September 2022

25th Annual Australasian Menopause Society Congress
Date: 9th-11th September 2022
The Cairns Convention Centre
See the congress website at AMS Congress – Australasian Menopause Society

7th Annual Conference PCOS India
Date: 16th-18th September 2022
The Leela, Mumbai
For more information https://www.pcosindia.org/

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 25th October 2022, one in English and one in Portuguese and 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.

19th World Congress  International Academy of Human Reproduction
Date: 15th to 18th March 2023
Venice, Italy
For more information https://hr2023.humanrepacademy.org/

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

11th International Symposium on Diabetes, Hypertension, Metabolic Syndrome and Pregnancy: Innovative Approaches in Maternal Offspring Health (DIP)
Date 4th-6th May 2023
Thessaloniki, Greece
For more information https://dip.comtecmed.com/

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 at the Marriott Downtown, Philadelphia, PA
For more information https://www.menopause.org/annual-meetings/future-meetings

Statin Use Articles
Statin Use for the Primary Prevention of Cardiovascular Disease in Adults
https://jamanetwork.com/journals/jama/fullarticle/2795521

Statin Use for the Primary Prevention of Cardiovascular Disease in Adults
US Preventive Services Task Force Recommendation Statement
https://jamanetwork.com/journals/jama/fullarticle/2584058

Statins for the Prevention of Cardiovascular Disease
https://jamanetwork.com/journals/jama/fullarticle/2795526

Statin Recommendations for Primary Prevention
More of the Same or Time for a Change?
https://jamanetwork.com/journals/jama/article-abstract/2795551

Shorter menstrual cycles may indicate earlier menopause and worse symptoms
New study finds that women with menstrual cycles of fewer than 25 days during their reproductive years had a higher frequency of total menopause symptoms and an earlier age of natural menopause, NAMS.
https://www.eurekalert.org/news-releases/962718

Data on cancer risk from hormone therapy ‘reassuring,’ menopause experts say
Peer-Reviewed Publication, University of Virginia Health System
https://www.eurekalert.org/news-releases/962774

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 Access

Spanish 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.

• Retrospective review of hysterectomies at seven Ontario, Canada hospitals from 2016 to 2019.
• Surgeries completed by oncologists or for invasive placentation were excluded.
• Patient, case, and surgeon characteristics were recorded along with pathologic diagnoses.
• Avoidable BSO criteria were: preoperative diagnosis of cervical dysplasia or benign diagnosis other than endometriosis, gender dysphoria, risk reduction or premenstrual dysphoric disorder; age < 51 years; absence of intraoperative endometriosis and adhesions; unjustified pathology (where “justified” pathology was endometriosis or (pre)malignant diagnosis except for cervical dysplasia).
• Patients with avoidable BSO were compared to those having at least one criterion for BSO.
• Binary logistic regression identified factors most strongly associated with avoidable BSO.

• Four thousand one hundred ninety-one hysterectomies were completed with 1,422 (33.9%) patients having concomitant BSO.
• Pathologic diagnosis justified BSO in most patients (1,035/1,422, 72.8%) with endometrial cancer being most common (439/1,422, 30.9%).
• When preoperative characteristics, intraoperative findings, and pathologic diagnoses were considered, 79 of 1,422 (5.6%) BSOs were avoidable.
• Compared to cases with at least one criterion for BSO, avoidable BSOs were more frequently completed by generalists (OR 1.80, 95% CI 1.10-2.99, P = 0.021), for preoperative diagnoses of abnormal uterine bleeding/menorrhagia (OR 3.82, 95% CI 2.35-6.30, P = 0.001) and fibroids (OR 4.25, 95% CI 2.63-6.92, P < 0.001).

• 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).

• 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.

• The results of this study 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.

• Participants in this study were selected from the Kongcun town aICAS study.
• MRH was collected through structured case report forms, in which menarche age, menstrual regularity, dysmenorrhea, number of pregnancies, number of childbirths, age of first pregnancy, breastfeeding, menopause, menopause age, and contraceptive methods were all involved.
• All characteristics were compared by chi-squared and nonparametric tests as applicable.
• Logistic regression model and sensitivity analysis were used to analyze the association between aICAS and MRH.

• A total of 1,052 female participants were involved in this study, of which 5.7% had moderate to severe aICAS.
• Tubal ligation was significantly associated with aICAS in univariate analysis [crude odds ratio (OR), 2.85; 95% CI, 1.22-6.62; P = 0.015].
• This association was still significant among female participants over 60 years old after multivariate adjustment (adjusted OR, 4.36; 95% CI, 1.55-12.24; P = 0.005).
• Sensitivity analysis showed a similar result (adjusted OR, 3.76; 95% CI, 1.24-11.41; P = 0.020).
• Menopause lost significant association with aICAS after multivariate adjustment (adjusted OR, 1.68; 95% CI, 0.66-4.24; P = 0.275).
• No other MRH factors were found to be associated with aICAS.

• Tubal ligation may be associated with a higher prevalence of aICAS in Chinese elderly women.
• This provides a new perspective to study the epidemiological characteristics of ICAS.

• Sarcopenia is an age-related disease characterized by a progressive loss of systemic muscle mass and/or decreased muscle strength and physical function.
• The occurrence of sarcopenia in patients with chronic diseases will not only cause further deterioration of diseases and adverse clinical outcomes, but also lead to high medical cost, suggesting a necessity and a great significance to explore the associated factors of sarcopenia in chronic patients in order to improve their quality of life.

• A total of 121 older patients with chronic diseases admitted to the Department of Geriatrics of Affiliated Kunshan Hospital of Jiangsu University from May 2019 to April 2021 were enrolled.
• According to the diagnostic criteria of sarcopenia formulated by the Asian Working Group for Sarcopenia (AWGS), the subjects were divided into a sarcopenia group (n=57) and a non-sarcopenia group (n=64).
• The authors analyzed the associated factors including bone mineral density, nutritional biomarkers, hormone levels and inflammatory cytokines.

• Compared to the non-sarcopenia group, the sarcopenia group was of older average age (P<0.001), exhibited a lower body mass index (BMI) (P<0.001), a lower bone mineral density (BMD) of the femoral neck (P<0.01), and a higher incidence of osteoporosis.
• In terms of hematology, the sarcopenia group exhibited significantly lower serum iron and zinc levels (both P<0.05), a higher growth hormone (GH) level (P<0.05), a significantly lower IGF-1 level (P<0.01), and a lower level of iron (P<0.01).
• Poor nutritional status (assessed via measurement of albumin and prealbumin levels) positively correlated with sarcopenia (P<0.01).

• Sarcopenia is closely associated with aging and has a close relationship with osteoporosis.
• Anemia, malnutrition, vitamin and trace element deficiencies, changes in hormone levels, and chronic inflammation are correlated with sarcopenia.
• Patients with these features above call for the screening of sarcopenia.
• Additionally, these characteristics may help providing clues for further research on the pathogenesis and risk factors of sarcopenia, along with disease prevention and intervention.

• It is estimated that over 45% of women in the United States are menopausal.
• Many of these women suffer from vasomotor symptoms of menopause, for which the gold standard treatment is menopause hormone therapy (MHT).
• However, MHT use has been controversial since the Women’s Health Initiative (WHI) study in 2001.
• Transdermal MHT has been shown to be effective for treatment of vasomotor symptoms and does not increase the risk of venous thromboembolism (VTE) when used in healthy postmenopausal women.
• However, there is little data on its safety in women at increased risk for VTE such as women with prior VTE, increased body mass index, thrombophilia, tobacco use, autoimmune disease, chronic inflammatory disorders, recent surgery, trauma, or immobilization.

• In women with prior VTE, two studies found a decrease in coagulability and no increased risk of recurrent VTE with transdermal MHT use.
• In women with increased body mass index, three studies found no increased VTE risk in transdermal MHT users.
• In women with prothrombotic genetic polymorphisms, three studies found minimal to no increased VTE risk in transdermal MHT users.
• In women with various proinflammatory comorbidities, five studies found an improved thrombotic profile and no increased VTE risk with transdermal MHT use.

• Two hundred postmenopausal women aged 50 to 65 years were recruited.
• Each participant was evaluated for FPHL according to Ludwig’s classification using standardized global photography in all six views and trichoscopy for hair density and diameter.
• Three dermatologists re-evaluated all pictures for confirmation of FPHL.
• The time since menopause, levels of scalp sebum, serum testosterone, estradiol, thyroid stimulating hormone, and hemoglobin; family history of hair loss, as well as an evaluation of low self-esteem were evaluated.
• Women who underwent recent hair loss treatments were excluded.
• Authors used simple and multivariable logistic regression analysis to identify the factors affecting FPHL.

• In total, 178 postmenopausal women were evaluated for hair-loss patterns.
• The average age and time since menopause were 58.8±4.1 and 9.2 ± 5.6 years, respectively.
• The prevalence of FPHL was 52.2% (95% CI, 44.6-59.8).
• Severity of FPHL by Ludwig grades I, II, and III was 73.2% (95% CI, 62.9-81.8), 22.6% (95% CI, 14.6-32.4), and 4.3% (95% CI, 1.2-10.7), respectively.
• Logistic regression analysis revealed that age, time since menopause, and body mass index were all significantly associated with FPHL.
• After adjusting for age and family history of FPHL, only body mass index ≥25 kg/m2 was significantly associated with FPHL (adjusted OR = 2.65, 95% CI, 1.23-5.70).

• The prevalence of FPHL was high in postmenopausal women, raising the need for hair loss awareness in menopause clinics.
• Early detection and proper treatment of FPHL may increase the quality of life in postmenopausal women.

• Four electronic databases were systematically searched to identify the eligible studies.
• The combined effect was assessed by calculating the relative risk (RR) with a 95% confidence interval (CI).
• More methodologies for this study were available in the PROSPERO (ID: CRD42021227255).

• Finally, three observational studies offering osteoporosis cases and two retrospective studies reporting fracture cases were included.
• One eligible study has provided independent data from three groups of fractures.
• Synthetic results revealed that hysterectomy without oophorectomies was significantly associated with an increased risk of osteoporosis as compared to the general population (combined RR from three studies = 1.47, 95%CI 1.253 to 1.725, P < 0.001; heterogeneity, I2 = 76.2%, P = 0.015).
• Consistently, the prevalence of fractures was also significantly higher in patients with hysterectomy without oophorectomies than in healthy controls (pooled RR from four studies = 2.333, 95%CI: 1.314 to 4.144, P = 0.004; heterogeneity, I2 = 92.3%, P < 0.001).

• This is the first study to quantify the association between hysterectomy without oophorectomies and osteoporosis/fracture risk through a meta-analysis and has subsequently confirmed its positive relationship.
• Additional large-sample rigorously prospective cohorts are still warranted to validate the present evidence.

• Premature ovarian insufficiency is cessation of ovarian function prior to 40 years of age.
• It is known to have varied short and long-term implications on the health of the women.
• The quality of life is affected in various domains.

• This was a cross sectional comparative study in which women with premature ovarian insufficiency with normal karyotype were included before initiation of hormone replacement therapy as cases and age matched women without any menstrual irregularity, infertility or any chronic illness were included as controls.
• Written informed consent was obtained from all patients.
• The pre-validated Tamil version of the WHOQOL-BREF (26 items, 4 domains) was filled through face-to-face interview.
• The score of each domain was transformed into 0-100 as per the guideline provided by WHOQOL-BREF.
• Statistical analysis was done using SPSS version 19.

• A total of 100 (50 women with POI and 50 control women) completed the WHOQOL-BREF questionnaire.
• The mean age of the women who participated in the study was 29.6 ± 6.5 years.
• Among the cases, 72% were nulliparous.
• There was statistically significant difference in the median scores of overall QOL, physical, psychological and social domains between the two groups.
• Univariate analysis showed that nulliparity and infertility were the factors responsible for poor QOL, however, these were not independently associated with poor QOL after applying bivariate linear regression analysis.

• A total of 273,240 women and 228,957 men without prevalent dementia from the UK Biobank were included in the analyses.
• Cox proportional hazard regressions estimated hazard ratios (HRs) for reproductive factors with incident all-cause dementia.
• Multiple adjusted models included age at study entry, SES, ethnicity, smoking status, systolic blood pressure, BMI, history of diabetes mellitus, total cholesterol, antihypertensive drugs, and lipid-lowering drugs.

• Over a median of 11.8 years of follow-up, 1,866 dementia cases were recorded in women and 2,202 in men.
• Multiple adjusted HRs ((95% confidence intervals (CIs)), p-value) for dementia were 1.20 (1.08, 1.34) (p = 0.016) for menarche <12 years and 1.19 (1.07, 1.34) (p = 0.024) for menarche >14 years compared to 13 years; 0.85 (0.74, 0.98) (p = 0.026) for ever been pregnant; 1.43 (1.26, 1.62) (p < 0.001) for age at first live birth <21 compared to 25 to 26 years; 0.82 (0.71, 0.94) (p = 0.006) for each abortion; 1.32 (1.15, 1.51) (p = 0.008) for natural menopause at <47 compared to 50 years; 1.12 (1.01, 1.25) (p = 0.039) for hysterectomy; 2.35 (1.06, 5.23) (p = 0.037) for hysterectomy with previous oophorectomy; and 0.80 (0.72, 0.88) (p < 0.001) for oral contraceptive pills use.
• The U-shaped associations between the number of children and the risk of dementia were similar for both sexes: Compared with those with 2 children, for those without children, the multiple adjusted HR ((95% CIs), p-value) was 1.18 (1.04, 1.33) (p = 0.027) for women and 1.10 (0.98, 1.23) (p = 0.164) for men, and the women-to-men ratio of HRs was 1.09 (0.92, 1.28) (p = 0.403); for those with 4 or more children, the HR was 1.14 (0.98, 1.33) (p = 0.132) for women and 1.26 (1.10, 1.45) (p = 0.003) for men, and the women-to-men ratio of HRs was 0.93 (0.76, 1.14) (p = 0.530).
• There was evidence that hysterectomy (HR, 1.31 (1.09, 1.59), p = 0.013) and oophorectomy (HR, 1.39 (1.08, 1.78), p = 0.002) were associated with a higher risk of dementia among women of relatively lower SES only.
• Limitations of the study included potential residual confounding and self-reported measures of reproductive factors, as well as the limited representativeness of the UK Biobank population.

• Information regarding 4,945 post-menopausal women was extracted from the database of the National Health and Nutrition Examination Survey (NHANES) 1999-2014, and then divided into 4 groups according to the type of menopause (natural or surgical) and early menopause (menopause at age <45) or not.
• The association between early menopause and CKD prevalence was examined using multivariable logistic regression, while the authors used multivariable Cox proportional hazards models to investigate the possible relationship between early menopause and all-cause mortality in CKD and non-CKD populations.
• The differences in the levels of sex hormones between women with and without CKD were also explored.

• Compared with women with natural menopause at age ≥45, women experiencing early natural menopause had a higher risk of CKD [OR = 1.26 (1.01-1.56)].
• Similarly, as compared to women with surgical menopause at age ≥ 45, women in the early surgical menopause group were more likely to have CKD [OR = 1.38 (1.05-1.81)].
• In addition, early surgical menopause was associated with higher mortality in the non-CKD group [HR = 1.62 (1.06-2.49)], but not in the CKD group.
• Women with CKD had a higher level of luteinizing hormone and follicle-stimulating hormone, combined with a lower level of testosterone and estradiol than the non-CKD women.

• Both early natural and surgical menopause were associated with a higher risk of CKD.
• Early surgical menopause was a hazard factor for survival in the non-CKD group, but not in the CKD group; further research is required to understand the mechanisms.