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IMS Menopause Live

Commentaries from the IMS on recently published scientific papers that may be of interest. The latest articles are available to Members only when logged in. Selected articles are open to public.

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Menopausal symptoms in mid-aged women from Paraguay

27 November 2023

Summary

Recently, Sánchez-Zarza et al. [1] aimed at determining the prevalence of menopausal symptoms and factors related to severity in mid-aged women from Asunción, Paraguay. For this, they carried out a cross-sectional study in which 216 urban-living women (40-60 years) were surveyed with the 10 item Cervantes Scale (CS-10) and a general questionnaire containing personal and partner data. They found that the median age of the sample of 48 years, 48.1% were postmenopausal, 8.8% used menopausal hormone therapy, 39.4% psychotropic drugs, 43.5% had hypertension, 6.5% diabetes, 51.9% abdominal obesity, and 89.3% had a partner (n = 193). A history of sexual abuse was present in 2.8%. The median total CS-10 score was 8.5. Overall, 93.3% (180/193) of women having a partner were sexually active, with a median coital frequency of 8 times per month. According to the CS-10, the three most prevalent menopausal symptoms were: aching in muscles and/or joints (70.8%), anxiety and nervousness (70.8%) and hot flashes/night sweats (54.2%). Factors associated with higher CS-10 scores were: female age and educational level, marital status, menopausal status, and marital sexual aspects. Multiple linear regression analysis found that higher total CS-10 scores (more severe menopausal symptoms) negatively correlated to coital frequency and positively correlated with peri- and postmenopausal status, parity, sedentary lifestyle and a history of sexual abuse. The authors conclude that menopausal symptoms of this mid-aged urban female Paraguayan sample were related to hormonal, sexual and other female aspects.

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Substantial lipid increases during the menopausal transition in Korean mid-aged women

21 November 2023

Summary

During the postmenopausal stage women often display adverse lipid profiles; however, evidence is insufficient regarding the association between lipids and reproductive aging in Korean women. Bearing this in mind, Park et al. [1] aimed to characterize lipid changes in relation to the timing of menopause in 1,436 Korean mid-aged (premenopausal) women who had a natural menopause during the follow-up period (median = 15.76 years) from the Korean Genome and Epidemiology Study (KoGES) Ansan and Anseong cohort. Lipid levels were measured every 2 years, and the magnitudes of annual lipid changes and differences in the changes by premenopausal body mass index were estimated using piecewise linear mixed-effects models. The authors found that all lipid levels increased greatly from 3 or 5 years before menopause to 1 year after menopause in all women, regardless of their premenopausal body mass index (BMI). During the period, HDL-C levels increased at 0.42 mg/dL per year (95% CI, 0.29 to 0.55). Nevertheless, non-HDL-C levels simultaneously increased at 3.42 mg/dL per year (95% CI, 3.11 to 3.72), and an annual change in the non-HDL-C to HDL-C ratio was 0.05 (95% CI, 0.04 to 0.06). One year after menopause, changes in all lipid parameters significantly slowed down, except for the non-HDL-C to HDL-C ratio (p < 0.001 for all). The ratio continued to increase until 3 years after menopause, but thereafter, the change leveled off. The researchers conclude that women experienced remarkable increases in lipid levels during menopausal transition, highlighting the need for early intervention strategies for cardiovascular disease (CVD) prevention in women.

Read more …Substantial lipid increases during the menopausal transition in Korean mid-aged women

Understanding the brain during menopause

24 October 2023

Summary

Zhu and colleagues [1] have undertaken a study to address the lack of a specific cognitive assessment in relation to menopause by evaluating the Everyday Memory Questionnaire-Revised (EMQ-R). The EMQ-R was first developed as a 35-item questionnaire to be used after closed head injury that was subsequently reduced to a 13-item questionnaire for broader use. The latter was what the authors evaluated in a “menopausal population” of women aged 30-60 years, recruited by targeted advertising to achieve a sample of women experiencing menopausal symptoms (i.e brain fog, hot flushes, and night sweats). Menopausal hormone therapy (MHT) users and women using therapies that would mask or inhibit menstrual bleeding, and hysterectomised women were not excluded. However, menopause staging was based on STRAW+10 bleeding criteria [2]. A total of 417 women completed the questionnaire, subdivided into premenopausal (n=107), perimenopausal (n=149), and early postmenopausal (n=161) groups and hormonal contraceptive (HC)/MHT use was 37%, 27% and 40%, respectively. The majority (>85%) had graduate education. The analysis focused on retrieval and attention domains of the EMQ-R as cognitive components of “brain fog”. The main findings were that there were no differences between the three groups for the total EMQ-R score or the attention subscale. However, the perimenopausal group had a poorer total score for the EMQ-R retrieval domain (mean 13.58, SD 6.99) compared with pre- (11.8, SD 7.36) and postmenopausal (11.73, SD 7.17) groups (p=0.043).

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Vaginal laser therapy for GSM/VVA: where we stand now - a review by the EUGA Working Group on Laser by the EUGA Working Group on Laser

16 October 2023

Summary

Due to the increase in female life expectancy (around 80 years) observed in the different continents and with an average age at menopause onset of 48.6 years, it is becoming very important to seek new strategies to maintain an adequate quality of life in the different aspects of mid-life women's health. In this regard, it has been observed that the Genitourinary Syndrome of Menopause (GSM) can affect up to 75% of postmenopausal women, seriously altering different aspects of their lives. The most frequently reported symptoms include vaginal dryness, pruritus, burning, dyspareunia, altered urination frequency, urgency, dysuria and different degrees of stress urinary incontinence. Sexuality is one of the most affected aspects. In July of this year, Salvatore et al. [1], as part of the working group of the European Urogynecology Association (EUGA), published a review on a still controversial topic comparing the 2 types of lasers most frequently used in gynecology to manage the GSM. In this regard, it clarifies that the current indication for its use is mainly the treatment of symptoms of vulvovaginal atrophy and/or the GSM, and not in the area of gynecological cosmetology where it has been widely used with very different results.

Read more …Vaginal laser therapy for GSM/VVA: where we stand now - a review by the EUGA Working Group on...

Continuous transdermal nitroglycerin does not decrease hot flush frequency and severity in peri- and postmenopausal women: results of a Randomized Placebo Controlled Clinical Trial

September 18th, 2023

Summary

There has been an increase in the use of non-hormonal options to treat hot flashes among many menopausal women, basically due to the potential risks of long-term systemic estrogen therapy. Physiologic studies have shown that nitric oxide is pivotal in mediating vasodilation related to hot flash. Hence, it can be suggested that non-hormonal medications that induce nitrate tolerance in the vasculature may offer therapeutic benefit for vasomotor symptoms. Bearing this in mind, recently, Huang et al. [1] carried out a randomized, double-blinded, placebo-controlled clinical trial that included peri- or postmenopausal women that reported 7 or more hot flashes per day, in order to determine if the uninterrupted administration of transdermal nitroglycerin (NTG, aimed to induce nitrate cross-tolerance) would decrease the frequency or severity of menopause-related hot flashes.

Women used daily NTG patches (dose titrated from 0.2-0.6 mg/h; n=65) or identical placebo patches (n=69), registering daily frequency and severity of their hot flashes for 12 weeks. At baseline women reported a daily mean of 10.8 ± 3.5 hot flashes and 8.4 ± 3.6 were moderate-to-severe. Over 5 weeks, the estimated change in any hot flash frequency associated with NTG vs placebo was -0.9 (95% CI, -2.1 to 0.3) episodes per day (P = .10), and change in moderate-to-severe hot flash frequency with NTG vs placebo was -1.1 (95% CI, -2.2 to 0) episodes per day (P = .05). At 12 weeks, treatment with NTG did not significantly decrease the frequency of any hot flashes or moderate-to-severe hot flashes relative to placebo. Even upon combining 5-week and 12-week data analysis, no significant differences in change in the frequency of any hot flashes or moderate-to-severe hot flashes were detected with NTG vs placebo. The authors conclude that the continuous use of NTG did not result in sustained improvements in hot flash frequency or severity relative to placebo and was associated with more early but not persistent headache.

Read more …Continuous transdermal nitroglycerin does not decrease hot flush frequency and severity in peri-...

Associations between dietary patterns and an array of inflammation biomarkers and plasma lipid profile in postmenopausal women

September 11th, 2023

Summary

Recently, Ilesanmi-Oyelere et al. [1] reported the results of a cross-sectional study that evaluated the association between four dietary patterns, nutrients and food intakes and an array of systemic inflammation biomarkers and lipid profile among 80 postmenopausal women from New Zealand. The authors used a food frequency questionnaire to collect nutrients and food intake. Four dietary patterns were identified by principal component analysis (PCA) and plasma samples collected for the measuring of inflammatory biomarkers and lipid profile. The authors found that there were negative correlations between intake of dietary fiber, soluble and insoluble non-starch polysaccharides (NSP), vitamin C and niacin and almost all the inflammatory markers for the whole group. Vegetables, tea/coffee and especially fruit intake were negatively correlated with the inflammatory biomarkers in the whole group. A high intake of Pattern 1 (potato, bread, and fruit pattern) was associated with a low risk of high interferon (IFN)-α2, IFN-λ, interleukin (IL)-6 and IL-8 levels while a high intake of Pattern 3 (fast-food pattern) was associated with a high risk of IFN-α2 levels. Multiple linear regression showed a negative correlation between Pattern 2 (soups and vegetables pattern) and levels of C-reactive protein (CRP) as well as ferritin. A positive association was observed between Pattern 3 (fast-food pattern) and CRP levels. Positive correlation was also observed between Pattern 2 and high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC) levels; however, Pattern 4 (meat and vegetables pattern) was negatively correlated with total cholesterol (TC), LDL-C and TC/HDL-C ratio. The researchers conclude that their findings reinforce the contribution and role of the diet in modifying inflammation in postmenopausal women.

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The reverse of reproductive aging: ovarian recovery through autologous platelet-rich plasma

September 4th, 2023

Summary

With the increase in health and life expectancy, the number of menopausal women has increased significantly. In parallel, there has been a reduction of birth rates influenced by women having their first maternity in an advanced age. Both trends have an impact on national demographics and impose a socioeconomic challenge for which there is no current solution. Women with symptomatic menopause and those with infertility/miscarriage may take advantage of standard therapies such as menopause hormone therapy (MHT) or in vitro fertilization, respectively. Although these interventions are effective, both are expensive, have low yield, and not free of controversial issues. As women age, the output of ovarian steroids and competent oocyte availability approach unrecoverable loss beyond the age of 35 years, no matter the treatment. Currently there is interest in native sex steroid rejuvenation, de novo euploid oogenesis, ovulation, blastocyst development, fetal growth, and healthy term livebirths-all apparently possible with intraovarian insertion of platelet-rich plasma (PRP).  Discrete functional analysis of the full platelet-derived cytokine array carried with PRP, unfortunately for now, is incomplete. Here, the release of constituents of selected platelets and measured effects are framed to address advances in wellness and women's health. Emphasis is on cytokines best positioned to enable recovery of senescent ovarian function sufficient to suspend synthetic MHT dependency and/or permit egg retrieval and pregnancy.

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The vagina as a source and target of androgens: implications for the treatment of the genitourinary syndrome of menopause

24 July 2023

Summary

The vagina has traditionally been conceived as a passive female reproductive organ that serves basically as a passageway for menstrual blood, sexual intercourse and childbirth. However, recent research, as revised by Cipriani et al. [1], has provided insights on the role of the vagina as an endocrine organ that plays a crucial role in female hormonal balance and overall health. Current evidence, taking into account the novel concept of “intracrinology”, highlights the fact that the human vagina may be considered both as a source and target of androgens. Aside from the well-known role of estrogens, androgens are also pivotal for the development and maintenance in women of healthy genitourinary tissues. During the female menopausal transition and the aging process per se, androgen and estrogen levels decline, thus exerting changes in the genitourinary system. Indeed, tissues become thinner, drier and less elastic, leading to a variety of uncomfortable and sometimes painful symptoms, clustered in the genitourinary syndrome of menopause (GSM). Due to the lack of testosterone-based or androstenedione-based products approved by regulatory agencies to treat GSM, the possibility of using intravaginal prasterone, which exerts effects by providing a local source of dehydroepiandrosterone (DHEA) to the vaginal tissues, appears to be a reasonable targeted treatment; however, further studies are needed to better assess its safety and efficacy. In this commentary I would like summarize main points revised by the authors [1].

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Age at natural menopause and risk of type 2 diabetes: a prospective cohort study

10 July 2023

Summary

Recently, Muka et al. [1] carried out a prospective cohort study that aimed at examining the association between the age at natural menopause and the risk of developing type 2 diabetes. For this, 3,639 postmenopausal women of the Rotterdam population based study were included. Age of natural menopause was retrospectively self-reported and was treated as a continuous variable and in categories: premature < 40 years, early 40-44 years, normal 45-55 years, and late > 55 years. Other potential mediators such as obesity, C-reactive protein (CRP), blood glucose, insulin level, total estradiol, and androgens were also included. Women were followed for a period of 9.2 years, time in which 348 women who developed type 2 diabetes were identified. After adjusting for the data, the results showed a hazard ratio (HR) of 3.7 (95% CI: 1.8, 7.5), 2.4 (95% CI: 1.3, 4.3), and 1.60 (95% Cl: 1.0, 2.8) for women with premature, early, and normal menopause, respectively, in developing type 2 diabetes, in comparison to those with late menopause. The HR for type 2 diabetes per 1 year older at menopause was 0.96 (95% CI 0.94, 0.98). Further adjustment for body mass index, glycaemic traits, metabolic risk factors, C-reactive protein, endogenous sex hormone levels or shared genetic factors did not affect this association. The authors conclude that early onset of natural menopause is an independent marker for type 2 diabetes in postmenopausal women.

Read more …Age at natural menopause and risk of type 2 diabetes: a prospective cohort study

Evaluation of the visceral adiposity index with cardiovascular risk factors, biomarkers in postmenopausal women to predict cardiovascular disease

26 June 2023

Summary

Reports indicate that the visceral adiposity index (VAI) is useful to predict cardiovascular disease (CVD) and the metabolic syndrome (MetS). Despite this, long-term studies that analyze the efficacy of the VAI in the prediction of CVD risk are limited and the association between the VAI and electrolytes is unclear. In this sense, Gulbahar et al. [1] reported results of a study aimed at determining if the VAI can be used as a predictor of CVD and provide the possibility of early diagnosis for future CVD. In addition, the authors also analyzed the impact of biomarkers and electrolytes on VAI as an indirect association with CVD. For this, postmenopausal women (aged >40 years; n=50) were included and categorized into two groups according to their VAI scores: mild/moderate and severe. The groups were compared in terms of insulin resistance, biochemical parameters, and anthropometric measurements. After ten years, women were re-assessed and surveyed for additional disease and cardiovascular risk. The study found that VAI scores of women with the MetS as compared to those without the syndrome were significantly higher (7.30 ± 4.75 vs. 2.95 ± 1.05, p < 0.01). In the sever group, serum magnesium levels were found significantly lower and serum zinc (Zn) and high sensitivity C-reactive protein (hsCRP) levels were higher. Correlation analysis showed significant positive correlations between VAI scores and total cholesterol, Zn, and fasting insulin levels and no significant association with the 10-year CVD incidence. The authors conclude that previous VAI results cannot assist in predicting the 10-year CVD risk. Additionally, including serum measurements of Zn, total cholesterol, fasting insulin, and glucose levels are a reasonable approach for managing postmenopausal women with unfavorable CVD risk profiles.

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