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IMS Menopause Live

Commentaries from the IMS on recently published scientific papers that may be of interest. The latest articles from February 2017 onward are available to Members only when logged in. Selected articles are open to public.

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Simple ovarian cysts in postmenopausal women: scope of conservative management

21 May 2012:

 

The prevalence of simple ovarian cysts in postmenopausal women may range from 3% to 15%. Simple cysts are usually followed conservatively, but concern about progression to malignancy may lead to surgical exploration, which in most cases would likely be for benign conditions. A recent retrospective study from the USA [1] evaluated 619 patients with 743 simple ovarian cysts; 305 patients (49.27%) were lost in follow-up. Therefore, 314 patients (50.73%) with 378 cysts were followed further by ultrasound study. In all, 175 (46.30%) of the 378 cysts that could be followed further had spontaneous resolution and 166 cysts (43.91%) persisted unchanged over the follow-up period. Thirty cysts (7.94%) turned into complex cysts and four cysts (1.06%) significantly increased in size. One cyst significantly decreased in size, although it did not resolve. Only one patient developed papillary serous carcinoma (high grade) of the ovary. This occurred 3 years after her last ultrasound for simple cyst surveillance. Thus, simple ovarian cysts during the menopause can be followed conservatively because their risk for malignant transformation is low. The majority of these cysts either resolve spontaneously or persist unaltered on follow-up.

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Physical activity across adulthood maintains physical capability in midlife

14 May 2012:

Cooper and colleagues [1] have recently reported that cumulative leisure-time physical activity across adulthood may affect physical performance and strength in midlife. In all, 1189 men and 1253 women from the UK Medical Research Council National Survey of Health and Development, born in March 1946, participated in the study. Self-reported leisure-time physical activity at ages 36, 43 and 53 years was assessed and compared to grip strength, standing balance and chair rise times at age 53 years. It was found that more women than men were inactive at ages 36 and 43, whereas activity levels between genders at age 53 did not differ. However, men were stronger and had better physical performance at age 53 than women. Men appeared to have been of a higher educational level and occupational class. More women were never-smokers than men. Health status at age 53 between women and men did not differ. Independent positive effects of physical activity at all ages on chair rise performance and at ages 43 and 53 on standing balance performance were found, whereas physical activity at age 53 was associated only in men with grip strength. This study confirmed the cumulative benefits of physical activity in both men and women across adulthood for physical performance in midlife.

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SSRIs for hot flushes and insomnia

30 April 2012:

The selective serotonin reuptake inhibitor (SSRI) and serotonin norepinephrine reuptake inhibitor (SNRI) antidepressants are used off-label to treat menopausal hot flushes. One of their most common side-effects is insomnia and, therefore, investigation of this mode of therapy in postmenopausal women with vasomotor symptoms and related sleep disturbances is of importance. The aim of a recent randomized, blinded, multicenter, placebo-controlled study was to determine the effect of escitalopram, a widely used SSRI, on insomnia symptoms and subjective sleep quality in healthy perimenopausal and postmenopausal women with hot flushes [1].

The study included 205 women (95 African-American, 102 white, eight other) who received escitalopram (10–20 mg/day) or placebo for a duration of 8 weeks. Insomnia symptoms (Insomnia Severity Index, ISI) and subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI) at weeks 4 and 8 were the pre-specified secondary outcomes. A total of 199 women (97%) provided ISI data and 194 (95%) women provided PSQI data at follow-up. At baseline, the mean hot flush frequency was 9.8 per day (standard deviation (SD) 5.60), the mean ISI was 11.4 (SD 6.3), and the mean PSQI was 8.0 (SD 3.7). Treatment with escitalopram reduced the ISI at week 8 (mean difference -2.00; 95% confidence interval (CI) -3.43 to -0.57; p < 0.001, overall treatment effect), with mean differences of -4.73 (95% CI -5.72 to -3.75) in the escitalopram group and -2.73 (95% CI -3.78 to -1.69) in the placebo group. The reduction in PSQI was greater in the escitalopram group than in the placebo group at week 8 (mean difference -1.31; 95% CI -2.14 to -0.49; p < 0.001, overall treatment effect). Clinical improvement in insomnia symptoms and subjective sleep quality (≥ 50% decreases in ISI and PSQI from baseline) was observed more frequently in the escitalopram group than in the placebo group (ISI: 50.0% vs. 35.4%, p = 0.04; PSQI: 29.6% vs. 19.2%, p = 0.09). The investigators' conclusions were that. among healthy perimenopausal and postmenopausal women with hot flushes, escitalopram at 10–20 mg/day compared with placebo reduced insomnia symptoms and improved subjective sleep quality at 8 weeks of follow-up.

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