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It gives me great pleasure to write my next president’s report for Our Menopause World.
Once again, I would like to take the opportunity to thank my IMS friends and colleagues for all their hard work and support at the IMS. I would like to give a special mention to our CAMS Steering Committee. I had the privilege of being able to participate in the latest meeting on Tuesday Sept 26th, capably chaired by Professor Duru Shah, and I was incredibly impressed by the degree of enthusiasm and engagement from our global CAMS leaders. As I mentioned in the meeting, the educational impact of IMS relies completely on being able to disseminate our educational products to the four corners of the globe. I feel confident that we can achieve our IMS mission and vision as a result of the efforts of our CAMS global and regional committees.
There are now eight CAMS microsites live and ten in development. We have now received seven CAMS Menopause Hour proposals from the following societies: Croatia, Canada, Italy, Russia, European Menopause and Andropause Society, Pakistan, and a joint proposal from Switzerland and Germany.I am also pleased that the CAMS membership offer below has been approved by the IMS Board. The offer is for individuals whose society is a member of CAMS and who are not currently members of the IMS. The online membership system for this offer is now being finalised; the options are:
One-year free Limited Professional Membership.
20% discount on Full Membership (£100 instead of £125); or
Please keep up with CAMS activities via the quarterly newsletter, CAMS Connect.
It is particularly important that we try to collaborate in as many regional and global meetings as possible to achieve our goals. I was, therefore, delighted that IMS Board members, such as Professor Duru Shah, Professor Santiago Palacios and Professor Tommaso Simoncini, were able to actively participate in recent meetings such as the 12th Congress of the Asia Pacific Initiative on Reproduction ASPIRE 2023; ‘Welcome back to our future’ in Australia; and The Philippine Society of Climacteric Medicine (PSCM) annual convention and 30th anniversary celebration EDSA with the theme ‘Road to menopause: Wellness and longevity’.
Congratulations to the Australasian Menopause Society on the success of its 26th Annual Congress in Queenstown, New Zealand from 1st – 3rd September. The theme was ‘Remarkable reflections on midlife and menopause’ and I was delighted and honoured to participate as a keynote speaker, having been invited by Dr Ashley Makepeace Chair of the Scientific Programme Committee and Dr Karen Magraith, President of AMS. Professors Rod Baber, Amanda Vincent and myself promoted the forthcoming IMS World Congress 2024 at the meeting and this was received with much enthusiasm. We very much look forward to our ongoing collaboration with the new AMS President, Dr Sylvia Rosevear and her Board, to run a successful 19th IMS World Congress in Melbourne, October 19-22 2024.Our IMS Joint Meeting with the Irish Menopause Society on 16th September was also a great success. IMS Executive members, Professor Rossella Nappi, Professor Steven Goldstein, Professor Ang Seng Bin, Professor Pauline Maki and myself spoke at the event. The programme was complimented by excellent local speakers and co-chaired by Irish Menopause Society President, Dr Barbara O’Beirne. It was a great opportunity to share academic information and practical management strategies with another sold-out audience, which included primary care physicians, gynecologists, endocrinologists and GPs.
We have an IMS Board meeting in Bali this week, where the Asia Pacific Menopause Federation (APMF) meeting will be held from October 6th to 8th. The theme of the meeting is ‘Normal lifestyles of menopausal women post the COVID-19 pandemic’. We are contributing an IMS educational event at the APMF meeting, with a large number of presentations from all our Board members, as well as the regional speakers. We really look forward to meeting as many of our IMS friends and colleagues as possible at this meeting. Further information and registration can be accessed via this link.
Our online educational programme continues to provide numerous opportunities for our members and wider professional menopause societies. The IMS webinar series continues on a monthly basis; the next one will be on Cardiovascular Disease on Tuesday Oct 17th 2023 at 15.00 CET (Central European Time), to coincide with the theme of World Menopause Day the following day. The webinar will be chaired by Professor Peter Schnatz and the speakers are Professor Samar El Khoudary and Professor Cynthia Stuenkel. You can view all recordings of IMS webinars, Clinical Colloquium and sponsored symposia on the Online Events page of the IMS website. Our Interview Series videos and podcasts are available here on the IMS website.
Please also view the programme for our IMS symposium at the 31st World Congress on ‘Controversies in Obstetrics, Gynecology and Infertility (COGI)’ in Vienna Nov 23rd – 25th 2023. The theme will be “Managing clinical dilemmas in day-to-day menopause practice” https://program.eventact.com/Program/icYoAAA/ixjY/en
The World Menopause Day 2023 White paper on cardiovascular disease is now ready for publication in Climacteric and will soon be free to download from the IMS Website. The consumer leaflet and promotional toolkit will also be available for World Menopause Day on October 18th, and our thanks once again to Professor Cynthia Stuenkel for her hard work in producing this seminal document.
Our World Congress Scientific Programme Committee (SPC), chaired by Professor Rod Baber, has been very busy creating an outstanding line-up of speakers and topics for our 19th World Congress in Melbourne, Australia on 19th – 22nd October 2024. I am delighted to inform you that, following on from the plenary sessions announced in my report of the last issue of Our Menopause World, the symposia speakers and topics have also now been selected by the SPC and will be announced soon. I look forward to seeing as many of you as possible at what promises to be an outstanding meeting!
Finally, I would like to share some sad news with you. Our dear friend and colleague Professor Linda Cardozo, Professor of Urogynaecology at King’s College Hospital, London, recently passed away on September 21st 2023. She was a true legend, not only in her specialty of urogynaecology but also in the wider menopause and medical worlds. Amongst her many positions of responsibility, Linda was the first woman to hold the post of British Menopause Society Chair, 2001-2003, and was founding Chair of the British Society of Urogynaecology. She was honoured by the United Kingdom Government as an Officer of the Order of the British Empire (OBE) in 2014 for services to Urogynaecology and Women’s Health. She published more than 700 peer-reviewed papers and trained countless healthcare professionals, who went on to become experts in the field, so her legacy will live on. She will also be remembered on our IMS memorial wall and at the IMS Congress in Melbourne next year.
Please continue to communicate regularly about any local or regional developments and send in your questions and suggestions to me and the team at the IMS office about our Society and the wider IMS family.
The 36th webinar in the IMS webinar series will be a World Menopause Day event on cardiovascular disease, moderated by Professor Peter Schnatz. Professor Samar R El Khoudary will be speaking on ‘Cardiometabolic changes during the menopause transition’ and Professor Cynthia Stuenkel, this year’s White Paper author, will be speaking on ‘Reproductive milestones across the lifespan and cardiovascular disease risk in women’.
For information and booking visit the IMS website.
The 35th webinar in the IMS webinar series – ‘Clinical Climacteric Conundrums was held on Tuesday 19th September, moderated by Dr Wendy Wolfman. The format was a panel discussion. Professor Peter Schnatz presented on ‘Patient not responding to HT’ and Dr Michelle Jacobson presented on ‘Breast cancer patient with symptoms’.
Clinical Colloquium 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 Professor Steven Goldstein; ‘Breast screening and prevention’ by Dr Lisa Larkin; ‘Cardiovascular health in midlife women’ by Professor Peter Schnatz; ‘A personalized treatment approach to cognitive and mood symptoms of menopause’ by Professor Pauline Maki and Pharmaceutical management of early menopause symptoms’ by Professor Tobie de Villiers.
IMS Interview Series
Our latest 1-1 interview series topic is ‘Implications of polycystic ovary syndrome’ with Professor Bart Fauser, is available here. This is available in a video or podcast format.
News, Events and Meetings Around the World
IMS at Events
The IMS recently had a stand at The Menopause Society Congress in Philadelphia. It was a pleasure to meet our members at the event.
World Menopause Day 18th October
World Menopause Day is held every year on the 18th of October. The purpose of the day is to raise awareness of the menopause and the support options available for improving health and wellbeing. We encourage professionals and women to participate in this global awareness-raising campaign by printing and sharing these materials, organising events to engage their communities, and sharing World Menopause Day social media posts.
The theme for World Menopause Day 2023 is cardiovascular disease
The White Paper, Information Leaflet, Engagement Toolkit, and all available translations will be available to download on the IMs website in the weeks prior to World Menopause Day.
9th Scientific Meeting of Asia Pacific Menopause Federation (APMF) in conjunction with Indonesia Society of Menopause/National Congress of Indonesia Society of Menopause 2023 (PERMINESIA), with this year’s theme: “Normal Lifestyle of Menopausal Woman Post Covid-19 Pandemic”. Date: 6th – 8th October 2023 Venue: The Stones, Kuta Bali, Indonesia
For registration: https://apmfbali2023.com
XXIV FIGO World Congress of Gynecology
Date: 9th – 12th October, 2023 Venue: Paris, France
For more information: https://figo2023.org/
Canadian Menopause Society’s 4th Biennial National Scientific Conference
Date: 10th and 11th November 2023. Venue: Marriott Pinnacle Downtown Hotel, Vancouver
There will be reduced rates for IMS and The Menopause Society (previously known as NAMS. Candidates from low- and middle-income countries will receive special training rates. For more information: https://www.cpd.utoronto.ca/sigmaconference/
French Menopause Society (GEMVI) 13th Congress
Date: 17th and 18th November, 2023 Venue: Paris (Novotel Tour Eiffel)
For more information: GEMVI
New study suggests growing use of cannabis to help manage menopause symptoms
Women and adults aged 50+ are now the fastest growing group of cannabis users https://www.eurekalert.org/news-releases/1001385
Race matters when prescribing hormone therapy for menopausal women
New study suggests that White women with psychiatric conditions are much more likely to receive a prescription for hormone therapy than their Black counterparts https://www.eurekalert.org/news-releases/1001552
New technologies aid in accurately identifying bone fragility
Presentation spotlights the evolving process of assessing bone health, especially in postmenopausal women https://www.eurekalert.org/news-releases/1001982
Hot flashes yet another early indicator for Alzheimer’s disease
New study suggests that hot flashes experienced during sleep may be a biomarker of women at higher risk of dementia https://www.eurekalert.org/news-releases/1002167
Post-traumatic stress symptoms can cause problems in the bedroom for midlife women
A new study suggests an association between PTSD and poor sexual functioning https://www.eurekalert.org/news-releases/1002319
Hot flashes linked with risk factors for cardiovascular disease
New study suggests that physiologically assessed hot flashes may be associated with greater systemic inflammation in midlife women https://www.eurekalert.org/news-releases/1002624
The impact of menopause stage on age-related changes in the brain
A new study suggests association between menopause transition and changes in cerebral hemodynamics https://www.eurekalert.org/news-releases/1002625
What your hair and saliva say about your risk for depression and cognitive shortfalls during menopause
A new study suggests hair and salivary cortisol levels may be correlated with depression symptom severity and cognitive performance https://www.eurekalert.org/news-releases/1002626
Free or Open Access with translated abstract to selected papers recently published in Climacteric
October Climacteric: a new White Paper for World Menopause Day
October is also the month in which we mark World Menopause Day on October 18th. This year, the theme is cardiovascular disease in women. Gender discrimination against women is marked in the world of cardiovascular disease. For too long women were discouraged from careers as cardiologists and for even longer women presenting with acute cardiovascular disease to the hospital emergency room were either misdiagnosed or ignored.
Thankfully that has changed, as evidenced by the IMS white paper on cardiovascular disease in women, which will be available online early October.
I commend it to you and hope you will encourage your family, friends and patients to practise the heart healthy lifestyle all of us, as clinicians, should be practising ourselves today.
Professor Rod Baber, Editor-in-Chief, Climacteric
Free access to selected papers 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, October Issue, chosen by our Editor-in-Chief, Professor Rod Baber, have Free Access for the next three months.
There are also two Open Access papers in the October issue.
The Abstracts from these Free Access and Open Access papers have been translated into Spanish. Professor Baber would like to thank Peter Chedraui, one of Climacteric’s Associate Editors, for providing the translations.
Spanish translation: Vermeulen RFM, van Altena JL, Gaarenstroom KN, van Beurden M, Kieffer JK, Aaronson NK, Kenter GG, Korse CM Impacto de la salpingooforectomía para reducir el riesgo sobre los determinantes lipídicos, la HbA1c y la PCR. Climacteric. 2023;26(5):489-496. https://pubmed.ncbi.nlm.nih.gov/37288958/
Resumen Objetivo: Se recomienda la salpingooforectomía para reducir el riesgo (SORR) antes de los 40-45 años para los portadores de la mutación BRCA1/2. Este estudio describe el efecto de la SORR sobre los determinantes lipídicos, la hemoglobina A1c (HbA1c) y la proteína C reactiva (PCR). Métodos: Se incluyeron un total de 142 mujeres con mayor riesgo de cáncer de ovario, 92 premenopáusicas y 50 postmenopáusicas. Se determinaron los niveles séricos de colesterol de lipoproteínas de baja densidad (LDL-C), colesterol de lipoproteínas de alta densidad (HDL-C) y colesterol total, triglicéridos, HbA1c y PCR en tres momentos: antes (T0) y 6 semanas (T1) y 7 meses (T2) después de la SORR. La Escala de Calificación de Sofocos se administró en los mismos momentos. Resultados: En mujeres premenopáusicas, los niveles de HDL-C, el índice de colesterol y la HBA1c aumentaron significativamente con el tiempo, aunque aún se mantuvieron dentro del rango de referencia. En este grupo, los sofocos aumentaron con el tiempo (p <0.001). En mujeres postmenopáusicas, no se observaron cambios significativos después de la SORR. En T2, el LDL-C sérico, los triglicéridos, la HbA1c y la PCR fueron significativamente más bajos en las mujeres premenopáusicas en comparación con las mujeres postmenopáusicas, mientras que el HDL-C aumentó. Conclusiones: Siete meses después de la SORR el perfil lipídico en mujeres premenopáusicas había cambiado, aunque manteniéndose dentro del rango de referencia. Para las mujeres postmenopáusicas, no observamos ningún cambio significativo. Nuestros resultados no sugieren un empeoramiento del riesgo cardiovascular dentro de los 7 meses posteriores a la SORR.
Palabras claves: Salpingooforectomía reductora de riesgo; riesgo cardiovascular; sofocos; menopausia.
Spanish translation: Vitale SG, Moore O, Riemma G, Carugno J, Yarto ML, Haimovich S. Ablación histeroscópica con láser para tratar fibromas uterinos sintomáticos: conocimientos de un estudio prospectivo. Climacteric. 2023;26(5):497-502. https://pubmed.ncbi.nlm.nih.gov/37165870/
Resumen Objetivo: Este estudio tuvo como objetivo evaluar la viabilidad y eficacia de la ablación histeroscópica en el consultorio de fibromas uterinos submucosos utilizando un láser de diodo. Método: Se realizó un estudio piloto entre enero del 2018 y enero de 2019 en un hospital universitario de tercer nivel de atención. Fueron elegibles para inclusión pacientes con al menos un fibroma uterino sintomático, clase 0-2 de clasificación FIGO, de tamaño ≤7 cm. La evaluación de los cambios en el tamaño y la vascularización de los fibromas se realizó mediante ecografía Doppler tridimensional. La vaporización del núcleo del fibroma se realizó utilizando un láser de diodo de longitud de onda de 980-1470 nm insertado a través del canal de trabajo del histeroscopio. El resultado primario fue la evaluación del volumen de los fibromas antes y 2 meses después del procedimiento. Resultados: Se inscribieron veinte mujeres en el estudio. A los 2 meses de seguimiento, el volumen de los fibromas se redujo significativamente (51.6 ± 22.5 vs. 33.4 ± 17.1 mm3; p < 0.001). También se logró una reducción importante de la vascularización ecográfica Doppler color tridimensional (observada por el mismo operador y confirmada por cuatro revisores cegados) en 12/20 pacientes (60%; p = 0.03), mientras que un síntoma informado de sangrado menstrual abundante disminuyó de 18/20 (90%) a 2/18 (10%; p < 0.01). Conclusión: La ablación histeroscópica con láser representa una alternativa factible y eficaz para el tratamiento de mujeres con miomas submucosos sintomáticos en el consultorio. Se necesitan más estudios con un tamaño de muestra más grande y períodos de seguimiento más prolongados para validar esta técnica prometedora. Mensaje clave: Este estudio piloto muestra que la ablación histeroscópica con láser en el consultorio podría ser una alternativa viable para tratar los fibromas uterinos submucosos sintomáticos mediante la coagulación de su núcleo, la reducción de su tamaño y su vascularización.
Palabras clave: Ablación histeroscópica con láser; sangrado menstrual abundante; histeroscopía; miomectomía en el consultorio; ecografía tridimensional.
Spanish translation: Sánchez-Borrego R, de Diego Pérez de Zabalza MV, Alfageme Gullón MJ, Alija Castrillo ML, Sánchez Prieto M, Palacios S, González Calvo AJ, Quijano Martín JJ, Cancelo MJ. Satisfacción y adherencia a la medicación en mujeres con atrofia vulvovaginal: el CRETA. Climacteric. 2023;26(5):437-444. https://pubmed.ncbi.nlm.nih.gov/37017707/
Resumen Objetivo: Este estudio tuvo como objetivo evaluar la satisfacción autoinformada de mujeres postmenopáusicas españolas actualmente tratadas por síntomas de atrofia vulvovaginal (AVV). Método: El CRETA (CRoss sectional European sTudy on Adherence; Estudio transversal Europeo sobre Adherencia) es un estudio transversal multicéntrico realizado en 29 hospitales públicos y privados de España, en el que se incluyeron mujeres postmenopáusicas que recibían tratamiento con ospemifeno, terapia hormonal local (TH) o cremas hidratantes vaginales para la AVV. Previo consentimiento informado de los pacientes, se recogieron datos sociodemográficos y de percepción del tratamiento mediante un cuestionario estructurado. Resultados: Entre 752 mujeres que completaron la encuesta, la puntuación de satisfacción fue significativamente mayor para el grupo tratado con ospemifeno (media 8.3 ± 1.4) en comparación con el grupo de TH local (7.2 ± 1.7) y el grupo de humectante vaginal (6.5 ± 2.1) según a una escala Likert de 10 puntos (p < 0.0001). En comparación con los humectantes vaginales y la TH local, las participantes tratadas con ospemifeno reportaron el mayor cumplimiento (96.7% versus 70.2% y 78.6%, respectivamente) y el menor número de dosis omitidas en el último mes (0.6 ± 1.3 versus 3.5 ± 4.3 y 2.0 ± 2.8, respectivamente) (p < 0.0001). El ospemifeno fue percibido significativamente como fácil de usar (83.9% vs. 44.9% y 58.6%, respectivamente; p < 0.0001), eficaz para reducir el tiempo para aliviar los síntomas (17.1% vs. 7.0% y 6.7%, p = 0.0005 y p = 0.0006, respectivamente) y conveniente para la vida sexual (53.1% vs. 25.6% y 42.3%, p < 0.0001 y p = 0.0234, respectivamente). Conclusión: Entre las mujeres postmenopáusicas con AVV, el tratamiento con ospemifeno tiene las percepciones más positivas y el mayor nivel de satisfacción general y podría ser un enfoque terapéutico óptimo, maximizando la adherencia del paciente.
Palabras clave: Ospemifeno; adherencia a los medicamentos; cumplimiento del paciente; satisfacción del paciente; encuestas y cuestionarios; atrofia vulvovaginal.
Pharmacokinetics, safety and preliminary pharmacodynamic evaluation of DARE-VVA1: a soft gelatin capsule containing tamoxifen for the treatment of vulvovaginal atrophy A. Thurman, et al. https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2211763 Open Access
Spanish translation:
Thurman A, Hull L, Stuckey B, Hatheway J, Mauck C, Zack N, Friend D. Farmacocinética, seguridad y evaluación farmacodinámica preliminar de DARE-VVA1: una cápsula de gelatina blanda que contiene tamoxifeno para el tratamiento de la atrofia vulvovaginal. Climacteric. 2023;26(5):479-488. https://pubmed.ncbi.nlm.nih.gov/37288962/
Resumen Objetivo: Este estudio tuvo como objetivo medir la seguridad, la farmacocinética sistémica y la eficacia preliminar de una cápsula vaginal de tamoxifeno (DARE-VVA1) entre mujeres postmenopáusicas con atrofia vulvovaginal de moderada a severa. Método: Este fue un estudio de fase 1/2, aleatorizado, controlado con placebo, doble ciego, de DARE-VVA1, en cuatro dosis (1, 5, 10 y 20 mg). Resultados: Se inscribieron diecisiete mujeres y 14 completaron el tratamiento de 8 semanas. DARE-VVA1 fue seguro, todos los eventos adversos fueron de gravedad leve o moderada y se distribuyeron de manera similar entre los grupos activo y placebo. Las concentraciones plasmáticas de tamoxifeno fueron más altas entre las mujeres que usaron DARE-VVA1 20 mg, pero las concentraciones plasmáticas medias máximas (desviación estándar) de tamoxifeno en el día 1 (2.66 ± 0.85 ng/ml) y el día 56 (5.69 ± 1.87 ng/ml) fueron <14% de los medidos después de una dosis oral de tamoxifeno. Las usuarias activas del producto del estudio tuvieron disminuciones significativas desde el inicio previo al tratamiento en el pH vaginal y la proporción de células parabasales vaginales (p = 0.,04 para ambos criterios de valoración), y las mujeres asignadas al azar a la dosis de 10 mg o 20 mg experimentaron el mayor impacto del tratamiento. La severidad de la sequedad vaginal y la dispareunia disminuyó significativamente desde el inicio con el uso activo del producto del estudio (p = 0.02 para ambos criterios de valoración). Conclusión: DARE-VVA1 es seguro y produce una exposición sistémica mínima al tamoxifeno. Los datos preliminares de eficacia respaldan un mayor desarrollo de este producto.
Palabras clave: Tamoxifeno; farmacocinética; terapia local tópica; atrofia vulvovaginal.
1. Ding H, Li Y, Ang TFA, Liu Y, Devine S, Au R, Doraiswamy PM, Liu C. Reproductive Markers in Alzheimer’s Disease Progression: The Framingham Heart Study. J Prev Alzheimers Dis. 2023;10(3):530-535.
Background
Reproductive status, such as the age of menarche or menopause, may be linked to cognitive abilities and risk for incident Alzheimer’s disease (AD) but the evidence is conflicting.
It is also not fully known if these factors interact with cortical beta-amyloid deposition.
Objective
To study the relationship between reproductive risks, sex hormone markers and risk for decline in specific cognitive domains in women.
Design
The authors analyzed the association of reproductive markers (age at menarche, number of births, age at menopause, sex hormone-binding globulin, estradiol, estrone, total testosterone, free testosterone) with incident AD and annualized cognitive decline in the community-based longitudinal Framingham Heart Study (FHS) Offspring women 60 years and older (n=772, mean age 68 years, mean follow-up 10.7 ± 3 years).
They also used the Cox proportional hazards regression model and linear regression model, adjusting for covariates.
The outcome measures included incident AD dementia as well as the annualized change in memory, language, attention and executive functions.
Main findings
Older age at menopause was associated with a lower risk of incident AD dementia (p = 0.047, 6% lower risk per older year) after adjusting for baseline age, education, hormone therapy status, and MMSE score.
Older age at menopause was significantly associated with a slower annualized decline in memory (beta = 0.085, p = 0.00059).
The lower level of plasma Aβ42 was also associated with a higher risk of incident AD (HR = 0.97, 95% CI = 0.95, 0.99; p = 0.0039) but there was no significant interaction effect with age at menarche, age at menopause or plasma sex hormone levels.
Take-home messages
Younger age at menopause is a risk factor for late-life memory decline and incident AD.
This risk appears to be independent of Aβ42 pathology.
Further studies to understand the biological and social mechanisms underlying the differential effects of reproductive risks are warranted.
2. Nilsson S, Hammar M, West J, Borga M, Thorell S, Spetz Holm AC. Resistance training decreased abdominal adiposity in postmenopausal women. Maturitas. 2023;176:107794.
Objective
To investigate if abdominal adipose tissue volumes and ratios change after a 15-week structured resistance training intervention in postmenopausal women with vasomotor symptoms (VMS).
Design
Sixty-five postmenopausal women with VMS and low physical activity were randomized to either three days/week supervised resistance training or unchanged physical activity for 15 weeks.
Women underwent clinical anthropometric measurements and magnetic resonance imaging (MRI) at baseline and after 15 weeks.
MRI was done using a Philips Ingenia 3.0 T MR scanner (Philips, Best, The Netherlands).
The per protocol principle was used in the analysis of data.
The absolute change from baseline to week 15 in visceral adipose tissue (VAT) volume and the relative ratio (VAT ratio) between VAT and total abdominal adipose tissue (TAAT), i.e. the sum of abdominal subcutaneous adipose tissue (ASAT) and VAT.
Main findings
There were no significant differences between the groups in characteristics, anthropometry or MRI measures at baseline.
Women who were compliant with the intervention (i.e. participated in at least two of the three scheduled training sessions per week) had significantly different reduction over time in ASAT (p = 0.006), VAT (p = 0.002), TAAT (p = 0.003) and fat ratio (p < 0.001) compared with women in the control group.
Take-home message
Implementation of a 15-week resistance training regimen in midlife may help women to counteract the abdominal fat redistribution associated with the menopausal transition.
3. He M, Hu S, Wang J, Wang J, Găman MA, Hariri Z, Tian Y. Effect of resistance training on lipid profile in postmenopausal women: A systematic review and meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2023;288:18-28.
Background
Physical exercise decreases cardiovascular risk and can alter the lipid profile in postmenopausal women.
Although it is believed that resistance training can potentially decrease serum lipid levels in postmenopausal females, the evidence remains inconclusive.
Objective
The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to clarify the impact of resistance training on the lipid profile in postmenopausal women.Design
Web of Science, Scopus, PubMed/Medline and Embase were searched. RCTs that evaluated the effect of resistance training on total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels were included in this review.
Effect size was estimated using the random effects model.
Subgroup analyses based on age, duration of intervention, pre-enrolment serum lipid levels and body mass index were performed.
Main findings
Data pooled from 19 RCTs revealed that resistance training can reduce TC [weighted mean difference (WMD) -11.47 mg/dl; p = 0.002], LDL-C (WMD -8.48 mg/dl; p = 0.01) and TG (WMD -6.61 mg/dl; p = 0.043) levels. TC levels decreased particularly in subjects aged < 60 years (WMD -10.77 mg/dl; p = 0.003), in RCTs lasting < 16 weeks (WMD -15.70 mg/dl; p = 0.048), and in subjects with hypercholesterolaemia (WMD -12.36 mg/dl; p = 0.001) or obesity (WMD -19.35 mg/dl; p = 0.006) before RCT enrolment.
There was a significant decrease in LDL-C (WMD -14.38 mg/dl; p = 0.002) levels in patients with LDL-C ≥ 130 mg/dl before trial enrolment.
Resistance training reduced HDL-C (WMD -2.97 mg/dl; p = 0.01) levels particularly in subjects with obesity. TG (WMD -10.71 mg/dl; p = 0.01) levels decreased particularly when the intervention lasted < 16 weeks.
Take-home messages
Resistance training can decrease TC, LDL-C and TG levels in postmenopausal females.
The impact of resistance training on HDL-C levels was small, and was only observed in individuals with obesity.
The effect of resistance training on the lipid profile was more notable in short-term interventions and in postmenopausal women with dyslipidaemia or obesity before trial enrolment.
4. Asadi M, Riazi H, Abbasinazari M, Majd HA, Montazeri A. Effect of folic acid on the sexual function of postmenopausal women: a triple-blind randomized controlled trial. J Sex Med. 2023;20(9):1180-1187.
Background
There are reports of sexual dysfunction in postmenopausal women, and several treatment recommendations are available.
Objective
To investigate the effect of folic acid on postmenopausal women’s sexual function.
Design
This triple-blind randomized controlled trial was conducted in Tehran, Iran, in 2020.
A sample of 100 postmenopausal women was recruited from comprehensive health centers affiliated with the Shahid Beheshti University of Medical Sciences.
Eligible women were randomly assigned to receive folic acid (5 mg) or placebo on an empty stomach every day for 8 weeks.
Women were assessed at 3 time points: baseline and 4 and 8 weeks after the intervention.
Sexual function was the main outcome, as measured by the Female Sexual Function Index.
Main findings
The mean ± SD age of participants in the folic acid and placebo groups was 53.2 ± 3.84 and 54.4 ± 4.05 years, respectively (P = .609).
The results obtained from mixed effects analysis of variance revealed a statistically significant difference between baseline and posttreatment scores and the interaction between time and group for desire, orgasm, satisfaction, arousal, pain, and total sexual function score, with the folic acid group improving more than control group.
Lubrication was the only domain that showed no significant difference for the interaction between time and group.
Take-home messages
Folic acid may beneficially affect sexual function in postmenopausal women.
Strengths of this study include the novelty of the subject, the triple-blind design, the block randomization, the administration of a standard scale for sexual function (Female Sexual Function Index), and the affordability and availability of folic acid.
Limitations: the study was conducted with a small sample size and short follow-up time; therefore, interpretation of the results requires great caution.
Despite this, the findings suggest that folic acid possibly improves sexual function in postmenopausal women: larger studies are needed to confirm the findings.
5. Zhu X, Li M, Dong X, Liu F, Li S, Hu Y. A systematic review of the relationship between normal range of serum thyroid-stimulating hormone and bone mineral density in the postmenopausal women. BMC Womens Health. 2023;23(1):358.
Objective
To adopt meta-analysis in evaluating the correlation between TSH and BMD, as well as osteoporosis in the postmenopausal women with normal thyroid function.
Design
Six databases were searched for articles concerning correlation between TSH and BMD in postmenopausal women.
The retrieval time was set from the date of database establishment to November 30, 2020.
Revman5.3 and Stata12.0 software were used for meta-analysis.
Main findings
A total of 19 articles were incorporated.
The Summary Fisher’ Z of the correlation between TSH and BMD was 0.16, 95% CI (0.00, 0.32), and the correlation coefficient of Summary Fisher’ Z conversion was 0.158.
Study on the relationship between TSH and osteoporosis based on OR demonstrated that the combined OR was 1.76, 95% CI (1.27, 2.45), P < 0.05.
The subgroup analyzing results displayed that the risk of osteoporosis of the subjects from community with low TSH was 1.89, 95% CI (1.43, 2.49).
The risk of osteoporosis for subjects with low TSH and from hospitals was 1.36, 95% CI (0.46, 3.99); 1.84 for subjects with low TSH and anti-osteoporosis drugs, 95% CI (1.05, 3.22); and 1.74 for those with low TSH but not taking anti-osteoporosis drugs, 95% CI (1.08, 2.82).
The dose-response relationship showed that the risk of osteoporosis tended to decrease when TSH was more than 2.5 mIu/L.
Take-home message
The serum TSH is positively related with BMD in postmenopausal women, and high TSH (> 2.5 mIu/L) within the normal range is possibly helpful to decrease the risk of osteoporosis in postmenopausal women.
6. Liao H, Cheng J, Pan D, Deng Z, Liu Y, Jiang J, Cai J, He B, Lei M, Li H, Li Y, Xu Y, Tang Y. Association of earlier age at menopause with risk of incident dementia, brain structural indices and the potential mediators: a prospective community-based cohort study. EClinicalMedicine. 2023;60:102033.
Background
To date, there is no homogeneous evidence of whether earlier age at menopause is associated with incident dementia.
Objective
Authors aimed to fill knowledge gaps related to the underlying mechanisms of whether earlier menopause is associated with dementia.
Design
This community-based cohort study included 154,549 postmenopausal women without dementia at enrolment (between 2006 and 2010) from the UK Biobank who were followed up until June 2021.
The authors followed up until June 2021.
Age at menopause was entered as a categorical variable (<40, 40-49, and ≥50 years) with ≥50 years taken as a reference.
The primary outcome was all-cause dementia in a time-to-event analysis and the secondary outcomes included Alzheimer’s disease, vascular dementia, and other types of dementia.
In addition, authors investigated the association between magnetic resonance (MR) brain structure indices with earlier menopause, and explored the potential underlying driven mediators on the relationship between earlier menopause and dementia.
Main findings
2266 (1.47%) dementia cases were observed over a median follow-up period of 12.3 years.
After adjusting for confounders, women with earlier menopause showed a higher risk of all-cause dementia compared with those ≥50 years (adjusted-HRs [95% CIs]: 1.21 [1.09-1.34] and 1.71 [1.38-2.11] in the 40-49 years and <40 years groups, respectively; P for trend <0.001).
No significant interactions between earlier menopause and polygenic risk score, cardiometabolic factors, type of menopause, or hormone-replacement therapy strata were found.
Earlier menopause was negatively associated with brain MR global and regional grey matter indices, and positively associated with white matter hyperintensity.
The relationship between earlier menopause and dementia was partially mediated by menopause-related comorbidities including sleep disturbance, mental health disorder, frailty, chronic pain, and metabolic syndrome, with the proportion (95% CI) of mediation effect being 3.35% (2.18-5.40), 1.38% (1.05-3.20), 5.23% (3.12-7.83), 3.64% (2.88-5.62) and 3.01% (2.29-4.40), respectively.
Multiple mediator analysis showed a combined effect being 13.21% (11.11-18.20).
Take-home messages
Earlier age at menopause was associated with risk of incident dementia and deteriorating brain health.
Further studies are warranted to clarify the underlying mechanisms by which earlier age at menopause is linked to an increased risk of dementia, and to determine public health strategies to attenuate this association.
7. Karamitrou EK, Anagnostis P, Vaitsi K, Athanasiadis L, Goulis DG. Early menopause and premature ovarian insufficiency are associated with increased risk of dementia: A systematic review and meta-analysis of observational studies. Maturitas. 2023;176:107792.
Background
Among other risk factors, the decline in estrogen concentrations during menopause may compromise cognitive function. Whether early menopause (EM) is associated with an increased risk of dementia remains unclear.
Objective
To systematically review and meta-analyze current evidence regarding the association between EM or premature ovarian insufficiency (POI) and the risk of dementia of any type.
Design
A comprehensive literature search was conducted through the PubMed, Scopus and CENTRAL databases up to August 2022. Study quality was assessed using the Newcastle-Ottawa scale.
Associations were calculated as odds ratio (OR) with 95 % confidence interval (CI).
The I2 index was employed for heterogeneity.
Main findings
Eleven studies (nine assessed as of good and two as of fair quality) were included in the meta-analysis (n = 4,716,862).
Women with EM demonstrated a greater risk of dementia of any type than women of normal age at menopause (OR 1.37, 95 % CI 1.22-1.54; I2 93%).
However, after excluding a large retrospective cohort study, the results were altered (OR 1.07, 95 % CI 0.78-1.48; I2 94%).
Increased risk of dementia was also found in women with POI (OR 1.18, 95 % CI 1.15-1.21; I2 0%).
Subgroup analysis showed that this risk was mostly evident in cohort studies, and those which included women with natural menopause.
Take-home message
Women with EM or POI may be at increased risk of dementia compared with women of normal age at menopause, but further research investigating that hypothesis is warranted.
8. Hao W, Fu C, Dong C, Zhou C, Sun H, Xie Z, Zhu D. Age at menopause and all-cause and cause-specific dementia: a prospective analysis of the UK Biobank cohort. Hum Reprod. 2023;38(9):1746-1754.
Background
Menopause marks the end of female reproductive period.
Age at menopause reflects the length of exposure to endogenous estrogen.
Evidence on the association between age at natural, surgical menopause, and risk of dementia has been inconsistent.
Objective
To determine if there are associations between natural or surgical menopause and incident dementia by age at menopause.Design
This was a population-based cohort study involving 160,080 women who participated in the UK Biobank study.
Women with no dementia at baseline, and who had no missing data on key exposure variables and covariates were included.
Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs on the association of categorical menopause age with incident all-cause dementia, Alzheimer’s disease (AD) and vascular dementia (VD).
Restricted cubic splines were used to model the non-linear relationship between continuous age at natural, surgical menopause, and risk of dementia.
In addition, we analyzed the interaction effect of ever-used menopausal hormone therapy (MHT) at baseline, income level, leisure activities, and age at menopause on risk of dementia.
Main findings
Compared to women with age at menopause of 46-50 years, women with earlier natural menopause younger than 40 years (1.36, 1.01-1.83) and 41-45 years (1.19, 1.03-1.39) had a higher risk of all-cause dementia, while late natural menopause >55 years was linked to lower risk of dementia (0.83, 0.71-0.98).
Compared to natural menopause, surgical menopause was associated with 10% higher risk of dementia (1.10, 0.98-1.24).
A U-shape relationship was observed between surgical menopause and risk of dementia.
Women with surgical menopause before age 40 years (1.94, 1.38-2.73) and after age 55 years (1.65, 1.21-2.24) were both linked to increased risk of all-cause dementia.
Women with early natural menopause without ever taking MHT at baseline had an increased risk of AD.
Also, in each categorized age at the menopause level, higher income level or higher number of leisure activities was linked to a lower risk of dementia.
Take-home message
Women who experienced natural menopause or had surgical menopause at an earlier age need close monitoring and engagement for preventive health measures to delay the development of dementia.
9. Ou YJ, Lee JI, Huang SP, Chen SC, Geng JH, Su CH. Association between Menopause, Postmenopausal Hormone Therapy and Metabolic Syndrome. J Clin Med. 2023;12(13):4435.
Objective
To explore the associations between menopause, postmenopausal hormone therapy, and metabolic syndrome in a large community-based group of Asian women.
Design
This is a cross-sectional study in which we enrolled women aged 30 to 70 years with sufficient information about menopausal status from the Taiwan Biobank.
The definition for metabolic syndrome used in this study aligns with the Bureau of Health Promotion’s (Taiwan) proposed definition.
Main findings
A total of 17,460 women were recruited.
The postmenopausal group had a higher metabolic syndrome prevalence (30% vs. 14%) and 1.17 times higher odds ratio (OR) than the premenopausal group (95% confidence interval [CI] = 1.02 to 1.33).
Regarding the types of menopause, surgical menopause was associated with metabolic syndrome (OR = 1.40; 95% CI = 1.20 to 1.63); however, natural menopause was not associated with metabolic syndrome.
Interestingly, postmenopausal hormone therapy was associated with a lower risk of metabolic syndrome in the women with natural menopause (OR = 0.79; 95% CI = 0.70 to 0.89), but not in those with surgical menopause.
Take-home message
The results suggest that menopause is associated with an increased prevalence of metabolic syndrome, while postmenopausal hormone therapy is associated with a lower prevalence of metabolic syndrome in women with natural menopause.
10. Xing Z, Alman AC, Kirby RS. Premature Menopause and All-Cause Mortality and Life Span Among Women Older Than 40 Years in the NHANES I Epidemiologic Follow-Up Study: Propensity Score Matching Analysis. J Womens Health (Larchmt). 2023;32(9):950-959.
Background
Findings from studies of the long-term effect of premature menopause on risks of all-cause mortality in women are equivocal.
Objective
To examine the causal association of premature menopause with all-cause mortality and life span among women older than 40 years.
Design
The data were from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study.
The authors calculated the propensity score of premature menopause using a logistic regression model, then matched premature menopause with non-premature menopause according to the score and the ratio of 1:1.
They also estimated mortality hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazard models; and analyzed and plotted the relationship between age at menopause and reproductive life span with all-cause mortality and life span.
Main findings
The mean age of 1,210 women was 55.4 ± 10.8 years at baseline.
The unadjusted and adjusted HRs of all-cause mortality for women with premature menopause were 1.46 (95% CI: 1.08-1.96) and 1.53 (95% CI: 1.13-2.08), respectively, compared to non-premature menopause.
Nonlinear associations were found between age at menopause, reproductive life span, all-cause mortality, and life span.
Menopausal age <37.5 years of age or reproductive life span <24 years increased the risk of all-cause mortality.
Women with menopausal age <39 years of age or reproductive life span <24 years had a lower mean life span than the overall average of 76 years.
Take-home messages
Premature menopause significantly increased all-cause mortality risk and shortened life span in women.
As women’s age at menopause or reproductive life span increases, their overall life span also tends to increase.
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