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It gives me great pleasure to write my last President’s Report for Our Menopause World for 2023. It has been a busy year for IMS where I believe much has been achieved. My report will focus on these activities and will also cover plans for 2024 and beyond, with a view to optimising women’s menopause and midlife health.
The key activities of IMS in 2023, with an emphasis on developments since my last report, are summarised below:
IMPART
There have been just under 10,000 registrations since 1st July 2020.
Trends of note include:
New registrations from Cyprus, Maldives and Mozambique.
Forty-three new registrations from Ireland (following the joint meeting with the Irish Menopause Society).
Forty-five new registrations from Singapore (following the APMF Congress).
A survey is currently in progress to gain feedback from those who have completed IMPART and for those who have registered but not yet completed.
We are grateful to Abbott for its continued support of this important educational resource.
Webinars and Interviews
Ten webinars and twenty-four interviews were produced during 2023. Our thanks to Besins for its continued support of the webinar series and to Viatris for its continued support for the interview series.
Memberships
There has been a 12% increase in members since January 2023 to end of October 2023 (compared to January-December 2022).
There has also been 57% increase in IMPART members since January 2023 to end of October 2023 (compared to January-December 2022).
Our members come from 87 countries; this is indicative of the global outreach of IMS.
We launched a CAMS joint membership offer.
Council of Affiliated Menopause Societies (CAMS)
CAMS has gone from strength-to-strength in 2023 under the leadership of Professor Duru Shah, with enthusiastic support from her co-chairs Professor Antonio Cano and Professor Fidel Ganis Siregar and the CAMS steering committee.The CAMS developments in 2023 are summarised below: Membership
IMS now has sixty-three member societies with several other applications due to be processed soon.
The following societies have joined from January-October 2023
Romania
Guatemala
SAFOMS (South Asian Federation of Menopause Societies)
Malta
Peru
Jordan
Rwanda
Pakistan
Mexico
Chennai (local menopause society and part of the Indian Menopause Society)
Microsites Live Online
There are now several new CAMS microsites already active, as shown below, with a number in development. There has been a considerable amount of use of these microsites already, with the Canadian Menopause Society leading the way with 651 views and 508 users thus far.
India
Canada
Argentina
APMF
Malaysia
Russia
Costa Rica
Philippines
Microsites in Development
Australasia
Hungary
Ecuador
South Africa
France
Indonesia
Germany
Taiwan
Switzerland
South Korea
CAMS Connect
Three issues of this popular online “magazine” have been published in March, June and October 2023.
Issue 4 will be published at the end of January 2024.
The IMS topic for this year’s WMD was cardiovascular health; there was a considerable amount of global engagement with over 100,000 visits to the IMS website to access resources.
The White Paper was translated into 15 languages and the women’s leaflet was translated into 17 Languages.
IMS collaborated with a number of regional and national menopause societies to optimise education globally.
Some of our recent involvement in key meetings of 2023 is summarised below:
IUGA Meeting (The Hague): keynote lecture
EMAS Congress (Florence): lectures/board meeting
British Menopause Society Meeting (UK): lecture
Malaysian Congress O & G: recorded lecture
Beijing Gyn Endo Meeting: recorded lecture
Australasian Menopause Society Meeting (New Zealand): keynote lectures
Irish Menopause Society Meeting (Dublin): IMS education program/exec meeting
APMF (Bali): IMS education program/board meeting
Canadian Menopause Society (Vancouver): keynote lecture
COGI (Vienna): IMS invited symposium
ESG (Amsterdam): lecture
Involvement with these meetings was most enjoyable and important to facilitate membership of IMS and CAMS and to enhance attendance at our forthcoming IMS Congress in Melbourne next year.
We have a number of meetings planned for next year, which will commence with an IMS board meeting in Costa Rica and an educational collaboration with the Costa Rican Society of Climacteric, Menopause and Osteoporosis (ACCMYO) Congress.
We have had a meeting with the current FLASCYM president, Dr Hoover Canaval, to discuss IMS participation in the 2025 FLASCYM meeting in Cartagena, Colombia.
These meetings will be an ideal opportunity to start communications in Latin America for our IMS Congress in Rio in 2026.
Inclusivity and Transparency
The Governance of IMS continues to evolve in a positive direction, with the aim of being as inclusive, accountable, and transparent as possible.
The Board Committee membership includes several non-Board members to increase diversity and to broaden our skillset and we will continue to seek individuals globally who can positively contribute to the running of the Society.
I am particularly proud to have set up the Innovations Committee whose aim is to advise the IMS Board regarding novel educational and research developments within the field of menopause and women’s midlife health.
There is also an open invitation to the representatives of all global menopause societies to join the CAMS steering group.
Through signposting and making this available on our website for all our members to access, this will maximise transparency of all IMS processes.
A strategic analysis and plan is being developed for the IMS which will cover the next 5 years and beyond with the key aims of:
Maximising outreach;
Increasing impact; and
Diversifying resources (new programmes/technologies/partnerships).
IMS Recommendations, Guidelines and Consensus Statements
A steering committee has been formed to lead the review and update of the IMS 2016 recommendations and consensus statements.
A stakeholder survey for Health Care Professionals and women has been distributed which will help to formulate the key questions for the authors, with the aim of making the recommendations as globally relevant as possible.
In the meantime, the update of the 2015 ESHRE POI guideline has been going well, in partnership with ESHRE, Monash and ASRM.
Climacteric
The Society’s journal has been going from strength-to-strength under the guidance and leadership of its Editor in Chief, Professor Rodney Baber with the support of his Associate Editors, Editorial Assistants and the Editorial Board.
The time has come for Professor Baber to step down from his position and I would like to take this opportunity to thank him, on behalf of myself and the IMS, for his considerable efforts in making Climacteric one of the most widely-read and respected menopause journals.
Mr Tim Hillard, currently an Associate Editor of Climacteric, has been appointed to the Editor in Chief position as successor to Professor Baber and I would like to wish him every success for the future; he will be formally taking over in January 2024.
I would now like to focus on the IMS plans for 2024 and beyond.
Online Education
We have already secured unrestricted education grants to support several of our online educational activities; we would like to extend our gratitude to our supporters.
Ten webinars and twenty-four interviews are planned for 2024.
There will also be an online symposium in the Spring on ‘Vasomotor Epidemiology and Impact in the Workplace’.
This will be supported by an unrestricted educational grant from Astellas.
The results of the IMPART survey will be used to inform update of the content and format of the modules.
All modules of IMPART Level 2 will be finalised next year.
There will be translations of IMPART into additional languages.
Our direct-to-consumer women’s education platform is Menopause Info.
The Menopause Info committee, led by our CEO Rebecca Cheshire, has developed high quality evidence-based content, to be provided via the website.
Menopause Live will continue to provide excellent reviews of recent publications under the expert guidance of Professor Peter Chedraui.
Membership
We will continue to expand the joint membership offer with CAMS members.
We will continue to offer the IMPART Level 1 completion membership offer, which will entitle completers a one-year limited professional membership.
CAMS
Membership
Further to our activities in 2023, twenty-one new memberships are in progress – we expect that these will proceed to completion.
We will continue to grow the number of menopause societies across the globe and CAMS members via our Holding Hands Program, a new initiative where more established societies support the development of smaller or new societies with the IMS’s newly produced Toolkit for Starting a Menopause Society.
Microsites
We will continue to grow the number of microsites and publish CAMS Connect quarterly to promote the events and support increased membership for our CAMS members.
Menopause Hour
This is a new online symposia series developed and delivered by CAMS members in their national/regional languages.
Thanks to Abbott for an unrestricted educational grant to support this new initiative.
The emphasis will be on the practical management of women in midlife and menopause, with emphasis on utilising local resources and challenges.
Inclusivity and Transparency
Our commitment to transparency will become even more apparent when the IMS Operations Manual is signed off at our March 2024 Board meeting.
This will enable all members to review the policies and procedures that guide the work of the society.
Further details on the manual will be announced in the next issue of Our Menopause World.
The open invitation to societies to join the CAMS Steering Group will continue.
IMS Recommendations, Guidelines and Consensus Statements
The aim is to finalise the recommendations by the time of the IMS Congress in Melbourne in October 2024 and the POI guideline by ESHRE July 2024.
In parallel with these projects, we will publish an IMS White Paper in 2024 which will focus on key issues in the prescribing of MHT.
We are also aiming to update the global consensus statement on MHT, in collaboration with key societies.
IMS World Congress Melbourne Oct 19th-22nd 2024
Planning for the next IMS World Congress is going very well. The plenary speakers and topics have been secured and the invitations are starting to go out for the symposia, meet the experts and debates.
We encourage our CAMS countries and regional societies to submit proposals for their symposia at the Congress, which can be in their local language(s). We also request that CAMS members bring as many of their colleagues as possible to attend these symposia, as well as the rest of the Congress programme.
The Congress promises to be an excellent opportunity for our global colleagues to network, as well as a great academic opportunity.
Free registration to the Congress for trainees in Australia and New Zealand.
In conclusion, there has been much IMS activity in 2023, which we aim to continue into 2024 and well beyond. We hope that you are happy with the direction in which your Society is progressing; we certainly feel optimistic about what the future holds for our IMS family.
As always, we ask you to continue communicating 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 affiliates.
I wish you “Season’s Greetings”, and a well-deserved rest if you are taking a vacation.
Webinars
The 38th webinar in the IMS webinar series will be ‘Approach to Bone Health in the Perimenopause and Postmenopause?’ to be held on Tuesday 16th January 3pm CET (Central European Time), moderated by Professor Steven Goldstein. Dr Michael McClung will be speaking on ‘When to Screen for Osteoporosis, How and Why after Menopause’ and Professor Aliya Khan will be speaking on ‘Options for Treatment Including Estrogen, New Therapeutic Options, and Possible Prophylactic Protection after Menopause?’ For information and booking visit the IMS website.The 37th webinar in the IMS webinar series – ‘Brain Teasers – Challenges in the cranium’ was held on Tuesday 14th November was moderated by Professor Pauline Maki. Professor Anne MacGregor presented on ‘Menopause and Migraine’ and Dr Riley Bove presented on ‘Hormone Therapy and Multiple Sclerosis – Help or Hindrance?’
This is now available on IMS Webinars.
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 Steven Goldstein; ‘Breast Screening and Prevention’ by Lisa Larkin; ‘Cardiovascular Health in Midlife Women’ by Peter Schnatz; ‘A Personalized Treatment Approach to Cognitive and Mood Symptoms of Menopause’ by Pauline Maki, ‘Pharmaceutical Management of Early Menopause Symptoms’ by Tobie de Villiers, ‘Non-Pharmaceutical Approaches to Treating Menopausal Symptoms: What Does the Evidence Tell Us’ by Carolyn Ee and ‘GSM (genitourinary syndrome of menopause) and Pelvic Floor Health’ by Tim Hillard
IMS Interview Series
Our latest 1-1 interview series topic is ‘How should we manage menopause in women with endometriosis’ with Professor Ludwig Kiesel available here. This is available in a video or podcast format. All the IMS podcasts are now available on Spotify.
News, Events and Meetings Around the World
International Society of Endocrinology (ISE) Precision Diagnostics for PCOS: Bridging the Gap Between Labs and Clinical Practice focusing on the changes and updates in the new 2023 PCOS guidelines and their potential impact on clinical practice. Helena Teede and Robert Norman will be presenting.
Date: 14th December 2023
Time: 1900-2000 (EST)
For information and registration click here
International Conference on Obstetrics and Gynaecology (ICOG) 2024 Date: 11th-12th January 2024
Venue: Bali, Indonesia
For more information: ICOG in January 2024
21st International Society of Gynaecological Endocrinology (ISGE) World Congress Date: 8th-11th May, 2024
Venue: Florence, Italy
For more information: ISGE Congress
European Calcified Tissue Society (ECTS) Congress Date: 25th– 28th May, 2024
Venue: Marseille, France
For more information: Home – ECTS 2024
28th Asia and Oceania Federation of Obstetrics and Gynaecology (AOFOG) Congress 2024 Date: 17th-21st May, 2024
Venue: Busan Exhibition & Convention Center (BEXCO), South Korea
For more information: AOFOG 2024
ENDO 2024, Endocrine Society Date: 1st– 4th June, 2024
Venue: Boston, MA
For more information visit: ENDO 2024 | Endocrine Society
The 11th International Congress of Gynaecology and Obstetrics (ICOG) Date: 12th-14th June, 2024
Venue: Budapest, Hungary
For more information: ICGO Congress 2024
The 2nd Conference on World Women Health and Gynecology 2024 Date: 5th– 8th August, 2024
Venue: Macau, China
For more information: WHG 2024 (lmsii.org)
International Experts Summit on Gynecology and Women’s Health Date: 26th-28th September
Venue: Tokyo, Japan
For more information: Summit on Gynecology and Women’s Health
Royal College of Obstetricians and Gynaecologists (RCOG) World Congress Date: 15th-17th October, 2024
Venue: Muscat, Oman
For more information: RCOG World Congress 2024
Menopause and mid-life women’s health publication news
British Menopause Society’s response to the NICE guidelines update
The NICE guideline: Menopause – Diagnosis and Management published in 2015 was a significant turning point in both raising awareness of the importance of menopause and in providing direction in management. However, updating is timely and very much welcomed.
It is well recognised that menopause care should be individualised as is emphasised, and so it is essential that women are aware of all treatment options. Greater emphasis on the importance and effectiveness of CBT is well placed, along with clear balancing of benefits and risks of HRT.
Genitourinary symptoms of menopause continue to be very common and often under recognised and under treated. The emphasis on offering a range of effective treatments should help address the problem.
Need for further research in certain areas has been highlighted and it is very much hoped that investment can be prioritised in this important area of women’s health.
Myra Hunter, Professor of clinical health psychology at King’s College London adds: “Our research has shown that women learn skills that can be used in everyday life to improve their experience of menopause. I’m delighted that this approach is now recommended by NICE as an option for women with troublesome menopausal symptoms.”
The BMS continues to provide evidence-based, peer-reviewed education and resources for healthcare professionals, together with accurate, authoritative, trustworthy information and guidance for women via the Women’s Health Concern website.
The BMS urges its members and the broader clinical and public community to read the updated guidance as it is now open for public consultation until 5th January 2024.
Please find a link to the NICE press release here and access to the draft Guideline here.
Combination of therapeutic touch and music key to a better night’s sleep during menopause
New study suggests effectiveness of touch and sound in improving sleep quality and reducing various menopause symptoms https://www.eurekalert.org/news-releases/1005870
UCLA researcher finds first proof of menopause in wild chimpanzees
A study of the Ngogo community in Uganda shows humans aren’t the only primates with long post-fertile life stage https://www.eurekalert.org/news-releases/1005952
6+ hours/day of sedentary leisure time linked to doubling in fibroids risk
Risk seems to be linear in women who’ve not yet gone through the menopause https://www.eurekalert.org/news-releases/1009177
Free or Open Access with translated abstract to selected papers recently published in Climacteric
Climacteric December 2023
Updated Practitioner’s Toolkit Published in the December issue is the revised 2023 Practitioner’s Tool Kit on Menopause, an update of the widely used and cited 2014 version. The 2023 Toolkit and supporting document provide accessible desk-top information to support health-care providers caring for women at midlife and has been endorsed by the International Menopause Society, Australasian Menopause Society, British Menopause Society, Endocrine Society of Australia, RANZCOG and Jean Hailes for Women’s Health.
The Toolkit to date has received more than 15,000 online views since publication in October. https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783
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, December issue, chosen by our Editor, Professor Rod Baber, have Free Access for the next three months. In addition to the Toolkit there are three other Open Access papers in the December 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.
Resumen Objetivo: El kit de herramientas para profesionales para el manejo de la menopausia, desarrollado en 2014, proporcionó una herramienta de escritorio accesible para los profesionales de la salud que atienden a mujeres de mediana edad. Para garantizar que los algoritmos del kit de herramientas y la información de respaldo reflejen las mejores prácticas actuales, el kit de herramientas se revisó de acuerdo con la literatura publicada. Método: Se llevó a cabo una búsqueda sistemática de directrices, posiciones y declaraciones de consenso relacionadas con la menopausia y publicadas después de 2014, y se determinó que mediante una evaluación formal las recomendaciones clave extraídas de las Guías de Práctica Clínica eran las más sólidas. Se buscó adicionalmente en la literatura revisada por pares las lagunas de información identificadas. Resultados: El kit de herramientas revisado proporciona algoritmos que guían la evaluación clínica y la atención de las mujeres relevantes a la menopausia. Se incluyen las razones por las que las mujeres se presentan, la información que debe determinarse, los problemas que pueden influir en la toma de decisiones compartida y los algoritmos que ayudan a determinar el estado menopáusico, la terapia hormonal de la menopausia (THM) y las opciones de tratamiento no hormonal para el alivio de los síntomas. Como se descubrió que faltaban pautas claras sobre cuándo podría estar indicada la THM para prevenir la pérdida ósea y la posterior osteoporosis en mujeres asintomáticas, el conjunto de herramientas se ha ampliado para apoyar la toma de decisiones compartida con respecto a la salud ósea. Conclusión: El kit de herramientas 2023 y el documento de respaldo brindan información de escritorio accesible para ayudar a los proveedores de atención médica que atienden a mujeres en la mediana edad. El kit de herramientas ha sido respaldado por la Sociedad Internacional de Menopausia, la Sociedad Australasia de Menopausia, la Sociedad Británica de Menopausia, la Sociedad Endocrina de Australia y Jean Hailes para la Salud de la Mujer.
Resumen Objetivo: Los autores compararon las tendencias del uso de terapia hormonal (TH) entre mujeres con y sin antecedente de preeclampsia. Métodos: Este estudio de cohorte nacional estuvo integrado por mujeres que tuvieron un embarazo preeclámptico (n = 31,688) o un embarazo normotenso (n = 91,726) (controles) durante 1969-1993. Los datos sobre su uso de TH durante 1994-2019 se rastrearon del Registro Nacional de Reembolso de Medicamentos. Resultados: Tanto las mujeres con antecedentes de preeclampsia como los controles iniciaron la terapia hormonal a una edad media de 49.9 años. El uso acumulado de TH™ durante el seguimiento total no difirió entre los grupos (31.1% vs. 30.6%, p = 0.066). Sin embargo, el uso de TH en mujeres previamente preeclámpticas fue menos común en 1994-2006 (20.2% vs. 22.4%, p < 0.001) y más común en 2007-2019 (22.1% vs. 21.1%, p < 0.001) que en los controles. Esta tendencia también se observó en los cambios anuales de iniciadoras de TH. Las mujeres con antecedentes de preeclampsia utilizaron TH durante menos tiempo (6.3 vs. 7.1 años, p < 0.001). Conclusiones: A diferencia de los controles, el uso de TH en mujeres previamente preeclámpticas aumentó durante la última mitad del seguimiento. Esto puede reflejar los cambios en las recomendaciones internacionales, la mayor conciencia sobre el riesgo cardiovascular relacionado con la preeclampsia en etapas posteriores de la vida y el objetivo de disminuir este riesgo con la TH.
Palabras claves: Preeclampsia; enfermedad cardiovascular; estradiol; trapia hormonal; desorden hipertensivo en el embarazo; terapia hormonal de la menopausia; progestina; tibolone.
Resumen Objetivo: Este estudio tuvo como objetivo evaluar la prevalencia y el tratamiento de los síntomas postmenopáusicos entre las mujeres ruandesas. Método: Se realizó un estudio descriptivo transversal en los cuatro hospitales de referencia más grandes de Ruanda desde agosto de 2017 hasta marzo de 2018 entre mujeres postmenopáusicas. Los datos sobre los síntomas postmenopáusicos se recopilaron utilizando el índice menopáusico de Blatt-Kupperman modificado y se utilizaron rangos de puntuación de 0 a 6, 7 a 15, 16 a 30 y >30 para medir el grado de severidad como ninguno, leve, moderado y severo, respectivamente. Resultados: Se reclutaron seiscientas participantes. La edad media de menopausia natural fue de 51.7 ± 5.6 años. Los síntomas comunes fueron sofocos (82%), molestias sexuales (66%) y dolor de cabeza (61%). La puntuación media del índice de Blatt-Kupperman fue 21.2 (1-58). Los síntomas de las participantes se clasificaron como severos (35.8%), moderados (49.0%), leves (11.3%) y ninguno (3.8%). Del 41.2% que había buscado atención médica, al 1.7% se le administró un reemplazo hormonal y al 36% sólo se le administraron analgésicos. La edad >50 años y la falta de pareja masculina se asociaron significativamente con puntuaciones más altas. Conclusión: Los síntomas postmenopáusicos siguen siendo una carga entre las mujeres ruandesas y se presta poca atención a su tratamiento óptimo. Es necesario que los proveedores de salud consideren esta fase inevitable de la vida en la agenda de políticas sanitarias para un envejecimiento saludable y equitativo.
Palabras clave: Índice de Kupperman; prevalencia; Ruanda; cuidado; postmenopausia.
Resumen
Los estudios han demostrado diferencias raciales/étnicas en la prevalencia de síntomas vasomotores (SVM), alteraciones del sueño y tratamiento de SVM en la menopausia. Para evaluar la reproducibilidad de estas diferencias, revisamos sistemáticamente estudios observacionales, publicados entre 2000 y 2021, que informaban sobre la prevalencia/incidencia de SVM, alteraciones del sueño o uso de tratamientos en mujeres menopáusicas estratificados por raza/etnia. Examinamos 3,799 registros de PubMed y Embase e incluimos 27 artículos (19 estudios). No se encontraron datos de incidencia. Los datos de prevalencia variaron ampliamente, pero surgieron algunos patrones comunes. En los cinco estudios que compararon SVM entre mujeres negras y mujeres blancas, hispanas y/o de Asia oriental, la prevalencia fue más alta en mujeres negras y más baja en mujeres de Asia oriental. La prevalencia general de trastornos del sueño se comparó entre mujeres negras, blancas y de Asia oriental en dos poblaciones de estudio, y fue más alta en mujeres blancas en ambos artículos. Los trastornos del sueño fueron más comunes que los SVM en mujeres del este de Asia. En los cuatro estudios que compararon el uso de terapia hormonal entre mujeres blancas y mujeres negras y/o de Asia oriental, el uso del tratamiento fue más común en las mujeres blancas. Estos resultados resaltan la necesidad de asesoramiento y tratamiento individualizados, extensión a minorías desatendidas y definiciones y medidas de resultados estandarizadas para SVM y alteraciones del sueño para estudios futuros.
Resumen Objetivo: Las mujeres de mediana edad enfrentan una variedad de factores estresantes biopsicosociales que aumentan el riesgo de depresión, con posibles consecuencias negativas en la edad adulta mayor. Se sabe que una menor autocompasión predice síntomas depresivos posteriores, pero se sabe poco sobre si los síntomas depresivos predicen niveles posteriores de autocompasión. Este estudio examinó las relaciones longitudinales y recíprocas entre la autocompasión y los síntomas depresivos durante un período de cinco años en la mediana edad. Método: Este estudio longitudinal utilizó datos de 272 mujeres de entre 40 y 60 años al inicio del estudio. Se utilizó un análisis de panel cruzado para investigar las relaciones recíprocas entre los síntomas depresivos y la autocompasión al inicio y a los 5 años de seguimiento. Resultados: Después de controlar los efectos autorregresivos, la autocompasión al inicio del estudio explicó el 4% de la variación única en los síntomas depresivos cinco años después. Los síntomas depresivos iniciales también predijeron los niveles posteriores de autocompasión, con un 2% de varianza única explicada. Conclusión: Este es el primer estudio que informa una relación longitudinal bidireccional entre la autocompasión y los síntomas depresivos. Las mujeres de mediana edad pueden experimentar un ciclo negativo en el que la baja autocompasión y los síntomas depresivos se refuerzan mutuamente durante la mediana edad y la edad adulta. Se requiere de ensayos clínicos que examinen las intervenciones de autocompasión en la mediana edad.
Resumen Objetivo: A las mujeres con alto riesgo de cáncer de ovario comúnmente se les recomienda someterse a una salpingooforectomía bilateral (SOB) para reducir el riesgo antes de la menopausia natural. Con frecuencia se informan síntomas cognitivos durante la transición natural a la menopausia; sin embargo, muy pocos estudios han examinado los cambios cognitivos después de la menopausia quirúrgica. Para abordar esta brecha, exploramos las experiencias cognitivas de las mujeres dentro de los 24 meses posteriores a la SOB. Método: Este sub-estudio observacional transversal es parte de un proyecto más amplio, el Estudio de cognición y menopausia temprana (EM-COG). Investigamos las experiencias cognitivas percibidas en mujeres australianas (n = 16) que se sometieron a una SOB para reducir el riesgo mediante entrevistas cualitativas. Se llevó a cabo un análisis temático para identificar temas clave. Resultados: Quince de 16 participantes (93.75%) informaron cambios en la cognición dentro de los 24 meses posteriores a la SOB. Los síntomas cognitivos clave informados fueron confusión mental, dificultades de memoria y recuperación, velocidad de procesamiento más lenta y dificultades de atención. Cinco participantes (31.3%) experimentaron síntomas de estado de ánimo negativos después de la SOB. Conclusión: Los hallazgos de este estudio sugieren que las mujeres experimentan cambios cognitivos subjetivos dentro de los 24 meses posteriores a la SOBO. Este período podría ser un momento vulnerable para la salud cognitiva de las mujeres. Si bien estos hallazgos deben ser confirmados por un gran estudio prospectivo, nuestra investigación indica que la psicoeducación y la conciencia serán útiles para controlar los síntomas cognitivos después de la menopausia quirúrgica.
1. Sánchez-Zarza SC, Armeni AK, Chedraui P, Pérez-López FR, Gavilanes AWD. Prevalence of menopausal symptoms and severity related factors among mid-aged Paraguayan women as measured with the 10-item Cervantes Scale. Gynecol Endocrinol. 2023;39(1):2235427.
Objective
To determine the prevalence of menopausal symptoms and factors related to severity in mid-aged women.
Design
Cross-sectional study in which 216 urban-living women from Asunción-Paraguay (40-60 years) were surveyed with the 10 item Cervantes Scale (CS-10) and a general questionnaire (personal and partner data).
Main findings
Median (interquartile range [IQR]) age of the sample was 48 [9] years, 48.1% were postmenopausal, 8.8% used menopausal hormone therapy, 39.4% psychotropic drugs, 43.5% had hypertension, 6.5% diabetes, 51.9% abdominal obesity, and 89.3% had a partner (n = 193).
A history of sexual abuse was present in 2.8%.
Median total CS-10 score was 8.5 [9.75]. Overall, 93.3% (180/193) of women having a partner were sexually active, with a median coital frequency of 8 times per month.
According to the CS-10, the three most prevalent menopausal symptoms were: aching in muscles and/or joints (70.8%), anxiety and nervousness (70.8%) and hot flashes/night sweats (54.2%).
Factors associated with higher CS-10 scores were: female age and educational level, marital status, menopausal status, and marital sexual aspects.
Partner educational level was inversely correlated (rho Spearman coefficient) with CS-10 total scores.
However, multiple linear regression analysis found that higher total CS-10 scores (more severe menopausal symptoms) negatively correlated to coital frequency and positively correlated with peri- and postmenopausal status, parity, sedentary lifestyle and a history of sexual abuse.
Take-home message
Menopausal symptoms in this mid-aged urban female Paraguayan sample were related to hormonal, sexual and other female aspects.
2. Martínez-Vázquez S, Hernández-Martínez A, Peinado-Molina RA, Martínez-Galiano JM. Impact of overweight and obesity in postmenopausal women. Climacteric. 2023 Jul 21:1-6.
Objective
To investigate the association between overweight and obesity in postmenopausal women and different aspects related to health such as quality of life, physical activity, sleep quality and level of physical activity.
Design
An observational cross-sectional study was carried out during 2021-2022 in Spain in postmenopausal women.
Health-related quality of life was assessed using the 12-item short-form survey (SF-12).
The Pittsburgh Sleep Quality Index (PSQI) was used to determine sleep quality, and the International Physical Activity Validated Questionnaire (IPAQ) was used for physical activity.
A multivariate analysis was conducted using binary logistic regression to control the confounding bias.
Main findings
A total of 395 postmenopausal women participated: 64.6% (n = 255) were overweight or obese.
Obesity was associated with higher odds of having a lower quality of life (adjusted odds ratio [aOR] = 2.88; 95% confidence interval [CI]: 1.51-5.49), including alterations in physical role and function, pain and vitality.
Postmenopausal women with overweight/obesity had higher odds of cardiovascular problems (aOR = 2.09; 95% CI: 1.04-4.19/aOR = 4.44; 95% CI: 2.12-9.31), and women with obesity were more likely to develop endocrine problems (aOR = 2.29; 95% CI: 1.10-4.75).
Finally, women with obesity had higher odds of suffering urinary incontinence (aOR = 2.10; 95% CI: 1.10-4.01) or fecal incontinence (aOR = 2.70; 95% CI: 1.35-5.39), and pelvic pain (aOR = 2.33; 95% CI: 1.18-4.59).
Take-home message
Obesity in postmenopausal women negatively affects perceived quality of life, sleep quality, physical activity, the development of cardiovascular problems and pelvic floor-related problems.
3. Liu J, Jin X, Chen W, Wang L, Feng Z, Huang J. Early menopause is associated with increased risk of heart failure and atrial fibrillation: A systematic review and meta-analysis. Maturitas. 2023;176:107784.
Background
Menopause is linked to a higher risk of cardiovascular disease; however, it is unclear whether premature menopause (defined as menopause before the age of 40 years) or early menopause (defined as menopause before the age of 45 years) is associated with an increased risk of heart failure or atrial fibrillation.
Objective
To examine the most reliable evidence on the relationship between early menopause and the risk of heart failure and atrial fibrillation.
Design
A comprehensive literature search was performed in three online databases, Embase, Web of Science, and PubMed, from database establishment to April 1, 2023.
The results were presented as hazard ratios with 95 % confidence intervals.
The I2 statistic was employed to assess heterogeneity, and the Egger’s test was used to determine publication bias.
Main findings
Nine cohort studies were included in the analysis, with a total of 6,255,783 postmenopausal women.
Women with premature and early menopause had an increased risk of heart failure (HR: 1.39, 95 % CI: 1.31-1.47; HR: 1.23, 95 % CI: 1.10-1.37, respectively) and atrial fibrillation (HR: 1.15, 95 % CI: 1.01-1.31; HR: 1.08, 95 % CI: 1.04-1.13, respectively) when compared with women who had undergone menopause after the age of 45 years.
Subgroup analysis showed that, compared with early menopause, premature menopause has a stronger association with an increased risk of heart failure and atrial fibrillation.
Take-home messages
Women who undergo premature menopause or early menopause have a higher risk of heart failure and atrial fibrillation compared with women who undergo menopause in the normal age range.
These reproductive factors need to be considered for measures that might reduce the risk of heart failure and atrial fibrillation.
4. LaVasseur C, Mathews R, Wang JSH, Martens K, McMurry HS, Peress S, Sabile J, Kartika T, Oleson I, Lo JO, DeLoughery TG, McCarty OJT, Shatzel JJ. Estrogen-based hormonal therapy and the risk of thrombosis in COVID-19 patients. Eur J Haematol. 2023;111(5):678-686.
Background
Estrogen-containing contraceptives and hormone replacement therapy are used commonly, however, the risks of venous and arterial thrombosis imparted by such medications during COVID-19 infection or other similar viral infections remain undescribed
Objective
To assess the risk of venous and arterial thrombosis in patients receiving oral estrogen-containing therapy (ECT) with COVID-19 as compared to those receiving non-estrogen-based hormonal therapy.
Design
Authors conducted a multicenter cohort study of 991 patients with confirmed COVID-19 infection, 466 receiving estrogen-containing hormonal therapy, and 525 receiving progestin-only or topical therapy.
Main findings
The use of estrogen-containing therapy was found to significantly increase the risk of venous thromboembolism (VTE) following COVID-19 diagnosis after controlling for age (HR 5.46 [95% CI 1.12-26.7, p = .036]).
This risk was highest in patients over age 50, with 8.6% of patients receiving estrogen-containing therapy diagnosed with VTE compared to 0.9% of those receiving non-estrogen-based therapies (p = .026).
The risk of arterial thrombosis was not significantly associated with oral estrogen use.
Take-home messages
These results suggest that estrogen-containing therapy is associated with a significantly increased risk of VTE in COVID-19 patients, especially in older individuals.
These findings may guide provider counseling and management of patients with COVID-19 on estrogen-containing therapy.
5. Folahan JT, Olorundare OE, Ajayi AM, Oyewopo AO, Soyemi SS, Adeneye AA, Okoye II, Afolabi SO, Njan AA. Oxidized dietary lipids induce vascular inflammation and atherogenesis in post-menopausal rats: estradiol and selected antihyperlipidemic drugs restore vascular health in vivo. Lipids Health Dis. 2023;22(1):107.
Background
Thermoxidation of edible oil through deep fat frying results in the generation of several oxidized products that promote lipid peroxidation and ROS production when eaten.
Consumption of thermoxidized oil in post-menopausal conditions where the estrogen level is low contributes to cardiovascular disease.
Objective
To evaluate the role of estradiol and antihyperlipidemic agents (AHD) in restoring the vascular health of ovariectomized (OVX) rats fed with thermoxidized palm oil (TPO) and thermoxidized soya oil (TSO) diets.
Design
A total of 10 groups of rats (n = 6) were set up for the experiment.
Group I (normal control) rats were sham handled while other groups were OVX to bring about estrogen deficient post-menopausal state.
Group II (OVX only) was not treated and received normal rat chow.
Groups III-X were fed with either TPO or TSO diet for 12 weeks and treated with estradiol (ETD) 0.2 mg/kg/day, atorvastatin (ATV) 10 mg/kg/day, and a fixed-dose combination of ezetimibe and ATV (EZE 3 mg/kg/day + ATV 10 mg/kg/day).
Main findings
Pro-atherogenic lipids levels were significantly elevated in untreated TSO and TPO groups compared to OVX and sham, resulting in increased atherogenic and Coronary-risk indices.
Treatment with Estradiol and AHDs significantly reduced the total cholesterol, triglycerides, low-density lipoprotein cholesterol as well as AI and CRI compared to untreated TSO and TPO groups, whereas TSO and TPO groups showed significant elevation in these parameters compared to Group I values.
Moreover, aortic TNF-α levels were extremely elevated in the untreated TSO and TPO compared to Group I. TNF-α levels were significantly reduced in rats treated with AHDs and ETD.
Localized oxidative stress was indicated in the aortic tissues of TSO and TPO-fed OVX rats by increased malondialdehyde and decreased glutathione, catalase, and superoxide dismutase levels.
This contributed to a depletion in aortic nitric oxide. AHDs and ETD replenished the nitric oxide levels significantly.
Histological evaluation of the aorta of TSO and TPO rats revealed increased peri-adventitia fat, aortic medial hypertrophy, and aortic recanalization.
These pathologic changes were less seen in AHDs and ETD rats.
Take-home message
This study suggests that ETD and AHDs profoundly attenuate oxidized lipid-induced vascular inflammation and atherogenesis through oxidative-stress reduction and inhibition of TNF-α signaling.
6. Haeri NS, Perera S, Greenspan SL. The association of vitamin D with bone microarchitecture, muscle strength, and mobility performance in older women in long-term care. Bone. 2023;176:116867.
Background
Osteoporosis and sarcopenia are prevalent in older adults. Trabecular bone score (TBS) is a novel method to evaluate bone microarchitecture, whereas grip strength and gait speed are simple methods to assess muscle strength and function.
Few studies have linked the relationship between vitamin D levels (25OHD) with TBS, grip strength, and gait speed in healthy community dwelling adults.
Objective
To investigate this relationship in older women with osteoporosis and multiple comorbid conditions residing in long-term care (LTC) facilities.
Design
Authors analyzed baseline 25OHD, spine TBS, grip strength, and gait speed in 246 women with osteoporosis who were residents of LTC and enrolled in a randomized controlled clinical trial.
Main findings
On average, participants were 81.6 years old and had a BMI of 26.8 kg/m2.
The correlation (r) of 25OHD with spine TBS, grip strength, and gait speed were (r = 0.15; p = 0.0208), (r = – 0.05; p = 0.4686), and (r = 0.19; p = 0.0041), respectively.
Each 5 ng/dl increase in 25OHD was associated with an increase of 0.006 in spine TBS and 0.014 m/s in gait speed.
After adjusting for covariates, each 5 ng/dl increase in 25OHD was associated with an increase of 0.004 in spine TBS (p = 0.0599) and 0.012 m/s in gait speed (p = 0.0144).
Take-home messages
In older women residing in LTC facilities, 25OHD was associated with spine TBS and gait speed.
The strengths of the associations suggest there may be other factors with a more prominent role in bone microarchitecture, muscle strength, and physical function in this population.
7. Casiano Evans EA, Hobson DTG, Aschkenazi SO, Alas AN, Balgobin S, Balk EM, Dieter AA, Kanter G, Orejuela FJ, Sanses TVD, Rahn DD. Nonestrogen Therapies for Treatment of Genitourinary Syndrome of Menopause: A Systematic Review. Obstet Gynecol. 2023;142(3):555-570.
Objective
To systematically review the literature and provide clinical practice guidelines regarding various nonestrogen therapies for treatment of genitourinary syndrome of menopause (GSM).
Design
MEDLINE, EMBASE, ClinicalTrials.gov, and Cochrane databases were searched from inception to July 2021.
Authors included comparative and noncomparative studies.
Interventions and comparators were limited to seven products that are commercially available and currently in use (vaginal dehydroepiandrosterone [DHEA], ospemifene, laser or energy-based therapies, polycarbophil-based vaginal moisturizer, Tibolone, vaginal hyaluronic acid, testosterone).
Topical estrogen, placebo, other nonestrogen products, as well as no treatment were considered as comparators.
Authors double-screened 9,131 abstracts and identified 136 studies that met criteria.
Studies were assessed for quality and strength of evidence by the systematic review group.
Main findings
Information regarding the participants, details on the intervention and comparator and outcomes were extracted from the eligible studies.
Alternative therapies were similar or superior to estrogen or placebo with minimal increase in adverse events.
Dose response was noted with vaginal DHEA and testosterone.
Vaginal DHEA, ospemifene, erbium and fractional carbon dioxide (CO 2) laser, polycarbophil-based vaginal moisturizer, tibolone, hyaluronic acid, and testosterone all improved subjective and objective signs of atrophy.
Vaginal DHEA, ospemifene, tibolone, fractional CO 2 laser, polycarbophil-based vaginal moisturizer, and testosterone improved sexual function.
Take-home message
Most nonestrogen therapies are effective treatments for the various symptoms of GSM; however, there are insufficient data to compare nonestrogen options to each other.
8. O’Neill MT, Jones V, Reid A. Impact of menopausal symptoms on work and careers: a cross-sectional study. Occup Med (Lond). 2023;73(6):332-338.
Background
Women over 50 years are one of the fastest-growing employment groups.
Menopausal symptoms can adversely impact quality of life, work performance and attendance; however, few studies look at the impact of individual menopausal symptoms on work and career development.
Objective
To measure the prevalence of menopausal symptoms in employees in a healthcare setting, to assess the impact of individual symptoms on work, attendance and career development and to explore perceptions about workplace supports.
Design
In this cross-sectional study of Irish hospital workers, menopausal employees were asked about the frequency of 10 menopausal symptoms and the extent to which each symptom impacted them at work.
Impacts on performance, attendance and career development were assessed, along with the benefits of workplace support.
Main findings
Responses from 407 women showed that the most common menopausal symptoms affecting employees greater than 50% of the time while at work were fatigue (54%), difficulty sleeping (47%), poor concentration (44%) and poor memory (40%). Work performance was impacted for 65% of respondents and 18% had taken sick leave.
There was a significant association between symptom severity at work and reduced work performance, career development decisions and attendance.
Manager awareness about menopause (29%) and flexible working times (29%) were selected as the most important workplace supports.
Take-home messages
Female employees are negatively impacted by menopausal symptoms while at work, particularly by psychological and neurocognitive symptoms which were associated with reduced work performance, attendance and career decisions.
Manager awareness and flexible schedules were considered the most beneficial workplace supports.
9. Swales DA, Lozza-Fiacco S, Andersen EH, Cooper JA, Treadway MT, Xia K, Schiller CE, Girdler SS, Dichter GS. Hormone sensitivity predicts the beneficial effects of transdermal estradiol on reward-seeking behaviors in perimenopausal women: A randomized controlled trial. Psychoneuroendocrinology. 2023;156:106339.
Background
Depression is highly prevalent during the menopause transition (perimenopause), and often presents with anxious and anhedonic features.
This increased vulnerability for mood symptoms is likely driven in part by the dramatic hormonal changes that are characteristic of the menopause transition, as prior research has linked fluctuations in estradiol (E2) to emergence of depressed mood in at risk perimenopausal women.
Transdermal estradiol (TE2) has been shown to reduce the severity of depression in clinically symptomatic women, particularly in those with recent stressful life events.
Objective
This research extends prior work by examining the relation between E2 and reward seeking behaviors, a precise behavioral indicator of depression.
Specifically, the current study utilizes a randomized, double blind, placebo-controlled design to investigate whether mood sensitivity to E2 flux (“hormone sensitivity”) predicts the beneficial effects of TE2 interventions on reward seeking behaviors in perimenopausal women, and whether recent stressful life events moderate any observed associations.
Design
Participants were 66 women who met standardized criteria for being early or late perimenopausal based on bleeding patterns.
Participants were recruited from a community sample; therefore, mood symptoms varied across the continuum and the majority of participants did not meet diagnostic criteria for a depressive or anxiety disorder at the time of enrollment.
Hormone sensitivity was quantified over an 8-week baseline period, using within-subjects correlations between repeated weekly measures of E2 serum concentrations and weekly anxiety (State Trait Anxiety Inventory) and anhedonia ratings (Snaith-Hamilton Pleasure Scale).
Women were then randomized to receive 8 weeks of TE2 (0.1 mg) or transdermal placebo, and reward-seeking behaviors were assessed using the Effort-Expenditure for Rewards Task (EEfRT).
Main findings
Participants who were randomized to receive transdermal estradiol and who demonstrated greater anxiety sensitivity to E2 fluctuations at baseline, demonstrated more reward seeking behaviors on the EEfRT task.
Notably, the strength of the association between E2-anxiety sensitivity and post-randomization EEfRT for TE2 participants increased when women experienced more recent stressful life events and rated those events as more stressful.
E2-anhedonia sensitivity was not associated with reward-seeking behaviors.
Take-home message
Perimenopausal women who are more sensitive to E2 fluctuations and experienced more recent life stress may experience a greater benefit of TE2 as evidenced by an increase in reward seeking behaviors.
10. Agrawal P, Singh SM, Able C, Dumas K, Kohn J, Kohn TP, Clifton M. Safety of Vaginal Estrogen Therapy for Genitourinary Syndrome of Menopause in Women With a History of Breast Cancer. Obstet Gynecol. 2023;142(3):660-668.
Objective
To assess the risk of recurrence of breast cancer associated with vaginal estrogen therapy in women diagnosed with genitourinary syndrome of menopause with a history of breast cancer using a large U.S. claims database.
Design
A U.S. health research network (TriNetX Diamond Network) was queried from January 2009 to June 2022.
Our cohort consisted of women diagnosed with breast cancer within 5 years before the initial genitourinary syndrome of menopause diagnosis.
Patients with active disease, defined as those undergoing mastectomy, radiation treatment, or chemotherapy within 3 months before diagnosis of genitourinary syndrome of menopause, were excluded.
Recurrence was defined as mastectomy, radiation, chemotherapy, or secondary malignancy within 3 months to 5 years after the initiation of vaginal estrogen therapy for genitourinary syndrome of menopause.
The study cohort included those with three or more vaginal estrogen prescriptions.
The control cohort included women with breast cancer without any vaginal estrogen prescriptions after genitourinary syndrome of menopause diagnosis.
Propensity matching was performed.
A sub analysis by positive estrogen receptor status, when available, was performed.
Main findings
The authors identified 42,113 women with a diagnosis of genitourinary syndrome of menopause after breast cancer diagnosis with any estrogen receptor status, 5.0% of whom received vaginal estrogen.
Of the initial cohort, 10,584 patients had a history of positive estrogen receptor breast cancer, and 3.9% of this group received vaginal estrogen.
Risk of breast cancer recurrence was comparable between those who received vaginal estrogen and those who did not in both the any estrogen receptor (risk ratio 1.03, 95% CI 0.91-1.18) and positive estrogen receptor (risk ratio 0.94, 95% CI 0.77-1.15) status analyses.
Take-home message
In a large, claims-based analysis, we did not find an increased risk of breast cancer recurrence within 5 years in women with a personal history of breast cancer who were using vaginal estrogen for genitourinary syndrome of menopause.
