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President’s Report


Dear Friends and Colleagues

Very warm wishes for a happy, healthy, and productive New Year from myself and the whole Board and Secretariat at the International Menopause Society (IMS).

Despite challenging times there is much for our growing IMS membership (now 829) and other healthcare professionals to be optimistic about in 2023. For example, the number of IMPART registrations continues to increase, from 7557 to 7757 for Level 1 and from 243 to 257 for Level 2 since my report in Our Menopause World (OMW) last month. Please do continue to encourage your colleagues to join IMS and to register for the free IMPART programme. The strength of the Society is positively influenced by the number and diversity of its membership and by the utilisation of the educational tools skilfully prepared by our world class menopause experts.

Also, registration is now open for our next IMS webinar on 17th January 2023, 15:00 CET:

Title: To Sleep, Perchance to Dream 
Chair: Professor Wendy Wolfman (Canada) 
Speakers/Topics
Professor Hadine Joffe (USA)
Impact of Menopause on Sleep 
Professor Tommaso Simoncini (Italy)
Treatment of Sleep Disorders Associated with Menopause 

The IMS Education Committee will be confirming the topics of the rest of the year’s webinars shortly, and I am very grateful to all our Board members for their excellent suggestions of cutting-edge subjects and speakers. I would also like to encourage applications to join our next IMS Clinical Colloquium educational series in 2023-2024, details of which will be available soon.

Further breaking news for 2023 is that the programme for our IMS collaborative symposium has been announced at the forthcoming European Menopause and Andropause Society (EMAS) meeting in Florence. Details are available on the EMAS congress website but for your convenience, details of the session are provided below. The EMAS congress will take place at The Firenze Fiera – Palazzo dei Congressi and Palazzo degli Affari, Florence on May 3rd to 5th 2023 and we hope to see you all there!

IMS Symposium
Friday, May 5, 08:00 – 09:00, Room 4
Title: Ethnic and Socio-Cultural Challenges of Global Menopause Care
Chairs: Nick Panay (UK), Santiago Palacios (Spain)
Speakers/Topics
Professor Duru Shah (India)
The Latur Project: Screening for non-communicable diseases in rural India
Dr Nicole Jaff (South Africa)
Does One Size Fit All? The usefulness of menopause education across low- and middle-income countries.
Professor Rossella Nappi (Italy)
Talking Sex in a Diverse World

The aim of this IMS symposium will be to highlight the demographic, ethnic and socio-cultural challenges of delivering healthcare and education globally, with a particular focus on regions of India and Africa. Duru Shah, Chair of our Council of Affiliated Menopause Societies (CAMS) and one of the speakers, continues to work tirelessly to connect IMS to the four corners of the globe through collaboration with our enthusiastic CAMS members and their societies.

In the next week I will be meeting with executive colleagues to finalise the IMS Strategic Plan for the next two years. The key issues that will be reviewed will include the Roles and Responsibilities of the Board and Secretariat, Education, Membership, Finances, Governance, CAMS, Partnerships and Menopause Info (the “consumer” arm of IMS).  I will report on the key outcomes of the meeting in the next issues of OMW once the strategy has been ratified by the IMS Board.

Over the next few weeks there will also be meetings of the Scientific Programme and Local Organising Committees to continue planning of our next World Congress in Melbourne, October 19th to 22nd 2024. I’d like to invite you all to spread the word amongst your colleagues and to ensure that these dates are firmly in your educational calendars. It promises to be a very exciting meeting both academically and culturally. I will ensure that a promotional slide is circulated to all our members for Melbourne 2024, which can be incorporated in all your academic presentations.

The topic of menopause is finally being pushed to the forefront of the health agenda in an increasing number of countries, mainly by women themselves who are not prepared to put up with the symptoms and reduced quality of life that many suffer through the menopause transition and beyond. One of our Board members from Canada, Professor Wendy Wolfman, has made us aware of the progress in her country which is nicely depicted in this You Tube video. Professor Wolfman gives an excellent interview on the subject, in which she highlights the urgent need for resources to train more healthcare professionals in this area thereby reducing waiting times for menopause care.

Following on from this, can I please once again remind you to make a contribution, however large or small, to our Endowment for Education and Research (EER) via this link. The EER is a vital source of funding for our menopause healthcare providers, present and future, who would not be able to attend meetings or perform research due to the economic challenges that many parts of the world are currently facing.

A good example of the EER working well is one of the beneficiaries of a Young Scholar’s Travel Bursary to the IMS World Congress in Lisbon, Dr Polyphile Ntihinyurwa. He presented a poster which vividly brought to our attention his team’s excellent work in evaluating the challenges faced by Rwandan physicians whilst managing postmenopausal symptoms and their opinion for system improvement.

Finally, as always please don’t hesitate to contact me directly with any queries or suggestions you may have.

Have a great year personally, socially, and professionally!

Nick Panay
nick.panay@imsociety.org


General Update


The 28th webinar in the IMS webinar series will be held on Tuesday 17th January 15:00 (CET) entitled “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 previous webinar  was held on Tuesday 22nd November. The 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. 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; A Mid-life Women’s Health Unit: Dos and don’tsSexual Function: Essentials in midlifeManaging Menopause without Hormones; and Genitourinary Syndrome of Menopause: Not just vulvovaginal atrophy.

Our latest 1-2-1 interview series topic on “Breast Health Made Personal” is available here. It is available in video or podcast format.


International Society Meetings 2023


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

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

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

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

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


Menopause and mid-life women’s health publication news


Subcutaneous fat emerges as a protector of females’ brains
https://www.eurekalert.org/news-releases/974209

Who is more prone to recurrent UTIs? Bladder bacteria may be key
https://www.eurekalert.org/news-releases/974200

This hormone may be the missing ingredient to heart-healthy cholesterol levels for menopausal women
https://www.eurekalert.org/news-releases/974107

Estrogen may offer protection against delirium
https://www.eurekalert.org/news-releases/973901

Does what you drink affect your risk of urinary incontinence?
https://www.eurekalert.org/news-releases/974430


Free access to selected papers recently published in Climacteric


IMS White Paper for World Menopause Day
World Menopause Day on October 18th last 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 counselling 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 the December 2022 edition of Climacteric. The Abstracts from both Open Access papers have also been translated into Spanish. The Editor of Climacteric would like to thank Peter Chedraui, one of the Associate Editors, for providing the translations.


Brain fog in menopause: a health-care professional’s guide for decision-making and counseling on cognition
P. M. Maki & N. G. Jaff
https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792
Permanent Free Access

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 

Resumen 
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.

Palabras clave: Menopausia;
perimenopausia; cognición; memoria; terapia hormonal menopáusica; demencia


Pulmonary embolism in menopausal hormone therapy: a population-based register study
M. Sundell, et al.
https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2127352
Open Access

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.

Resumen
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.


The mediating role of socioeconomic status on the relationship between pregnancy history and later-life cognition
A.J. Giudicessi, et al.
https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2129004
Open Access

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.

Resumen
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.

Palabras clave: Embarazo; función cognitiva; índice federal ingresos/pobreza; paridad; salud reproductiva; estatus socioeconómico



1. Lohner V, Pehlivan G, Sanroma G, Miloschewski A, Schirmer MD, Stöcker T, Reuter M, Breteler MMB. Relation Between Sex, Menopause, and White Matter Hyperintensities: The Rhineland Study. Neurology. 2022;99(9):e935-e943.

Background
There is mounting evidence that implies that there are sex differences in white matter hyperintensity (WMH) burden in older people. Questions remain regarding possible differences in WMH burden between men and women of younger age, sex-specific age trajectories and effects of (un)controlled hypertension, and the effect of menopause on WMH.

Objective
To investigate these sex differences and age dependencies in WMH load across the adult life span and to examine the effect of menopause.

Design

  • This cross-sectional analysis was based on participants of the population-based Rhineland Study (30-95 years) who underwent brain MRI.
  • The investigators automatically quantified WMH using T1-weighted, T2-weighted, and fluid-attenuated inversion recovery images.
  • Menopausal status was self-reported.
  • Authors examined associations of sex and menopause with WMH load (logit-transformed and z-standardized) using linear regression models while adjusting for age, age-squared, and vascular risk factors.
  • In addition, they checked for an age × sex and (un)controlled hypertension × sex interaction and stratified for menopausal status comparing men with postmenopausal women (persons aged 59 years or younger), men with premenopausal women (persons aged 45 years or older), and premenopausal with postmenopausal women (age range 45-59 years).

Main findings

  • Of 3,410 participants with a mean age of 54.3 years (SD = 13.7), 1,973 (57.9%) were women, of which 1,167 (59.1%) were postmenopausal.
  • Authors found that the increase in WMH load accelerates with age and in a sex-dependent way.
  • Premenopausal women and men of similar age did not differ in WMH burden.
  • WMH burden was higher and accelerated faster in postmenopausal women compared with men of similar age.
  • Authors observed changes related to menopause, in that postmenopausal women had more WMH than premenopausal women of similar age.
  • Women with uncontrolled hypertension had a higher WMH burden compared with men, which was unrelated to menopausal status.

Take-home messages

  • After menopause, women displayed a higher burden of WMH than contemporary premenopausal women and men and an accelerated increase in WMH.
  • Sex-specific effects of uncontrolled hypertension on WMH were not related to menopause.
  • Further studies are warranted to investigate menopause-related physiologic changes that may inform on causal mechanisms involved in cerebral small vessel disease progression.

https://pubmed.ncbi.nlm.nih.gov/35768207/


2. Huang L, Wang H, Shi M, Kong W, Jiang M. Lipid Profile in Patients With Primary Ovarian Insufficiency: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2022;13:876775.

Background
A large number of studies have investigated the effect of early menopause on cardiovascular disease (CVD) outcomes and the relationship between the levels of lipid profile and primary ovarian insufficiency (POI); however, the results are inconsistent.

Objective
The aim of this meta-analysis was to assess whether the levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) changed in women with POI relative to healthy controls.

Design

  • In order to identify eligible studies, references published prior to December 2021 were searched in the PubMed, Embase, Cochrane Library and Web of Science databases.
  • DerSimonian-Laird random-effects model was used to estimate the overall standard mean difference (SMD) between POI and healthy control subjects.
  • Subgroup analysis and sensitivity analysis were preformed, and publication bias was assessed.

Main findings

  • A total of 12 studies featuring 846 women with primary ovarian insufficiency and 959 healthy women were selected for analysis.
  • The meta-analysis showed that the levels of TC (SMD: 0.60; 95% CI: 0.32 to 0.89; P<0.0001), TG (SMD: 0.36; 95% CI: 0.12 to 0.60; P=0.003), LDL (SMD: 0.46; 95% CI: 0.16 to 0.76; P=0.003) were significantly increased in women with POI.
  • There was no significant change in the level of HDL (SMD: 0.25; 95% CI: -0.12 to 0.61; P=0.19).
  • Subgroup analysis showed that the heterogeneity in this meta-analysis of the correlation between lipid profile and POI might come from by region, sample size, number of cases, mean body mass index (BMI) value of cases and mean age of cases.

Take-home messages

  • Scientific evidence suggests that the lipid profile levels were altered in patients with primary ovarian insufficiency compared to healthy controls.
  • Therefore, we recommend that early medical intervention (such as hormone replacement therapy (HRT)) to minimize the risk of CVD morbidity and mortality associated with dyslipidemia in patients with POI.

https://pubmed.ncbi.nlm.nih.gov/35757391/


3. Kalenga CZ, Hay JL, Boreskie KF, Duhamel TA, MacRae JM, Metcalfe A, Nerenberg KA, Robert M, Ahmed SB. The Association Between Route of Post-menopausal Estrogen Administration and Blood Pressure and Arterial Stiffness in Community-Dwelling Women. Front Cardiovasc Med. 2022;9:913609.

Background

  • Postmenopausal hormone therapy (HT) is associated with increased cardiovascular risk.
  • Although the route of estrogen administration may play a role in mediating risk, previous studies have not controlled for concomitant progestin use.

Objective          
To investigate the association between the route of estrogen therapy (oral or non-oral) HT use, without concomitant progestin, and blood pressure and arterial stiffness in postmenopausal women.

Design
Systolic blood pressure , diastolic blood pressure, arterial stiffness (aortic pulse wave velocity  and augmentation index at 75 beats per minute  were measured using a validated automated brachial cuff-based oscillometric approach (Mobil-O-Graph) in a community-dwelling sample of 328 women.

Main findings

  • 55 participants (16.8%) were ever users (current and past use) of estrogen-only HT (oral [n = 16], transdermal [n = 20], vaginal [n = 19]), and 223 were never HT users (control).
  • Ever use of oral estrogen was associated with increased SBP and DBP (Oral: SBP: 137 ± 4 mmHg, DBP: 79 ± 2 mmHg) compared to use of non-oral estrogen (transdermal: SBP: 118 ± 2 mmHg, DBP: 73 ± 1 mmHg; p < 0.01 & p = 0.012, respectively; vaginal: SBP: 123 ± 2 mmHg DBP: 73 ± 2 mmHg; p = 0.02 & p = 0.01, respectively.) and controls (SBP: 124 ± 1 mmHg, DBP: 74 ± 1 mmHg, p = 0.03, p = 0.02, respectively) after adjustment for covariates. aPWV was higher in oral estrogen ever users (9.9 ± 1 m/s) compared to non-oral estrogen (transdermal: 8.6 ± 0.3 m/s, p < 0.01; vaginal: 8.8 ± 0.7 m/s, p = 0.03) and controls (8.9 ± 0.5 m/s, p = 0.03) but these associations were no longer significant after adjustment for covariates.
  • AIx was higher in oral estrogen (29 ± 2 %) compared to non-oral estrogen (transdermal: 16 ± 2 %; vaginal: 22 ± 1.7 %) but this association was no longer significant after adjustment for covariates (p = 0.92 vs. non-oral; p = 0.74 vs. control).

Take-home messages

  • Ever use of oral estrogen was associated with increased SBP and DBP compared to non-oral estrogen use and no use.
  • Given the cardiovascular risk associated with both menopause and increased blood pressure, further studies are required exploring the potential benefits of non-oral estrogen in postmenopausal women.

https://pubmed.ncbi.nlm.nih.gov/35757351/


4. Dalgaard LB, Oxfeldt M, Dam TV, Hansen M. Intramuscular sex steroid hormones are reduced after resistance training in postmenopausal women, but not affected by estrogen therapy. Steroids. 2022;186:109087.

Background

  • Animal and human studies suggest that low concentrations of circulating sex steroid hormones play a critical role in the accelerated loss of muscle mass and strength after menopause.
  • The skeletal muscle can produce sex steroid hormones locally, however, their presence and regulation remain mostly elusive.

Objective and design

  • To examine sex steroid hormone concentrations in skeletal muscle biopsies from postmenopausal women before and after 12-weeks of resistance training with (n = 15) or without (n = 16) estrogen therapy, and after acute exercise.
  • Furthermore, associations between circulating sex hormones, intramuscular sex steroid hormones and muscle parameters related to muscle strength, mass and quality were elucidated.
  • Blood and muscle samples, body composition (DXA-scan), muscle size (MR), and muscle strength measures were determined before and after the intervention.
  • An additional blood and muscle sample was collected after the last resistance exercise bout.

Main findings

  • The results demonstrated reduced intramuscular estradiol, testosterone and dehydroepiandrosterone (DHEA) concentrations after resistance training irrespective of estrogen therapy.
  • Acute exercise had no effect on intramuscular sex hormone levels.
  • Low circulating levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) associated with high muscle mass at baseline, and a decline in circulating FSH after the intervention associated with a greater gain in muscle cross-sectional area in response to the resistance training.

Take-home messages

  • Intramuscular estradiol, testosterone and DHEA were reduced by resistance training and unaffected by changes in circulating estrogen levels induced by estrogen therapy.
  • Serum FSH and LH were superior predictors of muscle mass compared to other circulating and intramuscular sex steroid hormones.

https://pubmed.ncbi.nlm.nih.gov/35809683/


5. Lozza-Fiacco S, Gordon JL, Andersen EH, Kozik RG, Neely O, Schiller C, Munoz M, Rubinow DR, Girdler SS. Baseline anxiety-sensitivity to estradiol fluctuations predicts anxiety symptom response to transdermal estradiol treatment in perimenopausal women – A randomized clinical trial. Psychoneuroendocrinology. 2022;143:105851.

Background

  • The menopausal transition (perimenopause) is associated with an increased risk of major depression, characterized by anxiety and anhedonia phenotypes.
  • Greater estradiol (E2) variability predicts the development of perimenopausal depression, especially within the context of stressful life events (SLEs).
  • While transdermal E2 (TE2) reduces perimenopausal depressive symptoms, the mechanisms underlying TE2 efficacy and predictors of TE2 treatment response remain unknown.

Objective
This study was aimed at determining relationships between E2 fluctuations, mood symptoms, and physiologic stress-reactivity (cortisol and interleukin-6) and whether differences in mood-sensitivity to E2 fluctuations predict mood responses to TE2 treatment.

Design

  • This randomized, double-blind, placebo-controlled trial investigated medically healthy women (46-60 years) in the early or late menopause transition.
  • Baseline E2-sensitivity strength was calculated from eight weekly individual correlations between week-to-week E2 change and index week anxiety (State-Trait Anxiety Inventory) and anhedonia (Snaith-Hamilton Pleasure Scale).
  • Women then received eight weeks of TE2 or transdermal placebo.

Main findings

  • Analyses included 73 women (active TE2 n = 35).
  • Greater baseline E2 fluctuations predicted greater anhedonia (p = .002), particularly in women with more SLEs.
  • Greater E2 fluctuations also predicted higher cortisol (p = .012) and blunted interleukin-6 (p = .02) stress-responses.
  • Controlling for baseline symptoms, TE2 was associated with lower post-treatment anxiety (p < .001) and anhedonia (p < .001) versus placebo.
  • However, the efficacy of TE2 for anxiety (p = .007) and also for somatic complaints (p = .05) was strongest in women with greater baseline E2 sensitivity strength.

Take-home messages

  • TE2 treatment reduced perimenopausal anxiety and anhedonia.
  • The ability of baseline mood-sensitivity to E2 fluctuations to predict greater TE2 efficacy has implications for individualized treatment of perimenopausal anxiety disorders.

https://pubmed.ncbi.nlm.nih.gov/35809362/ 


6. Syu DK, Hsu SH, Yeh PC, Kuo YF, Huang YC, Jiang CC, Chen M. The association between coronary artery disease and osteoporosis: a population-based longitudinal study in Taiwan. Arch Osteoporos. 2022;17(1):91.

Objective
To analyze for the first time in a large population based fashion the association between coronary artery disease (CAD) and osteoporosis (OP), from the National Health Insurance Research Database (NHIRD) in Taiwan, to determine if CAD is associated with OP.

Design

  • Data from NHIRD, a national, population-based, retrospective, matched cohort study of 23 million patients, were collected to recruit two matched cohorts: with (n = 192,367) and without (n = 192,367) CAD.
  • The Cox model was used to compare the incidence rate ratio and crude hazard ratio (HR) between the two cohorts for osteoporotic fracture and OP.

Main findings

  • Data from NHIRD, a national, population-based, retrospective, matched cohort study of 23 million patients, were collected to recruit two matched cohorts: with (n = 192,367) and without (n = 192,367) CAD.
  • The Cox model was used to compare the incidence rate ratio and crude hazard ratio (HR) between the two cohorts for osteoporotic fracture and OP.

Take-home message

  • A positive association exists between CAD and development of subsequent osteoporotic fracture and OP.
  • Patients with CAD have a significantly increased risk of developing vertebral compression fracture and a higher incident rate ratio of OP.

https://pubmed.ncbi.nlm.nih.gov/35804272/


7. Thong EP, Hart RJ, Teede HJ, Vincent AJ, Enticott JC. Increased mortality and non-cancer morbidity risk may be associated with early menopause and varies with aetiology: An exploratory population-based study using data-linkage. Maturitas. 2022;164:60-66.

Background

  • Latrogenic early menopause (EM), that is, menopause before the age of 45 years due to surgery or chemotherapy or radiotherapy, is associated with negative health impacts.
  • However, it is unclear how these vary according to the cause of EM.

Objective
The authors investigated mortality and non-cancer morbidity in women with iatrogenic EM of different etiologies.

Design

  • This was a population-based retrospective cohort study with 36-year follow-up using data-linkage with the Western Australia hospital morbidity database, cancer, birth, and death registries, the midwives notification system and the mental health information system.
  • The sample comprised women aged 20-44 years of age at index date with iatrogenic EM associated with breast or gynaecological cancer (n = 607), or benign bilateral oophorectomy (n = 414), and age-matched female controls (n = 16,998).
  • Index date (breast, ovarian or uterine cancer diagnosis or oophorectomy procedure) ranged from 1982 to 1997, with follow-up until 2018.
  • Main outcome measures were mortality and hospitalization for circulatory disorders, endocrine, psychological, respiratory, musculoskeletal and gastrointestinal morbidities.

Main findings

  • Significant differences in mortality were observed (% dead by follow-up: cancer, 53.0; oophorectomy, 10.9; and controls, 3.5; p < 0.001).
  • Incidence rate ratios (IRRs) were increased for circulatory (1.23, 95 % CI 1.07-1.42) and endocrine disorders (1.31, 95%CI 1.08-1.56) and hip fracture (3.90, 95 % CI 1.83-7.40) in cancer survivors, compared with controls.
  • IRRs for circulatory (0.62, 95 % CI 0.53-0.72) and endocrine disorders (0.62, 95 % CI 0.38-0.97) were reduced in the oophorectomy group, but were increased for psychological (8.53, 95 % CI 7.29-9.94) and gastrointestinal morbidities (1.43, 95%CI 1.21-1.67) compared with controls.

Take-home message
Cancer-related or benign iatrogenic EM may be associated with increased mortality and morbidity, which vary with the cause of EM.

https://pubmed.ncbi.nlm.nih.gov/35803198/


8. Kravitz HM, Colvin AB, Avis NE, Joffe H, Chen Y, Bromberger JT. Risk of high depressive symptoms after the final menstrual period: the Study of Women’s Health Across the Nation (SWAN). Menopause. 2022;29(7):805-815.

Objective
To examine depressive symptoms during postmenopause and the contribution of depressive symptom trajectories before the final menstrual period (FMP) and psychosocial/health factors to postmenopause depressive symptoms.

Design

  • This was a longitudinal analysis of depressive symptoms (Center for Epidemiologic Studies-Depression scale) collected every 1 to 2 years from 1996 to 2017 from 1,551 midlife women in the Study of Women’s Health Across the Nation for a median follow-up of 19.0 years.
  • Latent class growth analysis identified depression trajectories from baseline to FMP.
  • Multivariable random effects (woman as random effect) linear or logistic regression models were conducted.

Main findings

  • Women had higher odds of reporting high depressive symptom score (≥16) during postmenopause than when they were premenopausal (OR = 1.49, 95% CI, 1.09-2.04), but not when perimenopausal.
  • Three pre-FMP trajectories were identified: Group 1 (47.7%), consistently low scores, Group 2 (39.9%), moderate scores below the high depressive symptom threshold, and Group 3 (12.4%), consistently high scores.
  • Both the moderate (OR = 2.62, 95% CI, 1.89-3.66) and high score (OR = 6.88, 95% CI, 4.72-10.02) groups, compared with the consistently low group, had significantly higher postmenopausal depressive symptom scores.
  • Other pre-FMP variables associated with high postmenopausal depressive symptoms were: higher odds of childhood trauma/maltreatment, poor role physical, high anxiety symptoms, sleep problems, high vasomotor symptoms, and lower odds for chronological aging and lower social support.

Take-home messages

  • Compared with premenopause, postmenopause remains a period of increased risk for higher depressive symptoms, especially for women with pre-FMP depressive symptoms.
  • Pre-FMP depressive symptom trajectories are highly predictive of postmenopause depressive symptoms independent of health and psychosocial factors.

https://pubmed.ncbi.nlm.nih.gov/35796553/


9. Samami E, Shahhosseini Z, Elyasi F. The effects of psychological interventions on menopausal hot flashes: A systematic review. Int J Reprod Biomed. 2022;20(4):255-272.

Background

  • Menopause is a normal physiological phenomenon, closely identified with a great deal of physical-psychological symptoms, including hot flashes (HFs) with a prevalence rate of 20-80%.
  • Various pharmacological and non-pharmacological interventions have been thus far practiced to reduce this common symptom of the menopausal transition.

Objective
This systematic review was conducted to evaluate the effects of psychological interventions on menopausal HFs.

Design

  • In this review, the databases of Google Scholar, Scopus, PubMed, Web of Science, Science Direct, the Cochrane Library, and Scientific Information Database were searched applying the Boolean searching operators as well as the keywords of `hot flashes’, `menopause’, `psychological intervention’, and `vasomotor symptoms’.
  • Accordingly, a total number of 20,847 articles published from January 2000 to June 2019 were retrieved.
  • After excluding the duplicate and irrelevant ones, the risk of bias of 19 clinical or quasi-experimental clinical trials was assessed using the Cochrane collaboration tool.

Main findings

  • The interventions implemented in the studies on menopausal HFs included cognitive behavioral therapy, mindfulness-based stress reduction, hypnotherapy, and relaxation techniques.
  • All the articles reported improvements in HFs in postmenopausal women, except for 4 studies.

Take-home message
Based on the findings of this systematic review, psychological interventions, especially cognitive behavioral therapy and relaxation techniques, are potentially effective for vasomotor symptoms and HFs in healthy postmenopausal women, although the quality of published research on this topic is sometimes questionable.

https://pubmed.ncbi.nlm.nih.gov/35822187/


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

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

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

Design

  • Analysis of a prospective cohort of 1,159 women attending preventive health care programs and followed during 28 years.
  • They underwent a clinical and laboratory evaluation from 1990 to 1993.
  • The diagnosis of OA was retrieved from registries of a special program for osteoarthritis in 2020.

Main findings

  • 24% of participants developed osteoarthritis during the follow-up. At the beginning of the study and compared with women without OA, they were older (median [interquartile range or IQR]: 49.6 [8.5] and 47.2 [8.2] years respectively), had a higher body mass index (26.3 [5.3] and 25.1 [5.3] respectively), and a higher frequency of jobs with low qualification (76 and 62% respectively).
  • The presence of type 2 diabetes mellitus, chronic hypertension, a previous history of alcohol or cigarette consumption, postmenopausal status and lipid and glucose blood levels did not differ between women with or without OA.
  • Cox regression showed a final model that incorporates body mass index (hazard ratio (HR): 1.04; 95% confidence intervals (CI): 1.01-1.07), age (HR: 1.05; 95% CI: 1.03-1.08) and having an unqualified job (HR: 1.88; 95% CI: 1.43-2.47) as risk factors for OA.

Take-home message
Obesity and the type of job are the most relevant risk factors found for OA: both may be modified with proper care.

https://pubmed.ncbi.nlm.nih.gov/35856964/


If you would like to comment or contribute to Our Menopause World, please email Editor Claire Bower claire.bower@imsociety.org


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