Weight excess and inflammation in menopause: pathophysiology of a dangerous liaison and role of lifestyles
Gabriella Pugliese1 – , Annamaria Colao1,2 – , Alessandra Graziottin3 –
1 – Department of Clinical Medicine and Surgery, Endocrinology Section, “Federico II” University of Naples, Naples, Italy
2 – Unesco Chair “Health Education and Sustainable Development”, Federico II University, Naples, Italy
3 – Center for Gynecology and Medical Sexology H. San Raffaele Resnati Milan, Italy; Graziottin Foundation for the treatment of pain in women, ONLUS, Italy
Corresponding Author: Gabriella Pugliese
Weight gain is a common condition in menopause. It recognizes both non- modifiable and modifiable multifactorial etiological mechanisms. The first include: age, climacteric hormonal changes, alteration of hunger and satiety circuits, reduction of energy expenditure and sleep disorders; while among non-modifiable factors: sedentary lifestyle and nutrition, including the ea- ting time (chrononutrition and chronotype). The redistribution of adipo- se tissue, mainly from the subcutaneous site to the visceral site, acts as a real endocrine organ capable of secreting adipokines and proinflammatory cytokines such as TNF-a, IL-1, IL-6 and leptin. This contributes to the meno- pausal chronic low-grade inflammation, that increases the risk of metabolic disorders, cardiovascular events and neurovegetative disorders. Lifestyles interventions are the first line approach to cope with this condition. To date there are no specific dietary and exercise recommendations to be prescribed in overweight/obese women at menopause. The purpose of this review is, first, to analyse the mechanisms that favour weight gain, with focus on the role of sleep disorders and of proinflammatory mediators produced by the adipose tissue; second, to provide practical recommendations focused on li- festyles, useful in the general clinical management of postmenopausal wo- men. The potential role of bowel microbiota and chronotype will be finally briefly discussed.
Keywords: menopause; obesity; inflammation; sleep disorders; adipose tissue; adipokines.
Available in LRIOG Nr.4 – 2021
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Metabolic syndrome in menopause
Roberta Scairati1 – , Renata Simona Auriemma1 – , Annamaria Colao1,2 – , Alessandra Graziottin3,4 –
1 – Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
2 – United Nations Educational, Scientific and Cultural Organization (UNESCO), Chair for Health Education and Sustainable Development, University Federico II, Naples, Italy
3 – Director of the Center for Gynecology and Medical Sexology, H. San Raffaele Resnati, Milan
4 – President of the Graziottin Foundation for the treatment of pain in women – Non profit organization
Corresponding Author: Roberta Scairati
Background: Menopause is associated with a high risk for cardiometabolic diseases, including metabolic syndrome (MetS), cardiovascular disease (CVD) and type 2 diabetes (DMT2).
Insulin resistance, abdominal obesity, dyslipidemia and hypertension are in- terdependent factors associated with menopause. The increase in the syste- mic inflammation is the common denominator of MetS. The purposes of this review are i) to clarify how the natural cessation of ovarian function, which is characterized by the decline of female sexual hormones and the relative in- crease of androgens, could explain the relationship between MetS, increase of the inflammatory indexes and menopause; ii) to understand how surgical menopause could influence the onset of MetS; iii) to highlight the role of hormone replacement therapy.
Methods: We revised the published literature in english language on PubMed database, from year 1992 to year 2021, by searching the following keywords, including 1) a refined definition of metabolic syndrome 2) relationship betwe- en metabolic syndrome and systemic inflammation 3) relationship between metabolic syndrome and obesity, insulin resistance, hypertension, osteoporo- sis and hypothyroidism, 4) surgical menopause and metabolic syndrome, 5) effects of HRT on the components of the MetS in post-menopausal women. Results: Derived evidences suggest an increased incidence of metabolic syn- drome in menopause, probably due to woman aging and hormonal chan- ges in menopause, worsened by hypothyroidism, inappropriate lifestyles and lack of timely initiated HRT.
Conclusions: Menopause plays a crucial role in the development of MetS and surgical menopause; sudden cessation of ovarian function can lead to a hi- gher incidence of MetS and systemic inflammation than physiological me- nopause. Hormone replacement therapy (HRT) and a healthy lifestyle may positively influence some aspects of Mets. Our observations can help in the clinical management of menopause-related MetS.
Keywords: menopause; surgical menopause; metabolic syndrome; inflammation; hormone replacement therapy.
Available in LRIOG Nr.4 – 2021
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The vagina: emerging evidence on the anti-inflammatory role of testosterone
Linda Vignozzi1,2– , Elisa Maseroli1 – , Ilaria Cellai2, Sandra Filippi3, Paolo Comeglio2, Sarah Cipriani2 – , Irene Scavello2 – , Giulia Rastrelli2 – , Margherita Frison2, Mario Maggi2 –
1 – SODc Andrology, Female Endocrinology and Gender Incongruence, Careggi University Hospital, Florence
2 – Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence
3 – Department of Neuroscience, Psychology, Pharmaceutical and Child Health Area, University of Florence
Corresponding author: Linda Vignozzi
The female genitourinary tract is constantly exposed to infectious and inflammatory insults. Inflammation is an essential mechanism, usually able to restore tissue homeostasis; however, uncontrolled and self-maintaining inflammation can lead to dysfunctional processes, which may contribute to the onset of chronic conditions affecting the female genitourinary tract. These include the Genitourinary Syndrome of Menopause (GSM), characterized by vulvovaginal atrophy and symptoms of the lower urinary tract. The primary cause of GSM is a drop of estrogen levels at menopause; however, a decline in androgen level and chronic inflammation also play a pathogenic role. Androgen signaling generally suppress the activity of immune cells. In recent years, androgens have been described to play a key role in maintaining vaginal health, by positively regulating vascular and non-vascular smooth muscle and collagen growth and function, nerve density and function, and genital hemodynamics. Recent in vitro evidence also suggests an anti-inflammatory action of androgens within the vagina. In fact, it has been shown that hu- man vagina smooth muscle cells are able to be involved in the inflammatory response, behaving as resident nonprofessional antigen presenting cells and producing cytokines, chemokines and growth factors. Testosterone, ac- ting through its more active metabolite DHT (Dihydrotestosterone), seems to exert a relevant anti-inflammatory effect on vagina smooth muscle cells, blunting their ability to respond to inflammatory stimuli and to perpetuate inflammation. In particular, DHT counteracts the secretion of Interferon (IFNg), the most potent Th1 cytokine, which plays a key role in development of autoimmunity and chronic, self-perpetuating inflammatory diseases. These data suggest that androgens represent a potential therapeutic strategy for the GSM and other inflammatory conditions of the female genitourinary tract, to be further investigated in clinical studies.
Keywords: androgens; menopause; vagina; inflammation; infection.
Available in LRIOG Nr.2 – 2021
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