I am delighted to have the opportunity to write my first report for Our Menopause World as incoming President of the International Menopause Society (IMS). It is a great honour and privilege to take over from Steven Goldstein as President of IMS, and I will do my utmost to emulate the achievements of Steve and the other past presidents in order to maintain IMS at the forefront of global menopause education and research.
First, I would like to express my immense gratitude to my colleagues who have recently departed the IMS board including our previous past president Susan Davis, and past board members Tim Hillard, Sunila Khandelwal and Robert Langer.
I am delighted to welcome our new and returning board members for 2022-2024. The IMS Executive members are Steven Goldstein (Past President), Rossella Nappi (President Elect), Pauline Maki (Treasurer), Ang Seng Bin (General Secretary) and the Board members are Peter Chedraui, Nicole Jaff, Santiago Palacios, Sonia Cerdas Pérez, Amos Pines, Xiangyan Ruan, Marla Shapiro, Tommaso Simoncini, Wendy Wolfman and Amanda Vincent. I look forward to working closely with my board of trustees, and with Rebecca Cheshire our CEO and her team, to ensure that the educational, charitable, financial and governance standards of IMS are maintained at the highest level.
I am also delighted to announce that our new Council of Affiliated Menopause Societies (CAMS) chair, Duru Shah, has joined the IMS board. I am very confident that Duru will utilise her vast experience and extensive connections to continue the excellent work of our immediate past CAMS chair Tommaso Simoncini in reaching out to our existing CAMS members and also in forging new CAMS relationships globally. I know that Duru has exciting plans for integrating our CAMS members into our IMS family through provision of society microsites in the IMS website, a regular newsletter and other initiatives. The mission of the IMS is to work globally to promote and support access to best practice health care for women through their menopause transition and post-reproductive years, enabling them to achieve optimal health and well-being. Fulfilling this mission will be heavily dependent on optimising the connections within our CAMS network, and I have every confidence that Duru will help us achieve this goal.
A priority during my term of office will be to update the 2016 IMS recommendations on women’s midlife health and menopause hormone therapy. I am aware that IMS members and many other individuals and societies have found these very useful in their practice. Implementation will be just as important as updating the recommendations. In order for this to be effective, it will be vital that the recommendations are translated into as many languages as possible and adapted to local health service provision. Our CAMS members will be key to making the recommendations locally relevant and applicable. Following on from this, achieving a consensus of global menopause and other societies will also be important to put women’s midlife health and menopause at the forefront of the health agenda. Working with organisations such as the United Nations, the World Health Organisation and The International Federation of Gynaecology and Obstetrics will help to achieve this.
I would like to extend my deep gratitude and appreciation both personally, and on behalf of the IMS, to Susan Davis (IMS Past President) and Tobie de Villiers (Chair of the Scientific Programme Planning Committee) and their committees for the immense amount of work they put into planning the 17th IMS 2020 World Congress in Melbourne which was on course to be a very successful meeting, but unfortunately had to be cancelled due to the Covid pandemic.
Thankfully, we have recently been able to stage the 18th IMS 2022 World Congress in Lisbon, and particular thanks goes to our past president Steven Goldstein and his committees (shown below) who put together a superb scientific programme.
Scientific Program Planning Committee (SPC)
Pauline Maki (Chair), Rossella Nappi (Co-chair), Tim Hillard (Co-chair), Luciano Pompei, Jericho T.P. Luna, Shaikh Zinnat Ara Nasreen.
Portuguese and Spanish Scientific Program Committee
Santiago Palacios, Fernanda Geraldes, Zully Benítez Roa, Nicolas Mendoza
Local Organizing Committee (LOC)
Fernanda Geraldes, Santiago Palacios, Nicolas Mendoza, Antonio Cano, Camil Castelo-Branco (PT/ES), Pluvio Coronado Martín, Claudio Rebelo
The number of delegates exceeded our most optimistic hopes given the Covid pandemic, with more than 1700 registrants from 76 countries. There were 414 different presenters on the scientific program, including 183 invited speakers and chairs. Immediate feedback indicated that the congress was a great success, with huge enthusiasm for the scientific programme and immense excitement to be able to network face to face once again at a major scientific menopause congress. The establishment of the Endowment for Education and Research (EER) by Steven Goldstein allowed us to award 22 travel bursaries to Young Scholars for the congress. We encourage all our professional and corporate members and others to continue contributing to this important charitable endeavour. It will provide a vital educational lifeline to our young investigators, particularly in disadvantaged parts of the world, enabling them to travel to congresses and to scientific centres of excellence for mentorship programmes.
Our thoughts now turn to the next (19th) IMS World Congress which will be held on Oct 19th – 22nd 2024 in Melbourne, Australia. We have already started to plan a stimulating Scientific and Cultural Programme with the theme “Optimising Menopause and Women’s Midlife Health”. The programme will be diverse, globally relevant and will appeal to all health care providers of menopause medicine. There will be particular focus on the challenges of the peri- and early menopause and premature ovarian insufficiency.
I am honoured to announce that the following colleagues have kindly agreed to participate in the committees for Melbourne 2024:
The Scientific Programme Planning Committee will be chaired by Rodney Baber and co-chaired by Tim Hillard and Tobie de Villiers. They will be joined by Premitha Damodaran, Susan Davis, Anna Fenton, Sonia Cerdas Pérez, and JoAnn Pinkerton.
The Local Organising Committee will be jointly chaired by Susan Davis and Amanda Vincent, who are both from Melbourne. They will be joined by Karen Magraith, President of the Australasian Menopause Society, Janet Hailes Michelmore AO, CEO, Board Member and Patron of the Jean Hailes Foundation for Women and Vicki Doherty, Executive Director of the Australasian Menopause Society (AMS). Close liaison with AMS will ensure that the programme is locally, as well as globally, relevant to menopause healthcare providers in both primary and secondary care, and culturally sensitive.
Our educational programme is the bedrock of IMS. It became apparent in 2020 that in order for the IMS educational programme and finances to weather the Covid pandemic “storm” we would have to move to an online educational platform. They say that “every cloud has a silver lining” and through the huge efforts of Susan Davis, Steven Goldstein and Rebecca Cheshire during this very difficult time, our online educational programme has gone from strength to strength. Unrestricted grants have made the society financially independent of the World Congress income and allowed us to provide a diverse portfolio of educational activities. This includes The Clinical Colloquium in Midlife Women’s Health, the IMS interview Series for professionals and women, the IMS monthly webinars, World Menopause Day papers and leaflets, and ongoing development of both levels of our IMPART online education series (originally initiated by Duru Shah) with more than 7000 registrations to date for Level 1.
Finally, I am particularly excited by the ongoing development of the women’s educational arm of the society “Menopause Info”, which will provide a new website and educational resources for women. It is crucial that the society reaches out directly to our “consumers” to provide them with evidence based educational resources. Ultimately it will be local and regional social influencers who will help us put menopause at the forefront of the health agenda, and they need information which has been produced and endorsed by the leading experts in menopause medicine.
I look forward to collaborating with as many of you as possible during my two-year term. We have a common goal to optimise women’s health all over the world, but I am aware that in order to achieve this effectively it will require approaches which are geographically, culturally and politically appropriate and diverse. Thank you in advance for accompanying me and my excellent team on this important journey. I look forward to your active involvement with our society through your comments, suggestions, CAMS activities, and engagement with our various sub committees.
The 27th webinar in the IMS webinar series will be held on Tuesday 22nd November 15:00 (CET). “The Heart of the Matter” will be moderated by Dr Chrisandra Shufelt. Professor Rossella Nappi will be presenting “Traditional and Female Specific Cardiac Risk Factors” and Dr Matthew Nudy will be presenting “Assessing Cardiac Risk in Midlife Women”. The link for registrations is Online Events – International Menopause Society (imsociety.org)
The 26th webinar in the IMS webinar series was held on Monday 3rd October. The webinar “Brain Fog in Menopause: A Healthcare Professional’s Guide for Decision Making and Counselling on Cognition” was moderated by Professor Claudio Soares. Professor Pauline Maki presented “Menopause and Brain Fog: Evidence-Based Messaging for the Provider” and Dr Nicole Jaff presented “Understanding and Addressing Risk Factors for Cognitive Issues at Midlife and Beyond This is now available on IMS Webinars
The November Clinical Colloquium will be “Managing Menopause without Hormones” with Professor Nick Panay. The recording will be available after the live roundtable session on 17th November. Recordings of the Clinical Colloquium in Midlife Women’s Health sessions are available exclusively for IMS members via this link. The following recordings are currently available: “Bone Health for the Generalist: Not just Osteoporosis”; “Cardiovascular Issues for Midlife Women”; “Cognition and Mood”; “Menopausal Hormone Therapy: Myths and Realities”; and “Sexual Function: Essentials in Midlife”.
11th International Symposium on Diabetes, Hypertension, Metabolic Syndrome and Pregnancy: Innovative Approaches in Maternal Offspring Health (DIP)
Date 4th-6th May 2023
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 or click on the image below for more details.
Traumatic Experiences May be Associated with Lower Levels of Sex Hormones
New study suggests that a history of trauma is associated with lower concentrations of estrone and estradiol, especially in women who get less sleep. https://www.eurekalert.org/news-releases/966698
Does a History of Migraines Mean You’re More Likely to Be a Poor Sleeper?
New study confirms an association between a history of migraine and poor sleep in premenopausal and perimenopausal women, although the reasons why are different depending on menopause status. https://www.eurekalert.org/news-releases/966814
Hormone Therapy may Help Prevent Shoulder Pain and Loss of Motion in Menopausal Women New study concludes that women not receiving hormone therapy have greater odds of adhesive capsulitis. https://www.eurekalert.org/news-releases/966924
Women with Diabetes at an Early Age Likely to Enter Menopause Early
New study suggests that the age at which a woman is diagnosed with either type 1 or type 2 diabetes will determine when she enters menopause. https://www.eurekalert.org/news-releases/967065
What’s New and What Works in the Treatment of Hot Flashes?
Presentation will highlight the approval status and effectiveness of various pharmacologic treatment options for vasomotor symptoms. https://www.eurekalert.org/news-releases/967211
Hot Flashes are not just Uncomfortable but also Could Be Hard on theHeart
Presentation highlights growing evidence linking vasomotor symptoms to an increased risk of cardiovascular disease. https://www.eurekalert.org/news-releases/967216
Could Hot Flashes Have Implications for Brain Health?
New study finds that vasomotor symptoms, especially those occurring during sleep, are associated with evidence of cerebral small vessel damage linked with later cognitive decline, dementia and mortality. https://www.medpagetoday.com/meetingcoverage/nams/101245
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, October Issue, chosen by our Editor, Professor Rod Baber, have Free Access for the next 3 months. There are also Open Access papers in the October 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.
Soares-Jr JM, Espósito Sorpreso IC, Nunes Curado JF, Ferreira Filho ES, Dos Santos Simões R, Bonfá E, Silva CA, Baracat EC. Efecto de la terapia hormonal en pacientes menopáusicas con lupus eritematoso sistémico: una revisión sistemática. Climacteric. 2022;25(5):427-433. doi: 10.1080/13697137.2022.2050205.
El lupus eritematoso sistémico (LES) afecta principalmente a las mujeres, que pueden necesitar terapia hormonal (TH) en la menopausia. Sin embargo, existe cierta preocupación en cuanto a su eficacia y seguridad. Esta revisión sistemática tuvo como objetivo determinar el efecto de la TH sobre la actividad del LES y su seguridad. El estudio fue una revisión sistemática cualitativa. La investigación se realizó con datos extraídos de las bases de datos Embase, MEDLINE y Cochrane utilizando términos MESH hasta abril de 2021, sin restricción de fecha o idioma. Dieciséis estudios fueron seleccionados para el análisis. La mayoría de ellos mostró que la TH es eficaz en el tratamiento de los síntomas de la menopausia sin impacto en la actividad del LES, pero un ensayo clínico aleatorizado mostró un aumento en el número de eventos trombóticos. La presente revisión sistemática demostró la eficacia de la TH para el tratamiento de los síntomas menopáusicos de las pacientes con LES. El riesgo de exacerbación de síntomas de LES y trombosis parece ser muy bajo.
Palabras claves: Lupus eritematoso sistémico; Terapia de reemplaz o hormonal; Terapia hormonal; menopausia.
Spanish translation: Ruan X, Mueck AO. Elección primaria de estrógeno y progestágeno como componentes para la TRH: una visión farmacológica clínica. Climacteric. 2022;25(5):443-452. doi: 10.1080/13697137.2022.2073811.
La prescripción de la terapia de reemplazo hormonal (TRH) requiere considerar la selección de sus dos componentes, el estrógeno y el progestágeno. En cuanto al estrógeno, la decisión es principalmente si se usa estradiol (E2) o estrógenos equinos conjugados (EEC). Estos son los componentes necesarios para tratar eficazmente los síntomas del climaterio y/o prevenir la osteoporosis, actualmente las únicas indicaciones etiquetadas. Aún existe controversia sobre las dosis adecuadas comparando E2 y EEC; sin embargo, el consenso es que las diferencias en la eficacia de E2 y EEC no son un problema real. Por lo tanto, se deben utilizar otros criterios. La primera razón para agregar el progestágeno es evitar el desarrollo de cáncer de endometrio (es decir, lograr la ‘seguridad endometrial’). Cualquier preparación de TRH ‘fija-combinada’ disponible tiene que ser probada para determinar la eficacia endometrial suficiente, porque la primera pregunta que hacen las autoridades sanitarias antes del registro del producto se relaciona con la seguridad endometrial. En general, podemos confiar en la seguridad endometrial de estos productos combinados fijos. Sin embargo, puede ser que queramos usar combinaciones ‘libres’, que son necesarias si usamos E2 transdérmico (parches, gel, spray), pero también para individualizar horarios, por ejemplo, al tratar problemas de sangrado. La pregunta aquí es cómo obtener conocimiento sobre la eficacia endometrial de los diferentes progestágenos y cómo monitorear la terapia. Intentaremos responder a estas dos preguntas desde el punto de vista de la ‘farmacología clínica’, como disciplina que considera preferentemente las propiedades farmacológicas, pero también relacionadas con la práctica clínica, para conseguir una terapia individualizada con una eficacia óptima, la mejor tolerabilidad y los mínimos riesgos.
Palabras claves: Estrógeno; Terapia de reemplazo hormonal; elección farmacológica; progestágeno
Spanish translation: Zouboulis CC, Blume-Peytavi U, Kosmadaki M, Roí E, Vexiau-Robert D, Kerob D, Goldstein SR. Piel, Cabello y más allá: el impacto de la menopausia. Climacteric. 2022;25(5):434-442. doi: 10.1080/13697137.2022.2050206.
La piel es un órgano endocrino y un objetivo importante de hormonas como los estrógenos, los andrógenos y el cortisol. Además de los síntomas vasomotores (SVM), los síntomas de la piel y el cabello a menudo reciben menos atención que otros síntomas de la menopausia a pesar de tener un efecto negativo significativo en la calidad de vida. Los síntomas menopáusicos de la piel y las mucosas incluyen sequedad y prurito, adelgazamiento y atrofia, arrugas y flacidez, mala cicatrización de heridas y reducción de la vascularización, mientras que las lesiones premalignas y malignas de la piel y los signos de envejecimiento de la piel son causados casi exclusivamente por factores ambientales, especialmente la radiación solar. Los síntomas capilares de la menopausia incluyen reducción del crecimiento capilar y la densidad en el cuero cabelludo (efluvio difuso debido a la rarefacción folicular y/o alopecia androgenética de patrón femenino), alteración de la calidad y la estructura del cabello, y aumento del crecimiento del vello no deseado en las áreas faciales. La terapia de reemplazo hormonal (TRH) no está indicada solo para síntomas de la piel y el cabello debido al balance riesgo-beneficio, pero los beneficios potenciales más amplios de la TRH (más allá del efecto del estrógeno sobre los SVM, los huesos, las mamas, el corazón y los vasos sanguíneos) que incluyen en la piel, el cabello y las mucosas deben discutirse con las mujeres para que sean capaz de tomar las mejores posibles decisiones informadas sobre cómo prevenir o manejar sus síntomas menopáusicos.
Spanish translation: Wang XY, Wang LH, Di JL, Zhang XS, Zhao GL. Asociación de estado y síntomas menopáusicos con síntomas depresivos en mujeres chinas de mediana edad. Climacteric. 2022;25(5):453-459. doi: 10.1080/13697137.2021.1998435.
Resumen: Objetivo: Este estudio tuvo como objetivo examinar la asociación del estado y los síntomas de la menopausia con los síntomas depresivos. Métodos: Fue una encuesta transversal basada en la comunidad que reclutó a 6,745 mujeres de 40 a 55 años de edad en las regiones oriental, central y occidental de China en 2018. El estado menopáusico se clasificó en etapa reproductiva, perimenopausia o postmenopausia según la clasificación del Taller de Etapas del Envejecimiento Reproductivo. Los síntomas menopáusicos se determinaron mediante el índice menopáusico de Kupperman modificado y se clasificaron como ninguno (puntuación total < 15), leves (puntuación total entre 15 ≥ y ≤ 24) o moderados a graves (puntuación total ≥ 25). Se utilizaron modelos de regresión logística para examinar las asociaciones del estado y los síntomas de la menopausia con los síntomas depresivos evaluados por el Cuestionario #9 de Salud del Paciente. Resultados: La prevalencia de síntomas depresivos entre mujeres en etapa reproductiva, perimenopausia y postmenopausia fue de 15.4%, 23.9% y 22.8%, respectivamente. Después del ajuste multivariable, la perimenopausia (odds ratio [OR] = 1.21, intervalo de confianza [IC] del 95%: 1.01-1.47) y la postmenopausia (OR = 1.28, IC del 95%: 1.04-1.58) se asociaron con un mayor riesgo de síntomas depresivos que durante la etapa reproductiva. Los síntomas menopáusicos leves (OR = 5.55, IC del 95%: 4.68-6.59) y de moderados a graves (OR = 14.77, IC del 95%: 10.94-19.94) se asociaron con una mayor probabilidad de síntomas depresivos en comparación con el grupo que no informó síntomas menopáusicos. síntomas. Conclusiones: El estado y los síntomas de la menopausia se asociaron de forma independiente con el riesgo de síntomas depresivos en mujeres chinas de mediana edad.
Spanish translation: Zhang Y, Fu WQ, Liu NN, Liu HJ. Alteraciones de la homogeneidad regional en la perimenopausia: un estudio de resonancia magnética funcional en estado de reposo. Climacteric. 2022;25(5):460-466. doi: 10.1080/13697137.2021.2014808.
Resumen: Objetivo: Se utilizó la homogeneidad regional (HoRe) para evaluar los cambios de la función cerebral y la relación con la función cognitiva en mujeres perimenopáusicas. Métodos: El estudio transversal reclutó a 25 mujeres perimenopáusicas y 25 mujeres postmenopáusicas que se sometieron a mediciones del nivel de hormonas sexuales, evaluaciones clínicas y neuropsicológicas y exploraciones por imágenes de resonancia magnética (IRM). La HoRe se midió en función de los datos de resonancia magnética funcional en estado de reposo (RMF-ER) y se compararon las diferencias en HoRe entre los grupos perimenopáusicos y postmenopáusicos. Se extrajeron los valores de volumen de materia gris (VMG) de las regiones cerebrales con diferencias (región de interés [RDI]) en HoRe y se compararon las diferencias de VMG entre los dos grupos. Analizamos las correlaciones de los valores HoRe y VMG de estos RDI con los resultados de los niveles de hormonas sexuales, evaluaciones clínicas y neuropsicológicas en los dos grupos. Resultados: Los valores de HoRe en la circunvolución lingual izquierda y la circunvolución precentral derecha aumentaron en la perimenopausia, mientras que los valores de HoRe en la circunvolución temporal inferior izquierda y el putamen bilateral disminuyeron. El análisis de correlación mostró que los valores de HoRe del giro temporal inferior izquierdo se correlacionaron positivamente con el tiempo de reacción de la prueba de palabra de color de Stroop en mujeres perimenopáusicas. Conclusiones: Los cambios en los patrones anormales de la HoRe en mujeres perimenopáusicas afectan la función cognitiva. Estos cambios en la función cerebral pueden proporcionar más conocimientos e información sobre los mecanismos neurales de la disfunción cognitiva en mujeres perimenopáusicas.
Lopez-Pentecost M, Crane TE, Garcia DO, Kohler LN, Wertheim BC, Hebert JR, Steck SE, Shivappa N, Santiago-Torres M, Neuhouser ML, Hatsu IE, Snetselaar L, Datta M, Kroenke CH, Sarto GE, Thomson CA. Role of dietary patterns and acculturation in cancer risk and mortality among postmenopausal Hispanic women: results from the Women’s Health Initiative (WHI). Z Gesundh Wiss. 2022;30(4):811-822.
To investigate the association between dietary patterns and total and obesity-related cancers risk. Additionally, to examine if acculturation modifies this relationship.
Dietary intake of postmenopausal Hispanic women (N=5,482) enrolled in the Women’s Health Initiative was estimated from a Food Frequency Questionnaire and used to calculate dietary pattern scores; Healthy Eating Index-2015 (HEI-2015), Mexican Diet (MexD) score, alternate Mediterranean Diet Score (aMED), and the energy adjusted-Dietary Inflammatory Index (E-DII™).
Associations were evaluated using Cox proportional hazards regression models.
631 cancers and 396 obesity-related cancers were diagnosed over a mean-follow up of 12 years.
Across dietary scores, there were no significant associations with cancer risk or mortality.
Trend analysis suggest a potentially lower risk for total cancer related to the highest MexD score (HR 0.68, 95% CI 0.45-1.04, P-trend=0.03), and lower risk for obesity-related cancer mortality related to the highest score category for MexD (HR 0.65, 95% CI 0.37-1.16, P-trend=0.02), and aMED (HR 0.87, 95% CI 0.45-1.67, P-trend=0.04).
Further analysis suggests less acculturated women with higher MexD scores had 56% lower risk for any cancer (HR 0.44, 95% CI 0.22-0.88, P-trend=0.03) and 83% lower risk for cancer mortality (HR 0.17, 95% CI 0.04-0.76, P-trend=0.01) compared to more acculturated Hispanic women.
Dietary patterns were not associated with cancer risk and mortality in postmenopausal Hispanic women.
Less-acculturated, Spanish-preferred speakers, who reported consuming a more traditional Mexican diet may experience a lower risk for cancer and cancer mortality.
Dixit A, Carden N, Stephens E, Chadwick M, Tamblyn J, Robinson L. Hormone replacement therapy subcutaneous implants for refractory menopause symptoms; the patient’s perspective. Post Reprod Health. 2022;28(2):79-91.
For women with menopause symptoms refractory to standard hormone replacement therapy (HRT) preparations, HRT implants offer an alternative.
To evaluate women’s perceptions regarding efficacy, tolerability, satisfaction and safety of implant therapy.
A single centre service evaluation study performed at Birmingham Women’s & Children’s Foundation Hospital Trust.
An anonymised semi-structured survey link was posted to all women (n = 397) recorded to have received HRT implant(s) at a tertiary Menopause clinic (May 1982 and Dec 2018).
Women attending clinic (June 2020 to Sept 2020) were opportunistically invited to complete a written version of the survey.
Data collected included demographics, medical and surgical history, therapy duration, type, indication and complications.
Climacteric symptoms were assessed using the Greene Climacteric Scale.
Data was obtained for 119 women.
The written survey yielded higher response rates (n = 73, 61.3%).
Most respondents were 51-60 years old (n = 51 42.9%) and 87.4% (n = 104) were ‘White British’. 70 women used estradiol only implants. 30.1%% (n = 34) of patients reported a low Greene Climacteric Scale score (0-5).
Subgroup analysis showed prevalence of sexual dysfunction and vasomotor symptoms across ages.
There was a lower prevalence of psychological symptoms amongst ≥51 year olds.
High satisfaction rates were reported.
Data from a large cohort is presented.
Good symptom control, satisfaction and long-term efficacy was demonstrated.
This study supports the value of HRT implants for refractory menopause symptoms.
A national database of implant users would be a useful tool to record satisfaction scores and adverse events.
Koçoğlu F, Kocaöz S, Kara P, Aşcı Ö. Relationship between menopausal symptoms and sleep quality in women during the climacteric period: a cross-sectional study. J Obstet Gynaecol. 2022;42(6):2393-2398.
Sleep disorders are a common health problem in women in the climacteric period.
To evaluate the relationship between the menopausal symptoms and sleep quality in women in the climacteric period.
This cross-sectional study was conducted on 383 women aged 40-64 years at the Cancer Early Diagnosis Screening and Training Centre.
The data were collected with the questionnaire form, Menopause Rating Scale (MRS) and the Pittsburgh Sleep Quality Index (PSQI).
The most common menopausal symptoms were joint and muscle problems, physical and emotional fatigue, nervousness, hot flushes, unhappiness, anxiety, and sleep problems in order of frequency.
The sleep quality was poor in 77.8% of the women in the study.
A significant relationship was found between PSQI scores and the somatic and psychological subscale scores of the MRS in the presence of other variables that could affect sleep according to multiple linear regression analysis (p < .05).
In addition, there was a weak positive significant relationship between the total PSQI score and the psychological and urogenital subscale scores of the MRS, in addition to a moderate positive significant relationship between the total PSQI scores and the total and somatic subscale scores of the MRS
Authors recommend training and consulting services provided by health care professionals and further experimental studies on the subject to decrease the negative effects of the somatic and psychological symptoms found to worsen sleep quality in women in the climacteric period.
LeBlanc ES, Hovey KM, Cauley JA, Stefanick M, Peragallo R, Naughton MJ, Andrews CA, Crandall CJ. Cumulative Endogenous Estrogen Exposure Is Associated with Postmenopausal Fracture Risk: The Women’s Health Initiative Study. J Bone Miner Res. 2022;37(7):1260-1269.
To evaluate the relationship between cumulative endogenous estrogen exposure and fracture risk in 150,682 postmenopausal women (aged 50 to 79 years at baseline) who participated in the Women’s Health Initiative.
The authors hypothesized that characteristics indicating lower cumulative endogenous estrogen exposure would be associated with increased fracture risk and they determined ages at menarche and menopause as well as history of irregular menses from baseline questionnaires and calculated years of endogenous estrogen exposure from ages at menarche and menopause.
Hence, incident clinical fractures were self-reported over an average 16.7 years of follow-up and multivariable proportional hazards models were used to assess the associations between the estrogen-related variables and incidence of any clinical fracture.
In fully adjusted models, those with the fewest years of endogenous estrogen exposure (<30) had an 11% higher risk of developing central body fractures and a 9% higher risk of lower extremity fractures than women with 36 to 40 years of endogenous estrogen exposure (the reference category).
In contrast, women with the most years of endogenous estrogen exposure (more than 45 years) had a 9% lower risk of lower extremity fractures than the reference category.
Women with irregular (not monthly) menstrual cycles were 7% to 8% more likely to experience lower extremity fractures than women with regular monthly cycles.
The findings of the study support the hypothesis that characteristics signifying lower cumulative endogenous estrogen exposure are associated with higher fracture risk.
Mittal M, McEniery C, Supramaniam PR, Cardozo L, Savvas M, Panay N, Hamoda H. Impact of micronised progesterone and medroxyprogesterone acetate in combination with transdermal oestradiol on cardiovascular markers in women diagnosed with premature ovarian insufficiency or an early menopause: a randomised pilot trial. Maturitas. 2022;161:18-26.
The European Society for Cardiology has identified carotid femoral pulse wave velocity (cfPWV) as the gold standard cardiogenic biomarker for risk stratification of arterial disease. Menopause has been shown to augment the age-dependent increase in arterial stiffness, with hormone replacement therapy (HRT) being the mainstay of management of women diagnosed with EMPOI.
To compare the difference between micronised progesterone (MP) and medroxyprogesterone acetate (MPA) in combination with transdermal oestradiol (t-E2) on cardiovascular disease (CVD) risk markers in women diagnosed with an early menopause and premature ovarian insufficiency (EMPOI).
A pilot randomised prospective open-label trial.
Women were randomised to either cyclical MP (Utrogestan® 200 mg) or MPA (Provera® 10 mg) in conjunction with t-E2 (Evorel® Patches 50mcg/day) for 12 months.
Seventy-one subjects were screened, and baseline data are available for 57 subjects.
Main outcome measure: Carotid-femoral pulse wave velocity (cfPWV).
PWV did not significantly change from baseline in either treatment arm.
MP + t-E2 demonstrated a positive effect on traditional CVD markers, with a significant improvement seen in cardiac output (CO) (0.71±1.01mL/min, 95% CI 0.20 to 1.21) and reduction in diastolic blood pressure (DBP) (-3.43±6.31mmHg, 95% Cl -6.57 to -0.29) and total peripheral resistance (TPR) (-0.15±0.19mmHg⋅min⋅mL-1, 95% CI -0.24 to -0.05) after 12 months.
MPA + t-E2, in contrast, did not demonstrate significant changes from baseline in traditional haemodynamic parameters.
The positive changes in traditional markers were not reflected in the cardiogenic biomarker, cfPWV, which has demonstrated a higher positive predictive value for cardiovascular events than traditional measurements.
Hirsch H, Manson JE. Menopausal symptom management in women with cardiovascular disease or vascular risk factors. Maturitas. 2022;161:1-6.
Women with pre-existing cardiovascular disease (CVD) or vascular risk factors commonly experience bothersome symptoms of menopause, including vasomotor symptoms (VMS) and genitourinary syndrome of menopause (GSM).
Due to confusion surrounding the safety of menopausal hormone therapy (HT) in symptomatic women with CVD, evidence-based guidelines should be followed regarding identifying candidates for treatment and HT decision making.
Objective and design
The aim of this review was to summarize best practices in the evaluation and treatment of VMS and GSM in women with pre-existing CVD, based on international expert consensus guidelines and/or expert opinion when data are scarce.
For women with pre-existing CVD or vascular risk factors who are candidates for HT, guidelines often address the appropriate formulation, dose, and route of delivery.
For women who are not candidates for HT, non-hormonal options were reviewed, and their safety and efficacy in treating VMS and GSM discussed.
Due to increased knowledge of the role that pregnancy-related complications play in maternal risk for future CVD, these conditions were considered when addressing the use of systemic HT.
Women at increased risk for future CVD without the use of HT, such as women with premature or early menopause, were also discussed, as well as the safely profile of HT in these special populations.
With worldwide rates of CVD increasing among women in midlife, it is important for clinicians to have clear guidelines for identifying candidates for hormonal and nonhormonal treatments for symptom management to safeguard the health and quality of life of these patients through the menopause transition and post-menopause.
Xiao PL, Cui AY, Hsu CJ, Peng R, Jiang N, Xu XH, Ma YG, Liu D, Lu HD. Global, regional prevalence, and risk factors of osteoporosis according to the World Health Organization diagnostic criteria: a systematic review and meta-analysis. Osteoporos Int. 2022;33(10):2137-2153.
Osteoporosis is a common metabolic bone disorder in the elderly, usually resulting in bone pain and an increased risk of fragility fracture, but few summarized studies have guided global strategies for the disease.
To estimate the global, regional prevalence, and risk factors of osteoporosis.
This was a systematic review and meta-analysis.
Authors conducted a comprehensive literature search through PubMed, EMBASE, Web of Science, and Scopus, to identify population-based studies that reported the prevalence of osteoporosis based on the World Health Organization (WHO) criteria.
Authors pooled the epidemiologic data to estimate the global, regional prevalence, and potential risk factors of osteoporosis; then meta-regression and subgroup analyses were used to explore the sources of heterogeneity.
The study was registered in the PROSPERO database (CRD42021285555).
Of the 57,933 citations evaluated, 108 individual studies containing 343,704 subjects were included.
The global prevalence of osteoporosis and osteopenia was 19.7% (95%CI, 18.0%-21.4%) and 40.4% (95%CI, 36.9%-43.8%).
Prevalence varied greatly according to countries (from 4.1% in Netherlands to 52.0% in Turkey) and continents (from Oceania 8.0% to 26.9% in Africa).
The prevalence was higher in developing countries (22.1%, 95%CI, 20.1%-24.1%) than in developed countries (14.5%, 95%CI, 11.5%-17.7%).
The present study indicates a considerable prevalence of osteoporosis among the general population based on WHO criteria, and the prevalence varies substantially between countries and regions.
Future studies with robust evidence are required to explore risk factors to provide effective preventive strategies for the disease.
Dias RC, Costa EH, Chrisostomo KR, Junior JK, Paiva ES, Azevedo PM, Skare TL, Nisihara RM. Fibromyalgia and menopause: an open study on postmenopausal hormone therapy. Minerva Obstet Gynecol. 2022 Jun 8. doi: 10.23736/S2724-606X.22.05085-0.
Fibromyalgia women (FM) seems to get worse at menopause suggesting some influence of estrogens on its pathophysiology.
To study the influence of postmenopausal hormone therapy (HT) in FM, the relationship with sleep and FM impact.
The authors analyzed prospectively 69 menopausal women, divided in two groups, FM group (FMG; n=32) and comparison group (CG; n=28) submitted to HT for twelve weeks (1,2mg/g transdermal estradiol, 100 mg micronized natural progesterone oral/daily).
Data on UQOL (Utian Quality of Life Questionnaire) and PSQI (Pittsburgh Sleep Quality Index) were obtained in both groups, at entrance and twelve weeks after HT. FM patients also completed the FIQ-R (Fibromyalgia Impact Questionnaire – revised) and FS (Fibromyalgia Severity).
FM patients improved significantly the FIQ-R (p=0.0001, median FIQ-R score 30% lower), mainly the severity of FM, assessed by FS (p<0.0001).
Both groups had improved quality of life and sleep (UQOL: p=0.0001; p=0.001 – PSQI: p<0.0001; p=0.007, respectively).
Differences between first and second PSQI were greater for CG than for FMG (p=0.008).
HT improved sleep and quality of life in both groups yet it was a significant clinical improvement seen by the FIQ and the FS tools in FM patients.
These changes characterize improvement of functional status and symptoms severity.
Heravi AS, Michos ED, Zhao D, Ambale-Venkatesh B, Doria De Vasconcellos H, Lloyd-Jones D, Schreiner PJ, Reis JP, Wu C, Lewis CE, Shikany JM, Sidney S, Guallar E, Ndumele CE, Ouyang P, Hoogeveen RC, Lima JAC, Vaidya D, Post WS. Oxidative Stress and Menopausal Status: The Coronary Artery Risk Development in Young Adults Cohort Study. J Womens Health (Larchmt). 2022;31(7):1057-1065.
Low endogenous estrogen concentrations after menopause may contribute to higher oxidative stress and greater cardiovascular disease (CVD) risk; however, differences in oxidative stress between similarly aged premenopausal and postmenopausal women are not well-characterized on a population level.
To compare measures of oxidative stress according to menopausal status. The authors hypothesized that urinary isoprostane concentrations, a standard measure of systemic oxidative stress, are higher in women who have undergone menopause compared to premenopausal women.
Investigators examined differences in urinary 8-isoprostane (iPF2α-III) and 2,3-dinor-8-isoprostane (iPF2α-III-M) indexed to urinary creatinine between 279 postmenopausal and 196 premenopausal women in the Coronary Artery Risk Development in Young Adults (CARDIA) study, using linear regression with progressive adjustment for sociodemographic factors and traditional CVD risk factors.
Unadjusted iPF2α-III-M concentrations were higher among postmenopausal compared to premenopausal women (Median [25th, 75th percentile]: 1762 [1178, 2974] vs. 1535 [1067, 2462] ng/g creatinine; p = 0.01). Menopause was associated with 25.5% higher iPF2α-III-M (95% confidence interval [6.5-47.9]) adjusted for age, race, college education, and field center.
Further adjustments for tobacco use (21.2% [2.9-42.6]) and then CVD risk factors (18.8% [0.1-39.6]) led to additional partial attenuation.
Menopause was associated with higher iPF2α-III in Black but not White women.
Postmenopausal women had higher oxidative stress, which may contribute to greater CVD risk.
Abenhaim HA, Suissa S, Azoulay L, Spence AR, Czuzoj-Shulman N, Tulandi T. Menopausal Hormone Therapy Formulation and Breast Cancer Risk. Obstet Gynecol. 2022;139(6):1103-1110.
To evaluate whether the increased risk of breast cancer is dependent on the formulation of menopausal hormone therapy (HT) used.
The authors performed a population-based case-control study of women aged 50 years or older using data from the U.K. Clinical Practice Research Datalink.
Women with incident cases of breast cancer were age-matched (1:10) with a control group of women with comparable follow-up time with no history of breast cancer.
Exposures were classified as ever or never for the following menopausal HT formulations: bioidentical estrogens, animal-derived estrogens, micronized progesterone, and synthetic progestin.
Logistic regression analyses were performed to estimate the adjusted effect of menopausal HT formulation on breast cancer risk.
Between 1995 and 2014, 43,183 cases of breast cancer were identified and matched to 431,830 women in a control group.
In adjusted analyses, compared with women who never used menopausal HT, its use was associated with an increased risk of breast cancer (odds ratio [OR] 1.12, 95% CI 1.09-1.15).
Compared with never users, estrogens were not associated with breast cancer (bioidentical estrogens: OR 1.04, 95% CI 1.00-1.09; animal-derived estrogens: OR 1.01, 95% CI 0.96-1.06; both: OR 0.96, 95% CI 0.89-1.03).
Progestogens appeared to be differentially associated with breast cancer (micronized progesterone: OR 0.99, 95% CI 0.55-1.79; synthetic progestin: OR 1.28, 95% CI 1.22-1.35; both OR 1.31, 0.30-5.73).
Although menopausal HT use appears to be associated with an overall increased risk of breast cancer, this risk appears predominantly mediated through formulations containing synthetic progestins.
When prescribing menopausal HT, micronized progesterone may be the safer progestogen to be used.