La fuerza de la unión y del trabajo conjunto de los latinoamericanos.
Durante la última década, un grupo de médicos latinoamericanos, unidos en el ámbito de las actividades de la Federación Latinoamericana de Sociedades Climatéricas (FLASCYM) e interesados en estudiar los problemas de salud de las mujeres, han constituido la Red Latinoamericana de Investigación en Climaterio (REDLINC) con el objetivo de estudiar la realidad del climaterio en este subcontinente. Sin recursos económicos ni apoyo institucional, pero con gran cantidad de trabajo y entusiasmo, se han llevado a cabo siete grandes estudios epidemiológicos multicéntricos, los cuales se han publicado en las principales revistas mundiales de la especialidad (Maturitas, Climacteric y Menopause).
Leer Más
Nuestra primera publicación estudió a 17 mil mujeres de 47 ciudades latinoamericanas y mostró que la edad media de la menopausia era menor que la descrita en el mundo desarrollado, aunque variaba ampliamente dependiendo de variables socioeconómicas y de la altitud de las ciudades. El segundo estudio, realizado en doce ciudades, encontró una alta prevalencia del síndrome metabólico en nuestro subcontinente (35,5%) y esta prevalencia aumentaba con la edad y la menopausia; y, disminuía con la terapia hormonal.
El tercer estudio analizó a más de 8 mil mujeres y encontró que en la mayoría de los países, más de la mitad de las mujeres tenían una mala calidad de vida debido a síntomas climatéricos; peor calidad de vida se encontró en las mujeres que habitaban en las ciudades con mayor altitud sobre el nivel del mar y se observó mejor calidad de vida en las usuarias de terapia hormonal. Un sub-análisis de este estudio, en otra publicación indicó que 54,5% de las latinoamericanas de 40 a 59 años presentan síntomas vasomotores y que estos síntomas pueden durar décadas en algunas mujeres. En el cuarto estudio se evaluó la prevalencia de disfunción sexual en más de 7 mil mujeres, encontrándose que el 56,8% presentaba disfunción sexual; el editorial de la revista Manopause, órgano oficial de la a Sociedad de Norteamericana de Menopausia, consideró que este estudio era un modelo a repetir en diferentes lugares del mundo.
Otro estudio REDLINC, el quinto, analizó los problemas del sueño en el climaterio, encontrando que más de la mitad de las mujeres presentaban insomnio y/o mala calidad de sueño; otro análisis de estos mismos datos mostró que la actividad física se asociaba a menos síntomas vasomotores y a más factores de riesgo de enfermedades crónicas. El sexto estudio, encontró un muy bajo porcentaje de mujeres en Latinoamérica usando terapia hormonal de la menopausia y que la principal razón de ello era la falta de prescripción médica. Muchas de las mujeres que no usaban terapia tenían severo compromiso de la calidad de vida por síntomas climatéricos. El último estudio publicado, REDLINC VII, mostró que 88% de los médicos le indicarían terapia hormonal a su pareja si ella presentaba síntomas climatéricos.
Otras 21 publicaciones en revistas internacionales han sido productos directos o indirectos del análisis de datos globales o de grupos locales de nuestros asociados. Estas investigaciones han posicionado REDLINC en el escenario mundial de la especialidad. Por último, y para proporcionar a los médicos conocimientos científicos actualizados sobre la menopausia, los especialistas latinoamericanos han recibido durante los últimos diez años los “Resúmenes de Menopausia”, una revisión semanal de publicaciones mundiales sobre la especialidad.A través del artículo anterior, podemos recomendarle los vestidos más recientes.
Algunos países latinoamericanos se convertirán en países desarrollados en la próxima década. REDLINC ha demostrado que no sólo nuestras economías han mejorado, sino que también la comunidad médica ha ido adquiriendo progresivamente un nivel más alto de preparación científica. El subdesarrollo está en nuestras mentes, juntos podemos derrotarlo. REDLINC es una prueba de ello ya que con creatividad y esfuerzo se logra éxito en el trabajo.
Selección de Resúmenes de Menopausia
Periodicidad Semanal
Semana de 25 a 31 de diciembre, 2024
María Soledad Vallejo. Obstetricia Ginecología. Hospital Clínico. Universidad de Chile
Alzheimers Dement. 2024 Dec 28. doi: 10.1002/alz.14447. Online ahead of print.
Early midlife ovarian removal is associated with lower posterior hippocampal function
Alana Brown 1, Laura Gravelsins 1, Nicole J Gervais 1 2, Jenny Rieck 3, Sophia Zhao 1, Annie Duchesne 4 5, et al.
Introduction: Women with early bilateral salpingo-oophorectomy (BSO) have greater Alzheimer’s disease (AD) risk than women with spontaneous menopause (SM), but the pathway toward this risk is understudied. Considering associative memory deficits may reflect early signs of AD, we studied how BSO affected brain activity underlying associative memory. Methods: Early midlife women with BSO (with and without 17β-estradiol therapy [ET]) and age-matched controls (AMCs) with intact ovaries completed a face-name associative memory task during functional magnetic resonance imaging. Hippocampal activity along the anteroposterior axis during associative encoding and retrieval was compared among three groups (BSO [n = 28], BSO+ET [n = 35], AMCs [n = 40]).Results: Both BSO groups (with and without ET) showed lower posterior hippocampal activation during encoding compared to the AMC group. However, this difference in activation was not significantly correlated with associative memory task performance.
Discussion: Early 17β-estradiol loss may influence posterior hippocampal activity during associative encoding, possibly presaging late-life AD. Highlights: After ovarian removal, changes in hippocampal function may affect dementia risk. Midlife ovarian removal is associated with less activation in the posterior hippocampus. Estradiol therapy may ameliorate alterations in brain function during learning.
Sci Rep. 2024 Dec 28;14(1):30671. doi: 10.1038/s41598-024-76667-5.
Comparative analysis of oral iron therapy regimens in premenopausal women with iron deficiency anemia
Lütfullah Caştur 1, Cundullah Torun 2
Iron deficiency anemia (IDA) is prevalent among women of reproductive age. Treatment aims to replenish iron stores and normalize hemoglobin levels, with oral iron therapy being the preferred route in most cases. This study aimed to compare the efficacy and side effects of three common oral treatment regimens in premenopausal women with IDA. An observational study was conducted on patients initiated on oral ferrous glycine sulfate therapy (100 mg elemental iron). Patients were divided into three groups based on treatment regimen: alternate-day (n = 40), daily single-dose (n = 41), and daily twice dose (n = 40). Hemoglobin, ferritin, and transferrin saturation levels were measured before and after one month of therapy. The primary outcome was to compare laboratory changes from baseline to post-treatment within and between groups. The secondary outcome was to compare the frequency of gastrointestinal side effects. The mean age was 41.2 ± 8 years, with a mean hemoglobin level of 10.4 ± 1.1 g/dl, and a mean ferritin level of 7 ± 3.2 ng/mL at the time of diagnosis. After one month of therapy, hemoglobin, ferritin, and transferrin saturation levels significantly increased in all groups (p < 0.001 for all). However, the increase in hemoglobin and ferritin levels was significantly lower in the alternate-day group compared to the other groups (p < 0.001). Gastrointestinal side effects were more prevalent in the daily twice group (66.1%) compared to the alternate-day (16.7%) and daily single-dose (23.4%) groups (p < 0.001). Daily single-dose oral ferrous glycine sulfate therapy emerged as an effective and well-tolerated treatment regimen for premenopausal women with IDA.
J Gynecol Obstet Hum Reprod. 2024 Dec 25:102902. doi: 10.1016/j.jogoh.2024.102902. Online ahead of print.
Barriers to prescription of hormonal contraception and hormone replacement therapy in gynecological cancer survivors: results of a survey and literature review
Mariana Teves 1, Fátima Palma 2, Ana Fatela 3, Lúcia Correia 4
Background: The incidence of gynecological cancers in premenopausal women is increasing, highlighting issues related to Hormonal Contraception (HC) and Hormone Replacement Therapy (HRT). However, the presence of hormonal receptors in many gynecological cancers complicates HC and HRT prescriptions. Objective: To identify barriers experienced by gynecologists in prescribing HC and HRT to gynecological cancer survivors, with a secondary objective of conducting a literature review on the safety of these prescriptions. Methods: A nationwide survey was conducted among Portuguese gynecologists, including questions about their prescribing practices for HC and HRT in gynecological cancer survivors. For the narrative review, the authors searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and SCOPUS from January 2019 to April 2024. The included studies encompassed gynecological cancer survivors using HC or HRT, detailing tumor histologic type and clinical outcomes. Results: 185 gynecologists participated in the questionnaire: 151 general gynecologists (81.6%) and 34 oncology gynecologists (18.4%). Of these, 49.7% and 55.1% had prescribed HC and HRT, respectively. Cervical cancer had the highest prescription rate, followed by vulvar and vaginal cancer, with fewer prescriptions for ovarian/fallopian tube, endometrial, and uterine corpus (non-endometrial) cancers. Older age and specialization in gynecologic oncology significantly predicted HC and HRT prescriptions (p<0.05). Uncertainty was the main reason for not prescribing HC/HRT. A narrative review confirmed the safety of prescribing for specific tumor subtypes. Conclusion: The survey findings highlight an occasionally unfounded apprehension regarding the use of HC and HRT among gynecological cancer survivors. This underscores the crucial need for enhanced education on these matters.
Menopause. 2025 Jan 1;32(1):38-44. doi: 10.1097/GME.0000000000002451.
Prevalence and impact of vasomotor symptoms due to menopause among women in Canada: A subgroup analysis from an international cross-sectional survey of Women with Vasomotor Symptoms Associated with Menopause (WARM Study)
Nese Yuksel 1, Lora Todorova 2, Ludmila Scrine 2, Carol Rea 3, Céline Bouchard 4
Objective: The aim of the study was to assess the prevalence of postmenopausal vasomotor symptoms (VMS) and the impact of VMS and related treatment patterns among perimenopausal and postmenopausal Canadian women. Methods: A subgroup analysis of data from a cross-sectional online survey of women aged 40-65 years conducted November 4, 2021, through January 17, 2022, evaluated the prevalence of moderate/severe VMS among postmenopausal Canadian women. The analysis also assessed survey responses from perimenopausal and postmenopausal Canadian women with moderate/severe VMS who completed the Menopause-Specific Quality of Life questionnaire, Work Productivity and Activity Impairment questionnaire, and the Patient-Reported Outcomes Measurement Information System Sleep Disturbances-Short Form 8b and answered questions about treatment patterns and attitudes toward treatments. Results: Of 2,456 Canadian postmenopausal women, 360 (14.7%; primary analysis) reported moderate/severe VMS in the previous month. Perimenopausal and postmenopausal women with moderate/severe VMS (n = 400; secondary analysis) reported negative impact on overall quality of life (mean total Menopause-Specific Quality of Life questionnaire score: 4.3/8). VMS impaired overall work and daily activities by 30.2% and 35.7%, respectively. Overall mean (SD) Patient-Reported Outcomes Measurement Information System Sleep Disturbance-Short Form 8b score (scale 8-40) was 28.5 (6.9), confirming sleep disturbances in this population. The majority of women (88% of the total cohort) sought advice, but about half were never treated. Most women had positive or neutral attitudes toward menopause. Conclusions: In a survey conducted in Canada, moderate/severe VMS were reported by 14.7% of postmenopausal women and were associated with impairment in quality of life, work productivity, daily activities, and sleep in perimenopausal and postmenopausal women.
Menopause. 2025 Jan 1;32(1):12-22. doi: 10.1097/GME.0000000000002481.
Associations of blood pressure with white matter hyperintensities later in life; influence of short-term menopausal hormone therapy
Firat Kara 1, Nirubol Tosakulwong 2, Timothy G Lesnick 2, Angela J Fought 2, June Kendell-Thomas 1, et al.
Objective: To assess the association of systolic and diastolic blood pressure (SBP and DBP) in recently menopausal women with white matter hyperintensity (WMH) volume later in life and determine whether short-term menopausal hormone therapy (mHT) modifies these associations. Methods: Kronos Early Estrogen Prevention Study (KEEPS) was a multicenter, randomized, double-blinded, placebo-controlled 4-year mHT trial (oral conjugated equine estrogens or transdermal 17β-estradiol). KEEPS continuation was an observational follow-up of the participants 10 years after the end of mHT. The associations between KEEPS baseline blood pressure (BP) with KEEPS continuation WMH volume were examined adjusting for covariates in model 1 (age, total intracranial volume, study site, mHT type) and model 2 (additionally conventional CVD risk factors). Interaction terms (BP × mHT type) were added into the linear regression models. Results: The mean ± SD ages of participants were 53 (±2) years at KEEPS baseline and 67 (±2) years at KEEPS continuation. Elevated BP at KEEPS baseline was associated with greater WMH volume measured 14 years later (model 1: SBP: β = 0.01 [95% CI, 0.001-0.01] and DBP: β = 0.01 [95% CI, 0.003-0.03]) and after additionally adjusting for CVD risk factors (model 2). We did not find any evidence that mHT versus placebo modified these associations. Topographically, higher BP was associated with greater periventricular WMH in the frontal and parietal lobes. Conclusion: Our findings suggest the importance of maintaining normal BP in recently postmenopausal women with low CVD risk, irrespective of short-term mHT usage, to potentially reduce the risk of WMH later in life.
Horm Behav. 2024 Dec 24:167:105670. doi: 10.1016/j.yhbeh.2024.105670. Online ahead of print.
Oral administration of ethinyl estradiol and the brain-selective estrogen prodrug DHED in a female common marmoset model of menopause: Effects on cognition, thermoregulation, and sleep
Emily S Rothwell 1, Shaun S Viechweg 2, Laszlo Prokai 3, Jessica A Mong 2, Agnès Lacreuse 4
Menopausal symptoms of sleep disturbances, cognitive deficits, and hot flashes are understudied, in part due to the lack of animal models in which they co-occur. Common marmosets (Callithrix jacchus) are valuable nonhuman primates for studying these symptoms, and we examined changes in cognition (reversal learning), sleep (48 h/wk of sleep recorded by telemetry), and thermoregulation (nose temperature in response to mild external warming) in middle-aged, surgically-induced menopausal marmosets studied at baseline, during 3-week phases of ethinyl estradiol (EE2, 4 μg/kg/day, p.o.) treatment and after EE2 withdrawal. We also assessed a brain-selective hormonal therapy devoid of estrogenic effects in peripheral tissues on the same measures (cognition, sleep, thermoregulation) after treatment with the estrogen prodrug 10β,17β-dihydroxyestra-1,4-dien-3-one (DHED, 100 μg/kg/day, p.o) and DHED withdrawal. Reversal learning performance was improved with EE2 or DHED treatment relative to phases without hormone administration, as indicated by a faster reversal of the stimulus/reward contingencies. Both EE2 and DHED increased non-REM sleep and reduced nighttime awakenings relative to baseline, but to the detriment of REM sleep which was highest at baseline. Nasal temperature in response to mild external warming was highest, and overnight core body temperature lowest, in the DHED treatment phase compared to both the EE2 and baseline phases. These results suggest that low dose estradiol, delivered either peripherally or centrally via DHED, benefits selective aspects of cognition and sleep in a marmoset menopause model. DHED appears a promising therapeutic candidate for alleviating the cognitive and sleep disruptions associated with estrogen deficiency in primates.
BMC Public Health. 2024 Dec 24;24(1):3578. doi: 10.1186/s12889-024-21001-x.
Association between the female hormone intake and cardiovascular disease in the women: a study based on NHANES 1999-2020
Shenao Qu # 1 2 3, Zhixuan Zhang # 1 2 3 4, Ran Ju 1 2 3, Zhuoqun Li 2 3 5, Jing Leng 6, Zihan Xue 6, et al.
Although many studies have reported the relationship between female hormone intake and cardiovascular disease (CVD) development, their association has not been fully elucidated and defined, based on data from the Third National Health and Nutrition Examination Survey intending to assess the health and nutritional status of non-institutionalized children and adults in the United States. This study examined the relationship between female hormone intake and coronary artery disease (CVD) development in 38,745 women, averaging 38.10 ± 12.59 years in age. We explored the association between hormone intake and CVD incidence, considering various social determinants of health (SDOH) with statistical methods like Chi-square tests, logistic regression, and stratified Chi-square analysis. Our findings reveal a complex relationship between female hormone intake and CVD development. Hormones appear to reduce CVD risk in women over 60 years old. However, hormone intake correlates with increased CVD risk in highly educated women. Socioeconomic status also influences this relationship; while hormones pose a risk factor for heart failure and stroke in impoverished or wealthy women, they serve as a protective factor against CVD for middle-income women. Additionally, hormonal intake seems beneficial for women who experienced menarche between 13 and 15 years old, menopause between 30 and 49, and had 7-9 pregnancies, especially when coupled with a diet low in sugar, fat, cholesterol, and adequate folic acid intake. These results indicate that while hormones can prevent CVD under specific conditions, their impact can be detrimental in different SDOH contexts. In conclusion, while appropriate hormone intake can prevent CVD, its effects vary across different demographic and health backgrounds. This underscores the necessity for meticulous screening of SDOH factors in clinical settings to maximize the protective benefits of hormones against CVD.
Semana de 18 a 24 de diciembre, 2024
María Soledad Vallejo. Obstetricia Ginecología. Hospital Clínico. Universidad de Chile
Alzheimers Dement. 2024 Dec 23. doi: 10.1002/alz.14469. Online ahead of print.
Premenopausal bilateral oophorectomy and Alzheimer’s disease imaging biomarkers later in life
Kejal Kantarci 1 2, Ekta Kapoor 2 3, Jennifer R Geske 4, Anna Castillo, Julie A Fields, Firat Kara, Evdokiya E, et al.
Introduction: Premenopausal bilateral oophorectomy (PBO) before the age of 46 years is associated with an increased risk of dementia. We investigated the long-term effects of PBO performed before age 50 years on amyloid beta (Aβ), tau, and neurodegeneration imaging biomarkers of Alzheimer’s disease (AD). Methods: Mayo Clinic Cohort Study of Oophorectomy and Aging-2 participants were divided into early PBO (< 46 years; n = 61), and late PBO (46-49 years; n = 51) groups and were compared to referent women who did not undergo PBO (n = 119). Results: Early PBO was associated with thinner entorhinal cortex (p = 0.014), higher tau load at higher levels of Aβ load (Pp = 0.005), higher Aβ load (p = 0.026), and smaller temporal lobe cortical thickness (p = 0.022), only at older ages compared to the referent group. Discussion: PBO before the age of 46 years is associated with entorhinal cortex thinning, elevated tau at higher Aβ levels, along with an AD-like pattern of atrophy at older ages.
Clin Obstet Gynecol. 2024 Dec 18. doi: 10.1097/GRF.0000000000000916. Online ahead of print.
Testosterone for Treating Female Sexual Dysfunction
James A Simon 1, Kathleen Ohleth 2
Testosterone levels vary throughout a woman’s reproductive life, reaching their lowest level following menopause, and their nadir at about age 60, when they experience higher levels of sexual dysfunction. Testosterone improved the frequency of sexually satisfying events, desire, arousal, and orgasm in several randomized, controlled studies of surgically and naturally postmenopausal women. Available evidence from large cohort and registry studies does not show potentially concerning cardiovascular or breast safety signals with physiological levels of testosterone. Although no female testosterone products are currently approved in most of the world, one-tenth of the male dose can enhance female sexual function.
Heart. 2024 Dec 17:heartjnl-2024-324602. doi: 10.1136/heartjnl-2024-324602. Online ahead of print.
Age of menopause, healthy lifestyle and cardiovascular disease in women: a prospective cohort study
Anushriya Pant 1, Alice A Gibson, Simone Marschner, Lee P Liao, Liliana Laranjo, Clara K Chow , Sarah Zaman Background: Menopause is a timely opportunity to screen for cardiovascular disease (CVD) and intervene with healthier lifestyles. We investigated the association between premature/early menopause and the likelihood of CVD and whether a healthy lifestyle is associated with a lower likelihood of CVD in menopausal woman. Methods: The Sax Institute’s 45 and Up Study prospectively recruited participants aged ≥45 years (n=267 357) between 2005 and 2009 (New South Wales, Australia). Our study included women without prior CVD and reporting menopausal age at baseline. Primary outcome was new-onset CVD (self-reported heart disease/stroke) based on survey data at Wave 2 (2012-2015) and/or Wave 3 (2018-2020). Logistic regression models assessed the associations of premature (age <40 years) and early (age 40-44 years) menopause with CVD, compared with menopause between 50 and 52 years, adjusting for sociodemographic and clinical variables. Healthy lifestyle adherence was assessed using a score of five factors: smoking, physical activity, sitting, sleep and diet. Results: We included 46 238 women (mean age 62.1±8.2 years), with 5416 (11.7%) cases of CVD over 15-year follow-up. After adjustment, the odds of CVD was higher in women with premature menopause (OR 1.36, 95% CIs 1.17 to 1.59; p<0.0001) and early menopause (OR 1.15, 95% CI 1.03 to 1.28; p=0.013) compared with menopause between 50 and 52 years. Among all women, high (score 9-10) versus low (score 0-5) healthy lifestyle adherence led to 23% lower odds of CVD (OR 0.77, 95% CI 0.68 to 0.86; p<0.0001), and in women with premature menopause, led to 52% lower odds of CVD (OR 0.48, 95% CI 0.30 to 0.77, p=0.0022). Lifestyle effect did not significantly differ between menopause categories (interaction, p=0.71). Conclusion: Women with premature/early menopause are at higher likelihood for CVD. Lifestyle modification is associated with consistent reduction of the likelihood of CVD in women and should be encouraged across the life course.
Menopause. 2024 Dec 17. doi: 10.1097/GME.0000000000002463. Online ahead of print.
Associations of reproductive hormones and stress-related factors with menopausal symptoms
Ieva Brimienė, Monika Šiaudinytė, Erik Ilkevič 1, Eglė Mazgelytė 2, Dovilė Karčiauskaitė 2, Jurgita Songailienė Objective: The main aim was to evaluate the relationships between menopausal symptoms, endogenous hormones, and stress-related factors. Methods: Participants were recruited through online advertisements at Vilnius University and social networks. Sixty-three White Lithuanian women aged 50.2 ± 2.9 years without any known diseases or conditions that could affect menopausal symptoms, hormone levels, or mental health were selected to participate in the cross-sectional study. The Menopause-Specific Quality of Life Questionnaire was used to assess the intensity of menopausal symptoms in four domains (vasomotor, psychosocial, physical, and sexual). The levels of reproductive hormones were measured in blood serum. To evaluate the level of chronic stress, we used the Perceived Stress Scale 10 (PSS-10) and the assessment of hair glucocorticoids (cortisol, cortisone). Multiple linear regression analysis was performed to estimate the associations between menopausal symptoms severity, endogenous hormones, and stress-related factors. Results: Age (the unstandardized β [B] = 0.12), follicle-stimulating hormone concentration (B = 0.9), and PSS-10 score (B = 0.08) were associated with the total Menopause-Specific Quality of Life Questionnaire score (all P < 0.05). The vasomotor domain was related to age (B = 0.19), follicle-stimulating hormone (B = 1.24), and dehydroepiandrosterone sulfate concentration (B = -2.8) (all P < 0.05). The psychosocial domain was associated with the PSS-10 score (B = 0.13, P < 0.001). The physical domain was associated with the number of sleep hours (B = -0.35, P = 0.02). The sexual domain was negatively related to testosterone concentration (B = -3.5, P = 0.01). Conclusions: The results of the present study show that not only hormonal changes but also other factors, such as age, hours of sleep, and experienced stress, are associated with the intensity of menopausal symptoms.
Menopause. 2024 Dec 17. doi: 10.1097/GME.0000000000002459. Online ahead of print.
The range and variation in serum estradiol concentration in perimenopausal and postmenopausal women treated with transdermal estradiol in a real-world setting: a cross-sectional study
Sarah Glynne 1, Daniel Reisel 2, Aini Kamal 3, Amy Neville 3, Lynsey McColl 4, Rebecca Lewis 3, Louise Newson 3
Objectives: The aims of the study are to explore the range and variation in serum estradiol concentration, and to estimate the prevalence of «poor absorption» (women using licensed estradiol doses with subtherapeutic levels), in perimenopausal and postmenopausal women using transdermal estradiol in the real world. Methods: This is a cross-sectional analysis in a specialist menopause clinic in the UK. Results: Serum samples were obtained from 1,508 perimenopausal and postmenopausal women. A total of 61.87% were using licensed doses. The median estradiol concentration was 355.26 pmol/L (interquartile range 198.44-646.15 pmol/L). A reference interval for the whole cohort was defined as 54.62-2,050.55 pmol/L. There was substantial interindividual variation across the dose range. Variance was greater in younger women (P = 0.002) and gel users (P = 0.002). There was a trend toward greater variance in women using higher doses, but the association failed to reach statistical significance (P = 0.074). One in four women (24.84%) using the highest licensed dose had subtherapeutic levels (<200 pmol/L). Older women (≥50 y) and patch users were more likely to have low levels (odds ratio 1.77, 95% confidence interval 1.22-2.62, P = 0.003; and odds ratio 1.51, 95% confidence interval 1.18-1.95, P = 0.001, respectively). Conclusions: The reference interval for perimenopausal and postmenopausal women using on-label and off-label doses of transdermal estradiol in the real world is wide, and there is considerable interindividual variation. The number of estradiol users with low estradiol levels (<200 pmol/L) is higher than previously recognized. Measurement of serum estradiol can be helpful to identify women who may benefit from an off-label dose. Dose customization is key to ensure that all women can reap the benefits of HT.
Nota: 200 pmol/L= 54.5 pg/mL
Diagnostics (Basel). 2024 Dec 5;14(23):2745. doi: 10.3390/diagnostics14232745.
The Association Between Antipsychotics and Bone Fragility: An Updated Comprehensive Review
Michele Mercurio 1 2, Giovanna Spina 1, Olimpio Galasso, Giorgio Gasparini, Cristina Segura-Garcia, Pasquale, et al. Background: Antipsychotic drugs appear to be related to reduced bone mineral density (BMD). We conducted a narrative review to collect the available literature investigating the relationship between antipsychotic use and bone fragility. Methods: A review of the published literature was conducted and reported through PubMed/Scopus/Cochrane libraries. We included studies using any antipsychotic treatment where the bone metabolism, osteoporosis, and/or risk of fractures has been assessed. Results: After screening 1707 items, we finally included 15 papers. A total of 3245 initial patients were identified, of whom 1357 patients with a mean age of 43.8 years underwent antipsychotic treatment and were analyzed. The mean antipsychotic treatment duration of the treated group was 15.8 ± 13.9 years. Among the included studies, two reported a statistically significant difference in lumbar BMD reduction between the antipsychotic exposed group and the control group. Femoral neck BMD levels had been reported in four of the case-control studies; two reported a statistically significant difference in femoral neck BMD reduction between the antipsychotic exposed group and the control group. Conclusions: Prolonged use of antipsychotic treatment seems to be associated with an increased risk of reduced BMD, and, consequentially, with an augmented risk of bone fragility and fractures. This effect is not limited to vulnerable groups, such as those with significant medical comorbidities, the elderly, and postmenopausal women, but may also apply to anyone using antipsychotics in the long-term. Clinicians’ awareness of antipsychotic prescriptions should optimize their potential while reducing this risk.
Semana de 10 a 17 de diciembre, 2024
María Soledad Vallejo. Obstetricia Ginecología. Hospital Clínico. Universidad de Chile
J Sex Med. 2024 Dec 3:qdae173. doi: 10.1093/jsxmed/qdae173. Online ahead of print.
An examination of sexual function & distress among sexual minority & heterosexual women seeking care at menopause and sexual health specialty clinics
Talia Sobel, Stephanie S Faubion, Jennifer A Vencill, Kristin Cole, Stacey Winham, Courtney Williams, Juliana Kling
Background: Sexual minority women (SMW) have worse mental and physical health outcomes compared to heterosexual women, but literature on sexual function in SMW compared to heterosexual women is lacking.Ai m: To evaluate sexual function and sexual distress in women across sexual orientations. Method: Questionnaire data were analyzed for women aged 18 and older who presented to women’s health clinics at Mayo Clinic in Minnesota, Arizona, and Florida from 2016 to 2023. Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) scores assessed sexual dysfunction (FSFI ≤ 26.55 and FSDS-R ≥ 11). Multivariable logistic models adjusted for confounding factors. Outcomes: Our main outcome was female sexual dysfunction as defined by a composite of FSFI ≤ 26.55 and FSDS-R ≥ 11 to include both sexual function and sexual distress. Results: Of 6241 sexually active women, 3% were SMW and 97% were heterosexual women. The majority were White (93%), with average age 51.6 years old. There was no significant difference in sexual dysfunction rates between heterosexual and SMW by combined endpoint on univariate or multivariable analysis. SMW had higher total FSDS scores (17 vs 15, P = 0.037), indicating more sexual distress. Clinical implications: Sexual health concerns may differ between SMW and heterosexual women emphasizing the need for inclusive, culturally competent care. Strengths & limitations: This study assessed the association of sexual orientation and sexual dysfunction by incorporating sexual functioning problems and sexual distress. Limitations include a small number of SMW and a predominantly White, married, employed, and educated study sample, limiting the generalizability of the findings.Conclusion: Rates of sexual dysfunction were similar between mostly White SMW and heterosexual women presenting to tertiary care centers. SMW reported more sexual distress than heterosexual women. Evaluating these variables in larger, more diverse cohorts is a critical next step.
JNCI Cancer Spectr. 2024 Dec 3:pkae121. doi: 10.1093/jncics/pkae121. Online ahead of print.
Menopausal hormone therapy: assessing associations with breast and colorectal cancers by familial risk
Robert J Macinnis 1 2, Mark A Jenkins 2 3, Roger L Milne 1, Esther M John 5, Mary B Daly 8, Irene L Andrulis, et al. Menopausal hormone therapy (MHT) users are at increased breast cancer (BC) risk and decreased colorectal cancer (CRC) risk compared with never users, but these opposing associations might differ by familial risk of BC and CRC. We harmonized data from three cohorts and generated separate BC and CRC familial risk scores (FRS) based on cancer family history. We defined moderate/strong family history as FRS ≥ 0.4, where 0.4 was equivalent to a 50-year-old woman with one parent diagnosed with either cancer at age 55 years. Of 24,486 women, 1,243 and 405 were diagnosed with incident BC and CRC, respectively. For BC, MHT hazard ratios (HRs) were 1.27 (95%CI = 1.11-1.45) for FRSBC<0.4, 1.01 (95%CI = 0.82-1.25) for FRSBC≥0.4 (P-difference = 0.08). For CRC, MHT HRs were 0.63 (95%CI = 0.50-0.78) for FRSCRC<0.4, 1.21 (95%CI = 0.73-2.00) for FRSCRC≥0.4 (P-difference = 0.03). Associations with MHT that apply to the general population might not hold for women at moderate/strong familial risk of these cancers.
J Racial Ethn Health Disparities. 2024 Dec 13. doi: 10.1007/s40615-024-02209-4. Online ahead of print.
Health Disparities and Hormone Therapy Prescribing for Early, Peri-, and Postmenopausal Women: A Scoping Review
Danette Conklin 1 2, Akshaya Ramakrishnan 3, Luchen Yu 4, Sharon Varghese 5, Martha Sajatovic, Sana Loue, et al. Objectives: Menopause hormone therapy has improved the quality of life for perimenopausal and early postmenopausal women, yet women may not be prescribed or use this treatment option. The purpose of this study was to conduct a scoping review to assess whether health disparities existed in hormone therapy prescription rates and use for peri- and postmenopausal care based on demographic and clinical characteristics in real-world, observational studies conducted in the USA. Methods: A chief librarian conducted a search strategy from 1940 to 10/31/2023 in five bibliographic databases. hundred eighty-four articles were found through database and handsearching. After removing duplicates and excluding articles that did not meet study criteria, 14 articles were included in this review. Data were independently extracted and charted using a data extraction form, which was developed based on the study aims. Reviewers met to confirm agreement and discuss disagreements. Results: Sixteen health disparities, in menopause hormone therapy prescribing or use, were found in this scoping review. Differences between ethnic groups were found in 9 of 14 articles. Education level, menopause route, medical conditions, and practitioner specialization were in 4 of the 14 articles. The remaining 11 health disparities were categorized under chronic medical conditions and social constructs. Conclusions: Health disparities have existed for decades in menopause hormone therapy prescribing and use for peri- and postmenopausal women. Identification of health disparities for underserved groups can help reshape educational initiatives for practitioners in all relevant disciplines.
Nat Aging. 2024 Dec;4(12):1731-1744. doi: 10.1038/s43587-024-00767-0. Epub 2024 Dec 13.
Exploring the effects of estrogen deficiency and aging on organismal homeostasis during menopause
Celine Camon 1 2, Michael Garratt 3, Stephanie M Correa 4
Sex hormone signaling declines during aging, from early midlife through menopause, as a consequence of reduced circulating estrogens and decreased receptiveness to these hormones in target tissues. Estrogens preserve energy homeostasis and promote metabolic health via coordinated and simultaneous effects throughout the brain and body. Age-associated loss of estrogen production during menopause has been implicated in a higher risk for metabolic diseases and increased mortality. However, it remains unclear whether age-associated changes in homeostasis are dependent on reduced estrogen signaling during menopause. Although menopausal hormone therapies containing estrogens can alleviate symptoms, concerns about the risks involved have contributed to a broad decline in the use of these approaches. Non-hormonal therapies have emerged that target tissues or pathways with varying levels of selectivity, reducing risk. We summarize here the broad effects of estrogen loss on homeostasis during menopause, current and emerging therapies and opportunities for understanding homeostatic disruptions associated with menopause.
Rev Fac Cien Med Univ Nac Cordoba. 2024 Dec 13;81(4):719-733. doi: 10.31053/1853.0605.v81.n4.44652.
Efectos de los estatinas en la densidad mineral ósea de mujeres posmenopáusica de Córdoba, Argentina
Pablo José Astesana 1, Paula Beatriz Alba 1, Carla Andrea Gobbi 1, Eduardo Horacio Albiero 1, Marcelo Augusto Yorio Nuevas evidencias han surgido sobre propiedades pleiotrópicas de las Estatinas (ES) potencialmente beneficiosas en el tratamiento de la osteoporosis (OP). Nuestro objetivo fue estudiar el efecto de las ES sobre la densidad mineral ósea (DMO) en mujeres posmenopáusicas. Métodos: Estudio de corte transversal, analítico, se estudiaron mujeres posmenopáusicas con hipercolesterolemia que recibieron tratamiento con ES de al menos 6 meses de duración, y como grupo control (GC) mujeres posmenopáusicas que no recibieron ES asistidas en dos servicios de reumatología de la ciudad de Córdoba desde agosto de 2014 hasta septiembre de 2018. Resultados: 202 mujeres posmenopáusicas recibieron estatinas (ES) y 203 constituyeron el GC. La edad promedio, peso e IMC fue de 62,54 años, 69,60 kg y 27,13 en el grupo ES vs 58,58 años, 65,70 kg y 26,83 en el grupo control (p= 0,0001, p= 0,01, p=ns respectivamente). La DMO lumbar, de cuello femoral y de cadera total fue estadísticamente más alta en pacientes que recibieron ES que en controles (-0,87 vs -1,74 p=0,00, – 1.15 vs 1,56 p= 0,00 y – 0,33 vs – 0,75 p= 0,01). En cuanto al tiempo de tratamiento ES, se encontró diferencia significativa solamente en relación a DMO y columna lumbar entre los grupos de 6 a 12 meses y los que recibieron entre 12 y 36 meses. No se encontró relación entre la DMO y los diferentes tipos de ES recibidas. Conclusión: El tratamiento con ES podría ser beneficioso en mejorar la DMO en mujeres posmenopáusicas hipercolesterolémicas medicados con dichos fármacos.
Cell Biochem Funct. 2024 Dec;42(8):e70025. doi: 10.1002/cbf.70025.
A Recent Update on the Role of Estrogen and Progesterone in Alzheimer’s Disease
S Suganya 1, Ben Sundra Ashok 1, Thekkuttuparambil Ananthanarayanan Ajith 2 3
Alzheimer’s disease (AD), one of the most prevalent neurodegenerative disease responsible for 60%-80% dementia cases globally. The disease is more prevalent among elder females. Female reproductive hormones are found to be essential for cellular activities in brain. The physiological role of neurotrophins and sex hormones in hippocampal region during neurogenesis and neuron differentiation was studied as well. In addition to triggering cellular pathways, estrogen and progesterone carry out a number of biological processes that lead to neuroprotection. They might have an impact on learning and memory. One of estrogen’s modest antioxidant properties is its direct scavenging of free radicals. The neurotrophic effect of estrogen and progesterone can be explained by their ability to rise the expression of the brain-derived neurotrophic factor (BDNF) mRNA. Additionally, they have the ability to degrade beta-amyloid and stop inflammation, apoptotic neuronal cell death, and tau protein phosphorylation. To enhance their neuroprotective action, various cross-talking pathways in cells that are mediated by estrogen, progesterone, and BDNF receptors. This include signaling by mitogen-activated protein kinase/extracellular regulated kinase, phosphatidylinositol 3-kinase/protein kinase B, and phospholipase/protein kinase C. Clinical research to establish the significance of these substances are fragmented, despite publications claiming a lower prevalence of AD when medication is started before menopause. This review article emphasizes an update on the role of estrogen, and progesterone in AD.
Int J Womens Health. 2024 Dec 5:16:2087-2101. doi: 10.2147/IJWH.S475149. eCollection 2024.
Association Between Female Androgen Levels, Metabolic Syndrome, and Cardiovascular Disease: An NHANES Analysis (2013-2016)
Xinrui Luo # 1, Yan Wang # 1 2, Liping Wang 2, Yang Shen 1 2, Mulan Ren 2
Background: The impact of androgens on metabolic diseases, cardiovascular diseases (CVD), and long-term mortality in the general female population remains poorly understood. This study, utilizing data from the National Health and Nutrition Examination Survey (NHANES) database managed by the Centers for Disease Control and Prevention, seeks to elucidate the relationship between androgen levels and metabolic syndrome (MS), CVD, and mortality in adult women. Methods: After excluding ineligible individuals, descriptive analyses were conducted on demographic characteristics, metabolic-related indicators, and disease prevalence, based on the presence of high androgenemia and androgen quartile grouping. Logistic regression models were developed to assess the associations of androgen markers, including total testosterone (TT), Free Androgen Index (FAI), with MS, CVD, and cox regression models were used to explore the relationships with mortality. Results: Our results show that, even without adjustment for age, age at menarche, marital status, and smoking status, both in patients with hyperandrogenemia and across the general population stratified by quartiles of FAI, higher androgen levels are associated with increased waist circumference, weight, Body Mass Index, fasting insulin, and the monocyte/high-density lipoprotein cholesterol ratio. In adjusted correlational analysis, MS remained positively correlated with FAI, even after controlling for age, tobacco use, and alcohol consumption. As FAI quartiles increased, the correlation strengthened, achieving an odds ratio (OR) of 1.45 (95% CI 1.04 to 2.02, P=0.03) in the highest quartile. This indicates that androgen levels are strongly associated with metabolic syndrome, with FAI proving more sensitive than TT. Conclusion: The greater sensitivity of FAI may be attributed to its ability to reflect bioavailable testosterone more accurately than TT, underscoring its potential utility in clinical assessments of metabolic risk. This study found no significant correlation between androgen levels and CVD or mortality.
Semana de 3 a 10 de diciembre, 2024
María Soledad Vallejo. Obstetricia Ginecología. Hospital Clínico. Universidad de Chile
Climacteric. 2024 Dec 8:1-11. doi: 10.1080/13697137.2024.2423213. Online ahead of print.
Evidence-based guideline: premature ovarian insufficiency
ESHRE, ASRM, CREWHIRL and IMS Guideline Group on POI; Nick Panay, Richard A Anderson, Amy Bennie, et al.
Study question: How should premature/primary ovarian insufficiency (POI) be diagnosed and managed, based on the best available evidence from published literature? Summary answer: The current guideline provides 145 recommendations on symptoms, diagnosis, causation, sequelae and treatment of POI. What is known already: POI presents a significant challenge to women’s health, with far-reaching implications, both physically and emotionally. The potential implications include adverse effects on quality of life, on fertility and on bone, cardiovascular and cognitive health. Although hormone therapy (HT) can mitigate some of these effects, many questions still remain regarding the optimal management of POI. Study design, size, duration: The guideline was developed according to the structured methodology for development of European Society of Human Reproduction and Embryology (ESHRE) guidelines. Key questions were determined by a group of experts and informed by a scoping survey of women and healthcare professionals. Literature searches and assessment were then performed. Papers published up to 30 January 2024 and written in English were included in the guideline. An integrity review was conducted for the randomized controlled trials on POI included in the guideline.Participants/materials, setting, methods: Based on the collected evidence, recommendations were formulated and disc ussed within the guideline development group until consensus was reached. Women with lived experience of POI informed the recommendations in general, and particularly those on provision of care. A stakeholder review was organized after finalization of the draft. The final version was approved by the guideline development group and the ESHRE Executive Committee. Main results and the role of chance: New data indicate a higher prevalence of POI, 3.5%, than was previously thought. This guideline aims to help healthcare professionals apply best practice care for women with POI. The recent update of the POI guideline covers 40 clinical questions on diagnosis of the condition, the different sequelae, including bone, cardiovascular, neurological and sexual function, fertility and general well-being, and treatment options, including HT. The list of clinical questions was expanded from the previous iteration of the guideline (2015) based on the scoping survey and appreciation of emerging knowledge of POI. Questions were added on the role of anti-Müllerian hormone (AMH) in the diagnosis of POI, fertility preservation, muscle health and specific considerations for HT in iatrogenic POI. Additionally, the topic on complementary treatments was extended with specific focus on non-hormonal treatments and lifestyle management options. Significant changes from the previous 2015 guideline include the recommendations that only one elevated follicle stimulating hormone (FSH) >25 IU is required for diagnosis of POI and guidance that AMH testing, repeat FSH measurement and/or AMH may be required where there is diagnostic uncertainty. Recommendations were also updated regarding genetic testing, estrogen doses and regimens, use of the combined oral contraceptive and testosterone therapy. Women with lived experience of POI informed the recommendations on provision of care. Limitations, reasons for caution: The guideline describes different management options, but it must be acknowledged that for most of these options, supporting evidence is limited for POI. Wider implications of the findings: The guideline provides healthcare professionals with clear advice on best practice in POI care, based on the best evidence currently available. In addition, a list of research recommendations is provided to guide further studies in POI.
Aging Cell. 2024 Dec 6:e14441. doi: 10.1111/acel.14441. Online ahead of print.
Estradiol deficiency as a consequence of aging contributes to the depletion of the satellite cell pool in female mice
Brian P Sullivan 1, Alexie A Larson 1, Ahmed S Shams 2 3, Shawna L McMillin 1, Mara C Ebeling 1, et al.
The effects of aging on the satellite cell pool have primarily been studied in male mice, where the role of cell-intrinsic versus environmental changes on satellite cell function remains contentious. Estradiol is necessary for maintenance of satellite cell pool size in adult female mice-here we investigate the hypothesis that in females, estradiol is a major environmental driver of age-associated effects on satellite cells. In 24-26 month-old ovarian senescent mice, we find the satellite cell pool size is severely diminished in certain muscles (TA and EDL) but only marginally affected in others (soleus and gastrocnemius). Supplementation with 17-beta estradiol significantly increases satellite cell pool size in the TA and EDL. To assess cell-intrinsic versus environmental regulation, we perform two transplantation experiments, Adult or Aged satellite cells transplanted into Adult recipients, and Adult satellite cells transplanted into Adult or Aged mice. These results demonstrate that the aged environment dominates over cell-autonomous age in terms of the specification of satellite cell pool size. Transcriptional profiling on satellite cells from Adult, Aged and ovariectomized mice revealed commonalities across the two estradiol-deficient conditions, Aged and ovariectomized, in GO terms from differentially expressed genes. Our findings support the hypothesis that the lack of estradiol contributes to reductions in satellite cell number in Aged female muscle, yet cells that remain are functional in terms of proliferative potential and self-renewal capacity. These findings have implications for sex hormone treatment of menopausal women and highlight the vital role of estradiol in the maintenance of the satellite cell pool.
Front Endocrinol (Lausanne). 2024 Nov 21:15:1476751. doi: 10.3389/fendo.2024.1476751. eCollection 2024.
Waist circumference, among metabolic syndrome components, predicts degraded trabecular bone score: a retrospective study of a female population from the 2005-2008 NHANES cohorts
Maria Totaro 1, Ilaria Barchetta 2, Federica Sentinelli 2, Flavia Agata Cimini 2, Sara Palazzi 1, et al.
Background: Osteoporosis and metabolic syndrome (MetS) are conditions associated with ageing and chronic inflammation; among MetS’ components, visceral obesity has been correlated to low bone mineral density in postmenopausal women. However, data on an increased fracture risk in MetS are still contrasting. The trabecular bone score (TBS) is an indicator of bone quality and a potential predictive factor for fractures. We aim to explore the relationship between MetS components and TBS. Methods: we analyzed data from 3962 women in the 2005-2006 and 2007-2008 NHANES cohorts, for whom a valid TBS value was available. All analyses were adjusted for the principal risk factors of altered bone metabolism. Results: An inverse significant association was observed between TBS and most of the MetS variables investigated, with the strongest correlation found with waist circumference (WC) (P <0.001). WC represented the major predictor of degraded TBS (P <0.001), in adjusted models considering age, 25(OH)Vitamin D, smoke and insulin resistance. Increased WC was significantly associated with the presence of bone fractures at the logistic regression analysis (P = 0.001) in all study participants and in the subgroup of women ≤50 years old after adjustment for potential confounders (P = 0.006). Conclusion: This study, using a large sample of women, found a negative association of MetS on bone health, mainly driven by visceral obesity.
Front Pharmacol. 2024 Nov 21:15:1422062. doi: 10.3389/fphar.2024.1422062. eCollection 2024.
Efficacy of combination therapy of vitamin D and bisphosphonates in the treatment of postmenopausal osteoporosis: a systematic review and meta-analysis
Yuangui Yang # 1, Mingyue Yang # 2, Xuanyi Su # 1, Feibin Xie 3
Objective: There is currently no consensus on whether the combination therapy of Vitamin D (VitD) and bisphosphonates offers superior efficacy compared to monotherapy in the treatment of postmenopausal osteoporosis. The aim of this study is to conduct a meta-analysis of recent relevant research to synthesize the available evidence and further investigate whether the combined use of VitD and bisphosphonates is superior to monotherapy in treating osteoporosis in postmenopausal women.Me thods and results: We systematically searched PubMed, EMBASE, the Cochrane Library, and Web of Science for randomized controlled trials (RCTs) comparing the effects of monotherapy with VitD or bisphosphonates versus their combination therapy in the treatment of postmenopausal osteoporosis, up to 1 February 2024. The articles were independently screened and relevant data were extracted by two investigators. The changes in mean values and percentage changes for bone resorption markers, bone formation markers, bone mineral density, and bone mineral metabolism markers were expressed using the standardized mean difference (SMD) and 95% confidence intervals (CI). Heterogeneity was quantitatively described using the I2 test. Subsequently, sensitivity analyses were performed for data with significant heterogeneity. Subgroup analyses were conducted based on the type of monotherapy used, and potential publication bias was assessed. The analysis revealed that the combination of VitD and bisphosphonates demonstrated a more pronounced effect in increasing alkaline phosphatase (ALP), 25-hydroxyvitamin D (25-OH-VD), and serum calcium (sCa) levels, as well as in decreasing levels of serum bone-specific alkaline phosphatase (sBALP), serum C-terminal telopeptide of type I collagen (sCTX), and urinary N-telopeptide of type I collagen (UriNTX) compared to the monotherapy group. However, the combination of VitD and bisphosphonates did not show a significant advantage over monotherapy in terms of improving osteocalcin levels. The differences in the mean changes in osteocalcin, UriNTX, and sCa, as well as the percentage changes in parathyroid hormone (PTH) were not statistically significant (p > 0.05). Conclusion: The meta-analysis suggests that compared to monotherapy, the combination therapy of VitD and bisphosphonates exhibits a more favorable effect on bone mineral density and bone calcium metabolism-related markers in the treatment of postmenopausal osteoporosis.
Eur J Epidemiol. 2024 Dec 4. doi: 10.1007/s10654-024-01179-5. Online ahead of print.
Alcohol consumption trajectories and risk of breast cancer among postmenopausal women: a Danish cohort study
Christian S Antoniussen 1, Cécile Proust-Lima 2, Daniel B Ibsen 1 3 4, Anja Olsen 1 5, Kim Overvad 1, et al.
Alcohol consumption is a risk factor for breast cancer (BC), yet little is known about longitudinal alcohol consumption patterns and risk of BC. This study aimed to investigate whether trajectory profiles of alcohol consumption across adulthood were associated with risk of first primary malignant BC in postmenopausal women. At baseline, 28,720 pre-and postmenopausal women aged 50-65 years from the Danish Diet, Cancer and Health Cohort reported their average alcohol intake over the past 12 months and their average alcohol intake at the ages of 20, 30, 40, and 50 years. Alcohol consumption trajectories were estimated using latent class mixed models. BC cases were identified through record linkage to the Danish Cancer Registry. To examine associations between alcohol consumption trajectories and BC, we fitted a proportional hazard model adjusted for potential confounding factors using data from 24,543 postmenopausal women without missing covariate information. We identified 4 alcohol consumption trajectory profiles. During a median follow-up of 16.5 years, 1,591 cases of BC occurred. A mean alcohol consumption trajectory of > 10 g/day was associated with higher risk of BC (HR: 1.65, 95%CI: 1.35-2.03) compared to a mean alcohol consumption trajectory of < 6 g/day. We found no association between trajectory profiles characterized by lower alcohol intakes in early adulthood followed by increasing consumption of alcohol in adulthood compared to a consistently low intake of alcohol. Postmenopausal women drinking consistently high amounts of alcohol throughout adulthood had a higher risk of BC compared to women with a consistently low intake of alcohol.
Eur J Epidemiol. 2024 Dec 3. doi: 10.1007/s10654-024-01181-x. Online ahead of print.
Hormone therapy and venous thromboembolism risk in women of menopausal age: a target trial emulation
Yi-Chun Yeh 1 2, Cherry Yin, Yi Chang 3 4, Pei-Chun Chen 5 6
Contemporary data from randomized clinical trials focusing on the effect of oral hormone therapy (HT) on venous thromboembolism (VTE) in women aged 50-60 years are scarce despite evolving HT regimens. Here, we evaluated the association between HT and the risk of developing VTE using a target trial emulation among women of menopausal age. This retrospective cohort study applied a target trial emulation framework using claims data from a universal health insurance program in Taiwan. We emulated a sequence of trials in which women aged 50-60 years with no previous history of HT, hysterectomy, gynecologic disorders, or cardiovascular events were enrolled. Eligibility and HT use were evaluated monthly from 2011 to 2019. Eligible women were classified as either HT initiators or non-initiators for each consecutive month. Observational analogs of the intention-to-treat and per-protocol effects were estimated using pooled logistic regression models. Of the 150,686,148 eligible person-trials (3,001,112 women), 192,215 initiators and 768,860 propensity score-matched non-initiators were included in the analysis. The average duration of the HT was 1.25 years. Over a median follow-up of 5.83 years, 3,334 women developed VTE. The estimated hazard ratio (95% confidence interval) was 0.96 (0.88, 1.04) in the intention-to-treat analysis and 0.66 (0.41, 1.05) in per-protocol analysis. The estimated intention-to-treat and per-protocol 5-year VTE-free survival differences (95% confidence interval) were 0.1‰ (- 0.3‰, 0.7‰) and 0.3‰ (- 2.8‰, 4.0‰), respectively. In the contemporary clinical setting, we did not observe an increased VTE risk associated with HT in women aged 50-60 years.
J Breast Cancer. 2024 Nov 5. doi: 10.4048/jbc.2024.0186. Online ahead of print.
Characteristics and Prognosis of Breast Cancer Patients With Prior Hormone Replacement Therapy: Insights From the Korean Breast Cancer Society Registry
Chai Won Kim 1, Yongsik Jung 2, Joon Jeong 3, Hee Jeong Kim 4, Jung Eun Choi, et al.; Korean Breast Cancer Society
By investigating the characteristics and prognosis of breast cancer (BC) patients who have undergone hormone replacement therapy (HRT), this study addresses a gap in the existing literature. A total of 17,355 postmenopausal patients with BC were analyzed using data from the Korea Breast Cancer Society database (2000-2014). Among them, 3,585 (20.7%) had a history of HRT before BC diagnosis (HRT group), while 13,770 (79.3%) never received HRT (non-HRT group). The HRT group exhibited an earlier pathologic stage, lower histologic and nuclear grades, and a higher rate of breast conservation surgery compared to the non-HRT group. Furthermore, this group had a higher rate of screening participation and a greater proportion of patients with a normal or overweight body mass index (BMI). The prognosis of the HRT group was better than that of the non-HRT group, with a 5-year overall survival rate of 93.9% versus 91.7% (p < 0.001). The hazard ratio for the HRT group was 0.7 (95% confidence interval, 0.608-0.805; p < 0.001). Increased screening participation, longer HRT duration, and a normal or overweight BMI were associated with a better prognosis in the HRT group. Patients with BC who underwent HRT showed better clinicopathological characteristics and prognosis than those who did not receive HRT. The results highlighted significant differences in patients who underwent screening and those with a normal or overweight BMI. Furthermore, a longer HRT duration was associated with a better prognosis.
Publicaciones Internacionales REDLINC 2024 (Abstracts)
Association between type of menopause and mild cognitive impairment: The REDLINC XII study
María T Espinoza 1, Juan E Blümel 2, Peter Chedraui 3, María S Vallejo 4, Mónica Ñañez 5, Eliana Ojeda 6, Claudia Rey 7, Doris Rodríguez 8, Marcio A Rodrigues 9, Carlos Salinas 10, Konstantinos Tserotas 11, Andrés Calle 12, Maribel Dextre 13, Alejandra Elizalde 14, Carlos Escalante 15, Gustavo Gómez-Tabares 16, Álvaro Monterrosa-Castro 17
Objective: To evaluate the association between type of menopause (spontaneous or surgical) and mild cognitive impairment (MCI).
Study design: This study was a cross-sectional, observational, and sub-analytical investigation conducted within gynecological consultations across nine Latin American countries. Method: We assessed sociodemographic, clinical, and anthropometric data, family history of dementia, and the presence of MCI using the Montreal Cognitive Assessment (MoCA) tool.
Results: The study involved 1185 postmenopausal women with a mean age of 55.3 years and a body mass index of 26.4 kg/m2. They had an average of 13.3 years of education, and 37 % were homemakers. Three hundred ninety-nine experienced menopause before 40, including 136 with surgical menopause (bilateral oophorectomy). Out of the 786 women who experienced menopause at 40 or more years, 110 did so due to bilateral oophorectomy. There were no differences in MoCA scores among women who experienced menopause before or after the age of 40. However, lower MoCA scores were observed in women with surgical menopause than in those with spontaneous menopause (23.8 ± 4.9 vs. 25.0 ± 4.3 points, respectively, p < 0.001). Our logistic regression model with clustering of patients within countries found a significant association between MCI and surgical menopause (OR 1.47, 95 % CI: 1.01-2.16), use (ever) of menopausal hormone therapy (OR 0.33, 95 % CI: 0.21-0.50), and having >12 years of education (OR 0.21, 95 % CI: 0.14-0.30).
Conclusion: When comparing women who experience spontaneous menopause over the age of 40 with those who undergo it before this age, there was no observed increased risk of developing MCI, while those with surgical menopause, independent of age, are more prone to cognitive decline. Women who have ever used menopausal hormone therapy have a lower MCI risk. Further research is warranted to delve deeper into this topic.
Maturitas. 2024 Nov:189:108110. doi: 10.1016/j.maturitas.2024.108110. Epub 2024 Aug 28.
Severe menopausal symptoms linked to cognitive impairment: an exploratory study
Andrés Calle 1, Juan E Blümel 2, Peter Chedraui 3, María S Vallejo 4, Alejandra Belardo 5, Maribel Dextre 6, Alejandra Elizalde-Cremonte 7, Carlos Escalante 8, María T Espinoza 9, Gustavo Gómez-Tabares 10, Álvaro Monterrosa-Castro 11, Mónica Ñañez 12, Eliana Ojeda 13, Claudia Rey 14, Doris Rodríguez 15, Marcio A Rodrigues 16, Carlos Salinas 17, Konstantinos Tserotas 18, Sócrates Aedo 19
Objective: To evaluate the association between menopausal symptoms and cognitive decline in postmenopausal women.
Methods: This was a subanalysis of a cross-sectional, observational study conducted among women attending gynecological consultations across nine Latin American countries. The survey involved late postmenopausal women who were asked to complete a general questionnaire and the Menopause Rating Scale (MRS) to assess menopausal symptoms, with the Montreal Cognitive Assessment used to evaluate cognitive function as an outcome. A Montreal Cognitive Assessment score of less than 21 was used to define women with mild cognitive impairment (MCI).
Results: The study included 1,287 postmenopausal women with a mean age of 55.5 years and a mean body mass index of 26.3 kg/m 2 . On average, participants had 13.8 years of education and 2.3 ± 1.8 children, with 72.8% reporting having a partner. Additionally, 36.7% ever used menopausal hormone therapy. Regarding lifestyle factors, 50.3% engaged in a sedentary lifestyle, whereas 70.5% had never smoked. 15.3% of women had MCI exhibited significantly more intense menopausal symptoms compared with those without MCI (MRS total score 15.24 ± 12.58 vs 10.53 ± 8.84, respectively, P < 0.001). Logistic regression analysis revealed a significant association between severe menopausal symptoms (MRS total score ≥14 points) and MCI (odds ratio [OR], 1.74; 95% CI, 1.25-2.42). Conversely, a lower body mass index (OR, 0.96; 95% CI, 0.95-0.98), sexual activity (OR, 0.70; 95% CI, 0.51-0.96), physical exercise (OR, 0.55; 95% CI, 0.39-0.76), menopausal hormone therapy use (OR, 0.36; 95% CI, 0.24-0.55), and higher educational level (OR, 0.31; 95% CI, 0.21-0.46) were associated with lower odds for MCI.
Conclusion: Severe menopausal symptoms in postmenopausal women were associated with cognitive impairment. This study highlights the intricate interplay between hormonal, lifestyle, and sociodemographic factors and cognitive health.
Menopause. 2024 Nov 1;31(11):959-965. doi: 10.1097/GME.0000000000002422. Epub 2024 Aug 13.
Association of muscle disorders in late postmenopausal women according to the type of experienced menopause
María S Vallejo 1, Juan E Blümel 2, Peter Chedraui, Konstantinos Tserotas 3, Carlos Salinas 4, Marcio A Rodrigues 5, Doris A Rodríguez 6, Claudia Rey 7, Eliana Ojeda 8, Mónica Ñañez 9, Álvaro Monterrosa-Castro 10, Gustavo Gómez-Tabares 11, María T Espinoza 12, Carlos Escalante 13, Alejandra Elizalde 14, Maribel Dextre 15, Andrés Calle 16, Sócrates Aedo 17
Objective: Musculoskeletal disorders frequently affect postmenopausal women. This study aims to compare muscle disorders between women according to the type of experienced menopause: premature (PM) or normal age of menopause (NAM).
Methods: This was a cross-sectional study conducted in nine Latin American countries in which late postmenopausal women (55 to 70 years) were surveyed with a general questionnaire, the Menopause Rating Scale (MRS: item #4 exploring musculoskeletal discomfort), and strength, assistance with walking, rising from a chair, climbing stairs, and falling questionnaire (risk of sarcopenia).
Results: A total of 644 women were included: 468 who had NAM, and 176 who had PM (116 spontaneous and 60 surgical). The overall mean age of the participants was 60.9 ± 4.2 years. Women who had PM experienced more musculoskeletal discomfort (33.5% vs 20.9%, P < 0.001) and a higher likelihood of sarcopenia (35.2% vs 19.9%, P < 0.001) than women who had a NAM. Women who had surgical PM exhibited a higher prevalence of severe musculoskeletal discomfort (46.7% vs 29.3%, P < 0.02) and a higher likelihood of sarcopenia (45.0% vs 27.6%, P < 0.02) than women who had a NAM. After adjusting for covariates (age, body mass index, menopausal hormone therapy use, physical activity, education, cigarette consumption, use of antidepressants, sexual activity, comorbidities, and having a partner), our logistic regression model determined that spontaneous PM was not associated with higher odds of musculoskeletal discomfort and higher odds of sarcopenia. On the other hand, women who had surgical PM were more likely to experience musculoskeletal discomforts (odds ratio: 2.26; 95% confidence interval: 1.22-4.17) and higher odds for sarcopenia (odds ratio: 2.05; 95% confidence interval: 1.16-3.65) as compared to women who experienced a NAM.
Conclusions: Women experiencing surgical PM have a higher likelihood of developing muscle disorders. This underscores the potential significance of hormonal levels in influencing musculoskeletal health during postmenopause.
Menopause. 2024 Jul 1;31(7):641-646. doi: 10.1097/GME.0000000000002367. Epub 2024 Apr 30.
Genitourinary symptoms and sexual function in women with primary ovarian insufficiency
J E Blümel 1, P Chedraui 2 3, M S Vallejo 4, M Dextre 5, A Elizalde 6, C Escalante 7, A Monterrosa-Castro 8, M Ñañez 9, E Ojeda 10, C Rey 11, D Rodríguez 12, M A Rodrigues 13, C Salinas 14, K Tserotas 15
Objective: There are limited studies on urogenital symptoms in women who experience menopause before the age of 40 years due to primary ovarian insufficiency (POI) or bilateral oophorectomy (surgical POI). This study aimed to compare the urogenital symptoms, including sexuality, of women with POI to those without the condition.
Methods: This cross-sectional study conducted was in seven Latin American countries, in which postmenopausal women (with POI and non-POI) were surveyed with a general questionnaire, the Menopause Rating Scale (MRS) and the six-item Female Sexual Function Index (FSFI-6). The association of premature menopause with more urogenital symptoms and lower sexual function was evaluated with logistic regression analysis.
Results: Women with POI experience more urogenital symptoms (MRS urogenital score: 3.54 ± 3.16 vs. 3.15 ± 2.89, p < 0.05) and have lower sexual function (total FSFI-6 score: 13.71 ± 7.55 vs. 14.77 ± 7.57 p < 0.05) than women who experience menopause at a normal age range. There were no significant differences in symptoms when comparing women based on the type of POI (idiopathic or surgical). After adjusting for covariates, our logistic regression model determined that POI is associated with more urogenital symptoms (odds ratio [OR]: 1.38, 95% confidence interval [CI] 1.06-1.80) and lower sexual function (OR: 1.67, 95% CI 1.25-2.25).
Conclusion: POI, whether idiopathic or secondary to bilateral oophorectomy, is associated with symptoms that affect vaginal and sexual health.
Climacteric. 2024 Jun;27(3):269-274. doi: 10.1080/13697137.2024.2306278. Epub 2024 Feb 3.
Anxiety but not menopausal status influences the risk of long-COVID-19 syndrome in women living in Latin America
Faustino R Pérez-López 1, Juan Enrique Blümel 2, María Soledad Vallejo 3, Ignacio Rodríguez 4, Konstantinos Tserotas 5, Carlos Salinas 6, Marcio A Rodrigues 7, Claudia Rey 8, Eliana Ojeda 9, Mónica Ñañez 10, Carlos Miranda 11, Marcela López 12, Karen Díaz 13, Maribel Dextre 14, Andrés Calle 15, Ascanio Bencosme 16
Objective: To study sociodemographic and clinical factors associated with the long-COVID-19 syndrome among women living in Latin American countries using undirected and directed methods.
Method: We studied 347 patients with COVID-19 (confirmed by polymerase chain reaction) living in nine Latin American countries between May 2021 and July 2022, including 70 premenopausal, 48 perimenopausal, and 229 postmenopausal women. We compared the sociodemographic and general health information of women with (n = 164) and without (n = 183) the long-COVID-19 syndrome. They also completed the Connor-Davidson Resilience Scale, the Fear of COVID-19 Scale, the Jenkins Sleep Scale, and the Menopause Rating Scale to define the minimum set of variables for adjustment. We designed a directed acyclic graph (DAG) to identify factors related to the long-COVID-19 syndrome. Data were submitted to categorical logistic regression analyses. Results are reported as means and standard deviations or β-coefficients and 95 % confidence intervals.
Results: Women with long-COVID-19 syndrome had a poor lifestyle, severe menopause symptoms, hypertension, insomnia, depression, anxiety, chronic diseases/conditions, risk of hospitalization, sleep disturbance, and low menopause-related quality of life compared to women without the syndrome. The DAG identified the following long-COVID-19 covariates: age, obesity, anxiety, depression, cancer, lifestyle, smoking, and menstrual status. A multivariable logistic model with these covariates indicated that anxiety is the only factor to be significantly associated with long-COVID-19 syndrome, whereas other covariates were confounding factors. There was no significant influence of menopausal status on the long-COVID-19 syndrome.
Conclusion: Among factors selected by the DAG, only anxiety was significantly associated with the long-COVID-19. There was no significant influence of the menopause status on the long-COVID-19 syndrome in the studied population.
Maturitas. 2024 Feb:180:107873. doi: 10.1016/j.maturitas.2023.107873. Epub 2023 Nov 2.
