It gives me great pleasure to write my latest report for Our Menopause World. There have been a number of recent developments which I would like to bring to your attention.I am particularly delighted to inform you that there has been great progress with our Council of Affiliated Menopause Societies (CAMS) thanks to the outstanding efforts of Professor Duru Shah and her team. Since my last report, Professor Antonio Cano and Professor Fidel Siregar have been appointed as Co-Chairs, and a steering group has been formed. Regional meetings were held in February and March 2023, and we have a new CAMS newsletter called CAMS Connect which you can access via this link. We are extending an open invitation to join the steering group; please see page 6 of CAMS Connect for more information.
A very big welcome to our newest CAMS members from Malta, Peru, Jordan and Rwanda. CAMS membership is open to any local or regional menopause society, and we are offering support to set up societies in areas where there are none. More information about how to join and to get support to set up a society can be found on page 20 of CAMS Connect.
I am also happy to report that the 2023-2024 series of the IMS Clinical Colloquium will commence this month. This second series has expanded from 10 topics and sessions to 12. We had nearly 200 competitive applications from across the globe for seats at the virtual roundtable with the world’s leading experts on menopause and midlife women’s health.
The 17 globally diverse participants (listed below) were selected through a rigorous process, and my warmest congratulations to them all. The applicants who were not selected for a seat at the roundtable will have the opportunity to view the sessions via livestream. Recordings of the sessions will be available exclusively for IMS members on our website.
Lee Mi Li
Gul e Rana
Our thanks to Viatris for supporting this important medical education programme via an unrestricted educational grant.
In other educational news, Level 2 Modules 12 and 13 of our popular IMPART series are now available. More information about IMPART Levels 1 and 2, translations and access to the learning platform can be found via this link. Our thanks to Abbott for supporting IMPART via unrestricted educational grants.
Our next webinar on 11th April, 2023 promises to be very interesting indeed! The subject is the hot topic of ‘The Microbiome and Nutrition in Midlife Women’. The webinar will be moderated by Professor Pauline Maki, with Professor Jack Gilbert speaking on ‘Menopause and the Gut Microbiome’ and Dr Kelsey Gabel speaking on ‘Intermittent Fasting in Postmenopausal Women’.
The next IMS board meetings will be immediately prior to the European Menopause and Andropause Society (EMAS) meeting in Florence on the 2nd May, 2023 and at the Asia Pacific Menopause Federation (APMF) meeting in Bali in October 2023. We are planning to run IMS educational events at both meetings which we encourage you to attend, and you will already have received details of our IMS symposium at EMAS in my previous report. More details of the APMF educational event by IMS should be available in my next report in a couple of months. Our next IMS Executive meeting will be held in Dublin on 15th September, 2023 with a regional educational event planned for 16th September 2023.
Finally, I am sorry to inform you that Professor Sven Skouby passed away on 13th March, 2023. He was a leading figure and a mentor for many. He was appointed Professor at Copenhagen University in 1999 and in 2008 he became head of the fertility clinic at Herlev Hospital, near Copenhagen, a position he held until his retirement in 2021. Sven held numerous positions, titles and leadership roles and was an active IMS board member from 2004 to 2010. He was a great educator and researcher, and delivered countless presentations globally. Sven was an expert not only in menopause, but in the whole of reproductive medicine. He will be sadly missed by all that knew him, including myself. He has been included on our IMS memorial wall, amongst other great contributors to our specialty and society.
As always, please do stay in touch about any regional developments and meetings you would like to inform us about and don’t hesitate to send in your questions about our society activities.
The 31st webinar in the IMS series will be held on Tuesday 11th April 15:00 (CET)/14:00 (UK) ‘The Microbiome and Nutrition in Midlife Women’. The webinar will be moderated by Professor Pauline Maki, with Professor Jack Gilbert speaking on ‘Menopause and the Gut Microbiome’ and Dr Kelsey Gabel speaking on ‘Intermittent Fasting in Postmenopausal Women’.
The link for registrations is Online Events – International Menopause Society (imsociety.org)
The 30th webinar in the IMS webinar series was held on Tuesday 7th March ‘Reproductive Conditions and Consequences for Menopausal Health and Management’ was moderated by Professor Ang Seng Bin. Professor Bart Fauser presented on ‘Polycystic Ovary Syndrome’ and Professor Ludwig Kiesel presented on ‘Endometriosis’. This is now available on IMS Webinars.
Recordings of the 2022-2023 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 Midlife Women’s Health unit: Dos and Don’ts’, ‘Sexual Function: Essentials in Midlife’, ‘Managing Menopause without Hormones’, ‘Genitourinary Syndrome of Menopause: Not just vulvovaginal atrophy’, ‘Breast Health Screening and Prevention’ and ‘Ultrasound’.
The 14th European Congress on Menopause and Andropause
Date: 3rd – 5th May, 2023
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
For more information https://dip.comtecmed.com/
Can hormone replacement therapy protect the heart and brain after menopause?
A unique therapy may prevent postmenopausal cardiovascular disease and cognitive decline when taken within six years of menopause https://www.eurekalert.org/news-releases/982169
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 2023, Volume 26 – April Issue, chosen by our Editor, Professor Rod Baber, have Free Access for the next three months.
The Abstracts from these Free 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.
Spanish translation: Li M, Zhu Y, Wei J, Chen L, Chen S, Lai D. La prevalencia global de la insuficiencia ovárica prematura: una revisión sistemática y meta-análisis. Climacteric. 2023;26(2):95-102. https://pubmed.ncbi.nlm.nih.gov/36519275/
Resumen: Objetivos: El objetivo de esta revisión fue responder a la prevalencia global de insuficiencia ovárica prematura (IOP) y explorar los factores asociados, incluida la etiopatología y las regiones con IOP. Métodos: La búsqueda se realizó mediante los informes de un total de ocho bases de datos que comprendían: Chinese National Knowledge Infrastructure (CNKI), Wanfang, China BioMedical Literature Database (CBM), PubMed, the Cochrane Library, Embase, Web of Science y Ovid MEDLINE® entre 1946 y 2021. Para analizar la fuente de heterogeneidad, realizamos un análisis de subgrupos basado en diferentes etiologías y regiones. El meta-análisis se llevó a cabo con el software Stata14.0. Resultados: Los resultados mostraron que la prevalencia global de IOP entre las mujeres fue del 3.5%. Por análisis de subgrupos, la prevalencia de IOP entre mujeres con etiología iatrogénica fue del 11.2%, seguida de autoinmunidad (10.5 %); la prevalencia de IOP por región fue del 11.3%, la más alta en América del Norte seguida de América del Sur (5.4%); y la prevalencia de IOP fue del 5.3% en un país en desarrollo, superior al 3.1% en un país desarrollado. La tendencia de prevalencia de IOP en los últimos 20 años fue en aumento (aunque p > 0.05). Conclusión: Recomendamos que las instituciones médicas y de salud fortalezcan la conciencia de salud pública, logren objetivos de educación para la salud relacionados con la IOP y aumenten la conciencia y la atención de las mujeres sobre la IOP.
Spanish translation: Murina F, Torraca M, Graziottin A, Nappi RE, Villa P, Cetin I. Validación de una herramienta clínica para el trofismo vestibular en mujeres postmenopáusicas. Climacteric. 2023;26(2):149-153. https://pubmed.ncbi.nlm.nih.gov/36722687/
Resumen: Objetivos: Este estudio tuvo como objetivo desarrollar y validar una herramienta clínica para evaluar el trofismo vestibular en mujeres con síndrome genitourinario de la menopausia (SGM). Métodos: En este estudio transversal, el centro del investigador principal y tres revisores externos evaluaron las imágenes vestibulares de mujeres postmenopáusicas utilizando una herramienta de múltiples ítems definida como salud trófica vestibular (VeTH por sus siglas en inglés), que evaluó cinco criterios: petequias, palidez, adelgazamiento, sequedad y enrojecimiento. También se evaluaron la sequedad, la dispareunia, el dolor vulvar y el Índice de Salud Vaginal (VHI, por sus siglas en inglés). Resultados: El análisis del coeficiente de correlación intra.clase (0.76; intervalo de confianza 0.62-0.82) y el coeficiente alfa de Cronbach (0.78; intervalo de confianza 0.64) indicó una confiabilidad y reproducibilidad entre evaluadores de VeTH en las 70 mujeres participantes en el estudio. La covarianza observada entre una puntuación alta de VeTH y la gravedad de los síntomas demostró una correlación significativa, que no fue evidente entre VeTH y la puntuación total de VHI. Conclusión: El vestíbulo vulvar es la principal localización de la hipersensibilidad genital, principal responsable del ardor/dolor y dispareunia a la penetración por su capacidad de desarrollar un exceso de nociceptores ante la privación de hormonas sexuales. Nuestro estudio indicó que VeTH puede ser una herramienta reproducible para la clasificación morfológica del trofismo vestibular y tiene una correlación significativa con la gravedad de los síntomas.
Palabras clave: Dispareunia; índice de salud vaginal; privación de hormonas sexuales; vestibulodinia; vestíbulo vulvar; dolor vulvar
1. Zuercher MD, Harvey DJ, Au LE, Shadyab AH, Nassir R, Robbins JA, Seldin MF, Garcia L. Genetic admixture and cardiovascular disease risk in postmenopausal Hispanic women. Int J Cardiol. 2022;367:99-104.
Hispanics are a heterogeneous population with differences in the prevalence of cardiovascular disease (CVD) and its related risk factors among ethnic sub-groups.
To evaluate the association of genetic admixture and CVD in self-identified Hispanic women from the Women’s Health Initiative (WHI).
Data came from the WHI Observational Study and the Clinical Trial Components conducted among postmenopausal women.
The CVD outcomes included coronary heart disease (CHD) and stroke.
The proportions of European (EUR), sub-Saharan African (AFR), and Amerindian (AMI) admixture were estimated using 92 ancestry-informative markers.
Cox regression models were used to assess the relationship between genetic admixture and CVD adjusting for age, lifestyle risk factors, known risk factors, and neighborhood socioeconomic status.
Among 5,195 participants EUR ancestry was associated with a lower CHD risk after adjusting for age (HR 0.41, p = 0.02), and in the fully adjusted model (HR 0.40, p = 0.03).
AFR ancestry was associated with a higher CHD risk after adjusting for age (HR 2.91, p = 0.03), but it only showed a trend in in the fully adjusted model (HR 2.46, p = 0.10).
AMI ancestry was not statistically significantly associated with CHD and none of the genetic admixture proportions were statistically significantly associated with stroke (p > 0.05).
EUR ancestry was associated with a lower risk of CHD in Hispanic women.
This highlights the need to account for genetic admixture in future CVD studies to consider different heritage groups to understand the role that genetic, neighborhood socioeconomic status, and environmental factors contribute to CVD health disparities in Hispanic women.
3. Duggan C, Tapsoba JD, Scheel J, Wang CY, McTiernan A. Weight loss reduces circulating micro-RNA related to obesity and breast cancer in postmenopausal women. Epigenetics. 2022;17(13):2082-2095.
Postmenopausal women with overweight or obesity have an increased risk of developing breast cancer but many of the mechanisms underlying this association remain to be elucidated.
MicroRNAs (miRNAs), short non-coding single-stranded RNAs, regulate many physiological processes by controlling post-transcriptional regulation of mRNA.
To analyze the relationship between weight loss and circulating micro-RNA related to obesity and breast cancer in postmenopausal women.
The authors measured circulating miRNA from 192 overweight/obese postmenopausal women (50-75 years) who were part of a randomized controlled trial, comparing independent and combined effects of a 12-month reduced-calorie weight-loss diet and exercise programme, versus control.
RNA was extracted from stored plasma samples, and 23 a priori selected miRNA targets related to aetiology of breast cancer or obesity were measured using NanoString nCounter miRNA Expression assays.
Changes from baseline to 12-months between controls and women in the diet/exercise weight loss arms were analysed using generalized estimating equations modification of linear regression, adjusted for confounders.
Authors next examined changes in levels of circulating miRNA by amount of weight loss (0-10% versus ≥10%).
Participants randomized to weight-loss interventions had statistically significantly greater reductions in miR-122 (-7.25%), compared to controls (+ 33.5%, P = 0.009), and miR-122 levels were statistically significantly correlated with weight loss (rho = 0.24; P = 0.001).
Increasing weight loss was associated with greater reductions in miR-122 versus controls (-11.7% (≥10% weight loss); +2.0% (0-10% weight loss) +33.5% (controls); P trend = 0.006), though this was not significant after correction for multiple testing (P = 0.05/23).
The present study supports the effect of weight loss on regulation of miRNA.
4. Clayton GL, Soares AG, Kilpi F, Fraser A, Welsh P, Sattar N, Nelson SM, Tilling K, Lawlor DA. Cardiovascular health in the menopause transition: a longitudinal study of up to 3892 women with up to four repeated measures of risk factors. BMC Med. 2022;20(1):299.
Women experience adverse changes in cardiovascular health in mid-life; whether the menopausal transition influences these remains strongly debated.
To examine associations of reproductive age (time since final menstrual period (FMP)) with change in carotid intima media thickness (CIMT) and cardiovascular risk factors and determine the role of chronological and reproductive age.
Authors used data from 1,702 women from a pregnancy-based UK cohort who had up to four repeat cardiovascular health measures between mean age 51 (SD = 4.0) and 56 (SD = 3.6) years and experienced a natural menopause.
Multilevel models were used to assess the relationship between cardiovascular measures and time since FMP (reproductive age), whilst adjusting for the underlying effects of chronological age and confounders (socioeconomic factors, body mass index, smoking, alcohol, parity, age at menarche).
In addition, researchers looked at the relationship between cardiovascular measures by chronological age according to menopausal stages (pre-, peri- and postmenopause) using information from women who had and had not experienced menopause (n = 3,892).
There was no strong evidence that reproductive age was associated with CIMT (difference in mean 0.8 μm/year, 95% CI – 0.4, 2.1), whereas there was a strong positive association of chronological age (7.6 μm/year, 95% CI 6.3, 8.9).
Consistent with this, authors found weaker linear associations of reproductive compared with chronological age for atherosclerotic risk factors, such as with systolic blood pressure (- 0.1 mmHg/year, 95% CI – 0.3, 0.1, and 0.4 mmHg/year, 95% CI 0.2, 0.5, respectively) and non-HDL-cholesterol (0.02 mmol/l/year, 95% CI 0.005, 0.03, and 0.06, 95% CI 0.04, 0.07, respectively).
In contrast, associations with fat mass (0.06 kg/m2/year, 95% CI 0.03, 0.10, and 0 kg/m2/year, 95% CI – 0.04, 0.04, respectively) and C-reactive protein (0.01, 95% CI 0.001, 0.02, and 0.01, 95% CI – 0.001, 0.02 natural logged mg/l/year, respectively) were stronger for reproductive compared with chronological age.
Both reproductive and chronological age were (weakly) positively associated with glucose (0.002, 95% CI 0.0001, 0.003, and 0.002, 95% CI 0.0001, 0.003 natural logged mmol/l/year, respectively).
This study suggests that going through the menopausal transition does not further increase women’s risk of atherosclerosis (measured by CIMT) beyond effects of ageing.
Menopausal transition may, in additional to ageing, modestly increase adiposity and glucose levels and therefore a possible associated diabetes risk.
5. Blümel JE, Aedo S, Murray N, Vallejo MS, Chedraui P. Health screening of middle-aged women: what factors impact longevity? Menopause. 2022;29(9):1008-1013.
To measure the impact of different risk factors in middle-aged women on longevity evaluated after three decades of an initial health screening.
Women who received an annual check-up between 1990 and 1993 were recruited.
Anamnesis and physical examination were recorded.
Blood samples for the measurement of glycemia and lipids were taken.
Data are reported as of December 2021.
A total of 1,158 women aged 40 to 60 were studied.
At 30.9 years of follow-up, the Kaplan-Meier overall survival was 75.6% (95% confidence interval, 72.6-78.3).
The main causes of the 260 deaths observed were the following: cancer ( n = 88; 33.8%), cardiovascular disease ( n = 55; 21.2%), and infectious disease ( n = 41; 15.8%).
The following hazard ratios were found with the flexible parametric survival model: personal history of fracture (hazard ratio, 2.55; 95% confidence interval, 1.29-5.02; P = 0.007), type 2 diabetes mellitus (2.14; 1.18-3.88; P = 0.012), personal history of heart disease (1.85; 1.09-3.13; P = 0.022), chronic arterial hypertension (1.65; 1.25-2.17; P < 0.001), postmenopausal status (1.60; 1.13-2.26; P = 0.008), unskilled jobs (1.56; 1.17-2.07; P = 0.002), cigarette smoking (1.51; 1.17-1.94; P = 0.002), age (1.06; 1.03-1.09; P < 0.001), body mass index (1.04; 1.01-1.07; P = 0.004), multiparous (0.72; 0.56-0.93; P = 0.012), and active sexual intercourse (0.68; 0.52-0.87; P = 0.003).
Lipid disorders did not reach statistical significance as a risk factor.
In this cohort, it was observed that most of the classic risk factors for mortality were present; however, a history of fracture appears in middle-aged women as a strong predictor of mortality, surpassing diabetes and arterial hypertension.
Multiparity, on the other hand, was a protective factor.
6. Santoro AM, Simpson CA, Cong E, Haas A, Sullivan RR, Parziale S, Deng Y, Insogna KL. Differing effects of oral conjugated equine estrogen and transdermal estradiol on vitamin D metabolism in postmenopausal women: a 4-year longitudinal study. Menopause. 2022;29(10):1200-1203.
To examine the effect of either conjugated equine estrogen or transdermal estradiol on vitamin D metabolism in postmenopausal women.
Twenty-five women from the Kronos Early Estrogen Prevention Study who were randomized to conjugated equine estrogen 0.45 mg/d and 20 women who were treated with transdermal estradiol 50 mg/d (patch replaced weekly) were analyzed in the present study.
All participants received micronized progesterone for 12 days per month.
There was no significant treatment effect on serum total 25-hydroxyvitamin D over 48 months in either study group, and there were no significant differences between treatment arms.
In contrast, at 12 months, directly measured free 25-hydroxyvitamin D was significantly higher in the transdermal estradiol group than in the conjugated equine estrogen group.
Directly measured free 25-hydroxyvitamin D subsequently increased significantly from 12 to 48 months in both treatment arms.
Calculated free 25-hydroxyvitamin D was also significantly higher in the transdermal estradiol group at 36 months.
Vitamin D-binding protein decreased significantly in both treatment groups from 12 to 48 months, but at 48 months, least square mean values were no different based on treatment assignment.
Directly measured free 25-hydroxyvitamin D levels, but not serum total 25-hydroxyvitamin D levels, were different within the first 12 months of estrogen replacement depending on the preparation; however, this difference was transient, in that there were no differences at 36 or 48 months.
These findings suggest that there may be a short-term benefit to prescribing transdermal estradiol for women who are either vitamin D deficient or insufficient.
7. Dam TV, Dalgaard LB, Johansen FT, Bengtsen MB, Mose M, Lauritsen KM, Gravholt CH, Hansen M. Effects of transdermal estrogen therapy on satellite cell number and molecular markers for muscle hypertrophy in response to resistance training in early postmenopausal women. Eur J Appl Physiol. 2023;123(3):667-681.
To investigate the effects of resistance training with or without transdermal estrogen therapy (TET) on satellite cell (SC) number and molecular markers for muscle hypertrophy in early postmenopausal women.
Using a double-blinded randomized controlled design, the authors allocated healthy, untrained postmenopausal women to perform 12 weeks of resistance training with placebo (PLC, n = 16) or TET (n = 15).
Muscle biopsies obtained before and after the intervention, and two hours after the last training session were analyzed for fiber type, SC number and molecular markers for muscle hypertrophy and degradation (real-time PCR, western blotting).
The analysis of SCs per Type I fiber showed a time x treatment interaction caused by a 47% decrease in PLC, and a 26% increase after TET after the training period.
Also, SCs per Type II fiber area was lower after the intervention driven by a 57% decrease in PLC.
Most molecular markers changed similarly in the two groups.
A decline in SC per muscle fiber was observed after the 12-week training period in postmenopausal women, which was counteracted when combined with use of transdermal TET.
8. Yoshikata R, Yamaguchi M, Mase Y, Tatsuyuki A, Myint KZY, Ohta H. Evaluation of the efficacy of Lactobacillus-containing feminine hygiene products on vaginal microbiome and genitourinary symptoms in pre- and postmenopausal women: A pilot randomized controlled trial. PLoS One. 2022;17(12):e0270242.
As estrogen level decreases with aging, the vaginal mucosa gets thinner, and collagen amount decreases.
In addition, the population of Lactobacillus in the vagina declines, increasing the risk of atrophic vaginitis, bacterial vaginosis, and genitourinary symptoms in the postmenopausal women.
To evaluate the effects of Lactobacillus-containing feminine hygiene products on vaginal microbiome and genitourinary symptoms in pre- and postmenopausal women.
This was a pilot randomized controlled trial in 35 premenopausal and 35 postmenopausal healthy women.
For four weeks, treatment 1 group (14 premenopausal and 16 postmenopausal women) used the Lactobacillus-containing feminine soap and cream, and treatment 2 group (15 premenopausal and 14 postmenopausal women) used Lactobacillus-containing feminine gel in addition to soap and cream.
The remaining six premenopausal and five postmenopausal women served as controls without using any products.
Authors then compared the changes in the vaginal microbiota, genitourinary symptoms, and other related biomarkers after completion of treatment.
Vaginal pH and pathogenic flora were reduced in both treatment groups compared to control group, which was more significant in the treatment 2 group of postmenopausal women.
Genitourinary symptoms significantly improved in 60% of premenopausal women in treatment 1 group and 81.3% of postmenopausal women in treatment 2 group, compared to control group (0%, p = 0.043 and p<0.01 respectively).
Overactive bladder symptom scores were significantly improved after using the products in eleven out of twelve postmenopausal women suspected of having overactive bladder.
The use of Lactobacillus-containing feminine products was associated with improved vaginal ecosystem and urogenital health compared to control group, especially in those women using feminine gel.
9. Lopez Gavilanez E, Navarro Chávez M, Gavilanes AWD, Cedeño German R, Chedraui P. Decreasing incidence rates of osteoporotic hip fractures in Ecuador during the COVID-19 pandemic. Arch Osteoporos. 2022;18(1):15.
The impact that the COVID-19 pandemic has had on fragility fractures is being recently evaluated in the literature. Despite this, data from Latin America in this regard is scarce.
To compare the incidence rate of hip fractures before and during the COVID-19 pandemic in older adults who received care in the public and private health system of Ecuador.
This was a descriptive and retrospective study that analyzed data of individuals aged 60 years and older who had hip fractures before and during the COVID-19 pandemic.
The information was obtained from the National Hospital Discharge Yearbook.
Authors calculated the incidence, average length of hospital-stay, mortality, and case-fatality rate associated with hip fractures.
There was a significant reduction in the incidence of hip fractures in adults 60 or older during the period of social isolation due to COVID-19.
Between March and December 2019, there was an incidence of 152 hip fractures per 100,000 inhabitants, whereas during the same period but in 2020 in the incidence was 110 per 100,000 inhabitants (p < 0.0001).
The main decrease was observed in women aged 80 or more.
The average length of hospital stay did not show significant changes.
Mortality displayed a non-significant decrease (p = 0.14), although this decrease was significant among women (p = 0.02).
Case-fatality rate showed a non-significant increase for the whole group (p = 0.68) and for men (p = 0.09).
Hip fracture rates decreased significantly in adults aged 60 and older in 2020 compared to 2019.
This decrease of hip fracture incidence rates was mainly due to the reductions observed in older people and women.
The average length of hospital-stay, mortality, and case-fatality rate associated with hip fractures did not show significant changes during the pandemic.
10. Lello S, Paris I, Cagnacci A, Sartori D, Caruso S, Iop A. Vasomotor symptoms and management of women undergoing treatment for breast cancer: literature review with focus on the therapeutic potential of cytoplasmic pollen extract. Gynecol Endocrinol. 2023 Jan 2:1-6. doi: 10.1080/09513590.2022.2162035.
Effective management of vasomotor symptoms (VMS) in patients undergoing treatment for breast cancer (BC) represents a critical but frequent unmet need.
To summarize the epidemiology, pathophysiology, and clinical features of VMS in patients with BC and provide a synopsis of the complementary and alternative medicine (CAM) approaches in relieving VMS with a focus on purified cytoplasm of pollen (PCP).
The authors reviewed the literature on VMS epidemiology, pathophysiology, clinical burden, and CAM treatment in healthy women and patients with BC.
VMS are common in patients with BC undergoing hormonal treatment and negatively impact quality of life, leading to treatment discontinuation in up to 25% of patients with detrimental impact on risk of BC recurrence and overall survival.
CAM approaches to treat VMS in patients with BC include vitamin E, phytoestrogens, and black cohosh, even if there is a lack of solid evidence to guide clinicians in the choice of treatment.
PCP, obtained according to standards of good manufacturing practice, has a definite pharmacological mechanism of action, is devoid of estrogen activity, and has shown clinical efficacy on menopause-associated symptoms with a favorable safety profile and high compliance.
As such, it appears to represent a valid management option to improve quality of life in patients with pre- and postmenopausal BC.
Physicians should actively investigate the presence and impact of VMS in patients receiving therapy for BC.
Additional and appropriately sized randomized clinical trials are needed to provide clear evidence on how to best meet the needs of patients with BC suffering from menopause-associated symptoms.