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MENOPAUSE, ANDROPAUSE 

The "male menopause" (sometimes called the andropause) is an unhelpful term sometimes used in the media. This label is misleading because it suggests the symptoms are the result of a sudden drop in testosterone in middle age, similar to what occurs in the female menopause.

Aging is associated with gender-specific hormonal changes that progressively lead to gonadal insufficiency, a condition which characterizes a minority of men and all women. Work-related factors, such as stress and pollutant exposure, affect gonadal function and can interfere with reproduction in both genders.

 

A systematic review of the PubMed, SCOPUS and EMBASE databases was conducted, according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) statement to investigate the effect of occupational factors on andropause and menopause.

 

A total of 26 studies met the inclusion and exclusion criteria: 9 studies evaluated the effects of work on andropause symptoms, 8 studies examined its effects on age at menopause onset, and 9 studies addressed its effects on menopausal symptoms. Work-related factors, such as psychological stress, physical effort, and sleep disorders, showed a significant correlation with andropause manifestations, whereas age at menopause and severity of menopausal symptoms were both influenced by factors such as pesticide exposure, high job strain, and repetitive work. Since work accompanies men and women for most of their lives, it is essential to identify and prevent the risk factors that may affect reproductive health.

1. Introduction

Aging is associated with modifications of the hypothalamic–pituitary–gonadal (HPG) axis, which in females lead to menopause and in a variable proportion of males lead to a clinical entity called andropause or, according to more recent terminology, late-onset hypogonadism (LOH).

The physiological age of menopause is on average 46 years; the diagnosis is made retrospectively after at least 12 months of amenorrhea . The Stages of Reproductive Aging Workshop + 10 (STRAW + 10) criteria, which are based on menstrual bleeding patterns, were established in 2001 and updated in 2012 . Vasomotor symptoms affect 80% of women, but their pathophysiology is not clearly understood. Notably, aside from reduced circulating estrogen, increased responsiveness of the hypothalamic thermoregulatory zone to changes in body temperature are believed to be affected by central mechanisms mediated by hormonal stimuli (e.g., high levels of luteinizing hormone (LH) from the pituitary gland) or local factors (e.g., hypothalamic neurokinin B).

Unlike aging women, most men do not experience a dramatic decline in gonadal function. In fact, although morning serum testosterone (T) levels decline progressively over time, only 20% of adults aged 65 years or more have T levels below the normal range for young men. In addition, unlike menopausal symptoms, most of the signs and symptoms of LOH are mild and difficult to distinguish from the effect of aging per se.

 

From a pathophysiological point of view, aging is associated with a progressive reduction in testicular T production as an effect of Leydig cell degeneration and of atherosclerosis of testicular arterioles. However, in most men, an increase in LH compensates for the reduced function of the testis and maintains adequate T levels, preventing the appearance of signs of hypogonadism. Additional factors, such as chronic diseases or obesity, which become more frequent with aging, can reduce HPG axis activity, disrupting the compensatory mechanisms and making hypogonadism clinically evident.

Work accompanies individuals of both genders for much of their lives and through all stages of adult life. The effects of the work environment combine with those of aging and of chronic conditions to determine the ultimate health status of the older person; occupational stress is an additive factor in the perception of menopause and LOH symptoms .

Menopause and LOH are both associated with increased cardiovascular mortality and the loss of sex hormones; combined with age-associated immunosuppression and chronic inflammation, they may contribute to define the patterns of cancer incidence and mortality in the elderly.

In recent years, a longer life expectancy has been paralleled by a later retirement age, increasing the proportion of older people in the workforce. Since work, aging, and hormonal changes appear to be closely linked in the later stages of life, it is essential to understand the influence of work on menopause and LOH and the mechanisms underlying these phenomena.

 

This review of the studies that have explored these aspects was conducted according to the PICO (Patient Intervention Comparison Outcome) model—P: general population or workers; I: aging and work-related conditions; C: comparison with no employment or between different types of employment; O: age at onset and signs/symptoms of andropause or menopause. We also assessed the quality of the available evidence according to the Cambridge Quality Checklists (CQCs).

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