Calle Miñaca, Andrés

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Facultad de Ciencias de la Salud y Bienestar Humano

Quito

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Sleep disorders and menopausal symptoms: a Latin American perspective on postmenopausal health
(2025)
Eugenio E. Arteaga
;
Juan E. Blümel
;
María S. Vallejo
;
Carlos Salinas
;
Konstantinos Tserotas
Objective: This cross-sectional, observational study, conducted in nine Latin American countries, aimed to examine the association between hot flashes and insomnia, and whether the severity of vasomotor symptoms (VMS) correlates with sleep disturbances. Method: The study collected sociodemographic and clinical data, and evaluated the presence of sleep disorders using Jenkin’s Sleep Scale (JSS-4) and menopausal symptoms using the Menopause Rating Scale (MRS) questionnaire. Results: The study included 1185 postmenopausal women with average age 56.9 ± 5.7 years, body mass index (BMI) of 26.5 ± 5.2 kg/m² and 8.6 ± 6.4 years since menopause. Overall, 20.6% reported sleep disturbances. Compared to those without sleep problems, affected women had longer postmenopausal duration (12 ± 9.0 vs. 10.8 ± 7.8, p < 0.03), had higher BMI (27.9 ± 5.6 vs. 26.1 ± 5.0, p < 0.001), were more often smokers and homemakers, and had more comorbidities. They were also less likely to have a partner or have used menopausal hormone therapy. Sleep disturbances increased proportionally with VMS severity (p < 0.01). In multivariate analysis, sleep disorders were associated with VMS (odds ratio [OR] 4.47), psychotropic use (OR 1.84), obesity (OR 1.45) and comorbidities (OR 1.45). Conclusion: Women with VMS were more likely to experience sleep disorders and this effect was proportional to the magnitude of the hot flashes. The study also presents several factors associated with sleep disorders in postmenopausal women that should be considered to help prevent these disturbances.
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Sleep disturbances are associated with cognitive impairment in postmenopausal women
(2025)
Álvaro Monterrosa-Castro
;
Peter Chedraui
;
Juan E. Blümel
;
Alejandra Elizalde-Cremonte
;
María T. Espinoza
To evaluate the association between severe sleep problems and mild cognitive impairment (MCI) in postmenopausal women, we conducted a sub-analysis of a cross-sectional, multinational investigation between January and November 2023 among postmenopausal women younger than 70 years attending gynecological consultations in nine Latin American countries. MCI was assessed using the Montreal Cognitive Assessment (MoCA) tool, and severe sleep problems were evaluated with two validated instruments: the third question of the Menopause Rating Scale (MRS, score ≥3) and the Jenkins Sleep Scale (JSS, total score ≥12). Two adjusted logistic regression models were used to examine the association between the two measures of severe sleep problems and MCI, adjusting for relevant covariates. The analysis included 1,185 postmenopausal women with a mean age of 56.9 years. Severe sleep problems were significantly more frequent among women with MCI compared to those without MCI, whether assessed by the MRS (28.3 percent vs. 16.6 percent) or the JSS (31.6 percent vs. 18.4 percent; both p <.001). In adjusted regression models, severe sleep problems remained independently associated with MCI (MRS: aOR = 1.81, 95 percent CI: 1.26–2.60; JSS: aOR = 1.88, 95 percent CI: 1.31–2.69). Additional factors associated with a higher likelihood of MCI included physical inactivity and greater parity, while ever-use of menopausal hormone therapy and higher educational attainment were associated with a reduced likelihood of MCI. In this sample of postmenopausal Latin American women, severe sleep problems were associated with a higher likelihood of MCI, and factors such as physical inactivity, educational attainment, parity, and ever use of menopausal hormone therapy were also independently related to this condition
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Association between type of menopause and mild cognitive impairment: The REDLINC XII study
(2024)
María T. Espinoza
;
Juan E. Blümel
;
Peter Chedraui
;
María S. Vallejo
;
Mónica Ñañez
Objective: To evaluate the association between type of menopause (spontaneous or surgical) and mild cognitive impairment (MCI). Study design: This study was a cross-sectional, observational, and sub-analytical investigation conducted within gynecological consultations across nine Latin American countries. Method: We assessed sociodemographic, clinical, and anthropometric data, family history of dementia, and the presence of MCI using the Montreal Cognitive Assessment (MoCA) tool. Results: The study involved 1185 postmenopausal women with a mean age of 55.3 years and a body mass index of 26.4 kg/m2. They had an average of 13.3 years of education, and 37 % were homemakers. Three hundred ninety-nine experienced menopause before 40, including 136 with surgical menopause (bilateral oophorectomy). Out of the 786 women who experienced menopause at 40 or more years, 110 did so due to bilateral oophorectomy. There were no differences in MoCA scores among women who experienced menopause before or after the age of 40. However, lower MoCA scores were observed in women with surgical menopause than in those with spontaneous menopause (23.8 ± 4.9 vs. 25.0 ± 4.3 points, respectively, p < 0.001). Our logistic regression model with clustering of patients within countries found a significant association between MCI and surgical menopause (OR 1.47, 95 % CI: 1.01–2.16), use (ever) of menopausal hormone therapy (OR 0.33, 95 % CI: 0.21–0.50), and having >12 years of education (OR 0.21, 95 % CI: 0.14–0.30). Conclusion: When comparing women who experience spontaneous menopause over the age of 40 with those who undergo it before this age, there was no observed increased risk of developing MCI, while those with surgical menopause, independent of age, are more prone to cognitive decline. Women who have ever used menopausal hormone therapy have a lower MCI risk. Further research is warranted to delve deeper into this topic.
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Impact of hysterectomy without oophorectomy on the health of postmenopausal women: Assessment of physical, psychological, and cognitive factors
(2025)
Juan E. Blümel
;
Peter Chedraui
;
María S. Vallejo
;
Carlos Escalante
;
Gustavo Gómez-Tabares
Objective: To determine the impact of hysterectomy without bilateral oophorectomy on the physical, psychological, and cognitive health of postmenopausal women. Methods: This study was a sub-analysis of a cross-sectional, observational study carried out during gynecological consultations in nine Latin American countries. We collected sociodemographic and clinical data and evaluated the women's health using the EQ-5D for health status, the Menopause Rating Scale for menopausal symptoms, the 6-item Female Sexual Function Index for sexual function, the Jenkins Sleep Scale for sleep disturbances, the SARC-F for the risk of sarcopenia, and the Montreal Cognitive Assessment test for cognitive function. Results: The sub-analysis involved 782 postmenopausal women with an average age of 56.9 years and an average body mass index of 26.5 kg/m2. The participants had an average of 13.9 years of education, and 45.9 % of them had a university degree. The group of 104 women who had undergone hysterectomy without oophorectomy had a higher body mass index (27.5 ± 4.9 vs 26.3 ± 5.1 kg/m2, p < 0.03), displayed more comorbidities (63.5 % vs 41.7 %, p < 0.001), worse self-perceived health (Odds ratio, OR 2.00, 95 % CI: 1.27–3.15), higher rates of severe menopausal symptoms (OR 2.39, 95 % CI: 1.51–3.77) and sleep disturbances (OR 1.75, 95 % CI: 1.10–2.79), and a higher likelihood of sarcopenia (OR 1.74, 95 % CI: 1.03–2.97) than those who had not undergone hysterectomy. No significant differences were observed regarding sexual function or cognitive performance between the two groups. Moreover, in the six assessed health domains, menopausal hormone therapy (ever use) was found to be a protective factor, regardless of whether or not the woman had undergone a hysterectomy. Conclusion: Women who undergo hysterectomy without oophorectomy may experience persistent physical and psychological symptoms that affect their mental health and quality of life. Menopausal hormone therapy is associated with improved health outcomes.
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Association of menopausal symptoms on work performance in midlife Latin American women
(2026)
Konstantinos Tserotas
;
Juan E. Blümel
;
Peter Chedraui
;
María S. Vallejo
;
Mónica Ñañez
OBJECTIVE: To explore the association between the severity of menopausal symptoms and work-related outcomes and performance. METHODS: This cross-sectional study involved 3,523 women aged 40-60 from 30 health care centres across 12 Latin American countries. The severity of menopausal symptoms was assessed with the Menopause Rating Scale (MRS). Work-related outcomes were surveyed, including absenteeism, medical visits, perceived reduced work performance, impact of menopause on work performance, and job loss. Comparisons employed suitable tests based on data distribution, and logistic regression was used to assess associations, adjusting for covariates such as menopausal symptoms, comorbidities, age, and education. RESULTS: Women with severe menopausal symptoms (total MRS score ≥14 points) were significantly older (51.1 ± 5.1 vs 49.7 ± 5.6y), had a higher body mass index (27.4 ± 4.8 vs 26.7 ± 4.6 kg/m 2 ), were postmenopausal in a higher proportion (69.9% vs 52.2%), had more comorbidities (42.8% vs 27.6%), higher smoking prevalence, and lower educational attainment. In addition, these women significantly reported more medical leaves (42.4% vs 29.5%), more medical visits (mean: 3.9 vs 2.5 visits), and a more significant perceived reduction of work performance (82.1% vs 56.7%). They also were more likely to believe that menopause significantly reduced their work capacity (67.0% vs 24.0%), had a higher prevalence of job dismissals (6.9% vs 2.0%), and more voluntary resignations or early retirements (8.1% vs 4.7%). Binary logistic regression determined that severe menopausal symptoms, subsequently adjusted for covariates, were primarily associated with more work absenteeism (aOR: 1.64; 95% CI: 1.41-1.90), more medical visits (aOR: 2.45; 95% CI: 1.97-3.05), decreased work performance (aOR: 3.13; CI 95%: 2.65-3.69), the perception of menopause negatively impacting their work performance (aOR: 5.84; 95% CI: 5.01-6.80), more job dismissals (aOR: 3.23; 95% CI: 2.21-4.72), and more voluntary resignations or early retirements (aOR: 1.44; 95% CI: 1.08-1.93). CONCLUSION: In this large sample of midlife Latin American women, severe menopausal symptoms were associated with reduced work capacity and adverse work-related outcomes. Copyright © 2025 by The Menopause Society.
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Severity of menopausal symptoms is associated with lower work-related quality of life and job satisfaction in midlife Latin American women: REDLINC XIII
(2026)
María S. Vallejo
;
Juan E. Blümel
;
Peter Chedraui
;
Juan Matsumura-Kasano
;
Paolo Meza
Background: Female participation in the workforce has increased, particularly among women over 50; hence, the influence of menopause on occupational well-being requires greater attention. Although the epidemiology of climacteric symptoms has been well documented, their impact on job satisfaction and work-related quality of life remains underexplored, especially in low- and middle-income countries, and is virtually absent from large, multinational studies in Latin America. Objective: To evaluate the relationship between severe menopausal symptoms and occupational well-being among salaried, employed midlife women in Latin America. Methods: A cross-sectional study was conducted between June 2024 and January 2025 across 30 centres in 12 Latin American countries, with a total of 2035 employed women (aged 40 to 60 years). Menopausal symptoms were assessed with the Menopause Rating Scale, and occupational well-being domains were assessed using the Work-Related Quality of Life Scale and the Job Satisfaction Scale. Hierarchical multiple linear regression analyses were conducted to assess the contribution of menopausal symptom severity to occupational well-being. Results: Women with severe menopausal symptoms scored significantly lower across all domains of both the Job Satisfaction Scale and the Work-Related Quality of Life Scale. Hierarchical regression analyses showed that menopausal symptoms were the strongest predictors of job satisfaction (R2 = 0.133). Higher education, menopausal hormone therapy use, and physical activity were positive predictors, whereas number of children, comorbidities, psychotropic medication use, and higher body mass index were associated with lower job satisfaction. For work-related quality of life (R2 = 0.121), education, physical activity, and sexual activity were the main positive predictors, while psychological and severe menopausal symptoms were the strongest negative predictors. The final models explained 13.3% of the variance in job satisfaction and 18.7% in work-related quality of life. Conclusions: This study, one of the first large multinational analyses in Latin-American, shows that the severity of menopausal symptoms is negatively associated with occupational well-being. These findings highlight the necessity for workplace strategies and public policies that recognise menopause as a significant determinant of women's occupational well-being. © 2026 Elsevier B.V.
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Physical activity as an alternative or adjunct to menopausal hormone therapy for symptom management in women with primary ovarian insufficiency
(2026)
Félix Ayala
;
Juan E. Blümel
;
María S. Vallejo
;
Peter Chedraui
;
Hugo Gutiérrez-Crespo
Background: Physical activity alleviates menopausal symptoms in women whose menopause occurs after the age of 45; however, its effect in primary ovarian insufficiency, which occurs before the age of 40, remains unknown. Objective: To examine the association between physical activity, menopausal symptoms, and the use of menopausal hormone therapy in women with primary ovarian insufficiency. Methods: We analysed data from 4708 participants from two studies conducted in 12 Latin American countries. After applying eligibility criteria, 564 women with primary ovarian insufficiency (351 idiopathic and 213 surgical) were included. Menopausal symptoms were assessed using a validated scale, and severe symptoms were defined according to established cut-offs. Physical activity was classified according to international recommendations for moderate-intensity activity. Logistic regression models were adjusted for sociodemographic, clinical, and lifestyle variables. Results: The prevalence of severe menopausal symptoms was 39.2%, with no significant difference between idiopathic and surgical primary ovarian insufficiency. Women with severe symptoms were less likely to meet recommended levels of physical activity or to be current users of menopausal hormone therapy. In adjusted models, regular physical activity (OR 0.65; 95% CI 0.45–0.94) and current use of menopausal hormone therapy (OR 0.27; 0.17–0.42) were associated with a lower likelihood of severe symptoms, whereas obesity and use of psychotropic medication were associated with a higher likelihood. Conclusions: Women with primary ovarian insufficiency who engage in regular physical activity or currently use menopausal hormone therapy report less severe menopausal symptoms. Regular exercise may be an important non-hormonal option for women who cannot or prefer not to use hormone therapy. © 2026 Elsevier B.V.
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Association of muscle disorders in late postmenopausal women according to the type of experienced menopause
(2024)
María S. Vallejo
;
Juan E. Blümel
;
Peter Chedraui
;
Konstantinos Tserotas
;
Carlos Salinas
Objective Musculoskeletal disorders frequently affect postmenopausal women. This study aims to compare muscle disorders between women according to the type of experienced menopause: premature (PM) or normal age of menopause (NAM). Methods This was a cross-sectional study conducted in nine Latin American countries in which late postmenopausal women (55 to 70 years) were surveyed with a general questionnaire, the Menopause Rating Scale (MRS: item #4 exploring musculoskeletal discomfort), and strength, assistance with walking, rising from a chair, climbing stairs, and falling questionnaire (risk of sarcopenia). Results A total of 644 women were included: 468 who had NAM, and 176 who had PM (116 spontaneous and 60 surgical). The overall mean age of the participants was 60.9 ± 4.2 years. Women who had PM experienced more musculoskeletal discomfort (33.5% vs 20.9%, P < 0.001) and a higher likelihood of sarcopenia (35.2% vs 19.9%, P < 0.001) than women who had a NAM. Women who had surgical PM exhibited a higher prevalence of severe musculoskeletal discomfort (46.7% vs 29.3%, P < 0.02) and a higher likelihood of sarcopenia (45.0% vs 27.6%, P < 0.02) than women who had a NAM. After adjusting for covariates (age, body mass index, menopausal hormone therapy use, physical activity, education, cigarette consumption, use of antidepressants, sexual activity, comorbidities, and having a partner), our logistic regression model determined that spontaneous PM was not associated with higher odds of musculoskeletal discomfort and higher odds of sarcopenia. On the other hand, women who had surgical PM were more likely to experience musculoskeletal discomforts (odds ratio: 2.26; 95% confidence interval: 1.22-4.17) and higher odds for sarcopenia (odds ratio: 2.05; 95% confidence interval: 1.16-3.65) as compared to women who experienced a NAM. Conclusions Women experiencing surgical PM have a higher likelihood of developing muscle disorders. This underscores the potential significance of hormonal levels in influencing musculoskeletal health during postmenopause.
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Severe menopausal symptoms linked to cognitive impairment: an exploratory study
(2024)
Calle Miñaca, Andrés
;
Juan E. Blümel
;
Peter Chedraui
;
María S. Vallejo
;
Alejandra Belardo
Objective To evaluate the association between menopausal symptoms and cognitive decline in postmenopausal women. Methods This was a subanalysis of a cross-sectional, observational study conducted among women attending gynecological consultations across nine Latin American countries. The survey involved late postmenopausal women who were asked to complete a general questionnaire and the Menopause Rating Scale (MRS) to assess menopausal symptoms, with the Montreal Cognitive Assessment used to evaluate cognitive function as an outcome. A Montreal Cognitive Assessment score of less than 21 was used to define women with mild cognitive impairment (MCI). Results The study included 1,287 postmenopausal women with a mean age of 55.5 years and a mean body mass index of 26.3 kg/m2. On average, participants had 13.8 years of education and 2.3 ± 1.8 children, with 72.8% reporting having a partner. Additionally, 36.7% ever used menopausal hormone therapy. Regarding lifestyle factors, 50.3% engaged in a sedentary lifestyle, whereas 70.5% had never smoked. 15.3% of women had MCI exhibited significantly more intense menopausal symptoms compared with those without MCI (MRS total score 15.24 ± 12.58 vs 10.53 ± 8.84, respectively, P < 0.001). Logistic regression analysis revealed a significant association between severe menopausal symptoms (MRS total score ≥14 points) and MCI (odds ratio [OR], 1.74; 95% CI, 1.25-2.42). Conversely, a lower body mass index (OR, 0.96; 95% CI, 0.95-0.98), sexual activity (OR, 0.70; 95% CI, 0.51-0.96), physical exercise (OR, 0.55; 95% CI, 0.39-0.76), menopausal hormone therapy use (OR, 0.36; 95% CI, 0.24-0.55), and higher educational level (OR, 0.31; 95% CI, 0.21-0.46) were associated with lower odds for MCI. Conclusion Severe menopausal symptoms in postmenopausal women were associated with cognitive impairment. This study highlights the intricate interplay between hormonal, lifestyle, and sociodemographic factors and cognitive health.
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Severe obesity and menopause symptoms are associated with cognitive impairment in postmenopausal women from Latin America
(2025)
Juan Enrique Blümel
;
Maria Soledad Vallejo
;
Peter Chedraui
;
Socrates Aedo
;
Marcio Alexandre Hipolito Rodrigues
Objective: This study aimed to evaluate the association between obesity and cognitive impairment. Methods: This study is a sub-analysis of an observational, cross-sectional study in nine Latin American counties. Sociodemographic, clinical and anthropometric data were collected, and cognition was assessed using the Montreal Cognitive Assessment (MoCA) tool in 722 postmenopausal women. Results: The mean age, body mass index (BMI) and years of education of the cohort were 56.9 years, 26.8 kg/m2 and 13.6 years, respectively. Women with cognitive impairment, compared to those without, had a higher BMI (27.8 ± 5.9 vs. 26.6 ± 4.9 kg/m2, p = 0.037), had more children (3.1 ± 2.4 vs. 2.5 ± 1.7, p = 0.023), experienced more severe menopausal symptoms (56.3% vs. 31.9%, p < 0.001) and presented more comorbidities (60.0% vs. 43.8%, p = 0.006). They also had fewer years of study (10.8 ± 5.1 vs. 13.9 ± 4.9 years, p = 0.001), were less physically active (35.0% vs. 49.1%, p = 0.018) and were less likely to use menopausal hormone therapy (MHT) (11.3% vs. 28.8%, p = 0.001). In binary logistic regression analysis, BMI ≥ 35.0 kg/m2 (odds ratio [OR] 2.27, 95% confidence interval [CI] 1.08–4.76) and severe menopausal symptoms (OR 2.10, 95% CI 1.29–3.43) were associated with cognitive impairment. In the model, factors related to lower risk were ever use of MHT (OR 0.44, 95% CI 0.21–0.92) and having more years of education (OR 0.38, 95% CI 0.20–0.64). Conclusion: Severe obesity and severe menopausal symptoms increased the risk of cognitive impairment in postmenopausal women, while higher education and ever use of MHT were protective factors.
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Calle Miñaca, Andrés

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