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President’s Report

Dear Friends and Colleagues,

We are in full flow preparation for the World Congress. I hope that you have had a chance to explore the scientific program, it can be found on the congress website. Our program is outstanding, with plenary topics covering covid, the microbiome, sleep, transgender health, testosterone, brain fog, environmental exposures and cardiovascular disease, and that’s just a start. New types of sessions are being introduced including Meet the Panel and Expert Commentators in the abstract sessions. We also have twenty symposia in Portuguese and Spanish. Please register here if you haven’t already, you will not want to miss this event.

The Arabic translation of IMPART is now online, along with the Chinese, Spanish and Portuguese translations. You can find out more about IMPART and register here.

World Menopause Day is 18th October. The theme this year is Cognition and Mood. Pauline Maki and Nicole Jaff are leading on the White Paper.

A reminder that all members have exclusive access to the recordings of the Clinical Colloquium in Midlife Women’s Health. The July roundtable was “Menopausal Hormone Therapy: Myths and Realities” with Susan Davis. The recordings can be found here. There will be no webinar in August due to the summer holiday, but we will be back again in September.

Finally, thank you to everyone who submitted a nomination for the 2022-2024 IMS Board of Directors. The ballot will go out this month and members in good standing will have the opportunity to vote.

I always welcome your comments and suggestions.

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

General Update

There will be a summer recess of the webinar series in August, and we will be back again in early September.

Therefore the 25th webinar in the IMS webinar series will be held on Tuesday 13th September 15.00 (CET).  The webinar “Abnormal Uterine Bleeding in Perimenopausal and Postmenopausal Women” will be moderated by Professor Wendy Wolfman. Professor Steven Goldstein will be presenting “Appropriate Evaluation of Abnormal Uterine Bleeding in Peri and Postmenopausal Bleeding” and Professor Scott Chudnoff will be presenting “Medical Management of Bleeding in Peri and Postmenopausal patients”.

The 24th webinar in the IMS webinar series “Osteoporosis for Midlife Women and Beyond” was held on Tuesday 12th July.  The webinar was moderated by Professor Peter Schnatz. Professor Michael Lewiecki presented “Review of the Current Guidelines on Diagnosis and When to Treat” and Professor Michael McClung presented “The Current and Best Therapeutic Options”. The recording 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 following sessions are available: “Bone Health for the Generalist: Not just Osteoporosis”; “Cardiovascular Issues for Midlife Women”; “Cognition and Mood”; and “Menopausal Hormone Therapy: Myths and Realities”.

Our latest in the Interview Series is available: Dr Marla Shapiro interviews Professor Richard Anderson “Can AMH diagnose or predict the menopause?” This is available in a video or podcast format via this link.

International Society Meetings 2022

25th Annual Australasian Menopause Society Congress
Date: 9th – 11th September 2022
The Cairns Convention Centre
See the congress website at www.amscongress.com.au where you can subscribe to the AMS Congress mailing list.

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   https://imslisbon2022.com/
IMS is organizing 2 pre-congress courses on Tuesday 25 October 2022, one in English and one in Spanish, on the main topics covered by the IMPART course Level 1. Registrations will open soon with limited seats available on a first-come first-served basis.

The 14th European Congress on Menopause and Andropause
Date: 3rd – 5th May 2023
Florence, Italy
For more information https://2023.emas-online.org/

The Mayo Clinic Transforming Women’s Health Course
Date: 8th – 10th June 2023
Westin Chicago River North, Chicago, Illinois. You will have the option to either attend in-person or virtually. Please follow this link for more details.

North American Menopause Society Annual Meeting
Date: 27th – 30th September 2023
The 2023 NAMS Annual Meeting will take place from September 27-30, 2023, at the Marriott Downtown, Philadelphia, PA
For more information https://www.menopause.org/annual-meetings/future-meetings

Menopause and mid-life women’s health publication news

Study finds women have more brain changes after menopause
https://www.eurekalert.org/news-releases/956951

The 2022 Hormone Therapy Position Statement of The North American Menopause Society Is Now Available Online
https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf

Telehealth Proves Effective in Treating Some Symptoms of Menopause, But Not All
https://www.eurekalert.org/news-releases/959405

Aspirin for the Primary Prevention of Atherosclerotic Cardiovascular Disease in Women
10.1001/jama.2022.11951

Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults
https://www.nejm.org/doi/full/10.1056/NEJMoa2202106

Prasterone shows promise in reducing severity of urinary urge incontinence
https://medicalxpress.com/news/2022-07-prasterone-severity-urinary-urge-incontinence.html

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, August Issue, chosen by our Editor, Professor Rod Baber, have Free Access for the next 3 months.

There is also an Open Access paper in the August 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 the Associate Editors, for providing the translations.

The impact of micronized progesterone on cardiovascular events – a systematic review
L. M. Kaemmle, et al.
https://www.tandfonline.com/doi/full/10.1080/13697137.2021.2022644
Free AccessSpanish translation:

Kaemmle LM, Stadler A, Janka H, von Wolff M, Stute P. El impacto de la progesterona micronizada en los eventos cardiovasculares: una revisión sistemática. Climacteric. 2022;25(4):327-336. doi: 10.1080/13697137.2021.2022644.Resumen
La terapia hormonal para la menopausia (THM) biológicamente idéntica, incluida la progesterona micronizada (PM), ha ganado mucha atención. El objetivo fue evaluar el impacto de la PM en la THM combinada sobre la tromboembolia venosa y arterial (TEV/TEA) (por ejemplo: trombosis venosa profunda/embolia pulmonar, infarto de miocardio [IM] y accidente cerebrovascular isquémico). Los artículos eran elegibles si proporcionaban criterios de resultado relacionados con los eventos cardiovasculares y el uso de PM exógena. Se diseñaron y ejecutaron búsquedas bibliográficas para las bases de datos Medline, Embase, CINAHL, Cochrane Library, ClinicalTrials.gov y la base de datos interdisciplinaria Web of Science. Se incluyeron doce estudios que consistían en ensayos controlados aleatorios (ECA), estudios de casos y controles y estudios de cohortes prospectivos o retrospectivos, y se evaluó el riesgo de sesgo. Solo una minoría evaluó los eventos tromboembólicos como criterio principal de resultado, lo que demuestra que, a diferencia de los derivados del norpregnano, el riesgo de TEV primario y recurrente no se modificó al combinar estrógenos con PM, lo que también fue cierto para el riesgo de accidente cerebrovascular isquémico. De manera similar, en los ECA controlados con placebo que evaluaron TEV/TEA como eventos adversos, no hubo diferencias significativas entre los grupos. Faltan estudios sobre el IM como criterio principal de resultado. En conclusión, si bien los datos disponibles sugieren que la PM como componente de la THM combinada puede tener un efecto neutral en el sistema vascular, se necesitan más ECA que investiguen el impacto de la PM sola o en la THM combinada sobre los criterios de resultados primarios vasculares.

Palabras claves: Progesterona micronizada; terapia combinada de estrógeno y progestágeno; terapia hormonal menopáusica; infarto de miocardio; embolia pulmonar; ictus; revisión sistemática; tromboembolismo venoso.

Menopausal hormonal therapy in surgically menopausal women with underlying endometriosis
P. Tanmahasamut, et al.
https://www.tandfonline.com/doi/full/10.1080/13697137.2021.1998434
Free Access

Spanish translation:
Tanmahasamut P, Rattanachaiyanont M, Techatraisak K, Indhavivadhana S, Wongwananuruk T, Chantrapanichkul P. Terapia hormonal menopáusica en mujeres quirúrgicamente menopáusicas con endometriosis subyacente. Climacteric. 2022;25(4):388-394. doi: 10.1080/13697137.2021.1998434.

Resumen
Objetivo: Este estudio tuvo como objetivo investigar la relación entre la terapia hormonal menopáusica (THM) y la recurrencia de la endometriosis en mujeres que se sometieron a histerectomía con salpingo-ooforectomía bilateral para tratar la endometriosis.
Método: Este estudio de cohorte retrospectivo incluyó a 330 mujeres que se sometieron a cirugía definitiva para tratar la endometriosis durante 1996-2012. Se analizaron los datos de seguimiento hasta diciembre del 2018. Las pacientes se agruparon como no usuarias de THM (no THM, n = 43), terapia con estrógenos solos (ET, n = 230), terapia con estrógenos y progestágenos (TEP, n = 39) y tibolona (n = 18).
Resultados: La edad media al momento de la cirugía fue de 41.5 ± 5.3 años. La mediana general de la duración del seguimiento fue de 6.0 años (rango intercuartílico [RIC]: 3.0-10.4), y la mediana de la duración del uso de THM fue de 66.0 meses (RIC: 36.0-116.3). La tasa de recurrencia general fue del 3.0 % (intervalo de confianza del 95%: 1.5-5.5) y no hubo diferencias significativas en la recurrencia entre los grupos de estudio. La recurrencia de la enfermedad se resolvió después de la interrupción de la THM o el cambio en el tipo y/o la dosis de la THM.
Conclusiones: En este estudio no se encontró una asociación significativa entre el uso de THM y la recurrencia de la endometriosis. La tasa de recurrencia de endometriosis no fue significativamente diferente entre ET y TEP. La endometriosis recurrente se puede tratar con éxito sin medidas invasivas. Ningún paciente del estudio tuvo transformación maligna después de una mediana de seguimiento de 6 años. Nuestros hallazgos sugieren que cualquiera de los tres regímenes de THM evaluados puede usarse en mujeres tailandesas con menopausia quirúrgica y endometriosis subyacente.

Palabras claves: Terapia hormonal menopáusica; endometriosis; recurrencia de la endometriosis; menopausia quirúrgica.

First live birth in China after cryopreserved ovarian tissue transplantation to prevent premature ovarian insufficiency
X. Ruan, et al.
https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2064215
Open Access

Spanish translation:
Ruan X, Du J, Lu D, Duan W, Jin F, Kong W, Wu Y, Dai Y, Yan S, Yin C, Li Y, Cheng J, Jia C, Liu X, Wu Q, Gu M, Ju R, Xu X, Yang Y, Jin J, Korell M, Montag M, Liebenthron J, Mueck AO. Primer nacido vivo en China después de trasplante de tejido ovárico crioconservado para prevenir la insuficiencia ovárica prematura. Climacteric. 2022;25(4):421-424. doi: 10.1080/13697137.2022.2064215. 

Resumen
Objetivo: Este artículo informa sobre el primer nacido vivo en China después de un trasplante de tejido ovárico crioconservado para prevenir la insuficiencia ovárica prematura.
Métodos: Una paciente con síndrome mielodisplásico recibió criopreservación de tejido ovárico antes del trasplante de células madre hematopoyéticas, y seis tiras de corteza ovárica fueron descongeladas y trasplantadas a su bolsa peritoneal 2 años después.
Resultados: El embarazo ocurrió espontáneamente 27 meses después del injerto y nació una niña sana a las 38 semanas de gestación. Hasta el momento, el niño se ha desarrollado con normalidad sin mayores enfermedades.
Conclusiones: Presentamos el primer nacido vivo en China resultante de la criopreservación y trasplante de tejido ovárico.

Palabras claves: China; crioconservación de tejido ovárico; primer; nacido vivo; insuficiencia ovárica prematura; trasplante.

 

Rahnavardi M, Khalesi ZB, Rezaie-Chamani S. Effects of lifestyle on sexual function among postmenopausal women. Afr Health Sci. 2021;21(4):1823-1829.

Background
A healthy lifestyle has a key role in reducing health problems. Since one of the most common problems in Postmenopausal women has been sexual dysfunction (SD).

Objective
To identify the effects of health-promoting lifestyle (HPL) on sexual function among postmenopausal women.

Design

  • This was a cross-sectional, descriptive, and analytical study conducted on 405 postmenopausal women aged 45-60 years, using the convenience sampling method.
  • Data collection was done using three questionnaires of demographic, health-promoting lifestyle profile-II (HPLP-II) and female sexual function index (FSFI).
  • Data were analyzed in the SPSS-16 using Pearson’s correlation coefficient.
  • The statistical significance level was regarded as less than 0.05.
Main findings
  • In general, the result of this study identified a 68% prevalence of SD among participants.
  • The mean score obtained from the HPLP II was 2.27 (SD = 0.42), the highest score of its sub-scales was spiritual growth and the lowest score was physical activity.
  • The mean score of FSFI among the studied women was 23.16 (SD = 0.29), the highest score of six sub-scales was satisfaction and the lowest score was lubrication among participants.
  • A strong correlation was found between the total FSFI scores, and spiritual growth (r=0.048), interpersonal relations (r=0.02), stress management (r=0.000), (p<0.0001).
Take-home messages
  • The results of the study revealed that a healthy lifestyle affects sexual function.
  • Given that a healthy lifestyle is one of the most important ways to help women overcome SD, a healthy lifestyle promoting interventions necessary for postmenopausal women.

Wen H, Lin X, Sun D. The association between different hormone replacement therapy use and the incidence of lung cancer: a systematic review and meta-analysis. J Thorac Dis. 2022;14(2):381-395.

Background
Many peri- and postmenopausal women use hormone replacement therapy (HRT) to relieve menopausal symptoms: however, the side effects of different HRT use (ever/current/former vs. never HRT use) on lung cancer risk in women are not completely consistent.

Objective
To examine, through a meta-analysis, the connection between current, former or ever HRT use and the incidence of lung cancer among women.

Design

  • The authors systematically searched the PubMed, Web of Science, EMBASE, Cochrane Library, SCOPUS, China National Knowledge Infrastructure, Wanfang and VIP databases to identify relevant articles published from the inception of the respective databases to February 18, 2022, regarding the relationship between different HRT use and the incidence of lung cancer among women.
  • Relevant risk estimates [relative risks (RRs), odds ratio (OR)] were combined based on specific study types.
  • The Newcastle-Ottawa Scale was used to evaluate the quality of included studies.
  • This analysis was registered in the International prospective register of systematic reviews (PROSPERO; CRD42020219728) and publication bias was tested based on Egger’s and Begg’s tests.
Main findings
  • A total of 22 studies (13 prospective cohort studies and 9 case-control studies) were included, comprising 911,194 participants and 17,329 patients.
  • Compared to never HRT users, in pooled cohort studies, current HRT users had a statistically decreased risk of lung cancer [RR 0.91, 95% confidence interval (CI): 0.86-0.97, I2=22.9%], and similar results were found among the postmenopausal women with current HRT use (RR 0.91, 95 CI: 0.85-0.98, I2=36%), while in pooled case-control studies, ever HRT users had a decreased risk of incidence of lung cancer [odds ratio (OR) 0.75, 95% CI: 0.69-0.81, I2=0%] as did female non-smokers with ever HRT use (OR 0.76, 95% CI: 0.66-0.87, I2=36.8%).
Take-home messages
  • Current or ever HRT use is partly correlated with the decreased incidence of lung cancer in women.
  • Concerns about the incidence of lung cancer can be reduced when perimenopausal and postmenopausal women use current HRT to reduce menopausal symptoms.
  • Meanwhile, given the roles of hormone receptors and relevant genes single nucleotide polymorphism (SNPs) among females, HRT use should be cautiously administered and individualized.

https://pubmed.ncbi.nlm.nih.gov/35280481/

La New JM, Borer KT. Effects of Walking Speed on Total and Regional Body Fat in Healthy Postmenopausal Women. Nutrients. 2022;14(3):627.

Objective

  • The study had two aims: (1) To confirm the efficacy of exercise speed and impulse (session duration at a given speed) to produce total and abdominal fat loss in postmenopausal women, and (2) compare the exercise speed and impulse necessary for the stimulation of fat loss to the suppression of bone mineral loss.
  • Of special interest was to compare these parameters of exercise on fat loss in the same study and with the same subjects where they were found to suppress bone mineral loss.
  • The authors hypothesized that (1) more total fat will be lost with slow walking and a longer impulse than with fast speed and shorter impulse, and (2) more abdominal subcutaneous (SC) and visceral fat (VF) will be lost with fast walking speed.
Design
  • Fat loss and suppression of bone mineral loss were measured in the same 25 subjects after 15 weeks, and fat measurements were also taken after 30 weeks in 16 residual subjects.
  • Study parameters were walking a 4.8 km distance 4 days/week at either 6.6 km/h (120% of ventilatory threshold (VT)) or at 5.5 km/h (101.6% of VT) and expending 300 kcal/session.
  • Body composition (fat and lean body mass, LBM) was measured with dual-energy X-ray absorptiometry (DXA) and anthropometric methods.
Main findings
  • Slow walkers in the residual group progressively lost a significant percent of total body fat over 30 weeks while no such loss occurred after 15 weeks in fast walkers in either group, supporting hypothesis 1.
  • However, the 20% higher starting body fat in 16 residual slow relative to fast subjects suggests that exercise fat loss is greater in overweight than in lean subjects.
  • In fast walkers, fat loss occurred after 30 weeks of training.
  • Hypothesis 2 was not supported as both speeds led to equal VF loss in 30-week group as estimated by waist circumference (CF) confirming that VF responds to the magnitude of energy expenditure and not the walking speed.
Take-home messages
  • Total body fat is lost through walking at all speeds, but the change is more rapid, clear, and initially greater with slow walking in overweight subjects.
  • A longer exercise impulse at a lower speed in our study initially produced greater total fat loss than a shorter one with fast walking speed.
  • This was reversed in comparison to how the same exercise in the same subjects suppressed bone mineral loss.
  • Data from other studies indicate that longer impulses may promote greater fat loss at both slow and high exercise speeds, and our study providing only a 4.8 km walking distance may have limited the walking impulse and the magnitude of fat loss.
  • Increased exercise energy expenditure at either walking speed produces equivalent declines in visceral fat in postmenopausal women, and with sufficiently long impulses, should reduce disabilities associated with central obesity.

https://pubmed.ncbi.nlm.nih.gov/35276986/

Han Y, Colditz GA, Toriola AT. Changes in adiposity over the life course and gene expression in postmenopausal women. Cancer Med. 2022;11(13):2699-2710.

Background
Early life adiposity and changes in adiposity over the life course are associated with mammographic breast density among postmenopausal women; however, the underlying mechanisms are unknown.

Objective
To comprehensively examine the associations of early life body mass index (BMI) and changes in BMI from ages 10, 18 to age at mammogram with growth factor, RANK pathway, and sex hormone gene expression in 372 postmenopausal women.

Design

  • The authors estimated early life BMI at age 10 using the validated 9-level Stunkard pictogram.
  • They calculated BMI at other ages (18, 30, and current age at mammogram) by dividing weight in kilograms at these ages with height in meters squared.
  • Sequencing for gene expression was performed using the NanoString nCounter system.
  • After adjusting for confounders, the authors estimated associations using multivariable linear regressions.
Main findings
  • A 10 kg/m2 increase in early life BMI at age 10 was associated with a 17.2% decrease in RANKL gene expression (95% confidence interval [CI] = -30.8, -0.9) but was not associated with changes in other markers.
  • BMI changes from ages 10, 18 to age at mammogram were associated with an increase in BMP2 and decreases in RANK, RANKL, and TNFRSF13B gene expression but were not associated with gene expression of other markers.
  • A 10 kg/m2 increase in early life BMI from age 10 to current age was associated with a 7.8% increase in BMP2 (95% CI = -1.4, 17.8), an 8.5% decrease in RANK (95% CI = -13.9, -2.8), a 10.4% decrease in RANKL (95% CI = -16.9, -3.3), and an 8.5% decrease in TNFRSF13B gene expression (95% CI = -13.8, -2.8).
Take-home message
The results provide new insights into the biological mechanisms underlying the associations of adiposity changes from early life to adulthood and early life adiposity with mammographic breast density in postmenopausal women.https://pubmed.ncbi.nlm.nih.gov/35304837/

Blümel JE, Mezones-Holguín E, Chedraui P, Soto-Becerra P, Arteaga E, Vallejo MS. Is premature ovarian insufficiency associated with mortality? A three-decade follow-up cohort. Maturitas. 2022;163:82-87.

Objective
To evaluate the association between premature ovarian insufficiency (POI) and mortality.

Design

  • This was a secondary analysis of a long-term cohort of Chilean women who received preventive health care between 1990 and 1993.
  • The exposure variable was POI and the outcome was death, and follow-up time was 30 years.
  • Patient data were extracted from medical records.
  • Data related to deaths were obtained from the records of the official government registry as of January 2021.
  • Cox regression proportional hazard models were used to estimate crude and adjusted hazard ratios (HR) and 95 % confidence intervals (CI).
Main findings
  • Data for a total of 1119 women were included in the analysis.
  • Median age was 47 years (interquartile range: 44-52).
  • The baseline prevalence of POI was 6.7 %.
  • At the end of the follow-up, 34.7 % of women with POI had died, compared with 19.3 % of women without the condition (p < 0.001).
  • A larger proportion of women with POI died from cardiovascular disease (12.0 % vs. 5.1 %; OR: 2.55, 95 % CI: 1.21-5.39) whereas there was no significant difference in cancer mortality (6.7 % vs. 7.7 %; OR: 0.86, 95 % CI: 0.34-2.19).
  • In the adjusted Cox model, POI was among the main factors associated with mortality (hazard ratio [HR] 1.60, 95 % CI: 1.03-2.47), after diabetes (HR 2.51, 95 % CI: 1.40-4.51) and arterial hypertension (HR 1.75, 95 % CI: 1.29-2.37).
Take-home message
Although POI affects a small group of women, its association with mortality seems to be relevant; hence it is necessary to implement measures that reduce this risk.https://pubmed.ncbi.nlm.nih.gov/35752062/

Blümel JE, Aedo S, Arteaga E, Vallejo MS, Chedraui P. Factores de riesgo de artrosis de rodilla, cadera o ambas en mujeres chilenas de mediana edad: un estudio de cohorte de tres décadas [Risk factors for the development of osteoarthritis in middle-aged women]. Rev Med Chil. 2022;150(1):46-53.

Background
Osteoarthritis (OA) is a health problem affecting millions of individuals worldwide.

Objective
To evaluate risk factors for hip and knee osteoarthritis (OA) in women aged 40 to 59 years.

Design

  • Analysis of a prospective cohort of 1159 women attending preventive health care programs and followed during 28 years.
  • They underwent a clinical and laboratory evaluation from 1990 to 1993.
  • The diagnosis of OA was retrieved from registries of a special program for osteoarthritis in 2020.
Main findings
  • Twenty-four percent of participants developed osteoarthritis during the follow-up.
  • At the beginning of the study and compared with women without OA, they were older (median [interquartile range or IQR]: 49.6 [8.5] and 47.2 [8.2] years respectively), had a higher body mass index (26.3 [5.3] and 25.1 [5.3] respectively), and a higher frequency of jobs with low qualification (76 and 62% respectively).
  • The presence of type 2 diabetes mellitus, chronic hypertension, a previous history of alcohol or cigarette consumption, postmenopausal status and lipid and glucose blood levels did not differ between women with or without OA.
  • Cox regression showed a final model that incorporates body mass index (hazard ratio (HR): 1.04; 95% confidence intervals (CI): 1.01-1.07), age (HR: 1.05; 95% CI: 1.03-1.08) and having an unqualified job (HR: 1.88; 95% CI: 1.43-2.47) as risk factors for OA.
Take-home message
Obesity and the type of job are the most relevant risk factors found for OD: both may be modified with proper care.https://pubmed.ncbi.nlm.nih.gov/35856964/

Nasr A, Matthews K, Janssen I, Brooks MM, Barinas-Mitchell E, Orchard TJ, Billheimer J, Wang NC, McConnell D, Rader DJ, El Khoudary SR. Associations of Abdominal and Cardiovascular Adipose Tissue Depots With HDL Metrics in Midlife Women: the SWAN Study. J Clin Endocrinol Metab. 2022;107(6):e2245-e2257.

Background
The menopause transition is accompanied by declines in the atheroprotective features of high-density lipoprotein (HDL), which are linked to deleterious cardiovascular (CV) outcomes.

Objective
To assess the relationship between abdominal and CV visceral adipose tissues (VAT) with future HDL metrics in midlife women, and the role of insulin resistance (IR) on these associations.

Design

  • Temporal associations compared abdominal and CV fat with later measures of HDL metrics.
  • This community-based cohort comprised 299 women, baseline mean age 51.1 years (SD: 2.8 years), 67% White, 33% Black, from the Study of Women’s Health Across the Nation (SWAN) HDL ancillary study.
  • Exposures included volumes of abdominal VAT, epicardial AT (EAT), paracardial AT (PAT), or perivascular AT (PVAT).
  • Main outcomes included HDL cholesterol efflux capacity (HDL-CEC); HDL phospholipids (HDL-PL), triglycerides (HDL-Tgs), and cholesterol (HDL-C); apolipoprotein A-I (ApoA-I), and HDL particles (HDL-P) and size.
Main findings
  • In multivariable models, higher abdominal VAT was associated with lower HDL-CEC, HDL-PL, HDL-C, and large HDL-P and smaller HDL size.
  • Higher PAT was associated with lower HDL-PL, HDL-C, and large HDL-P and smaller HDL size.
  • Higher EAT was associated with higher small HDL-P.
  • Higher PVAT volume was associated with lower HDL-CEC.
  • The Homeostatic Model Assessment of Insulin Resistance partially mediated the associations between abdominal AT depots with HDL-CEC, HDL-C, large HDL-P, and HDL size; between PVAT with HDL-CEC; and PAT with HDL-C, large HDL-P, and HDL size.
Take-home messages
  • In midlife women, higher VAT volumes predict HDL metrics 2 years later in life, possibly linking them to future CV disease.
  • Managing IR may preclude the unfavorable effect of visceral fat on HDL metrics.

https://pubmed.ncbi.nlm.nih.gov/35298649/

Mishra SR, Waller M, Chung HF, Mishra GD. Association between reproductive lifespan and risk of incident type 2 diabetes and hypertension in postmenopausal women: Findings from a 20-year prospective study. Maturitas. 2022;159:52-61.

Objective
To examine the association between reproductive lifespan and incident type 2 diabetes mellitus (T2DM) and hypertension in mid-age women; also to explore the combined effect of reproductive lifespan and body mass index (BMI) on the risks of T2DM and hypertension.

Design

  • Reproductive lifespan was defined as the difference between age at menopause and age at menarche, and categorized as <35, 35-37, 38-40, and ≥41 years based on the quartile distribution.
  • A multivariable Cox proportional hazard regression was used, adjusting for socio-demographic, lifestyle, and reproductive factors.
Main findings
  • Of 6357 postmenopausal women included (mean [SD] age at last follow-up, 66.3[3.3] years), a total of 655 developed incident T2DM (10.3%) and 1741 developed hypertension (30.0%) during 20 years of follow-up. The total sample had a mean (SD) reproductive lifespan of 37.9 (4.5).
  • Compared with the women who had a reproductive lifespan of 38-40 years, those with a short reproductive lifespan (<35 years) had a 30% increased risk of T2DM and twice the risk of hypertension.
  • Under the combined model, women who had a short reproductive lifespan (<35 years) and who had a BMI ≥30 kg/m2 at baseline showed a higher risk of T2DM (HR: 6.30, 95% CI: 4.41-8.99) and hypertension (HR: 6.06, 4.86-7.55) compared with women who had a reproductive lifespan of 38-40 years and a BMI < 25 kg/m2.
Take-home messages
  • A higher risk of both incident T2DM and hypertension at midlife was found among women experiencing a shorter reproductive lifespan, with pronounced risk for women experiencing both a short reproductive lifespan (<35 years) and a higher baseline BMI (≥30 kg/m2).
  • Women with a short reproductive lifespan may benefit from maintaining healthy body weight in midlife.

https://pubmed.ncbi.nlm.nih.gov/35337613/

Ryu KJ, Park H, Park JS, Lee YW, Kim SY, Kim H, Lee YJ, Kim T. Vasomotor symptoms and carotid artery intima-media thickness among Korean midlife women. Maturitas. 2022;159:1-6.

Objective
To evaluate the association between vasomotor symptoms (VMS) and carotid intima-media thickness (CIMT) in Korean midlife women.

Design

  • This was a cross-sectional study that included 918 Korean women aged 45-65 years who attended their routine health checkup at a single institution between 2013 and 2016.
  • All participants’ results on the Menopause Rating Scale were used to assess the VMS.
  • Severe and very severe VMS were combined into severe VMS.
  • CIMT and blood flow velocities were measured on the common carotid arteries using duplex ultrasound.
Main findings
  • Overall, participants’ mean age was 54.73 ± 5.37 years, and 627 (68.3%) were postmenopausal.
  • A total of 401 (43.7%) women reported VMS: 217 (23.6%), mild; 109 (11.9%), moderate; and 75 (8.2%), severe.
  • The mean CIMT was 0.062 ± 0.017 mm and 0.064 ± 0.019 mm in premenopausal and menopausal women, respectively.
  • In the multivariate linear regression analysis, the CIMT of women with moderate VMS was 0.102 mm (95% confidence interval [CI] = 0.002-0.009) more than that of women with no VMA, and the CIMT of women with severe VMS was 0.246 mm (95% CI = 0.012-0.021) more than that of women with no VMS, after adjusting for several confounders, including age, body mass index, and lifestyle factors.
  • Severe VMS were associated with the risk of thickened CIMT (≥0.075 mm) and/or plaques (odds ratio = 2.90, 95% CI = 1.74-4.84) in the logistic regression analysis after adjusting for the same variables.
Take-home messages
  • Moderate and severe VMS are independently associated with increased CIMT in otherwise healthy Korean midlife women.
  • Clinicians managing midlife women with bothersome VMS should consider screening for subclinical cardiovascular diseases.

https://pubmed.ncbi.nlm.nih.gov/35337608/

Yeo JH, Kim MT. Association of weight, smoking, and alcohol consumption with age at natural menopause. J Women Aging. 2022 Mar 21:1-11.

Background
In South Korea, rapid economic growth and modernization have led to changes in lifestyle factors that may affect age at natural menopause.

Objective
To examine the association of weight, smoking, and alcohol consumption with age at natural menopause.

Design

  • Data from 4,793 women aged ≥55 years, who had a natural menopause, were analyzed from the Korea National Health and Nutrition Examination Survey (2013-2017).
  • Multinomial logistic regression was used to examine the association between lifestyle factors and age at natural menopause after adjusting for birth cohort (Model 1) and sociodemographic and reproductive factors (Model 2).
Main findings
  • Overall, 3.1% of women experienced premature menopause (<40 years), 7.6% early menopause (40-44 years), and 12.8% late menopause (≥55 years).
  • Women born in the 1940s or earlier among the birth cohorts had the highest prevalence of premature (70.0%), early (58.5%), and late (43.1%) menopause.
  • In Model 2, current smoking (odds ratio = 3.99 and 95% confidence interval = 1.35-11.81) was associated with premature menopause. Low (<18.5 kg/m2) and high (≥25 kg/m2) body mass index were associated with early (odds ratio = 2.30 and 95% confidence interval = 1.01-5.22) and late (odds ratio = 1.38 and 95% confidence interval = 1.10-1.72) menopause respectively.
  • Conversely, there was no association between age at natural menopause and alcohol consumption.
Take-home messages
  • The results suggest that healthy lifestyle factors, such as not smoking and proper weight maintenance, are significant factors affecting age at natural menopause.
  • The findings may help develop health policies and provide targeted care to improve women’s health after midlife.
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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