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President’s Report

Dear Friends and Colleagues

Given that this will be my last report for Our Menopause World, I thought that it would be fitting to share some reflections on my term. It has been an incredible honour and a great experience to serve as IMS President. I have been fortunate to work with a dedicated and talented Board of Directors: Susan Davis (Past President), Nick Panay (President Elect), Rossella Nappi (General Secretary), Ang Seng Bin (Treasurer), Tommaso Simoncini (CAMS Chair), Sonia Cerdas Pérez, Robert Langer, Sunila Khandelwal, Pauline Maki, Xiangyan Ruan, Marla Shapiro, Tim Hillard, Amos Pines, Santiago Palacios, and Amanda Vincent. My sincerest gratitude for  their contributions and dedication. My term began during the early days of the pandemic, so our Board meeting in Lisbon will actually be our first in-person meeting.

I’m very pleased to continue as a Board member in the position of Past President and look forward to working with incoming President Nick Panay and the 2022-2024 Board to grow and sustain the Society. I’m proud of the achievements during the 2020-2022 term but I don’t want to give away too much before my Van Keep lecture at the World Congress, so for now here is a brief overview: –

  • Initiated two new medical education programs, The Clinical Colloquium in Midlife Women’s Health and the IMS Interview Series;
  • Created new arm of the Society for women/consumers, Menopause Info, comprised of new website and educational resources for women;
  • Delivered 21 webinars and two online sponsored symposia;
  • Delivered 34 interviews (for professionals and women);
  • Two World Menopause Days and White Papers, Bone Health in 2021 and Brain Fog/Cognition in 2022;
  • Established the Endowment for Education and Research (EER) and awarded 22 bursaries to Young Scholars;
  • Membership numbers increased by 11.8%;
  • Nearly 7,000 registrations for IMPART Level 1, which resulted in an increase of free IMPART memberships by 68.7%;
  • Launch of Portuguese, Chinese and Arabic translations of IMPART Level 1;
  • Launch of IMPART Level 2;
  • Income increased by 23.4%; and
  • Updated CAMS Charter to offer membership to any local/regional society and streamlined selection of CAMS Chair.
When I finish my term, the last point on the list above will be the first World Congress to be held in-person since Covid turned the world upside down. This Congress is going to be remarkable, with an outstanding scientific program and a celebration of meeting friends old and new. A huge thank you to the teams that have crafted our exceptional program.

Scientific Program Planning Committee
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
Fernanda Geraldes, Santiago Palacios, Nicolas Mendoza, Antonio Cano, Camil Castelo-Branco (PT/ES), Pluvio Coronado Martín, Claudio Rebelo

I sincerely hope to meet you all in Lisbon. I encourage you to click on this link to view the Scientific Program for the World Congress and, if you haven’t already done so,  register here.

I always welcome your comments and suggestions.


Steve Goldstein

General Update

World Menopause Day is 18th October. Resources, including the White Paper, consumer leaflet, engagement toolkit and social media assets will be available via this link World Menopause Day – International Menopause Society ( Please share your plans for the day with us so that we can help promote via social media.

The 26th webinar in the IMS webinar series will be held on Monday 3rd October 15:00 (CET) entitled “Brain Fog in Menopause: A Healthcare Professional’s Guide for Decision Making and Counseling on Cognition” will be moderated by Professor Claudio Soares.  Professor Pauline Maki will be presenting on “Menopause and Brain Fog: Evidence-Based Messaging for the Provider” and Dr Nicole Jaff will be presenting on “Understanding and Addressing Risk Factors for Cognitive Issues at Midlife and Beyond”. The link for registrations is  Online Events – International Menopause Society (

The 25th webinar in the IMS webinar series was held on Tuesday 13th September. The webinar “Abnormal Uterine Bleeding in Perimenopausal and Postmenopausal Women was moderated by Dr Wendy Wolfman. Professor Steven Goldstein presented “Appropriate Evaluation of Abnormal Uterine Bleeding in Peri and Postmenopausal Bleeding” and Professor Scott Chudnoff  presented “Medical Management of Bleeding in Peri and Postmenopausal Patients”. This is now available on IMS Webinars

Recordings of the Clinical Colloquium in Midlife Women’s Health sessions are available exclusively for IMS members via this link. The sessions available are: “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”.

Our latest 1-1 interviews series topic will be available shortly – Cognition for World Menopause Day on 18th October . This will be available in video and podcast format.

International Society Meetings 2022

North American Menopause Society Annual Meeting 
Date: 12th-15th October 2022
Location: Atlanta, GA
For more information visit 2022 Meeting (

18th IMS World Congress on Menopause
Date: 26th – 29th October 2022
IMS is organizing 2 pre-congress courses on Tuesday 25th October 2022, one in English and one in Spanish, on the main topics covered by Level 1 of the IMPART course. 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

19th World Congress  International Academy of Human Reproduction
Date: 15th-18th March 2023
Venice, Italy
For more information

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

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.

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


Menopause and mid-life women’s health publication news

Past history of abuse leads to worse menopause symptoms
New study finds that history of psychosocial stressors from childhood through pregnancy is associated with worse menopause symptoms and poorer well-being almost 2 decades later

Frequency of premenstrual anxiety, mood swings a public health issue, study finds
More than 64% of women experience mood swings or anxiety

The neonatal ketone body determines the female ovarian aging via regulating follicle reserve

CBD shows health benefits in estrogen-deficient mice that model postmenopause
Rutgers study shows cannabidiol may be a possible treatment for postmenopausal women

USPSTF recommends anxiety screening in adults younger than 65

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.

Hormone therapy effect on menopausal systemic lupus erythematosus patients: a systematic review
J. M. Soares-Jr, et al.
Free Access

Spanish translation:
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.

Primary choice of estrogen and progestogen as components for HRT: a clinical pharmacological view
X. Ruan & A. O. Mueck
Free Access

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

Skin, hair and beyond: the impact of menopause
C. C. Zouboulis, et al.
Open Access

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.

Palabras claves: Menopausia; exposoma; cabello; terapia de reemplazo hormonal; hormonas; mucosa; perimenopausia; piel.

Association of menopausal status and symptoms with depressive symptoms in middle-aged Chinese women
X. Y. Wang, et al.
Open Access

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.

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.

Palabras claves: Síntomas menopáusicos; síntomas depresivos; menopausia; perimenopausia; postmenopausia.

Alterations of regional homogeneity in perimenopause: a resting-state functional MRI study
Y. Zhang, et al.
Open Access

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.

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.

Palabras claves: Homogeneidad regional; función cognitiva; resonancia magnética funcional; perimenopausia.



López-Gómez JJ, Pérez-Castrillón JL, García de Santos I, Pérez-Alonso M, Izaola-Jauregui O, Primo-Martín D, De Luis-Román DA. Influence of Obesity on Bone Turnover Markers and Fracture Risk in Postmenopausal Women. Nutrients. 2022;14(8):1617.


  • The relationship between obesity and bone metabolism is controversial.
  • In recent decades, the protective role of obesity in the development of osteoporosis has been questioned.
To evaluate the differences in bone turnover markers between postmenopausal women with and without obesity and to compare the risk of fracture at five years between these groups.


  • This was an observational longitudinal prospective cohort study of postmenopausal women with obesity (O) (body mass index (BMI) > 30 kg/m2) and non-obesity (NoO) (BMI < 30 kg/m2).
  • A total of 250 postmenopausal women were included in the study (NoO: 124 (49.6%) and O: 126 (50.4%)).
  • Measured variables included epidemiological, dietary (calcium intake, vitamin D intake, smoking, alcohol consumption, and physical activity), biochemicals (β-crosslap, type I procollagen amino-terminal peptide (P1NP), 25OH-vitamin D, and parathyroid hormone (PTH)), anthropometrics, and fracture data five years after the start of the study.
Main findings
  • The mean age was 56.17 (3.91) years.
  • Women with obesity showed lower levels of vitamin D (O: 17.27 (7.85) ng/mL, NoO: 24.51 (9.60) ng/mL; p &lt; 0.01), and higher levels of PTH (O: 53.24 (38.44-65.96) pg/mL, NoO: 35.24 (25.36-42.40) pg/mL; p &lt; 0.01).
  • Regarding the bone formation marker (P1NP), it was found to be high in women without obesity, O: 45.46 (34.39-55.16) ng/mL, NoO: 56.74 (45.34-70.74) ng/mL; p &lt; 0.01; the bone resorption marker (β-crosslap) was found to be high in women with obesity, being significant in those older than 59 years (O: 0.39 (0.14) ng/mL, NoO 0.24 (0.09) ng/mL; p &lt; 0.05).
  • No differences were observed in the risk of fracture at 5 years based on BMI (OR = 0.90 (95%CI 0.30-2.72); p = 0.85).
Take-home message
Postmenopausal women with obesity showed lower levels of bone formation markers; older women with obesity showed higher markers of bone resorption.

Soares-Jr JM, Espósito Sorpreso IC, Nunes Curado JF, Ferreira Filho ES, Dos Santos Simões R, Bonfá E, Silva CA, Baracat EC. Hormone therapy effect on menopausal systemic lupus erythematosus patients: a systematic review. Climacteric. 2022;25(5):427-433.

Systemic lupus erythematosus (SLE) primarily affects women, who may need hormone therapy (HT) in menopause; there is, however, some concern as to its efficacy and safety.

This systematic review aimed to determine the effect of HT on the activity of SLE and its safety.


  • The study was a qualitative systematic review.
  • Research was conducted with data retrieved from Embase, MEDLINE and Cochrane databases using MESH terms up to April 2021, with no bar on date or language.
Main findings
  • Sixteen studies were selected for analysis.
  • Most of them showed HT to be effective in the treatment of menopausal symptoms with no impact in SLE activity, but one randomized clinical trial showed an increase in the number of thrombotic events.
Take-home messages
  • The present systematic review demonstrated the efficacy of HT for treating the menopausal symptoms of SLE patients.
  • The risk of flare and thrombosis seems to be very low.

Mattick LJ, Bea JW, Singh L, Hovey KM, Banack HR, Wactawski-Wende J, Manson JE, Funk JL, Ochs-Balcom HM. Serum Follicle-Stimulating Hormone and 5-Year Change in Adiposity in Healthy Postmenopausal Women. J Clin Endocrinol Metab. 2022;107(8):e3455-e3462.


  • Evidence from animal studies suggests that the gradual rise in follicle-stimulating hormone (FSH) during reproductive senescence may contribute to the change in adiposity distribution characteristic of menopause.
  • The potential independent role the interrelationships of FSH and estradiol (E2) may play in postmenopausal adiposity changes are not well studied.
To evaluate the associations of FSH and dual x-ray absorptiometry (DXA)-derived adiposity measures, with consideration of estradiol and postmenopausal hormone therapy use.

The authors studied in a sample of 667 postmenopausal women from the Women’s Health Initiative Buffalo OsteoPerio Ancillary Study the associations of serum FSH and E2 levels with dual x-ray absorptiometry (DXA)-derived adiposity measures via cross-sectional and longitudinal analyses (5-year follow-up).

Main findings

  • In cross-sectional analyses, FSH levels were inversely associated with all measures of adiposity in models adjusted for age, years since menopause, smoking status, pack-years, and hormone therapy (HT) use; these associations were not influenced by adjustment for serum E2.
  • In longitudinal analyses, the subset of women who discontinued HT over follow-up (n = 242) experienced the largest increase in FSH (+33.9 mIU/mL) and decrease in E2 (-44.3 pg/mL) and gains in all adiposity measures in unadjusted analyses.
  • In adjusted analyses, an increase in FSH was associated with a gain in percentage of total body fat, total body fat mass, and subcutaneous adipose tissue (SAT).
 Take-home messages
  • While cross-sectional findings suggest that FSH is inversely associated with adiposity, our longitudinal findings suggest that greater increases in FSH were associated with greater increases in percentage of total body fat, total body fat mass, and SAT.
  • Future studies are needed to provide additional insight into FSH-adiposity mechanisms in larger samples.

Vogt EC, Real FG, Husebye ES, Björnsdottir S, et al. Premature menopause and autoimmune primary ovarian insufficiency in two international multi-center cohorts. Endocr Connect. 2022;11(5):e220024.

To investigate markers of premature menopause (<40 years) and specifically the prevalence of autoimmune primary ovarian insufficiency (POI) in European women.


  • Postmenopausal women were categorized according to age at menopause and self-reported reason for menopause in a cross-sectional analysis of 6,870 women.
  • Variables associated with the timing of menopause and hormone measurements of 17β-estradiol and follicle-stimulating hormone were explored using multivariable logistic regression analysis.
  • Specific immunoprecipitating assays of steroidogenic autoantibodies against 21-hydroxylase (21-OH), side-chain cleavage enzyme (anti-SCC) and 17alpha-hydroxylase (17 OH), as well as NACHT leucine-rich-repeat protein 5 were used to identify women with likely autoimmune POI.
Main findings
  • Premature menopause was identified in 2.8% of women, and these women had higher frequencies of nulliparity (37.4% vs 19.7%), obesity (28.7% vs 21.4%), osteoporosis (17.1% vs 11.6%), hormone replacement therapy (59.1% vs 36.9%) and never smokers (60.1% vs 50.9%) (P < 0.05), compared to women with menopause ≥40 years.
  • Iatrogenic causes were found in 91 (47%) and non-ovarian causes in 27 (14%) women, while 77 (39%) women were classified as POI of unknown cause, resulting in a 1.1% prevalence of idiopathic POI.
  • After adjustments nulliparity was the only variable significantly associated with POI (odds ratio 2.46; 95% CI 1.63-3.42).
  • Based on the presence of autoantibodies against 21 OH and SCC, 4.5% of POI cases were of likely autoimmune origin.
Take-home messages
  • Idiopathic POI affects 1.1% of all women and almost half of the women with premature menopause.
  • Autoimmunity explains 4.5% of these cases judged by positive steroidogenic autoantibodies.

Farahmand M, Rahmati M, Azizi F, Behboudi Gandevani S, Ramezani Tehrani F. The Impact of Endogenous Estrogen Exposure Duration on Fracture Incidence: a Longitudinal Cohort Study. J Clin Endocrinol Metab. 2022;107(8):e3321-e3329.

Although it is well documented that estrogen hormone is positively associated with bone mineral density and lower risk of fracture, there are limited studies on the association between duration of endogenous estrogen exposure (EEE) and fracture, especially by longitudinal design.

To investigate the relationship between EEE with fracture incidence by longitudinal design in a community-based study.


  • A total of 5269 eligible postmenarcheal women, including 2411 premenopausal and 2858 menopausal women, were recruited from among the Tehran Lipid and Glucose Study.
  • Cox proportional hazards regression model with adjustment of potential confounders was performed to assess the relationship between duration of EEE and incident of any hospitalized fractures.
Main findings
  • A total of 26.7% (1409/5269) women were menopausal at the baseline, and 2858 of the remaining participants reached menopause at the end of follow-up.
  • Results of the unadjusted model demonstrated that the EEE z-score was negatively associated with fracture incidence [unadjusted hazard ratio (HR) 0.81, 95% CI 0.68-0.96] in postmenarchal women, indicating that per 1-SD increase of EEE z-score, the hazard of fracture reduced by 19%.
  • Results remained statistically unchanged after adjustment for potential confounders (adjusted HR 0.70, 95% CI 0.58-0.86).
Take-home message
The findings of this cohort study suggest that a longer duration of EEE has a protective effect on fracture incidence; a point that needs to be considered in fracture risk assessment.

Nie G, Yang X, Wang Y, Liang W, Li X, Luo Q, Yang H, Liu J, Wang J, Guo Q, Yu Q, Liang X. The Effects of Menopause Hormone Therapy on Lipid Profile in Postmenopausal Women: A Systematic Review and Meta-Analysis. Front Pharmacol. 2022;13:850815.


  • The incidence of dyslipidemia increases after menopause.
  • Menopause hormone therapy (MHT) is recommended for menopause related disease; however, it is benefit for lipid profiles is inconclusive.
To conduct a systematic review and meta-analysis of randomized controlled trials to evaluate the effects of MHT on lipid profile in postmenopausal women.


  • Related articles were searched on PubMed/Medline, EMBASE, Web of Science, and Cochrane Library databases from inception to December 2020.
  • Data extraction and quality evaluation were performed independently by two reviewers.
  • The methodological quality was assessed using the “Cochrane Risk of Bias checklist”.
Main findings
  • Seventy-three eligible studies were selected.
  • The results showed that MHT significantly decreased the levels of TC (WMD: -0.43, 95% CI: -0.53 to -0.33), LDL-C (WMD: -0.47, 95% CI: -0.55 to -0.40) and LP (a) (WMD: -49.46, 95% CI: -64.27 to -34.64) compared with placebo or no treatment.
  • Oral MHT led to a significantly higher TG compared with transdermal MHT (WMD: 0.12, 95% CI: 0.04-0.21).
  • The benefits of low dose MHT on TG was also concluded when comparing with conventional-dose estrogen (WMD: -0.18, 95% CI: -0.32 to -0.03).
  • The results also showed that conventional MHT significantly decreased LDL-C (WMD: -0.35, 95% CI: -0.50 to -0.19), but increase TG (WMD: 0.42, 95%CI: 0.18-0.65) compared with tibolone.
  • When comparing with the different MHT regimens, estrogen (E) + progesterone (P) regimen significantly increased TC (WMD: 0.15, 95% CI: 0.09 to 0.20), LDL-C (WMD: 0.12, 95% CI: 0.07-0.17) and Lp(a) (WMD: 44.58, 95% CI:28.09-61.06) compared with estrogen alone.
Take-home messages
  • MHT plays a positive role in lipid profile in postmenopausal women, meanwhile for women with hypertriglyceridemia, low doses or transdermal MHT or tibolone would be a safer choice.
  • Moreover, E + P regimen might blunt the benefit of estrogen on the lipid profile.

Gosset A, Susini M, Vidal F, Tanguy-Le-Gac Y, Chantalat E, Genre L, Trémollières F. Quality of life of patients with bilateral oophorectomy before the age of 45 for the treatment of endometriosis. Maturitas. 2022;162:52-57.

To evaluate the quality of life and associated factors among women who underwent bilateral oophorectomy (BO) before the age of 45 for the treatment of deep infiltrating endometriosis (DIE).


  • This was a cross-sectional study carried out in 52 women who were treated from January 2014 to December 2019 in 2 public and private DIE surgical centers in Toulouse.
  • All women answered the Menopausal Quality of Life questionnaire (MenQOL).
  • Mean MenQOL scores were compared according to age at BO, smoking, BMI, level of education, delay between BO and the survey and post-BO hormone replacement therapy (HRT) using Mann-Whitney and Anova tests.
  • Spearman’s correlation coefficient was used to analyze the correlations between all the MEnQOL domain scores and clinical variables.
  • The variables associated with the outcomes in univariate analyses with p < 0.2 were jointly evaluated using multiple linear regression.
Main findings
  • The mean age at the time of the survey was 43.4 ± 3.4 years while the mean age at BO was 40.5 ± 3.4 years.
  • The mean MenQOL score was 3.96 (± 1.45), with the highest scores in the sexual (4.77) and vasomotor (4.01) domains.
  • BMI and smoking were independently and significantly associated with the mean total MenQOL score, all domain scores being significantly higher in overweight/obese women.
  • A trend towards worse MenQOL scores was found in patients who had BO before the age of 41.
  • The authors did not find any difference according to whether or not they were taking HRT.
Take-home messages
  • This is a first study evaluating quality of life in a specific population of oophorectomized women under the age of 45 using MenQOL for DIE.
  • While BO is effective in relieving pain in women with severe DIE, the induced premature menopause is associated with a poor quality of life, which deserves further attention.

Kim SM, Shin W, Kim HJ, Lee JS, Min YK, Yoon BK. Effects of Combination Oral Contraceptives on Bone Mineral Density and Metabolism in Perimenopausal Korean Women. J Menopausal Med. 2022;28(1):25-32.

To evaluate the effects of combination oral contraceptives (COCs) on bone mineral density (BMD) and metabolism in perimenopausal Korean women.


  • The was a retrospective cohort study subjects that comprised two groups.
  • The COC group included 55 women who took low-dose COC for at least one year to control vasomotor symptoms.
  • Another 55 women who had annual checkups without history of COC use served as controls.
  • BMD and bone turnover markers were assessed periodically.
Main findings
  • In the control group, 12-month BMD values at the lumbar spine (LS) and total hip (TH) significantly decreased with a greater magnitude at LS, and bone resorption (BR) and formation (BF) markers increased concurrently with a larger change in BR. COCs increased BMD at LS after 12 months and prevented BMD decline at TH.
  • Multivariable linear regression revealed a significant difference in LS BMD between groups at 12 months.
  • In the COC group, there were significant negative correlations between baseline BMD and Z-score at LS and corresponding changes at 12 months.
  • COCs did not alter BR markers, whereas BF markers were significantly decreased at 3 months.
  • Group comparison at 12 months, as tested with adjusted linear regression, disclosed significant differences in both BR and BF makers.
Take-home messages
  • Bone loss associated with activated bone turnover is evident during the menopausal transition, and COCs might prevent BMD decrease and suppress bone turnover markers in perimenopausal Korean women.
  • Significant increase in LS BMD and decreases in BF makers suggest underlying mechanisms of greater impact on BF.

Li J, Hao W, Fu C, Zhou C, Zhu D. Sex Differences in Memory: Do Female Reproductive Factors Explain the Differences? Front Endocrinol (Lausanne). 2022;13:837852.

The sex differences in memory impairment are inconclusive, and the effect of female reproductive factors (age at menarche, age at menopause, and reproductive period) on the differences is not clear.

To examine the sex differences in objective and subjective memory impairment in postmenopausal women and age- and education-matched men and explore whether the differences were differed by female reproductive factors.


  • Data were obtained from the China Health and Retirement Longitudinal Study.
  • Using the case-control matching method, 3,218 paired postmenopausal women and men matched for age and education were selected.
  • Memory was assessed using the three-word recall task and a self-rated question.
  • Poisson regression models with a robust error variance were used.
Main findings
  • The relative risk was 1.22 (95% confidence interval 1.08-1.38) for objective memory impairment in women compared with men (23.87% vs. 27.36%), and 1.51 (1.36-1.67) for subjective memory impairment (39.34% vs. 28.25%) after adjusting the confounders.
  • The higher risk of objective memory impairment in women was different among groups of age at menarche in a linear pattern, with younger age at menarche associated with higher risks of objective memory impairment (p < 0.001 for trend).
  • It was also different among groups of menopausal age and reproductive period in an approximate U-shaped pattern, with a similar risk of objective memory with men in women menopause at 52-53 years and having a reproductive period of 31-33 years and higher risks in women with earlier or later menopause (RRs raging form 1.17 to1.41) and a shorter or longer period of reproduction (RR, 1.23-1.29).
  • The higher risks of subjective memory impairment in women were not different among different groups of reproductive factors.
Take-home messages
  • Postmenopausal women were at an increased risk of objective and subjective memory impairment than men.
  • The higher risks in objective memory, but not subjective memory, were varied by age at menarche, age at menopause, and reproductive periods, which may help understand the underlying mechanisms of sex differences in cognitive ageing and guide precise intervention to preventing dementia among older women and men.

Dambha-Miller H, Hinton W, Wilcox CR, Joy M, Feher M, de Lusignan S. Mortality in COVID-19 among women on hormone replacement therapy: a retrospective cohort study. Fam Pract. 2022;cmac041. doi: 10.1093/fampra/cmac041.

Limited recent observational data have suggested that there may be a protective effect of oestrogen on the severity of COVID-19 disease.

To investigate the association between hormone replacement therapy (HRT) or combined oral contraceptive pill (COCP) use and the likelihood of death in women with COVID-19.


  • The authors undertook a retrospective cohort study using routinely collected computerized medical records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database.
  • They identified a cohort of 1,863,478 women over 18 years of age from 465 general practices in England.
  • Mixed-effects logistic regression models were used to quantify the association between HRT or COCP use and all-cause mortality among women diagnosed with confirmed or suspected COVID-19 in unadjusted and adjusted models.
Main findings
  • There were 5,451 COVID-19 cases within the cohort. HRT was associated with a reduction in all-cause mortality in COVID-19 (adjusted OR 0.22, 95% CI 0.05 to 0.94).
  • There were no reported events for all-cause mortality in women prescribed COCPs.
  • This prevented further examination of the impact of COCP.
Take-home messages
  • The authors found that HRT prescription within 6 months of a recorded diagnosis of COVID-19 infection was associated with a reduction in all-cause mortality.
  • Further work is needed in larger cohorts to examine the association of COCP in COVID-19, and to further investigate the hypothesis that oestrogens may contribute a protective effect against COVID-19 severity.

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