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It gives me great pleasure to write my latest President’s report for Our Menopause World. Firstly, I would like to take the opportunity to thank my colleagues in the office, and in particular our CEO, Rebecca Cheshire, without whom our IMS activities would not be possible!
CAMS continues to go from strength to strength, capably led by Chair, Duru Shah, and Co-chairs, Antonio Cano and Fidel Siregar. We now have eight microsites for CAMS members on the IMS website (with many more to come). We are launching an online symposium series called CAMS Menopause Hour, and we will soon have a joint IMS membership offer for members of CAMS societies. These are just some of the latest highlights of our exciting CAMS initiatives; please read the latest issue of the quarterly newsletter, CAMS Connect, for further details.
Our popular IMS Webinar series is taking a summer break but will be back in September. Please remember that you can view all recordings of IMS webinars, Clinical Colloquium and sponsored symposia on the Online Events page of the IMS website. Our Interview Series videos and podcasts can be found here on the website. Our Education Committee, chaired by Peter Schnatz, is developing a sponsored symposium on the topic of Vasomotor Epidemiology and Management. This symposium will be freely available live online in the autumn. We will provide more details about the topics, speakers and registration as soon as possible.
Our educational programme continues to provide numerous opportunities for our members and wider professional menopause societies. As mentioned in my previous report, I think it is important that as a global society we reach out to regional and national societies for collaborative educational and networking opportunities. I was, therefore, delighted to be invited to deliver a virtual presentation on Premature Ovarian Insufficiency at the recent meeting of the Obstetric and Gynaecological Society of Malaysia in Penang July 21st – 23rd. One of our past Presidents, Susan Davis, also made an important contribution to the programme through her menopause case studies.
I’m very pleased to share further details about the IMS and Irish Menopause Society Joint Meeting on 16th September in Dublin. I will be lecturing along with other members of our IMS Executive, Steve Goldstein, Rossella Nappi, Ang Seng Bin and Pauline Maki. Speakers from Ireland will include Deirdre Lundy, Cath Casey and Donal Brennan. The full programme and registration can be accessed via this link.
We have been working in close partnership with the Asia Pacific Menopause Federation (APMF) scientific committee to develop the IMS educational offering at the 9th Scientific Meeting of APMF in Bali, Indonesia on 6th – 8th October. Most of the IMS Board members will be speaking at the event. Further information and registration can be accessed via this link.
The programme for our IMS symposium at the forthcoming 31st World Congress on ‘Controversies in Obstetrics, Gynecology and Infertility (COGI)’ in Vienna Nov 23rd – 25th, 2023 is also ready to view via this link. The theme of our symposium will be “Dilemmas in Day-to-day Clinical Practice”, held on 24th November, 10:20am – 12:20pm.
Our World Congress Scientific Programme Committee (SPC), chaired by Rod Baber, has been very busy creating an outstanding line-up of speakers and topics for our 19th World Congress in Melbourne, Australia on 19th – 22nd October. I am delighted to share with you details of our excellent plenary speakers who will deliver diverse topics as shown below:
Jason Abbott (AU) – Treating GSM with Laser
Karen Walker Bone (UK/AU) – Menopause in the Workplace
Priya Sumithran (AU) – Pharmacotherapy for Obesity
As President, I am honoured to be delivering the Pieter van Keep Memorial Lecture at the meeting, which will be on Premature Ovarian Insufficiency. The SPC will be meeting soon to finalise the symposia topics and speakers and the information will be passed on to you as soon as we have it. We look forward to seeing you all at the congress; we hope you will also encourage your colleagues to register for what promises to be a very special academic and social networking opportunity.
Last but by no means least, the theme for World Menopause Day 2023 is Cardiovascular Disease and my thanks to Professor Cynthia Stuenkel for authoring our White Paper. We will share the paper, consumer leaflet and promotional toolkit in advance of World Menopause Day. Do share them widely with colleagues and women in your networks.
Please continue to inform the IMS office about any regional developments and meetings you are aware of and don’t hesitate to send in your questions and suggestions about our society activities. For those of you taking well-earned vacations in August, I wish you happy holidays!
There will be a summer recess of the webinar series and we will be back again on the 19th September. Details will be available shortly.
The 34th webinar in the IMS webinar series – ‘Genetic Causes of POI’ – was held on Tuesday 11th July, moderated by Dr Wendy Wolfman. Professor Joop Laven presented on ‘Advances in POI Genetics’ and Professor Randi Hagerman presented on ‘Fragile X and POI ‘. This is now available on IMS Webinars.
The 2023/2024 Clinical Colloquium in Midlife Women’s Health sessions are available exclusively for IMS members via this link. The recordings include the latest sessions: ‘Bone health is not just bone mass’ by Steven Goldstein; ‘Breast screening and prevention’ by Lisa Larkin; ‘Cardiovascular health in midlife women’ by Peter Schnatz; and ‘A personalized treatment approach to cognitive and mood symptoms of menopause’ by Pauline Maki.
Our latest 1-1 interview series topic is ‘Menopause and work’ with Professor Kathleen Riach available here https://www.imsociety.org/education/videos/. This is available in video or podcast format.
News, Events and Meetings Around the World
26th Annual Australasian Menopause Society Congress
Date: 1st – 3rd September 2023
Venue: The Millennium, Queenstown, New Zealand
Please follow this link for more information.
The Philippine Society of Climacteric Medicine (PSCM)Annual Convention “Road to Menopause: Wellness and Longevity” and 30th Anniversary Celebration.
Date: 4th – 5th September, 2023
Venue: EDSA Shangri-La Hotel
For more information: PSCM – Philippine Society of Climacteric Medicine, Inc. (pscminc.org)
The International Menopause Society is pleased to announce a joint meeting with the Irish Menopause Society Date: 16th September, 2023 Venue: Dublin
Please follow this link to see the programme and register.
9th Scientific Meeting of Asia Pacific Menopause Federation (APMF) in conjunction with Indonesia Society of Menopause/National Congress of Indonesia Society of Menopause 2023 (PERMINESIA) with this year’s theme: “Normal Lifestyle of Menopausal Woman Post Covid-19 Pandemic”. Date: 6th – 8th October, 2023 Venue: The Stones, Kuta Bali, Indonesia
For registration: https://apmfbali2023.com
XXIV FIGO World Congress of Gynecology
Date: 9th – 12th October, 2023 Venue: Paris, France
For more information: https://figo2023.org/
Canadian Menopause Society’s 4th Biennial National Scientific Conference
Date: 10th and 11th November, 2023. Venue: Marriott Pinnacle Downtown Hotel, Vancouver
There will be reduced rates for IMS and NAMS members. Candidates from low-resource countries will receive special training rates.
For more information: https://www.cpd.utoronto.ca/sigmaconference/
French Menopause Society (GEMVI) 13th Congress
Date: 17th and 18th November, 2023 Venue: Paris (Novotel Tour Eiffel)
For more information: GEMVI
Free or Open Access with translated abstract to selected papers recently published in Climacteric
Welcome to the August issue of Climacteric. The theme for this issue is genitourinary syndrome of the menopause (GSM). We are extremely grateful to Professor Rosella Nappi, who has acted as Guest Editor for our GSM issue. The August Climacteric includes a wide range of papers covering various aspects of this topic, which we hope you will find interesting and instructive.
This issue also contains two excellent review articles and three articles of original research.
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, August issue, chosen by our Editor, Professor Rod Baber, have Free Access for the next three months.
There are also three Open Access papers in the August issue. The Abstracts from these Free Access and Open Access papers have been translated into Spanish. Professor Baber would like to thank Peter Chedraui, one of Climacteric’s Associate Editors, for providing the translations.
Spanish translation: Castelo-Branco C, Mension E, Torras I, Cebrecos I, Anglès-Acedo S. Tratamiento del síndrome genitourinario de la menopausia en sobrevivientes de cáncer de mama: principales desafíos y estrategias prometedoras. Climacteric. 2023;26(4):296-301. https://pubmed.ncbi.nlm.nih.gov/36946290/
Resumen
Muchas sobrevivientes de cáncer de mama (SCM) sufren las consecuencias de los tratamientos antineoplásicos que inducen un estado hipoestrogénico, dando lugar a síntomas climatéricos crónicos como el síndrome genitourinario de la menopausia (SGM), provocando una importante alteración en su calidad de vida. Las terapias no hormonales (TNH) son tratamientos de primera línea, seguros, pero con una eficacia moderada. Cuando se enfrenta a SGM moderado a severo, las opciones para las SCM son limitadas: terapia de estrógeno local, considerada el ‘estándar de oro’ pero con preocupaciones sobre la seguridad; andrógenos vaginales y prasterona, que parecen desencadenar una activación de los receptores de estrógenos y andrógenos de las capas del epitelio vaginal, sin activar los receptores de estrógenos en otros tejidos, siendo potencialmente seguros pero aún sin evidencia sólida a favor de SCM; láseres vaginales, que parecen mejorar la vascularización de la mucosa vaginal al estimular la remodelación del tejido conectivo subyacente, pero con resultados contradictorios de eficacia en ensayos clínicos aleatorizados recientes; y ospemifeno, un modulador oral selectivo de los receptores de estrógenos que presenta una potencia estrogénica vaginal leve y un efecto antiestrogénico a nivel del endometrio y de la mama, pero aún no se recomienda su uso en SCM en las directrices recientes de la Sociedad Norteamericana de Menopausia. Es necesario realizar más estudios que evalúen objetivamente la eficacia y la seguridad de estas prometedoras opciones terapéuticas. Por otro lado, la sexualidad debe ser vista como un tema multifactorial, donde SGM es solo una parte del problema; la evidencia muestra que la consejería sexual mejora la calidad de vida de las SCM. Finalmente, existe la necesidad de limitar el sub-diagnóstico y el sub-tratamiento del SGM en SCM; el objetivo principal de los médicos que tratan SCM con respecto a este problema debe ser proporcionar información sobre qué esperar con respecto a los síntomas genitales y sexuales de las SCM y asesorar sobre tratamientos tempranos de primera línea que pueden ayudar a prevenir un SGM más grave.
Palabras claves: Síndrome genitourinario de la menopausia; vaginitis atrófica; cáncer de mama; disfunción sexual; atrofia vulvovaginal.
Spanish translation: Kingsberg SA, Adler B, Metropoulos J, Faubion SS. El yin y el yang del SGM y el bajo deseo sexual. Climacteric. 2023;26(4):323-328. https://pubmed.ncbi.nlm.nih.gov/37083058/
Resumen
Numerosas encuestas han documentado que la sexualidad y/o la actividad sexual son importantes para las mujeres en todas las etapas de la edad adulta, incluida la postmenopausia. El síndrome genitourinario de la menopausia (SGM) y el trastorno hipoactivo del deseo sexual (THDS) son trastornos comunes en las mujeres postmenopáusicas y pueden coexistir. Ambos a menudo no se diagnostican debido a la falta de conocimiento del trastorno, la incomodidad de los profesionales de la salud al hablar de problemas sexuales o la falta de exámenes de detección de rutina. Corresponde a los profesionales de la salud identificar y diferenciar estas condiciones en las mujeres a través de una evaluación biopsicosocial y puede requerir un examen físico enfocado. Numerosos tratamientos, tanto no farmacológicos como farmacológicos, están disponibles para abordar el SGM y THDS.
Palabras clave: Disfunción sexual femenina; síndrome genitourinario de la menopausia; trastorno hipoactivo del deseo sexual; bajo deseo; atrofia vulvovaginal.
Spanish translation: Jahangirifar M, Fooladi E, Davis SR, Islam RM. Síntomas de la menopausia, disfunciones sexuales y trastornos del piso pélvico en mujeres refugiadas y solicitantes de asilo: una revisión de alcance. Climacteric. 2023;26(4):373-380. https://pubmed.ncbi.nlm.nih.gov/36779420/
Resumen
Las mujeres refugiadas y solicitantes de asilo enfrentan una variedad de desafíos de salud. Sin embargo, se sabe poco a nivel mundial sobre los problemas de salud de estas mujeres en la mediana edad y más allá, incluidos los síntomas de la menopausia, las disfunciones sexuales y los trastornos del suelo pélvico. Esta revisión de alcance tuvo como objetivo comprender estos problemas de salud desatendidos con respecto a la prevalencia y los factores de riesgo. Se realizaron búsquedas en ocho bases de datos en agosto de 2022 sin límite de año de publicación. Los datos se analizaron de forma narrativa. Se incluyeron un total de 10 informes de siete estudios con 945 mujeres que vivían en Australia, Canadá, EE. UU. y Pakistán. Tres informes se referían a la menopausia, siete a las disfunciones sexuales y uno a los trastornos del suelo pélvico. No hubo datos sobre los síntomas de la menopausia; sin embargo, las percepciones de la menopausia variaron ampliamente entre los estudios. Pocos estudios informaron una alta prevalencia de disfunciones sexuales y prolapsos de órganos pélvicos, pero ninguno de ellos utilizó un cuestionario validado. Los tabúes y los factores culturales, la falta de conocimiento y educación, la falta de apoyo familiar, la insuficiencia del idioma y los problemas financieros fueron barreras comunes para no buscar atención para estos problemas de salud. Esta revisión demuestra la falta de evidencia de estos problemas de salud desatendidos en mujeres de mediana edad refugiadas y solicitantes de asilo, y se necesitan más estudios con cuestionarios validados y muestras más grandes.
Palabras clave: Menopausia; solicitantes de asilo; trastornos del suelo pélvico; refugiados; disfunciones sexuales.
Spanish translation: Palacios S, Nappi RE, Cancelo MJ, Sánchez S, Simoncini T. Opinión de expertos sobre el tratamiento de la atrofia vulvovaginal con ospemifeno basada en nueva evidencia. Climacteric. 2023;26(4):388-391. https://pubmed.ncbi.nlm.nih.gov/37017751/
Resumen
La atrofia vulvovaginal (AVV) es una afección crónica infradiagnosticada e infratratada que provoca cambios fisiológicos e histológicos en el tracto genitourinario de las mujeres postmenopáusicas. El tratamiento de la AVV de moderada a grave incluye estrógenos locales, dehidroepiandrosterona (DHEA) y ospemifeno oral, un modulador selectivo del receptor de estrógeno (SERM) de tercera generación. Debido a problemas de seguridad relacionados con la tromboembolia venosa (TEV) clásicamente asociados con la clase SERM, y como parte de su autorización de comercialización original (ACO), la Agencia Europea de Medicamentos (AEM) solicitó la realización de un estudio de seguridad posterior a la autorización (ESPA) de 5 años para estudiar la tasa de incidencia de TEV entre mujeres que reciben ospemifeno. Los resultados han dado lugar a importantes cambios regulatorios en el etiquetado de ospemifeno, ampliando su indicación y eliminando medidas concertadas de gestión de riesgos. Un panel de expertos discutió y llegó a un consenso sobre el impacto de estos cambios regulatorios en la práctica clínica, reflexionando sobre la tranquilidad del balance beneficio-riesgo del ospemifeno y recomendando su posicionamiento como una opción de tratamiento farmacológico de primera línea para la AVV moderado a grave junto con terapias locales. En un escenario donde diferentes tratamientos presentan perfiles similares de eficacia y seguridad, una decisión compartida entre el clínico y paciente, según sus necesidades y preferencias a lo largo del tiempo, es fundamental para mejorar la adherencia y persistencia con el tratamiento secuencial, contribuyendo al logro de resultados de salud.
Palabras clave: Atrofia vulvovaginal; tratamiento de primera línea; síndrome genitourinario de la menopausia; cambios de etiqueta; ospemifeno; mujeres postmenopáusicas; seguridad; tromboembolismo venoso
Spanish translation: Bonassi Machado R, Pompei LM, Nahas EAP, Nahas-Neto J, Costa-Paiva LD, Del Debbio SYO, Badalotti M, Wender MCO, Cruz AM. Eficacia y seguridad de dosis ultrabajas de estradiol y noretisterona en mujeres postmenopáusicas brasileñas. Climacteric. 2023;26(4):401-407. https://pubmed.ncbi.nlm.nih.gov/36977423/
Resumen Objetivo: Este estudio tuvo como objetivo evaluar la eficacia y seguridad de la combinación oral continua de dosis ultrabaja de 17β-estradiol (17β-E2) y acetato de noretisterona (NETA) en mujeres brasileñas postmenopáusicas. Métodos: Se incluyeron mujeres postmenopáusicas (edad 45-60 años) con amenorrea >12 meses y útero intacto, con síntomas vasomotores moderados a severos. Los síntomas vasomotores y el sangrado endometrial se evaluaron mediante un diario durante 24 semanas, y las mujeres fueron evaluadas al inicio y al final. Resultados: Se incluyeron un total de 118 mujeres. El grupo tratado con 0.5 mg de 17β-E2/0.1 mg de NETA (n = 58) mostró una reducción porcentual del 77.1% en la frecuencia de síntomas vasomotores frente al 49.9 % en el grupo placebo (n = 60) (p = 0.0001). La puntuación de severidad mostró una reducción en el grupo de tratamiento en comparación con el placebo (p < 0.0001). Los eventos adversos fueron comparables entre los grupos; sin embargo, en el grupo de 0.5 mg de 17β-E2/0.1 mg de NETA hubo más quejas de sangrado vaginal; a pesar de eso, en la mayoría de los ciclos en ambos grupos de tratamiento, más del 80% de las mujeres experimentaron amenorrea. Conclusiones: La combinación de 0.5 mg de 17β-E2/0.1 mg de NETA en un régimen de combinación continua se mostró eficaz en la reducción de la frecuencia y la severidad de los síntomas vasomotores en mujeres postmenopáusicas brasileñas.
1. Rahnavardi M, Khalesi ZB, Rezaie-Chamani S. Effects of lifestyle on sexual function among postmenopausal women. Afr Health Sci. 2021;21(4):1823-1829.
Background
A healthy lifestyle has a key role in reducing health problems. Since one of the most common problems in Postmenopausal women has been sexual dysfunction (SD).
Objective
To identify the effects of health-promoting lifestyle (HPL) on sexual function among postmenopausal women.
Design
This was a cross-sectional, descriptive, and analytical study conducted on 405 postmenopausal women aged 45-60 years, using the convenience sampling method.
Data collection was done using three questionnaires of demographic, health-promoting lifestyle profile-II (HPLP-II) and female sexual function index (FSFI).
Data were analyzed in the SPSS-16 using Pearson’s correlation coefficient.
The statistical significance level was regarded as less than 0.05.
Main findings
In general, the result of this study identified a 68% prevalence of SD among participants.
The mean score obtained from the HPLP II was 2.27 (SD = 0.42), the highest score of its sub-scales was spiritual growth and the lowest score was physical activity.
The mean score of FSFI among the studied women was 23.16 (SD = 0.29), the highest score of six sub-scales was satisfaction and the lowest score was lubrication among participants.
A strong correlation was found between the total FSFI scores, and spiritual growth (r=0.048), interpersonal relations (r=0.02), stress management (r=0.000), (p<0.0001).
Take-home messages
The results of the study revealed that a healthy lifestyle affects sexual function.
Given that a healthy lifestyle is one of the most important ways to help women overcome SD, a healthy lifestyle promoting interventions necessary for postmenopausal women.
2. Wen H, Lin X, Sun D. The association between different hormone replacement therapy use and the incidence of lung cancer: a systematic review and meta-analysis. J Thorac Dis. 2022;14(2):381-395.
Background
Many peri- and postmenopausal women use hormone replacement therapy (HRT) to relieve menopausal symptoms: however, the side effects of different HRT use (ever/current/former vs. never HRT use) on lung cancer risk in women are not completely consistent.
Objective
To examine, through a meta-analysis, the connection between current, former or ever HRT use and the incidence of lung cancer among women.
Design
The authors systematically searched the PubMed, Web of Science, EMBASE, Cochrane Library, SCOPUS, China National Knowledge Infrastructure, Wanfang and VIP databases to identify relevant articles published from the inception of the respective databases to February 18, 2022, regarding the relationship between different HRT use and the incidence of lung cancer among women.
Relevant risk estimates [relative risks (RRs), odds ratio (OR)] were combined based on specific study types.
The Newcastle-Ottawa Scale was used to evaluate the quality of included studies.
This analysis was registered in the International prospective register of systematic reviews (PROSPERO; CRD42020219728) and publication bias was tested based on Egger’s and Begg’s tests.
Main findings
A total of 22 studies (13 prospective cohort studies and 9 case-control studies) were included, comprising 911,194 participants and 17,329 patients.
Compared to never HRT users, in pooled cohort studies, current HRT users had a statistically decreased risk of lung cancer [RR 0.91, 95% confidence interval (CI): 0.86-0.97, I2=22.9%], and similar results were found among the postmenopausal women with current HRT use (RR 0.91, 95 CI: 0.85-0.98, I2=36%), while in pooled case-control studies, ever HRT users had a decreased risk of incidence of lung cancer [odds ratio (OR) 0.75, 95% CI: 0.69-0.81, I2=0%] as did female non-smokers with ever HRT use (OR 0.76, 95% CI: 0.66-0.87, I2=36.8%).
Take-home messages
Current or ever HRT use is partly correlated with the decreased incidence of lung cancer in women.
Concerns about the incidence of lung cancer can be reduced when perimenopausal and postmenopausal women use current HRT to reduce menopausal symptoms.
Meanwhile, given the roles of hormone receptors and relevant genes single nucleotide polymorphism (SNPs) among females, HRT use should be cautiously administered and individualized.
3. La New JM, Borer KT. Effects of Walking Speed on Total and Regional Body Fat in Healthy Postmenopausal Women. Nutrients. 2022;14(3):627.
Objective
The study had two aims: (1) To confirm the efficacy of exercise speed and impulse (session duration at a given speed) to produce total and abdominal fat loss in postmenopausal women, and (2) compare the exercise speed and impulse necessary for the stimulation of fat loss to the suppression of bone mineral loss.
Of special interest was to compare these parameters of exercise on fat loss in the same study and with the same subjects where they were found to suppress bone mineral loss.
The authors hypothesized that (1) more total fat will be lost with slow walking and a longer impulse than with fast speed and shorter impulse, and (2) more abdominal subcutaneous (SC) and visceral fat (VF) will be lost with fast walking speed.
Design
Fat loss and suppression of bone mineral loss were measured in the same 25 subjects after 15 weeks, and fat measurements were also taken after 30 weeks in 16 residual subjects.
Study parameters were walking a 4.8 km distance 4 days/week at either 6.6 km/h (120% of ventilatory threshold (VT)) or at 5.5 km/h (101.6% of VT) and expending 300 kcal/session.
Body composition (fat and lean body mass, LBM) was measured with dual-energy X-ray absorptiometry (DXA) and anthropometric methods.
Main findings
Slow walkers in the residual group progressively lost a significant percent of total body fat over 30 weeks while no such loss occurred after 15 weeks in fast walkers in either group, supporting hypothesis 1.
However, the 20% higher starting body fat in 16 residual slow relative to fast subjects suggests that exercise fat loss is greater in overweight than in lean subjects.
In fast walkers, fat loss occurred after 30 weeks of training.
Hypothesis 2 was not supported as both speeds led to equal VF loss in 30-week group as estimated by waist circumference (CF) confirming that VF responds to the magnitude of energy expenditure and not the walking speed.
Take-home messages
Total body fat is lost through walking at all speeds, but the change is more rapid, clear, and initially greater with slow walking in overweight subjects.
A longer exercise impulse at a lower speed in our study initially produced greater total fat loss than a shorter one with fast walking speed.
This was reversed in comparison to how the same exercise in the same subjects suppressed bone mineral loss.
Data from other studies indicate that longer impulses may promote greater fat loss at both slow and high exercise speeds, and our study providing only a 4.8 km walking distance may have limited the walking impulse and the magnitude of fat loss.
Increased exercise energy expenditure at either walking speed produces equivalent declines in visceral fat in postmenopausal women, and with sufficiently long impulses, should reduce disabilities associated with central obesity.
4. Han Y, Colditz GA, Toriola AT. Changes in adiposity over the life course and gene expression in postmenopausal women. Cancer Med. 2022;11(13):2699-2710.
Background
Early life adiposity and changes in adiposity over the life course are associated with mammographic breast density among postmenopausal women; however, the underlying mechanisms are unknown.
Objective
To comprehensively examine the associations of early life body mass index (BMI) and changes in BMI from ages 10, 18 to age at mammogram with growth factor, RANK pathway, and sex hormone gene expression in 372 postmenopausal women.
Design
The authors estimated early life BMI at age 10 using the validated 9-level Stunkard pictogram.
They calculated BMI at other ages (18, 30, and current age at mammogram) by dividing weight in kilograms at these ages with height in meters squared.
Sequencing for gene expression was performed using the NanoString nCounter system.
After adjusting for confounders, the authors estimated associations using multivariable linear regressions.
Main findings
A 10 kg/m2 increase in early life BMI at age 10 was associated with a 17.2% decrease in RANKL gene expression (95% confidence interval [CI] = -30.8, -0.9) but was not associated with changes in other markers.
BMI changes from ages 10, 18 to age at mammogram were associated with an increase in BMP2 and decreases in RANK, RANKL, and TNFRSF13B gene expression but were not associated with gene expression of other markers.
A 10 kg/m2 increase in early life BMI from age 10 to current age was associated with a 7.8% increase in BMP2 (95% CI = -1.4, 17.8), an 8.5% decrease in RANK (95% CI = -13.9, -2.8), a 10.4% decrease in RANKL (95% CI = -16.9, -3.3), and an 8.5% decrease in TNFRSF13B gene expression (95% CI = -13.8, -2.8).
Take-home message
The results provide new insights into the biological mechanisms underlying the associations of adiposity changes from early life to adulthood and early life adiposity with mammographic breast density in postmenopausal women.
5. Blümel JE, Mezones-Holguín E, Chedraui P, Soto-Becerra P, Arteaga E, Vallejo MS. Is premature ovarian insufficiency associated with mortality? A three-decade follow-up cohort. Maturitas. 2022;163:82-87.
Objective
To evaluate the association between premature ovarian insufficiency (POI) and mortality.
Design
This was a secondary analysis of a long-term cohort of Chilean women who received preventive health care between 1990 and 1993.
The exposure variable was POI and the outcome was death, and follow-up time was 30 years.
Patient data were extracted from medical records.
Data related to deaths were obtained from the records of the official government registry as of January 2021.
Cox regression proportional hazard models were used to estimate crude and adjusted hazard ratios (HR) and 95 % confidence intervals (CI).
Main findings
Data for a total of 1119 women were included in the analysis.
Median age was 47 years (interquartile range: 44-52).
The baseline prevalence of POI was 6.7 %.
At the end of the follow-up, 34.7 % of women with POI had died, compared with 19.3 % of women without the condition (p < 0.001).
A larger proportion of women with POI died from cardiovascular disease (12.0 % vs. 5.1 %; OR: 2.55, 95 % CI: 1.21-5.39) whereas there was no significant difference in cancer mortality (6.7 % vs. 7.7 %; OR: 0.86, 95 % CI: 0.34-2.19).
In the adjusted Cox model, POI was among the main factors associated with mortality (hazard ratio [HR] 1.60, 95 % CI: 1.03-2.47), after diabetes (HR 2.51, 95 % CI: 1.40-4.51) and arterial hypertension (HR 1.75, 95 % CI: 1.29-2.37).
Take-home message
Although POI affects a small group of women, its association with mortality seems to be relevant; hence it is necessary to implement measures that reduce this risk.
6. Blümel JE, Aedo S, Arteaga E, Vallejo MS, Chedraui P. Factores de riesgo de artrosis de rodilla, cadera o ambas en mujeres chilenas de mediana edad: un estudio de cohorte de tres décadas [Risk factors for the development of osteoarthritis in middle-aged women]. Rev Med Chil. 2022;150(1):46-53.
Background
Osteoarthritis (OA) is a health problem affecting millions of individuals worldwide.
Objective
To evaluate risk factors for hip and knee osteoarthritis (OA) in women aged 40 to 59 years.
Design
Analysis of a prospective cohort of 1159 women attending preventive health care programs and followed during 28 years.
They underwent a clinical and laboratory evaluation from 1990 to 1993.
The diagnosis of OA was retrieved from registries of a special program for osteoarthritis in 2020.
Main findings
Twenty-four percent of participants developed osteoarthritis during the follow-up.
At the beginning of the study and compared with women without OA, they were older (median [interquartile range or IQR]: 49.6 [8.5] and 47.2 [8.2] years respectively), had a higher body mass index (26.3 [5.3] and 25.1 [5.3] respectively), and a higher frequency of jobs with low qualification (76 and 62% respectively).
The presence of type 2 diabetes mellitus, chronic hypertension, a previous history of alcohol or cigarette consumption, postmenopausal status and lipid and glucose blood levels did not differ between women with or without OA.
Cox regression showed a final model that incorporates body mass index (hazard ratio (HR): 1.04; 95% confidence intervals (CI): 1.01-1.07), age (HR: 1.05; 95% CI: 1.03-1.08) and having an unqualified job (HR: 1.88; 95% CI: 1.43-2.47) as risk factors for OA.
Take-home message
Obesity and the type of job are the most relevant risk factors found for OD: both may be modified with proper care.
7. Nasr A, Matthews K, Janssen I, Brooks MM, Barinas-Mitchell E, Orchard TJ, Billheimer J, Wang NC, McConnell D, Rader DJ, El Khoudary SR. Associations of Abdominal and Cardiovascular Adipose Tissue Depots With HDL Metrics in Midlife Women: the SWAN Study. J Clin Endocrinol Metab. 2022;107(6):e2245-e2257.
Background
The menopause transition is accompanied by declines in the atheroprotective features of high-density lipoprotein (HDL), which are linked to deleterious cardiovascular (CV) outcomes.
Objective
To assess the relationship between abdominal and CV visceral adipose tissues (VAT) with future HDL metrics in midlife women, and the role of insulin resistance (IR) on these associations.
Design
Temporal associations compared abdominal and CV fat with later measures of HDL metrics.
This community-based cohort comprised 299 women, baseline mean age 51.1 years (SD: 2.8 years), 67% White, 33% Black, from the Study of Women’s Health Across the Nation (SWAN) HDL ancillary study.
Exposures included volumes of abdominal VAT, epicardial AT (EAT), paracardial AT (PAT), or perivascular AT (PVAT).
Main outcomes included HDL cholesterol efflux capacity (HDL-CEC); HDL phospholipids (HDL-PL), triglycerides (HDL-Tgs), and cholesterol (HDL-C); apolipoprotein A-I (ApoA-I), and HDL particles (HDL-P) and size.
Main findings
In multivariable models, higher abdominal VAT was associated with lower HDL-CEC, HDL-PL, HDL-C, and large HDL-P and smaller HDL size.
Higher PAT was associated with lower HDL-PL, HDL-C, and large HDL-P and smaller HDL size.
Higher EAT was associated with higher small HDL-P.
Higher PVAT volume was associated with lower HDL-CEC.
The Homeostatic Model Assessment of Insulin Resistance partially mediated the associations between abdominal AT depots with HDL-CEC, HDL-C, large HDL-P, and HDL size; between PVAT with HDL-CEC; and PAT with HDL-C, large HDL-P, and HDL size.
Take-home messages
In midlife women, higher VAT volumes predict HDL metrics 2 years later in life, possibly linking them to future CV disease.
Managing IR may preclude the unfavorable effect of visceral fat on HDL metrics.
8. Mishra SR, Waller M, Chung HF, Mishra GD. Association between reproductive lifespan and risk of incident type 2 diabetes and hypertension in postmenopausal women: Findings from a 20-year prospective study. Maturitas. 2022;159:52-61.
Objective
To examine the association between reproductive lifespan and incident type 2 diabetes mellitus (T2DM) and hypertension in mid-age women; also to explore the combined effect of reproductive lifespan and body mass index (BMI) on the risks of T2DM and hypertension.
Design
Reproductive lifespan was defined as the difference between age at menopause and age at menarche, and categorized as <35, 35-37, 38-40, and ≥41 years based on the quartile distribution.
A multivariable Cox proportional hazard regression was used, adjusting for socio-demographic, lifestyle, and reproductive factors.
Main findings
Of 6357 postmenopausal women included (mean [SD] age at last follow-up, 66.3[3.3] years), a total of 655 developed incident T2DM (10.3%) and 1741 developed hypertension (30.0%) during 20 years of follow-up. The total sample had a mean (SD) reproductive lifespan of 37.9 (4.5).
Compared with the women who had a reproductive lifespan of 38-40 years, those with a short reproductive lifespan (<35 years) had a 30% increased risk of T2DM and twice the risk of hypertension.
Under the combined model, women who had a short reproductive lifespan (<35 years) and who had a BMI ≥30 kg/m2 at baseline showed a higher risk of T2DM (HR: 6.30, 95% CI: 4.41-8.99) and hypertension (HR: 6.06, 4.86-7.55) compared with women who had a reproductive lifespan of 38-40 years and a BMI < 25 kg/m2.
Take-home messages
A higher risk of both incident T2DM and hypertension at midlife was found among women experiencing a shorter reproductive lifespan, with pronounced risk for women experiencing both a short reproductive lifespan (<35 years) and a higher baseline BMI (≥30 kg/m2).
Women with a short reproductive lifespan may benefit from maintaining healthy body weight in midlife.
9. Ryu KJ, Park H, Park JS, Lee YW, Kim SY, Kim H, Lee YJ, Kim T. Vasomotor symptoms and carotid artery intima-media thickness among Korean midlife women. Maturitas. 2022;159:1-6.
Objective
To evaluate the association between vasomotor symptoms (VMS) and carotid intima-media thickness (CIMT) in Korean midlife women.
Design
This was a cross-sectional study that included 918 Korean women aged 45-65 years who attended their routine health checkup at a single institution between 2013 and 2016.
All participants’ results on the Menopause Rating Scale were used to assess the VMS.
Severe and very severe VMS were combined into severe VMS.
CIMT and blood flow velocities were measured on the common carotid arteries using duplex ultrasound.
Main findings
Overall, participants’ mean age was 54.73 ± 5.37 years, and 627 (68.3%) were postmenopausal.
A total of 401 (43.7%) women reported VMS: 217 (23.6%), mild; 109 (11.9%), moderate; and 75 (8.2%), severe.
The mean CIMT was 0.062 ± 0.017 mm and 0.064 ± 0.019 mm in premenopausal and menopausal women, respectively.
In the multivariate linear regression analysis, the CIMT of women with moderate VMS was 0.102 mm (95% confidence interval [CI] = 0.002-0.009) more than that of women with no VMA, and the CIMT of women with severe VMS was 0.246 mm (95% CI = 0.012-0.021) more than that of women with no VMS, after adjusting for several confounders, including age, body mass index, and lifestyle factors.
Severe VMS were associated with the risk of thickened CIMT (≥0.075 mm) and/or plaques (odds ratio = 2.90, 95% CI = 1.74-4.84) in the logistic regression analysis after adjusting for the same variables.
Take-home messages
Moderate and severe VMS are independently associated with increased CIMT in otherwise healthy Korean midlife women.
Clinicians managing midlife women with bothersome VMS should consider screening for subclinical cardiovascular diseases.
10. Yeo JH, Kim MT. Association of weight, smoking, and alcohol consumption with age at natural menopause. J Women Aging. 2022 Mar 21:1-11.
Background
In South Korea, rapid economic growth and modernization have led to changes in lifestyle factors that may affect age at natural menopause.
Objective
To examine the association of weight, smoking, and alcohol consumption with age at natural menopause.
Design
Data from 4,793 women aged ≥55 years, who had a natural menopause, were analyzed from the Korea National Health and Nutrition Examination Survey (2013-2017).
Multinomial logistic regression was used to examine the association between lifestyle factors and age at natural menopause after adjusting for birth cohort (Model 1) and sociodemographic and reproductive factors (Model 2).
Main findings
Overall, 3.1% of women experienced premature menopause (<40 years), 7.6% early menopause (40-44 years), and 12.8% late menopause (≥55 years).
Women born in the 1940s or earlier among the birth cohorts had the highest prevalence of premature (70.0%), early (58.5%), and late (43.1%) menopause.
In Model 2, current smoking (odds ratio = 3.99 and 95% confidence interval = 1.35-11.81) was associated with premature menopause. Low (<18.5 kg/m2) and high (≥25 kg/m2) body mass index were associated with early (odds ratio = 2.30 and 95% confidence interval = 1.01-5.22) and late (odds ratio = 1.38 and 95% confidence interval = 1.10-1.72) menopause respectively.
Conversely, there was no association between age at natural menopause and alcohol consumption.
Take-home messages
The results suggest that healthy lifestyle factors, such as not smoking and proper weight maintenance, are significant factors affecting age at natural menopause.
The findings may help develop health policies and provide targeted care to improve women’s health after midlife.
