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President’s Report


Dear Friends and Colleagues,

The preliminary notice of convocation of the IMS General Assembly has been sent out. It will be held on Friday October 28th, 18:30-19:30 at the 18th IMS World Congress on Menopause at the Lisbon Congress Centre, Praça das Indústrias, 1300-307 Lisbon, Portugal.

The notice contains the invitation for nominations for the 2022-2024 IMS Board of Directors and directions for submitting a nomination. In order to be nominated, an individual needs to be a member in good standing: a full member for the current and previous year, or continuously in the previous two years. All nominations must be received by 30th July 2022. The election will take place in August. Please contact Rebecca Cheshire if you have any questions rebecca.cheshire@imsociety.org.

I strongly encourage eligible members to consider running for a seat on the Board. Working closely with colleagues from across the globe to shape the strategic direction and develop resources for the Society is invigorating and enlightening. The Board is very active so one needs to be prepared and able to commit time and effort.

The scientific program for the World Congress can be found here on the congress website. We are incredibly proud of this exciting program, which includes twenty symposia in Portuguese and Spanish. Please register here, if you haven’t already, you will not want to miss this event.

We have received an impressive number of abstracts. We have received a lot of requests for a deadline extension and for this reason we have decided to re-open abstract submission. The new deadlines are:

  • Monday 4th July for Oral Communication and The Greenblatt Award
  • Monday 18th July for Poster Presentation

This is the very last chance to submit a scientific work, so please inform your colleagues and/or young researchers who might be interested in sending their papers, to submit their work as soon as possible.

Finally, a reminder that the Education Committee is welcoming expressions of interest from new members. Please contact Rebecca Cheshire for more information.

I always welcome your comments and suggestions.

Until next month,
Steve Goldstein
steven.goldstein@imsociety.org

 


General Update


The 24th webinar in the IMS webinar series will be held on Tuesday 12th July 15.00 (CET).  The webinar “Osteoporosis for midlife women and beyond will be moderated by Professor Peter Schnatz. Professor Michael Lewiecki will be presenting “Review of the current guidelines on diagnosis and when to treat” and Professor Michael McClung will be presenting “The current and best therapeutic options”. The link for registrations is Online Events – International Menopause Society (imsociety.org)

The 23rd webinar in the IMS webinar series was held on Tuesday 21st June.  The webinar was moderated by Professor Steven Goldstein. Professor James Simon presented “Body weight-what happens at menopause?” and Professor Angela Fitch presented “What treatment strategies can we offer for obesity?” This is now available on IMS Webinars

Recordings of the Clinical Colloquium in Midlife Women’s Health sessions are available exclusively for IMS members via this link. The first three sessions are available: “Bone Health for the Generalist: Not just Osteoporosis”; “Cardiovascular Issues for Midlife Women”; and “Cognition and Mood”.

Our latest 1-1 interview series topic “Menopause and Diabetes Mellitus” with Professor Irene Lambrinoudaki is now available on the IMS website. Click here to view or download it in either video or podcast formats.

 


International Society Meetings 2022


2nd World Congress on Women’s Health: Innovations and Inventions
Date: 11th July 2022
Location: Tel Aviv
For more information visit https://whii.comtecmed.com/program

Aesthetic Gynecology Conference
Date: 28th July – 29th July
Location: Cairo
For more information visit https://amasedu.com/conference-details/1

North American Menopause Society Annual Meeting 
Date: 12th – 15th October 2022
Location: Atlanta, GA
For more information visit 2022 Meeting (menopause.org)

18th IMS World Congress on Menopause
Date: 26th – 29th October 2022
Location: Lisbon, Portugal
Abstract submission deadline for Oral Presentations – 4th July 2022
For more information visit https://www.imslisbon2022.com

 


Menopause and mid-life women’s health publication news


Top Sexual Health Concerns of Midlife Women Include Pain and Lack of Desire
New NAMS video encourages women to initiate conversations with healthcare professionals to seek help for sexual dysfunction that affects 60% to 80% of perimenopausal and postmenopausal women
https://www.menopause.org/docs/default-source/press-release/sexual-health-concerns-june-video-release.pdf

Phase 3 study finds fezolinetant reduces the frequency and severity of menopausal hot flashes
The Endocrine Society
https://www.eurekalert.org/news-releases/955094

Evidence-based recommendations on menopause management advise individualized care
Society for Endocrinology
https://www.eurekalert.org/news-releases/955317

Hormones are linked with sleep apnea, snoring in postmenopausal women.
Study found an association between obstructive sleep apnea risk and low estrogen and progesterone levels in women  
PLOS
https://www.eurekalert.org/news-releases/956246


Free access to selected papers recently published in Climacteric


By way of a special arrangement with our publishers, Taylor & Francis, our journal Climacteric is able to offer Free Access to some recently published papers for a limited time.

Two papers from Climacteric 2022, Volume 25, June Issue, chosen by our Editor, Professor Rod Baber, have Free Access for the next 3 months.

There are also four Open Access papers in the June issue

The Abstracts from these Free Access and Open Access papers have been translated into Spanish. The Editor of Climacteric would like to thank Peter Chedraui, one of Climacteric’s Associate Editors, for providing the translations.


Use of aromatase inhibitors in menopausal deep endometriosis: a case report and literature review
O. Rotenberg, et al.
https://www.tandfonline.com/doi/full/10.1080/13697137.2021.1990259
Free Access

Spanish translation:
Rotenberg O, Kuo DYS, Goldberg GL. Uso de inhibidores de la aromatasa en la endometriosis profunda menopáusica: reporte de un caso y revisión de la literatura. Climacteric. 2022;25(3):235-239. doi: 10.1080/13697137.2021.1990259.

Resumen
Presentamos y revisamos la eficacia clínica de los inhibidores de la aromatasa en una paciente con endometriosis refractaria, recurrente e infiltrante. Demostramos excelentes respuestas clínicas, radiológicas y endoscópicas después del fracaso de muchas otras modalidades. Nuestro caso y la literatura muestran que el letrozol como agente único es capaz de tratar la endometriosis infiltrante profunda que involucra el recto y el tracto urinario. El uso del tratamiento con inhibidores de la aromatasa para la endometriosis en mujeres postmenopáusicas tiene sentido, es seguro y se tolera bien. Los casos difíciles de endometriosis infiltrante profunda pueden requerir el uso de modalidades combinadas de tratamiento médico y quirúrgico. Puede ser necesaria la participación multidisciplinaria del ginecólogo, el cirujano intestinal, el urólogo y el radiólogo invasivo. Los inhibidores de la aromatasa deben considerarse una parte integral del arsenal en el tratamiento de mujeres con endometriosis, especialmente en casos refractarios que han fallado en las modalidades terapéuticas convencionales.

Palabras claves: inhibidores de la aromatasa; endometriosis; sangrado vaginal


Menopause status and climacteric symptoms in a birth cohort of mid-life New Zealand women
G. F. H. McLeod, et al.
https://www.tandfonline.com/doi/full/10.1080/13697137.2021.1948005
Free Access

Spanish translation:
McLeod GFH, Cleland L, Welch J, Spittlehouse JK, Fenton A, Boden JM, Horwood LJ. Estado de la menopausia y síntomas climatéricos en una cohorte de nacimiento de mujeres neozelandesas de mediana edad. Climacteric. 2022;25(3):271-277. doi: 10.1080/13697137.2021.1948005.

Resumen
Antecedentes:
Existe poca investigación actualizada sobre la transición a la menopausia natural entre grupos contemporáneos de mujeres de mediana edad a los 40 años.
Objetivo: Este estudio informa sobre las mujeres miembros de la cohorte del Estudio de Salud y Desarrollo de Christchurch. Esta investigación tuvo como objetivo: documentar el estado de la menopausia, los resultados reproductivos y los síntomas climatéricos de las mujeres a los 40 años; examinar las asociaciones entre el estado de la menopausia y las medidas simultáneas de bienestar psicosocial y económico; y documentar las asociaciones entre el estado de la menopausia y los predictores potenciales de la menopausia que reflejan factores de la infancia, la familia y el individuo antes de los 40 años.

Métodos:
El Estudio de Salud y Desarrollo de Christchurch es una cohorte longitudinal, representativa y prospectiva de 1,265 bebés (630 mujeres) nacidos en Nueva Zelanda en 1977. A la edad de 40 años, 470 mujeres (que no habían experimentado menopausia quirúrgica) fueron entrevistadas sobre su estado de menopausia, síntomas climatéricos y factores asociados.

Resultados:
La mayoría de las mujeres eran premenopáusicas, alrededor del 20% eran perimenopáusicas y el 2% eran postmenopáusicas. Se encontraron asociaciones estadísticamente significativas que reflejan tasas más altas de diagnóstico de trastornos reproductivos, síntomas climatéricos, estatus ocupacional bajo, sexualidad no heterosexual y exposición al abuso sexual infantil entre mujeres perimenopáusicas y postmenopáusicas a los 40 años.

Conclusión:
Estos datos informarán directrices para la recopilación y el análisis de datos en el futuro.

Palabras claves: Cohorte longitudinal de nacimiento; Fertilidad; menopausia; perimenopausia; mujeres; wahine maorí.


Weight gain in menopause: systematic review of adverse events in women treated with black cohosh
B. Naser, et al.
https://www.tandfonline.com/doi/full/10.1080/13697137.2021.1973993
Open Access

Spanish translation:
Naser B, Castelo-Branco C, Meden H, Minkin MJ, Rachoń D, Beer AM, Pickartz S. Aumento de peso en la menopausia: revisión sistemática de eventos adversos en mujeres tratadas con cohosh negro.  Climacteric. 2022;25(3):220-227. doi: 10.1080/13697137.2021.1973993.

Resumen
El aumento de peso es un problema frecuente en mujeres perimenopáusicas y postmenopáusicas. La cimicifuga racemosa (CR) es una opción de tratamiento popular para los síntomas de la menopausia. El objetivo de esta revisión fue investigar si existe evidencia científica de que la CR provoque aumento de peso. Se realizaron búsquedas en nuestra base de datos de eventos adversos espontáneos médicamente confirmados relacionados con el aumento de peso, en la literatura para informes de casos y ensayos controlados aleatorios. Treinta casos en total se informaron espontáneamente en 15 años. La causalidad no se consideró cierta/probable en ninguno de los casos. Una enfermera (consumidora) evaluó la causalidad como posible. Solo un caso fue publicado en la literatura. Sin embargo, no se informó ningún cambio en la composición de la grasa corporal y la causalidad parece poco probable. De los 31 estudios identificados, 17 fueron doble ciego controlados con placebo, cinco fueron doble ciego controlados por referencia y nueve fueron abiertos controlados por referencia. En total, 1,839 mujeres fueron tratadas con CR hasta por 12 meses. Dos estudios informaron el aumento de peso como un evento adverso; sin embargo, no se observaron diferencias significativas en los cambios de peso entre los grupos. Se informó un caso de aumento de peso (alrededor de 2 kg), pero los autores no especificaron en qué grupo de tratamiento. En conclusión, este estudio no proporciona evidencia científica de que el uso de CR cause aumento de peso en mujeres menopáusicas.

Palabras claves: Actaea racemosa; Cimicifuga racemosa; Hypericum perforatum; eventos adversos; cohosh negro; extracto isopropanólico; menopausia; aumento de peso.


Swiss consensus on the role of DHEA in the management of genitourinary syndrome of menopause
P. Stute, et al.
https://www.tandfonline.com/doi/full/10.1080/13697137.2021.2008894
Open Access

Spanish translation:
Stute P, Bertschy S, Birkhaeuser M, Bitzer J, Ging A, Raggi A, Steimann S, Stute V. Consenso suizo sobre el papel de la DHEA en el tratamiento del síndrome genitourinario de la menopausia.  Climacteric. 2022;25(3):246-256. doi: 10.1080/13697137.2021.2008894.

Resumen
El síndrome genitourinario de la menopausia (SGM) tiene un impacto significativamente negativo en la vida de las mujeres afectadas. Sin embargo, a pesar del creciente número de opciones de tratamiento para el SGM (por ej. productos vaginales no hormonales, hormonas vaginales [estrógenos], dehidroepiandrosterona [DHEA; prasterona], terapia vaginal con láser, ospemifeno oral), muchas mujeres siguen sin recibir tratamiento. El objetivo de la reunión de consenso interdisciplinaria suiza sobre SGM fue desarrollar herramientas para el manejo  del SGM en la práctica diaria: un algoritmo de manejo del SGM (medicina personalizada); una herramienta de comunicación para la DHEA vaginal (caja de información sobre medicamentos); y una herramienta de comunicación para la comprensión de las autoridades reguladoras y la discrepancia entre los datos científicos y los prospectos. Se seguirá investigando la aceptación y aplicabilidad de dichas herramientas.

Palabras claves: Síndrome genitourinario de la menopausia; cuadro de datos de drogas; consenso interdisciplinario; tratamiento personalizado; prasterona; estrógeno vaginal.


Effects of resistance training on quality of life in postmenopausal women with vasomotor symptoms
E. Berin, et al.
https://www.tandfonline.com/doi/full/10.1080/13697137.2021.1941849
Open Access

Spanish translation:
Berin E, Hammar M, Lindblom H, Lindh-Åstrand L, Spetz Holm AC. Efectos del entrenamiento de resistencia sobre la calidad de vida en mujeres postmenopáusicas con síntomas vasomotores. Climacteric. 2022;25(3):264-270. doi: 10.1080/13697137.2021.1941849.

Objetivo:
La mayoría de las mujeres experimentan síntomas vasomotores (SVM) alrededor de la menopausia que pueden afectar negativamente la calidad de vida. Existe tratamiento farmacológico eficaz, pero no se recomienda para todas las mujeres, y existe una demanda de alternativas para reducir los síntomas y mejorar la calidad de vida. El objetivo de este estudio fue investigar el efecto de una intervención de entrenamiento de resistencia en la calidad de vida relacionada con la salud (CVRS) en mujeres postmenopáusicas con SVM.

Métodos:
Este ensayo controlado aleatorizado, abierto, incluyó a 65 mujeres postmenopáusicas mayores de 45 años con SVM diarios. Las participantes fueron asignadas aleatoriamente a 15 semanas de entrenamiento de resistencia tres veces por semana o a un grupo de control sin tratamiento. El Cuestionario de Salud de la Mujer (WHQ) y la Encuesta de Salud de Formato Corto (SF-36) se utilizaron para evaluar la CVRS al inicio y después de 15 semanas.

Resultados:
El grupo de entrenamiento de resistencia mejoró en comparación con el grupo de control en los dominios del WHQ, de SVM (p = 0.002), problemas para dormir (p = 0.003) y síntomas menstruales (p = 0.01) desde el inicio hasta después de la intervención. No se encontraron diferencias significativas entre los grupos en las puntuaciones de resumen del SF-36 ni en ninguno de sus dominios.

Conclusión:
En mujeres postmenopáusicas con SVM moderados a severo, el entrenamiento de resistencia tres veces por semana durante 15 semanas mejoró la CVRS específica de la menopausia.


Ultra-low-dose estradiol and dydrogesterone: a phase III study for vasomotor symptoms in China
M. Ren, et al.
https://www.tandfonline.com/doi/full/10.1080/13697137.2021.1956894
Open Access

Spanish translation:
Ren M, Ruan X, Gu L, Pexman-Fieth C, Kahler E, Yu Q. Estradiol y didrogesterona en dosis ultrabajas: un estudio de fase III para síntomas vasomotores en China. Climacteric. 2022;25(3):286-292. doi: 10.1080/13697137.2021.1956894.

Objetivo:
Este estudio tuvo como objetivo evaluar la eficacia y la seguridad de dosis ultrabajas de estradiol más didrogesterona para los síntomas vasomotores en mujeres postmenopáusicas en China (registro de ensayo CTR20160689).

Métodos:
Un total de 332 pacientes fueron aleatorizados para recibir en forma combinada continua estradiol 0.5 mg + didrogesterona 2.5 mg o placebo durante 12 semanas. El principal criterio de valoración de la eficacia fue el cambio en el número de sofocos por día desde el inicio hasta el final del tratamiento. Los criterios de valoración secundarios de la eficacia incluyeron el cambio en la cantidad de sofocos de moderados a intensos por día, los síntomas de la menopausia desde el inicio y la calidad de vida.

Resultados:
Entre el inicio y el final del tratamiento, el cambio en el número promedio de sofocos por día fue de -5.9 (intervalo de confianza [IC] del 95%: 6.6, -5.2) con estradiol + didrogesterona y de -4.5 (IC del 95%: -5.1, -3.8) con placebo, con una diferencia media de -1.4 sofocos por día (IC del 95%: -2.2; -0.7; p < 0.001). También se observaron diferencias significativas a favor de estradiol + didrogesterona en varios criterios de valoración secundarios de eficacia. El tratamiento del estudio fue bien tolerado.

Conclusión:
El esquema combinado continuo el estradiol 0.5 mg + 2.5 mg de didrogesterona redujeron los sofocos en mujeres postmenopáusicas en China. Este régimen de dosis ultrabaja brinda una opción adicional para las mujeres que experimentan los síntomas vasomotores de la menopausia. Estos datos son consistentes con resultados previos en otras poblaciones.

Palabras claves: Estradiol; didrogesterona; terapia hormonal menopáusica; síntomas vasomotores.

 



Mok CC, Tse SM, Chan KL, Ho LY. Estimation of fracture risk by the FRAX tool in patients with systemic lupus erythematosus: a 10-year longitudinal validation study. Ther Adv Musculoskelet Dis. 2022;14:1759720X221074451. doi: 10.1177/1759720X221074451.

Background

  • The fracture risk assessment tool has been widely used to stratify the 10-year fracture risk to guide therapy.
  • Using the actual fracture data of a 10-year longitudinal cohort of older patients with systemic lupus erythematosus, the authors reported an underestimation of the tool in predicting major symptomatic osteoporotic fractures.
  • Treatment of osteoporosis in systemic lupus erythematosus should not be based on fracture risk estimation alone.
  • Relevant time-dependent risk factors should be taken into account for an individualized decision.

Objective

To compare the observed fracture incidence in a 10-year longitudinal cohort of patients with systemic lupus erythematosus (SLE) with the fracture risk prediction from the fracture risk assessment (FRAX) tool.

Design

  • Adult patients (⩾40 years) with SLE who had a first DEXA scan performed in 2005-2009 were studied.
  • The 10-year rates of major osteoporotic and hip fractures were estimated by FRAX using clinical data at DEXA with adjustment for prednisolone dosage.
  • The actual incidence of clinical fractures at 10 years was compared with the estimated rates.
  • Factors associated with new fractures were studied by logistic regression.

Main findings

  • A total of 229 SLE patients were studied (age: 50.2 ± 6.6 years, 93% women).
  • Glucocorticoid was used in 148 (65%) patients at baseline (mean dose: 7.3 ± 6.9 mg/day; 34% ⩾ 7.5 mg/day).
  • Osteoporosis (bone mineral density T score ⩽ -2.5) at the hip, femoral neck, or spine was present in 61 (27%) patients.
  • The estimated 10-year risk of major osteoporotic and hip fractures by FRAX was 3.4 ± 4.5% and 0.95 ± 2.3%, respectively.
  • After 10 years, three patients developed hip fracture, 6 patients had limb fractures and 20 patients had symptomatic vertebral fractures (major osteoporotic fracture 12.7%, hip fracture 1.3%).
  • The actual major osteoporotic fracture rate was significantly higher than the FRAX estimation (12.7% vs 3.4%; p < 0.001).
  • Logistic regression revealed that osteoporosis (odds ratio (OR): 4.07 [1.51-10.9]), previous fragility fracture (OR: 3.18 [1.02-9.90]), and a parental history of fracture (OR: 4.44 [1.16-17.0]) were independently associated with new clinical fractures at 10 years.

Take-home message

The FRAX tool underestimates the major clinical fracture risk at 10 years in patients with SLE.

https://pubmed.ncbi.nlm.nih.gov/35154418/


Maseroli E, Vignozzi L. Are Endogenous Androgens Linked to Female Sexual Function? A Systemic Review and Meta-Analysis. J Sex Med. 2022;19(4):553-568.

Background

The benefits of treatment with testosterone (T) in women with loss of desire suggest that low androgens may distinguish women with sexual dysfunction (SD) from others; however, evidence on this point is lacking.

Objective

The authors aimed at performing a systemic review and meta-analysis in order to answer the question: is there an association between endogenous levels of androgens and sexual function in women?

Design

  • Authors performed an extensive search in MEDLINE, Embase and PsycInfo.
  • Four separate meta-analyses were conducted for total T, free T, Free Androgen Index (FAI), and Dehydroepiandrosterone sulphate (DHEAS).
  • Cohort, cross-sectional, and prospective studies were included.
  • Main analyzed outcome was the association between endogenous androgens and sexual desire.
  • Global sexual function was considered as a secondary outcome.
  • The effect measure was expressed as standardized mean difference (SMD).

Main findings

  • The meta-analysis on total T included 34 studies involving 3,268 women, mean age 36.5 years.
  • In 11 studies, a significant association was found between sexual desire, measured by validated psychometric instruments, and total T (SMD = 0.59 [0.29;0.88], P < 0.0001), with a moderate effect.
  • The association with global sexual function (n = 12 studies) was also significant (SMD = 0.44 [0.21;0.67], P <0.0001).
  • Overall, total T was associated with a better sexual function (SMD = 0.55 [0.28;0.82)], P < 0.0001), with similar results obtained when poor quality studies were removed.
  • Age showed a negative relationship with the overall outcome.
  • No differences were found when stratifying the studies according to menopausal status, type of menopause, age at menopause, use of hormonal replacement therapy, relationship status, method for T measurement, phase of the menstrual cycle or use of hormonal contraception.
  • The meta-analysis of T derivatives (free T and FAI) also showed a significant, moderate association with sexual desire.
  • In contrast, DHEAS seems not to exert any significant influence on desire, whilst showing a positive association with global sexual function.
  • Endogenous androgens showed a moderate association with a better sexual function in women; however, the role of psychological, relational and other hormonal factors should not be overlooked.

Take-home messages

  • There appears to be a moderate association between total T and sexual desire/global sexual function, which is confirmed, although weak, in studies employing liquid chromatography-mass spectrometry (LC-MS).
  • Similar results on desire were obtained for free T and FAI.
  • DHEAS only showed a positive association with global sexual function; more research is needed.

https://pubmed.ncbi.nlm.nih.gov/35227621/


Mai PL, Miller A, Black A, Falk RT, Boggess JF, Tucker K, Stuckey AR, Rodriguez GC, Wong C, Amatruda TT, Wilkinson KJ, Modesitt SC, Yamada SD, Bixel KL, Glaser GE, Rose PG, Greene MH, Sherman ME. Effect of risk-reducing salpingo-oophorectomy on sex steroid hormone serum levels among postmenopausal women: an NRG Oncology/Gynecologic Oncology Group study. Am J Obstet Gynecol. 2022;S0002-9378(22)00124-7.

Background

  • Risk-reducing salpingo-oophorectomy is an effective ovarian cancer risk reduction strategy; however, bilateral oophorectomy has also been associated with increased long-term nonneoplastic sequelae, effects suggested to be mediated through reductions in systemic sex steroid hormone levels.
  • Currently, it is unclear whether the postmenopausal ovary contributes to the systemic hormonal milieu or whether postmenopausal ovarian volume or other factors, such as body mass index and age, affect systemic hormone levels.

Objective

Authors aimed at examining the impact of oophorectomy on sex steroid hormone levels in postmenopausal women. In addition, they explored how well ovarian volume measured by transvaginal ultrasound correlated with direct ovarian measures obtained during surgical pathology evaluation and investigated the association between hormone levels and ovarian volumes.

Design

  • Postmenopausal women who underwent risk-reducing salpingo-oophorectomy (180 cases) or ovarian cancer screening (38 controls) enrolled in an international, prospective study of risk-reducing salpingo-oophorectomy and risk of ovarian cancer algorithm-based screening among women at increased risk of ovarian cancer (Gynecologic Oncology Group-0199) were included in this analysis.
  • Controls were frequency matched to the cases on age at menopause, age at study entry, and time interval between blood draws.
  • Ovarian volume was calculated using measurements obtained from transvaginal ultrasound in both cases and controls and measurements recorded in surgical pathology reports from cases.
  • Serum hormone levels of testosterone, androstenedione, androstenediol, dihydrotestosterone, androsterone, dehydroepiandrosterone, estrone, estradiol, and sex hormone-binding globulin were measured at baseline and follow-up.
  • Spearman correlation coefficients were used to compare ovarian volumes as measured on transvaginal ultrasound and pathology examinations.
  • Correlations between ovarian volumes by transvaginal ultrasound and measured hormone levels were examined using linear regression models.
  • All models were adjusted for age.
  • Paired t tests were performed to evaluate individual differences in hormone levels before and after risk-reducing salpingo-oophorectomy.

Main findings

  • Ovarian volumes measured by transvaginal ultrasound were only moderately correlated with those reported on pathology reports (Spearman rho [ρ]=0.42).
  • The median time interval between risk-reducing salpingo-oophorectomy and follow-up for the cases was 13.3 months (range, 6.0-19.3), and the median time interval between baseline and follow-up for the controls was 12.7 months (range, 8.7-13.4).
  • Sex steroid levels decreased with age but were not correlated with transvaginal ultrasound ovarian volume, body mass index, or time since menopause.
  • Estradiol levels were significantly lower after risk-reducing salpingo-oophorectomy (percentage change, -61.9 post-risk-reducing salpingo-oophorectomy vs +15.2 in controls; P=.02), but no significant differences were seen for the other hormones.

Take-home messages

  • Ovarian volumes measured by transvaginal ultrasound were moderately correlated with volumes directly measured on pathology specimens and were not correlated with sex steroid hormone levels in postmenopausal women.
  • Estradiol was the only hormone that declined significantly after risk-reducing salpingo-oophorectomy.
  • Thus, it remains unclear whether the limited post-risk-reducing salpingo-oophorectomy changes in sex steroid hormones among postmenopausal women impact long-term adverse outcomes.

https://pubmed.ncbi.nlm.nih.gov/35216968/


Mezones-Holguín E, Arriola-Montenegro J, Cutimanco-Pacheco V, Al-Kassab-Córdova A, Niño-García R, Zeta LA, Urrunaga-Pastor D, Blümel JE, Chedraui P, Pérez-López FR. Low sexual function is associated with menopausal status in mid-aged women with human immunodeficiency virus infection. Menopause. 2022;29(3):317-326.

Objective

To assess the association between menopausal status and female sexual function among mid-aged women with human immunodeficiency virus (HIV) infection.

Design

  • The authors carried out a cross-sectional study of 221 sexually active HIV-infected women ages 40 to 59 years, based on a secondary analysis of a three-hospital survey in Lima, Perú.
  • They classified menopausal status according to Stages of Reproductive Aging Workshop criteria (STRAW+10); this exposure variable was categorized as binary (non-postmenopausal and postmenopausal) and-for exploratory analysis-as multinomial (pre-, peri-, and postmenopausal).
  • Low sexual function (LSF) was defined using the 6-item Female Sexual Function Index (total score ≤19). Socio-demographic and clinical variables were assessed, including age, used highly active antiretroviral therapy scheme, disease duration, depressive symptoms, and co-morbidities.
  • Authors carried out Poisson generalized linear models with a robust variance to estimate 95% confidence interval (CI), crude prevalence ratios (cPRs), and adjusted prevalence ratios (aPRs) by epidemiological and statistical approaches using nonparametric method of bias-corrected and accelerated bootstrap resampling with 1,000 repetitions.

Main findings

  • Studied women had a median age of 47.0 years (interquartile range: 7.5); 25.3% were premenopausal, 25.8% were perimenopausal, and 48.9% were postmenopausal.
  • Also, 64.3% had LSF. The frequency of LSF was 53.6% in non-postmenopausal and 75.0% in postmenopausal women.
  • Postmenopausal status was associated with LSF in both the crude (cPR = 1.39; 95% CI: 1.13-1.71) and the adjusted regression models (aPR = 1.38; 95% CI: 1.12-1.71).

Take-home message

HIV-infected postmenopausal women have a higher prevalence of LSF than those non-postmenopausal ones, even when adjusting for multiple potential confounders.

https://pubmed.ncbi.nlm.nih.gov/35213519/


Urrunaga-Pastor D, Mezones-Holguin E, Blümel JE, Apolaya-Segura M, Barón G, Belzares E, Bencosme A, Calle A, Espinoza MT, Flores D, Izaguirre H, León-León P, Lima S, Monterrosa A, Mostajo D, Navarro D, Ojeda E, Soto E, Vallejo MS, Tserotas K, Chedraui P. Female orgasmic dysfunction and severe climacteric symptomatology in women aged 40 to 59 years: an independent association from an analysis of a multicenter Latin American study. Menopause. 2022;29(6):654-663.

Objective

To evaluate the association between the severity of climacteric symptoms (CS) and orgasmic dysfunction (OD), controlled by demographic, clinical, and partner variables.

Design

  • The authors carried out a secondary analysis of a multicenter Latin American cross-sectional study that surveyed sexually active women 40 to 59 years old.
  • They assessed CS (global, somatic, psychological, or urogenital domains) and OD; in addition, they explored clinical variables and partner sexual conditions, performing logistic regression models with nonparametric bootstrap resampling to estimate crude and adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Main findings

  • A total of 5,391 women were included in the analysis.
  • Regarding CS, 24.8%, 10.8%, 28.4%, and 32.9% had respectively severe symptoms according to total, somatic, psychological, and urogenital domain scores of the Menopause Rating Scale.
  • OD was found in 25.4% of women.
  • The adjusted model (including menopausal status and partner sexual dysfunction) showed that severe CS increased the odds of OD (aOR = 2.77; 95% CI: 2.41-3.19 [total Menopause Rating Scale score]; aOR = 1.65; 95% CI: 1.37-2.00 [somatic domain]; aOR = 2.02; 95% CI: 1.76-2.32 [psychological domain] and aOR = 3.89; 95% CI: 3.40-4.45 [urogenital]).

Take-home message

Severe CS were associated with OD independently of demographic, clinical, and partner variables. Severe urogenital symptoms had the strongest association.

https://pubmed.ncbi.nlm.nih.gov/35674646/


Bräuner EV, Wilson LF, Koch T, Christensen J, Dehlendorff C, Duun-Henriksen AK, Priskorn L, Abildgaard J, Simonsen MK, Jørgensen JT, Lim YH, Andersen ZJ, Juul A, Hickey M. The long-term association between bilateral oophorectomy and depression: a prospective cohort study. Menopause. 2022;29(3):276-283.

Background

  • Depression is a leading cause of disability globally and affects more women than men.
  • Ovarian sex steroids are thought to modify depression risk in women and interventions such as bilateral oophorectomy that permanently change the sex steroid milieu may increase the risk of depression.

Objective

To investigate the associations between unilateral and bilateral oophorectomy and depression over a 25-year period (1993-2018) and whether this varied by age at oophorectomy or use of menopausal hormone therapy.

Design

  • Twenty-five thousand one hundred eighty-eight nurses aged ≥45 years from the Danish Nurse Cohort were included. Nurses with depression prior to baseline were excluded.
  • Poisson regression models, with log-transformed person-years as offset, were used to assess the associations between oophorectomy and incident depression.
  • Nurses who retained their ovaries were the reference group.

Main findings

  • Compared with nurses with retained ovaries, bilateral oophorectomy was associated with a slightly higher rate of depression (rate ratio [RR], 1.08; 95% confidence interval [CI], 0.95-1.23), but without statistical significance.
  • However, when stratified by age at oophorectomy, compared with nurses with retained ovaries, bilateral oophorectomy at age ≥51 years was associated with higher rates of depression (RR 1.16; 95% CI, 1.00-1.34), but not bilateral oophorectomy at age <51 years (RR 0.86; 95% CI, 0.69-1.07); P value for difference in estimates = 0.02.
  • No association between unilateral oophorectomy and depression was observed.

Take-home message

In this cohort of Danish female nurses, bilateral oophorectomy at age ≥51 years, but not at younger ages, was associated with a slightly higher rate of depression compared with those who retained their ovaries.

https://pubmed.ncbi.nlm.nih.gov/35213515/


Zhang H, Sun T, Cheng Y, Zhang J, Zhang H, Krittanawong C, El-Am E, Karam RA, Wang S, Wang Q, Ma N. Impact of metabolic syndrome and systemic inflammation on endothelial function in postmenopausal women. Turk Kardiyol Dern Ars. 2022;50(1):57-65.

Background

Data on the impact of metabolic syndrome (MetS) and systemic inflammation on endothelial function remains scarce.

Objective

To investigate the combined effects of MetS and systemic inflammation on endothelial function in postmenopausal women.

Design

  • Authors identified 423 postmenopausal women from February 2019 through July 2020.
  • MetS was diagnosed according to the International Diabetes Federation (IDF) criteria, and high sensitivity C-reaction protein (hs-CRP) was measured to assess the degree of underlying inflammation.
  • The measurement of endothelial function was using digital arterial tonometry by assessing reactive hyperemia-induced vasodilation in one arm and adjusting for changes in the contralateral arm (reactive hyperemia index, RHI).

Main findings

  • There were 156 patients with MetS and 267 without MetS.
  • Compared to the group without MetS, patients with MetS had significantly lower natural logarithmic RHI (0.66±0.29 versus 0.91±0.31; p<0.001), but higher levels of hs-CRP (0.98 [0.31, 3.54] versus 0.53 [0.20, 2.14]; p<0.001).
  • In sequential multivariable analysis, the presence of hs-CRP (ΔR2=0.047, p=0.004) had a significant and independent influence on natural logarithmic RHI. Furthermore, the interaction of hs-CRP*MetS was synergistically associated with endothelial dysfunction even in the fully adjusted model (β=-0.107, 95% CI [-0.161~-0.053], p=0.009).

Take-home messages

  • MetS and systemic inflammation are synergistically associated with endothelial dysfunction in postmenopausal women.
  • Postmenopausal women with both these conditions appear to be at a significantly higher risk for adverse cardiovascular events.

https://pubmed.ncbi.nlm.nih.gov/35197234/


Sills Eric Scott, Tan Seang Lin. Preliminary cost variance modeling to compare autologous intraovarian platelet-rich plasma vs. standard hormone replacement therapy for menopause management. Ceska Gynekol. 2022;87(1):28-34.

Background

  • Menopause symptoms and hormone replacement therapy (HRT) are among the most common reasons patients seek gynecological advice.
  • Although at least half of all women in developed countries will use HRT during their lifetime, the treatment is not without risk and guidance on HRT is mixed; hence, greater awareness of HRT risks from extended use has piqued interest in safer options.

Objective

To preliminarily investigate the cost variance modeling in order to compare autologous ovarian platelet-rich plasma (OPRP) versus standard hormone replacement therapy (HRT) for the management of the menopause.

Design

HRT and OPRP data from USA were projected to compare cumulative 1yr patient costs using stochastic Monte Carlo modeling.

Main findings

  • Mean ± SD cost-to-patient for HRT including initial consult plus pharmacy refills was estimated at about $576 ± 246/yr.
  • While OPRP included no pharmacy component, an estimated 4 visits over 1yr for OPRP maintenance entailed ultrasound, phlebotomy/sample processing, surgery equipment, and incubation/laboratory expense, yielding mean ± SD cost for OPRP at $8,710 ± 4,911/yr (P < 0.0001 vs. HRT, by T-test).
  • Upper-bound estimates for annual HRT and OPRP costs were $1,341 and $22,232, respectively.

Take-home messages

  • While HRT and OPRP may have similar efficacy and safety for menopause therapy, they diverge sharply in cost-effectiveness.
  • Most patients would likely find OPRP too complex, invasive, and expensive to be competitive vs. HRT.
  • Although OPRP is an interesting and cautiously useful technique for selected menopause patients reluctant to use HRT, repurposing this infertility treatment for wider use appears inefficient compared to standard HRT options that are currently marketed.

https://pubmed.ncbi.nlm.nih.gov/35240833/


Gould LM, Gordon AN, Cabre HE, Hoyle AT, Ryan ED, Hackney AC, Smith-Ryan AE. Metabolic effects of menopause: a cross-sectional characterization of body composition and exercise metabolism. Menopause. 2022;29(4):377-389.

Objective

To evaluate body composition, fat distribution, and metabolism at rest and during exercise in premenopausal, perimenopausal, and postmenopausal women.

Design

  • This was a cross-sectional study in which 72 women aged 35 to 60 years were evaluated for body composition via a four compartment model, fat distribution using dual-energy x-ray absorptiometry-derived android to gynoid ratio, metabolic measures via indirect calorimetry, and lifestyle factors using surveys.
  • One-way analyses of variance and one-way analyses of covariance co-varied for age and hormone levels (estrogen and progesterone) were used to compare groups.

Main findings

  • Body fat percent was significantly lower in premenopausal than perimenopausal women (mean difference ± standard error: – 10.29 ± 2.73%, P = 0.026) despite similarities in fat mass and fat-free mass between groups (P≥0.217).
  • Android to gynoid ratio was significantly lower in premenopausal than perimenopausal women (MD ± SE: -0.16 ± 0.05 a.u., P = 0.031).
  • Resting energy expenditure was similar between groups (P = 0.999).
  • Fat oxidation during moderate intensity cycle ergometer exercise was significantly greater in premenopausal than postmenopausal women (MD ± SE: 0.09 ± 0.03 g/min, P = 0.045).
  • The change in respiratory exchange ratio between rest and moderate intensity exercise was significantly lower in premenopausal women than peri- (MD ± SE: -0.05 ± 0.03 a.u., P = 0.035) and postmenopausal women (MD ± SE: -0.06 ± 0.03 a.u., P = 0.040).
  • Premenopausal women reported significantly fewer menopause symptoms than peri- (MD ± SE: -6.58 ± 1.52 symptoms, P = 0.002) and postmenopausal participants (MD ± SE: -4.63 ± 1.52 symptoms, P = 0.044), while similarities between groups were observed for lifestyle factors including diet and physical activity (P>0.999).

Take-home message

Perimenopause may be the most opportune window for lifestyle intervention, as this group experienced the onset of unfavorable body composition and metabolic characteristics.

https://pubmed.ncbi.nlm.nih.gov/35231009/


Xie R, Huang X, Zhang Y, Liu Q, Liu M. High Low-Density Lipoprotein Cholesterol Levels are Associated with Osteoporosis Among Adults 20-59 Years of Age. Int J Gen Med. 2022;15:2261-2270.

Background

  • Serum lipids are highly inheritable and play a major role in bone health.
  • However, the relationship between low-density lipoprotein cholesterol (LDL-C) and bone mineral density (BMD) remains uncertain.

Objective

To examine if there was a link between LDL-C levels and BMD in persons aged 20 to 59.

Design

  • Authors used data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018, performing multivariate logistic regression models to investigate the association between LDL-C and lumbar BMD.
  • Fitted smoothing curves and generalized additive models were also used.

Main findings

  • The analysis included a total of 4909 adults.
  • After controlling for various variables, authors discovered that LDL-C was negatively linked with lumbar BMD.
  • The favorable connection of LDL-C with lumbar BMD was maintained in subgroup analyses stratified by gender and race in both males and females, Whites and Mexican Americans, but not in Blacks and other races.
  • The relationship between LDL-C and lumbar BMD in other races was an inverted U-shaped curve with the inflection point: 2.327 (mmol/L).

Take-home messages

  • In people aged 20 to 59, our research discovered a negative relationship among LDL-C and lumbar BMD.
  • Among races other than Whites, Blacks, Mexican Americans, this relationship followed an inverted U-shaped curve (inflection point: 2.327mmol/L).
  • LDL-C measurement might be used as a responsive biomarker for detecting osteoporosis early and guiding therapy.
If you would like to comment or contribute to Our Menopause World, please email Editor Claire Bower claire.bower@imsociety.org

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