As President of the International Menopause Society (IMS), I am delighted to have the opportunity to provide the last update for Our Menopause World of 2022.
It is already more than six weeks since our successful World Congress in Lisbon. Planning for the 19th IMS World Congress Oct 19th – 22nd 2024 in Melbourne has now started in earnest. The programme will focus on the challenges of the peri- and early menopause and premature ovarian insufficiency with an emphasis on a life course approach to women’s health. Through close liaison with our local and global affiliates, the programme will be universally relevant, culturally sensitive and attractive to all levels of healthcare providers from Trainees to Professors, in order to achieve optimal attendance and engagement. We are also planning to have an IMS symposium on ethnic and cultural issues at the forthcoming EMAS meeting in Florence (May 3rd to 5th 2023) and a regional workshop in October 2023; the venue for this will be announced soon.
Our educational programme goes from strength to strength. Concerning our IMPART programme, as of November 30th we have had 7557 registrations for Level 1, an increase of 463 since the World Congress and 243 for Level 2, an increase of 13 since the World Congress. There are 13 countries with more than 100 registrations, and we have received registrations from 115 countries in total thus far! English, Spanish, Portuguese, Chinese and Arabic translations are currently available.
The recordings of our popular webinar series continue to gain views on our YouTube channel, with views for the first webinar now over 40,000. The IMS YouTube channel now has 3,560 subscribers. There are usually over 1000 registrants per webinar and more than 500 live attendants. I am delighted to report that we have secured an ongoing unrestricted educational grant from Besins for our Webinar Series in 2023. The webinars will be held on the following dates in 2023 at 15:00 CET so please put these dates in your diaries: 17 January, 14 February, 7 March, 11 April, 16 May, 13 June, 11 July, 29 August, 19 September, 17 October, 14 November and 12 December. Our next webinar will be on 17th January 2023, 15:00 CET :
Title: To Sleep, Perchance to Dream
Chair: Wendy Wolfman (Can)
Speaker: Hadine Joffe (USA) Impact of Menopause on Sleep
Speaker: Tommaso Simoncini (IT) Treatment of Sleep Disorders Associated with Menopause
We are committed to continuing our Clinical Colloquium and Interview series into 2023/2024. Please look out for the next advertisement for applications to join our next Colloquium educational series which we hope will commence by April 2023.
We now have 829 members, an increase of 39 since the World Congress and we would like to see this number increase significantly; the strength of the society is in the diversity and outreach that our members give us. In particular, I would like to see more of our limited professional memberships being converted to associate and full memberships. I believe these memberships represent excellent value for money for all healthcare professionals involved in menopause care.
One of the key benefits is the subscription to Climacteric, the society’s excellent journal. The bimonthly journal has a good impact factor and publishes high standard original articles as well as reviews and recommendations under the editorship of Prof Rod Baber and his editorial team, who took over from myself and my co-editor in chief Anna Fenton in 2016. One of the key reasons for the Journal’s success has undoubtedly been that it has been expertly “chaperoned” by Jean Wright, the Journal’s Managing Editor since 1998, who was subsequently joined by her excellent editorial assistant Susan Brown. Jean’s meticulous attention to detail, and her devotion to the Journal, its editors, and authors, has been second to none and she will be irreplaceable when she retires this month. Jean also worked as Executive Director (equivalent of CEO) of IMS from 2003 through till 2011. Jean stated recently “I have thoroughly enjoyed working with all the Editors and Editorial Boards of Climacteric over the years and appreciate their friendship and support. I consider it a privilege to have served the IMS in so many ways. I will continue to follow the progress of the Society and Climacteric in the future – and I will miss all the friends I have made worldwide.” We thank Jean for her many years of superb service to IMS and the Journal and wish her a happy and healthy retirement!
On a sad note, one of the great contributors to the menopause world, Manuel Neves-e-Castro, recently passed away on Nov 28th, 2022. To quote his daughter Isabel Castro “A great mind and a great man has left behind remarkable work. We shall always remember him.” Professor Martin Birkhaeuser had these words to say about Manuel “He was a dear friend and great support in our engagement to develop in the different European countries a common thinking about menopause that made 25 years ago the foundation of EMAS possible. At the same time, Manuel always supported IMS with all his forces, particularly for its educational mission. He was a great figure in menopause.”
Our CAMS chair, Duru Shah and I have been writing to CAMS members who attended our IMS World Congress General Assembly, and the plan is to conduct a series of interviews to establish how each respondent can best contribute to IMS. We will select Vice Chairs and a steering committee based on the outcome of the interviews, but we would also like to involve a number of these key members in our sub committees to give us a global outreach.
Over the next month I will be meeting with my board and executive colleagues to finalise the IMS strategic plan for the next two years. Key issues will include:
Ensuring the financial future of the society is of paramount importance.
Ensuring that the society’s processes are transparent, ethical and efficient.
Optimising the organisational structure of IMS will help us to deliver our strategic goals effectively.
Recommendations and Position statements
Delivery of new IMS recommendations and updated ESHRE POI guidelines (through collaboration of ESHRE, ASRM, Monash) is a priority.
Consensus statements to follow through collaboration with national, regional and global organisations.
The mission of the International Menopause Society (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. As mentioned in my first communication for OMW, fulfilling this mission will be dependent on optimising our connections within the CAMS network and membership in general. With this aim in mind, please continue to write in with your suggestions, advice and questions. Can I also remind you to contribute to our Endowment for Education and Research that will help us to educate and support the menopause healthcare professionals of the future.
For those of you going on vacation soon, I wish you, on behalf of the whole team at IMS, happy and healthy holidays!
The next IMS webinar will be held on Tuesday 17th January 15:00 (CET). “To Sleep, Perchance to Dream” will be moderated by Professor Wendy Wolfman. Professor Hadine Joffe will be presenting on “Impact of Menopause on Sleep” and Professor Tommaso Simoncini will be presenting on “Treatment of Sleep Disorders Associated with Menopause”.
The link for registrations is Online Events – International Menopause Society (imsociety.org)
The November webinar “The Heart of the Matter” was moderated by Dr Chrisandra Shufelt. Professor Rossella Nappi presented on “Traditional and Female Specific Cardiac Risk Factors” and Dr Matthew Nudy presented on “Assessing Cardiac Risk in Midlife Women”. 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. These sessions are available: “Bone Health for the Generalist: Not Just Osteoporosis” with Professor Steven Goldstein; “Cardiovascular Issues for Midlife Women” with Professor Peter Schnatz; “Cognition and Mood” with Professor Pauline Maki; “Menopausal Hormone Therapy: Myths and Realities” with Professor Susan Davis; “A Mid-life Women’s Health Clinic: Dos and Don’ts” with Professor Wendy Wolfman; “Sexual Function: Essentials in Midlife” with Professor Sheryl Kingsberg and “Managing Menopause without Hormones” with Professor Nick Panay.
Our latest 1-1 interviews on the topic of Cognition are available here. This is available in video or podcast format.
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.
Free access to selected papers recently published in Climacteric
IMS White Paper for World Menopause Day
World Menopause Day on October 18th this year addressed the important issue of cognitive change around the menopause transition, the so-called ‘brain fog’ of which many women so often complain.
The December issue of Climacteric contains the IMS White Paper on ‘Brain fog in menopause: a health-care professional’s guide for decision-making and counseling on cognition’, authored by Professor Pauline Maki and Dr Nicole Jaff. Climacteric’s Editor-in-Chief, Professor Rod Baber, strongly recommends this paper to all readers of Climacteric, and describes the paper as a ‘strong clinically based’ report, built on the foundations of an ever-growing evidence base.
Climacteric’s publishers, Taylor & Francis, have granted permanent Free Access to the IMS White Paper.
The abstract of this paper has been translated into Spanish and appears below.
There are also two Open Access papers in Climacteric 2022, Volume 25, December Issue
The Abstracts from both Open Access papers have also been translated into Spanish below.
The Editor of Climacteric would like to thank Peter Chedraui, one of the Associate Editors, for providing the translations.
Spanish translation: Maki PM, Jaff NG. Niebla cerebral en la menopausia: una guía del profesional de la salud para la toma de decisiones y el asesoramiento sobre la cognición. Climacteric 2022
Las mujeres de mediana edad comúnmente experimentan cambios en su función cognitiva a medida que pasan por la menopausia y expresan su preocupación acerca de si estos cambios representan las etapas iniciales de un trastorno cognitivo más grave. Los profesionales de la salud juegan un papel importante en el asesoramiento de las mujeres sobre los cambios cognitivos en la mediana edad y la normalización de la experiencia de las mujeres. El objetivo de este documento sobre cognición encargado por la Sociedad Internacional de Menopausia es proporcionar a los profesionales una descripción general de los datos que informan la atención clínica de las mujeres menopáusicas y un marco para el asesoramiento clínico y la toma de decisiones. Entre los temas presentados se encuentran los cambios cognitivos específicos que ocurren en la menopausia, la duración de dichos cambios y su gravedad. Se revisa el papel del estrógeno y los síntomas de la menopausia. Presentamos puntos de discusión para el asesoramiento clínico sobre los efectos de la terapia hormonal en la cognición y el riesgo de demencia en las mujeres, incluida la discusión del riesgo absoluto. Por último, se presenta una breve revisión de los factores de riesgo modificables para el deterioro cognitivo relacionado con la edad y la demencia, con orientación para asesorar a los pacientes sobre cómo optimizar su salud cerebral en la mediana edad y más allá.
Spanish translation: Sundell M, Spetz Holm AC, Fredrikson M, Hammar M, Hoffmann M, Brynhildsen J. Embolia pulmonar en la terapia hormonal de la menopausia: un estudio poblacional. Climacteric. 2022;25(6):615-621. doi: 10.1080/13697137.2022.2127352.
Objetivo: La terapia hormonal menopáusica (THM) oral, pero no la transdérmica, aumenta el riesgo de tromboembolismo venoso. No hay evidencia sobre el riesgo de la complicación grave embolia pulmonar (EP). El objetivo fue investigar el riesgo de EP en mujeres que usan THM según la vía de administración, el tipo de progestágeno y la duración del tratamiento.
Método: El estudio de casos y controles basado en la población abarcó a 1.771.253 mujeres de 40 a 69 años de edad, durante 2006-2015. Los diagnósticos de EP (<i>n</i> = 13,974) y las dispensaciones de medicamentos se recibieron de registros nacionales validados.
Resultados: Las usuarias actuales de THM tenían un mayor riesgo de EP que las no usuarias (odds ratio [OR] 1.15, intervalo de confianza [IC] del 95% 1.05-1.26). Usuarias primera vez tuvieron el mayor riesgo (OR 2.07, IC del 95%: 1.23-3.50). La administración transdérmica no se asoció con un mayor riesgo de EP. El OR fue leve, pero no significativamente mayor con estrógeno combinado con acetato de medroxiprogesterona que con acetato de noretisterona.
Discusión: El riesgo de EP aumentó significativamente en las usuarias de MHT oral pero no transdérmica, siendo el riesgo más alto en las usuarias por primera vez de estrógenos orales combinados con acetato de medroxiprogesterona. El riesgo fue considerablemente menor en las mujeres con tratamiento recurrente, probablemente por el efecto de usuaria sana.
Conclusión: La EP fue más frecuente cerca del inicio del tratamiento oral. La THM transdérmica no aumentó el riesgo de EP.
Palabras claves: Terapia hormonal para la menopausia; administración cutánea; estrógenos; terapia hormonal sustitutiva; estudio poblacional; progestinas; embolia pulmonar; estudio de registro; tratamiento transdérmico; tromboembolismo venoso.
Spanish translation Giudicessi AJ, Saelzler UG, Shadyab AH, Posis AIB, Sundermann EE, Banks SJ, Panizzon MS. El rol mediador del estatus socioeconómico en la relación entre el antecedente de embarazo y cognición en la adultez. Climacteric. 2022;25(6):627-633. doi: 10.1080/13697137.2022.2129004.
Objetivo: La asociación del embarazo con la cognición en etapas posteriores de la vida no se comprende bien. Examinamos si los embarazos a término y los incompletos estaban asociados con la cognición en una muestra de mujeres postmenopáusicas, y si los factores del estado socioeconómico (ESE) mediaban en estas relaciones.
Método: Se examinó un total de 1,016 mujeres cognitivamente normales de la Encuesta Nacional de Examen de Salud y Nutrición (NHANES). Las medidas cognitivas incluyeron la prueba de sustitución de símbolos digitales (DSST), fluidez animal (AF) y el Consorcio para establecer un registro para la enfermedad de Alzheimer (CERAD) aprendizaje de palabras (CERAD-WL) y tareas de recuerdo diferido (CERAD-DR). Los análisis examinaron la relación entre el número de embarazos a término e incompletos con el rendimiento cognitivo, así como los efectos mediadores de la educación y el índice federal de ingresos/pobreza (PIR).
Resultados: Un mayor número de embarazos a término se asoció con un peor rendimiento en el DSST (<i>β</i> = -0.09, intervalo de confianza [IC] del 95%: -0.12, -0.06), AF (<i>β</i> i> = -0.03, IC del 95%: -0.07, 0.00) y CERAD-DR (<i>β</i> = -0.04, IC del 95%: -0.08, -0.01). Haber tenido más embarazos incompletos se asoció con un mejor rendimiento de CERAD-DR (<i>β</i> = 0.07, IC del 95%: 0.01, 0.13), y el 28% (IC del 95%: 0.17, 0.42) de la asociación de embarazos a término con el DSST fue mediado por el PIR.
Conclusiones: Un mayor número de embarazos a término se asoció con un peor rendimiento cognitivo, mientras que un mayor número de embarazos incompletos se asoció con un mejor rendimiento cognitivo. Los resultados indican la necesidad de considerar los factores del ESE al estudiar la relación entre el embarazo y la cognición.
Monterrosa-Castro Á, Prada-Tobar M, Monterrosa-Blanco A, Pérez-Romero D, Salas-Becerra C, Redondo-Mendoza V. Clinical suspicion of sarcopenic obesity and probable sarcopenic obesity in Colombian women with a history of surgical menopause: a cross-sectional study. Menopause. 2022;29(6):664-670.
To identify the frequency of clinical suspicion of sarcopenic obesity (CSSO) and probable sarcopenic obesity (PSO) and to estimate the association between them and surgical menopause.Design
A cross-sectional study carried out in women residing in Colombia, ages 60 to 75 years.
Body mass index, the SARC-F scale, SARC-CalF < 31, and SARC-CalF <33 versions adding the calf circumference measurement in the last two were used to identify CSSO.
Muscle strength measurement was added to the above measures to establish PSO. Surgical menopause was defined in women who underwent bilateral oophorectomy simultaneously with hysterectomy before natural menopause.
Adjusted and unadjusted logistic regression were performed between CSSO or PSO with surgical menopause, bilateral oophorectomy after natural menopause, and abdominal hysterectomy with ovarian preservation.
All participants provided informed consent. P < 0.05 was statistically significant.
Seven hundred women 67.0 ± 4.8 years old were included; 23.7% were obese, 68.1% had reduced muscle strength, and 4.2% had surgical menopause.
CSSO was found in 3.0% with SARC-F and with SARC-CalF < 31; whereas 2.0% were found with SARC-CalF <33.
PSO was found in 2.4%, 1.5%, and 2.2% with SARC-F, SARC-CalF <31, and SARC-CalF <33, respectively.
Surgical menopause was associated with PSO but was not associated with CSSO.
Bilateral oophorectomy after menopause and hysterectomy with ovarian preservation were not associated with CSSO or PSO.
In a group of older adult women, the frequency of CSSO was up to 3.0% and PSO up to 2.4%.
Surgical menopause was statistically significantly associated with PSO.
Urrunaga-Pastor D, Mezones-Holguin E, Blümel JE, Apolaya-Segura M, Barón G, Belzares E, Bencosme A, Calle A, Espinoza MT, Flores D, Izaguirre H, León-León P, Lima S, Monterrosa A, Mostajo D, Navarro D, Ojeda E, Soto E, Vallejo MS, Tserotas K, Chedraui P. Female orgasmic dysfunction and severe climacteric symptomatology in women aged 40 to 59 years: an independent association from an analysis of a multicenter Latin American study. Menopause. 2022;29(6):654-663.
To evaluate the association between the severity of climacteric symptoms (CS) and orgasmic dysfunction (OD), controlled by demographic, clinical, and partner variables.
The authors carried out a secondary analysis of a multicenter Latin American cross-sectional study that surveyed sexually active women 40 to 59 years old.
They assessed CS (global, somatic, psychological, or urogenital domains) and OD.
Also, they explored clinical variables and partner sexual conditions; and performed logistic regression models with nonparametric bootstrap resampling to estimate crude and adjusted odds ratios (aOR) with 95% confidence intervals (CI).
The data of a total of 5,391 women were included for the analysis.
Regarding CS, 24.8%, 10.8%, 28.4%, and 32.9% had respectively severe symptoms according to total, somatic, psychological, and urogenital domain scores of the Menopause Rating Scale.
OD was found in 25.4% of women.
The adjusted model (including menopausal status and partner sexual dysfunction) showed that severe CS increased the odds of OD (aOR = 2.77; 95% CI: 2.41-3.19 [total Menopause Rating Scale score]; aOR = 1.65; 95% CI: 1.37-2.00 [somatic domain]; aOR = 2.02; 95% CI: 1.76-2.32 [psychological domain] and aOR = 3.89; 95% CI: 3.40-4.45 [urogenital]).
Severe CS were associated with OD independently of demographic, clinical, and partner variables.
Severe urogenital symptoms had the strongest association.
Goldštajn MŠ, Mikuš M, Ferrari FA, Bosco M, Uccella S, Noventa M, Török P, Terzic S, Laganà AS, Garzon S. Effects of transdermal versus oral hormone replacement therapy in postmenopause: a systematic review. Arch Gynecol Obstet. 2022 Jun 17. doi: 10.1007/s00404-022-06647-5.
To summarize available evidence comparing the transdermal and the oral administration routes of hormone replacement therapy (HRT) in postmenopausal women.
The authors performed a systematic review of the literature on multiple databases between January 1990 and December 2021.
They included randomized controlled trials and observational studies comparing the transdermal and oral administration routes of estrogens for HRT in postmenopausal women regarding at least one of the outcomes of interest: cardiovascular risk, venous thromboembolism (VTE), lipid metabolism, carbohydrate metabolism, bone mineral density (BMD), and risk of pre-malignant and malignant endometrial lesions, or breast cancer.
The systematic literature search identified a total of 1369 manuscripts, of which 51 were included.
Most studies were observational and of good quality, whereas the majority of randomized controlled trials presented a high or medium risk of bias.
Oral and transdermal administration routes are similar regarding BMD, glucose metabolism, and lipid profile improvements, as well as do not appear different regarding breast cancer, endometrial disease, and cardiovascular risk.
Identified literature provides clear evidence only for the VTE risk, which is higher with the oral administration route.
Available evidence comparing the transdermal and oral administration routes for HRT is limited and of low quality, recommending further investigations.
VTE risk can be considered the clearest and strongest clinical difference between the two administration routes, supporting the transdermal HRT as safer than the oral administration route.
Kim H, Yoo J, Han K, Lee DY, Fava M, Mischoulon D, Jeon HJ. Hormone therapy and the decreased risk of dementia in women with depression: a population-based cohort study. Alzheimers Res Ther. 2022;14(1):83.
The literature has shown depression to be associated with an increased risk of dementia.
In addition, hormone therapy can be a responsive treatment option for a certain type of depression.
To evaluate the association between hormone therapy, including lifetime oral contraceptive (OC) use, and hormone replacement therapy (HRT) after menopause with the occurrence of dementia among female patients with depression.Design
The authors examined the South Korean national claims data from January 1, 2005, to December 31, 2018.
Female subjects aged 40 years or older with depression were included in the analyses.
Information on hormone therapy was identified from health examination data and followed up for the occurrence of dementia during the average follow-up period of 7.72 years.
Among 209,588 subjects, 23,555 were diagnosed with Alzheimer’s disease (AD) and 3023 with vascular dementia (VD).
Lifetime OC usage was associated with a decreased risk of AD (OC use for < 1 year: HR, 0.92 [95% CI, 0.88-0.97]; OC use for ≥ 1 year: HR, 0.89 [95% CI, 0.84-0.94]), and HRT after menopause was associated with a decreased risk of AD (HRT for < 2 years: HR, 0.84 [95% CI, 0.79-0.89]; HRT for 2-5 years: HR, 0.80 [95% CI, 0.74-0.88]; and HRT for ≥ 5 years : HR, 0.78 [95% CI, 0.71-0.85]) and VD (HRT < 2 years: HR, 0.82 [95% CI, 0.71-0.96]; HRT for 2-5 years: HR, 0.81 [95% CI, 0.64-1.02]; and HRT for ≥ 5 years: HR, 0.61 [95% CI, 0.47-0.79]).
In this nationwide cohort study, lifetime OC use was associated with a decreased risk of AD, and HRT after menopause was associated with a decreased risk of AD and VD among female patients with depression.
However, further studies are needed to establish causality.
Mahajan SS, Arora M, Tandon VR, Mahajan A, Kotwal S. Improvement in Quality of Life of Postmenopausal Women with Depression with commonly used Antidepressants (Escitalopram vs. Desvenlafaxine): A Randomized Controlled Trial in a Tertiary Care Teaching Hospital of North India. J Midlife Health. 2022;13(1):80-84.
The postmenopausal symptoms affect the quality of life (QoL) of women.
Depression and anxiety too have been associated with diminished QoL.
It is known that antidepressants escitalopram and desvenlafaxine are effective in the treatment of depression and anxiety.
As the comparative effect on the QoL of postmenopausal women with depression and anxiety has not been studied in the Indian setup, the authors aimed at comparing the effect of commonly used antidepressants (Escitalopram vs. Desvenlafaxine) over quality of life in postmenopausal women with depression.Design
The present study was a randomized, intention to treat, open-label trial undertaken in North India’s a tertiary care teaching hospital.
Postmenopausal women attending the psychiatry outpatient department and newly diagnosed with depression and anxiety were randomized in two groups to receive Tab.
Escitalopram 10-20 mg and Tab. Desvenlafaxine 50-100 mg.
Their QoL was assessed using the WHOQOL BREF scale at baseline, 3 weeks and 6 weeks.
Escitalopram was observed to be statistically better than desvenlafaxine in improving the overall QoL score of the WHOQOL-BREF scale.
Individually, escitalopram significantly improved the scores of the physical health domain, psychological and environmental domains except for the social relationship domain.
Desvenlafaxine significantly improved scores of all four domains.
Escitalopram was observed to be significantly better than desvenlafaxine in improving the overall QoL scores.
Xu Z, Chung HF, Dobson AJ, Wilson LF, Hickey M, Mishra GD. Menopause, hysterectomy, menopausal hormone therapy and cause-specific mortality: cohort study of UK Biobank participants. Hum Reprod. 2022;37(9):2175-2185.
Self-reported MHT use following early natural menopause, surgical menopause or premenopausal hysterectomy is associated with a lower risk of breast cancer mortality and is not consistently associated with the risk of mortality from cardiovascular disease or other causes.
Evidence from the Women’s Health Initiative randomized controlled trials showed that the use of estrogen alone is not associated with the risk of cardiovascular mortality and is associated with a lower risk of breast cancer mortality, but evidence from the Million Women Study showed that use of estrogen alone is associated with a higher risk of breast cancer mortality.
To determine the association between menopausal hormone therapy (MHT) and cause-specific mortality.Design
This was a cohort study (the UK Biobank) of 178,379 women, recruited in 2006-2010.
Included for analysis was data of postmenopausal women who had reported age at menopause (natural or surgical) or hysterectomy, and information on MHT and cause-specific mortality.
Age at natural menopause, age at surgical menopause, age at hysterectomy and MHT were exposures of interest.
Natural menopause was defined as spontaneous cessation of menstruation for 12 months with no previous hysterectomy or oophorectomy.
Surgical menopause was defined as the removal of both ovaries prior to natural menopause.
Hysterectomy was defined as removal of the uterus before natural menopause without bilateral oophorectomy.
The study outcome was cause-specific mortality.
Among the 178,379 women included, 136 790 had natural menopause, 17 569 had surgical menopause and 24 020 had hysterectomy alone.
Compared with women with natural menopause at the age of 50-52 years, women with natural menopause before 40 years (hazard ratio (HR): 2.38, 95% CI: 1.64, 3.45) or hysterectomy before 40 years (HR: 1.60, 95% CI: 1.23, 2.07) had a higher risk of cardiovascular mortality but not cancer mortality.
MHT use was associated with a lower risk of breast cancer mortality following surgical menopause before 45 years (HR: 0.17, 95% CI: 0.08, 0.36), at 45-49 years (HR: 0.15, 95% CI: 0.07, 0.35) or at ≥50 years (HR: 0.28, 95% CI: 0.13, 0.63), and the association between MHT use and the risk of breast cancer mortality did not differ by MHT use duration (<6 or 6-20 years).
MHT use was also associated with a lower risk of breast cancer mortality following natural menopause before 45 years (HR: 0.59, 95% CI: 0.36, 0.95) or hysterectomy before 45 years (HR: 0.49, 95% CI: 0.32, 0.74).
The current international guidelines recommend women with early menopause to use MHT until the average age at menopause; the findings of the study support this recommendation.
Ganji V, Sukik L, Hoque B, Boutefnouchet L, Shi Z. Association of Serum 25-Hydroxyvitamin D Concentration with Breast Cancer Risk in Postmenopausal Women in the US. J Pers Med. 2022;12(6):944.
The association between serum 25-hydroxyvitamin D [25(OH)D] concentration and breast cancer risk in postmenopausal women is not well understood.
To investigate the association between serum 25(OH)D concentration and breast cancer in postmenopausal women in the United States using nationally representative sample surveys.
The authors used the data from seven cycles of National Health and Nutrition Examination Surveys from 2001 to 2014.
Participants were non-institutionalized postmenopausal women (n = 8108).
In restricted cubic spline analysis, a significant, nonlinear, invert ‘U’ relationship was observed between serum 25(OH)D concentrations and breast cancer in postmenopausal women (p = 0.029).
Overall, breast cancer risk was highest (OR = 1.5) between 70 nmol/L and 80 nmol/L of serum 25(OH)D concentration.
Then after serum 25(OH)D 80 nmol/L concentration, the breast cancer risk declined.
In multivariate-adjusted logistic regression, the risk of having breast cancer was significantly higher in serum 25(OH)D 75-˂100 nmol/L category compared to the 25(OH)D < 30 nmol/L category [OR and 95% CI: 2.4 (1.4-4.0)].
Serum Vitamin D concentrations ≥ 100 nmol/L were associated with reduced risk of breast cancer in postmenopausal women.
Controlled trials are required to verify if serum 25(OH)D ≥ 100 nmol/L offers protection against breast cancer in postmenopausal women.
Peterson A, Gottesman RT, Miller EC, Tom SE. The association of vasomotor symptoms during the menopausal transition and cognition in later life. Menopause. 2022;29(7):832-839.
The majority of women experience vasomotor symptoms (VMS) during the menopausal transition.
Whether self-reported VMS are associated with cognitive test performance later in life remains unclear.
To determine whether a greater burden of VMS is associated with poor later-life cognition.Design
The Wisconsin Longitudinal Study is a prospective study of randomly selected Wisconsin high school graduates of the class of 1957.
At ages 65 and 72, a random subset of participants completed six cognitive tests, including similarities, letter and category fluency, immediate and delayed word recall, and digit ordering.
Nested regression models were used to examine the association between extent of VMS, assessed at age 54, and baseline cognition at 65, adjusting for early-life socioeconomic status, women’s reproductive health variables, intelligence quotient, and midlife income.
This series of models was also used to examine the association between VMS and change in cognition score from age 65 to 72.
In sensitivity analyses, models were repeated in a sample using multiple imputation for missing covariates.
Of the 5,326 women enrolled, 874 had data on VMS, covariates, and all cognitive tests.
In an unadjusted model, higher VMS were associated with a lower similarities score (b = -0.09 95% CI -0.16 to -0.02) at age 65 but no other cognitive tests. In adjusted models, VMS were not related to cognition at age 65 or change in cognition.
Results remained similar with multiple imputation.
Stute P, Cano A, Thurston RC, Small M, Lee L, Scott M, Siddiqui E, Schultz NM. Evaluation of the impact, treatment patterns, and patient and physician perceptions of vasomotor symptoms associated with menopause in Europe and the United States. Maturitas. 2022;164:38-45.
To analyze the views of physicians and patients with vasomotor symptoms (VMS) associated with menopause on the impact of VMS and treatment patterns/perceptions.
Data from the Adelphi VMS Disease Specific Programme, a point-in-time survey conducted in 5 European countries and the United States in 2020, were used.
Primary care providers (PCPs) and gynecologists seeing ≥3 patients/week with VMS associated with menopause completed a survey and chart review; their patients were invited to complete a survey and questionnaires.
Physicians reported treatment patterns and patient-specific symptoms and treatment preferences.
Patients described symptoms, impact of VMS, and treatment satisfaction.
Participants included 115 PCPs and 118 gynecologists.
Physicians reviewed the charts of 1816 patients, 854 of whom completed surveys.
Moderate/severe impact of VMS on sleep, mood, quality of life, and work/study was reported by 35.8 %, 31.6 %, 23.6 %, and 15.4 % of women, respectively.
Based on chart review, 64.8 % of women were currently prescribed treatment for VMS, most commonly hormone therapy (HT; 73.1 %), followed by selective serotonin or serotonin-norepinephrine reuptake inhibitors (31.3 %).
Most women (57.3 %) with VMS were eligible for HT but averse to using it.
Despite 91.4 % of physicians finding HT to be effective, 62.7 % agreed (slightly-strongly) that their patients are generally reluctant to use it.
One-third of women were dissatisfied with VMS control.
VMS can considerably impact daily life.
Effective treatment options that are better accepted could potentially improve management of VMS and lead to better quality of life for women with VMS associated with menopause.
Chu JH, Michos ED, Ouyang P, Vaidya D, Blumenthal RS, Budoff MJ, Blaha MJ, Whelton SP. Coronary artery calcium and atherosclerotic cardiovascular disease risk in women with early menopause: The Multi-Ethnic Study of Atherosclerosis (MESA). Am J Prev Cardiol. 2022;11:100362.
To determine the utility of coronary artery calcium (CAC) for atherosclerotic cardiovascular disease (ASCVD) risk stratification in women with and without early menopause (EM); and examine the association between CAC and incident ASCVD.
The authors performed Kaplan-Meier survival analysis and multivariable Cox proportional hazards modeling using data from 2,456 postmenopausal women in the Multi-Ethnic Study of Atherosclerosis (MESA) with or without EM, defined as occurring at <45 years of age.
The cohort was 64.1 ± 9.1 years old and 28.0% experienced EM.
There were 291 ASCVD events over 12.5 ± 3.6 years’ follow-up with a higher event rate among those with EM compared to those without EM of 13.6 vs. 9.0 per 1,000-year follow-up (p < 0.01).
Women with EM had a slightly lower prevalence of CAC = 0 (55.1%) than women without EM (59.7%) (p = 0.04) despite no difference in mean age.
Among women with CAC = 0, the cumulative incidence of ASCVD at 10 years was low-to-borderline for women with (5.4%) and without EM (3.2%) (p = 0.06).
However, women with EM had a significantly higher 15-year risk with an adjusted HR of 1.96 (95% CI: 1.26-3.04).
In multivariable Cox models, women with CAC ≥ 1 had progressively increased ASCVD risk that did not significantly differ by EM status.
In MESA, >50% of middle-aged postmenopausal women with EM had CAC = 0, similar to those without EM.
Among women with CAC = 0, those with EM had a low to borderline 10-year risk of ASCVD, but the 15-year risk was significantly higher for women with EM versus those without EM.
When CAC ≥ 1, the incidence of ASCVD was similar for women with and without EM.
These findings support the use of CAC to help improve ASCVD risk stratification in women with EM.