AMS eChanges Volume 2023:02 | 27 February 2023

President's Report 

Dear AMS Members,

Many AMS members are clinicians who treat women with early or premature menopause or see the consequences of inadequate clinical care.

Early menopause is the loss of ovarian function under the age of 44 and affects up to 12% of women. Premature menopause, also called premature ovarian insufficiency (POI), is the loss of ovarian function under age 40, and is experienced by up to 4% of women globally.(1) Early and premature menopause can be spontaneous or can be caused by medical treatments such as chemotherapy, radiotherapy or surgical removal of the ovaries.

POI should be considered when a woman under 40 presents with oligo/amenorrhoea. Unfortunately, the diagnosis is sometimes delayed as women or their clinicians may not consider POI as a cause of oligo/amenorrhoea, preferring alternative explanations such as post-pill amenorrhoea or polycystic ovarian syndrome. Delayed diagnosis can lead to missed opportunities in fertility, bone health, sexual health, cardiovascular health and psychosocial support for women.

A diagnosis of POI can be unexpected and devastating and appropriate support should be offered. Women need a comprehensive assessment including evaluation for a cause (Figure 1) and for management of both short- and long-term health. Referral to an appropriate specialist is recommended. A suggested approach to the management of women with POI is summarised in this algorithm (Figure 2). For some women loss of fertility is the primary concern.(2) Sexual health and management of genitourinary symptoms should be addressed.

Assessment of bone health is important, along with reducing modifiable risk factors for osteoporosis, and optimising calcium, vitamin D and exercise. Bone densitometry is MBS reimbursed in Australia for women with hypogonadism aged under 45 years. Hormone replacement therapy is recommended for women without contraindications, for maintenance of bone health. Hormone therapy containing at least 2 mg oral estradiol or equivalent is needed to maintain bone density.(3)

Cardiovascular disease risk is elevated in women with POI. Assessment and management of risk factors and promotion of healthy lifestyle is very important. Hormone therapy may reduce risk.(4)

Women with POI need high quality information to guide them. There are now excellent resources available to women with early menopause including Askearlymenopause, a freely available app giving reliable information (Figure 3).

Australian general practitioners are reminded that patients with POI are eligible for Chronic Disease Management Plan item numbers under Medicare. Many women will benefit from a multidisciplinary team approach including allied health practitioners such as exercise physiologists, psychologists, dieticians and physiotherapists.

Clinical Associate Professor Amanda Vincent, a Past President of AMS and a current Board member of the International Menopause Society, leads a research and education program at Monash University. Her team have developed the algorithms reproduced here, and a range of other resources. Amanda is part of an international group updating the 2016 European Society for Human Reproduction and Embryology POI guideline,(4) expected to be ready next year. POI will also be part of the IMS World Congress on Menopause in Melbourne 2024 – so save the date!

References

1. Golezar S, Ramezani Tehrani F, Khazaei S, Ebadi A, Keshavarz Z. The global prevalence of primary ovarian insufficiency and early menopause: a meta-analysis. Climacteric. 2019;22(4):403–11.
2. Dhanushi Fernando W, Vincent A, Magraith K. Premature ovarian insufficiency and infertility. Australian Journal for General Practitioners. 2023;52:32–8.
3. Gazarra LBC, Bonacordi CL, Yela DA, Benetti-Pinto CL. Bone mass in women with premature ovarian insufficiency: a comparative study between hormone therapy and combined oral contraceptives. Menopause. 2020;27(10):1110–6.
4. Webber L, Davies M, Anderson R, Bartlett J, Braat D, Cartwright B, et al. ESHRE Guideline: management of women with premature ovarian insufficiency. Hum Reprod. 2016;31(5):926–37.

Figure 1

A PDF of Algorithm: Diagnosis/evaluation of premature ovarian insufficiency for personal use is available here

Reproduced with permission from Monash Centre for Health Research and Implementation (MCHRI), Monash University, Clayton, Victoria, Australia
(https://www.mchri.org.au/guidelines-resources/health-professionals/early-menopause-practice-tools/). Copyright © MCHRI.

Figure 2

A PDF of  Algorithm: Management of premature ovarian insufficiency for personal use is available here

Reproduced with permission from Monash Centre for Health Research and Implementation (MCHRI), Monash University, Clayton, Victoria, Australia
(https://www.mchri.org.au/guidelines-resources/health-professionals/early-menopause-practice-tools/). Copyright © MCHRI.

Figure 3

Yours sincerely,

Dr Karen Magraith

IMS World Congress on Menopause in Melbourne 2024

Improving my practice with online mental health resources – a GP reflects

Dr Carmel Reynolds

I had planned to spend my summer break reading useful books that are available for women trying to manage menopausal symptoms. I have a collection and thought I would: 1) make my own notes about who the books would help; 2) appraise the quality of the information; and 3) have them ready to lend once I got back to work. The books are very new and still in a neat pile on my bedside table. The reality is, at the end of 2022, I was really tired and I wanted to read books that were fun, light-hearted and didn’t require any great academic appraisal – and did not mention COVID.

Instead, I decided to think about how GPs and other non-GP specialists can better use and be assisted by books, online resources and apps.

Much has been documented in GP literature about high rates of burnout and dissatisfaction with increasing workloads combined with fewer resources and less money. GPs are retiring, changing to other subspeciality roles, reducing hours and we have not been able to fill training positions. Fewer medical graduates are interested in pursuing a career in General Practice.(1) Popular media outlets seem to want to brand us as greedy doctors, patients cannot get appointments and people can’t afford appointments.

From my perspective, I want a system that is fit for purpose and, yes, I do want to be paid for the work I do. But what I really want is to be able to access services for my patients. This is my job. I care about people and I want to help, but I know so many people are barely getting by week to week and more than are few are sinking further into debt. I can’t do my job well if patients cannot access the care they need.

Despite that doom and gloom, I really like my job. I like being a GP. I have a unique window into people’s lives and can offer comprehensive “holistic” and intergenerational care. I am sure many, if not most GPs, feel the same.

My style is mostly slow medicine. I assist a cohort that is female predominant, too often with a history of not being heard and with high rates of mental health concerns. Again, I am sure many of you reading this are in the same boat. I would like item numbers that reward this work, without feeling like we cannot bill them for fear of audit.

Menopause consults are often longer and incorporate symptom management, chronic disease prevention, early detection of cancer and mood symptoms. Yet, there is no adequate single item number that reflects the work involved. And it is known that many of us often under-bill.(2)

Why am I writing about this in eChanges? I want healthcare reform that acknowledges this work and makes it easier to build multi-disciplinary teams that people can afford to access. To say I felt frustrated when the government reduced funding to psychological therapies for 2023 by half is an understatement. I acknowledge but won’t be able to address the inequities of access to these services that have always existed and remain – not to mention the long wait times faced by those who can afford to access psychological therapy.

We know that mood symptoms are common in perimenopause and that the rates are higher in those with a previous depressive episode or history of hormone-related mood disorder. Perimenopausal depression and anxiety present differently to other mood disorders and using a menopause-specific assessment tool such as Meno D can help in diagnosis. Consideration of hormonal therapy (MHT), antidepressant medication and psychological therapies all need consideration.(3) We know that Cognitive Behaviour Therapy can help manage mood symptoms, hot flushes and sleep issues.(4) How do we assist access to these therapies while we have reductions in funding, increasing gaps and limited availability of practitioners? Invariably much of this falls back on the GP to manage, with a reduction in multidisciplinary care.

I used my holiday to make a mental to-do list. One of the items on my list was to collate a list of e-health resources and find recommendations for books from trusted sources. There is evidence to suggest that e-health resources can be effective in the management of mild- moderate anxiety and depression. They offer convenience, are often low or no cost and are cost effective and time efficient.(5) Menopause is trendy right now and there is a lot of good information out there, but unfortunately a lot of misinformation is also available. I think it is helpful for us to have some knowledge of trends and be able to suggest sites that are evidence based.

Below is a short list of my go-to mental health resources and I hope this is helpful to you. Some resources, such as “This Way Up”, allow practitioners to register and refer, waiving the patient fee and keeping us informed of their progress. I continually find new resources and information and it will take a time commitment from me to get a better understanding of what they can offer.

I also have favourite social media sites specifically for menopause, but I won’t include all of those here. I follow the Australasian Menopause Society (AMS) on the usual socials (AMS is on twitter, Facebook, LinkedIn and Instagram) and follow our President (@KarenMagraith) on twitter. I share the information on the AMS website with colleagues and consumers alike – we have excellent resources.

I will read that pile of books I mentioned – perhaps on the plane on my way to Queenstown for the AMS 2023 Congress.

Online mental health resources

• Centre for clinical interventions – https://www.cci.health.wa.gov.au/ – Consumer Information sheets for a wide range of mental health conditions
• Head to Health, Australian Government – https://www.headtohealth.gov.au/search-resources – A resource for clinician and consumers alike with links to apps, websites, online learning tools
• This Way Up – https://thiswayup.org.au/ – A Variety of online programs for consumers. If clinicians are registered, they can register patients and fee is waived. Clinicians receive updates of progress
• Future learn – https://www.futurelearn.com/courses/mindfulness-life – A free online mindfulness course
• Clinical resources and tools – mental health and young people, NPS Medicinewise – https://www.nps.org.au/professionals/mental-health-and-young-people/clinical-resources-and-tools – A comprehensive list of apps and websites for mental health, most general, but does include some specific to younger people
• Black Dog Institute, Digital tools & apps – https://www.blackdoginstitute.org.au/resources-support/digital-tools-apps/

References

1. Australian Medical Association, AMA report projects “staggering” GP shortage, published online 25 November 2022. Available at: https://www.ama.com.au/gpnn/issue-22-number-46/articles/ama-report-projects-staggering-gp-shortage
2. NewsGP, Survey suggests huge scale of GP under-billing, published online 31 October 2022. Available at: https://www1.racgp.org.au/newsgp/professional/survey-suggests-huge-scale-of-gp-under-billing
3. Kulkarni J, Perimenopausal depression – an under-recognised entity. Australian Prescriber, 2018;41:183–185. DOI: https://doi.org/10.18773/austprescr.2018.060
4. Hunter MS and Chilcot J, Is cognitive behaviour therapy an effective option for women who have troublesome menopausal symptoms? Br J Health Psychol, 2021; 26: 697–708. DOI: https://doi.org/10.1111/bjhp.12543
5. RACGP, e-Mental health A guide for GPs, updated September 2018. Available at: https://www.racgp.org.au/getattachment/a5a2daae-77ca-4d0a-8dfd-81b04105409e/e-Mental-health-A-guide-for-GPs.aspx

Article available online here

AMS Advocacy Campaign and Menopause Survey for Women - Get on board!

The AMS advocacy campaign to raise awareness of menopause and direct health professionals and consumers to evidence-based information and resources on menopause and midlife women’s health is underway. This advocacy campaign ties in with the upcoming Parliamentary Round Table discussion entitled “Menopause Matters” on 7 March 2023 which is being hosted by AMS, where we will advocate for health professional education and community awareness about menopause.

AMS is running a social media campaign #EmbracetheChange and we encourage you and your patients to engage and cross-promote on platforms such as Facebook, LinkedIn, Twitter and Instagram and also by tagging us with #AMSmenopause.

AMS is also surveying consumers experience of menopause to collect some quick, easy data that we can highlight to government. It is not intended to be a representative sample, but has been designed with mostly closed questions so we can analyse quickly. The survey can be found here or via the QR Code and we encourage you to pass it on to anyone that you know who is peri- or post-menopausal.

26th AMS Congress, Queenstown, New Zealand, 1-3 September 2023

The AMS is pleased to advise that the 26th AMS Congress will be held at The Millennium Hotel, Queenstown, New Zealand from 1-3 September 2023. The theme of the Congress is “Remarkable reflections on midlife and menopause”. Dr Ashley Makepeace is Chair of the Scientific Committee and will be sure to put together an up-to-date and stimulating scientific program. Dr Sylvia Rosevear is Chair of the Local Organising Committee and is looking forward to welcoming delegates to Queenstown to experience the beauty and adventure of this amazing destination. So please add the dates 1-3 September 2023 in your diaries and keep up to date about the Congress at www.amscongress.com.au  

Impact of hormone therapy on the bone density of women with premature ovarian insufficiency

IMS Live: 31 January 2023

Summary

Women with premature ovarian insufficiency (POI) are exposed to a long period of estrogenic deficiency, which potentially brings higher health risks, especially regarding bone health. Recently Costa et al. [1] performed a systematic review of the literature to evaluate the effect of hormone therapy (HT) on bone mineral density (BMD) in women with POI. They performed a search in MEDLINE and EMBASE databases up to September 2021 and included studies that analyzed women with spontaneous idiopathic POI treated with HT, to whom BMD was evaluated. Analysis of risk of bias of the selected studies was also performed. The authors found 335 articles and selected 16 studies according to the inclusion criteria. Most of the studies revealed lower bone density in both the femoral neck and lumbar spine in women with POI compared with healthy women. Bone mass had the tendency to remain stable in women treated with estrogen + progestin therapy; however, in those already with bone mass loss, the therapy - in the doses most frequently used - was not able to revert the loss. Higher estrogenic doses seemed to have a positive impact on BMD, as did combined oral contraceptives used continuously. In addition, the interruption of HT for longer than one year was associated with significant bone loss. The authors conclude that although HT brings clear benefits, further studies are needed to establish its long-term effects, as well as doses and formulations with better protective effects on the bone mass of women with POI.

Commentary

This is a useful systematic review [1] of the currently available data concerning POI and the impact of various HT regimens including menopause hormone therapy (MHT) and the combined oral contraceptive pill (COC) on BMD. Despite the stated limitations, it illustrates several issues which are important for clinical practice; these are:

• making the diagnosis of POI as early as possible is crucial in order to commence HT in a timely fashion to prevent bone loss, which may not be recoverable.
• ensuring adequate compliance with HT to optimize bone protection.
• avoiding the hormone free interval in COC users to maximize bone protection.
• prescribing a sufficiently high dose of HT to adequately protect, and ideally increase, BMD.

Unfortunately, long-term prediction of POI using biomarkers such as anti-mullerian hormone remains problematic [2,3]. We must therefore combine clinical acumen with public health information, for example, menstrual irregularities should be reported early to primary healthcare providers. Toolkits for primary care physicians can also be of assistance in the early diagnosis and efficient management of POI [4].
 
The focus of this paper was on BMD in women with POI. We must not lose sight of the fact that the gold standard outcome measure of bone health is fracture prevention, for which there are no good quality long term prospective randomized controlled data in women with POI. Even if bioequivalence of COC pill versus MHT is demonstrated regarding BMD, care must be taken in extrapolating this to fracture prevention; for instance, it is possible that the quality of preserved/formed bone with MHT is better than that with the COC pill. It also well recognized that the rationale for hormone replacement in POI is not only to prevent bone loss, but also to maintain the possibility of pregnancy, preserve quality of life, and protect against cardiometabolic and cognitive deterioration. For instance, some data indicate that MHT can achieve better cardiovascular benefits than the COC pill e.g. favorable blood pressure effects [5].
 
The meta-analysis [1] excluded studies of women with cancer, treatment with chemo or radiotherapy, surgical menopause, Turner syndrome and other genetic disorders. This was logical in terms of analyzing the “pure” effect of POI on BMD. However, these concerning populations of hypoestrogenic young women, also affected by the added impact of malignancy and/or iatrogenic interventions, or genetic disorders, should not be neglected, and are worthy of extensive research.
 
The principles of diagnosis and management of POI were comprehensively covered in the International Menopause Society (IMS) white paper published for World Menopause Day in 2020 [6]. The paper illustrated the deficiency of large long-term prospective studies comparing the impact of MHT compared to COCs on bone health and other parameters. A large multicenter study funded by the National Institute of Health and Care Research in the UK (POISE) is currently recruiting women with POI of all causes and randomizing them to MHT versus COC. The primary outcome measure is the change in lumbar spine density at two years, but quality of life and cardiometabolic parameters will also be studied. Subjects will be randomized for five years with a possible observational extension after this.
 
The authors of the current commented meta-analysis [1] state that “further prospective studies, in different centers, with a randomized clinical trial design will, therefore be required to control for possible risks of bias regarding the different treatments, thus providing a better level of evidence.” Recommendations and guidelines are only as good as the data that are used for their formulation. The ESHRE guidelines on POI [8] are currently being updated in collaboration with Monash University, the American Society for Reproductive Medicine and the IMS. This should ideally remain a “live” document to facilitate regular updates as new data are published. In the absence of data from long term prospective randomized trials, large POI registries from the UK and China such as the https://poiregistry.net could usefully contribute data going forward. Preliminary registry data from the UK support the findings of the meta-analysis here commented [1] that in the absence of HT, BMD is reduced. The adage of “prevention is better than cure” has never been more apt than in young women with POI. Further POI registry data were also recently presented from Spain and Finland at the 2022 IMS World Congress in Lisbon, Portugal [9,10]. It is hoped that the totality of global data will be amalgamated from these and other registries in the future, to facilitate understanding and management of this distressing condition.
 
Nick Panay
Professor of Practice, Imperial College London, UK
President, International Menopause Society

References online here

Menopausal vasomotor symptoms and white matter hyperintensities in midlife women

IMS Live: 13 February 2023

Summary

Recently, Thurston et al. [1] investigated whether vasomotor symptoms (VMS), when rigorously assessed using physiologic measures, were associated among midlife women with greater white matter hyperintensity volume (WMHV). The authors considered a range of potential explanatory factors in these associations and explored whether VMS were associated with the spatial distribution of WMHV. For this, women aged 45-67 (n=226) who were free of hormone therapy underwent 24 hours of physiologic VMS monitoring (sternal skin conductance), actigraphy assessment of sleep, physical measures, phlebotomy, and 3 Tesla neuroimaging. Associations between VMS (24-hour, wake, and sleep VMS, with wake and sleep intervals defined by actigraphy) and whole brain WMHV were analyzed in linear regression models adjusted for age, race, education, smoking, body mass index, blood pressure, insulin resistance, and lipids. Secondary models considered WMHV in specific brain regions (deep, periventricular, frontal, temporal, parietal, occipital) and additional covariates including sleep. The investigators found that physiologically-assessed VMS were associated with greater whole brain WMHV in multivariable models, with the strongest significant associations observed for sleep VMS [24-hour VMS, wake VMS, sleep VMS]. Associations were not accounted for by additional covariates including actigraphy-assessed sleep (wake after sleep onset). When considering the spatial distribution of WMHV, sleep VMS were associated with both deep, periventricular and frontal lobe WMHV. The authors conclude that VMS, particularly those occurring during sleep, were associated with greater WMHV. In addition, they recommend the crucial need of finding female-specific midlife markers of poor brain health later in life in order to identify women who warrant early intervention and prevention. VMS have the potential to serve as this female-specific midlife marker of brain health in women.

Commentary

VMS are commonly regarded just as annoying and uncomfortable side effects of ovarian failure, which may either be temporary and wane within up to several years in the postmenopause, or can be successfully treated by menopausal hormone therapy, but having no otherwise health significance. Contrarily, many recent studies showed that VMS are related to important clinical situations, and therefore the occurrence of VMS should raise attention to potential problems in various body systems. Accumulating evidence indicates that VMS are associated with cardiovascular health and with an increased risk for several chronic diseases, including the metabolic syndrome, obesity, type 2 diabetes mellitus, non-alcoholic fatty liver diseases, and osteoporosis in peri- and postmenopausal women [2].

White matter hyperintensities (WMHs) are brain white matter lesions that are hyperintense on fluid attenuated inversion recovery magnetic resonance imaging (FLAIR-MRI) scans. WMHs are commonly seen on brain MRIs in older people, but appear also in certain disease conditions, mainly in neurological and psychiatric disorders [3]. One of the underlying mechanisms is ischemia, expressed as small vessel disease. Larger WMH volumes have been associated with Alzheimer's disease (AD) and with cognitive decline [4].

So these are the facts: 1) the menopausal transition has been recognized as an important period for women's brain health; 2) VMS frequently occur from the early stage of menopause onward; and 3) the existence of WMHs points at a higher risk for cognitive decline. The present commented paper of Thurston et al. [1] tied all these parameters and investigated the association between VMS, monitored objectively by sternal skin conduction rather than according to women’s subjective report, and WMHs recorded by very accurate MRI scans. Study findings pointed at a clear association between VMS, especially if occurring during sleep [5], and greater whole brain WMH volume. Such results may indicate that VMS should be considered as a valuable early marker for future cognitive impairment. Understanding the scope of the VMS phenomenon clearly contradicts the previous commonly held belief of its irrelevance to major health issues in various body systems. 
 
Amos Pines, MD
Sackler Faculty of Medicine, Tel-Aviv University, Israel

References online here

Our Menopause World February 2023

President’s Report
Nick Panay BSc MB BS FRCOG MFSRH

Dear Friends and Colleagues,

It is a great pleasure to communicate with you once again. It has been a busy start to the year for the International Menopause Society. 

We held an online webinar on Tuesday 17th January chaired by Professor Wendy Wolfman on the important topic of sleep. There were excellent presentations by Professor Hadine Joffe on the topic of Impact of Menopause on Sleep and by Professor Tommaso Simoncini on the topic of Treatment of Sleep Disorders associated with the Menopause with stimulating interactive discussions after the presentations.
 
Registration is now open for our next webinar on 14th February 2023, 15:00 CET which is on the very topical subject of Menopause in the Workplace (archive version will be available thereafter) and these will continue on a monthly basis with a diverse range of speakers and topics, kindly supported by an unrestricted educational grant from Besins Healthcare who has no influence on the choice of speakers and subject material. We are most grateful to all our speakers and chairs who have selflessly given of their time and efforts over the years since the online educational platform was started.
 
We also held a meeting of the IMS Executive Committee in London on January 18th/19th 2023 in which we spent a considerable amount of time reviewing and reflecting on the roles of the IMS Executive and Board, and the many achievements of the President and Board from 2020-2022. We then used this information for strategic planning of the priorities for the current term of office, 2022-2024, and beyond. This was a highly fruitful exercise which enabled us to optimise various important aspects of the running of IMS including finance, governance, education and communication with both healthcare providers (HCPs) and the public.
 
The key points that emerged from the two-day meeting was that strategic principles of IMS have been, and will continue to be:

• Good communication and transparency in all aspects of societal governance as outlined by the society’s Scheme of Governance, Management and Delegation document;
• Fiscal prudence, which aims to optimise the financial security of the society whilst supporting the academic activity of IMS members and the wider menopause world;
• Ensuring data protection and security, especially cybersecurity – achieved through active risk assessment, protection and response from professional security organisations; and
• Continuing to grow our collaboration with other societies and global organisations.

There was also much discussion about the organisational structure of the IMS going forward, with emphasis on the importance of the many “sub” committees which are an invaluable way of the IMS Executive and Board obtaining new information from our wider membership. New committees in development include Menopause Info, Young Professionals, Council of Affiliated Menopause Societies (CAMS) steering group and IMS Recommendations. We will be reaching out soon to a you, our members, to help populate these committees.
 
There was also considerable discussion about the plans for the CAMS. Scheduling is already underway for quarterly online CAMS regional meetings and the first issue of our “CAMS Connect” newsletter. Both of these endeavours are designed to improve our communication with our global network of menopause and midlife healthcare providers.
 
A more detailed report of our strategic activities will be produced in due course which will contribute to the development of a “Manual of Operations” for the society. This will also help us to update and compliment the society’s Constitution and Rules.
 
Menopause continues to be in the news. The UK government recently responded to the Women and Equalities Committee’s report on Menopause and the Workplace. There has already been considerable progress in the field of menopause in general; these are some of the initiatives:

• Publication of a Women’s Health Strategy with education of HCPs and the public a priority, and appointment of a Women’s Health Ambassador, Professor Lesley Regan;
• Establishment of an NHS England National Menopause Care Improvement programme aligned with the NICE guideline on menopause diagnosis and management;
• Provision of HRT pre-payment certificates from April 2023 to reduce the cost of prescriptions, and removal of dual prescription charges for estrogen and progesterone; and
• Ensuring provision of at least one menopause specialist in every healthcare region of the country by 2024.

However, it was not accepted by the government that menopause should be a characteristic protected by law. There is still much work to be done, but I believe that much progress has been made, and some aspects could be adapted in other countries and regions of the world, with appropriate sensitivity to local political, cultural, religious and financial issues.
 
Regional issues and more will be covered in our symposium at EMAS as mentioned in my previous report. Full details are now available on the EMAS meeting website and shown below https://emas2023.abstractserver.com/program/#/details/sessions/3.
 
Title: Ethnic and Socio-Cultural Challenges of Global Menopause Care
Chairs: Nick Panay (UK) Santiago Palacios (Spain)
Speakers/Topics
Professor Duru Shah (India)
The Latur Project: Screening for Non-Communicable Diseases in Rural India
Dr Nicole Jaff (South Africa)
Does one size fit all? The usefulness of menopause education across low- and middle-income countries.
Professor Rossella Nappi (Italy)
Talking sex in a diverse world 15 mins
 
The next IMS Board meeting will take place just before the EMAS meeting on May 2nd, 2023 and will be followed by meetings of the “sub” committees on May 3rd, 2023.
 
The Scientific Programme and Local Organising Committees continue to plan our next World Congress in Melbourne Oct 19th to 22nd 2024. Can I please ask you all once again to spread the word amongst your colleagues; by now you should have received the promotional slide that you can incorporate in all your academic activities and forward to your academic institutions. Finally, please do contribute to our Endowment for Education and Research (EER). Attendance at our World Congresses would otherwise be impossible for many trainees without travel bursaries from the EER The IMS Endowment for Education and Research - International Menopause Society (imsociety.org)
 
As mentioned above, the Executive Committee discussed communication in our January meeting. Our aim is to ensure that the amount of information we send to our members balances being respectful of your very busy schedules and keeping you up to date. Therefore, we have agreed some modifications to the frequency of our member communications. The full and more detailed issue of Our Menopause World, containing the President's Report, will alternate monthly with a streamlined issue that offers you an 'at a glance' update on our latest news and educational initiatives. The excellent critical analyses of recent papers from Menopause Live will be provided on an alternate weekly basis. In the meantime, I look forward to receiving your ongoing suggestions and contributions to improve our society. 

Read more online here...

Our Menopause World February 2023

European Menopause and Andropause Society (EMAS) Newsletter

AMS is an affiliate of EMAS.

See a copy of the EMAS February 2023 Newsletter