Facebook Follow AMS on Linkedin Follow us on Twitter @amsCoolAgain

IMS Menopause Live

Commentaries from the IMS on recently published scientific papers that may be of interest. The latest articles from November 2016 onward are available to Members only when logged in. Selected articles are open to public.

Need help with your username and password? Email This email address is being protected from spambots. You need JavaScript enabled to view it. 

Cigarette smoking and age of menopause

23 July, 2012:

A recent 21-year follow-up prospective study was designed to analyze the association between smoking and the onset of menopause at an earlier age in a large cohort of middle-aged women after adjustment for a number of potential confounders [1]. The main outcomes were age of menopause measured at the 21-year follow-up, smoking and menopausal status. This study was based on 3545 women who provided data on their menopausal status at the 21-year follow-up of the study and prospective as well as concurrent data on smoking. In univariate analysis, tobacco smoking during the reproductive life course, socioeconomic status and gravidity were significantly associated with earlier age of menopause. In multivariate analyses, women who smoked cigarettes were more prone to develop earlier menopause than non-smokers. Compared to current smokers, risk of early menopause was significantly lower in those women who were former smokers. In summary, data from this study suggest that the impact of smoking is independent of other covariates associated with both smoking and age of menopause. These findings raise the possibility that effective programs for smoking cessation may lead to a later age of menopause and reduce the risk of adverse health consequences of early menopause.

Continue Reading

PrintEmail

Long-term effects of the Women’s Health Initiative in the USA

16 July, 2012:

To study long-term prescriptions of hormone therapy (HT) in postmenopausal women, during a decade after the Women's Health Initiative (WHI), Steinkellner and colleagues [1] used a national pharmacy database from 2000 to 2009. Women who were 50 years and older at the start of the calendar year with continuous pharmacy benefits during the entire 12-month period were included in the study population for that year. The yearly study population varied from a low of 3,579,838 in 2000 to a high of 9,712,325 in 2009. The prevalence of HT use in each year's study population dropped from 21.6% in the year 2000 to 8.8% in the year 2009. The sharpest decline occurred between 2001 and 2003 and then it remained relatively stable. Analysis of different age groups showed a maximum fall in the decade 65–74 years old.

In the year 2000, oral HT accounted for 19% of this 21.6% and then it went down to a prevalence of 4.8% in 2009. Transdermal estrogen, not very popular in the US, remained stable throughout this period of time – around 4%, and vaginal formulations increased from an annual incidence of 0.9% in the year 2000 to 1.7% in 2009.

High and standard doses showed a prevalence of 16.6% in 2000 and then declined very fast in 2003 and continued to run low till 2009 with a share of 2.4%. Low-dose preparations remained constant in the range of 2.3–2.5% during the study period.

At the beginning of this survey, the prevalence of women prescribed by GP/IM/FP (Family Practice/Internal Medicine/General Practice) was 9.9% and gynecologists contributed another 8.8%. At the end of the decade, the gynecologists became the main prescribers of HT, with a prevalence of 5.3%, whereas GP/IM/FP accounted for only 2.9%.

Continue Reading

PrintEmail

Mood, menopause and hysterectomy

9 July, 2012:

In a recent study by Gibson and colleagues, depression and anxiety symptoms were assessed in 1970 women followed up annually since premenopause for up to 10 years in a sub-study of the SWAN (Study of Women's Health Across the Nation) cohort, with the objective of examining whether mood symptoms were influenced negatively by hysterectomy, with or without bilateral oophorectomy, relative to natural menopause [1]. Women were recruited in a community-based setting, which is one of SWAN's specifications together with its multiethnic commitment [2]. They were 42–52 years of age, premenopausal, had an intact uterus and at least one ovary at baseline, as well as one or more menstrual cycles in the 3 months before. Symptoms were measured with the 'Center for Epidemiological Studies Depression Index' along with the evaluation of four anxiety items. In line with multivariate analyses, piece-wise hierarchical growth models were used to relate natural menopause, hysterectomy with ovarian conservation, and hysterectomy with bilateral oophorectomy to trajectories of mood symptoms before and after the final menstrual period or surgery.

Around 90% of the women reached natural menopause by the tenth annual visit, whereas 5.2% (n = 101) reported hysterectomy with bilateral oophorectomy and 3.9% (n = 76) hysterectomy with ovarian conservation. Depressive symptoms declined before the final menstrual period or surgery (regardless of whether the ovaries were conserved) and continued to decline afterwards. There was no significant difference in the mean rate of change in depressive symptoms relative to natural menopause. Both depressive and anxiety symptoms generally improved over the course of the menopausal transition for all women.

Hormone therapy (HT) was concurrently associated with lower levels of depressive and anxiety symptoms, while antidepressant use increased anxiety scores. HT was used at some point of the study by the majority of participants and was particularly common among women with hysterectomy and oophorectomy; but exclusion of HT users, as stated by the authors, did not affect the trajectories of changes in depressive or anxiety symptoms.

Continue Reading

PrintEmail

Testosterone concentrations in ovarian insufficiency: a review

25 June 2012

An important and to date not clearly resolved question in clinical reproductive medicine has been whether premature loss of ovarian function (e.g. primary ovarian insufficiency (POI) below the age of 40 years) and iatrogenic premature loss of ovarian function (as a result of surgery, gonadotoxic chemotherapy or pelvic irradiation) result in a significant decrease in circulating testosterone concentrations and hence might merit testosterone treatment. Many published studies have included small sample sizes and/or non-uniform control groups. Janse and colleagues [1] have undertaken a systematic review and meta-analysis of the literature and conclude that testosterone levels are lower, though the magnitude of the difference is relatively small. They reviewed 206 articles on POI and 1358 on iatrogenic menopause, of which nine and 17, respectively, were selected for final analysis. In both groups, there was evidence of a lower testosterone concentration than in controls. Weighted mean differences were -0.38 nmol/l (95% confidence interval (CI) -0.55 to -0.22) and -0.29 nmol/l (95% CI -0.39 to -0.18), respectively. The mean differences represented a range of 1–49% lower (average 25%) in POI and a range of 11% higher to 77% lower (average 22% lower) for iatrogenic menopause. A sensitivity analysis of the three highest-quality studies in each group did not change the data substantially. The significance of such relatively small differences and their clinical importance are unclear.

Continue Reading

PrintEmail

The relationship of mammographic density and age

11 June 2012:

Chemoprevention of breast cancer has the potential of a bright future in menopausal medicine. However, before chemoprevention can be implemented effectively, better methods for the reliable prediction of breast cancer are needed. Three major strategies for early prediction or risk assessment of breast cancer have been established. Next to the algorithm of epidemiological factors, as given by the Gail criteria, rank the assessment of the endocrine environment, mainly the circulating sex steroids, and mammographic density of the breast. The latter has been shown to provide an independent prediction of the breast cancer risk, although the link between enhanced mammographic density and the cellular and molecular pathways leading to breast cancer has not yet been elucidated.

 

Checka and co-workers [1] now present a retrospective analysis of a large cohort of more than 7000 women, in which the relationship between mammographic density, as given by the BI-RADS density categories, and age is analyzed. BI-RADS is the acronym for Breast Imaging-Reporting and Data System and was defined and published by the American College of Radiology. The BI-RADS assessment system consists of seven categories, but only those ranking from 1 to 4 can be used for the prediction of breast cancer risk, as they classify mammographic density differences from negative to suspicious. The median age of the cohort was 57 years. There was a significant inverse relationship between age and breast density (p g biopsy.

Continue Reading

PrintEmail

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.

Continue Reading

PrintEmail

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.

Continue Reading

PrintEmail

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.

Continue Reading

PrintEmail

Search

Facebook Follow AMS on Linkedin Follow us on Twitter @amsCoolAgain