We use cookies to make sure you can have the best experience on our website. If you continue to use this site we assume that you will be happy with it.
It gives me great pleasure to provide my latest president’s report for OMW in which I would particularly like to highlight the collaborative efforts of IMS to connect with our members and global partners. We are now approaching 1,000 paying and honorary members and the numbers are increasing, which is great news!There has been further progress with our Council of Affiliated Menopause Societies (CAMS), thanks once again to the outstanding efforts of CAMS Chair Professor Duru Shah. Since my last report I have attended two online regional meetings chaired by CAMS Co-Chairs Professors Fidel Siregar (Asia Pacific) and Antonio Cano (Europe/Africa/Middle East) held in May 2023. We started planning the programme for local CAMS webinars which will be called the CAMS Symposia Series. The series will be comprised of online medical education symposia, developed and delivered by CAMS member societies and the IMS. Featuring speakers from CAMS societies and the IMS, these symposia will focus on local and regional issues and the latest scientific topics in the field of menopause, and mid-life women’s health. They will be delivered in the native language of the society, with subtitles.
CAMS membership is open to any local or regional menopause society, and we are offering support to set up and support societies in areas where there are none; through provision of CAMS toolkits and mentorship from larger more established CAMS. A big welcome to our newest CAMS members from Mexico and Pakistan. We would also like contributions from our affiliates on any relevant topics for the second issue of our popular newsletter CAMS ConnectCAMS Connect – March 2023 Edition – International Menopause Society (imsociety.org) which is due to be circulated in June 2023.
Our educational programme goes from strength to strength. IMPART registrations are now at 6,482 in English, 1,014 Portuguese, 943 Spanish, 319 Chinese and 18 Arabic. There have been 321 registrations for Level 2, with five modules now available. We are planning a review of IMPART in June, starting with a survey for registrants. Our ongoing thanks to Abbott for supporting IMPART via unrestricted educational grants. In addition to these ventures, the society continues to educate both healthcare professionals and the public through the Clinical Colloquium, the Interview Series (thanks to Marla Shapiro), Menopause Live (thanks to Peter Chedraui), Climacteric (thanks to Rod Baber and editors), Menopause Info (thanks to our CEO Rebecca Cheshire) and our monthly webinars (thanks to all contributors). Our next webinar will be as follows:
Date & Time: Jun 13, 2023 15.00 CET Title: Pay Attention on Your Way In! The vulva is an important organ too. Moderator: Prof. Rossella Nappi Speakers: Dr Jan Shifren: ‘Management of genitourinary syndrome of menopause’ & Dr Tami Rowen: ‘Dyspareunia and vulvodynia’
I think it is important that as a global society we regularly reach out to regional and national societies for collaborative educational and networking opportunities. This was the rationale for deciding to hold our next IMS board meeting in Bali, where the Asia Pacific Menopause Federation (APMF) is located, the meeting will be held on October 6th to 8th, 2023. The theme of the meeting is ’Normal lifestyle of menopausal women post the COVID-19 pandemic’. We are planning to run an IMS educational event at the APMF meeting with presentations from all our attending board members.
Our next IMS Executive meeting will be held in Dublin, Ireland on 15th September, 2023 with a regional educational event planned on 16th September, 2023 in collaboration with the Irish Menopause Society. We will also be holding an IMS symposium at the forthcoming 31st World Congress on ‘Controversies in Obstetrics, Gynecology and Infertility (COGI)’ in Vienna November 23rd to 25th, 2023 in which IMS board members will deliver presentations on dilemmas in day-to-day clinical practice.
Amanda Vincent and I have been jointly chairing the guideline development group which is updating the ESHRE guidelines on Premature Ovarian Insufficiency (POI) in partnership with ESHRE, ASRM and Monash University. It is hoped that the first draft of the POI guidelines will be produced by the time of the ESHRE meeting on June 25th, 2023 and then finalised at the ASRM meeting in New Orleans on October 19th, 2023.
You may be aware that there has been some controversy as to the types and doses of hormone therapy being prescribed in some countries, which are outside of conventionally regulated regimens. IMS is planning to publish guidance on this issue in collaboration with other international societies. As this coincides with the requirement to update both our IMS Recommendations and Global Consensus Statement on Menopause and MHT, the timing could not be better. The aim is that the Global Consensus will focus on the issue of safety and efficacy of different estrogen, progestogen and testosterone regimens with guidance provided about compounded varieties of hormone therapies.
We are now well and truly on the countdown to our next world congress in Melbourne October 19th to 22nd, 2024. Professor Rod Baber has just chaired our second meeting of the scientific programme committee (SPC), where the selection of plenary speakers was prioritised. The aim of the congress will of course be to maintain the high scientific standards of previous IMS congresses. It was felt strongly by the whole SPC that the congress should also provide ample opportunity for the delegates to engage in discussions about clinical conundrums and dilemmas; particularly in more challenging areas such as premature, early and peri menopause, with particular attention to ethnic and cultural aspects. The congress will also provide the opportunity to present key information from new guidelines, recommendations, and consensus statements. We hope to see you all at the meeting!
As always, do stay in touch about any regional developments and meetings you have been involved in, and please don’t hesitate to send in your questions and suggestions about our society activities.
The 33rd webinar in the IMS series will be held on Tuesday 13th June at 15:00 CET/14:00 UK – ‘Pay Attention on Your Way In! The vulva is an important organ too’. The webinar will be moderated by Professor Rossella Nappi, with Dr Jan Shifren speaking about ‘Management of genitourinary syndrome of menopause’ and Dr Tami Rowen speaking on ‘Dyspareunia and vulvodynia’. The link for registrations is Online Events – International Menopause Society (imsociety.org)
The 32nd webinar in the IMS webinar series was held on Tuesday 16th May. ‘Management of Menopause in Obese Patients’ and was moderated by Professor Katrin Schaudig, Professor John Stevenson presented on ‘Menopause in obese patients and cardiovascular risk’ and Dr Santiago Palacios presented on ‘Management of obesity in menopausal patients’. This is now available on IMS Webinars.
The 2023/2024 Clinical Colloquium in Midlife Women’s Health sessions are available exclusively for IMS members via this link. The recordings include the latest sessions, ‘Bone health is not just bone mass’ by Steven Goldstein and ‘Breast screening and prevention’ by Lisa Larkin.
North American Menopause Society Annual Meeting
Date: 27th – 30th September, 2023
The 2023 NAMS Annual Meeting will take place on September 27-30, 2023 at the Marriott Downtown, Philadelphia, PA
For more information https://www.menopause.org/annual-meetings/future-meetings
9th Scientific Meeting Asia Pacific Menopause Federation
Date: 6th – 8th October, 2023
Venue: The Stones, Kuta Beach, Bali, Indonesia
For more information 9th-scientific-meeting-of-apmf
The 19th IMS World Congress on Menopause
Date: 19th – 22nd October, 2024
Venue: Melbourne, Australia
Click here to download the First Announcement
Menopause and mid-life women’s health publication news
Patients with low bone density may be at higher dementia risk Individuals with low bone mineral density scores on dual-energy x-ray absorptiometry could be more likely over time to develop dementia, according to a study from Erasmus MC in Rotterdam, the Netherlands. https://www.auntminnieeurope.com/index.aspx?sec=sup&sub=xra&pag=dis&ItemID=623840
ASCO23: ‘Better sexual health for female patients on endocrine therapy: Strategies across the age spectrum’
Sylvester Comprehensive Cancer Center’s Dr. Kristin Rojas addresses quality of life for patients receiving endocrine therapy for breast cancer, chairing a session that includes advances in improving sexual health, fertility preservation, and bone health. https://www.eurekalert.org/news-releases/990428
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.
The June issue of Climacteric includes a selection of papers based on presentations by speakers at the 18th World Congress on Menopause held in Lisbon in 2022.
Our Editor, Professor Rod Baber, commends these papers to you and thanks our authors for contributing so generously of their expertise and time.
Two papers from Climacteric 2023, Volume 26.3 June issue, chosen by Professor Baber, have Free Access for the next three months.
There are also two Open Access papers in the issue.
The Abstracts from these Free Access and Open Access papers have been translated into Spanish.
The Editor of Climacteric would like to thank Peter Chedraui, one of our Associate Editors, for providing the translations.
Resumen
El sangrado uterino anormal es un motivo común para acudir a los proveedores de atención médica. Se estima que una mujer de cada tres acudirá a un proveedor de atención con sangrado uterino anormal (SUA) durante los años reproductivos, y que al menos una mujer de cada 10 tendrá experimentar sangrado postmenopáusico. Aunque existen algunas variaciones en las pautas nacionales para la investigación, el diagnóstico y el manejo del SUA premenopáusico, hay muchas más áreas de acuerdo que de desacuerdo. Se realizó una búsqueda bibliográfica exhaustiva para revisar las pautas nacionales e internacionales con respecto a la investigación, el diagnóstico y el tratamiento de SUA en mujeres premenopáusicas y postmenopáusicas. Se identifican las áreas de controversia y se revisa la evidencia más reciente. Aunque los esfuerzos para reducir las histerectomías por SUA en mujeres premenopáusicas a través del manejo médico han tenido éxito en gran medida, hay áreas en las que se necesita más investigación para guiar la investigación y el manejo óptimo. Aunque, muchos países tienen pautas bien definidas para la investigación y el manejo del SUA premenopáusico, hay menos pautas bien desarrolladas para la investigación y el manejo del sangrado postmenopáusico. Hay escasez de datos basados en evidencia sobre el manejo del sangrado no programado durante la terapia hormonal menopáusica.
Resumen
En los últimos años se ha alcanzado una mejora regular en la supervivencia de las mujeres después del tratamiento del cáncer. La terapia hormonal para la menopausia (THM) sigue siendo el tratamiento más eficaz para aliviar los síntomas del climaterio y mejorar la calidad de vida de las mujeres sintomáticas. Los efectos a largo plazo de la deficiencia de estrógeno pueden prevenirse, al menos parcialmente, con la THM. Sin embargo, el uso de THM en un contexto oncológico puede estar asociado a contraindicaciones. Las pacientes que han experimentado cáncer de mama con frecuencia enfrentan síntomas climatéricos severos, pero los resultados de los ensayos aleatorios no están a favor del uso de THM en estas mujeres. Tres ensayos aleatorizados están disponibles en mujeres tratadas con THM después del cáncer de ovario e informan mejores tasas de supervivencia en el grupo activo de tratamiento, lo que sugiere que, al menos en el carcinoma de ovario seroso de alto grado, se podría permitir la THM. No hay datos sólidos disponibles para la THM después del carcinoma de endometrio. Según diversas guías, la THM podría ser posible en grados bajos con buen pronóstico. El progestágeno, sin embargo, no está contraindicado y puede ayudar a aliviar los síntomas del climaterio. El carcinoma de cuello uterino de células escamosas no es dependiente de hormonas y, por lo tanto, las pacientes pueden ser tratadas con THM sin restricciones, mientras que es probable que el adenocarcinoma de cuello uterino sea dependiente de estrógenos, a pesar de la falta de datos sólidos y, por lo tanto, solo se podría usar progesterona o progestina. Es posible que, en el futuro, una mejor caracterización molecular de los perfiles genómicos de varios tipos de cáncer permita el uso de THM en algunas pacientes.
Palabras clave: Cáncer de mama; cáncer de cuello uterino; cáncer endometrial; cáncer de ovario; sarcoma uterino
Spanish translation: Cheung AS, Nolan BJ, Zwickl S. La salud transgénero y el impacto del envejecimiento y la menopausia. Climacteric. 2023;26(3):256-262. https://pubmed.ncbi.nlm.nih.gov/37011669/
Resumen
Muchas personas transgénero utilizan la terapia hormonal de afirmación de género (GAHT, por sus siglas en inglés) para reducir la incongruencia de género y mejorar el funcionamiento psicológico. Como la GAHT comparte muchas similitudes con la terapia hormonal de la menopausia, los médicos que apoyan a las personas durante la menopausia están en una posición ideal para manejar la GAHT. Esta revisión narrativa proporciona una descripción general de la salud de las personas transgénero y analiza los efectos a largo plazo de la GAHT a considerar cuando se trata a las personas transgénero a lo largo de la vida. La menopausia es menos relevante para las personas transgénero que toman GAHT (a menudo administrados de por vida) para alcanzar concentraciones de esteroides sexuales generalmente en el rango del género afirmado. Para las personas que utilizan la terapia hormonal feminizante, existe un riesgo elevado de tromboembolismo venoso, infarto de miocardio, accidente cerebrovascular y osteoporosis en relación con las personas cisgénero. Para las personas trans que utilizan la terapia con hormonas masculinizantes, existe un mayor riesgo de policitemia, un probable mayor riesgo de infarto de miocardio y dolor pélvico, que es poco conocido. La mitigación proactiva de los factores de riesgo cardiovascular es importante para todas las personas transgénero y la optimización de la salud ósea es importante para quienes usan hormonas feminizantes. Debido a la falta de investigación para guiar la GAHT en la vejez, se recomienda un enfoque de toma de decisiones compartida para la provisión de GAHT para lograr objetivos individuales y minimizar los posibles efectos adversos.
Palabras clave: Personas transgénero; envejecimiento; estradiol; menopausia; testosterone.
Spanish translation: Russo E, Misasi G, Montt-Guevara MM, Giannini A, Simoncini T. Efectos del ospemifeno sobre la vejiga hiperactiva en mujeres postmenopáusicas con atrofia vulvovaginal. Climacteric. 2023;26(3):284-288. https://pubmed.ncbi.nlm.nih.gov/36912363/
Resumen Objetivo: La vejiga hiperactiva (VH) es un síndrome complejo y multifactorial asociado a polaquiuria, urgencia e incontinencia. Los cambios hormonales asociados con la menopausia juegan un papel en el desarrollo de esta condición. Los estrógenos vaginales son eficaces para mejorar la VH en mujeres postmenopáusicas (MPM) con atrofia vulvovaginal (AVV). El ospemifeno es un modulador selectivo de los receptores de estrógeno autorizado para el tratamiento de la AVV. Este estudio tuvo como objetivo evaluar los efectos del ospemifeno sobre los síntomas de VH en MPM con AVV.
Métodos: Cuarenta MPM con VH y AV recibieron ospemifeno oral (60 mg/día) durante 12 semanas. Todos los pacientes fueron evaluados con estudio urodinámico, diario vesical de 3 días y cuestionarios validados (International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form [ICIQ-UI SF] e International Consultation on Incontinence Questionnaire – Overactive Bladder [ICIQ-OAB]) al momento de la inscripción del estudio y al final del misno.
Resultados: La capacidad citométrica, la distensibilidad de la vejiga y las respuestas del umbral sensorial verbal durante el llenado de la vejiga mejoraron después del tratamiento. El diario miccional mostró una
reducción significativa de las micciones diarias, los episodios de incontinencia urinaria de urgencia y los eventos nocturnos. Las medianas de puntuaciones generales del ICIQ-UI y el ICIQ-OAB también mejoraron significativamente.
Conclusiones: Nuestro estudio sugiere que el tratamiento con ospemifeno en MPM que padecen VH se asocia con una reducción de los síntomas de VH debido a una disminución de la sensibilidad de la vejiga y con una mejora en la calidad de vida.
Palabras clave: Vejiga hiperactiva; envejecimiento; menopausia; ospemifeno; modulador selectivo del receptor de estrógeno; atrofia vulvovaginal.
1. Wang J, Gaman MA, Albadawi NI, Salem A, Kord-Varkaneh H, Okunade KS, Alomar O, Al-Badawi IA, Abu-Zaid A. Does Omega-3 Fatty Acid Supplementation Have Favorable Effects on the Lipid Profile in Postmenopausal Women? A Systematic Review and Dose-response Meta-analysis of Randomized Controlled Trials. Clin Ther. 2023;45(1):e74-e87.
Background
Menopause is associated with disturbances in the metabolism of lipids; moreover, during the postmenopausal period, female subjects are more prone to develop dyslipidemia.
Omega-3 fatty acids, which exert cardioprotective, anti-inflammatory, and lipid-lowering actions, are commonly recommended in postmenopausal women; however, their effect on serum lipids in this population remains unclear.
Objective
To evaluate the effect of Omega-3 Fatty Acid Supplementation on the lipid profile in postmenopausal women.Design
The authors conducted a systematic review and meta-analysis of randomized clinical trials (RCT).
Authors searched the Web of Science, Scopus, PubMed/MEDLINE, and EMBASE databases from their inception until January 3, 2022.
The DerSimonian and Laird random-effects model was used to combine effect sizes.
Main findings
Omega-3 fatty acid supplementation resulted in a decrease in triglyceride concentrations (weighted mean difference [WMD], -17.8 mg/dL; 95% CI, -26 to -9.6; P < 0.001), particularly in the RCTs that lasted ≤16 weeks (WMD, -18.6 mg/dL), when the baseline triglyceride concentrations were ≥150 mg/dL (WMD, -22.8 mg/dL), in individuals with a body mass index ≥30 kg/m2 (WMD, -19.3 mg/dL), and when the dose of omega-3 fatty acids was ≥1 g/d (WMD, -21.10 mg/dL).
LDL-C (WMD, 4.1 mg/dL; 95% CI, 1.80 to 6.36; P < 0.001) and HDL-C (WMD, 2.1 mg/dL; 95% CI, 0.97 to 3.2; P < 0.001) values increased.
Total cholesterol levels (WMD, -0.15 mg/dL; 95% CI, -4 to 3.74; P = 0.94) remained unchanged after administration of omega-3 fatty acids.
Take-home message
In postmenopausal women, supplementation with omega-3 fatty acids resulted in a significant reduction in triglyceride concentrations and a modest elevation in HDL-C and LDL-C levels, whereas this intervention did not affect total cholesterol values.https://pubmed.ncbi.nlm.nih.gov/36641259/
2. Saleh RNM, Hornberger M, Ritchie CW, Minihane AM. Hormone replacement therapy is associated with improved cognition and larger brain volumes in at-risk APOE4 women: results from the European Prevention of Alzheimer’s Disease (EPAD) cohort. Alzheimers Res Ther. 2023;15(1):10.
Background
The risk of dementia is higher in women than men.
The metabolic consequences of estrogen decline during menopause accelerate neuropathology in women.
The use of hormone replacement therapy (HRT) in the prevention of cognitive decline has shown conflicting results.
Objective
To investigate the modulating role of the APOE genotype and age at HRT initiation on the heterogeneity in cognitive response to HRT.
Design
The analysis used baseline data from participants in the European Prevention of Alzheimer’s Dementia (EPAD) cohort (total n= 1906, women= 1178, 61.8%).
Analysis of covariate (ANCOVA) models were employed to test the independent and interactive impact of APOE genotype and HRT on select cognitive tests, such as MMSE, RBANS, dot counting, Four Mountain Test (FMT), and the supermarket trolley test (SMT), together with volumes of the medial temporal lobe (MTL) regions by MRI.
Multiple linear regression models were used to examine the impact of age of HRT initiation according to APOE4 carrier status on these cognitive and MRI outcomes.
Main findings
APOE4 HRT users had the highest RBANS delayed memory index score (P-APOE*HRT interaction = 0.009) compared to APOE4 non-users and to non-APOE4 carriers, with 6-10% larger entorhinal (left) and amygdala (right and left) volumes (P-interaction= 0.002, 0.003, and 0.005 respectively).
Earlier introduction of HRT was associated with larger right (standardized β= -0.555, p=0.035) and left hippocampal volumes (standardized β= -0.577, p=0.028) only in APOE4 carriers.
Take-home messages
HRT introduction is associated with improved delayed memory and larger entorhinal and amygdala volumes in APOE4 carriers only.
This may represent an effective targeted strategy to mitigate the higher life-time risk of AD in this large at-risk population subgroup.
Confirmation of findings in a fit for purpose RCT with prospective recruitment based on APOE genotype is needed to establish causality.
3. Moir ME, Corkery AT, Senese KA, Miller KB, Pearson AG, Loggie NA, Howery AJ, Gaynor-Metzinger SHA, Cody KA, Eisenmenger LB, Johnson SC, Barnes JN. Age at natural menopause impacts cerebrovascular reactivity and brain structure. Am J Physiol Regul Integr Comp Physiol. 2023;324(2):R207-R215.
Background
Menopause is associated with adverse changes in vascular health coinciding with an increased risk of stroke and vascular cognitive impairment; however, there is significant variation in the age at menopause.
Objective
To examine how the age at natural menopause impacts cerebrovascular reactivity and structural biomarkers of brain aging.
Design
Thirty-five healthy postmenopausal women were classified as early-onset menopause (Early; n = 19, age at menopause: 47 ± 2 yr) or later-onset menopause (Late; n = 16, age at menopause: 55 ± 2 yr).
Middle cerebral artery blood velocity (MCAv), mean arterial blood pressure (MAP), and end-tidal carbon dioxide (ETCO2) were recorded during a stepped hypercapnia protocol.
Reactivity was calculated as the slope of the relationship between ETCO2 and each variable of interest.
Brain volumes and white matter hyperintensities (WMHs) were obtained with 3T MRI.
Main findings
Resting MAP was greater in the Early group (99 ± 9 mmHg) compared with the Late group (90 ± 12 mmHg; P = 0.02).
Cerebrovascular reactivity, assessed using MCAv, was blunted in the Early group (1.87 ± 0.92 cm/s/mmHg) compared with the Late group (2.37 ± 0.75 cm/s/mmHg; P = 0.02).
Total brain volume did not differ between groups (Early: 1.08 ± 0.07 L vs. Late: 1.07 ± 0.06 L; P = 0.66), but the Early group demonstrated greater WMH fraction compared with the Late group (Early: 0.36 ± 0.14% vs. Late: 0.25 ± 0.14%; P = 0.02).
Take-home message
The results of this study suggest that age at natural menopause impacts cerebrovascular function and WMH burden in healthy postmenopausal women.
4. Venborg E, Osler M, Jørgensen TSH. The association between postpartum depression and perimenopausal depression: A nationwide register-based cohort study. Maturitas. 2023;169:10-15.
Objective
To investigate whether postpartum depression is associated with a risk of depression during perimenopause.
Design
This was a Danish nationwide register-based cohort study of 270,613 individuals who were born in 1960-1968, who gave birth to a liveborn child recorded in the Medical Birth Register before the age of 40, and who lived in Denmark when turning 47 years old.
The association between postpartum depression and depression during perimenopause was analyzed using a Cox Proportional Hazards model adjusted for education level, marital status, and age at first delivery.
Depression during perimenopause was identified by a diagnosis of depression during nine years of follow-up registered in the Danish National Patient Registry.
Main findings
A total of 7694 (2.9 %) study participants were diagnosed with depression during perimenopause.
Postpartum depression was associated with 12.82 [95 % confidence interval (CI): 8.93;18.41] times higher hazard of depression during perimenopause, while depression prior to study baseline was associated with 11.91 [95 % CI: 11.14;12.73] times higher hazard compared with individuals with no history of depression.
There was no difference in the association between postpartum depression and depression prior to study baseline for depression during perimenopause.
Take-home message
Prior depression, no matter the timing, is associated with markedly higher risk of depression during perimenopause; thus, individuals who have experienced postpartum depression do not experience a greater risk of depression during perimenopause compared with individuals who have experienced depression unrelated to periods of hormonal changes during their fertile life.
5. Mugnier B, Goncalves A, Daumas A, Couderc AL, Mezni E, Viret F, de Nonneville A, Villani P. Prevention of aromatase inhibitor-induced bone loss with anti-resorptive therapy in post-menopausal women with early-stage breast cancer. Osteoporos Int. 2023;34(4):703-711.
Background
Antiresorptive treatment can prevent aromatase inhibitor-induced bone loss in patients with early breast cancer
Previously the authors have observed that patients who did not receive antiresorptive treatment had a 20.8-fold increase in risk of bone loss after 24 months of aromatase inhibitors therapy.
Objective
To describe changes in femoral and lumbar bone mineral density (BMD) after 24 months of aromatase inhibitors (AIs) and antiresorptive treatment in postmenopausal women with estrogen receptor-positive breast cancer.
Design
This was a prospective, longitudinal study in a real-life setting with a 2-year follow-up.
Patients underwent a complete baseline bone assessment including clinical assessment, biological evaluation, BMD measurement, and spine X-ray.
Antiresorptive treatment was prescribed to patients with a T-score < – 2 or a T-score < – 1.5 SD with additional osteoporosis risk factors.
A follow-up bone assessment was carried out after 24 months.
Main findings
Among 328 patients referred to the center of the authors, 168 patients (67.7 ± 10.6 years) were included in the study, and 144 were eligible for antiresorptive treatment.
After 24 months, patients receiving antiresorptive treatment experienced a significant increase of + 6.28% in femoral-BMD (F-BMD) and + 7.79% in lumbar-BMD (L-BMD).
This increase was not significantly different between osteoporotic and osteopenic patients.
Conversely, patients not receiving antiresorptive treatment presented significant F-BMD and L-BMD loss regardless of the baseline BMD.
In the multivariate logistic model, the lack of antiresorptive treatment was the only predictive factor for major femoral bone loss with a 20.83 odds ratio (CI95%:4.2-100, p < 0.001).
Take-home messages
This real-life study confirmed that antiresorptive treatment significantly increases femoral and lumbar BMD regardless of the baseline BMD in postmenopausal patients receiving AIs for early breast cancer.
Patients who did not receive antiresorptive treatment had a 20.8-fold increased risk of major bone loss; nevertheless, the best threshold to adopt for starting antiresorptive agents remains undetermined.
6. Li S, Ma L, Huang H, Lou Z, Qi T, Huang Y, Zou Y, Zhou J. Loss of muscle mass in women with premature ovarian insufficiency as compared with healthy controls. Menopause. 2023;30(2):122-127.
Background
Menopausal transition has been known to be associated with the loss of muscle mass; however, muscle health in women with premature menopause, that is, premature ovarian insufficiency (POI), remains unclear.
Objective
To investigate and compare muscle mass parameters and the prevalence of low muscle mass between patients with spontaneous POI and healthy controls.
Design
In this cross-sectional study, 59 women with spontaneous POI and 57 premenopausal controls with normal ovarian function were enrolled at the Women’s Hospital, Zhejiang University School of Medicine (Hangzhou, China) from June 17, 2020, to August 20, 2021.
Muscle mass parameters were measured by dual-energy x-ray absorptiometry, and low muscle mass was diagnosed using the Asian Working Group for Sarcopenia criteria.
In addition, participants provided their sociodemographic data, menstrual and reproductive history, lifestyle factors, and medical history.
Multivariate linear regression analysis was conducted.
Main findings
Muscle mass parameters, including appendicular skeletal muscle mass (ASM), ASM/height2, ASM/weight, ASM/body mass index, total skeletal muscle mass (TSM), and TSM/weight, were significantly lower in women with POI as compared with healthy controls (ASM: 14.62 ± 2.08 vs 15.97 ± 1.78, P < 0.001; ASM/height2: 5.71 ± 0.64 vs 6.15 ± 0.62, P < 0.001; ASM/weight: 0.27 [0.25, 0.28] vs 0.28 [0.27, 0.29], P = 0.002; ASM/BMI: 0.68 ± 0.07 vs 0.73 ± 0.06, P = 0.001; TSM: 33.85 ± 4.08 vs 36.43 ± 3.56, P < 0.001; TSM/weight: 0.63 [0.59, 0.65] vs 0.64 [0.61, 0.67], P = 0.02).
The prevalence of low muscle mass in POI patients was significantly higher than that in controls (32.20% vs 8.77%, χ2 = 9.70, P = 0.002).
Furthermore, multivariate linear regression analyses demonstrated that POI status was an independent risk factor for ASM (β = -1.13; 95% CI, -1.62 to -0.65), ASM/height2 (-0.35, -0.47 to -0.22), ASM/weight (-0.01, -0.02 to -0.009), ASM/BMI (-0.05, -0.07 to -0.02), TSM (-2.16, -3.14 to -1.17), and TSM/weight (-0.03, -0.04 to -0.02).
Take-home messages
Women with POI exhibit significant loss of muscle mass as compared with healthy controls.
Early diagnosis and long-term health management in POI patients are important.
7. Vroom AJ, Bongarts S, Bongers MY, Kooreman LFS, Bosch SL, Geomini PMAJ, van Hanegem N. The effects of Saline Infusion Sonography on the histological quality of endometrial sampling in women with postmenopausal bleeding. BMC Womens Health. 2023;23(1):46.
Background
Hypothetically, saline infusion could disrupt the tissue and therefore affect the quality of the sample.
Objective
To determine which histological features have impact on the quality of the endometrial sample.
Design
The authors performed a randomized controlled trial (ESPRESSO trial) in which they analyzed the aspiration samples in two groups.
Women were allocated either to saline contrast sonohysterography and subsequent endometrial sampling (SCSH-Sampling group) or to the opposite order (Sampling-SCSH group).
Dedicated gyneco-pathologists retrospectively assessed the specimens and recorded the type (blood, mucus, epithelium, intact glands, stroma and tissue context) and quantity (on a scale of 0-3) of material that was found in the specimens.
Main findings
This analysis consisted of 197 samples, with 101 women in the SCSH-Sampling group and 96 women in the Sampling-SCSH group.
No significant differences were found in the histological features between the two groups.
All significant histological features differed significantly in the sufficient samples compared to the insufficient samples: higher amounts of blood, more endometrial epithelium, presence of intact endometrial glands, better stroma and tissue context.
Oppositely, a significantly higher amount of mucus was found in the insufficient samples.
Take-home message
This study shows that the histological features of the endometrial sample were not affected by the saline contrast sonohysterography, when performed prior to the tissue sampling.
8. Tan A, Thomas RL, Campbell MD, Prior SL, Bracken RM, Churm R. Effects of exercise training on metabolic syndrome risk factors in post-menopausal women – A systematic review and meta-analysis of randomised controlled trials. Clin Nutr. 2023;42(3):337-351.
Background
Alterations in the hormonal profiles as women transition to the menopause predisposes individuals to the metabolic syndrome (MetS).
In postmenopausal women, this can be exacerbated by sedentary behaviour and physical inactivity.
Physical activity can convey many health benefits including improvement in MetS risk factors; however, it remains to be elucidated how differing exercise intensities and its mode of delivery can ameliorate MetS risk factors and resultant progression amongst post-menopausal women.
Objective
The purpose of this systematic review and meta-analysis was to investigate the effects and efficacy of exercise training on MetS risk factors in postmenopausal women.
Design
Database searches using PubMed, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials were conducted from inception to December 2021 for randomised controlled studies (RCTs) investigating exercise training (>8 weeks) in at least one of the MetS risk factors in post-menopausal women.
Utilising the random-effects model, appropriate standardised mean differences (SMD) or mean differences (MD) with 95% confidence interval (CI) for each MetS risk factor were used to calculate the overall effect size between the exercise and control groups.
Sub-group analyses were performed for exercise intensity, modality, and duration for each risk factor.
Meta-regression was performed for categorical (health status) and continuous (body mass index) covariates.
Main findings
39 RCTs (40 studies) involving 2132 participants were identified as eligible.
Overall, the meta-analysis shows that exercise training significantly improved all MetS risk factors: waist circumference (WC) [MD: -2.61 cm; 95% CI: -3.39 to -1.86 cm; p < 0.001; 21 studies]; triglycerides (TG) [SMD: -0.40 mmol/L; 95% CI: -0.71 to -0.09 mmol/L; p = 0.01; 25 studies]; high-density lipoprotein (HDL) [SMD: 0.84 mmol/L (95% CI: 0.41-1.27 mmol/L; p < 0.001; 26 studies]; fasting glucose (BG) [SMD: -0.38 mmol/L (95% CI: -0.60 to -0.16 mmol/L; p < 0.001; 20 studies]; systolic blood pressure (SBP) [MD: -5.95 mmHg (95% CI: -7.98 to -3.92 mmHg; p < 0.001; 23 studies]; and diastolic blood pressure (DBP) [MD: -4.14 mmHg (95% CI: -6.19 to -2.08 mmHg; p < 0.001; 23 studies].
Furthermore, sub-group analyses identified that moderate intensity and combined exercise training significantly improved MetS risk factors (p < 0.05) except for HDL, with combined exercise being the most effective.
Long duration (≥12 weeks) training also significantly improved MetS risk factors except for TG.
Meta-regression revealed no moderating effects on any MetS risk variables.
Take-home messages
This study reinforces the importance of regular physical activity as a non-pharmacological tool in the reduction of MetS risk in post-menopausal women, with significant metabolic improvements seen in interventions spanning 8-10 weeks.
Moderate intensity and combined training significantly benefitted abdominal obesity, dyslipidaemia, dysglycaemia and hypertension in post-menopausal women.
Improvements in at least one MetS risk were also seen with other exercise modalities and intensities.
9. Johnson KA, Martin N, Nappi RE, Neal-Perry G, Shapiro M, Stute P, Thurston RC, Wolfman W, English M, Franklin C, Lee M, Santoro N. Efficacy and Safety of Fezolinetant in Moderate-to-Severe Vasomotor Symptoms Associated With Menopause: A Phase 3 RCT. J Clin Endocrinol Metab. 2023:dgad058. doi: 10.1210/clinem/dgad058.
Background
Vasomotor symptoms (VMS) are common, bothersome, and can persist for years before and after menopause.
Objective
To assess efficacy/safety of fezolinetant for treatment of moderate-to-severe VMS associated with menopause.
Design
In this double-blind, placebo-controlled, 12-week (W) phase 3 trial with a 40W active treatment extension (NCT04003142; SKYLIGHT 2) women aged 40-65 years with minimum average 7 moderate-to-severe VMS/day were randomized to 12 weeks’ once-daily placebo, fezolinetant 30 mg, or fezolinetant 45 mg.
Completers were rerandomized to fezolinetant 30/45 mg for 40 additional weeks.
Coprimary efficacy endpoints were mean daily change from baseline to W4 and W12 in VMS frequency and severity.
Safety was also assessed.
Main findings
Both fezolinetant doses statistically significantly reduced VMS frequency/severity at W4 and W12 vs placebo.
For VMS frequency, W4 least squares mean (SE) reduction vs placebo: fezolinetant 30 mg, -1.82 (0.46; P < .001); 45 mg, -2.55 (0.46; P < .001); W12: 30 mg, -1.86 (0.55; P < .001); 45 mg, -2.53 (0.55; P < .001). For VMS severity, W4: 30 mg, -0.15 (0.06; P<.05); 45 mg, -0.29 (0.06; P < .001); W12: 30 mg, -0.16 (0.08; P <.05); 45 mg, -0.29 (0.08; P < .001).
Improvement in VMS frequency and severity was observed by W1; maintained through W12.
Serious TEAEs were infrequent; these were reported by 2%, 1%, and 0% of those receiving fezolinetant 30 mg, fezolinetant 45 mg, and placebo, respectively.
Take-home message
Daily fezolinetant 30 mg and 45 mg were efficacious and well-tolerated for treating moderate-to-severe VMS associated with menopause.
10. Fighera TM, Santos BR, Motta L, Casanova G, Spritzer PM. Associations between bone mass, hormone levels, and body composition in postmenopausal women. Menopause. 2023;30(3):317-322.
Background
Effective management of vasomotor symptoms (VMS) in patients undergoing treatment for breast cancer (BC) represents a critical but frequent unmet need.
Objective
To explore body composition parameters and hormone levels as risk factors for low bone mass (osteopenia/osteoporosis) in postmenopausal women.
Design
The authors analyzed biorepository samples from 139 postmenopausal women with no clinical evidence of cardiovascular disease.
Inclusion criteria were menopause occurring after 40 years of age and no use of hormone therapy in the past 3 months.
Bone mineral density and body composition were assessed by dual-energy x-ray absorptiometry.
Sex hormone-binding globulin (SHBG) and follicle-stimulating hormone (FSH) levels were measured in all participants.
Serum estradiol was measured by gas chromatography/tandem mass spectrometry in a subset of 57 participants.
Free estrogen index was calculated by dividing estradiol by SHBG × 100.
Main findings
Body mass index (25.0 [22.5-26.5] vs 27.7 [26.6-31.9] kg/m 2 , P < 0.001), estradiol (3.0 [2.7-4.5] vs 6.0 [2.7-15.0] pg/mL, P = 0.006), waist circumference (84 ± 9 vs 93 ± 12 cm, P < 0.001), appendicular lean mass (ALM) (15.739 ± 2.129 vs 17.184 ± 2.104 kg, P = 0.001), and fat mass index (9.36 [7.29-11.43] vs 11.38 [9.95-15.33] kg/m 2 , P < 0.001) were lower in women with low bone mass by dual-energy x-ray absorptiometry.
Univariate analysis showed that free estrogen index, time since menopause, SHBG, and fat mass were significant predictors of low bone mass, and ALM was a significant predictor against low bone mass.
Appendicular lean mass persisted as an independent predictor against low bone mass in multivariate models with fat mass and SHBG.
In turn, fat mass was no longer significant in this multivariate model after inclusion of SHBG.
No association of FSH with low bone mass was observed.
Take-home messages
Appendicular lean mass was a significant independent predictor against low bone mass in postmenopausal women.
Further prospective studies are needed to investigate whether lean mass, fat mass, and FSH have a direct effect on bone mass in postmenopausal women, adding to the consequences of hypoestrogenism in this group.
