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Another two months have passed since my last report – where does time go?
We have recently published the editorial for Climacteric which will act as a “call to action” regarding the latest publicity on menopause management. This is the first salvo in a series of key documents to follow from IMS through our collaboration other respected societies that will promote evidence led information in the academic and social media.
The key event since my last report was the ISGE meeting in Florence Italy. This was another great opportunity to network with our global colleagues both from academic and social perspectives.
We (IMS) took the opportunity to hold a pre ISGE Executive meeting which was most constructive. The focus of the meeting was to finalise the documents that will be available in our IMS Handbook of Operations. The development and review of key governance documents for the Handbook has identified the need to change elements of the Constitution. Full Members in good standing will receive information about these changes and the ballot.
We also reviewed the progress of the 2024 IMS White Paper on MHT, updated ESHRE POI guidelines and updated IMS Recommendations. The Publications Steering Committee has been coordinating these papers for IMS and we hope that you will find the documents helpful in supporting your day-to-day clinical practice once they are published.
During the last two months, I have also had the opportunity to meet online with our CAMS steering committee colleagues from the Americas/Caribbean and Asia/Pacific regions. The work they are doing to disseminate information through the IMS/CAMS network, led by Professor Duru Shah, is inspiring; we are most grateful for all the selfless efforts of the committee members. Our recent CAMS Americas meeting highlighted the importance of networking not only with FLASCYM but also with FLASOG (Latin American Federation of Obstetrics and Gynecology Societies) to maximise the impact of IMS in Latin America.
CAMS members represent 63 countries and regions. The next issue of our well received online magazine, CAMS Connect, will be published later this month. The IMS Toolkit for Starting a Menopause Society has now been distributed to groups in 22 countries and we encourage all others to join.
Five CAMS Menopause Hour online events have been delivered thus far in 2024:
January – Swiss and German
February – Italian
March – Canadian
April – Mexican
May – EMAS
The next event is 27th June with the Chinese Menopause Society. This will be delivered in Chinese. Thank you to Abbott for their ongoing support with this venture.
Our outreach continues to grow; in terms of our membership there has been a 32.4% increase in the past year (since May 2023). We now have members from 90 countries and 102 new members have joined via the CAMS Membership offer. The total number of IMPART registrations continues to grow: Level 1 is now at 11,561 and Level 2 is at 489, with registrations from 121 countries.
Preparations for our IMS World Congress in Melbourne on October 19th to 22nd are now at an advanced stage. The latest version of the scientific programme, and registration information, is available on the website IMS World Congress in Melbourne 2024 (imsmelbourne2024.com).
We are delighted that nineteen CAMS members will be delivering CAMS symposia in Melbourne, which is one of the highest levels of engagement we’ve had for these sessions at World Congresses. There is still a CAMS group registration discount of 15% available.
Details of the Pre-congress Course on World Menopause Day Oct 18th are now also on the website.
The deadline for the Young Scholars Bursary and Utian CAMS Award is 18th June; more information is available on the website » Awards · IMS World Congress in Melbourne 2024 (imsmelbourne2024.com). Details of the Henry Burger award are also available on the website – the deadline for this award has been extended to 30th June – we encourage all those who have made a significant scientific contribution to menopause medicine in the last 5 years to apply.
We also encourage the nomination of scholars under the age of 40 to represent their country in the Menopause Olympics; the deadline for this is 31st August -please contact claire.bower@imsociety.org for further information.
As a reminder, we will also have IMS representation at the following meetings leading up to the World Congress and we look forward to seeing as many of you as possible at these meetings, as well as in Melbourne.
British Menopause Society Annual Meeting, June 27/28th
ESHRE Congress, Amsterdam, July 7-10th
Philippine Society of Climacteric Medicine, Annual Convention September 2/3rd
Jordanian Society of Obstetrics and Gynaecology, Meeting September 4-6th
The Menopause Society Meeting, September 11-14th
Menopause Society of Ireland Meeting, September 14th
Beijing OBGYN, Capital Medical University Meeting, September 24th
In other news, nomination information for the IMS board of trustees’ elections and timescales will be sent out to Full Members in good standing via the Preliminary Notice of Convocation of the General Assembly on 21st June. We look forward to enriching the composition of our IMS board with elected representatives from all four corners of the globe!
I’d like to take this opportunity to remind you to respond to the informal invitation to submit a proposal for original research articles or systematic reviews and meta-analyses that will be published in a special themed June 2025 issue of Climacteric on “menopause in Low and Middle Income countries (LMICs).”
There is a scarcity of research on menopause and its effects on health and quality of life in midlife women in LMICs and the Editor in Chief, Tim Hillard, and Guest Editors Nigel Crowther and Nicole Jaff would be delighted to receive your proposals for papers in this important issue.
Finally, we have received the sad news that Monique Boulet, the first Executive Director of the IMS, has passed away. She held this position from 1978-2003 and, as stated by her successor Jean Wright, ‘Monique was one of the pioneers and outstanding personalities of the IMS and without her the Society would not be as it is today.’ Jean’s full memorial, which is included in the following section and will be added to our Memorial Wall, illustrates the great impact that passion and dedication can have on past, present and future generations. I’m sure you all join me in sending our best wishes to Monique’s family.
As always, we very much encourage your feedback to improve the impact of our society on women’s midlife health and menopause globally.
The 43rd webinar in the IMS webinar series will be ‘Sexual Dysfunctions, Update on Gynae Cancers and Management’. It will be held on Tuesday 18th June 2024 3pm CEST. It will be moderated by Professor Johannes Bitzer. Dr Michael Krychman will be speaking on ‘Approach to Sexual Dysfunction’ and Dr Sheryl Kingsberg will be speaking on ‘How to Talk Sex with Cancer Patients’. For information and booking visit the IMS Website.
The 42nd webinar in the series, ‘Perimenopausal Contraception’, was held on Tuesday 21st May and was moderated by Professor Rossella Nappi. Dr Andrew Kaunitz presented on ‘Contraceptive Pills’ and Dr Pelin Batur presented on ‘IUD and Endometrial Protection’ 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 Professor Steven Goldstein;
‘Breast Screening and Prevention’ by Dr Lisa Larkin;
‘Cardiovascular Health in Midlife Women’ by Professor Peter Schnatz;
‘A Personalised Treatment Approach to Cognitive and Mood Symptoms of Menopause’ by Professor Pauline Maki;
‘Pharmaceutical Management of Early Menopause Symptoms’ by Dr Tobie de Villiers;
‘Non-pharmaceutical Approaches to Treating Menopausal Symptoms: What Does the Evidence Tell Us’ by Dr Carolyn Ee;
‘GSM (genitourinary syndrome of menopause) Pelvic Floor Health’ by Dr Tim Hillard;
‘Premature Ovarian Insufficiency: Unique and Underappreciated’ by Professor Nick Panay;
‘Obesity and its Emerging Importance in Midlife Women by Dr Ang Seng Bin;
‘A Midlife Women’s Health Unit: How to Organise it’ by Professor Wendy Wolfman;
‘How to Diagnose and Treat Sexual Symptoms Associated with Menopause’ by Professor Rossella Nappi and
‘Ultrasound in Midlife Women: When Does it Fit In?’ by Professor Steven Goldstein.
1-1 Interview Series with Marla Shapiro
Our latest 1-1 interview series topic is ‘Metabolic Syndrome in Midlife Women’ with Professor Antonio Cano. All IMS interviews are available in a video or podcast format on our website via this link and the IMS podcasts are also available on Spotify.
CAMS Menopause Hour
The next CAMS Menopause Hour will be on Thursday 27th June at 1 pm CEST. The topic will be ‘New Development in Menopausal Management Among Chinese Women’ and it will be moderated by Professor Qi Yu. Professor Mulan Ren will be presenting ‘The Updated Chinese Guideline of Menopausal Management and Menopause Hormone Therapy’ and Professor Rong Chen will be presenting ‘Modern Medical Research Methods Facilitate the Application of Traditional Chinese Medicine in the Treatment of Climacteric Syndrome’.
This event will be presented in Chinese and a recording will be available after the event on the IMS website with English subtitles.
The IMS is pleased to announce that the closing date for applications has been extended to 18th June 2024. 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
Nominations are now open for the Henry Burger Award. This 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. The deadline for applications 30th June 2024. For more information visit 19th World Congress on Menopause – International Menopause Society (imsociety.org)
Menopause Olympics at World Congress
The Menopause Olympics is an interactive quiz at the World Congress for professionals aged below 40 years on day one of the World Congress. It’s a great opportunity for individuals to represent their country in a fun atmosphere. The winner receives a one-year Full Membership to the IMS. Please nominate a candidate to represent your country via email to: claire.bower@imsociety.org
Remembering Monique Boulet
When I was Director of Publishing at Parthenon, I started to work on books by menopause specialists and then the Proceedings of the Congresses of the International Menopause Society (IMS). Thus I came to know many of the leading members of the Society and to realise that Monique, the Executive Director, was a legendary figure of the IMS. I recall that I first actually met and talked to her at the Congress in Berlin, where she was constantly answering members’ queries, chatting to everyone, organising meetings, just being the stalwart backbone of the Society. I liaised with David Sturdee and Alastair McLennan as they became the first Editors of the Society’s journal, Climacteric, and began to work more closely with Monique. In 2003 she wished to retire and I was appointed to take over from her as the next Executive Director of the IMS, a formidable task. She kindly invited me to her apartment in Belgium so she could show me all that was involved in running the Society. I was amazed by the complexity of the operation, the great number of paper files, one for each member – past and present, the careful accounts, the records of every congress and meeting, the Minutes of every Board meeting, the files of correspondence between her and the Presidents and Boards, and the periodic Newsletters. All these records were in paper form, being before the time when such records were kept as computer files. Monique spent much time with me, answering all my many questions, and eventually shipped all the documents to me in the UK.
Later, reading the many documents, I began to realise how the Society was Monique’s life. She had worked with Pieter van Keep from the beginning, knew the members personally, organised the early congresses and workshops, and corresponded daily with the successive Presidents and Officers, Boards, national societies, individual members, and, of course, the Editors of the Society’s journal, first Maturitas and then Climacteric.
I met her several times later at congresses and heard how she was enjoying her retirement. She took up golf for the first time, played lots of tennis and had many friends.
Monique was one of the pioneers and outstanding personalities of the IMS and without her the Society would not be as it is today.
Jean Wright, former Executive Director
Free or Open Access with translated abstract to selected papers recently published in Climacteric
Climacteric June 2024
Welcome to the June 2024 issue of Climacteric.
The editorial in this issue is written by three distinguished members of the present and past IMS Board, Rossella Nappi, Nick Panay and Susan Davis. The cue to the editorial is the recent series of papers in The Lancet on the menopause and how it is treated and perceived.
Informal invitation from Climacteric
Climacteric is planning a special issue on the effect and treatment of the menopause in low- and middle-income countries. The editor of Climacteric, Dr Tim Hillard and our guest editors, Dr Nicole Jaff and Dr Nigel Crowther, invite proposals for papers.
Free access to selected papers recently published in Climacteric
By way of a special arrangement with our publishers, Taylor & Francis, our journal Climacteric is able to offer Free Access to some recently published papers for a limited time.
Two papers from Climacteric 2024, Volume 27, June issue, chosen by our Editor, Dr Tim Hillard, have Free Access for the next three months.
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 papers plus one Open Access paper have been translated into Spanish.
Climacteric’s Editor, Dr Tim Hillard, would like to thank Dr Peter Chedraui, one of our Associate Editors, for providing these translations.
Spanish translation: Ong C, Monita M, Liu M. Terapia hormonal de afirmación de género y salud cardiovascular en adultos transgénero. Climacteric. 2024;27(3):227-235. https://pubmed.ncbi.nlm.nih.gov/38597210/
Resumen
Un número creciente de personas se identifican como transgénero y de género no binario en los EE. UU. y en todo el mundo. Al mismo tiempo, un número cada vez mayor de pacientes reciben terapia hormonal de afirmación de género (THAG) para lograr la congruencia de género. THAG tiene efectos de amplio alcance sobre los marcadores clínicos y subclínicos de riesgo cardiovascular. Los pacientes transgéneros también parecen tener un mayor riesgo de sufrir enfermedades cardiovasculares en comparación con sus pares cisgénero y el impacto de la terapia de afirmación de género en la salud cardiovascular no está claro. Los estudios sobre el efecto de THAG en los resultados cardiovasculares se ven confundidos por las diferencias en los regímenes THAG y los desafíos metodológicos en una población diversa e históricamente de difícil acceso. Las pautas cardiovasculares actuales no incorporan la identidad de género y el estado hormonal en la estratificación del riesgo y la toma de decisiones clínicas. En esta revisión, brindamos una descripción general del impacto cardiometabólico y las consideraciones clínicas de la THAG para el riesgo cardiovascular en pacientes transgénero.
Palabras claves: LGTBQ; Salud transgénero; perfil cardiometabólico; salud cardiovascular; Terapia hormonal de afirmación de género.
Spanish translation: Vollrath S, Theis S, Kolokythas A, Janka H, Schleich S, Moreth J, Kiesel L, Stute P. Soluciones de autogestión de eSalud para la menopausia: una revisión sistemática de alcance. Climacteric. 2024;27(3):255-268. https://pubmed.ncbi.nlm.nih.gov/38685754/
Resumen Objetivo: El propósito de esta revisión de alcance fue resaltar la evidencia científica actual sobre herramientas de información basadas en eSalud para la menopausia en términos de calidad, requisitos y resultados de intervenciones anteriores. Método: Buscamos sistemáticamente en bases de datos electrónicas (Embase, CINAHL, Cochrane Library, Global Health Database [Ovid], Web of Science, ClinicalTrials.gov [NLM], LIVIVO Search Portal [ZB MED] y Google Scholar) desde 1974 hasta marzo de 2022 para registros pertinentes. Resultados: Nuestra búsqueda arrojó 1,773 registros, de los cuales 28 cumplieron con nuestros criterios de inclusión. Trece de 28 estudios seleccionados fueron transversales con análisis de contenido cualitativo de sitios web sobre menopausia; nueve estudios fueron estudios de cohortes que examinaron el impacto de una intervención de eSalud; dos estudios fueron ensayos controlados aleatorios que compararon herramientas de eSalud con herramientas convencionales; y cuatro estudios fueron revisiones bibliográficas no sistemáticas. Conclusiones: Esta revisión de alcance destaca el potencial de las herramientas de información basadas en eSalud para el tratamiento de la menopausia y muestra que la mayoría de las herramientas de información basadas en eSalud son inadecuadas en términos de legibilidad y visión equilibrada de la información. Los proveedores de herramientas de información basadas en eSalud deben prestar atención al diseño participativo, la legibilidad, el equilibrio del contenido y el uso de herramientas multimedia para la entrega de información para mejorar la comprensión.
Palabras clave: Estrategias de salud digital; Servicios basados en Internet; soluciones de eSalud; viaje del paciente menopáusico; portales web para pacientes; replantear la menopausia; autocontrol de la menopausia.
Spanish translation: Davis SR, Azene ZN, Tonkin AM, Woods RL, McNeil JJ, Islam RM. Un nivel más alto de testosterona se asocia con niveles más altos de colesterol HDL y concentraciones más bajas de triglicéridos en mujeres mayores: un estudio observacional. Climacteric. 2024;27(3):282-288. https://pubmed.ncbi.nlm.nih.gov/38345304/
Resumen Objetivo: Este estudio tuvo como objetivo determinar si las concentraciones de testosterona y su principal precursor después de la menopausia, la dehidroepiandrosterona (DHEA), están asociadas con las lipoproteínas y otros lípidos en mujeres mayores que viven en comunidades. Método: El estudio Sex Hormones in Older Women (SHOW; Hormonas sexuales en mujeres mayores) fue un estudio observacional de 6,358 mujeres australianas, de al menos 70 años de edad, sin ningún evento cardiovascular adverso importante previo, a quienes se les midieron las hormonas sexuales mediante cromatografía líquida-espectrometría de masas en tándem. Las asociaciones entre hormonas y lípidos se examinaron mediante regresión multilineal ajustada para posibles factores de confusión. Resultados: Los análisis transversales incluyeron 3,231 participantes, edad media 74.0 (rango intercuartil 71.7-77.9) años. En comparación con las concentraciones en el cuartil más bajo (Q1), las concentraciones de testosterona en los cuartiles más altos (Q3 y Q4) se asociaron positivamente con el colesterol unido a lipoproteínas de alta densidad (HDL-C) (p = 0.002 y p < 0.001, respectivamente), mientras que la testosterona en las concentraciones Q4 se asociaron positivamente con el colesterol total (p = 0.038). Las concentraciones de testosterona Q2, Q3 y Q4 se asociaron significativamente de manera inversa con los triglicéridos (TG) (p = 0.024, p = 0.003 y p < 0.001, respectivamente). Para DHEA, las concentraciones de Q4 se asociaron positivamente con el C-no-HDL (p = 0.024). Conclusiones: En mujeres mayores, las concentraciones más altas de testosterona endógena se asocian significativamente con un HDL-C más alto y un TG más bajo, lo que indica un perfil menos aterogénico. Estos hallazgos sugieren un efecto neutral o potencialmente protector de la testosterona sobre la enfermedad cardiovascular en mujeres mayores.
1. Albalawi NS, Almohammadi MA, Albalawi AR. Comparison of the Efficacy of Vaginal Hyaluronic Acid to Estrogen for the Treatment of Vaginal Atrophy in Postmenopausal Women: A Systematic Review. Cureus. 2023;15(8):e44191.
Background
Topical estrogen is effective for treating postmenopausal vaginal atrophy. However, there is a potential risk of estrogen-related adverse effects. There is a need for finding effective non-hormonal treatment for vaginal atrophy. The topical application of moisturising agents, such as hyaluronic acid (HA), represents a promising non-hormonal treatment for the relief of vaginal atrophy.
Objective
This study aimed to summarize the evidence regarding the efficacy of topical HA compared to topical estrogen in postmenopausal women with vaginal atrophy.
Design
The literature search covered English-published studies from database inception till February 2023.
The search included the electronic databases of MEDLINE/PubMed, Cochrane Library, Web of Science, ProQuest, and Scopus, using the terms “Hyaluronic Acid” AND “Postmenopause” AND “Vagina” AND “Atrophy”.
Due to the diversity in reporting outcomes, meta-analysis was not feasible.
A narrative synthesis with a systematic approach was conducted by vote counting of studies that included a direct comparison between topical HA and topical estrogen.
Main findings
Six studies were included.
Intra-group comparisons showed that both interventions were significantly effective in alleviating the symptoms of vaginal atrophy and dyspareunia as well as improving vaginal pH and cell maturation index.
However, inter-group comparisons in most studies showed that estrogen was superior to HA in relieving vaginal symptoms and improving vaginal pH, dyspareunia, and the cell maturation index.
There is no evidence to show the superiority of HA to estrogen in the treatment of postmenopausal vaginal atrophy.
Take-home messages
Although the therapeutic efficacy of HA seems to be comparable to estrogen and considering its safety, HA can be used as an alternative to estrogen in patients who do not want to use estrogen.
The available studies have several limitations, and the reporting of outcomes was considerably heterogeneous.
2. Comini ACM, Carvalho BM, Moreira MJB, Reis PCA, Colapietro L, Northern J, Batalini F. Safety and Serum Estradiol Levels in Hormonal Treatments for Vulvovaginal Atrophy in Breast Cancer Survivors: A Systematic Review and Meta-Analysis. Clin Breast Cancer. 2023;23(8):835-846.
Background
Vulvo-vaginal atrophy (VVA) or genitourinary syndrome of menopause (GSM) is a common condition among breast cancer (BC) patients, especially those undergoing antiestrogen therapy. Despite being an option in refractory cases, the safety of hormonal treatment remains uncertain in this population.
Objective
To review the safety and serum estrogen levels of hormonal therapy in patients with BC history presenting with VVA symptoms.
Design
Pubmed, Embase, and Cochrane were searched for studies comparing different hormonal treatment options for VVA in breast cancer survivors.
Statistical analysis was performed using a random effects model and heterogeneity using Cochran’s Q-statistic and the I2 index.
Main findings
Authors included 17 studies, of which 5 were randomized controlled trials (RCTs).
Treatment modalities included in this study were topical vaginal estradiol and estriol preparations, vaginally applied testosterone, DHEA, and ospemifene.
Authors found that, among patients treated with the estriol and estradiol preparations, there was an average increase of 7.67 pg/mL (SMD 7.67 pg/mL; 95% CI -1.00, 16.35; p < .001).
Analysis of the testosterone group found temporary peaks of serum estradiol levels, but 1 study showed persistent elevation above normal postmenopausal levels.
One study with prasterone revealed no elevation of serum estradiol concentration.
One study with ospemifene demonstrated no increase in the risk of BC recurrence.
Take-home messages
Among treatments available for BC survivors, low-dose vaginal estrogen showed the smallest changes in serum estradiol levels and had the most evidence, but safety remains unclear, especially for patients on aromatase inhibitors.
Alternative treatments such as ospemifene need more data supporting safety and efficacy.
The study results suggest that concerns related to cancer recurrence should keep aiming for the lowest possible concentration.
3. Logan S, Wong BWX, Tan JHI, Kramer MS, Yong EL. Menopausal symptoms in midlife Singaporean women: Prevalence rates and associated factors from the Integrated Women’s Health Programme (IWHP). Maturitas. 2023;178:107853.
Background
Menopausal symptoms can substantially impact quality of life.
Objective
Authors aimed to study somatic, psychological, and urogenital symptoms and their associated factors.
Design
This was a cross-sectional study of healthy midlife Singaporean women from three major Asian ethnic groups.
Study included women aged 45 to 69 who attended from 2014-2016 well-woman clinics at the National University Hospital Singapore who completed the Menopause Rating Scale (MRS).
Sociodemographic, reproductive, medical, anthropometric, body composition, and physical performance characteristics were assessed using validated questionnaires and strict protocols.
Authors analysed sub-scales and total scores by median split, and adjusted odds ratios using multivariable logistic regression.
Main findings
Of the 1,054 eligible women, 62.6 % reported at least one moderate to extremely severe symptom.
The top five menopausal symptoms were joint and muscle discomfort, sleep problems, vaginal dryness, physical and mental exhaustion, and hot flushes.
Higher total scores on the MRS were associated with moderate disability (adjusted odds ratio: 9.80, 95 % confidence interval: 2.88-33.34), poorer self-rated health status (2.18, 1.60-2.97), menstrual irregularity at 25 years (1.63, 1.07-2.49), and slower chair stands (1.49, 1.09-2.03).
Age ≥65 (0.54, 0.30-0.94) and a lower level of education (0.45, 0.26-0.76) had significant inverse associations with total MRS score.
Take-home messages
Menopausal symptoms were associated with disability, poorer health status, and weaker lower-body muscle strength.
This data adds to the limited Asian evidence and raises the profile of this important area of health.
4. Waetjen LE, Crawford SL, Gajer P, Brooks MM, Gold EB, Reed BD, Hess R, Ravel J. Relationships between the vaginal microbiota and genitourinary syndrome of menopause symptoms in postmenopausal women: the Study of Women’s Health Across the Nation. Menopause. 2023;30(11):1073-1084.
Objective
To describe vaginal microbiota classified by community state types (CST) in a diverse cohort of postmenopausal women and evaluate relationships among genitourinary syndrome of menopause (GSM) symptoms (vaginal dryness, vulvovaginal irritation, sexual pain, dysuria, urinary urgency), CSTs, estrogen, vaginal maturation index (VMI), and vaginal pH.
Design
In the Study of Women’s Health Across the Nation, 1,320 women aged 60.4 to 72.5 years self-collected (2015-2017) vaginal samples analyzed for microbiota composition and structure (CSTs) using 16S rRNA gene amplicon sequencing, VMI, and pH. GSM symptoms were collected with self-administered questionnaires; interviewers elicited estrogen use and measured body mass index.
Serum E2 and E1 were measured using high-performance liquid chromatography.
Authors analyzed data using Pearson χ2 tests, analysis of variance, Kruskal-Wallis tests, and binomial logistic regression.
Main findings
The most frequently occurring CST was low Lactobacillus species IV-C (49.8%); 36.4% of women had CSTs dominated by Lactobacillus species.
More than half of the women with vaginal atrophy biomarkers (VMI <50 and pH >5) had CST IV-C0, whereas women using estrogen or with higher E1 and E2 levels had a higher prevalence of Lactobacillus crispatus – dominated CST I (P values < 0.001).
Sexual pain was associated with atrophy biomarkers and independently associated with Streptococcus species-dominated CST IV-C1 (odds ratio, 2.26; 95% confidence intervals, 1.20-4.23).
For all other GSM symptoms, authors found no consistent associations with E1 or E2 levels, atrophy biomarkers, or any CST.
Take-home message
Although close relationships exist among estrogen, CSTs, VMI, and pH, sexual pain was the only GSM symptom associated with the structure of vaginal microbiota and atrophy biomarkers.
5. Salin SAE, Savukoski SM, Pesonen PRO, Auvinen JP, Niinimäki MJ. Sleep disturbances in women with early-onset menopausal transition: a population-based study. Menopause. 2023;30(11):1106-1113.
Objective
To investigate sleep disturbances in 46-yr-old women and their association with early-onset menopausal transition.
Design
The women of this cross-sectional birth cohort study were divided into climacteric (n = 359) and preclimacteric (n = 2,302) groups by their menopausal status, defined by follicle-stimulating hormone levels and menstrual history.
Sleep disturbances were evaluated with Athens Insomnia Scale 5.
Authors performed univariable and multivariable logistic regression models in which sleep parameters were dependent variables and climacteric status, hot flashes, smoking, and education level were independent variables.
The use of hormone therapy was also evaluated in women suffering from sleeping disturbances.
Main findings
On the basis of the scale questions, climacteric women experienced significantly delayed sleep induction (12.2% vs 8.7%, P = 0.047), more problems with awakenings during the night (23.4% vs 14.6%, P < 0.001), earlier final awakening (13.8% vs 9.9%, P = 0.039), and more unsatisfying sleep quality (11.9% vs 7.9%, P = 0.023).
Climacteric women who were experiencing hot flashes reported unsatisfactory sleep quality more frequently compared with climacteric women who did not experience hot flashes (17.0% vs 9.2%, P = 0.047).
In the univariable and multivariable logistic regression models, being climacteric was independently associated with different impaired sleeping parameters.
Most climacteric women who had a scale score of 4 or greater were not using hormone therapy, according to their medicine purchases over the past year.
Take-home messages
Being climacteric was associated with sleep disturbances in women in their mid-40s; however, this association seemed to be particularly driven by hot flashes.
Most climacteric women with clinically significant sleeping disturbances were not using hormone therapy.
6. Thai NQN, LaCroix AZ, Haring B, Wactawski-Wende J, Manson JE, Posis AIB, Shadyab AH. The association of leukocyte telomere length with exceptional longevity among older women. Geroscience. 2024;46(2):2083-2092.
Background
The association of leukocyte telomere length (LTL) with survival to late life with intact mobility has not been adequately studied.
Objective
To investigate the association of leukocyte telomere length with exceptional longevity among older women.
Design
This prospective cohort study consisted of 1,451 postmenopausal women from a Women’s Health Initiative ancillary study, who were eligible, because of birth year, to survive to age 90 as of March 6, 2021. LTL was measured by Southern blot at baseline (1993-1998).
Associations between LTL and survival to age 90 were evaluated using logistic regression models adjusted for socio-demographic characteristics, health factors, and lifestyle factors.
Multinominal logistic regression was utilized to examine associations of LTL with survival to age 90 with or without intact mobility.
Mediation analysis examined the extent to which incident coronary heart disease and stroke mediated the association between LTL and longevity.
Main findings
Overall, 76.7% of women were White, and 23.3% were Black; average age at baseline was 70.4±3.5 years.
Relative to death before age 90, the odds of survival to age 90 were 60% higher (OR, 1.60; 95% CI, 1.28-2.01), the odds of survival to age 90 with mobility limitation were 72% higher (OR, 1.72; 95% CI, 1.33-2.21), and the odds of survival to age 90 with intact mobility were 44% higher (OR, 1.44; 95% CI, 1.06-1.95) for every one kilobase longer LTL.
Absence of CHD, stroke, or CHD/stroke mediated the association of LTL with survival to age 90 by 11.1%, 37.4%, and 31.3%, respectively; however, these findings were not significant.
Take-home message
Longer LTL was associated with higher odds of survival to age 90 among older women.
7. Petrick JL, Joslin CE, Johnson CE, Camacho TF, Peres LC, Bandera EV, Barnard ME, Beeghly A, Bethea TN, Dempsey LF, Guertin K, Harris HR, Moorman PG, Myers ER, Ochs-Balcom HM, Rosenow W, Setiawan VW, Wu AH, Schildkraut JM, Rosenberg L. Menopausal hormone therapy use and risk of ovarian cancer by race: the ovarian cancer in women of African ancestry consortium. Br J Cancer. 2023;129(12):1956-1967.
Background
Most studies examining post-menopausal menopausal hormone therapy (MHT) use and ovarian cancer risk have focused on White women and few have included Black women.
Objective
To assess the relation between menopausal hormone therapy use and the risk of ovarian cancer in accordance with ethnicity.
Design
Authors evaluated MHT use and ovarian cancer risk in Black (n = 800 cases, 1783 controls) and White women (n = 2710 cases, 8556 controls), using data from the Ovarian Cancer in Women of African Ancestry consortium.
Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association of MHT use with ovarian cancer risk, examining histotype, MHT type and duration of use.
Main findings
Long-term MHT use, ≥10 years, was associated with an increased ovarian cancer risk for White women (OR = 1.38, 95%CI: 1.22-1.57) and the association was consistent for Black women (OR = 1.20, 95%CI: 0.81-1.78, Pinteraction = 0.4).
For White women, the associations between long-term unopposed estrogen or estrogen plus progesterone use and ovarian cancer risk were similar; the increased risk associated with long-term MHT use was confined to high-grade serous and endometroid tumors.
Based on smaller numbers for Black women, the increased ovarian cancer risk associated with long-term MHT use was apparent for unopposed estrogen use and was predominately confined to other epithelial histotypes.
Take-home message
The association between long-term MHT use and ovarian cancer risk was consistent for Black and White women.
8. Wong GRM, Lee EJA, Liaw QY, Rajaram H. The role of oestrogen therapy in reducing risk of Alzheimer’s disease: systematic review. BJPsych Open. 2023;9(6):e194.
Background
Studies have shown a relationship between oestrogen and Alzheimer’s disease; however, there is neither clear nor strong evidence on the use of oestrogen-only therapy in reducing the risk of Alzheimer’s disease.
Objective
To assess the effects of oestrogen-only therapy on reducing the risk of Alzheimer’s disease.
Design
Inclusion criteria was determined with the PICO framework. Outcome was cognitive function measured by neuropsychological tests and strict protocols.
Exclusion criteria included non-Alzheimer’s dementia, progesterone-only therapy and pre-menopausal women.
Searches were conducted in nine electronic healthcare databases, last searched in July 2022.
Quality assessments conducted on randomised controlled trials (RCTs) were performed with the GRADE assessment, and cohort studies and case-control studies were assessed with the Newcastle-Ottawa Scale.
Extracted data was used to analyse participants, interventions and outcomes.
Main findings
Twenty-four studies satisfied the search criteria (four RCTs, nine cohort studies, 11 case-control studies).
Fifteen studies showed positive associations for oestrogen-only therapy reducing the risk of Alzheimer’s disease, and the remaining nine found no evidence of association.
Fifteen studies showed that oestrogen-only therapy effectively reduced the risk of Alzheimer’s disease, whereas nine showed no correlation.
Studies also investigated oestrogen-related variables such as length of oestrogen exposure, being an apolipoprotein E ε4 carrier and concomitant use of non-steroidal anti-inflammatory drugs, and their role in neuroprotection.
This review was limited by the limited ranges of duration of oestrogen treatment and type of oestrogen-only therapy used.
Take-home message
Oestrogen-only therapy has the potential for use in preventing Alzheimer’s disease, although current evidence is inconclusive and requires further study.
9. Crestol A, Rajagopal S, Lissaman R, LaPlume AA, Pasvanis S, Olsen RK, Einstein G, Jacobs EG, Rajah MN. Menopause Status and Within-Group Differences in Chronological Age Affect the Functional Neural Correlates of Spatial Context Memory in Middle-Aged Females. J Neurosci. 2023;43(50):8756-8768.
Background
Reductions in the ability to encode and retrieve past experiences in rich spatial contextual detail (episodic memory) are apparent by midlife – a time when most females experience spontaneous menopause, yet, little is known about how menopause status affects episodic memory-related brain activity at encoding and retrieval in middle-aged premenopausal and postmenopausal females, and whether any observed group differences in brain activity and memory performance correlate with chronological age within group.
Objective
To determine how menopause status and within-group differences in chronological age affect the functional neural correlates of spatial context memory in middle-aged females.
Design
The authors conducted an event-related task fMRI study of episodic memory for spatial context to address this knowledge gap.
Multivariate behavioral partial least squares was used to investigate how chronological age and retrieval accuracy correlated with brain activity in 31 premenopausal females (age range, 39.55-53.30 years; mean age, 44.28 years; SD age, 3.12 years) and 41 postmenopausal females (age range, 46.70-65.14 years; mean age, 57.56 years; SD age, 3.93 years).
Main findings
Authors found that postmenopausal status, and advanced age within postmenopause, was associated with lower spatial context memory.
The fMRI analysis showed that only in postmenopausal females, advanced age was correlated with decreased activity in occipitotemporal, parahippocampal, and inferior parietal cortices during encoding and retrieval, and poorer spatial context memory performance.
In contrast, only premenopausal females exhibited an overlap in encoding and retrieval activity in angular gyrus, midline cortical regions, and prefrontal cortex, which correlated with better spatial context retrieval accuracy.
These results highlight how menopause status and chronological age, nested within menopause group, affect episodic memory and its neural correlates at midlife.
Take-home messages
This is the first fMRI study to examine how premenopause and postmenopause status affect the neural correlates of episodic memory encoding and retrieval, and how chronological age contributes to any observed group similarities and differences.
It was found that both menopause status (endocrine age) and chronological age affect spatial context memory and its neural correlates.
Menopause status directly affected the direction of age-related and performance-related correlations with brain activity in inferior parietal, parahippocampal, and occipitotemporal cortices across encoding and retrieval.
Moreover, authors found that only premenopausal females exhibited cortical reinstatement of encoding-related activity in midline cortical, prefrontal, and angular gyrus, at retrieval; suggesting that spatial context memory abilities may rely on distinct brain systems at premenopause compared with postmenopause.
10. Davis SR, Taylor S, Hemachandra C, Magraith K, Ebeling PR, Jane F, Islam RM. The 2023 Practitioner’s Toolkit for Managing Menopause. Climacteric. 2023;26(6):517-536.
Background
The Practitioner’s Toolkit for Managing the Menopause, developed in 2014, provided an accessible desktop tool for health-care practitioners caring for women at midlife.
Objective
To ensure the Toolkit algorithms and supporting information reflect current best practice, the Toolkit was revised in accordance with the published literature.
Design
A systematic search for guidelines, position and consensus statements pertaining to the menopause and published after 2014 was undertaken, and key recommendations extracted from the Clinical Practice Guidelines determined to be the most robust by formal evaluation.
The peer-reviewed literature was further searched for identified information gaps.
Main findings
The revised Toolkit provides algorithms that guide the clinical assessment and care of women relevant to menopause.
Included are the reasons why women present, information that should be ascertained, issues that may influence shared decision-making and algorithms that assist with determination of menopausal status, menopause hormone therapy (MHT) and non-hormonal treatment options for symptom relief.
As clear guidelines regarding when MHT might be indicated to prevent bone loss and subsequent osteoporosis in asymptomatic women were found to be lacking, the Toolkit has been expanded to support shared decision-making regarding bone health.
Take-home messages
The 2023 Toolkit and supporting document provide accessible desktop information to support health-care providers caring for women at midlife.
The Toolkit has been endorsed by the International Menopause Society, Australasian Menopause Society, British Menopause Society, Endocrine Society of Australia and Jean Hailes for Women’s Health.
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/
40th Annual Meeting of European Society of Human Reproduction and Embryology Date: 7th – 10th July, 2024 Venue: RAI Amsterdam, Amsterdam, Netherlands
For more information: https://www.eshre.eu/ESHRE2024/
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)
The 16th International Congress of the Jordanian Society of Obstetricians and Gynecologists Date: 4th – 6th September 2024
Venue: Amman, Jordan
For more information: The 16th International Congress – JSOG
Beijing Obstetrics and Gynaecology Hospital Date: 24th September, 2024
Venue: Capital Medical University, Beijing
International Experts Summit on Gynecology and Women’s Health Date: 26th – 28th September, 2024
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
