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I hope this update finds you well during these turbulent times for the world.
Firstly, I would like to report on our recent meeting in Costa Rica with the IMS Board.
I am delighted to say we were admirably hosted by Dra Sonia Cerdas and her colleagues; it was an excellent academic and networking opportunity.
Following our Board meeting, the IMS Board contributed to the programme of the Costa Rican Society of Climacteric, Menopause and Osteoporosis (ACCMYO) Congress.
The feedback from this meeting was extremely positive. We also had the opportunity to meet key opinion leaders from other Latin American countries, including Argentina, Brazil Guatemala, Nicaragua, and Panama.
This was important not only to consolidate our relationships with our affiliated societies in these countries, but also to lay down the pathways to future successful World Congresses in Melbourne, Australia later this year, and in Rio, Brazil in 2026.
We also look forward to actively contributing to the FLASCYM meeting in Cartagena, Colombia next year, possibly with a pre-Congress IMPART course.
We are currently processing the information you have kindly provided regarding our IMPART programme and membership requirements and will try to ensure that we implement your advice from these surveys.
Our outreach continues to grow, both in terms of our membership (we now have members in 89 countries) and in terms of our affiliated societies (we now have CAMS representation in 63 countries). This is vital if we are to achieve our IMS mission and vision, in particular to disseminate evidence-based information on menopause and midlife women’s health to the four corners of the globe.
At a time when the subject of menopause is at the forefront of the health agenda in many countries, and yet continues to create controversy and polarise the views of healthcare providers as to how it should be managed, this is important.
My view, and that of the IMS, is that each woman should be empowered to manage her individual transition through the menopause via the provision of clear individualised information, and ideally a full range of treatment options.
Clearly this will depend on access to education and resources, which governments should prioritise in this UN designated “Decade of Healthy Ageing”.
We are currently preparing an editorial for Climacteric which will act as a “call to action” regarding the latest publicity on menopause management.
Subsequent publication of updated POI guidelines and the World Menopause Day White Paper on MHT and Recommendations on Menopause will act as blueprints for our members and others concerned with optimising women’s health. This information will be disseminated with locally relevant, translated information by our CAMS network.
All of these publications will, of course, complement our excellent online academic programme in which so many of you continue to actively participate.
We will also be providing easily digestible direct-to-consumer information through Menopause Info and publicity campaigns; these activities are vital if we are to achieve implementation of all our educational aims.
Our planned “Manual of Operations” will ensure that governance and transparency are at the forefront of IMS procedures.
We hope you have enjoyed reading the 4th issue of CAMS Connect. CAMS is the lifeblood of the IMS and through the Toolkit for Starting a Menopause Society and the Helping Hands Programme we expect the number of societies to steadily grow. We encourage you to continue submitting CAMS microsites and your proposals for national and regional CAMS Menopause Hour webinars.
We now look forward to one of the next major global women’s health events, which will be the ISGE meeting in Florence, May 8th-11th 2024 where the IMS will hold an Executive meeting, as well as representation on the academic programme. We are also planning to have IMS representation at the following meetings later this year in the lead up to our World Congress:
British Menopause Society Annual Meeting, Jun 27th/28th
ESHRE Congress, Amsterdam, Jul 7th-10th
Philippine Society of Climacteric Medicine, Annual Convention Sep 2nd/3rd
Jordanian Society of Obstetrics and Gynaecology Meeting, Sep 4th-6th
The Menopause Society Meeting, Sept 11th-14th
Menopause Society of Ireland Meeting, Sep 14th
Beijing OBGYN Capital Medical University Meeting, Sep 24th
The programme for our IMS Congress in Melbourne October 19th-22ndis now almost complete and we encourage you all to register for this premier global menopause event.
I’m delighted to announce that there are Young Scholar Travel Bursary awards available to attend the IMS Congress for both young scientists and clinicians. Application details have already been circulated to our membership and are also available via this link.
Also a reminder that nominations are open for the IMS Wulf Utian CAMS Award for Achievement in Furthering Women’s Health. This award recognises any individual member of an IMS affiliated menopause society who has demonstrated exceptional work to further education on menopause in their country. The nomination form is available via this link.
Finally, we would value any constructive feedback that you have regarding the direction in which we are taking your society. We will use your valuable input to guide our activities in optimising women’s menopause and midlife health.
The 41st webinar in the IMS series will be ‘Non-pharmacological Interventions for VMS’ to be held on Tuesday 16th April 3pm CEST. It will be moderated by Professor Peter Schnatz. Professor Myra Hunter will present ‘Cognitive Behavioral Therapy’ and Dr Gary Elkins will present ‘Hypnosis’. For information and booking visit the IMS website.
The 40th webinar in the IMS series ‘Non-hormonal Pharmacological Interventions for VMS’ was held on Tuesday 19th March and moderated by Professor Wendy Wolfman. Professor Chrisandra Shufelt presented ‘The Menopause Society Guidelines’ and Professor Petra Stute presented ‘New Therapeutic Strategies Addressing KNDy Neurons’ 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; and ‘A personalized treatment approach to cognitive and mood symptoms of menopause’ by Pauline Maki, ‘Pharmaceutical Management of Early Menopause Symptoms’ with Tobie de Villiers, ‘Non-pharmaceutical Approaches to Treating Menopausal Symptoms: What Does the Evidence Tell us’ with Carolyn Ee, ‘GSM Pelvic Floor Health’ with Tim Hillard, ‘Premature Ovarian Insufficiency: Unique and Underappreciated’ with Nick Panay, ‘Obesity and its Emerging Importance in Midlife Women with Ang Seng Bin and ‘A Midlife Women’s Health Unit: How to Organise it’ with Wendy Wolfman.
1-1 Interview Series with Marla Shapiro
Our latest interview ‘Preventing Bone Loss at Menopause’ with Dr Michael McClung is available via this link. This is available in a video or podcast format. All IMS podcasts are also available on Spotify.
Online Symposium
An online symposium ‘Vasomotor Epidemiology and Challenges in the Workplace’ will be held on 15th May at 3pm CEST. Supported by Astellas, the symposium will be moderated by Professor Peter Schnatz and Professor Wendy Wolfman. Professor Rebecca Thurston will present ‘Vasomotor Symptoms: Epidemiology and pathophysiology’, Professor Rossella Nappi will present ‘Hormonal Management of Vasomotor Symptoms’ and Professor Petra Stute will present ‘Non-hormonal Management of Vasomotor Symptoms’. Registration will open one month before the event via this link.
CAMS Menopause Hour
The next CAMS Menopause Hour will be a panel discussion from the Mexican Menopause Society. The topic is ‘Genitourinary Syndrome of Menopause’ and it will be held on the 25th April at 3pm CEST.
It will be moderated by Prof Víctor Manuel Vargas Hernández. Dr Erika Torres Valdez will present ‘Urological Alterations that Occur in Women with Urogenital Syndrome and Preventive Measures and Conservative Management’, Dr Gerardo Andres Alba Jasso will present ‘Development of Urogenital Syndrome and Different Hormonal Treatments’ and Dr Víctor Manuel Vargas Aguilar Vargas will present ‘Oncological Risk in Patients, Making Differential Diagnoses with Other Pathologies of the Urogenital Syndrome, and the Risks or Benefits in Oncological Patients Who Develop the Syndrome’.
This CAMS Menopause Hour will be presented in Spanish. A recording will be available on the IMS website after the event with English subtitles.
Applications are invited for the 19th World Congress on Menopause Young Scholars’ Bursary. The World Congress will be held on 19th-22nd October 2024 in Melbourne, Australia.
We are also pleased to announce the following updates:
The number of bursaries available has increased.
The eligibility requirements have expanded.
The deadline has been extended.
Click here to download the application form and for further details. Please share this information with your colleagues and widely across your networks.
Wulf Utian Council of Affiliated Menopause Societies (CAMS) Award for Achievement in Furthering Women’s Health
The Wulf Utian CAMS Award is now open for nominations. Information about the award and how to nominate can be found via this link.
The closing date for nominations is 18th June 2024.
Henry Burger Award
The Henry Burger Award is given to the investigator who is determined to have published the most significant contribution(s) to the field of menopause in basic science or clinical studies in the previous five years prior to the World Congress. Nominations will open on 18th April and more information can be found via this link.
Free or Open Access with translated abstract to selected papers recently published in Climacteric
Welcome to the April 2024 issue of Climacteric, which is the first issue for our new Editor-in-Chief, Dr Tim Hillard. His editorial (link below) sets out the journal’s plans for the next eighteen months.
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, April issue, chosen by our Editor-in-Chief, Dr Tim Hillard, have Free Access for the next three months.
There are also two Open Access papers in this 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. Climacteric’s Editor-in-Chief, Dr Tim Hillard, would like to thank Peter Chedraui, one of our Associate Editors, for providing these translations.
https://pubmed.ncbi.nlm.nih.gov/38251874/ https://www.tandfonline.com/doi/full/10.1080/13697137.2024.2302429Resumen
La menopausia es una transición cardiometabólica en la que muchas mujeres experimentan aumento de peso y redistribución de la grasa corporal. Los cambios hormonales pueden afectar también varias dimensiones del bienestar, incluida la función sexual, con una alta tasa de disfunción sexual femenina (DSF), que muestra una etiología multifactorial. Los factores biológicos más importantes van desde la inflamación crónica de bajo grado, asociada con adipocitos hipertróficos que pueden traducirse en disfunción endotelial y compromiso del flujo sanguíneo a través del sistema genitourinario, hasta la resistencia a la insulina y otros mecanismos neuroendocrinos que apuntan a la respuesta sexual. Los factores psicosociales incluyen una mala imagen corporal, trastornos del estado de ánimo, baja autoestima y satisfacción con la vida, así como la salud de la pareja y la calidad de la relación, y el estigma social. Incluso los estilos de vida poco saludables, las enfermedades crónicas y los supuestos medicamentos vinculados al peso pueden influir. El objetivo de la presente revisión narrativa es actualizar y resumir el estado del arte sobre el vínculo entre la obesidad y la DSF en mujeres postmenopáusicas, señalando la escasez de estudios de alta calidad y la necesidad de realizar más investigaciones con puntos finales validados para evaluar ambos. Biomarcadores de obesidad y DSF. Además, brindamos información general sobre el diagnóstico y tratamiento de la DSF en la menopausia con un enfoque en intervenciones dietéticas, actividad física, medicamentos contra la obesidad y cirugía bariátrica.Palabras claves: Función sexual; intervenciones contra la obesidad; disfunción sexual femenina; menopausia; obesidad; exceso de peso.
Resumen Objetivo: La artralgia es un síntoma menopáusico común en mujeres de mediana edad y sus causas aún no están claras. Examinamos la prevalencia de la artralgia menopáusica con varios factores, incluida la calidad del sueño, la depresión/ansiedad, la fuerza muscular y el rendimiento físico entre mujeres de mediana edad de Singapur. Método: El Programa Integrado de Salud de la Mujer (PISM) estuvo compuesto por 1,120 mujeres sanas que vivían en la comunidad de etnias china, malaya o india (de 45 a 69 años) que asistían a clínicas de salud para mujeres en el Hospital Universitario Nacional de Singapur. Los datos sociodemográficos, menopáusicos, reproductivos y de salud se obtuvieron con cuestionarios validados. Se midió la fuerza muscular, el rendimiento físico y la absorciometría de rayos X de energía dual. Las mujeres con síntomas de moderados a muy graves según la Escala de calificación de la menopausia (MRS) se clasificaron como tener artralgias. Los análisis de regresión logística multivariable examinaron los factores de riesgo de artralgia. Resultados: Un tercio de las participantes refirió artralgia, y el 12.7%, 16.2% y 71.2% se encontraban en el período premenopáusico, perimenopáusico y postmenopáusico, respectivamente. Los síntomas de la menopausia, como sequedad vaginal (odds ratio ajustado [aOR]: 2.64, intervalo de confianza [IC] del 95%: 1.64, 4.24) y agotamiento físico/mental (aOR: 2.83, IC del 95%: 1.79, 4.47), fueron factores de riesgo independientes de artralgia. La fuerza muscular deficiente (aOR: 2.20; IC del 95%: 1.29, 3.76), la obesidad (aOR: 1.94; IC del 95%: 1.13; 3.32) y la artritis reumatoide (aOR: 7.73; IC del 95%: 4,47, 13.36) también fueron factores independientes asociados con artralgia después del ajuste por factores de confusión. Conclusiones: La artralgia en mujeres singapurenses de mediana edad se asoció con síntomas menopáusicos de sequedad vaginal y agotamiento físico y mental. Las mujeres con poca fuerza muscular tenían más probabilidades de experimentar artralgia menopáusica.
Palabras clave: Artralgia; Programa Integrado de Salud de la Mujer; dolor articular y muscular; menopausia; fuerza muscular.
Resumen
El síndrome genitourinario de la menopausia (SGM) afecta hasta al 84% de las mujeres postmenopáusicas y puede reducir significativamente la calidad de vida de algunas. Para aliviar los síntomas, existen varios productos vaginales hormonales y no hormonales disponibles. En Europa, el estriol vaginal (E3) es el estrógeno elegido con mayor frecuencia para el tratamiento del SGM. El objetivo de esta revisión sistemática fue evaluar el impacto del E3 vaginal en los niveles séricos de hormonas sexuales, un resultado que se ha utilizado previamente para evaluar la seguridad en productos similares. En nuestra revisión, no encontramos ninguna alteración en los niveles séricos de estrona, estradiol, testosterona, progesterona y globulina fijadora de hormonas sexuales después de la aplicación vaginal de E3. Por el contrario, algunos estudios mostraron una disminución mínima y transitoria de los niveles séricos de gonadotropinas, que sin embargo se mantuvieron dentro del rango postmenopáusico. De manera similar, sólo unos pocos estudios informaron un aumento mínimo y transitorio de los niveles séricos de E3, y el resto no informó cambios. La falta de cambios clínicamente relevantes a largo plazo en los niveles séricos de hormonas sexuales respalda la literatura actual que proporciona evidencia sobre la seguridad de los productos vaginales E3.
Palabras clave: Estriol vaginal; síndrome genitourinario de la menopausia; menopausia; seguridad; nivel hormonal sérico.
Resumen Objetivo: El estetrol (E4) representa un nuevo estrógeno de interés para aliviar los síntomas vasomotores. E4 activa el receptor nuclear de estrógeno α (ER-α), pero antagoniza la vía de señalización de esteroides iniciada por membrana dependiente de estradiol ER-α. Las distintas propiedades farmacológicas del E4 podrían explicar su bajo impacto sobre la hemostasia. Este estudio tuvo como objetivo evaluar el efecto de E4 sobre la coagulación en mujeres postmenopáusicas, utilizando el ensayo de generación de trombina (EGT). Método: Los datos se recopilaron de un estudio multicéntrico, aleatorizado, controlado con placebo, de búsqueda de dosis en mujeres postmenopáusicas (NCT02834312). Se administró E4 oral (2.5 mg, n = 42; 5 mg, n = 29; 10 mg, n = 34; o 15 mg, n = 32) o placebo (n ‘= 31) diariamente durante 12 semanas. Se extrajeron los trombogramas y los parámetros EGT de cada sujeto al inicio del estudio y después de 12 semanas de tratamiento. Resultados: Después de 12 semanas de tratamiento, todos los grupos de tratamiento mostraron un trombograma promedio (± 95% intervalo de confianza [IC] de la media) dentro de los rangos de referencia, es decir, el percentil 2.5-97.5 de todos los trombogramas iniciales (n = 168), así como para los parámetros EGT. Conclusiones: La ingesta de 15 mg de E4 durante 12 semanas produjo cambios significativos, pero no clínicamente relevantes en comparación con el valor inicial, ya que los valores promedios (±95% IC de la media) se mantuvieron dentro de los rangos de referencia, lo que demuestra un perfil neutro de este estrógeno en la hemostasia.
Palabras clave: Menopausia; NCT02834312; resistencia a la proteína C activada; coagulación; estetrol; hemostasia; generación de trombina.
1. Tschiderer L, Peters SAE, van der Schouw YT, van Westing AC, Tong TYN, Willeit P, et al. Age at Menopause and the Risk of Stroke: Observational and Mendelian Randomization Analysis in 204 244 Postmenopausal Women. J Am Heart Assoc. 2023;12(18):e030280.
Background
Observational studies have shown that women with an early menopause are at higher risk of stroke compared with women with a later menopause. However, associations with stroke subtypes are inconsistent, and the causality is unclear.
Objective
To determine the association between age at menopause and risk of stroke in postmenopausal women.
Design
Authors analysed data of the UK Biobank and EPIC-CVD (European Prospective Investigation Into Cancer and Nutrition-Cardiovascular Diseases) study.
A total of 204 244 postmenopausal women without a history of stroke at baseline were included (7,883 from EPIC-CVD [5,292 from the sub-cohort], 196,361 from the UK Biobank).
Main findings
Pooled mean baseline age was 58.9 years (SD, 5.8), and pooled mean age at menopause was 47.8 years (SD, 6.2).
Over a median follow-up of 12.6 years (interquartile range, 11.8-13.3), 6,770 women experienced a stroke (5,155 ischemic strokes, 1,615 hemorrhagic strokes, 976 intracerebral hemorrhages, and 639 subarachnoid hemorrhages).
In multivariable adjusted observational Cox regression analyses, the pooled hazard ratios per 5 years younger age at menopause were 1.09 (95% CI, 1.07-1.12) for stroke, 1.09 (95% CI, 1.06-1.13) for ischemic stroke, 1.10 (95% CI, 1.04-1.16) for hemorrhagic stroke, 1.14 (95% CI, 1.08-1.20) for intracerebral hemorrhage, and 1.00 (95% CI, 0.84-1.20) for subarachnoid hemorrhage.
When using 2-sample Mendelian randomization analysis, authors found no statistically significant association between genetically proxied age at menopause and risk of any type of stroke.
Take-home messages
In the present study, earlier age at menopause was related to a higher risk of stroke.
There was no statistically significant association between genetically proxied age at menopause and risk of stroke, suggesting no causal relationship.
2. Jin J, Ruan X, Hua L, Mueck AO. Prevalence of metabolic syndrome and its components in Chinese women with premature ovarian insufficiency. Gynecol. Endocrinol. 2023;39(1):2254847.
Objective
To assess the prevalence of metabolic syndrome (MetS) and its components in Chinese women with premature ovarian insufficiency (POI) and to explore the metabolic profile of Chinese women with POI.
Design
118 POI women aged 20-38 years and 151 age-and-BMI-matched control women were recruited.
Measurements included body height, weight, waist circumference (WC), hip circumference (HC), blood pressure, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG) and fasting insulin (FINS).
Prevalence and components of MetS and metabolic indices were compared between the two groups.
Main findings
The prevalence of MetS in POI women and age-and-BMI-matched control women was 16.9% and 11.3%, respectively, which was not significantly different (p > .05).
The prevalence of hypertriglyceridemia and high fasting glucose was significantly higher in POI than control (17.8% vs. 9.3%, p = .039; 16.9% vs. 6.6%, p = .008), without significant differences in the prevalence of other components of MetS (p > .05).
The levels of TG, FINS, and HOMA-IR in POI were significantly higher than in control (p < .05) but without significant differences in WC, WHR, SBP, DBP, TC, HDL-C, LDL-C, and FPG (p > .05).
HOMA-IR was positively correlated with WC, DBP, TG, and FPG and negatively correlated with HDL-C in both POI women and control (p < .05).
Take-home messages
POI women presented with more unfavorable cardiovascular risk factors (higher prevalence of hypertriglyceridemia and high fasting glucose; higher TG, FINS, and HOMA-IR).
Therefore, women diagnosed with POI should always be covered with special care of metabolic profile.
3. Critchlow AJ, Hiam D, Williams R, Scott D, Lamon S. The role of estrogen in female skeletal muscle ageing: A systematic review. Maturitas. 2023;178:107844.
Background
Ageing is associated with a loss of skeletal muscle mass and function that negatively impacts the independence and quality of life of older individuals.
Females demonstrate a distinct pattern of muscle ageing compared to males, potentially due to menopause, when the production of endogenous sex hormones declines.
Objective
This systematic review aimed to investigate the current knowledge about the role of estrogen in female skeletal muscle ageing.
Design
A systematic search of MEDLINE Complete, Global Health, Embase, PubMed, SPORTDiscus, and CINHAL was conducted.
Studies were considered eligible if they compared a state of estrogen deficiency (e.g. postmenopausal females) or supplementation (e.g. estrogen therapy) to normal estrogen conditions (e.g. premenopausal females or no supplementation).
Outcome variables of interest included measures of skeletal muscle mass, function, damage/repair, and energy metabolism.
Quality assessment was completed with the relevant Johanna Briggs critical appraisal tool, and data were synthesized in a narrative manner.
Thirty-two studies were included in the review.
Main findings
Compared to premenopausal women, postmenopausal women had reduced muscle mass and strength, but the effect of menopause on markers of muscle damage and expression of the genes involved in metabolic signaling pathways remains unclear.
Some studies suggest a beneficial effect of estrogen therapy on muscle size and strength, but evidence is largely conflicting and inconclusive, potentially due to large variations in the reporting and status of exposure and outcomes.
Take-home message
The findings from this review point toward a potential negative effect of estrogen deficiency on ageing skeletal muscle, but further mechanistic evidence is needed to clarify its role.
4. Shi JW, Wu JN, Zhu XY, Zhou WH, Yang JY, Li MQ. Association of serum 25-hydroxyvitamin D levels with all-cause and cause-specific mortality among postmenopausal females: results from NHANES. J Transl. Med. 2023;21(1):629.
Background
Vitamin D deficiency is common among the population, but its relationship with mortality of postmenopausal females is unclear.
Objective
To explore the association between serum 25-Hydroxyvitamin D (25(OH)D) and all-cause and cause-specific mortality among postmenopausal women in the United States.
Design
6,812 participants of postmenopausal females from the National Health and Nutrition Examination Survey (2001-2018) were included in this study.
The mortality status of the follow-up was ascertained by linkage to National Death Index (NDI) records through 31 December 2019.
Authors used Cox proportional hazards models to estimate the association of serum 25(OH)D concentrations and mortality of postmenopausal females.
Main findings
The mean level of serum 25(OH)D was 72.57 ± 29.93 nmol/L, and 65.34% had insufficient vitamin D.
In postmenopausal females, low serum 25(OH)D concentrations were significantly associated with higher levels of glycohemoglobin, glucose, and lower levels of HDL.
During follow-up, 1,448 all-cause deaths occurred, including 393 cardiovascular disease (CVD)-related deaths and 263 cancer deaths.
After multivariate adjustment, higher serum 25(OH)D levels were significantly related with lower all-cause and CVD mortality.
In addition, serum 25(OH)D presented an L-shaped relationship with all-cause mortality, while appeared a U-shaped with CVD mortality, and the cut-off value is 73.89 nmol/L and 46.75 nmol/L respectively.
Take-home messages
Low serum 25(OH)D levels are associated with the higher risk of all-cause and CVD mortality in postmenopausal females.
These findings provide new ideas and targets for the health management of postmenopausal women.
5. Mielke MM, Kapoor E, Geske JR, Fields JA, LeBrasseur NK, Morrow MM, Winham SJ, Faubion LL, Castillo AM, Hofrenning EI, Bailey KR, Rocca WA, Kantarci K. Long-term effects of premenopausal bilateral oophorectomy with or without hysterectomy on physical ageing and chronic medical conditions. Menopause. 2023;30(11):1090-1097.
Objective
To examine the long-term effects of premenopausal bilateral oophorectomy (PBO) with or without concurrent or preceding hysterectomy on physical and cognitive function and on odds of chronic conditions.
Design
Authors enrolled 274 women with PBO with or without concurrent or preceding hysterectomy and 240 referents aged 55 years and older who were residents of Olmsted County, MN as of the PBO or index date.
Chronic conditions were assessed via medical record abstraction.
Cognitive diagnoses were based on neurocognitive testing.
A physical function assessment included measures of strength and mobility.
Multivariable regression models compared characteristics for women with PBO <46 years, PBO 46-49 years, and referent women with adjustments for age and other confounders.
Main findings
The clinical visits (median age, 67 years) were a median of 22 years after the PBO or index date.
Of 274 women with PBO, 161 (59%) were <46 years at PBO and 113 (41%) were 46-49 years.
Compared with referents, women with a history of PBO <46 years had increased odds of arthritis (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.06-2.55), asthma (OR, 1.74; 95% CI, 1.03-2.93), obstructive sleep apnea (OR, 2.00; 95% CI, 1.23-3.26), and bone fractures (OR, 2.86; 95% CI, 1.17-6.98), and walked a shorter mean distance on a 6-minute walk test ( b = -18.43; P = 0.034).
Compared with referents, women with a history of PBO at age 46-49 years had increased odds of arthritis (OR, 1.92; 95% CI, 1.16-3.18) and obstructive sleep apnea (OR, 2.21; 95% CI, 1.33-3.66).
There were no significant differences in cognitive status in women with PBO compared with referents.
Take-home message
Women with a history of PBO with or without concurrent or preceding hysterectomy, especially at age <46 years, have more chronic conditions in late mid-life compared with referents.
6. Yuk JS, Lee JS, Park JH. Menopausal hormone therapy and risk of dementia: health insurance database in South Korea-based retrospective cohort study. Front Aging Neurosci. 20237;15:1213481.
Background
Menopausal hormone therapy (MHT) is used to alleviate the symptoms associated with menopause, despite the lack of recommendations for MHT in preventing dementia.
Recent nationwide studies have explored the association between MHT and dementia risk, but the findings remain limited.
Objective
To investigate the association between MHT and the incidence of Alzheimer’s disease (AD) and non-AD dementia using national population data from Korea.
Design
Authors conducted a retrospective study using data from the National Health Insurance Service in Korea between January 1, 2002, and December 31, 2019.
Women over 40 years were eligible for this study and classified into the MHT or non-MHT groups.
The MHT group consisted of women who used Tibolone (TIB), combined estrogen plus progestin by the manufacturer (CEPM), estrogen, combined estrogen plus progestin by a physician (CEPP), and transdermal estrogen during menopause.
They also compared the risk of dementia between the MHT and non-MHT groups.
Main findings
The study included 1,399,256 patients, of whom 387,477 were in the MHT group, and 1,011,779 were in the non-MHT group.
The median duration of MHT was 23 months (range: 10-55 months).
After adjusting for available confounders, we found that different types of MHT had varying effects on the occurrence of dementia. TIB (HR 1.041, 95% confidence interval (CI) 1.01-1.072) and oral estrogen alone (HR 1.081, 95% CI 1.03-1.134) were associated with a higher risk of AD dementia.
In contrast, there was no difference in the risk of AD dementia by CEPM (HR 0.975, 95% CI 0.93-1.019), CEPP (HR 1.131, 95% CI 0.997-1.283), and transdermal estrogen (HR 0.989, 95% CI 0.757-1.292) use.
The use of TIB, CEPM, and oral estrogen alone increased the risk of non-AD dementia (HR 1.335, 95% CI 1.303-1.368; HR 1.25, 95% CI 1.21-1.292; and HR 1.128, 95% CI 1.079-1.179; respectively), but there was no risk of non-AD dementia in the other MHT groups (CEPP and topical estrogen).
Take-home messages
The findings indicate that MHT has varying effects on the incidence of AD and non-AD dementia.
Specifically, TIB, CEPM, and oral estrogen alone increase the risk of non-AD dementia, while transdermal estrogen is not associated with dementia risk.
It is essential to consider the type of MHT used when assessing the risk of dementia in women.
7. Allen JT, Laks S, Zahler-Miller C, Rungruang BJ, Braun K, Goldstein SR, Schnatz PF. Needs assessment of menopause education in United States obstetrics and gynecology residency training programs. Menopause. 2023;30(10):1002-1005.
Objective
To assess the variance in menopause education, educational resources, and the needs of obstetrics and gynecology (ObGyn) residency programs by conducting a national survey of program directors (PDs).
Design
In 2022, an institutional review board-approved Web-based Qualtrics survey was designed and distributed electronically to 145 US ObGyn residency PDs.
The survey consists of 15 questions. The main outcomes are reported using descriptive statistics.
Main findings
The survey was completed by 99 of 145 PDs (68.3%).
Almost all participants (92.9%) strongly agreed that residents nationwide should have access to a standardised menopause curriculum that could be utilised in their programs.
Only 31.3% reported having a menopause curriculum in their residency program.
Of the programs with a menopause curriculum, 96.8% reported using lectures, 77.4% reported assigned readings, and 74.2% had either dedicated menopause clinics or other clinics with a high volume of menopausal patients.
Of all programs surveyed, only 29.3% reported that trainees had dedicated time assigned to a menopause clinic.
A total of 83 of 99 PDs agreed or strongly agreed that their programs needed more menopause educational resources, and most (89.7%) stated they were likely or very likely to use self-paced menopause modules that include performance feedback if available.
Take-home messages
Data from the needs assessment questionnaire revealed that menopause education and resources vary across residency programs, with the majority lacking a dedicated menopause curriculum.
Most PDs expressed a desire for more educational resources and standardised training materials, and preferred to access an online national menopause curriculum.
8. Garcia de Leon R, Baaske A, Albert AY, Booth A, Racey CS, Gordon S, Smith LW, Gottschlich A, Sadarangani M, Kaida A, Ogilvie GS, Brotto LA, Galea LAM. Higher perceived stress during the COVID-19 pandemic increased menstrual dysregulation and menopause symptoms. Women’s Health (Lond). 2023;19:17455057231199051.
Background
The increased stress the world experienced with the coronavirus disease (COVID-19) pandemic affected mental health, disproportionately affecting females.
However, how perceived stress in the first year affected menstrual and menopausal symptoms has not yet been investigated.
Objective
To evaluate the effect that the first year of the COVID-19 pandemic had on female reproductive and mental health.
Design
This was a population-based online retrospective survey.
Residents in British Columbia, Canada, were surveyed online as part of the COVID-19 Rapid Evidence Study of a Provincial Population-Based Cohort for Gender and Sex.
A subgroup of participants (n = 4,171), who were assigned female sex at birth (age 25-69 years) and were surveyed within the first 6-12 months of the pandemic (August 2020-February 2021), prior to the widespread rollout of vaccines, was retrospectively asked if they noticed changes in their menstrual or menopausal symptoms, and completing validated measures of stress, depression and anxiety.
Main findings
The authors found that 27.8% reported menstrual cycle disturbances and 6.7% reported increased menopause symptoms.
Those who scored higher on perceived stress, depression and anxiety scales were more likely to report reproductive cycle disturbances.
Free-text responses revealed that reasons for disturbances were perceived to be related to the pandemic.
Take-home messages
The COVID-19 pandemic has highlighted the need to research female-specific health issues, such as menstruation.
The findings indicate that in the first year of the pandemic, almost one-third of the menstruating population reported disturbances in their cycle, which was related to perceived stress, depression and anxiety scores.
9. Speksnijder EM, Ten Noever de Brauw GV, Malekzadeh A, Bisschop PH, Stenvers DJ, Siegelaar SE. Effect of Postmenopausal Hormone Therapy on Glucose Regulation in Women With Type 1 or Type 2 Diabetes: A Systematic Review and Meta-analysis. Diabetes Care. 2023;46(10):1866-1875.
Background
Blood glucose regulation in women with diabetes may change during and after menopause, which could be attributed, in part, to decreased estrogen levels.
Objective
To determine the effect of postmenopausal hormone therapy (HT) on HbA1c, fasting glucose, postprandial glucose, and use of glucose-lowering drugs in women with type 1 and women with type 2 diabetes.
Design
The authors conducted a systematic search of MEDLINE, Embase, Scopus, the Cochrane Library, and the ClinicalTrials.gov registry to identify randomized controlled trials (RCTs).
They selected RCTs on the effect of HT containing estrogen therapy in postmenopausal women (≥12 months since final menstrual period) with type 1 or type 2 diabetes.
Data was extracted for the following outcomes: HbA1c, fasting glucose, postprandial glucose, and use of glucose-lowering medication.
Main findings
Nineteen RCTs were included (12 parallel-group trials and 7 crossover trials), with a total of 1,412 participants, of whom 4.0% had type 1 diabetes.
HT reduced HbA1c (mean difference -0.56% [95% CI -0.80, -0.31], -6.08 mmol/mol [95% CI -8.80, -3.36]) and fasting glucose (mean difference -1.15 mmol/L [95% CI -1.78, -0.51]).
Authors indicate that of included studies, 50% were at high risk of bias.
Take-home messages
When postmenopausal HT is considered for menopausal symptoms in women with type 2 diabetes, HT is expected to have a neutral-to-beneficial impact on glucose regulation.
Evidence for the effect of postmenopausal HT in women with type 1 diabetes was limited.
10. Yang Y, Valdimarsdóttir UA, Manson JE, Sievert LL, Harlow BL, Eliassen AH, Bertone-Johnson ER, Lu D. Premenstrual Disorders, Timing of Menopause, and Severity of Vasomotor Symptoms. JAMA Netw. Open. 2023;6(9):e2334545.
Background
Although premenstrual disorders (PMDs) end at menopause, it is unclear whether they are associated with the timing and symptom severity of menopause.
Objective
To prospectively examine whether women with PMDs have increased risks of early menopause and menopause-related vasomotor symptoms (VMS).
Design
This was a population-based cohort study nested in the Nurses’ Health Study II (data collected from questionnaire sent between June 1991 and June 2017).
Analysis of menopause timing included participants who did not have natural or surgical menopause before study entry, while the analysis of VMS was restricted to women who provided information on VMS.
Data was analysed from August 2022 to March 2023.
PMDs were identified by self-reported diagnosis and confirmed with symptom questionnaires from 1991 to 2005.
Participants were age-matched to women without PMD diagnoses and confirmed absence of or minimal premenstrual symptoms.
During follow-up through 2017, timing of natural menopause was assessed biennially, and VMS were assessed in 2009, 2013, and 2017.
The association of PMDs with early menopause was assessed by Cox proportional hazards models and with VMS by logistic regression models.
Main findings
Of 1,220 included women with PMDs, the median (IQR) age was 40.7 (37.3-43.8) years; of 2,415 included women without PMDs, the median (IQR) age was 41.7 (38.3-44.8) years.
The median (IQR) follow-up in this study was 20.3 (17.8-22-2) years.
Early natural menopause (menopause before age 45 years) was reported by 17 women with PMDs (7.1 per 1,000 person-years) and 12 women without PMDs (2.7 per 1,000 person-years; adjusted hazard ratio, 2.67; 95% CI, 1.27-5.59).
In addition, 795 women with PMDs (68.3%) and 1,313 women without PMDs (55.3%) reported moderate or severe VMS (adjusted odds ratio, 1.68; 95% CI, 1.32-2.14).
There was no observed association between PMDs and mild VMS (adjusted odds ratio, 0.99; 95% CI, 0.76-1.28).
Take-home messages
In this cohort study of US women, PMDs were associated with increased risks of early menopause and moderate or severe VMS.
PMDs may be indicative of underlying physiology linked to early menopause and VMS, suggesting a phenotype observable during the reproductive years that may allow clinicians to target women at risk of earlier menopause and subsequent health risks later in the life course.
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
9th Annual Conference in collaboration with The Androgen Excess and PCOS Society & Mumbai Obstetric and Gynaecological Society Date: 21-23rd June, 2024 Venue: The Leela Mumbai
For more information: https://pcosindia.org/annualconference2024/
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
Age when periods first start and early menopause linked to heightened COPD risk
Miscarriage, stillbirth, infertility, and having 3 or more children additional risk factors
Menopause and migraines: New findings point to power of prevention
Higher risk of heart issues and stroke only seen in those with long-term hot flashes, night sweats and migraines; earlier focus on cardiovascular risk reduction and migraine care are needed. https://www.eurekalert.org/news-releases/1034220
