30 / 08 / 2022 REDLINC
Selección de Resúmenes de Menopausia
Semana del 24 a 30 de agosto 2022
María Soledad Vallejo. Clínica Quilín. Universidad de Chile
Endocrinol Diabetes Nutr (Engl Ed). 2022 Aug 23;S2530-0180(22)00133-0. doi: 10.1016/j.endien.2022.08.002.
Guide of management of alterations in mineral and bone metabolism during gestation and lactation
Antonia García Martín 1, María Rosa Alhambra Expósito 2, María Cortés Berdonces 3, Esteban Jódar Gimeno et al.
Objective: To provide practical recommendations for the management of mineral and bone metabolism alterations in pregnancy and lactation. Participants: Members of the Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology and Nutrition. Methods: Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. A systematic search was carried out in Medline of the available evidence for each pathology. Papers in English with publication date until 29 February 2020 were included. A methodologist resolved the differences that arose during the process of reviewing the literature and formulating recommendations. The recommendations were discussed and approved by all members of the Working Group. Conclusions: The document establishes practical recommendations based on evidence about the management of mineral and bone metabolism disorders in pregnancy and lactation.
J Hypertens. 2022 Jun 1;40(Suppl 1):e200. doi: 10.1097/01.hjh.0000837476.69155.75.
Ambulatory blood pressure in postmenopausal women on estrogen, androgen or progesterone therapy
Milos Stojanovic 1, Svetlana Vujovic, Miomira Ivovic, Milina Tancic Gajic, Ljilja Marina, Marija Miletic, et al.
Objective: Objective of this study was to evaluate different hormone replacement therapy (HRT) combinations on ambulatory blood pressure (ABPM) and body mass index (BMI) in postmenopausal women. Design and method: One hundred and fifty women 47-62 y's of age were first on estrogen/androgen therapy, then they were without HRT therapy for three months and later on estradiol and drospirenone combined therapy. Validated, Meditech ABPM 05 was used to obtain 24-h blood pressure (BP) after each regime. All women did not change antihypertensive treatment during the study. Wilcoxon Signed Rank Test was used to examine whether there was a statistically significant difference in blood pressure and body mass index values at different hormone therapy regimens. Results: There were no significant differences in BP parameters and BMI between different therapy regimes but lowest BP and BMI values were recorded while women were on estradiol and drospirenone combined therapy. The affinity of progesterone for the mineralocorticoid receptor is about five times that of aldosterone and may well antagonize the salt-retaining effect of estrogens, and thus lowering of blood pressure. Conclusions: We may conclude that estradiol and drospirenone combined therapy lowers blood pressure and maintains a stable body weight in postmenopausal women.
Epidemiol Psychiatr Sci. 2022 Aug 26;31:e60. doi: 10.1017/S2045796022000439.
Depressive symptoms and suicidality by menopausal stages among middle-aged Korean women
Se Young An 1, Yejin Kim 1 2, Ria Kwon 1 2, Ga-Young Lim 1 2, Hye Rin Choi 1 2, Sunju Namgoung, et al.
Aims: There has been increasing evidence of hormonal changes during reproductive events that lead to mood changes. However, studies on the severity of psychological problems according to the menopausal stage are limited. Thus, this study aimed to investigate the association between menopausal stages, depression and suicidality. Methods: A total of 45 177 women who underwent regular health check-ups between 2015 and 2018 at Kangbuk Samsung Hospital were included. Participants were stratified into four groups (pre-menopause, early transition, late transition and post-menopause) based on the Stages of Reproductive Aging Workshop Criteria. The Center for Epidemiological Studies-Depression scale (CESD) was used to evaluate depressive symptoms, and the degree of depressive symptoms was classified as moderate (CESD score 16-24) or severe (CESD score ⩾ 25). To measure suicide risk, we administered questionnaires related to suicidal ideation. Results: Overall, the prevalence of CESD scores of 16-24 and ⩾ 25 was 7.6 and 2.8%, respectively. Menopausal stages were positively associated with depressive symptoms in a dose-dependent manner. Multivariable-adjusted prevalence ratios (PRs, 95% confidence intervals) for CESD scores of 16-24 comparing the stages of the early menopausal transition (MT), late MT and post-menopause to pre-menopause was 1.28 (1.16-1.42), 1.21 (1.05-1.38) and 1.58 (1.36-1.84), respectively. The multivariable-adjusted PRs for CESD scores ⩾ 25 comparing the stages of the early MT, late MT and post-menopause to pre-menopause were 1.31 (1.11-1.55), 1.39 (1.12-1.72), 1.86 (1.47-2.37), respectively. In addition, the multivariable-adjusted PRs for suicidal ideation comparing the early MT, late MT and post-menopause stages to the pre-menopause stage were 1.24 (1.12-1.38), 1.07 (0.93-1.24) and 1.46 (1.25-1.70) (p for trend <0.001), respectively. Conclusions: These findings indicate that the prevalence of depressive symptoms and suicidal ideation increases with advancing menopausal stage, even pre-menopause.
Menopause. 2022 Aug 23. doi: 10.1097/GME.0000000000002024. Online ahead of print.
Immunization for midlife women
Vivien Brown 1
Objective: Menopause occurs at a critical juncture in life when preventative health care can have a major impact. However, recommendations for immunizations are often neglected, leading to unnecessary morbidity and mortality in aging women. The aim of this review is to highlight the importance of immunization checkpoints at menopause to optimize the quality of care and health maintenance in older women and to provide an overview of the impact of immunizations on women's health. Methods: This is an opinion article based on the current US and Canadian guidelines. A review of various guidelines from the Centers for Disease Control and Prevention and National Advisory Committee on Immunizations were conducted for each vaccine. Results and conclusions: Disease prevention benefits are well established for several diseases, such as hepatitis A, hepatitis B, tetanus, human papillomavirus, streptococcus pneumonia, shingles, and COVID-19. During clinical encounters, a needs assessment regarding vaccinations should be conducted. However, barriers to adult vaccination including lack of patient and provider knowledge about the need for vaccination, lack of priority for preventive services, and concerns regarding costs, insurance coverage, and reimbursement all contribute to the adult immunization gap. Given the importance of immunization and the need to decrease vaccine-preventable diseases, it is the obligation of healthcare practitioners to recommend vaccines and provide education on vaccination guidelines and associated risks. As women often seek medical attention at menopause because of changes in their physiology that require attention, it is the ideal time to discuss the importance of immunization.
Arch Gynecol Obstet. 2022 Aug 23. doi: 10.1007/s00404-022-06732-9. Online ahead of print.
Citalopram improves vasomotor syndrome and urogenital syndrome of menopause in Mexican women: a randomized clinical trial
Alan Rios-Espinosa 1, Magdalena Cruz-Luna 1, Carolina Garmendia-Gallardo 1, Merle Yasmin Hernández-Castañón
Purpose: This study aimed to determine the efficacy of non-hormonal therapy with citalopram vs fluoxetine for treating vasomotor syndrome (VMS) and urogenital syndrome of menopause (GSM) in Mexican women. Methods: A parallel prospective randomized clinical trial was conducted in 91 postmenopausal women with a total score on the Menopause Rating Scale (MRS) ≥ 17 and with the clinical diagnosis of VSM and GSM. Patients were randomly assigned to receive citalopram (n = 49) or fluoxetine (n = 42). Follow-up was carried out at 3 and 6 months. Results: The citalopram group experienced a significant improvement compared to the fluoxetine group in the MRS total score (p < 0.01), as well as in the psychological (p < 0.001) and somatic (p < 0.0001) domains at 3 and 6 months of follow-up. After 6 months of follow-up, the group that received citalopram decreased the relative risk (RR) to present VMS symptoms (RR = 0.30, CI 0.19-0.5, p = 0.0001), depressed mood (RR = 0.31, CI 0.15-0.6, p = 0.0002), irritability (RR = 0.40, CI 0.22-0.73, p = 0.002), anxiety (RR = 0.30, CI 0.13-0.69, p = 0.003), physical and mental exhaustion (RR = 0.35, CI 0.18-0.67, p = 0.001), sexual problems (RR = 0.18, CI 0.06-0.48, p = 0.0001), vaginal dryness (RR = 0.34, CI 0.14-0.80, p = 0.01), and urinary problems (RR = 0.36, CI 0.14-0.92, p = 0.043). Conclusion: We conclude that citalopram tends to improve VSM and GSM symptoms in postmenopausal Mexican women. Thus, we recommend the daily use of citalopram 20 mg. However, further studies will be required to support the results of the present work. These should include a larger number of patients and a placebo group.
Front Endocrinol (Lausanne). 2022 Aug 5;13:899375. doi: 10.3389/fendo.2022.899375. eCollection 2022.
The effects of vegetarian diets on bone health: A literature review
Alberto Falchetti 1, Guido Cavati 2, Roberto Valenti 3, Christian Mingiano 2, Roberta Cosso 4, et al.
In these recent years many people are adopting a vegetarian type diet due to the numerous positive health effects of this regimen such as the reduction of the incidence of many chronic disorders like diabetes, hypertension, obesity and cancer. However this diet is quite restrictive and so it could be possible to have a deficiency in some specific nutrients, increasing the risk of osteoporosis and fractures. Although there are conflicting results on the effects of the vegetarian diet on bone health and fracture incidence, it is always recommendable in vegetarian people to have an adequate intake of calcium and vitamin D, through an increased intake of supplements, natural and fortified foods, an adequate intake of protein, fruit, vegetables, as well as vitamin B12. The aim of this literature review is to revise the actual knowledge of the effect of some nutrients and vegetarian diets on bone health.
Aust N Z J Obstet Gynaecol. 2022 Aug 21. doi: 10.1111/ajo.13604. Online ahead of print.
Determining a threshold measurement of endometrial thickness for asymptomatic postmenopausal women: A tertiary centre case series
Amy Stewart 1 2, Gurjot Gill 3, Emma Readman 2, Sonia R Grover 2 3, Samantha S Mooney 2 3
Background: An incidental finding of a thickened endometrium on ultrasound in the postmenopausal patient without bleeding is a common presentation to gynaecological services; however there is limited evidence to guide clinical practice as to when hysteroscopic evaluation and endometrial sampling is required. Aims: To determine the endometrial thickness at which endometrial sampling is indicated in asymptomatic postmenopausal women referred with thickened endometrium on ultrasound. Materials and methods: A single-centre retrospective case series of postmenopausal women without bleeding undergoing hysteroscopy was conducted. Logistic regression was used to examine the association between a range of variables and pre-malignant or malignant pathology and endometrial thickness. The optimal endometrial thickness threshold was identified to maximise model sensitivity. Results: A total of 404 postmenopausal women were included in this study, having undergone a hysteroscopy at the study site between 1 July 2008 and 30 June 2018. The mean (SD) age of patients at presentation was 65 (9.09) years and the mean body mass index was 29.86 kg/m2 (6.52). Of these women, nine (2.2%) were diagnosed with endometrial carcinoma and seven (1.7%) had endometrial hyperplasia with atypia. The most common histopathological finding was of a benign endometrial polyp (153: 37.9%). When including hyperplasia with or without atypia in histopathology of interest, a cut-off of ≥9 mm provides the greatest sensitivity (83.3%) and specificity (63.8%) for a diagnosis of pre-malignant or malignant pathology (classification accuracy of 64.8%; area under the receiver operating characteristic: 0.7358, 95% CI: 0.6439, 0.8278) in this cohort. Conclusions: Using an endometrial thickness of ≥9 mm can be used as a cut-off for endometrial sampling in postmenopausal women without bleeding.
J Am Med Dir Assoc. 2022 Aug 17;S1525-8610(22)00553-9. doi: 10.1016/j.jamda.2022.07.012.
Low Bone Mineral Density With Risk of Dementia: A Prospective Cohort Study
Xiaowen Zhang 1, Warrington W Q Hsu 1, Chor-Wing Sing 2, Gloria H Y Li 3, Kathryn C B Tan 4, et al.
Objectives: Osteoporosis and dementia often coexist, but the association between the 2 diseases remains unclear. This study aimed to investigate the relationship between bone mineral density (BMD) and the risk of incident dementia.Design: Prospective cohort study, the Hong Kong Osteoporosis Study (HKOS). Setting and participants: Data were from the HKOS and the Clinical Data Analysis and Reporting System (CDARS) in Hong Kong. A total of 5803 participants aged ≥40 years and free of dementia were included in the HKOS. : The baseline BMD at the lumbar spine, femoral neck, trochanter, and total hip were measured using dual-energy x-ray absorptiometry (DXA). The incidence of dementia was identified using their International Classification of Diseases, Ninth Revision, codes. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs. Results: The median follow-up time of the HKOS was 16.8 years. Higher BMD T scores at the lumbar spine, trochanter, and total hip were significantly associated with the reduced risk of dementia with the respective HR of 0.85 (95% CI 0.76-0.95; P = .004), 0.78 (95% CI 0.68-0.90; P < .001), and 0.82 (95% CI 0.72-0.93; P = .003). The subgroup analyses showed that associations were significant in women but not in men, whereas the associations were unaltered after adjusting for serum estradiol. Conclusions and implications: Low BMD was associated with an increased risk of dementia, particularly in women. Future studies evaluating the clinical usefulness of BMD on dementia prediction and management are warranted.