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I hope the start of the new year is going well for you.
Firstly, I am delighted to report that our online education programme is going from strength to strength since its relaunch in July 2020. Concerning IMPART, there have been over 10,000 registrations and the numbers of people completing Levels 1 and 2 continue to grow every month.
We conducted a survey with IMPART registrants, the results of which are currently being collated, to gather feedback from those who have completed, those who have registered but not completed, those who renewed and those who did not renew their IMS membership. This will provide us with very important information to plan our future educational programmes and to maximise membership of the IMS.
Our membership continues to grow in size and breadth; in 2023 we gained over 400 new members and our membership now spans 88 countries. We will continue to expand the joint membership offer with the Council of Affiliated Menopause Societies (CAMS) members and the IMPART Level 1 completion membership offer, which will entitle completers a one-year Limited Professional membership.
Our CAMS activities continue, with 63 members and counting. We are committed to increasing the number of menopause societies around the world, particularly in underserved areas, and have developed a Toolkit for Starting a Menopause Society. The Toolkit will be used to support society development via a new initiative, the CAMS Helping Hands Program, which pairs established societies with smaller/new societies to support their development.
Three issues of the online CAMS Connect magazine were published in March, June and October 23 and Issue 4 will be published soon. All issues of CAMS Connect and more information about CAMS, including the executive and steering groups, members, and microsites can be found here on the CAMS pages of the IMS website.
Several CAMS Menopause Hour symposia have already been planned; the next two are summarised below. The emphasis will be on the practical management of women in midlife and menopause utilising local resources.
29th February 3pm CET Italian Menopause Society
Language: Italian with English subtitles The Clinical Management of the Risk of Postmenopausal Osteoporosis
Moderator: Dr Angelo Cagnacci
Speaker 1: Early Diagnosis and Hormonal Therapy – Dr Marco Gambacciani
Speaker 2: Non-Hormonal Therapy for Postmenopausal Osteoporosis – Dr Stefano Lello
28th March 2024 3pm CET Canadian Menopause Society A Practical Approach to Management of Menopause
Moderator: Dr Denise Black
Speaker 1: Early Menopausal Cases: Detect early menopause, its cause and symptoms, risks, prevention and management – Dr Denise Black
Speaker 2: Risk Factors in Mature Women’s Health – Dr Ardelle Piper
Our IMS online webinars also continue to provide excellent state-of-the-art educational opportunities. The next one will be as shown below:
Webinar: Tuesday 20th February, 3.00pm CET Hormones and Stroke: An update on treatment and risk
Moderator: Professor Antonio Cano
Speaker 1: Hormonal Effects on the Risk of Stroke – Dr Matthew Nudy
Speaker 2: New Treatments in Stroke Prevention and Management – Professor Dominique Cadilhac
The IMS will be present at a number of meetings this year. This will commence with an IMS board meeting in Costa Rica in March 2024, followed by an educational collaboration with the Costa Rican Society of Climacteric, Menopause and Osteoporosis (ACCMYO) Congress. Other key meetings include the ISGE meeting in Florence May 2024, and the Menopause Society meeting in Chicago Sept 2024, where the IMS will hold executive meetings.
IMS representation is also planned at the meetings of the Philippine Society of Climacteric Medicine, the Jordanian Society of Obstetrics and Gynaecology, the Beijing Capital Medical University, and the Menopause Society of Ireland, all scheduled for September 2024.
These meetings will lead into our main congress in Melbourne, Australia October 19th-22nd. Planning for the meeting by Professor Rod Baber and the Scientific Programme Committee is going very well and we look forward to seeing all of you there! The plenary speakers and topics have been secured and invitations have now gone out to speakers for the symposia. Key announcements for this meeting are shown below:
Free registration to the Congress is available for trainees in Australia and New Zealand until 23rd September 2024.
Discounted registration is offered to IMS and Australasian Menopause Society members.
Discounted registration is offered to those who were registered for the 2020 World Congress in Melbourne.
Discounted group registration is offered to national/regional menopause societies that are members of CAMS.
The local organising committee, led by co-chairs Professors Susan Davis and Amanda Vincent, has a great social and cultural programme planned for the meeting.
Regarding our society journal ‘Climacteric’, Professor Rod Baber has recently stepped down from his position as Editor-in-Chief and I would like to take this opportunity to thank him once again, on behalf of myself and the IMS, for his considerable efforts in making the journal one of the most widely-read and respected menopause journals globally.
Dr Tim Hillard, Associate Editor of Climacteric has now succeeded Professor Baber and I would like to wish him every success. I would also like to take this opportunity to thank Professor Cynthia Stuenkel for her hard work, not only in authoring the excellent World Menopause Day White Paper on Cardiovascular Disease but also for editing the February issue of Climacteric, the theme of which is Cardiovascular Disease in Women.
The ESHRE/Monash/ASRM/IMS partnership update of the ESHRE POI guideline is nearing completion. A presentation of the key points of the guideline is planned at the ESHRE meeting in Amsterdam in July 2024.
The 2024 update of the IMS recommendations is now well under way; authors for the key questions are being allocated and it is hoped that the draft recommendations will be ready by the time of the IMS Congress in Melbourne in October this year.
Finally, the UK NICE menopause guideline 2024 update draft was circulated to stakeholders, including the IMS, for comments; the closing deadline for consultation was last month. An amalgamated response from the IMS board was submitted to NICE, highlighting areas of concern and recommended changes. A joint response letter, endorsed by the IMS board, was also submitted to NICE in collaboration with RCOG, BMS and EMAS.
Finally, please continue to stay in touch about any regional developments and meetings you have been involved in, and don’t hesitate to send in your questions and suggestions about our society activities.
I look forward to seeing each and every one of you in Melbourne, if not before!
Webinars
The 39th webinar in the IMS webinar series will be ‘Hormones and Stroke: An Update on Treatment and Risk’ to be held on Tuesday 20th February 3pm CET. It will be moderated by Professor Antonio Cano. Dr Matthew Nudy will be speaking on ‘Hormonal Effects on the Risk of Stroke’ and Professor Dominique Cadilhac will be speaking on ‘New Treatments in Stroke Prevention and Management’ For information and booking visit the IMS website.
The 38th webinar in the IMS webinar series ‘Approach to Bone Health in the Perimenopause and Postmenopause?’ was held on Tuesday 16th January and moderated by Professor Steven Goldstein. Dr Michael McClung presented on ‘When to Screen for Osteoporosis, How and Why After Menopause’ and Professor Aliya Khan presented on ‘Options for Treatment including Estrogen, New Therapeutic Options, and Possible Prophylactic Protection After Menopause’ 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, ‘GSM (genitourinary syndrome of menopause) Pelvic Floor Health’ by Tim Hillard and ‘Premature Ovarian Insufficiency: Unique and Underappreciated’ by Nick Panay.
IMS Interview Series
Our latest 1-1 interview series topic is ‘Genitourinary Syndrome of Menopause’ with Professor Jan Shifren available here https://www.imsociety.org/education/videos/. This is available in a video or podcast format. All the IMS podcasts are now available on Spotify.
CAMS Menopause Hour The next IMS Council of Affiliated Menopause Societies (CAMS) Menopause Hour will be ‘The Clinical Management and Risk of Postmenopausal Osteoporosis’ on the 29th February at 3pm CET. This CAMS Menopause Hour will be presented in Italian. A recording will be available on the IMS website after the event with English subtitles. Moderated by Dr Angelo Cagnacci, Dr Marco Gambacciani will be speaking on ‘Early Diagnosis and Hormonal therapy’and Dr Stefano Lello will be speaking on ‘Non-hormonal Therapy for Postmenopausal Osteoporosis’. To book visit: https://www.imsociety.org/2024/02/05/cams-menopause-hour-the-clinical-management-and-risk-of-postmenopausal-osteoporosis-webinar/
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
Soybean oil production residue can be used to make a product that treats symptoms of menopause
Scientists in Brazil have tested a method to obtain a substance similar to estrogen from soy isoflavones. They aim to create a product that reduces the discomfort suffered by many women in the menopause https://www.eurekalert.org/news-releases/1010783
Women exposed to toxic metals may experience earlier aging of their ovaries
Study links metal exposure to lower egg count in women approaching menopause https://www.eurekalert.org/news-releases/1031985
Free or Open Access with translated abstract to selected papers recently published in Climacteric
February Climacteric: Special issue focusing on Cardiovascular Health in Women
This special issue focuses on Cardiovascular Health in Women and has Professor Cynthia Stuenkel as Guest Editor.
We thank Professor Stuenkel for her outstanding work in bringing this issue together and would also like to thank our excellent invited contributors.
The issue also contains the IMS White Paper on cardiovascular disease in women, published online in October 2023 to mark World Menopause Day. https://www.tandfonline.com/toc/icmt20/current
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 2024, Volume 27, February issue, chosen by our Editor, Professor Rod Baber, have Free Access for the next three months. The IMS White Paper on cardiovascular disease in women has 12 months Free Access from October 2023.
There are also five Open Access papers in the February issue.
IMS members have full access to all papers in Climacteric at Taylor & Francis Online; they are accessed via the Climacteric page in the members area of the IMS website.
The Abstracts from these selected Free Access, plus the 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: Stuenkel CA. Hitos reproductivos a lo largo de la vida y riesgo de enfermedad cardiovascular en las mujeres. Climacteric. 2024;27(1):5-15. https://pubmed.ncbi.nlm.nih.gov/37769699/
Resumen
Las enfermedades cardiovasculares (ECV) son la principal causa de muerte entre las mujeres en todo el mundo desarrollado y en desarrollo. Más allá de los factores de riesgo cardiovascular tradicionales, se han reconocido una serie de hitos reproductivos. El objetivo de este documento, publicado por la Sociedad Internacional de Menopausia junto con el Día Mundial de la Menopausia 2023, es resaltar los hitos reproductivos femeninos en términos de riesgo cardiovascular potencial y revisar recomendaciones para minimizar ese riesgo. Los principales hitos discutidos se relacionan con la ciclicidad menstrual, los resultados adversos del embarazo, los tratamientos para el cáncer de mama y la menopausia. Cada una de estas categorías tiene una serie de permutaciones que, según se ha demostrado en estudios observacionales, están asociadas con mayores riesgos cardiovasculares. En la atención clínica actual, se ha fomentado el reconocimiento de estos hitos reproductivos para que las pacientes puedan estar informadas y motivadas para participar en la prevención primaria de las ECV en las primeras etapas de su vida, en lugar de hacerlo retrospectivamente más adelante. Las opciones de atención específicamente dirigida con equipos de especialistas están diseñadas para mejorar el éxito en la identificación de riesgos, cribado y posible detección de ECV y, de manera óptima, la prevención primaria o secundaria de ECV. La promoción de la salud cardiovascular de las mujeres tiene efectos de gran alcance para ellas mismas, sus familias y sus descendientes. Es hora de hacer de la salud cardiovascular de las mujeres una prioridad.
Palabras claves: Riesgo de enfermedad cardiovascular; resultados adversos del embarazo; estrógeno; menopausia; duración de la vida reproductiva.
Spanish translation: Benham JL, Goldberg A, Teede H, Tay CT. Síndrome de ovario poliquístico: asociaciones con enfermedad cardiovascular. Climacteric. 2024;27(1):47-52. https://pubmed.ncbi.nlm.nih.gov/38073517/
Resumen
El síndrome de ovario poliquístico (SOP), caracterizado por períodos menstruales anormales, niveles elevados de andrógenos y morfología del ovario poliquístico en la ecografía, es el trastorno endocrino más común entre las mujeres. El SOP se asocia con factores de riesgo de enfermedades cardiovasculares (ECV), como diabetes, obesidad, síndrome metabólico, resultados adversos del embarazo como preeclampsia y angustia psicosocial, incluida la depresión. La evidencia anterior sobre la asociación entre el SOP y las ECV no es concluyente, pero la última Guía internacional sobre el SOP basada en evidencia de 2023 identifica al SOP como un factor de riesgo de ECV. Esta revisión discutirá la relación entre SOP y ECV junto con la dirección actual para la detección y prevención de ECV entre personas con SOP.
Palabras clave: Síndrome de ovario poliquístico; enfermedad cardiovascular; salud de la mujer
Spanish translation: Nudy M, Buerger J, Dreibelbis S, Jiang X, Hodis HN, Schnatz PF. Terapia hormonal menopáusica y enfermedad coronaria: la historia de la montaña rusa. Climacteric. 2024;27(1):81-88. https://pubmed.ncbi.nlm.nih.gov/38054425/
Resumen
En Estados Unidos se estima que más de un millón de mujeres llegan a la menopausia cada año. La enfermedad coronaria (EC) es la principal causa de mortalidad en mujeres menopáusicas a nivel mundial. La mayoría de las mujeres perimenopáusicas y postmenopáusicas experimentan síntomas molestos que incluyen sofocos, sudores nocturnos, cambios de humor, alteraciones del sueño, sangrado irregular y disfunción sexual. Si bien la terapia hormonal menopáusica (THM) trata eficazmente la mayoría de estos síntomas, su uso se ha vuelto confuso, especialmente en relación con el riesgo de enfermedad coronaria. A pesar de años de estudios observacionales y retrospectivos que respaldan un beneficio para las enfermedades coronarias y una mejor supervivencia entre las usuarias de THM, el Estudio del corazón y reemplazo de estrógeno/progestina (HERS) y la Iniciativa de salud de la mujer (WHI) plantearon dudas sobre esta premisa de larga data. Desde entonces ha surgido la hipótesis de la ventana de oportunidad y afirma que cuando se inicia la THM en mujeres más jóvenes, poco después del inicio de la menopausia, puede haber un beneficio cardiovascular. La siguiente revisión analiza la historia de la montaña rusa del uso de THM en lo que respecta a la enfermedad coronaria en mujeres postmenopáusicas. Se revisan los estudios que resaltan el beneficio de la THM en las enfermedades coronarias y brindan seguridad de que la THM utilizada en mujeres postmenopáusicas más jóvenes adecuadamente seleccionadas cerca del inicio de la menopausia es segura desde una perspectiva cardiovascular, de acuerdo con las recomendaciones de consenso.
Palabras clave: Terapia hormonal; enfermedad cardiovascular; enfermedad coronaria; menopausia; hipótesis de la ventana de oportunidad.
Spanish translation: Patel N, Greene N, Guynn N, Sharma A, Toleva O, Mehta PK. Enfermedad arterial coronaria isquémica pero no obstructiva: más de lo que parece. Climacteric. 2024;27(1):22-31. https://pubmed.ncbi.nlm.nih.gov/38224068/
Resumen
Las mujeres sintomáticas con angina tienen con más frecuencia isquemia arterial coronaria no obstructiva (IACNO) en comparación con los hombres. Tanto en hombres como mujeres, la IACNO no es benigna y asociada con eventos cardiovasculares adversos, incluyendo hospitalizaciones por infarto del miocardio, insuficiencia cardiaca y angina. Las mujeres IACNO tienen más angina y una menor calidad de vida en comparación con los hombres, pero a menudo se les tranquiliza falsamente debido a la falta de enfermedad arterial coronaria obstructiva (EAC) y la percepción de bajo riesgo. La disfunción microvascular coronaria (DMC) es un factor fisiopatológico clave en la IACNO, y se utilizan métodos de imágenes no invasivos para detectar un flujo microvascular alterado. El vasoespasmo coronario es otro mecanismo de IACNO y puede coexistir con la DMC, pero generalmente requiere pruebas de función coronaria (PFC) invasivas con pruebas de provocación para un diagnóstico definitivo. Además de los factores de riesgo tradicionales de enfermedades cardíacas, en la IOCNA están implicados factores de riesgo inflamatorios, hormonales y psicológicos que afectan el tono microvascular. El tratamiento de los factores de riesgo y el uso de medicamentos antiateroscleróticos y antianginosos ofrecen beneficios. Aumentar la concientización y la derivación temprana a centros especializados que se centren en el manejo de IOCNA puede mejorar los resultados orientados al paciente. Sin embargo, se necesitan ensayos de tratamiento aleatorios de gran tamaño para investigar el impacto sobre los eventos cardiovasculares adversos mayores. En esta revisión enfocada, discutimos la prevalencia, fisiopatología, presentación, diagnóstico y tratamiento de IOCNA.
Spanish translation: Ray M, Butel-Simoes LE, Lombard JM, Nordman IIC, Van der Westhuizen A, Collins NJ, Ngo DTM, Sverdlov AL. La salud cardiovascular de la mujer: el rompecabezas cardiooncológico. Climacteric. 2024;27(1):60-67. https://pubmed.ncbi.nlm.nih.gov/38073542/
Resumen
Las mejoras en la atención del cáncer han llevado a un aumento exponencial de la supervivencia del cáncer. Este es particularmente el caso del cáncer de mama, donde la supervivencia a cinco años en Australia supera el 90%. La enfermedad cardiovascular (ECV) se ha convertido en una de las causas competitivas de morbilidad y mortalidad entre las sobrevivientes de cáncer, tanto como una complicación de las terapias contra el cáncer como porque los factores de riesgo del cáncer se comparten con los de la ECV. En esta revisión cubrimos los aspectos clave de la atención cardiovascular para las mujeres a lo largo de su trayectoria contra el cáncer: la necesidad de una evaluación y manejo del riesgo cardiovascular de referencia, un componente crucial de la atención cardiovascular; la importancia de la vigilancia a largo plazo para el mantenimiento continuo de la salud cardiovascular; y evidencia sólida de los efectos beneficiosos del ejercicio físico para mejorar los resultados cardiovasculares y del cáncer. Existe una disparidad general en los resultados cardiovasculares de las mujeres, que se agrava aún más cuando coexisten las enfermedades cardiovasculares y el cáncer. La colaboración entre los servicios de oncología y cardíacos, con el surgimiento de todo el campo de la cardiooncología, permite acelerar la investigación y el tratamiento de estas pacientes. Esta colaboración, así como un enfoque holístico de la atención al paciente y el papel clave de los médicos generales de las pacientes, son esenciales para garantizar la salud a largo plazo de las personas que viven con, durante y después del cáncer.
Palabras clave: Cardiooncología; cáncer; enfermedad cardiovascular; factores de estilo de vida; manejo de factores de riesgo.
Spanish translation: Maas AHEM. Cardiovascular risk assessment in women: which women are suited for menopausal hormone therapy? Evaluación del riesgo cardiovascular en mujeres: ¿qué mujeres son adecuadas para la terapia hormonal de la menopausia? Climacteric. 2024;27(1):89-92. https://pubmed.ncbi.nlm.nih.gov/37931647/
Resumen
La evaluación individual del riesgo de enfermedad cardiovascular aterosclerótica es importante para la prescripción segura de hormonas en la menopausia. Además de los factores de riesgo tradicionales, las variables de riesgo específicas de las mujeres relacionadas con el embarazo y las condiciones ginecológicas contribuyen de manera importante a una evaluación de riesgos más personalizada en mujeres de mediana edad. De estas, el antecedente de preeclampsia/síndrome de HELLP (hemólisis, enzimas hepáticas elevadas y plaquetas bajas) y la menopausia espontánea temprana (<40 años) parecen ser las variables de riesgo adversas más fuertes. También se deben tener en cuenta los trastornos inflamatorios concomitantes. Agregar una puntuación de calcio en las arterias coronarias con una tomografía computarizada a la evaluación de riesgos tiene un alto valor predictivo para futuros eventos cardiovasculares. Esto debe considerarse para discriminar entre mujeres de bajo y alto riesgo cuando existe incertidumbre. En mujeres con riesgo intermedio, la terapia hormonal para la menopausia se puede combinar fácilmente con medicación preventiva si hay factores de riesgo cardiovascular presentes. En mujeres con mayor riesgo que tienen síntomas vasomotores incapacitantes severos, se puede considerar una dosis más baja de terapia hormonal con una buena colaboración entre el ginecólogo y el cardiólogo/especialista vascular.
Palabras clave: Enfermedad cardiovascular aterosclerótica; puntuación de calcio en las arterias coronarias; factores de riesgo específicos para mujeres; trastornos inflamatorios; terapia hormonal para la menopausia.
Spanish translation: Bontempo S, Yeganeh L, Giri R, Vincent AJ. Uso de THM en mujeres con enfermedades cardiovasculares: una revisión sistemática y un meta-análisis. Climacteric. 2024;27(1):93-103.Climacteric. 2024;27(1):93-103. https://pubmed.ncbi.nlm.nih.gov/37933495/
Resumen
Esta revisión sistemática evalúa el efecto de la terapia hormonal menopáusica (THM) sobre los resultados cardiovasculares y los factores de riesgo en mujeres postmenopáusicas con enfermedad cardiovascular (ECV). Se realizaron búsquedas en las bases de datos Medline, Embase y Cochrane desde el inicio hasta diciembre de 2022 en busca de ensayos controlados aleatorios (ECA) y estudios observacionales utilizando la metodología de una revisión Cochrane anterior. La evaluación de la calidad utilizó la herramienta Cochrane de riesgo de sesgo y la escala de Newcastle-Ottawa, respectivamente. De 5,647 estudios identificados, se incluyeron 29 (23 ECA y seis estudios observacionales). La mayoría de los estudios se realizaron en América del Norte o Europa e investigaron los estrógenos orales. Las participantes eran mayores con una frecuencia variable de factores de riesgo cardíaco y ECV subyacente. No se observaron diferencias significativas entre las usuarias de THM y los controles con respecto a los resultados primarios de infarto de miocardio no fatal, muerte cardiovascular o accidente cerebrovascular. No se observaron diferencias en la frecuencia de angina, insuficiencia cardíaca y ataques isquémicos transitorios. Se observaron efectos inconsistentes de la THM sobre la progresión angiográfica y variaron con el estado glucémico. El estradiol tuvo un efecto positivo sobre la dilatación mediada por flujo. Pocos estudios identificaron diferentes efectos de la THM sobre los factores de riesgo cardíaco, que varían según la preparación de estrógeno. Este estudio confirma que la THM no tiene ningún beneficio para la prevención secundaria de ECV, lo que destaca las limitaciones de la evidencia y la importancia de la toma de decisiones compartida al controlar los síntomas de la menopausia en mujeres con ECV.
Spanish translation: Gray MP, Vogel B, Mehran R, Leopold JA, Figtree GA. Prevención primaria de la enfermedad cardiovascular en la mujer. Climacteric. 2024;27(1):104-112. https://pubmed.ncbi.nlm.nih.gov/38197424/
Resumen
La cardiopatía isquémica es la principal causa de mortalidad por enfermedades cardiovasculares (ECV) tanto en hombres como en mujeres. Las estrategias dirigidas a los factores de riesgo modificables tradicionales son esenciales –entre ellos la hipertensión, el tabaquismo, la dislipidemia y la diabetes mellitus–, en particular para la aterosclerosis, pero también para los accidentes cerebrovasculares, la insuficiencia cardíaca y algunas arritmias. Sin embargo, persisten los desafíos relacionados con la educación, la detección y el acceso equitativo a terapias preventivas efectivas, y son particularmente problemáticos para las mujeres de todo el mundo y las de grupos socioeconómicos más bajos. La asociación de factores de riesgo específicos de las mujeres (por ejemplo, menopausia prematura, hipertensión gestacional, nacimientos pequeños para la edad gestacional) con ECV proporciona una ventana potencial para estrategias de prevención específicas. Sin embargo, se necesitan urgentemente más pruebas para la detección y las intervenciones específicas y efectivas. Además de los factores a nivel poblacional involucrados en el aumento del riesgo de sufrir un evento de ECV, los esfuerzos están aprovechando el enorme potencial de las ‘ómicas’ basadas en la sangre, biomarcadores de imágenes mejorados y enfoques analíticos bioinformáticos cada vez más complejos para esforzarse por lograr una detección temprana y terapias preventivas más personalizada de la enfermedad. Estas tácticas novedosas pueden ser particularmente relevantes para las mujeres en quienes los factores de riesgo tradicionales funcionan mal. Aquí analizamos enfoques establecidos y emergentes para mejorar la evaluación de riesgos, la detección temprana de enfermedades y estrategias preventivas efectivas para reducir la gigantesca carga de ECV en las mujeres.
Palabras clave: Enfermedad de las arterias coronarias; biomarcadores; medicina de precisión; prevención; factores de riesgo.
1. Titcomb TJ, Richey P, Casanova R, Phillips LS, Liu S, Karanth SD, Saquib N, Nuño T, Manson JE, Shadyab AH, Liu L, Wahls TL, Snetselaar LG, Wallace RB, Bao W. Association of type 2 diabetes mellitus with dementia-related and non-dementia-related mortality among postmenopausal women: A secondary competing risks analysis of the women’s health initiative. Alzheimer’s Dement. 2024;20(1):234-242.
Background
Alzheimer’s disease (AD) and AD-related dementias (ADRD) are leading causes of death among older adults in the United States. Efforts to understand risk factors for prevention are needed.
Objective
To determine the association of type 2 diabetes mellitus (T2DM) with dementia-related (AD/ADRD) and non-dementia (non.AD/ADRD) related mortality in postmenopausal women.
Design
Participants (n = 146,166) enrolled in the Women’s Health Initiative without AD at baseline were included.
Diabetes status was ascertained from self-reported questionnaires and deaths attributed to AD/ADRD from hospital, autopsy, and death records.
Competing risk regression models were used to estimate the cause-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for the prospective association of T2DM with AD/ADRD and non-AD/ADRD mortality.
Main findings
There were 29,393 treated T2DM cases and 8628 AD/ADRD deaths during 21.6 (14.0-23.5) median (IQR) years of follow-up.
Fully adjusted HRs (95% CIs) of the association with T2DM were 2.94 (2.76-3.12) for AD/ADRD and 2.65 (2.60-2.71) for the competing risk of non-AD/ADRD mortality.
Take-home messages
T2DM was associated with AD/ADRD and non-AD/ADRD mortality.
Type 2 diabetes mellitus was more strongly associated with Alzheimer’s disease (AD)/AD and related dementias (ADRD) mortality compared to the competing risk of non-AD/ADRD mortality among postmenopausal women. This relationship was consistent for AD and ADRD, respectively.
Also, this association was strongest among participants without obesity or hypertension and with younger age at baseline, higher diet quality, higher physical activity, higher alcohol consumption, and older age at the time of diagnosis of type 2 diabetes mellitus.
2. Park KY, Jung JH, Hwang HS, Park HK, Han K, Nam GE. Bone Mineral Density and the Risk of Parkinson’s Disease in Postmenopausal Women. Mov Disord. 2023;38(9):1606-1614.
Background and objective
Whether bone mineral density (BMD) is related to the risk of Parkinson’s disease (PD) is unclear. The objective of this study was to examine the association between BMD status and incident PD in postmenopausal women.
Design
Investigators retrospectively examined a nationwide cohort of 272,604 women aged 66 years who participated in the 2009-2012 Korean national health screening for transitional ages.
BMD was evaluated using dual-energy X-ray absorptiometry of the central bones.
The use of antiosteoporosis medications (AOMs) was assessed.
Authors performed multivariable Cox proportional hazards regression to evaluate the association between BMD and PD risk by calculating hazard ratios (HRs) and 95% confidence intervals (CIs).
Main findings
During the median follow-up of 7.7 years, 2,884 (1.1%) incident PD cases developed.
After adjusting for confounding factors, lower BMD was associated with an increased risk of PD (P for trend <0.001).
Individuals with osteoporosis had a 1.40-fold higher HR (1.40, 95% CI: 1.25-1.56) than those with a normal BMD.
Sensitivity analyses suggested the associations robust to longer lag periods and further adjustment.
These associations were prominent in individuals without AOM use before or after enrollment (P for interaction = 0.031 and 0.014).
Increased risks of PD in individuals with osteopenia and osteoporosis who did not use AOMs were attenuated by the medication use during the follow-up period, regardless of previous AOM use.
Take-home messages
Lower postmenopausal BMD and osteoporosis were associated with an increased risk of PD. In addition, this association could be mitigated using AOMs.
Proper management of BMD in postmenopausal women may help prevent PD.
3. Rhodes JR, Alldredge CT, Elkins GR. Magnitude of placebo response in clinical trials of paroxetine for vasomotor symptoms: a meta-analysis. Front Psychiatry. 2023;14:1204163.
Background
Vasomotor symptoms, or hot flashes, are among the most common complaints for menopausal and postmenopausal women.
As an alternative to hormone replacement therapy, paroxetine mesylate became the only non-hormonal treatment approved by the U.S. FDA, despite limited evidence for its efficacy.
More specifically, there is uncertainty around paroxetine’s unique benefit and the magnitude of the placebo response in clinical trials of paroxetine.
Objective
To determine the magnitude of placebo response in clinical trials of paroxetine for vasomotor symptoms by means of a meta-analysis.Design
Relevant databases were searched to identify randomized clinical trials examining the efficacy of paroxetine to treat hot flashes.
The primary outcomes of interest were hot flash frequency and hot flash severity scores.
Data was extracted from the published results, and risk of bias assessments were conducted.
Main findings
Six randomized clinical trials that included a total of 1,486 women were coded and analyzed.
The results demonstrated that 79% of the mean treatment response for hot flash frequency is accounted for by a placebo response, resulting in a mean true drug effect of 21% at most.
Additionally, 68% of the mean treatment response for hot flash severity is accounted for by a placebo response, resulting in a maximum true drug effect of 32%.
Take-home messages
The results herein call into question the actual efficacy of the only FDA approved, non-hormonal treatment for hot flashes by demonstrating that a placebo response accounts for the majority of treatment responses for reductions in both hot flash frequency and severity.
The findings provide evidence to re-evaluate the use of paroxetine to treat postmenopausal hot flashes and emphasize the importance of considering effective, alternative treatments for vasomotor symptoms.
4. Dennis N, Hobson G. Working well: Mitigating the impact of menopause in the workplace – A narrative evidence review. Maturitas. 2023;177:107824.
Background
In recent years there has been a much greater recognition by some employers of the need to support female employees experiencing the menopause; however, despite an increased awareness of the need to reduce the impact of menopause on the workforce, employers rarely have the opportunity to implement evidence-based interventions.
Objective
This evidence review aimed to provide an insight into the effectiveness of workplace programmes supporting women experiencing menopause symptoms, and to identify knowledge gaps as drivers for future research.
Design
A search for papers published in English between 2012 and 2023 was carried out on the PsycINFO, Medline, and Embase databases.
Abstract review was used to screen initial returns before a subsequent full-text review determined the final studies included.
Main findings
Twelve studies were selected for in-depth review: four conducted in the UK, seven in continental Europe and one in South America.
The findings of the papers fell into five categories: work ability, improved symptom management, mental wellbeing and empowerment, increased openness about menopause in the workplace, and the impact of management/leadership.
None of the included interventions were reported to give a significant improvement in measures of work ability.
However, there were improvements in women’s wellbeing, and their ability to manage symptoms. Interventions to improve workplace openness and managers’ skills were well received by participants.
Take-home messages
The evidence for effective workplace interventions for women experiencing menopause symptoms is currently lacking.
There is considerable need for further high-quality evaluations of interventions designed to support women in the workplace.
5. Thurman A, Hull ML, Stuckey B, Hatheway J, Zack N, Mauck C, Friend D. A phase 1/2, open-label, parallel group study to evaluate the preliminary efficacy and usability DARE-HRT1 (80 μg estradiol/4 mg progesterone and 160 μg estradiol/8 mg progesterone intravaginal RinGSM) over 12 weeks in healthy postmenopausal women. Menopause. 2023;30(9):940-946.
Background
DARE-HRT1 is an intravaginal ring (IVR) that releases 17β2-estradiol (E2) with progesterone (P4) over 28 days. It is the first combination E2 and P4 IVR being developed for the treatment of vasomotor symptoms (VMS) in healthy postmenopausal women with an intact uterus.
Objective
The exploratory objectives of this study were to evaluate the usability and acceptability and to conduct a preliminary evaluation of the efficacy of DARE-HRT1.
Design
This was a randomized, open-label, 2-arm, parallel group study in 21 healthy postmenopausal women.
Women were randomized (1:1) to either DARE-HRT1 IVR1 (E2 80 μg/d with P4 4 mg/d) or DARE-HRT1 IVR2 (E2 160 μg/d with P4 8 mg/d).
They used the assigned IVR for three 28-day cycles, inserting a new IVR monthly.
Preliminary genitourinary syndrome of menopause (GSM) treatment efficacy was estimated by measuring changes from baseline in vaginal pH, vaginal maturation index (VMI), and changes in the severity of GSM symptoms.
Preliminary systemic VMS efficacy was measured by changes in responses to the Menopause-Specific Quality of Life (MENQOL) questionnaire.
Acceptability was assessed by product experience surveys.
Main findings
Preliminary local GSM treatment efficacy was supported by significant decreases in vaginal pH and % parabasal cells, and significant increases in the overall VMI and % superficial cells for both IVR groups (all P values <0.01).
Preliminary VMS efficacy was supported by significant decreases in all domains of the MENQOL questionnaire from baseline for both dosing groups (all P values <0.01).
Take-home message
Data from this study support further development of DARE-HRT1 for the treatment of menopausal symptoms.
6. DePree B, Shiozawa A, King D, Schild A, Zhou M, Yang H, Mancuso S. Association of menopausal vasomotor symptom severity with sleep and work impairments: a US survey. Menopause. 2023;30(9):887-897.
Objective
This online survey evaluated associations between vasomotor symptom severity and perceived sleep quality and work productivity.
Design
Participants were perimenopausal or postmenopausal US women aged 40 to 65 years with ≥14 vasomotor symptom episodes per week for ≥1 week in the past month.
The women, who were recruited from Dynata panels via email invitation and categorized by vasomotor symptom severity based on the Menopause Rating Scale, were surveyed about sleep and work productivity and completed the Patient-Reported Outcomes Measurement Information System Sleep Disturbance Short Form 8b (primary outcome) and Sleep-Related Impairment Short Form 8a, Pittsburgh Sleep Quality Index, and Work Productivity and Activity Impairment questionnaire.
Main findings
Among 619 respondents (mean age, 53 y; White, 91%; perimenopausal, 34%; postmenopausal, 66%; 57.5% were never treated for vasomotor symptoms), vasomotor symptoms were mild in 88, moderate in 266, and severe in 265.
A majority (58% overall) were employed, including 64.8%, 49.6%, and 64.2% of women with mild, moderate, and severe VMS, respectively.
Of the 90.8% who reported that vasomotor symptoms affect sleep (81.8%, 86.8%, and 97.7% of those with mild, moderate, and severe VMS), 83.1% reported sleep-related changes in productivity (75.0%, 73.2%, and 94.2%, respectively).
Patient-Reported Outcomes Measurement Information System Sleep Disturbance Short Form 8b mean T scores in the mild (T score, 53.5), moderate (57.3), and severe (59.8) VMS cohorts indicated more sleep disturbance than in the general population (T score, 50; overall P < 0.001 before and after controlling for confounding variables).
Sleep-Related Impairment 8a results were similar.
Vasomotor symptom severity was positively associated with Pittsburgh Sleep Quality Index mean scores, presenteeism, absenteeism, overall work impairment, and impairment in general activities.
Take-home message
Greater vasomotor symptom severity was associated with more sleep disturbance, more sleep-related impairment, worse sleep quality, and greater impairment in daytime activities and work productivity.
7. Lara LA, Cartagena-Ramos D, Figueiredo JB, Rosa-E-Silva ACJ, Ferriani RA, Martins WP, Fuentealba-Torres M. Hormone therapy for sexual function in perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2023;8(8):CD009672.
Background
The perimenopausal and postmenopausal periods are associated with many symptoms, including sexual complaints. This review is an update of a review first published in 2013.
Objective
To assess the effect of hormone therapy on sexual function in perimenopausal and postmenopausal women.
Design
Search methods: On 19 December 2022 authors searched the Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, ISI Web of Science, two trials registries, and OpenGrey, together with reference checking and contact with experts in the field for any additional studies.
Selection criteria were randomized controlled trials that compared hormone therapy to either placebo or no intervention (control) using any validated assessment tool to evaluate sexual function.
Authors considered hormone therapy: estrogen alone; estrogen in combination with progestogens; synthetic steroids, for example, tibolone; selective estrogen receptor modulators (SERMs), for example, raloxifene, bazedoxifene; and SERMs in combination with estrogen.
Investigators used standard methodological procedures recommended by Cochrane.
They analyzed data using mean differences (MDs) and standardized mean differences (SMDs).
The primary outcome was the sexual function score, and secondary outcomes were the domains of sexual response: desire; arousal; lubrication; orgasm; satisfaction; and pain.
The certainty of the evidence was assessed using the GRADE approach.
Main findings
A total of 36 studies (23,299 women; 12,225 intervention group; 11,074 control group) were included, of which 35 evaluated postmenopausal women; only one study evaluated perimenopausal women.
The ‘symptomatic or early postmenopausal women’ subgroup included 10 studies, which included women experiencing menopausal symptoms (symptoms such as hot flushes, night sweats, sleep disturbance, vaginal atrophy, and dyspareunia) or early postmenopausal women (within five years after menopause).
The ‘unselected postmenopausal women’ subgroup included 26 studies, which included women regardless of menopausal symptoms and women whose last menstrual period was more than five years earlier.
No study included only women with sexual dysfunction and only seven studies evaluated sexual function as a primary outcome.
Authors deemed 20 studies at high risk of bias, two studies at low risk, and the other 14 studies at unclear risk of bias.
Nineteen studies received commercial funding.
Estrogen alone versus control probably slightly improves the sexual function composite score in symptomatic or early postmenopausal women (SMD 0.50, 95% confidence interval (CI) (0.04 to 0.96; I² = 88%; 3 studies, 699 women; moderate-quality evidence), and probably makes little or no difference to the sexual function composite score in unselected postmenopausal women (SMD 0.64, 95% CI -0.12 to 1.41; I² = 94%; 6 studies, 608 women; moderate-quality evidence).
The pooled result suggests that estrogen alone versus placebo or no intervention probably slightly improves sexual function composite score (SMD 0.60, 95% CI 0.16 to 1.04; I² = 92%; 9 studies, 1307 women, moderate-quality evidence).
Authors were uncertain of the effect of estrogen combined with progestogens versus placebo or no intervention on the sexual function composite score in unselected postmenopausal women (MD 0.08 95% CI -1.52 to 1.68; 1 study, 104 women; very low-quality evidence).
Also, authors were uncertain of the effect of synthetic steroids versus control on the sexual function composite score in symptomatic or early postmenopausal women (SMD 1.32, 95% CI 1.18 to 1.47; 1 study, 883 women; very low-quality evidence) and of their effect in unselected postmenopausal women (SMD 0.46, 95% CI 0.07 to 0.85; 1 study, 105 women; very low-quality evidence). In addition, also uncertain of the effect of SERMs versus control on the sexual function composite score in symptomatic or early postmenopausal women (MD -1.00, 95% CI -2.00 to -0.00; 1 study, 215 women; very low-quality evidence) and of their effect in unselected postmenopausal women (MD 2.24, 95% 1.37 to 3.11 2 studies, 1525 women, I² = 1%, low-quality evidence).
Additional uncertainty of the effect of SERMs combined with estrogen versus control on the sexual function composite score in symptomatic or early postmenopausal women (SMD 0.22, 95% CI 0.00 to 0.43; 1 study, 542 women; very low-quality evidence) and of their effect in unselected postmenopausal women (SMD 2.79, 95% CI 2.41 to 3.18; 1 study, 272 women; very low-quality evidence).
The observed heterogeneity in many analyses may be caused by variations in the interventions and doses used, and by different tools used for assessment.
Take-home messages
Hormone therapy treatment with estrogen alone probably slightly improves the sexual function composite score in women with menopausal symptoms or in early postmenopause (within five years of amenorrhoea), and in unselected postmenopausal women, especially in the lubrication, pain, and satisfaction domains.
There is uncertainty whether estrogen combined with progestogens improves the sexual function composite score in unselected postmenopausal women.
Evidence regarding other hormone therapies (synthetic steroids and SERMs) is of very low quality and we are uncertain of their effect on sexual function.
The current evidence does not suggest the beneficial effects of synthetic steroids (for example tibolone) or SERMs alone or combined with estrogen on sexual function.
More studies that evaluate the effect of estrogen combined with progestogens, synthetic steroids, SERMs, and SERMs combined with estrogen would improve the quality of the evidence for the effect of these treatments on sexual function in perimenopausal and postmenopausal women.
8. Casiraghi A, Calligaro A, Zerbinati N, Doglioli M, Ruffolo AF, Candiani M, Salvatore S. Long-term clinical and histological safety and efficacy of the CO2 laser for treatment of genitourinary syndrome of menopause: an original study. Climacteric. 2023;26(6):605-612.
Objective
To evaluate histological modifications of the vaginal mucosa after repeated microablative fractional CO2 laser treatments. As secondary objectives, authors evaluated the clinical effects associated with repeated microablative fractional CO2 laser treatments using validated questionnaires.
Design
This was a prospective intervention study performed in the Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San Raffaele Scientific Institute with 15 postmenopausal women complaining of genitourinary syndrome of menopause symptoms.
The cohort of patients had submitted to at least two previous laser treatment cycles in the past years.
The Vaginal Health Index (VHI), visual analog scale (VAS), Female Sexual Function Index (FSFI), Urinary Distress Inventory-6 (UDI-6), International Consultation on Incontinence Questionnaire – Urinary Incontinence (ICIQ-UI) and 5-point Likert scale were used.
Also, histological examinations were carried out on all samples.
Main findings
At 4 weeks after the last treatment, the VHI score and all FSFI items were significantly increased compared with baseline.
Authors observed a statistically significant decrease in both frequency and severity for all urinary symptoms after the follow-up.
There was a statistically significant increase in the number of epithelial cell layers with a consequent increase in epithelial thickness, in the number of glycogen-filled cells and in the number of papillae after the laser treatment.
No signs of fibrosis were observed as neovascularization was observed in each woman.
Take-home message
This is the first study demonstrating the histological persistency of efficacy in repeated annually laser treatment cycles, with tissue changes always leading to regenerative results without any sign of fibrosis.
9. Kim S, Kim SM, Hwang H, Kim MK, Kim HJ, Park S, Han DH. The effects of music therapy on the psychological status of women with perimenopause syndrome. Menopause. 2023;30(10):1045-1052.
Background
Women experience many physical and psychological changes with the reduction of progesterone and estrogen as ovarian function gradually weakens.
Objective
To evaluate the effect of music therapy on the psychological status of women with perimenopause syndrome. Authors applied a music psychotherapy program as a nonpharmacological treatment method in addition to treatment using drugs such as hormone therapy for perimenopausal women.
Design
This study’s pre-post, control-experimental research compared 20 women in the music psychotherapy experimental group and 20 in the cognitive behavioral therapy (CBT) control group.
The perimenopausal women aged between 40 and 60 years experienced no menstrual period for 1 year.
Authors provided eight sessions of music psychotherapy, including CBT, each lasting 60 minutes.
The study period was 4 months from the time of recruitment.
Main findings
The music therapy group showed a more significant decrease in the Menopause Rating Scale total (change over time, 9.2 points and 3.5 points, respectively; P = 0.008) and psychology subcategory (change over time, 6.5 points and 0.9 points, respectively; P = 0.004) of Menopause Rating Scale scores, compared with the CBT group.
In addition, the music therapy group increased their quality-of-life psychological score, but the CBT group did not.
Take-home messages
These results suggest that music therapy can help the psychological and emotional symptoms of perimenopausal women and is effective for treatment.
Results also provide a therapeutic basis for developing treatments for nonpharmacological mediation.
10. Alinia T, Sabour S, Hashemipour M, Hovsepian S, Pour HR, Jahanfar S. Relationship between vitamin D levels and age of menopause and reproductive lifespan: Analysis based on the National Health and Nutrition Examination Survey (NHANES) 2001-2018. Eur J Obstet Gynecol Reprod Biol. 2023;289:183-189.
Objective
To determine the association between serum vitamin D levels and age at menopause and reproductive lifespan in a group of US postmenopausal women.
Design
Data from 6,326 postmenopausal US women in the National Health and Nutrition Examination Survey (NHANES) database 2001-2018 was obtained.
Weighted multinomial logistic regression models were used to obtain odds ratios (OR) and 95% confidence intervals (CI).
Statistical analyzes were performed using SAS (version 9.4; SAS Institute), and complex survey designs were considered.
Main findings
Vitamin D deficiency was associated with a higher likelihood of early menopause (OR = 1.34, 95% CI: 1.15, 1.58; p = 0.008) and lower odds of late menopause (OR = 0.79, 95% CI: 0.52, 0.95) in the unadjusted model but not in the adjusted model.
Lower vitamin D levels were associated with a higher risk of a shorter reproductive lifespan.
The strongest association was seen in the first tertile of vitamin D deficiency (OR = 1.54; 95% CI: 1:29-1:83).
After adjustment, the associations were somewhat weakened but remained statistically significant.
Take-home messages
The results of this study suggest that vitamin D deficiency and inadequacy might be associated with earlier age at menopause.
It may also reduce the reproductive lifespan in women.
Given the cross-sectional nature of the NHANES dataset, these results should be interpreted with caution due to temporality bias.
Menopausal age is a multifactorial phenomenon, and the identification of factors and their interactions should be evaluated in future studies.
