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The study acronym ERMA comes from the title Estrogenic Regulation of Muscle Apoptosis that was used in the grant application for ERMA study. Accordingly, one of the main aims of ERMA was to understand hormonal aging and menopause associated changes in skeletal muscle. In addition to biological mechanisms, ERMA investigates menopause-related hormonal changes in the broader context of women's physiology and mental well-being ().

ERMA baseline study collected age cohort of 47–55-years old women, About 80% of the age cohort was invited to participate.The data was collected during four different phases. Phases 1 (pre-questionnaires), 2 (questionnaires and blood sampling) and 3 (lab visit for physiological measurements) are cross-sectional and were conducted during 2014–2016. According to the blood hormones and menstruation diaries the women were divided into the groups of premenopause, early perimenopause, late perimenopause and postmenopause. In the phase 3, a large questionnaire, health screening, body composition analysis, and measurements for physical performance, functional capacity and cognition were executed. In addition, for some participants, thigh and leg were imaged with CT scan and muscle biopsies were obtained. The participants were also provided with physical activity monitors that were returned after a 7-day measurement period.

The women in the groups of perimenopause will take part in the longitudinal part of the ERMA study (phase 4). This phase ended by the end of 2018. The participating women took part in follow-up measurements every 3 to 6 months. In this phase, blood samples were obtained, body composition was measured, and the participants filled in a questionnaire. The measurements of physical activity, using questionnaires as well as accelerometer, was also repeated. As soon as a woman had past the menopause and entered at postmenopausal stage, the measurements that were performed at baseline in the phase 3 were be repeated.

The phase 5 of the ERMA study is the EsmiRs-follow-up study that was started at Autumn 2018.

Physical health examination

Weight, height, waist-to-hip ratio and blood pressure were measured and the blood sample for complete blood counts (CBC) was taken in the physical health examination carried out by a nurse. Furthermore, the overall health was assessed based on the questionnaire and interview. If necessary, further examination was carried out by a medical doctor before the physical performance tests.

Questionnaires

In addition to basic information, the questionnaires are used for assessing the socioeconomic status (e.g. level of education, occupational status), life habits (e.g. sleeping, physical activity, nutrition, smoking), psychological factors (e.g. experience of age, personality, mental well-being) and gynecologic variables (e.g. menopausal symptoms, the use of hormonal products). 

Blood sampling

Venous blood samples were taken after overnight fasting. The samples were used for measuring the concentration of sex steroid hormones and follicle-stimulating hormone (FSH). FHS is used together with menstrual bleeding diaries for determining the menopausal status. Furthermore, the blood samples are used for determining other health-related factors, such as blood sugar levels, cholesterol levels, complete blood counts, in addition to genetic testing (DNA/RNA/proteins) and other biomarkers.

Muscle strength and power

Grip strength and maximal isometric knee extension force were measured using a dynamometer chair. Lower body muscle power was assessed by studying the force production during a vertical jump.

Body composition

The percentages of fat-free mass, body fat mass and the characteristics of the bones were assessed by bioimpedance analysis (Inbody 720) and Dual-energy X-ray absorptiometry (DXA).

Test of the walking performance

Two different walk tests were used. The maximal walking speed was measured using a 10-meter walk test and the aerobic capacity was tested using a 6-minute walk test. During the 6-minute walk test, heart rate and perceived exertion were measured in addition to the distance covered over a 6-minute time.

Cognitive function

Cognitive performance was assessed with traditional pen-and-paper tests. The tests were used, e.g., for evaluating linguistic fluency, memory, orderliness and flexibility of action in addition to psychomotor learning. 

Muscle biopsy

Muscle biopsies were taken from vastus lateralis muscle using a muscle biopsy needle from a sub-sample of participants. The biopsies are used for studying how estrogen affects muscle function and examining the cellular-level muscle composition.

CT scan

From the sub-sample of the participants, lower extremity muscle size and composition was assessed using a CT scan (computer tomography scan) that uses the combination of computer and X-rays to create cross-sectional images of the body. CT-scans were done at the Hospital Nova of the Central Finland Wellbeing county (prev, Central Finland Health Care district).

Physical activity

In addition to physical activity assessment using questionnaires, physical activity was also measured with ActiGraph-accelerometers. An accelerometer was worn for seven consecutive days on the right hip during the waking hours to capture all activities during the 7 days. These measurements were conducted in collaboration with Likes by Jamk.

EsmiRs

In the EsmiRs research project, four-year follow-up measurements were carried out for those participants of the ERMA study who were willing to continue in the new study. EsmiRs is a separate research project that investigates the biological functional mechanisms of the female sex hormone estrogen. By combining the data, it is possible to study the effects of menopause over a longer follow-up period.

The MATCH research project investigates the effects of menopause on HDL particle composition and function. As research data, the MATCH project uses blood samples from the ERMA and EsmiRs studies and data from the women who participated in these studies.

PANINI was European PhD training network project that ended 2021. Sarianna Sipilä was Finnish PI of the network. Dmitriy Bondarev was PhD student trained by PANINI (supervisors Sarianna Sipilä, Taija Juutinen and Katja Kokko) and he used ERMA research data for his thesis to understand meaning of psychological factors and physical activity on middle-aged women's neuromuscular functioning. Bondarev's dissertation was 20.5.2022 from the topic:

PATHWAY

PATHWAY-research project investigates individual factors related to exercise habits. Of particular interest is whether personality influences the adoption of an active lifestyle or exclusion from exercise. The ERMA research data is one of the three research datasets used in the PATHWAY project.  Research Director Katja Kokko is PI of the Pathway-study.