels , Kupperman index and Cervantes Scale . RESULTS Mean serum leptin and TNF-alpha levels declined after 6 months in both groups of the study , but only women in the soy isoflavones group showed a significant increase of mean serum levels of adiponectin . CONCLUSIONS Diet , physical exercise and daily oral intake of a soy isoflavones extract ( Fisiogen ( ® ) ) contained 200 mg of Glycine max , which corresponded to 80 mg of isoflavone ( 60.8 mg of genistein , 16 mg of daidzein and 3.2 mg of glicitein ) have a beneficial effect on serum leptin , adiponectin and TNF-α in healthy obese postmenopausal women after 6 months of treatment Objective : The purpose of this study was to evaluate the isolated and associated effects of estrogen therapy ( estradiol valerate 1 mg/d orally ) and physical exercise ( moderate aerobic exercise , 3 h/wk ) on health-related quality of life ( HRQOL ) and menopausal symptoms among women who had undergone hysterectomy . Design : A 6-month , r and omized , double-blind , placebo-controlled clinical trial with 44 postmenopausal women who had undergone hysterectomy . The interventions were physical exercise and hormone therapy ( n = 9 ) , being sedentary and hormone therapy ( n = 14 ) , physical exercise and placebo ( n = 11 ) , and being sedentary and placebo ( n = 10 ) . HRQOL was assessed by a Brazilian st and ard version of the Medical Outcome Study Short-Form Health Survey and symptoms by Kupperman Index at baseline and after 6 months . Results : There was a decrease in symptoms in all groups , but only groups who performed physical exercise showed an increase in quality of life . Analysis of variance showed that changes in physical functioning ( P = 0.001 ) and bodily pain ( P = 0.012 ) scores over the 6-month period differed significantly between women who exercised and women who were sedentary , regardless of hormone therapy . Hormone therapy had no effect , and there was also no significant association between physical exercise and hormone therapy in HRQOL . Conclusions : Physical exercises can reduce menopausal symptoms and enhance HRQOL , independent of whether hormone therapy is taken The purpose of this r and omized clinical trial study was to determine the effectiveness of a 24-week , home-based , moderate-intensity , walking intervention in improving symptoms ( vasomotor , uro-genital/sexual , sleep , psychological , cognitive , physical ) experienced by midlife women . One hundred and seventy-three Caucasian and African American women aged 45 to 65 who were not on hormone therapy , had no major signs or symptoms of cardiovascular disease , and were sedentary in their leisure activity were r and omly assigned to the  moderate-intensity walking group or the nonexercise control group . The exercise prescription was walking at a frequency of 4 times a week for a duration of 20 to 30 minutes . The symptom impact inventory included the frequency , intensity , and bothersomeness of 33 symptoms collected at baseline and 24 weeks . Adherence was measured with a heart rate monitor and exercise log . Average adherence to frequency of walking  was 71.6 % of the expected walks . After 24 weeks , there were no differences between the walking and control group on change in symptoms . However , multiple regression revealed that frequency of adherence to walking  along with change in physical symptoms and menopausal status were significant predictors of change in sleep symptoms .  While walking did not improve most symptoms experienced by midlife women , frequency of walking may improve sleep With advancing age , the postural balance function deteriorates as a consequence of decreased functional capacity . Deteriorating balance is a risk factor for bone fractures due to increased risks of falls . It has been suggested that the loss of estrogen , which occurs in relation to the menopause , may be associated with loss of balance . Regular physical exercise without balance training has , in some studies , been shown to have positive effects on the postural balance . The aim of the present study was to examine balance function during the perimenopausal period , and evaluate the effect of estrogen plus progesterone therapy ( EPT ) or  aerobic training  on balance .  Sixty perimenopausal women were recruited to the study . The subjects were then r and omised to either physical training ( n = 20 ) , EPT ( n = 20 ) , or to a control group ( n = 20 ) . The study period was 18 months . Postural stability was measured every third month using a custom‐made force platform . The women using EPT achieved better results in 3 of 6 parameters , after 18 months Menopause is associated with a considerable variety of physical , psychological and social symptoms that can be treated using cognitive-behavioral techniques . In the present study , 21 women took part in an eight-week group intervention consisting of weekly two-hour sessions to address their slight symptoms related to the climacteric stage of life . The intervention included : psycho education on menopause , relaxation techniques , nutrition and fitness exercises , Kegel exercises , and problem-solving techniques . A control group was included that did not receive treatment and consisted of 28 women . The results revealed a significant reduction in most symptoms ( including depression and anxiety ) after intervention as compared to the baseline period . No changes appeared in the control group . The relevance of this work lies in the potential element of prevention this therapeutic package could offer to relieve various symptoms , slight and incipient , during the perimenopausal stage The effects of physical training and hormone replacement therapy ( HRT ) on bone mineral density in perimenopausal women were studied . Sixty perimenopausal women were r and omized to either physical training ( n=20 ) , HRT ( n=20 ) , or control group ( n=20 ) . The study period was 18 months . Bone mineral density ( BMD ) in the femoral neck and lumbar spine was measured using dual-energy X-ray absorptiometry ( DXA ) . DXA was performed before treatment and after 6 and 18 months . Blood sample s for analysis of the bone markers U-deoxypyridinoline and osteocalcin were collected at the same time points . After 18 months , BMD in the spine had not decreased in either the training group or in the HRT group . In the control group , spine BMD had significantly decreased ( p=0.0014 ) . U-Deoxypyridinoline and osteocalcin were increased significantly in the control group ( p=0.0198 , p=0.0295 , respectively ) . No significant changes in bone marker levels were found in the training group or the HRT group . We found that both HRT and physical training can prevent loss of spine BMD in perimenopausal women over a period of 18 months . HRT remains a cornerstone in the treatment of vasomotor symptoms and preservation of BMD . However , HRT can only be used for limited periods of time due to the potential serious adverse effects . This study indicates a beneficial effect of physical activity on spine BMD in the perimenopausal period , and highlights its potential as an alternative to HRT during this period OBJECTIVE To assess the feasibility and efficacy of a yoga treatment for menopausal symptoms . Both physiologic and self-reported measures of hot flashes were included . METHODS A prospect i ve within-group pilot study was conducted . Participants were 12 peri- and post-menopausal women experiencing at least 4 menopausal hot flashes per day , at least 4 days per week . Assessment s were administered before and after completion of a 10-week yoga program . Pre- and post-treatment measures included : Severity of question naire-rated menopausal symptoms ( Wiklund Symptom Check List ) , frequency , duration , and severity of hot flashes ( 24-h ambulatory skin-conductance monitoring ; hot-flash diary ) , interference of hot flashes with daily life ( Hot Flash Related Daily Interference Scale ) , and subjective sleep quality ( Pittsburgh Sleep Quality Index ) .  Yoga classes included breathing techniques , postures , and relaxation poses design ed specifically for menopausal symptoms . Participants were asked to practice at home 15 min each day in addition to weekly classes . RESULTS Eleven women completed the study and attended a mean of 7.45 ( S.D. 1.63 ) classes . Significant pre- to post-treatment improvements were found for severity of question naire-rated total menopausal symptoms , hot-flash daily interference ; and sleep efficiency , disturbances , and quality . Neither 24-h monitoring nor accompanying diaries yielded significant changes in hot flashes . CONCLUSIONS The yoga treatment and study procedures were feasible for midlife women . Improvement in symptom perceptions and well being warrant further study of yoga for menopausal symptoms , with a larger number of women and including a control group Lifestyle interventions for weight loss are the cornerstone of obesity therapy , yet their optimal design is debated . This is particularly true for postmenopausal women ; a population with a high prevalence of obesity yet toward whom fewer studies are targeted . We conducted a year-long , 4-arm r and omized trial among 439 overweight-to-obese postmenopausal sedentary women to determine the effects of a calorie-reduced , low-fat diet ( D ) , a moderate-intensity , facility-based aerobic exercise program ( E ) , or the combination of both interventions ( D+E ) , vs. a no-lifestyle-change control ( C ) on change in body weight and composition . The group-based dietary intervention had a weight-reduction goal of ≥10 % , and the exercise intervention consisted of a gradual escalation to 45-min aerobic exercise 5 day/week . Participants were predominantly non-Hispanic whites ( 85 % ) with a mean age of 58.0 ± 5.0 years , a mean BMI of 30.9 ± 4.0 kg/m(2 ) and an average of 47.8 ± 4.4 % body fat .  Baseline and 12-month weight and adiposity measures were obtained by staff blinded to participants ' intervention assignment . Three hundred and ninety nine women completed the trial ( 91 % retention ) . Using an intention-to-treat analysis , average weight loss at 12 months was -8.5 % for the D group ( P < 0.0001 vs. C ) , -2.4 % for the E group ( P = 0.03 vs. C ) , and -10.8 % for the D+E group ( P < 0.0001 vs. C ) , whereas the C group experienced a nonsignificant -0.8 % decrease . BMI , waist circumference , and % body fat were also similarly reduced . Among postmenopausal women , lifestyle-change involving diet , exercise , or both combined over 1 year improves body weight and adiposity , with the greatest change arising from the combined intervention OBJECTIVES this paper aims to report the prevalence of symptoms in the Hong Kong Chinese perimenopausal women ; to construct reported symptoms into symptom groupings ; and to clarify whether the symptom groups are associated with menopausal status . METHODS a r and om telephone survey of perimenopausal women aged 44 - 55 years was conducted in 1996 . Eligible subjects were identified through telephone dialing of a r and om sample of the numbers listed in the residents ' telephone directory . St and ardized question naire , including a 22-item symptom check list , was administered over the telephone . The principal component analysis method followed by varimax rotation was used to examine the relations among the symptoms . RESULTS differences in the prevalence of menstrual problems across the menopausal status were noted with perimenopausal women having the most complaints . Musculoskeletal conditions were the top complaints reported by the respondents , followed by headaches and psychological symptoms . About 10 % of the women complained of hot flushes , and less than 5 % of cold sweats . Five symptom clusters , namely psychological , musculoskeletal/gastrointestinal , non-specific somatic , respiratory , and vasomotor , have been identified . After adjustment for age , the analysis of variance showed that psychological , non-specific somatic and vasomotor symptoms were significantly associated with menopausal status , while musculoskeletal and respiratory were of borderline statistical significance . CONCLUSIONS compared with pre- and post-menopausal women , perimenopausal women had the highest reports of symptom complaints . Musculoskeletal complaints were the most prevalent complaints , followed by psychological symptoms . While vasomotor symptoms were significantly associated with menopausal status , their prevalence was comparatively lower than that reported in Caucasian population INTRODUCTION Current controversies involve the adverse effects of hysterectomy on women 's psychosocial functioning and whether subtotal as opposed to total hysterectomy mitigates these effects . AIM To investigate the psychosocial effects of hysterectomy by examining sexual , pain , and psychological outcomes of total vs. subtotal hysterectomy in a r and omized controlled trial . METHODS Patients suffering from benign gynecological conditions were r and omly assigned to one of two groups : ( i )  total hysterectomy , that is ,  laparoscopic assisted vaginal hysterectomy (  TOT , N = 32 ) ; or ( ii ) subtotal hysterectomy  , that is , supracervical laparoscopic hysterectomy ( SUB , N = 31 ) . Both groups were premenopausal and underwent hysterectomy without concurrent oophorectomy .  Two premenopausal control groups : ( i ) minor gynecological surgery ( SURG-CON , N = 30 ) ; and ( ii ) healthy nonsurgical controls ( NORM-CON , N = 40 ) , were also tested . All surgical groups were assessed 2 - 3 weeks before surgery and then 6 - 7 months afterward ; the nonsurgical control group was assessed at the time of recruitment and 6 - 7 months later . OUTCOME MEASURES Assessment s included semistructured interviews , st and ardized question naires , and st and ardized gynecological examinations . RESULTS For the TOT group , sexual drive , arousal , and sexual behavior significantly improved postoperatively . For the SUB group , sexual behavior and overall sexual functioning significantly improved . For both TOT and SUB groups , unprovoked pain in the abdomen and pain in the abdomen during gynecological examinations was significantly reduced . For both TOT and SUB groups , overall psychological functioning did not significantly change postoperatively . Although between 3 % and 16 % of women undergoing hysterectomy reported adverse changes in psychosocial well-being after surgery , similar percentages of women in the control groups reported such effects . CONCLUSIONS Hysterectomy result ed in a consistent reduction in abdominal pain , some improvement in sexual functioning , but no change in overall psychological functioning . There was no evidence supporting the idea that subtotal hysterectomy produced more favorable psychosocial outcomes than total hysterectomy nor was there any evidence that either type of hysterectomy result ed in adverse effects OBJECTIVE To assess the effect of soy protein and progressive resistance training on body composition and lipids in postmenopausal women . DESIGN In a controlled trial , 46 postmenopausal women were r and omized to one of four groups : 25 g of soy protein ( SP , n=10 ) , 25 g of soy protein plus resistance exercise ( SPE , n=14 ) , 25 g of maltodextrine ( placebo ) ( PL , n=11 ) , or placebo plus resistance exercise ( PLE , n=11 ) . Progressive resistance training was held three times a week for 16 weeks and included 8 exercises ( 3 series of 8 - 12 repetitions ) . At baseline and after 16 weeks , body mass index , waist circumference ( WC ) , body fat , muscle mass and serum lipid levels were measured . To confirm isoflavone absorption , urinary concentrations were determined . The t-test of Student and ANOVA were used in the statistical analysis . RESULTS Subjects were classified as overweight and showed and roid fat distribution . Urinary isoflavone excretion indicated compliance to soy protein treatment . After 16 weeks of intervention , both SPE and PLE groups showed a significant increase of 1.3 kg in muscle mass and reduction in WC of -1.4 and -2.1 cm , respectively ( p<0.05 ) . Significant decreases in the mean values of total cholesterol and LDL ( -29.0 and -24.0 mg/dL , p<0.001 and p<0.006 , respectively ) were observed in the users of soy protein alone ( SP ) . CONCLUSIONS Soy protein supplementation did not influence the indicators of body composition . However , it exerted possible favorable effects on lipid profile in postmenopausal women . The increase in muscle mass and reduction in abdominal fat were correlated with resistance training BACKGROUND The decision to take hormone replacement therapy ( HRT ) is a choice many women encounter when entering menopause . The purpose of this study was to examine the choice to take HRT while participating in a lifestyle intervention to reduce cardiovascular risk through the menopause . METHODS The Women 's Healthy Lifestyle Project is a r and omized clinical trial design ed to examine whether a behavioral lifestyle intervention can decrease the expected rise in cardiovascular risk through the menopause . Participants ( N = 535 ) completed question naires and were interviewed regarding menopausal symptoms , menopausal status , hot flashes , and  HRT  use at baseline and 54 months . RESULTS The intervention was successful in preventing risk elevation through the 54-month visit . At the final visit , there was no difference between the intervention and control groups in the percentage who had become postmenopausal ( 32.9 % vs 35.0 % , respectively ) , there was no difference between control and intervention with  HRT  use , with 31.2 % reporting use of HRT , and there was no difference between groups with menopausal symptoms . The women started HRT an average of 6 months after they missed a period . Baseline risk factors did not predict HRT use at the 54-month visit . CONCLUSIONS A sizable number of women reported HRT use . The decision to use HRT was not influenced by the lifestyle intervention or their baseline cardiovascular risk , and these women started HRT very early in the peri- to postmenopause . Further , weight loss in the perimenopause did not affect menopausal symptoms Objective : To study the effect of yoga on the climacteric symptoms , perceived stress , and personality in perimenopausal women . Design : One hundred twenty participants ( ages 40 - 55 y ) were r and omly divided into two study arms , ie , yoga and control . The yoga group practice d an integrated approach to yoga therapy comprising surya namaskara ( sun salutation ) with 12 postures , pranayama ( breathing practice s ) , and avartan dhyan ( cyclic meditation ) , whereas the control group practice d a set of simple physical exercises under supervision of trained teachers for 8 weeks ( 1 h daily , 5 days per week ) . The assessment s were made by Greene Climacteric Scale , Perceived Stress Scale , and Eysenck 's Personality Inventory before and after the intervention . Results : Of the three factors of the Greene Climacteric Scale , the Mann-Whitney test showed a significant difference between groups ( P < 0.05 ) in the vasomotor symptoms , a marginally significant difference ( P = 0.06 ) in psychological factors but not in the somatic component . Effect sizes were higher in the yoga group for all factors . There was a significantly greater degree of decrease in Perceived Stress Scale scores ( P < 0.001 , independent sample s t test ) in the yoga group compared with controls ( between-group analysis ) with a higher effect size in the yoga group ( 1.10 ) than the control ( 0.27 ) . On the Eysenck 's Personality Inventory , the decrease in neuroticism was greater ( P < 0.05 ) in the yoga group ( effect size = 0.43 ) than the control group ( effect size = 0.21 ) with no change in extroversion in either the yoga or control group . Conclusions : Eight weeks of an integrated approach to yoga therapy decreases climacteric symptoms , perceived stress , and neuroticism in perimenopausal women better than physical exercise BACKGROUND Higher body mass index is associated with worse hot flushes during menopause but the effect of weight loss on flushing is unclear . METHODS Self-administered question naires were used to assess bothersome hot flushes in a 6-month r and omized controlled trial of an intensive behavioral weight loss program ( intervention ) vs a structured health education program ( control ) in 338 women who were overweight or obese and had urinary incontinence .  Weight , body mass index , abdominal circumference , physical activity , calorie intake , blood pressure , and physical and mental functioning were assessed at baseline and at 6 months . Repeated- measures proportional odds models examined intervention effects on bothersome hot flushes and potential mediating factors . RESULTS Approximately half of participants ( n = 154 ) were at least slightly bothered by hot flushes at baseline . Among these women , the intervention was associated with greater improvement in bothersome flushes vs control ( odds ratio [ OR ] for improvement by 1 Likert category , 2.25 ; 95 % confidence interval [ CI ] , 1.20 - 4.21 ) . Reductions in weight ( OR , 1.32 ; 95 % CI , 1.08 - 1.61 ; per 5-kg decrease ) , body mass index ( 1.17 ; 1.05 - 1.30 ; per 1-point decrease ) , and abdominal circumference ( 1.32 ; 1.07 - 1.64 ; per 5-cm decrease ) were each associated with improvement in flushing , but changes in physical activity , calorie intake , blood pressure , and physical and mental functioning were not related . The effect of the intervention on flushing was modestly diminished after adjustment for multiple potential mediators ( OR , 1.92 ; 95 % CI , 0.95 - 3.89 ) . CONCLUSION Among women who were overweight or obese and had bothersome hot flushes , an intensive behavioral weight loss intervention result ed in improvement in flushing relative to control . Trial Registration clinical trials.gov Identifier : NCT00091988 Objectives . To observe the effect of yoga on  menopausal symptoms  using a prospect i ve , r and omized , 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 design ed 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 ABSTRACT Background Postmenopausal women seem to favor alternative therapies such as exercise and phytoestrogens as a substitute for potentially harmful hormone replacement therapy . Based on previous research , we hypothesized that phytoestrogens combined with exercise could have a synergic effect on women 's health . Objective To verify whether phytoestrogens enhance the response to mixed training regarding menopausal symptoms and quality of life in postmenopausal women . Methods From a pool of women participating in a 6-month r and omized , controlled exercise study , 21 received a placebo ( mean age 58.3 ± 5.4 years , body mass index 29.8 ± 5.1 kg/m2 ) and 19 received phytoestrogen supplements ( mean age 60.1 ± 3.4 years ; body mass index 30.3 ± 4.6 kg/m2 ) . Body weight , fat mass and lean body mass ( dual-energy X-ray absorptiometry ) were assessed . Quality of life was estimated by the Short Form-36 ( SF-36 ) and Perceived Stress Scale-10 ( PSS-10 ) question naires , and menopausal symptoms by the Kupperman index . All measurements were performed before and after the intervention . Results Although the Kupperman index and PSS-10 remained unchanged in both groups , the SF-36 Physical Component Summary and almost all the SF-36 subscales ( except for role-emotional and mental health ) increased only in the exercise group taking phytoestrogens ( 0.001 < p < 0.04 ) . Conclusion While phytoestrogens combined with mixed exercise were not sufficient to improve menopausal symptoms , it seemed to be a better strategy than exercise alone to improve the general quality of life in postmenopausal women AIM AND OBJECTIVE To evaluate the influence of an exercise programme on postmenopausal women with symptoms of anxiety and depression .  BACKGROUND The menopause is a period of hormonal changes when mood variations are probably more severe than at any other period of women 's lives . DESIGN Prospect i ve study with control group and pre- and post-treatment measures , after six months treatment . Conducted at two healthcare clinics , in the province of Granada ( Spain ) . METHODS A convenience sample of 60 postmenopausal women aged 60 - 70 years , with symptoms of depression and anxiety , was recruited . The women were r and omly divided into two groups : ( 1 ) control group , no treatment ( n = 30 ) ; ( 2 ) exercise group , which carried out a programme of mixed physical exercises with musical support ( n = 30 ) . All subjects answered question naires for the Hamilton Anxiety Scale and the Brink and Yesavage Geriatric Depression Scale before and after treatment . RESULTS In the exercise group , statistically significant improvements were observed in subjects with moderate and severe depression ( 18 and 22 % , respectively ) and in those with symptoms of anxiety . No such changes were observed in the control group . CONCLUSIONS A controlled programme of physical exercise for postmenopausal women alleviates symptoms of anxiety and depression , and its inclusion in primary healthcare programmes should be considered . RELEVANCE TO CLINICAL PRACTICE Menopausal women may benefit from physical exercise , which attenuates the effects of the physiological and psychological changes associated with the menopause and prevents pathologic changes Objective : To test the hypothesis that physical leisure time activities reduce the risk of developing persistent fatigue . Methods : The hypothesis was tested in a sample that was homogeneous with respect to sex and occupation , with a prospect i ve cohort design . Of 6234 vocationally active , female , Norwegian nurses ’ aides , not on leave because of illness or pregnancy when they completed a mailed question naire in 1999 , 5341 ( 85.7 % ) completed a second question naire 15 months later . The main outcome measure was the prevalence of persistent fatigue — that is , always or usually feeling fatigued in the daytime during the preceding 14 days . Results : In participants without persistent fatigue at baseline , reported engagement in physical leisure time activities for 20 minutes or more at least once a week during the three months before baseline was associated with a reduced risk of persistent fatigue at the follow up ( odds ratio = 0.70 ; 95 % confidence interval 0.55 to 0.89 ) , after adjustments for age , affective symptoms , sleeping problems , musculoskeletal pain , long term health problems of any kind , smoking , marital status , tasks of a caring nature during leisure time , and work factors at baseline . Conclusion : The study supports the hypothesis that physical leisure time activities reduce the risk of developing persistent fatigue OBJECTIVES To describe Australian-born women 's experience of symptoms during the natural menopause transition and the relative contribution of menopausal and health status , social factors and lifestyle behaviours . DESIGN A community based cross-sectional survey by telephone interview was carried out on a r and omly derived sample of Melbourne women . PARTICIPANTS The participants were 2000 Australian-born women , aged between 45 and 55 years . OUTCOME MEASURES A list of 22 symptoms was used . Explanatory variables were : sociodemographic variables ; menopausal and health status ; lifestyle behaviours ; attitudes to ageing and to menopause . RESULTS A 70 % response rate was achieved for eligible women who could be contacted during the study . Premenopausal women were the least symptomatic and perimenopausal women the most symptomatic . Factor analysis found seven common factors from the 22 symptoms studied . Menopausal status based on menstrual history was significantly related to two groups of symptoms : vasomotor symptoms , which increased through the menopausal transition ; and general somatic symptoms which were more frequent in the perimenopause . Analysis of variance of factor scores found fewer symptoms with increasing years of education , better self-rated health , the use of fewer non-prescription medications , the absence of chronic health conditions , a low level of interpersonal stress , the absence of premenstrual complaints , not currently smoking , exercise at least once a week , and positive attitudes to ageing and menopause . CONCLUSIONS Many factors unrelated to hormonal changes contributed to the symptoms . Longitudinal investigation is needed to determine the relative importance of hormonal , psychosocial and lifestyle variables in the aetiology of mid-life symptoms Objective : Physical activity has been shown to enhance quality of life ( QOL ) ; however , few investigations of these effects exist in women undergoing the menopausal transition . The present study examined the long-term effects of physical activity on menopause-related QOL and tested the mediating effects of physical self-worth and positive affect in this relationship . Methods : Middle-aged women previously enrolled in a 4-month r and omized controlled trial involving walking and yoga , and a control group completed a follow-up mail-in survey 2 years after the end of the trial . The survey included a battery of psychological and physical activity measures , including measures of menopausal symptoms and menopause-related QOL . Longitudinal linear panel analysis was conducted within a covariance modeling framework to test whether physical self-worth and positive affect mediated the physical activity-QOL relationship over time . Results : At the end of the trial , physical activity and menopausal symptoms were related to physical self-worth and positive affect , and in turn , greater levels of physical self-worth and positive affect were associated with higher levels of menopause-related QOL . Analyses indicated that increases in physical activity  and decreases in menopausal symptoms over the 2-year period were related to increases in physical self-worth ( & bgr;s = 0.23 and −0.52 , physical activity and menopausal symptoms , respectively ) and , for symptoms , also to decreased positive affect ( & bgr ; = −0.47 ) , and both physical self-worth ( & bgr ; = 0.34 ) and affect ( & bgr ; = 0.43 ) directly influenced enhancements in QOL ( R2 = 0.775 ) . Conclusions : The findings support the position that the effects of physical activity on QOL are mediated , in part , by intermediate psychological outcomes and that physical activity can have long-term benefits for women undergoing the menopausal transition CONTEXT Observational studies have found lower rates of coronary heart disease ( CHD ) in postmenopausal women who take estrogen than in women who do not , but this potential benefit has not been confirmed in clinical trials . OBJECTIVE To determine if estrogen plus progestin therapy alters the risk for CHD events in postmenopausal women with established coronary disease . DESIGN R and omized , blinded , placebo-controlled secondary prevention trial . SETTING Outpatient and community setting s at 20 US clinical centers . PARTICIPANTS A total of 2763 women with coronary disease , younger than 80 years , and postmenopausal with an intact uterus . Mean age was 66.7 years . INTERVENTION Either 0.625 mg of conjugated equine estrogens plus 2.5 mg of medroxyprogesterone acetate in 1 tablet daily ( n = 1380 ) or a placebo of identical appearance ( n = 1383 ) . Follow-up averaged 4.1 years ; 82 % of those assigned to hormone treatment were taking it at the end of 1 year , and 75 % at the end of 3 years . MAIN OUTCOME MEASURES The primary outcome was the occurrence of nonfatal myocardial infa rct ion ( MI ) or CHD death . Secondary cardiovascular outcomes included coronary revascularization , unstable angina , congestive heart failure , resuscitated cardiac arrest , stroke or transient ischemic attack , and peripheral arterial disease . All-cause mortality was also considered . RESULTS Overall , there were no significant differences between groups in the primary outcome or in any of the secondary cardiovascular outcomes : 172 women in the hormone group and 176 women in the placebo group had MI or CHD death ( relative hazard [ RH ] , 0.99 ; 95 % confidence interval [ CI ] , 0.80 - 1.22 ) . The lack of an overall effect occurred despite a net 11 % lower low-density lipoprotein cholesterol level and 10 % higher high-density lipoprotein cholesterol level in the hormone group compared with the placebo group ( each P<.001 ) . Within the overall null effect , there was a statistically significant time trend , with more CHD events in the hormone group than in the placebo group in year 1 and fewer in years 4 and 5 . More women in the hormone group than in the placebo group experienced venous thromboembolic events ( 34 vs 12 ; RH , 2.89 ; 95 % CI , 1.50 - 5.58 ) and gallbladder disease ( 84 vs 62 ; RH , 1.38 ; 95 % CI , 1.00 - 1.92 ) . There were no significant differences in several other end points for which power was limited , including fracture , cancer , and total mortality ( 131 vs 123 deaths ; RH , 1.08 ; 95 % CI , 0.84 - 1.38 ) . CONCLUSIONS During an average follow-up of 4.1 years , treatment with oral conjugated equine estrogen plus medroxyprogesterone acetate did not reduce the overall rate of CHD events in postmenopausal women with established coronary disease . The treatment did increase the rate of thromboembolic events and gallbladder disease . Based on the finding of no overall cardiovascular benefit and a pattern of early increase in risk of CHD events , we do not recommend starting this treatment for the purpose of secondary prevention of CHD . However , given the favorable pattern of CHD events after several years of therapy , it could be appropriate for women already receiving this treatment to continue BACKGROUND Menopause is associated with poor sleep quality and daytime sleepiness , which may lead to impaired quality of life and impaired functioning in daily activities . OBJECTIVE To study whether exercise training improves sleep quality or decreases the amount of night time hot flushes among menopausal women with vasomotor symptoms . STUDY DESIGN A r and omized controlled trial . Sedentary women ( N=176 ) aged 43 - 63 years with menopausal symptoms were r and omized to a six-month unsupervised aerobic training intervention ( 50 min 4 times per week ) or a control group . Both groups attended lectures on physical activity and health once a month . MAIN OUTCOME MEASURES Sleep quality and the amount of hot flushes disturbing sleep . The women reported daily via mobile phone whether hot flushes had disturbed their sleep and how they had slept ( scale 1 - 5 ) . Responses received by mobile phone over the 6-month period totaled on average 125 ( 5.2 per week ) responses per participant . RESULTS At baseline there was no difference between the groups in the demographic variables . Sleep quality improved significantly more in the intervention group than in the control group ( OR 1.02 ; 95 % CI=1.0 - 1.05 , p=0.043 ) . The odds for sleep improvement were 2 % per week in the intervention group and a decrease of 0.5 % per week in the control group . The amount of hot flushes related to sleep diminished ( p=0.004 ) by the end of the intervention . CONCLUSIONS Aerobic training for 6 months may improve sleep quality and reduce hot flushes among symptomatic menopausal women OBJECTIVE To determine the effects of moderate-intensity exercise training on self-rated ( subjective ) sleep quality among healthy , sedentary older adults reporting moderate sleep complaints . DESIGN R and omized controlled trial of 16 weeks ' duration . SETTING General community . PARTICIPANTS Volunteer sample of 29 women and 14 men ( of 67 eligible subjects ) aged 50 to 76 years who were sedentary , free of cardiovascular disease , and reported moderate sleep complaints . No participant was withdrawn for adverse effects . INTERVENTION R and omized to 16 weeks of community-based , moderate-intensity exercise training or to a wait-listed control condition . Exercise consisted primarily of four 30- to 40-minute endurance training sessions ( low-impact aerobics ; brisk walking ) prescribed per week at 60 % to 75 % of heart rate reserve based on peak treadmill exercise heart rate . MAIN OUTCOME MEASURE Pittsburgh Sleep Quality Index ( PSQI ) . RESULTS Compared with controls ( C ) , subjects in the exercise training condition ( E ) showed significant improvement in the PSQI global sleep score at 16 weeks ( baseline and posttest values in mean [ SD ] for C=8.93 [ 3.1 ] and 8.8 [ 2.6 ] ; baseline and posttest values for E=8.7 [ 3.0 ] and 5.4 [ 2.8 ] ; mean posttest difference between conditions=3.4 ; P<.001 ; 95 % confidence interval , 1.9 - 5.4 ) , as well as in the sleep parameters of rated sleep quality , sleep-onset latency ( baseline and posttest values for C=26.1 [ 20.0 ] and 23.8 [ 15.3 ] ; for E=28.4 [ 20.2 ] and 14.6 [ 13.0 ] ; net improvement=11.5 minutes ) , and sleep duration baseline and posttest scores for C=5.8 [ 1.1 ] and 6.0 [ 1.0 ] ; for E=6.0 [ 1.1 ] and 6.8 [ 1.2 ] ; net improvement=42 minutes ) assessed via PSQI and sleep diaries ( P=.05 ) . CONCLUSIONS Older adults with moderate sleep complaints can improve self-rated sleep quality by initiating a regular moderate-intensity exercise program An evaluation of the long term impact of a health education intervention in primary care , for premenopausal women ( 45 years of age ) , is presented . The intervention included information and group discussion about menopause , stress management , health behaviours ( smoking , exercise , diet ) and treatment choices . Question naires were sent to 86 women who had been r and omised into two groups ( prepared/control ) and were now aged 50 ( response rate 91 % ) . The prepared group had significantly greater knowledge of menopause and attributed fewer symptoms to the menopause than the controls . There were no group differences in measures of general health or mood , but there was a tendency for the prepared group to report more interest in sexual activity . Subjective evaluation of the intervention was positive in terms of increasing knowledge and helping women to deal with the emotional and practical aspects of the menopause Phytoestrogens and training could be effective to reduce cardiovascular and type 2 diabetes mellitus risk factors in postmenopausal women . Nevertheless , the impact of their combination on adipokines and systemic inflammation was never investigated . The objective was to verify if 6 months of mixed training combined with phytoestrogens could have an additional effect on adipokine levels and systemic inflammation in obese postmenopausal women . Fifty-two obese women aged between 50 and 70 years were r and omly assigned to ( 1 ) exercise with placebo ( EX + PL ; n = 25 ) or ( 2 ) exercise with phytoestrogens ( EX + PHY ; n = 27 ) . Body weight , waist circumference , fat mass , and lean body mass ( dual-energy x-ray absorptiometry ) were assessed . Fasting plasma glucose and insulin , adiponectin , leptin , and C-reactive protein ( CRP ) levels were obtained after a 12-hour overnight fast . Total energy intake was measured with a 3-day dietary record . All measurements were performed before and after the 6-month intervention . Although energy intake remained unchanged , body composition was improved in all women ( all Ps < .02 ) . Plasma CRP and leptin levels decreased in both groups similarly ( all Ps < .03 ) , whereas plasma adiponectin and insulin did not change with exercise combined with placebo or phytoestrogens . Correlation analyses showed that homeostasis model assessment of insulin resistance ( r = -0.58 , P = .02 ) and fasting insulin levels ( r = -0.42 , P = .02 ) at baseline were both correlated with changes in leptin levels . Baseline fasting glucose ( r = -0.36 , P = .03 ) and adiponectin ( r = 0.45 , P = .005 ) levels were associated with changes in CRP concentrations . Although mixed exercise program combined with phytoestrogens does not seem to provide any additional effect , mixed training improves systemic inflammation and leptin concentrations in obese postmenopausal women A r and omly selected community cohort of 2000 Australian born women aged 45 to 55 were interviewed on the telephone and information obtained on their health and well-being . These women were divided into pre- , peri- , natural and surgical menopausal groups on their menstrual history . A physical activity question naire was sent to 1181 women in the first three of these groups . These question naires were completed and returned by 61.6 % of the women . The response rate in all groups was significantly associated with the years of education , employment status , body mass index ( BMI ) and self-rated health of the participants . The aim of the study was to test the hypothesis that physical activity is a major contributor to health and well-being by establishing the relationships between physical activity and certain health outcomes , such as menopausal symptoms , psychological well-being , self-rated health and BMI in this cohort of mid-life women . The inter-relationship between physical activity and other variables , including menopausal status , interpersonal stress , health related and preventive health behaviours was examined . Levels of  physical activity  were significantly associated with better self-rated health , lower BMI measurements , moderate alcohol intake and self-breast examination . There was no significant association between levels of physical activity , psychological well-being and women 's experience of symptoms during the natural menopause transition Objective : To investigate factors associated with the presence , severity , and frequency of hot flushes . Design : A 9-year prospect i ve study of 438 Australian-born women , aged 45 to 55 years and menstruating at baseline .  Annual fasting blood collection , physical measurements , and interviews including questions about bothersome hot flushes in previous 2 weeks were performed . A “ hot flush index ” score was calculated from the product of the severity and frequency data . Data were analyzed using r and om-effects time-series regression models . Results : A total of 381 women supplied complete data over the follow-up years . A total of 350 women experienced the menopause transition , of whom 60 ( 17 % ) never reported bothersome hot flushes . At baseline , women who reported hot flushes were significantly more likely to have higher negative moods , not be in full- or part-time paid work , smoke , and not report exercising every day . Over the 9-year period of the study , variables significantly associated with reporting bothersome hot flushes were relatively young age ( P < 0.001 ) , low exercise levels ( P < 0.05 ) , low estradiol levels ( P < 0.001 ) , high follicle-stimulating hormone ( FSH ) levels ( P < 0.001 ) , smoking ( P < 0.01 ) , being in the late menopause transition ( P < 0.001 ) , or being postmenopausal ( P < 0.001 ) . In women reporting hot flushes , the hot flush index score increased as their FSH levels increased ( P < 0.01 ) , as they entered the late stage of the menopause transition ( P < 0.001 ) , and as they became postmenopausal ( P < 0.05 ) , and decreased with as their age ( P < 0.001 ) and exercise level ( P < 0.05 ) increased . Between-women analyses found that the hot flush index score was greater in women with higher average FSH levels over time ( P < 0.05 ) . Conclusion : Menopause status , FSH and estradiol levels , age , exercise level , and smoking status all contributed to the experience of bothersome hot flushes OBJECTIVES The relationship between enhanced physical activity and decreased menopause symptoms is equivocal . In this study we sought to better underst and this relationship by examining the association of physical activity to different symptom domains and by examining mediating and moderating variables . STUDY DESIGN Women participating in a r and omized control trial on physical activity  were given a menopause symptom measure ( MENQOL ) at follow-up . Of the 280 women participating , 113 ( mean age=52 ) reported having symptoms they attributed to menopause . Regression analyses were run to examine if change in physical activity predicted fewer symptoms .  Exercise self-efficacy was examined as a mediator and depressive symptoms as a moderator . RESULTS An increase in  physical activity  from baseline was found to be related to reporting fewer total menopause symptoms ( beta=-0.22 , p=.02 ) . When the total menopause symptoms score was examined by domain , increased physical activity was found to be related to reporting fewer general symptoms attributed to menopause ( psychosocial ( beta=-0.18 , p=.05 ) and physical ( beta=-0.23 , p=.01 ) ) , but had no effect on specific symptoms of menopause ( vasomotor and sexual ) . Exercise self-efficacy was found to mediate the relationship between increased physical activity and total , physical and psychosocial menopause symptoms . Finally , for individuals with high depressive symptoms , those who increased physical activity the most reported fewer sexual symptoms of menopause . CONCLUSION This study suggests that physical activity participation is associated with lower general symptom reporting as opposed to specifically impacting menopause symptoms . Further , exercise self-efficacy mediates the relationship between physical activity and general menopause symptoms , suggesting a psychological pathway Abstract : Cross – sectional studies and intervention programs have suggested that physical activity is a potential contributor to the health and wellbeing of mid – life and older women . This prospect i ve longitudinal study investigates whether natural changes in physical activity are associated with changes in health outcomes in a population –based cohort of Australian – born women aged 45–55 years living in Melbourne . Of the 352 women from the Melbourne Women 's Midlife Health Project who filled in a base – line physical activity question naire , 292 ( 83 per cent ) were evaluated around three years later with regard to physical activity , psychological wellbeing , self – rated health , symptoms experienced , body mass index ( BMI ) , blood pressure and serum lipids . Mean ( SD ) physical activity measured at base – line was 5.9 ( 5.7 ) hours/week , or 1496 ( 1449 ) kcal/week ; mean ( SD ) change in physical activity per week was 0.05 ( 5.24 ) hours , or 44 ( 1347 ) kcal , indicating that although mean change was small there was substantial variation in change . There were significant increases in BMI ( P < 0.001 ) , wellbeing ( P < 0.05 ) , the number of reported menopause – related symptoms , and high – density lipoprotein cholesterol ( HDL – C ) levels ( P < 0.001 ) , and a decrease in low – density lipoprotein cholesterol ( LDL – C ) levels ( P < 0.05 ) . Change in level of physical activity was positively associated with change in HDL – C ( P < 0.01 ) and change in wellbeing ( P= 0.08 ) and negatively associated with change in coronary heart disease risk score . By increasing physical activity in mid – life , women may reduce at least one risk factor ( HDL – C ) associated with coronary heart disease Objective : Exercise and physical activity provide a wide range of health benefits for postmenopausal women , although the impact of maintained exercise participation on psychological well-being is unclear . An exploration of continued exercise participation in psychological well-being after a moderate-intensity exercise program in previously inactive postmenopausal women was therefore undertaken . Design : Twenty-three healthy sedentary postmenopausal women ( age 56 ± 4 years ) were r and omly assigned to two groups . All participants completed the Short Form-36 , Hospital Anxiety and Depression Scale ( HADS ) , and Health Anxiety Question naire ( HAQ ) and then began a 6-week walking program at 50 % heart rate reserve defined by & OV0312;o2 treadmill testing . Post-intervention , all participants underwent repeat & OV0312;o2 treadmill testing and question naires . Group 1 was then instructed to continue exercising , whereas group 2 was instructed to desist for an additional 6-week period . On completion of the 6-week follow-up , participants completed a final set of question naires . Results : Participants performed 97 % of the prescribed 15-hour ( 900 minute ) exercise program ( 875.1 ± 177.4 minutes ) in an average of 26 ± 5 sessions . Total HAQ ( P = 0.001 ) , health worry ( P = 0.001 ) , fear of illness ( P = 0.037 ) , reassurance seeking behavior ( P = 0.037 ) , SF-36 well-being ( P = 0.037 ) , total HADS ( P = 0.019 ) , and HADS depression ( P = 0.015 ) improved significantly following the exercise program . At follow-up , group 1 had lower HADS anxiety ( P = 0.013 ) , total HADS ( P = 0.02 ) , total HAQ ( P = 0.03 ) , and HAQ interference with life ( P = 0.03 ) and significantly higher SF-36 energy ( P = 0.01 ) than group 2 . Conclusions : Healthy postmenopausal women gain significant psychological benefit from moderate-intensity exercise . However , exercise participation must continue to maintain improvements in psychological well-being and quality of life BACKGROUND Evidence suggests that a high proportion of perimenopausal and postmenopausal women experience vasomotor symptoms ( hot flushes/night sweats ) that can be severe and disruptive and which are the principal reason for seeking medical intervention . Hormone therapy ( HT ) is known to be an effective treatment for troublesome hot flushes/night sweats but research has raised questions about the safety of HT and there have been negative high profile media reports about its use . Consequently many women are seeking alternatives and exercise might be one such option but there is a lack of high quality evidence on its effectiveness . AIMS This RCT initially aims to investigate the feasibility/acceptability of two exercise interventions identified from our previous preference study in 165 women , and if found to be feasible/acceptable , continue to recruit sufficient women ( n=261 ) to examine the effect of these interventions on hot flushes/night sweats and other outcomes relevant to menopausal women . METHOD We aim to recruit inactive perimenopausal and menopausal symptomatic women not using HT and r and omise them to one of two exercise interventions or usual care for six months . RESULTS We will assess outcomes at baseline and 6 and 12 months from r and omisation . CONCLUSION We hope this RCT will contribute towards increasing the evidence regarding the question of whether exercise is an effective treatment for vasomotor symptoms in women not taking HT BACKGROUND Epidemiological studies suggest a low incidence of hot flashes in population s that consume dietary soy . The present study examined the effect of soy nuts on hot flashes and menopausal symptoms . METHODS Sixty healthy postmenopausal women were r and omized in a crossover design to a therapeutic lifestyle changes ( TLC ) diet alone and a TLC diet of similar energy , fat , and protein content in which one-half cup soy nuts divided into three or four portions spaced throughout the day ( containing 25 g soy protein and 101 mg aglycone isoflavones ) replaced 25 g of nonsoy protein . During each 8-week diet period , subjects recorded the number of hot flashes and amount of exercise daily . At the end of each 8-week diet period , subjects filled out the menopausal symptom quality of life question naire . RESULTS Compared to the TLC diet alone , the TLC diet plus soy nuts was associated with a 45 % decrease in hot flashes ( 7.5 + /- 3.6 vs. 4.1 + /- 2.6 hot flashes day , respectively , p < 0.001 ) in women with > 4.5 hot flashes/day at baseline and 41 % in those with < or=4.5 hot flashes/day ( 2.2 + /- 1.2 vs. 1.3 + /- 1.1 , respectively , p < 0.001 ) . Soy nut intake was also associated with significant improvement in scores on the menopausal symptom quality of life question naire : 19 % decrease in vasomotor score ( p = 0.004 ) , 12.9 % reduction in psychosocial score ( p = 0.01 ) , 9.7 % decrease in physical score ( p = 0.045 ) , and a trend toward improvement in the sexual score , with a 17.7 % reduction in symptoms ( p = 0.129 ) . The amount of exercise had no effect on hot flash reduction . CONCLUSIONS Substituting soy nuts for nonsoy protein in a TLC diet and consumed three or four times throughout the day is associated with a decrease in hot flashes and improvement in menopausal symptoms A case-control study design was used to examine whether habitual physical activity prior to the final menstrual period ( FMP ) was associated with reduced risk of vasomotor and other symptoms during the perimenopausal period . Both cases and controls were identified through a screening interview with r and omly selected women members , ages 48 - 52 , of a large health maintenance organization . Cases ( n = 82 ) were defined as women 3 - 12 months past their FMP who reported regularly having hot flashes or night sweats at least once a day or night during the 3 months following their FMP . Controls ( n = 89 ) were of the same biologic age with respect to the FMP but reported vasomotor symptoms less than once a week during the reference time period . Neither cases nor controls had a history of hormone replacement therapy ( HRT ) , hysterectomy , or bilateral oophorectomy .  Case-control status , habitual physical activity ( including recreational , housework , child care , and occupational activity ) , and psychological and somatic symptoms were assessed by self-report . Participation in vigorous recreational activity during the year prior to the FMP was not associated with reduced risk of frequent vasomotor symptoms after the FMP ( odds ratio [ OR ] = 1.03 for a 50-unit increase in activity score , 95 % confidence interval [ CI ] = 0.97 - 1.1 ) . This lack of relationship was observed in all domains of activity . Factors that were associated with decreased risk included higher body mass index ( BMI ) ( weight in kg/(height in meters)2 ) ( OR = 0.95 per 1 unit increase in BMI , 95 % CI = 0.90 - 1.00 ) and higher education ( having a college degree relative to less education ) ( OR = 0.56 , 95 % CI = 0.40 - 0.80 ) .  Physical activity  was also unassociated with reduced risk of psychologic distress , depressive feelings , or somatic symptoms , but , relative to controls , having vasomotor symptoms ( being a case ) was strongly associated with increased risk of experiencing those symptoms ( OR ranging from 1.83 for psychologic distress to 2.84 for depressive feelings ) . These findings suggest that regular physical activity before the FMP may not reduce the likelihood of experiencing symptoms during the perimenopause , although the small sample size may limit the inferences that can be drawn
target: Evidence was insufficient to show whether exercise is an effective treatment for vasomotor menopausal symptoms .
  One small study suggested that HT is more effective than exercise .
  Evidence was insufficient to show the relative effectiveness of exercise when compared with HT or yoga
background: BACKGROUND Evidence suggests that many perimenopausal and early postmenopausal women will experience menopausal symptoms ; hot flushes are the most common .
  Symptoms caused by fluctuating levels of oestrogen may be alleviated by hormone therapy ( HT ) , but a marked global decline in its use has result ed from concerns about the risks and benefits of HT .
  Consequently , many women are seeking alternatives .
  As large numbers of women are choosing not to take HT , it is increasingly important to identify evidence -based lifestyle modifications that have the potential to reduce vasomotor menopausal symptoms .
  OBJECTIVES To examine the effectiveness of any type of exercise intervention in the management of vasomotor symptoms in symptomatic perimenopausal and postmenopausal women .