Menopause Current Awareness Bulletin - April 2022 - Royal United Hospitals Bath

Menopause
Current Awareness Bulletin
April 2022
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Women's Health Strategy: Consultation Outcome.
Department of Health and Social Care (DHSC); 2022.
https://www.gov.uk/government/consultations/womens-health-strategy-call-for-evidence
[We have published the full analysis of this call for evidence in 2 separate reports. The first
analytical report (December 2021) summarises feedback from nearly 100,000 individuals
who responded to the ‘Women’s Health – Let’s talk about it’ survey component of the
consultation. The second report (April 2022) summarises feedback from 436 individuals and
organisations with expertise in women’s health. Both reports should be read together for a
complete picture of the evidence.]

1. Female astronauts: Impact of space radiation on menopause.
Author(s): Rose
Source: European Journal of Obstetrics & Gynecology & Reproductive Biology; Apr 2022;
vol. 271 ; p. 210-213
Publication Date: Apr 2022
Publication Type(s): Academic Journal
PubMedID: NLM35228092
Abstract: Space travel has different effects on the reproductive capacity of women compared
to men. The radiation exposure intrinsic to deep space travel causes destruction of some of
a woman's primordial follicles. Data suggests that a typical Mars mission may reduce a
women's ovarian reserve by about 50%. This has consequences to a woman's reproductive
capacity and, more significantly, decreases the time interval to her menopause. A reduced
time interval to menopause is associated with earlier mortality. Estrogen replacement
therapy and cryopreservation of a female astronaut's oocytes may be used to address these
issues. However, cortical tissue freezing provides advantages to more directly compensate
for these workplace complications. Cortical tissue freezing especially provides advantages if
there are plans to reproduce in an extraterrestrial location.
Database: CINAHL
2. Women's experiences in the transition to menopause: a qualitative research.
Author(s): Refaei ; Mardanpour, Soraya; Masoumi, Seyedeh Zahra; Parsa, Parisa
Source: BMC Women's Health; Feb 2022; vol. 22 (no. 1); p. 1-8
Publication Date: Feb 2022
Publication Type(s): Academic Journal
PubMedID: NLM35219295
Available at BMC Women's Health - from BioMed Central
Abstract: Background: Around the time of transition to menopausal period, women
experience mental, and psychological disorders that require adequate attention to these
symptoms. This study aimed to explore the experiences of women in the face of
premenopausal symptoms. Methods: This qualitative study was conducted using a content
analysis method in Javanrood, Iran, in 2020. The data were collected through in-depth semi-
structured face to face interviews with 16 premenopausal using interview guide in a private
room in comprehensive health centers. The women inclusion criteria were approaching
menopause, having irregular menstruation, and having no disease or medication that affects
menstruation. Furthermore, the exclusion criteria were the absence of menstruation for more
than 12 months, and the women's refusal to continue the interview. The participants were
selected using purposive sampling and sampling continued until data saturation. The
collected data were analyzed with MAXQDA10 software following the multi-step method
proposed by Graneheim and Lundman. Results: The participants' mean age was
47 ± 2.98 years. The data analysis revealed 5 categories including: "menopause and aging",
"life transformation", confrontation of fear and hope", "life adjustment", and "need to facilitate
the transition time". Conclusion: This study suggested the women's experience of the
transition to menopause was characterized by the fear of the future and its consequences
and the need for reassurance about it. Besides, the women sought solutions to their
problems in health care providers, peers, and the family.
Database: CINAHL

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3. Quality of sleep in women with menopause and its related factors

Item Type: Journal Article

Authors: Ahmady, Fatemeh;Niknami, Maryam and Khalesi, Zahra Bostani

Publication Date: 2022

Journal: Sleep Science (Sao Paulo, Brazil) 15, pp. 209-214

Abstract: Background: Menopausal period is one of the most critical stages of a womans life.
Complications of the menopausal period including sleep disorders can affect the physical
and mental state of women. As sleep disorder has a determinant role in the quality of life,
this study was conducted to evaluate postmenopausal womens quality of sleep and its
related factors., Material and Methods: This cross-sectional-analytical study was conducted
on 323 postmenopausal women based on convenience and consecutive sampling. The
data-gathering tool consisted of two parts; sociodemographic characteristics and the
Pittsburgh Sleep Quality Index (PSQI). Data analysis was performed using descriptive and
inferential statistical tests at a significance level of p

hormonal status. Bearing in mind that synergistic/additive effects between HT and
mechanical stimulation can only be expected in situations of hormonal insufficiency, further
clinical studies should consider baseline endogenous estrogen production but also HT
dosing more carefully.Copyright © The Author(s) 2022. Published by Oxford University
Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-
mail: journals.permissions@oup.com.

5. Impact of Qigong exercises on the severity of the menopausal symptoms and
health-related quality of life: A randomised controlled trial

Item Type: Journal Article

Authors: Carcelen-Fraile, M. D. C.;Hita-Contreras, F.;Martinez-Amat, A.;Loureiro, V.
B.;Loureiro, N. E. M. D.;Jimenez-Garcia, J. D.;Fabrega-Cuadros, R. and Aibar-Almazan, A.

Publication Date: 2022

Journal: European Journal of Sport Science
Abstract: The aim of the present study was to analyze the effects of a Qigong exercise
programme on the severity of the menopausal symptoms and health-related quality of life
(HRQoL) of community-dwelling postmenopausal women. This was done by means of a
randomised clinical trial with a sample of 125 women who were assigned to either a control
(n = 62) or an experimental group (n = 63). The severity of their menopause-related
symptoms and HRQoL were assessed through the Menopause Rating Scale (MRS) and the
36-item Short-Form Health Survey (SF-36) respectively, before and after the intervention
period. The main findings of our study reveal significant improvement in the severity of
menopausal symptoms at the somatic, psychological, and urogenital levels, as well as in the
total score of the MRS. Additionally, participants assigned to the Qigong group experienced
improvement in the general health, physical functioning, role-physical, bodily pain, vitality,
and mental health domains of the 36-item Short-Form Health Survey, as well as in its
physical component and mental component summaries. We can therefore conclude that,
among Spanish postmenopausal women, a twelve-week Qigong exercise programme has
beneficial effects on the severity of menopausal symptoms and HRQoL. Highlights: We have
studied the effects of Qigong on menopause-related quality of life. Qigong is a useful tool in
the management of the severity of menopausal symptoms. A 12-week Qigong programme
showed benefits on health-related quality of life. Trial registration: ClinicalTrials.gov identifier:
NCT03989453.
Copyright © 2022 European College of Sport Science.

6. Effects of Pilates Exercise on Bone Mineral Density in Postmenopausal Women: A
Systematic Review and Meta-analysis

Item Type: Journal Article

Authors: de Oliveira, R. G.;Anami, G. E. U.;Coelho, E. A. and de Oliveira, L. C.

Publication Date: 2022

Journal: Journal of Geriatric Physical Therapy (2001) 45(2), pp. 107-114

Abstract: BACKGROUND AND PURPOSE: Despite the popularity of Pilates exercises
among postmenopausal women, few studies have devoted attention to verifying the effects
of the technique on bone mineral density (BMD), and, to date, no systematic review and
meta-analysis have been conducted on this topic. Our objective was to conduct a systematic
review and meta-analysis of randomized controlled trials examining the effect of Pilates on

BMD. METHOD(S): Randomized controlled trials were considered eligible, with follow-up of
6 months and more, which verified the effects of Pilates exercise on the BMD of
postmenopausal women. The calculations of the meta-analysis were performed through the
weighted mean difference between the Pilates exercise and control groups, through the
absolute change between pre- and postintervention in the areal bone mineral density.
RESULT(S): Three randomized controlled trials met the inclusion criteria and were included
in the meta-analysis. Only 1 study presented satisfactory methodological quality. Pilates
exercises did not offer significant effects to improve areal bone mineral density of the lumbar
spine (0.019 g/cm2 95% confidence interval (CI), -0.018 to 0.057], P = .32), total hip (0.012
g/cm2 95% CI, -0.002 to 0.027], P = .10), or femoral neck (0.000 g/cm2 95% CI, -0.021 to
0.022], P = .97). CONCLUSION(S): Pilates exercises had no significant effects on BMD in
postmenopausal women. However, the few studies included in the meta-analysis and the
low methodological quality of the majority of the studies do not allow safe extrapolation of the
results at this time. More robust randomized controlled trials with high methodological quality
are needed so that the results of this meta-analysis can be confirmed. Copyright © 2021
APTA Geriatrics, An Academy of the American Physical Therapy Association.

7. Cardiometabolic risk factors, physical activity, and postmenopausal breast cancer
mortality: results from the Women's Health Initiative

Item Type: Journal Article

Authors: Dieli-Conwright, Christina;Nelson, Rebecca A.;Simon, Michael S.;Irwin, Melinda
L.;Neuhouser, Marian L.;Reding, Kerryn W.;Crane, Tracy E.;Manson, JoAnn E.;Nassir,
Rami;Shadyab, Aladdin H.;LaMonte, Michael;Qi, Lihing;Thomson, Cynthia A.;Kroenke,
Candyce H.;Pan, Kathy;Chlebowski, Rowan T. and Mortimer, Joanne

Publication Date: 2022b

Journal: BMC Women's Health 22(1), pp. 1-7

Abstract: Background: Higher physical activity levels are associated with lower breast
cancer-specific mortality. In addition, the metabolic syndrome is associated with higher
breast cancer-specific mortality. Whether the physical activity association with breast cancer
mortality is modified by number of metabolic syndrome components (cardiometabolic risk
factors) in postmenopausal women with early-stage breast cancer remains unknown.
Methods: Cardiovascular risk factors included high waist circumference, hypertension, high
cholesterol, and diabetes. Breast cancers were verified by medical record review. Mortality
finding were enhanced by serial National Death Index queries. Cox proportional hazards
regression models were used to estimate associations between baseline physical activity
and subsequent breast cancer-specific and overall mortality following breast cancer
diagnosis in Women's Health Initiative participants. These associations were examined after
stratifying by cardiometabolic risk factor group. Results: Among 161,308 Women's Health
Initiative (WHI) participants, 8543 breast cancers occurred after 9.5 years (median) follow-up
in women, additionally with information on cardiometabolic risk factors and physical activity
at entry. In multi-variable analyses, as measured from cancer diagnosis, higher physical
activity levels were associated with lower all-cause mortality risk (hazard ratio HR] 0.86, 95%
confidence interval CI] 0.78-0.95, trend P < 0.001) but not with breast cancer-specific
mortality (HR 0.85, 95% CI 0.70 to 1.04, trend P = 0.09). The physical activity and all-cause
mortality association was not significantly modified by cardiometabolic risk factor number.
Conclusions: Among women with early-stage breast cancer, although higher antecedent
physical activity was associated with lower risk of all-cause mortality, the association did not
differ by cardiometabolic risk factor number.

8. Menopause care in women living with HIV in the UK - A review

Item Type: Journal Article

Authors: Dragovic, B.;Rymer, J. and Nwokolo, N.

Publication Date: 2022

Journal: Journal of Virus Eradication 8(1), pp. 100064

Abstract: Advances in HIV care over the last 30 years have transformed a virtually fatal
condition into a chronic, manageable one. Antiretroviral therapy (ART) has dramatically
changed the outlook for people living with HIV so that most individuals with well controlled
disease have a normal life expectancy. As result of this increase in life expectancy, one-third
of women living with HIV are of menopausal age. Adding to the shift in age distribution, rates
of new HIV diagnosis are increasing in the over 50-year age group, likely the result of a
combination of low condom use and perception of transmission risk and in women, an
increased risk of HIV acquisition due to the mucosal disruption that accompanies vaginal
atrophy. Many women living with HIV are unprepared for menopause, have a high
prevalence of somatic, urogenital and psychological symptomatology and low rates of
menopausal hormone therapy (MHT) use. Many women experience enormous frustration
shuttling between their general practitioner and HIV care provider trying to have their needs
met, as few HIV physicians have training in menopause medicine and primary care
physicians are wary of managing women living with HIV, in part, because of fears about
potential drug-drug interactions (DDIs) between MHT and ART. Several data gaps exist with
regard to the relationship between HIV and the menopause, including whether the risk of
HIV transmission is increased in virally-suppressed women with vaginal atrophy, whether or
not menopause amplifies the effects of HIV on cardiovascular, psychological and bone
health, as well as the safety and efficacy of MHT in women living with HIV. Menopausal
women living with HIV deserve high quality individualised menopause care that is tailored to
their needs. More research is needed in the field of HIV and menopause, primarily on
cardiovascular disease and bone health outcomes as well as symptom control, and
strategies to reduce HIV acquisition, encourage testing, and maintain older women in care in
order to inform optimal clinical management. Copyright © 2022 The Authors.

9. The relation of number of childbirths with age at natural menopause: a population
study of 310 147 women in Norway

Item Type: Journal Article

Authors: Gottschalk, Marthe S.;Eskild, Anne;Hofvind, Solveig and Bjelland, Elisabeth K.

Publication Date: 2022

Journal: Human Reproduction 37(2), pp. 333-340

Abstract: Study Question: Does age at natural menopause increase with increasing of
number of childbirths? Summary Answer: Age at menopause increased with increasing
number of childbirths up to three childbirths; however, we found no further increase in age at
menopause beyond three childbirths. What Is Known Already: Pregnancies interrupt
ovulation, and a high number of pregnancies have therefore been assumed to delay
menopause. Previous studies have had insufficient statistical power to study women with a
high number of childbirths. Thus, the shape of the association of number of childbirths with
age at menopause remains unknown. Study Design, Size, Duration: A retrospective
population study of 310 147 women in Norway who were 50-69 years old at data collection.

Participants/materials, Setting, Methods: The data were obtained by two self-administered
questionnaires completed by women attending BreastScreen Norway, a population-based
screening program for breast cancer. The associations of number of childbirths with age at
menopause were estimated as hazard ratios by applying Cox proportional hazard models,
adjusting for the woman's year of birth, cigarette smoking, educational level, country of birth,
oral contraceptive use and body mass index. Main Results and the Role Of Chance: Women
with three childbirths had the highest mean age at menopause (51.36 years; 95% CI: 51.33-
51.40 years), and women with no childbirths had the lowest (50.55 years; 95% CI: 50.48-
50.62 years). Thus, women with no childbirths had higher hazard ratio of reaching
menopause compared to women with three childbirths (reference group) (adjusted hazard
ratio, 1.24; 95% CI: 1.22-1.27). Beyond three childbirths, we estimated no further increase in
age at menopause. These findings were confirmed in sub-analyses among (i) women who
had never used hormonal intrauterine device and/or systemic menopausal hormonal
therapy; (ii) women who were born before 1950 and (iii) women who were born in 1950 or
after. Limitations, Reasons For Caution: Information about age at menopause was based on
self-reports. Wider Implications Of the Findings: If pregnancies truly delay menopause, one
would expect that women with the highest number of childbirths had the highest age at
menopause. Our results question the assumption that interrupted ovulation during
pregnancy delays menopause. Study Funding/competing Interest(s): This work was
supported by the South-Eastern Norway Regional Health Authority 2016112 to M.S.G.] and
by the Norwegian Cancer Society 6863294-2015 to E.K.B.]. The authors declare no conflicts
of interest. Trial Registration Number: N/A.

10. Metabolic effects of menopause: a cross-sectional characterization of body
composition and exercise metabolism

Item Type: Journal Article

Authors: Gould, Lacey M.;Gordon, Amanda N.;Cabre, Hannah E. M. S., R.D.N.;Hoyle,
Andrew T.;Ryan, Eric D.;Hackney, Anthony C. D. Sc;Smith-Ryan, Abbie;Cabre, Hannah E.
and Hackney, Anthony C.

Publication Date: 2022

Journal: Menopause (10723714) 29(4), pp. 377-389

Abstract: Objectives: To evaluate body composition, fat distribution, and metabolism at rest
and during exercise in premenopausal, perimenopausal, and postmenopausal
women.Methods: This cross-sectional study in 72 women ages 35 to 60 years evaluated
body composition via a fourcompartment model, fat distribution using dual-energy x-ray
absorptiometry-derived android to gynoid ratio, metabolic measures via indirect calorimetry,
and lifestyle factors using surveys. One-way analyses of variance and one-way analyses of
covariance covaried for age and hormone levels (estrogen and progesterone) were used to
compare groups.Results: Body fat percent was significantly lower in premenopausal than
perimenopausal women (mean difference ± standard error: - 10.29 ± 2.73%, P = 0.026)
despite similarities in fat mass and fat-free mass between groups (P≥0.217). Android to
gynoid ratio was significantly lower in premenopausal than perimenopausal women (MD ±
SE: -0.16 ± 0.05 a.u., P = 0.031). Resting energy expenditure was similar between groups
(P = 0.999). Fat oxidation during moderate intensity cycle ergometer exercise was
significantly greater in premenopausal than postmenopausal women (MD ± SE: 0.09 ± 0.03
g/min, P = 0.045). The change in respiratory exchange ratio between rest and moderate
intensity exercise was significantly lower in premenopausal women than peri- (MD ± SE: -
0.05 ± 0.03 a.u., P = 0.035) and postmenopausal women (MD ± SE: -0.06 ± 0.03 a.u., P =
0.040). Premenopausal women reported significantly fewer menopause symptoms than peri-
(MD ± SE: -6.58 ± 1.52 symptoms, P = 0.002) and postmenopausal participants (MD ± SE: -

4.63 ± 1.52 symptoms, P = 0.044), while similarities between groups were observed for
lifestyle factors including diet and physical activity (P>0.999).Conclusions: Perimenopause
may be the most opportune window for lifestyle intervention, as this group experienced the
onset of unfavorable body composition and metabolic characteristics.Video
Summary: http://links.lww.com/MENO/A932.

11. Dietary factors and onset of natural menopause: A systematic review and meta-
analysis

Item Type: Journal Article

Authors: Grisotto, Giorgia;Farago, Julian S.;Taneri, Petek E.;Wehrli, Faina;Roa-Díaz, Zayne
M.;Minder, Beatrice;Glisic, Marija;Gonzalez-Jaramillo, Valentina;Voortman, Trudy;Marques-
Vidal, Pedro;Franco, Oscar H. and Muka, Taulant

Publication Date: 2022

Journal: Maturitas 159, pp. 15-32

Abstract: Background: Diet has been suggested to play a role in determining the age at
natural menopause; however, the evidence is inconsistent.Objective: We systematically
reviewed and evaluated published research about associations between diet and onset of
natural menopause (ONM).Methods: We searched 6 databases (Medline, Embase,
Cochrane, PubMed, Web of Science and Google Scholar) through January 21,2021 to
identify prospective studies assessing the association between diet and ONM. Two
independent reviewers extracted data using a predesigned data-collection form. Pooled
hazard risks (HRs) were calculated using random effect models.Results: Of the 6,137
eligible references we reviewed, we included 15 articles in our final analysis. Those 15
articles included 91,554 women out of 298,413 who experienced natural menopause during
follow-up. Overall, there were 89 food groups investigated, 38 macronutrients and
micronutrients, and 6 dietary patterns. Among the food groups, higher intake of green and
yellow vegetables was associated with earlier age of ONM, while high intakes of some dairy
products, such as low-fat, skimmed milk, and low intake of alcohol were associated with a
later onset. We observed no consistent association between macronutrient and micronutrient
intake and ONM. Our results suggests that a vegetarian diet could be associated with early
ONM; we did not observe any other consistent effect from other dietary patterns. Limitations
included the number of studies, lack of replication studies and the research being of an
observational nature; most studies (11/15) were at medium risk of bias.Conclusion: Although
some food items were associated with ONM, the overall evidence about associations
between diet and ONM remains controversial. Prospero id: CRD42021232087.

12. The effects of estrogen and hormone replacement therapy on platelet activity: a
review

Item Type: Journal Article

Authors: Hashemzadeh, Mehrnoosh;Haseefa, Fathima;Peyton, Lee;Park, Shery and
Movahed, Mohammed Reza

Publication Date: 2022

Journal: American Journal of Blood Research 12(1), pp. 33-42

Abstract: Many studies have shown that an increase in cardiovascular disease in women is
related to hormonal changes occurring particularly after menopause with increasing age.

While the results of large clinical trials reporting no benefit of hormone replacement therapy
(HRT) in cardiovascular disease have been known for some time, there is an increasing
body of knowledge regarding the various mechanisms by which estrogen modulates platelet
function that could in part explain the higher cardiovascular risk occurring in postmenopausal
women and potential benefits of HRT on cardiovascular health. Our review summarizes our
current knowledge regarding the effect of endogenous and exogenous estrogen on platelet
activity, which can help researchers design future studies. We collected information from 21
peer-reviewed articles published from 1993 to 2021. Studies have indicated that
postmenopausal women have higher platelet activity than premenopausal women, which
can increase the risk of thrombo-embolic events and cardiovascular disease. Although some
studies have reported pro-thrombotic effects of estrogen replacement therapy such as
increased platelet activation and adhesion, other studies demonstrated decreased platelet
aggregation by inhibiting GP IIb/IIIa receptor expression. This is mediated by estrogen
receptors on the platelet membrane in a non-genomic manner and suggests an opportunity
for the usage of estrogen replacement therapy with subtle changes in the formulation and
route, particularly if started early after menopause. The effect of estrogen on platelet activity
is promising as an important factor in reducing the risk of cardiovascular events, warranting
further investigation. AJBR Copyright © 2022.

13. Hormone therapy for postmenopausal osteoporosis management

Item Type: Journal Article

Authors: Jiang, X. and Kagan, R.

Publication Date: 2022

Journal: Climacteric 25(1), pp. 50-55

Abstract: Menopausal hormone therapy (MHT) has been used for prevention and treatment
of postmenopausal osteoporosis for several decades. However, public concerns were raised
over the safety of MHT after the initial report was published in 2002 by the Women's Health
Initiative. We conducted a historical review on this subject, primarily focusing on level I
evidence from randomized controlled trials, systematic reviews and meta-analyses, and
summarized high-quality evidence on the efficacy and safety of MHT in management of
postmenopausal osteoporosis. Clinical issues were also discussed on MHT initiation,
identification of treatment candidates and treatment duration, as well as discontinuation of
MHT.Copyright © 2021 International Menopause Society.

14. Influence of Menopausal Hormone Therapy on the Breast: Counseling Your
Patients Before You Prescribe

Item Type: Journal Article

Authors: Lester, Sara P. and Vegunta, Suneela

Publication Date: 2022

Journal: Journal of Women's Health (15409996) 31(2), pp. 167-170

Abstract: Menopausal hormone therapy (HT) aims to improve a woman's quality of life by
treating bothersome menopausal symptoms associated with low estrogen levels. Although
HT is prescribed to millions of women worldwide, its breast-related adverse effects have
always been a concern. Some of the common adverse effects of HT are breast fullness,
increased breast density, and increased breast cancer (BC) risk. Health care professionals

need to be aware of the influence of HT on breast tissue to provide appropriate counseling
as part of informed decision making. Our review summarizes the influence of HT on breast
symptoms, breast density, mammograms, and BC risk.

15. Association of possible sarcopenic obesity with osteoporosis and fragility
fractures in postmenopausal women

Item Type: Journal Article

Authors: Lin, Y. -H and Teng, M. M. H.

Publication Date: 2022

Journal: Archives of Osteoporosis 17(1), pp. 65

Abstract: Summary: Possible sarcopenic obese women had a decreased likelihood of
osteoporosis but an increased likelihood of fragility fractures compared with non-sarcopenic
non-obese and sarcopenia-only women. Furthermore, possible sarcopenic obese women
had lower values of trabecular bone score than non-sarcopenic non-obese and sarcopenia-
only women. Purpose(s): The coexistence of possible sarcopenia and obesity may have
opposing effects on osteoporosis. This study aimed to investigate whether possible
sarcopenic obesity is associated with osteoporosis or fragility fracture. Method(s): In this
cross-sectional study of 1007 postmenopausal women from Taiwan, bone mineral density of
the spine and hips was evaluated using dual-energy X-ray absorptiometry (DXA), and bone
microarchitecture was evaluated using the trabecular bone score (TBS) derived from a
lumbar spine image acquired by DXA. According to the definition of sarcopenia by the 2019
Asian Working Group for Sarcopenia, possible sarcopenia was defined by either low muscle
strength or reduced physical performance. Obesity was defined as a body mass index of >=
27 kg/m2. Based on the presence of possible sarcopenia and obesity, study participants
were classified as follows: control (non-sarcopenic non-obese), sarcopenic (non-obese),
obese (non-sarcopenic), and sarcopenic obese. Prevalent fragility fractures were determined
by retrospectively reviewing medical records. Result(s): In this study, 10.1% of participants
were classified as sarcopenic obese, 9.1% as obese, 35.2% as sarcopenic, and 45.6% as
control. Relative to the control group, the sarcopenic obese group (OR, 0.28; 95% CI 0.18,
0.46) and obese group (OR, 0.38; 95% CI 0.23, 0.61) had a decreased likelihood of
osteoporosis. However, the sarcopenic obese group (OR, 2.29; 95% CI 1.31, 4.00) and
obese group (OR, 1.94; 95% CI 1.04, 3.62) had an increased likelihood of fragility fractures
than with the control group. In addition, the sarcopenic obese group had a higher likelihood
of fragility fractures than the sarcopenic group. Possible sarcopenic obese women also had
significantly lower TBS values than those in the control and sarcopenic groups.
Conclusion(s): Possible sarcopenic obese women had a lower likelihood of osteoporosis but
a higher likelihood of fragility fractures than non-sarcopenic non-obese and sarcopenia-only
women. Furthermore, possible sarcopenic obese individuals had lower values of TBS than
non-sarcopenic non-obese and sarcopenia-only women.Copyright © 2022, International
Osteoporosis Foundation and National Osteoporosis Foundation.

16. Safety and efficacy of compounded bioidentical hormone therapy (cBHT) in
perimenopausal and postmenopausal women: A systematic review and meta-analysis
of randomized controlled trials

Item Type: Journal Article

Authors: Liu, Y.;Yuan, Y.;Day, A. J.;Zhang, W.;John, P.;Ng, D. J. and Banov, D.

Publication Date: 2022a

Journal: Menopause 29(4), pp. 465-482

Abstract: Importance: More information is needed about the efficacy and safety of
compounded bioidentical hormone therapy (cBHT) in the published literature. A thorough
synthesis of existing data is not currently available. Objective(s): To provide a systematic
review and meta-analysis of the existing evidence related to the safety and efficacy of
commonly prescribed cBHT preparations in perimenopausal and postmenopausal women.
Evidence Review: PubMed, ClinicalTrials.gov, and The Cochrane Central Register of
Controlled Trials were searched. Randomized controlled trials (RCTs) comparing cBHT with
a placebo or FDA-approved products in perimenopausal or postmenopausal women were
eligible. The risk of bias was assessed by the Cochrane risk of bias tool. The primary safety
outcome was changes in lipid profile and glucose metabolism, and the primary efficacy
outcome was the change of vaginal atrophy symptoms. The secondary outcomes included
the change of endometrial thickness, risk of adverse events, vasomotor symptoms, change
of serum hormone levels, and change of bone mineral density. Finding(s): A total of 29
RCTs reported in 40 articles containing 1,808 perimenopausal and postmenopausal women
were included. Two risk factors of cardiovascular disease, lipid profile, and glucose
metabolism, were evaluated with cBHT. The results showed that compounded androgen
was not associated with change of lipid profile or glucose metabolism. There was no change
in endometrial thickness or serious adverse events. There were more androgenic side
effects with compounded dehydroepiandrosterone compared with placebo as expected.
Other safety measures including clinical cardiovascular events, endometrial biopsy, and risk
of breast cancer were not studied. cBHT in the form of compounded vaginal androgen was
found to significantly improve vaginal atrophy symptoms (SMD -0.66 95% CI, -1.28 to -0.04];
I2= 86.70%). This finding was supported by the association between compounded vaginal
androgen and improved female sexual function scores. The changes of serum hormone
levels were also evaluated. Despite the variations in absorption from different types of
compounded hormones, routes, and strengths, the trends were consistent with published
data from FDA-approved products. Conclusions and Relevance: This review found that
cBHT used in primarily short-term RCTs is not associated with adverse changes in lipid
profile or glucose metabolism. cBHT in the form of vaginal androgens appears beneficial for
vaginal atrophy symptoms. There are insufficient RCTs of cBHT to assess clinical risk of
breast cancer, endometrial cancer, or cardiovascular disease. Long-term studies with clinical
endpoints are needed.Copyright © 2022 Lippincott Williams and Wilkins. All rights reserved.

17. Characteristics of COVID-19 in peri-and postmenopausal women. Role of hormone
replacement therapy

Item Type: Journal Article

Authors: Marchenkova, L. A. and Makarova, E. V.

Publication Date: 2022

Journal: Voprosy Ginekologii, Akusherstva i Perinatologii 21(1), pp. 85-90

Abstract: A literature review on the effect of peri-and postmenopausal period on the course
of novel coronavirus infection and post-COVID-19 syndrome was performed. The aspects of
hormone replacement therapy against the background of therapy for COVID-19 and post-
COVID-19 syndrome were studied. The postmenopausal period in women was found to be a
risk factor for a more severe course of COVID-19. Estradiol may act as a protective factor for
women with COVID-19 by regulating cellular and humoral immunity factors such as
interleukin-2,-6,-8, tumor necrosis factor-alpha and C3. Prolonged course of COVID-19,
persistence of its symptoms and development of severe post-COVID-19 syndrome are

associated with female sex, with women in peri-and postmenopausal period being most
vulnerable. Symptoms of estrogen deficiency and menopause may be similar to the
manifestations of post-COVID-19 syndrome, and these conditions can coexist and aggravate
each other. According to international experts, the use of hormone replacement therapy will
help to improve the well-being of women, their quality of life, and relieve the symptoms
typical of menopause and post-COVID-19 syndrome. Copyright © 2022, Dynasty Publishing
House. All rights reserved.

18. Body composition and cardiometabolic health across the menopause transition

Item Type: Journal Article

Authors: Marlatt, Kara L.;Pitynski-Miller, Dori;Gavin, Kathleen M.;Moreau, Kerrie
L.;Melanson, Edward L.;Santoro, Nanette and Kohrt, Wendy M.

Publication Date: 2022

Journal: Obesity (Silver Spring, Md.) 30(1), pp. 14-27

Abstract: Every year, 2 million women reach menopause in the United States, and they may
spend 40% or more of their life in a postmenopausal state. In the years immediately
preceding menopause-known as the menopause transition (or perimenopause)-changes in
hormones and body composition increase a woman's overall cardiometabolic risk. In this
narrative review, we summarize the changes in weight, body composition, and body fat
distribution, as well as the changes in energy intake, energy expenditure, and other
cardiometabolic risk factors (lipid profile, glucose metabolism, sleep health, and vascular
function), that occur during the menopause transition. We also discuss the benefits of
lifestyle interventions in women in the earlier stages of menopause before these detrimental
changes occur. Finally, we discuss how to include perimenopausal women in research
studies so that women across the life-span are adequately represented. Copyright © 2021
The Obesity Society.

19. Resilience and sexual health among menopausal women: a cross-sectional study

Item Type: Journal Article

Authors: Oliva, Agustin;Serrano-Garcia, Irene;Asenjo, Juan E.;Cedeira, Elisa;Gil-Prados,
Ines;Herraiz, Miguel A.;Coronado, Pluvio J.;Serrano-García, Irene and Gil-Prados, In

Publication Date: 2022

Journal: Menopause (10723714) 29(4), pp. 408-414

Abstract: Objectives: Resilience can be defined as the capacity to overcome stressful
situations, such as menopausal transition. Female sexual dysfunction is a problem that
prevents women from experiencing satisfaction from sexual activity. In this study, we
assessed resilience, sexual function, and quality of life among a sample of mid-aged
Spanish menopausal women. Methods: This cross-sectional study was performed in 101
symptomatic menopausal women. Participants filled out the 14-item Wagnild and Young
Resilience Scale, the 19-item Female Sexual Function Index (FSFI), the 16-item Cervantes-
SF form, and a sociodemographic questionnaire. Results: Resilience scores were
significantly higher among women with high sexual function scores (FSFI > 26), with a 14-
item Wagnild and Young Resilience Scale total valuation of 86 80-94] versus 74 66-79.50]
(P

high resilience one (P2.5 kg; >2.5 cm), stable (+/-2.5 kg; +/-2.5 cm), and gain
(2.5-4.9 kg, >=5 kg; 2.5-4.9 cm, >=5 cm). WC gain of 5 cm or more during menopausal
transition was associated with an increased risk of breast cancer with an HR of 1.15 (95% CI
= 1.01-1.30), compared to stable WC (+/-2.5 cm). Among obese premenopausal women,
increased WC >=5 cm during menopausal transition was associated with increased breast
cancer risk with an HR of 1.22 (95% CI = 1.03-1.44). Similarly, in women with
premenopausal WC >=80 cm, increased WC of >=5 cm during menopausal transition was
likely to increase the breast cancer risk (HR = 1.36, 95% CI = 1.13-1.88) than in women with
stable WC. However, in premenopausal women with BMI

worldwide, so that all can receive high quality training on menopause.Materials and
Methods: Literature review and consensus of expert opinion.Summary Recommendations:
Training programs for healthcare professionals worldwide should include menopause and
postmenopausal health in their curriculum. It should include assessment, diagnosis and
evidence-based management strategies.

22. Effect of menopausal symptom treatment options on palpitations: a systematic
review

Item Type: Journal Article

Authors: Sheng, Y.;Carpenter, J. S.;Elomba, C. D.;Alwine, J. S.;Yue, M.;Chen, C. X. and
Tisdale, J. E.

Publication Date: 2022a

Journal: Climacteric : The Journal of the International Menopause Society 25(2), pp. 128-140

Abstract: This systematic review provides an overview of the effects of menopausal
symptom treatment options on palpitations, defined as feelings of missed or exaggerated
heart beats, reported by perimenopausal and postmenopausal women. Guided by the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines,
searches were conducted in PubMed, CINAHL and PsycINFO to identify articles meeting
pre-specified inclusion criteria. Of 670 unique articles identified, 37 were included in the
review. Treatments included drug therapies and non-drug therapies. Palpitations were
studied as an outcome in 89% of articles and as an adverse effect in 11%. Articles provided
mostly level II/III evidence due to their design and/or small sample sizes. Based on available
evidence, no therapies can be fully recommended for clinical practice. Only some hormonal
agents (e.g. estradiol) can be recommended with caution based on some positive evidence
for reducing palpitation prevalence or severity. However, other drug therapies (e.g.
moxonidine, atenolol), dietary supplementary treatments (e.g. isoflavones, Rheum
rhaponticum, sage), cognitive-behavioral intervention and auricular acupressure cannot be
recommended given the existing evidence. Additional well-designed randomized controlled
treatment trials focusing on palpitations during the menopause transition as an inclusion
criteria and outcome are needed to advance the field.

23. Transdermal estrogen therapy in menopausal women at increased risk for
thrombotic events: A scoping review

Item Type: Journal Article

Authors: Sobel, T. H. and Shen, W.

Publication Date: 2022a

Journal: Menopause 29(4), pp. 483-490

Abstract: Importance and Objective: It is estimated that over 45% of women in the United
States are menopausal. Many of these women suffer from vasomotor symptoms of
menopause, for which the gold standard treatment is menopause hormone therapy (MHT).
However, MHT use has been controversial since the Women's Health Initiative (WHI) study
in 2001. Transdermal MHT has been shown to be effective for treatment of vasomotor
symptoms and does not increase the risk of venous thromboembolism (VTE) when used in
healthy postmenopausal women. However, there is little data on its safety in women at
increased risk for VTE such as women with prior VTE, increased body mass index,

thrombophilia, tobacco use, autoimmune disease, chronic inflammatory disorders, recent
surgery, trauma, or immobilization. This scoping review of the literature provides clinicians
with an overview of the evidence on the risk profile of transdermal MHT use in these
postmenopausal women at increased risk of VTE. Method(s): We searched all published
studies from 2000 to 2020 and included 13 primary articles on transdermal MHT use in
postmenopausal women at increased risk of VTE. Discussion and Conclusion(s): In women
with prior VTE, two studies found a decrease in coagulability and no increased risk of
recurrent VTE with transdermal MHT use. In women with increased body mass index, three
studies found no increased VTE risk in transdermal MHT users. In women with
prothrombotic genetic polymorphisms, three studies found minimal to no increased VTE risk
in transdermal MHT users. In women with various proinflammatory comorbidities, five
studies found an improved thrombotic profile and no increased VTE risk with transdermal
MHT use. This scoping review provides data regarding the safety of transdermal MHT use in
postmenopausal women with risk factors for VTE, and clinicians should have risk versus
benefit discussions with each patient regarding its use. Copyright © 2022 Lippincott Williams
and Wilkins. All rights reserved.

Choice of the month from the Newson Health website:
Healthy eating for the menopause
https://www.newsonhealth.co.uk/uploads/2021/08/Healthy-Eating-for-the-menopause-P2.pdf

In the News:

Women’s health experts call for mandatory menopause training for GP nurses
Nursing in Practice (13 Apr 2022)
Practice nurses and GPs should receive standardised menopause training, focusing on the
root causes of symptoms and how they overlap with other conditions, it has been suggested.
The mandatory menopause training proposal is part of a summary of written responses from
436 organisations and experts, collected between March and June 2021 and published by
the DHSC today ahead of the Women’s Health Strategy for England due later this year.
https://www.nursinginpractice.com/latest-news/womens-health-experts-call-for-mandatory-
menopause-training-for-gp-nurses/

UK National Osteoporosis Guideline Group launch new UK Guideline for ‘The Prevention
and Treatment of Osteoporosis’
8 April 2022
The UK National Osteoporosis Guideline Group (NOGG) has just launched its new UK
Guideline for ‘The Prevention and Treatment of Osteoporosis’, which has been endorsed by
NICE. This clinical guideline reviews the assessment and diagnosis of osteoporosis, the
therapeutic interventions available and the approaches for the prevention of fragility
fractures, in postmenopausal women, and in [...]
https://thebms.org.uk/2022/04/uk-national-osteoporosis-guideline-group-launch-new-uk-
guideline-for-the-prevention-and-treatment-of-osteoporosis/

I'm anxious about menopause - Nicola Sturgeon
Scotland's first minister has revealed that she is anxious about how going through
menopause will affect her.
Nicola Sturgeon said she was in the "foothills" of menopause but felt nervous to speak out
about the "intensely personal" experience.
Speaking to ITV's Loose Women programme, Ms Sturgeon said she hoped addressing the
issue would help tackle the stigma around the subject.
https://www.bbc.co.uk/news/uk-scotland-scotland-politics-61160624

Sources Used:
The following databases are used in the creation of this bulletin: CINAHL, Medline, EMBASE
& KnowledgeShare, British Menopause Society, BBC website, SWIMs catalogue

Disclaimer
The results of your literature search are based on the request that you made, and consist of
a list of references, some with abstracts. Royal United Hospital Bath Healthcare Library will
endeavour to use the best, most appropriate and most recent sources available to it, but
accepts no liability for the information retrieved, which is subject to the content and accuracy
of databases, and the limitations of the search process. The library assumes no liability for
the interpretation or application of these results, which are not intended to provide advice or
recommendations on patient care.