Our Menopause World - March 2022

President's Report

Dear Friends and Colleagues,

We have all chosen to work as health professionals and to be members of this society because we care. We care about the wellbeing of others, and we focus our efforts on maximizing their chances for long, healthy lives. This is why I have no doubt that each and every one of us is gravely concerned and cares deeply about the situation in Ukraine. Our chapter in history is proving to be tumultuous but we can continue to stand together as friends and colleagues and care.

It will be a joyful occasion to meet in person at the IMS World Congress in Lisbon. I am very excited about the scientific program, which includes a wide variety of Spanish and Portuguese symposia. We look forward to sharing it with you soon. Please visit the Congress website to keep up to date with the latest news, register and submit your abstracts for the opportunity to present your research at the Congress. The deadline is 21st June for abstract submissions and Greenblatt Award submissions.

Today is the last day to apply for our new medical education program, “The Clinical Colloquium in Midlife Women’s Health”. As you can see from the list of sessions below, we have some excellent topics. My sincerest thanks to the outstanding line up of experts who have agreed to join me in delivering this program, and to Viatris for their support through an unrestricted educational grant. It’s not too late to apply, please click here for more information.

 Bone Health for the Generalist  Professor Steven Goldstein
 Cardiovascular Issues for Midlife Women  Professor Peter Schnatz
 Cognition and Mood   Professor Pauline Maki
 Menopausal Hormone Therapy: Myths and Realities  Professor Susan Davis
 A Mid-life Women’s Health unit: Dos and Don’ts  Professor Wendy Wolfman
 Sexual Function: Essentials in Midlife  Professor Sheryl Kingsberg
 Managing Menopause without Hormones  Professor Nick Panay
 Genitourinary Syndrome of Menopause: Not just vulvovaginal atrophy  Professor Rosella Nappi
 Breast Health Screening/Prevention  Doctor Lisa Larkin
 Ultrasound in Midlife Women: Whether you order or
perform it
 Professor Steven Goldstein

I would also like to note that tomorrow is International Women’s Day. The women’s health mission for International Women’s Day is to assist women to be in a position of power to make informed choices about their health. I’m very proud that the IMS mission and vision is fully aligned with this, and we work every day to promote and support equitable access to best practice healthcare and information that empowers women to make fully informed choices. You can find out more about International Women’s Day here.

I always welcome your comments and suggestions. 

Until next month,
Steve Goldstein

General Update

The 20th webinar in the IMS webinar series “Sexual health issues in menopause” will be held on Tuesday 15th March 15.00 (CET).  The webinar will be moderated by Professor James A. Simon.  Professor Margaret Cruickshank will be presenting on “HPV emergence in menopause” and Dr Nneka Nwokolo will be presenting on “Sexually transmitted diseases in older women”

The link for registrations is Online Events - International Menopause Society (imsociety.org)

The 19th webinar in the IMS webinar series “The early menopausal patient” was held on Tuesday 15th February and was moderated by Professor Peter Schnatz.  The speaker Professor Phillip Sarrel presented on “Risks of hypoestrogenism in patients with early menopause, POI or surgical menopause” and Professor Mary Jane Minkin presented on “Treating the early menopausal women, considering whether the patient has a uterus and route, dose, and duration”.
This is now available at IMS Webinars.

International Society Meetings 2021/22

20th World Congress on Gynecological Endocrinology
Date: 11th - 14th May 2022
Location: Florence, Italy
ISGE is delighted to announce the return to an in-person event for the 20th World Congress on Gynecological Endocrinology. The virtual meeting option will also be available.

31st British Menopause Society Annual Scientific Conference
Date: 30th - 1st July 2022
‘’Menopause Care: maintaining the momentum
Chesford Grange, Kenilworth, Warwickshire, England
The BMS is also calling for Abstracts for the Annual Conference.
Submission deadline: 3 May 2022    
Guidelines and online submission https://www.thebms.org.uk/abstract

18th IMS World Congress on Menopause
Date: 26th – 29th October 2022
Location: Lisbon, Portugal
The IMS is calling for Abstracts for the World Congress in Lisbon 
Submission deadline: 21 June 2022
Guideline and online submission https://imslisbon2022.com/abstracts/

Menopause and mid-life women’s health publication news

Sleep apnoea may lead to increased joint pain in postmenopausal women
New study examines the effect of sleep apnoea on joint pain, fatigue, and other physical issues commonly associated with the menopause transition
New study suggests best chance for battling menopausal weight gain is during perimenopause
Unfavorable body composition and metabolic characteristics found to begin before menopause transition
Obesity may lead to a decline in lung function in premenopausal and postmenopausal women
New study evaluates effect of body mass index and waist circumference on chronic obstructive pulmonary disease and asthma
Age of natural menopause linked with intergenerational violence exposures
New study demonstrates that a woman's own abuse, as well as witnessing the abuse of others, affects reproductive aging
Oestrogen levels linked to risk of COVID-19 death in older women
May be worth exploring hormone therapy to reduce infection severity, say researchers
More than half of postmenopausal women experience female pattern hair loss
New study evaluates prevalence of hair loss during the menopause transition and factors contributing to it, including obesity
UMass Amherst study examines associations between contraceptive methods and early menopause
Researchers looked at a biomarker for ovarian aging
Bilateral Oophorectomy Could Increase a Woman's Risk for Dementia
New study helps to explain why dementia disproportionately affects women
Low testosterone levels in women associated with double the risk of cardiac events
Evaluation of social isolation, loneliness, and cardiovascular disease among older women in the US


By way of a special arrangement with our publishers, Taylor & Francis, Climacteric is able to offer Free Access to recently published papers.
There are two Free Access papers in the February issue; both are available for three months commencing 1st February 2022. There are also three Open Access papers.
The Abstracts from these Free and Open Access papers have been translated into Spanish. The Editor of Climacteric would like to thank Peter Chedraui, one of the Associate Editors, for providing the translations

Hormone therapy for postmenopausal osteoporosis management
X. Jiang, et al.
Free Access

Spanish translation:
Jiang X, Kagan R. Terapia hormonal para el manejo de la osteoporosis postmenopáusica. Climacteric. 2022;25(1):50-55. doi: 10.1080/13697137.2021.1957818.

La terapia hormonal menopáusica (THM) se ha utilizado para la prevención y el tratamiento de la osteoporosis postmenopáusica durante varias décadas. Sin embargo, surgieron inquietudes públicas sobre la seguridad de la MHT después de que estudio de la Iniciativa de Salud de la Mujer publicara el informe inicial en 2002. Realizamos una revisión histórica sobre este tema, centrándonos principalmente en la evidencia de nivel I de ensayos aleatoriso, controlados, revisiones sistemáticas y meta-análisis, y resumimos la evidencia de alta calidad sobre la eficacia y seguridad de la THM en el tratamiento de la osteoporosis postmenopáusica. También se discute cuestiones clínicas sobre el inicio de la THM, la identificación de candidatos a tratamiento y la duración del tratamiento, así como la interrupción de la THM.

Palabras claves: Terapia hormonal; osteoporosis; osteoporosis postmenopáusica.

Osteoanabolic therapy for osteoporosis in women
M. R. McClung, et al.
Free Access

Spanish translation:
McClung MR, Clark AL. Terapia osteoanabólica para la osteoporosis en mujeres. Climacteric. 2022;25(1):60-66. doi: 10.1080/13697137.2021.1953463.

Se requiere terapia para activar la formación ósea para revertir y restaurar la arquitectura ósea dañada encontrada en mujeres con osteoporosis postmenopáusica. Los fármacos osteoanabólicos incluyen teriparatida, que ha estado disponible durante varios años, y abaloparatida y romosozumab, nuevos fármacos osteoanabólicos que han estado disponibles más recientemente. Al estimular la formación ósea, estos medicamentos producen mayores aumentos en la masa ósea y la fuerza ósea, y lo hacen más rápidamente en comparación con los medicamentos anti-remodeladores (también llamados anti-resortivos) de uso común, como los bisfosfonatos. En ensayos comparativos, la teriparatida y el romosozumab reducen el riesgo de fractura de forma más eficaz que los bisfosfonatos orales en mujeres con osteoporosis y alto riesgo de fractura. Los fármacos osteoanabólicos tienen un rol pequeño en la prevención de la pérdida ósea durante la menopausia temprana, pero tienen un lugar importante en el tratamiento de mujeres con un riesgo muy alto de fractura o que siguen teniendo un riesgo alto de fractura después de un curso de terapia con bisfosfonatos. Principalmente debido al alto costo de los medicamentos, en la mayoría de los países, estas terapias son iniciadas por especialistas en lugar de médicos de atención primaria. Esta revisión presentará la evidencia de la eficacia y la seguridad de estos fármacos para que los médicos puedan discernir su uso apropiado al atender a mujeres postmenopáusicas con osteoporosis.

Palabras claves: Osteoanabólicos; abaloparatida; osteoporosis; romosozumab; secuencia; teriparatida.

Osteoporosis and fractures in women: the burden of disease
M. Lorentzon, et al.
Open Access

Spanish translation:
Lorentzon M, Johansson H, Harvey NC, Liu E, Vandenput L, McCloskey EV, Kanis JA. Osteoporosis y fracturas en mujeres: la carga de la enfermedad. Climacteric. 2022;25(1):4-10. doi: 10.1080/13697137.2021.1951206.

La osteoporosis es una enfermedad caracterizada por el deterioro de la microarquitectura ósea y la reducción de la densidad mineral ósea (DMO), lo que da como resultado la fragilidad ósea y un mayor riesgo de fractura. En las sociedades occidentales, una de cada tres mujeres y uno de cada cinco hombres sufrirán una fractura osteoporótica en el resto de su vida a partir de los 50 años. Las fracturas por fragilidad, especialmente de la columna vertebral y la cadera, suelen dar lugar a una mayor morbilidad y mortalidad. En los cinco países europeos más grandes y Suecia, las fracturas por fragilidad fueron la causa de 2.6 millones de años de vida ajustados por discapacidad en 2016 y los costes relacionados con las fracturas aumentaron de €29.6 billones en 2010 a €37.5 billones en 2017. En la Unión Europea y el EEUU, solo a una pequeña proporción de mujeres elegibles para tratamiento farmacológico se les prescribe medicación para la osteoporosis. La prevención secundaria de fracturas, utilizando los servicios de enlace de fracturas, se puede utilizar para aumentar las tasas de evaluación del riesgo de fracturas, las pruebas de DMO y el uso de medicamentos para la osteoporosis a fin de reducir el número de fracturas. Además, se recomiendan estrategias de prevención primaria establecidas, basadas en métodos de detección de casos que utilicen herramientas de predicción de fracturas, como el FRAX, para identificar a las mujeres sin fractura pero con un riesgo elevado, a fin de reducir aún más el número de fracturas.

Palabras claves: Osteoporosis; epidemiologóa; fractura; postmenopausia.

Fracture risk assessment by the FRAX model
E. V. McCloskey, et al.
Open Access

Spanish translation:
McCloskey EV, Harvey NC, Johansson H, Lorentzon M, Liu E, Vandenput L, Leslie WD, Kanis JA. Evaluación del riesgo de fractura mediante el modelo FRAX Climacteric. 2022;25(1):22-28. doi: 10.1080/13697137.2021.1945027.

La introducción de los algoritmos FRAX ha facilitado la evaluación del riesgo de fractura en base a la probabilidad de fractura. El FRAX integra la influencia de varios factores de riesgo de fractura bien validados con o sin el uso de la densidad mineral ósea. Dado que las tasas de fractura y muerte específicas por edad difieren en todo el mundo, los modelos FRAX se calibran con respecto a la epidemiología de la fractura de cadera (preferiblemente de fuentes nacionales) y la mortalidad (generalmente fuentes de las Naciones Unidas). Los modelos están actualmente disponibles para 73 naciones o territorios que cubren más del 80% de la población mundial. El FRAX se ha incorporado a más de 80 guías en todo el mundo, aunque la naturaleza de esta aplicación ha sido heterogénea. Las limitaciones de FRAX han sido ampliamente revisadas. Se han propuesto procedimientos aritméticos para abordar algunas de estas limitaciones, que se pueden aplicar a las estimaciones FRAX convencionales para acomodar el conocimiento de la exposición a la dosis de glucocorticoides, datos concurrentes sobre la densidad mineral ósea de la columna lumbar, información sobre la puntuación del hueso trabecular, longitud del eje de la cadera, historial de caídas, diabetes tipo 2, estado migratorio y el antecedente reciente de una fractura.

Palabras claves: FRAX; factores de riesgo clínicos; probabilidad de fractura; umbrales de intervención; evaluación de riesgos.

A pas de deux of osteoporosis and sarcopenia: osteosarcopenia
F. Laskou, et al.
Open Access

Spanish translation:
Laskou F, Patel HP, Cooper C, Dennison E. Un pas de deux de osteoporosis y sarcopenia: osteosarcopenia. Climacteric. 2022;25(1):88-95. doi: 10.1080/13697137.2021.1951204.

Las condiciones musculoesqueléticas, osteoporosis y sarcopenia, son altamente prevalentes en adultos mayores. La osteoporosis se caracteriza por una masa ósea baja y el deterioro de la microarquitectura del hueso, mientras que la sarcopenia se identifica por la pérdida de fuerza, función y masa muscular. La osteoporosis representa un problema de salud importante que contribuye a millones de fracturas en todo el mundo cada año, mientras que la sarcopenia se asocia con una variedad de resultados físicos y metabólicos adversos. Ambos afectan la función física y social, la confianza y la calidad de vida, además de contribuir a un alto nivel de atención de la salud. Osteosarcopenia es el término dado cuando ambas condiciones ocurren concomitantemente y se ha sugerido que las interacciones entre estas dos condiciones pueden acelerar la progresión de la enfermedad individual ya que la coexistencia de osteoporosis y sarcopenia se asocia con una mayor morbilidad por caídas, fracturas, discapacidad y mortalidad. En esta revisión, describiremos la epidemiología, la patogénesis y las consecuencias clínicas de la osteosarcopenia y discutiremos las estrategias disponible para su manejo.

Palabras claves: Osteoporosis; epidemiología; manejo; osteosarcopenia; mujeres postmenopáusicas; sarcopenia.

Akter N, Kulinskaya E, Steel N, Bakbergenuly I. The effect of hormone replacement therapy on the survival of UK women: a retrospective cohort study 1984-2017. BJOG. 2021 Nov 12. doi: 10.1111/1471-0528.17008.

To estimate the effect of estrogen-only and combined hormone replacement therapy (HRT) on the hazards of overall and age-specific all-cause mortality in healthy women aged 46-65 at first prescription.

  • This was a matched cohort study of 105,199 HRT users (cases) and 224, 643 non-users (controls) matched on age and general practice extracted from the electronic primary care records from The Health Improvement Network (THIN) database, UK (1984-2017).
  • Authors performed Weibull-Double-Cox regression models adjusted for age at first treatment, birth cohort, type 2 diabetes, hypertension and hypertension treatment, coronary heart disease, oophorectomy, hysterectomy, body mass index, smoking and deprivation status. Main outcome measure was all-cause mortality.
Main findings
  • A total of 21 751 women died over an average of 13.5 years follow-up per participant, of whom 6329 were users and 15 422 non-users.
  • The adjusted hazard ratio (HR) of overall all-cause mortality in combined HRT users was 0.91 (95% CI 0.88-0.94), and in estrogen-only users was 0.99 (0.93-1.07), compared with non-users.
  • Age-specific adjusted HRs for participants aged 46-50, 51-55, 56-60 and 61-65 years at first treatment were 0.98 (0.92-1.04), 0.87 (0.82-0.92), 0.88 (0.82-0.93) and 0.92 (0.85-0.98) for combined HRT users compared with non-users, and 1.01 (0.84-1.21), 1.03 (0.89-1.18), 0.98 (0.86-1.12) and 0.93 (0.81-1.07) for estrogen-only users, respectively.
Take-home message
Combined HRT was associated with a 9% lower risk of all-cause mortality and estrogen-only formulation was not associated with any significant changes.


Lee HR, Shin J, Han K, Chang J, Jeong SM, Chon SJ, Choi SJ, Shin DW. Obesity and Risk of Diabetes Mellitus by Menopausal Status: A Nationwide Cohort Study. J Clin Med. 2021;10(21):5189.

Although both obesity and menopause are associated with increased risk of diabetes mellitus (DM), the association between obesity and DM according to menopausal status remains uncertain.

To examine the relationship between obesity and incidence of diabetes mellitus (DM) in premenopausal and postmenopausal women.

  • A total of 926,196 premenopausal and 1,193,881 postmenopausal women who underwent health examinations from 2009 to 2014 were identified using the database of the Korean National Health Insurance Service.
  • Authors compared the incidence and risk of DM according to body mass index (BMI) and waist circumference (WC) in the two groups of women.
  • Cox proportional hazards analyses were performed to evaluate the association between the presence of obesity and risk of DM according to menopausal state.
Main findings
  • During the 7.8-year follow-up period, 37,736 (4.1%) premenopausal women and 121,102 (10.1%) postmenopausal women were diagnosed with DM.
  • Compared to the reference group (BMI 18.5-23), a stronger association between obesity and risk of DM was observed in both pre- and postmenopausal women: multivariable-adjusted hazard ratios and 95% confidence intervals for BMI subgroups <18.5, 23-25, 25-30, and >30 were 0.62 (0.54, 0.70), 1.91 (1.85, 1.97), 3.38 (3.28, 3.47), and 6.25 (6.02, 6.48), respectively (p trend < 0.001) in premenopausal women and 0.87 (0.82, 0.92), 1.44 (1.41, 1.46), 2.00 (1.97, 2.03), and 2.96 (2.89, 3.02) in postmenopausal women (p trend < 0.001, p-interaction < 0.001).
  • A similar trend was observed for WC. Subgroup analyses of women aged 45 to 55 also showed a stronger association with DM in premenopausal than in postmenopausal women.
Take-home messages
  • The association between obesity and DM was stronger in premenopausal women than in postmenopausal women.
  • As estrogens are synthesized in adipose tissue by aromatization of androgens after menopause, increased estrogen levels in obese postmenopausal might have a protective effect against DM.

Salas R, Tijerina A, Cardona M, Bouzas C, Ramirez E, Martínez G, Garza A, Pastor R, Tur JA. Association between Bone Mineral Density and Metabolic Syndrome among Reproductive, Menopausal Transition, and Postmenopausal Women. J Clin Med. 2021;10(21):4819.

The menopausal transition stage brings physiological changes associated with the development of metabolic syndrome (MetS), which can affect bone mineral density (BMD), and may be more evident in the postmenopausal stage.

To assess the association between low BMD and MetS and its components among reproductive/menopausal transition and postmenopausal women in the northeast region of Mexico.

  • This was a descriptive cross-sectional study carried out (2015-2016) in 40-60-year-old women (n = 376) who were residents in the metropolitan area of Monterrey, in Nuevo Leon State, Mexico.
  • Anthropometric measurements, blood pressure, a dual-energy X-ray absorptiometry (DXA) evaluation of BMD of two anatomical sites (lumbar spine and dual femur), and a biochemical analysis were obtained.
Main findings
  • The prevalence of MetS was 57.2%.
  • In participants without MetS, the prevalence of osteopenia was 27.3% in the lumbar spine and 18.6% in the dual femur, while in participants with MetS, the prevalence of osteopenia was 35.8% in the lumbar spine and 14.4% in the dual femur.
  • Osteoporosis in participants without MetS was present in 6.8% in the lumbar spine and in 1.8% in the dual femur, while in women with MetS, its prevalence was 4.7% in the lumbar spine and 0.5% in the dual femur.
  • An association between low BMD at the lumbar spine and dual femur and components of MetS diseases was identified in Mexican women as follows: waist circumference ≥ 88 cm showed an increase risk for low BMD at femoral site in both reproductive/menopausal transition (OR 7.638; 95% CI: 1.607-36.298; p = 0.011) and postmenopausal women (OR 2.600; 95% CI: 1.023-6.609; p = 0.045); HDL < 50 mg/dL was associated with low BMD in both the femur (OR 3.639; 95% CI: 1.039-12.743; p = 0.043) and lumbar spine (OR 2.654; 95% CI: 1.092-6.447; p = 0.031); hypertension in postmenopausal women increased the risk for low BMD in the femur (OR 2.634; 95% CI: 1.150-6.035; p = 0.022).
Take-home messages
  • The components of the MetS were associated with low BMD, thus indicating that MetS increases the risk for developing osteopenia or osteoporosis.
  • Furthermore, age was found to be an independent risk factor for low BMD.

Rocca WA, Lohse CM, Smith CY, Fields JA, Machulda MM, Mielke MM. Association of Premenopausal Bilateral Oophorectomy With Cognitive Performance and Risk of Mild Cognitive Impairment. JAMA Netw Open. 2021;4(11):e2131448.

The associations of bilateral oophorectomy among premenopausal women, age at oophorectomy, and use of estrogen therapy after oophorectomy with cognitive performance later in life remain controversial.

To investigate whether women who underwent premenopausal bilateral oophorectomy were at increased risk of mild cognitive impairment (MCI) and experienced decreased global or domain-specific cognitive performance.

  • This was a case-control study and cross-sectional study made possible by combining data from the Mayo Clinic Study of Aging (MCSA) and the Rochester Epidemiology Project (REP) medical record-linkage system.
  • The studies were conducted among a population-based sample in Olmsted County, Minnesota, consisting of 2,732 women aged 50 to 89 years who participated in the MCSA study from 2004 to 2019 and underwent a clinical evaluation and comprehensive cognitive testing.
  • Data were analyzed from January to May 2021.
  • Exposures were medical record documentation of bilateral oophorectomy abstracted from a medical record-linkage system (ie, REP) and main outcomes and measures: Odds of MCI and global or domain-specific z scores on cognitive tests were measured at the first MCSA visit. The median (IQR) lag time between bilateral oophorectomy performed before menopause and before age 50 years and cognitive evaluation was 30 (22-38) years.
Main findings
  • Among 2,732 women aged 50 to 89 years (median [IQR] age at evaluation, 74 [66-81] years) who participated in the MCSA, the case-control study included 283 women with MCI (10.4%) and 2449 women without cognitive impairment (89.6%).
  • Bilateral oophorectomy before menopause and before age 46 years was associated with clinically diagnosed MCI (adjusted odds ratio [aOR], 2.21; 95% CI, 1.41-3.45; P < .001) compared with no bilateral oophorectomy.
  • The presence of an association with MCI varied by surgical indication, with an association among 259 women with bilateral oophorectomy before menopause and before age 50 years for the indication of benign ovarian condition (aOR, 2.43; 95% CI, 1.36-4.33; P = .003) but not for cancer or no ovarian condition.
  • The presence of an association did not vary by estrogen therapy after bilateral oophorectomy, with associations among women aged less than 46 years with estrogen therapy (aOR, 2.56; 95% CI, 1.24-5.31; P = .01) and without estrogen therapy (aOR, 2.05; 95% CI, 1.18-3.52; P = .01). The cross-sectional study included 625 women with a history of bilateral oophorectomy (median [IQR] age, 75 [70-82] years) and 2107 women without a history of bilateral oophorectomy (median [IQR] age, 73 [65-80] years).
  • Premenopausal bilateral oophorectomy was performed before age 46 years among 161 women and was associated with decreased global cognition z score (β, -0.17; 95% CI, -0.32 to -0.03; P = .02), attention and executive domain z score (β, -0.21; 95% CI, -0.36 to -0.05; P = .009), and Short Test of Mental Status score (β, -0.51; 95% CI, -0.95 to -0.08; P = .02) compared with no bilateral oophorectomy.
Take-home message
Women who underwent bilateral oophorectomy before menopause had increased odds of MCI and poorer performance on cognitive tests approximately 30 years later compared with women who did not undergo bilateral oophorectomy.


Khandkar C, Vaidya K, Karimi Galougahi K, Patel S. Low bone mineral density and coronary artery disease: A systematic review and meta-analysis. Int J Cardiol Heart Vasc. 2021 Oct 23;37:100891. doi: 10.1016/j.ijcha.2021.100891.

  • Coronary artery disease (CAD) and osteoporosis both cause significant morbidity and mortality.
  • Recent interest in inflammation and the bone-vascular axis suggests a mechanistic link between the two conditions.
To examine the potential association between low bone mineral density (BMD) and CAD in adults.

  • This was a review and meta-analysis.
  • Two authors searched for studies that examined the association between low BMD and CAD.
  • Risk of bias assessment was conducted using the modified Newcastle Ottawa score.
  • Ten studies were selected from the 2258 unique records identified.
Main findings
  • Pooled analysis showed a significant association between low BMD and CAD (OR 1.65, 95%CI 1.37-2.39, p < 0.01).
  • Subgroup analysis investigating males and females separately was not significant.
  • The subgroup analyses looking for any differences across geographic locations and differences between coronary imaging modalities were also negative.
  • Studies with adjusted ORs (n = 4) were also pooled (OR 3.01, 95%CI 0.91-9.99, p = 0.07).
Take-home messages
  • Low BMD is associated with CAD; however, it is unclear whether this result is confounded by common risk factors given the heterogeneity between study populations and methodologies.
  • Further large-scale epidemiological studies are required.

Sharma A, Ogunmoroti O, Fashanu OE, Zhao D, Ouyang P, Budoff MJ, Thomas IC, Michos ED. Associations of endogenous sex hormone levels with the prevalence and progression of valvular and thoracic aortic calcification in the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis. 2022;341:71-79.

  • Sex hormones (SH) may contribute to sex differences in cardiovascular disease (CVD).
  • High free testosterone (T) and low sex hormone binding globulin (SHBG) have been associated with progression of coronary artery calcification in women.
To examine the association of SH with extra-coronary calcification (ECC) prevalence and progression among MESA participants.

  • Authors studied 2,737 postmenopausal women and 3,130 men free of clinical CVD with baseline SH levels.
  • ECC measurements [ascending and descending thoracic aortic calcification (ATAC, DTAC), mitral annular calcification (MAC), aortic valve calcification (AVC)] were obtained by computed tomography at baseline and after 2.4 ± 0.9 years.
  • Investigators used multivariable Poisson regression to evaluate associations with ECC prevalence and incidence (Agatston scores >0) and linear mixed effects models for ECC progression, per 1-SD increment in log(SH) in women and men separately.
Main findings
  • The mean age was 65 ± 9 and 62 ± 10 years for women and men, respectively.
  • In women, greater free T and lower SHBG were associated with MAC incidence in a demographic-adjusted model only.
  • In men, lower free T was associated with MAC prevalence, DTAC incidence and progression, while greater SHBG was associated with MAC prevalence and DTAC progression after further adjusting for CVD risk factors.
Take-home messages
  • In this diverse cohort free of CVD, authors found some associations of SH with ECC measures.
  • In particular, free T was inversely associated with prevalent MAC and DTAC progression in men independent of CVD risk factors.
  • SH may influence vascular calcification, but further work is needed to understand clinical implications of these findings.

Tanmahasamut P, Rattanachaiyanont M, Techatraisak K, Indhavivadhana S, Wongwananuruk T, Chantrapanichkul P. Menopausal hormonal therapy in surgically menopausal women with underlying endometriosis. Climacteric. 2021 Nov 16:1-7. doi: 10.1080/13697137.2021.1998434.

To investigate the relationship between menopausal hormone therapy (MHT) and endometriosis recurrence in women who underwent hysterectomy with bilateral salpingo-oophorectomy to treat endometriosis.

  • This was a retrospective cohort study that included 330 women who underwent definitive surgery to treat endometriosis during 1996-2012.
  • Follow-up data until December 2018 were analyzed.
  • Patients were grouped as MHT non-users (non-MHT, n = 43), estrogen-only therapy (ET, n = 230), estrogen-progestogen therapy (EPT, n = 39) and tibolone (n = 18).
Main findings
  • The mean age at surgery was 41.5 ± 5.3 years.
  • The overall median follow-up duration was 6.0 years (interquartile range [IQR]: 3.0-10.4), and the median duration of MHT use was 66.0 months (IQR: 36.0-116.3).
  • The overall recurrence rate was 3.0% (95% confidence interval: 1.5-5.5) and there was no significant difference in recurrence among the study groups.
  • Disease recurrence resolved after MHT discontinuation, or change in MHT type and/or dose.
Take-home messages
  • No significant association between MHT use and endometriosis recurrence was found in this study.
  • The endometriosis recurrence rate was non-significantly different between ET and EPT.
  • Recurrent endometriosis can be successfully treated without invasive measures.
  • No study patients had malignant transformation after a median follow-up of 6 years.
  • Findings suggest that any of the three evaluated MHT regimens can be used in surgically menopausal Thai women with underlying endometriosis.

Pourhassan M, Buehring B, Stervbo U, Rahmann S, Mölder F, Rütten S, Trampisch U, Babel N, Westhoff TH, Wirth R. Osteosarcopenia, an Asymmetrical Overlap of Two Connected Syndromes: Data from the OsteoSys Study. Nutrients. 2021;13(11):3786.

Osteoporosis and sarcopenia are two chronic conditions, which widely affect older people and share common risk factors.

To investigate the prevalence of low bone mineral density (BMD) and sarcopenia, including the overlap of both conditions (osteosarcopenia).

  • This was a prospective observational multicenter study that included 572 older hospitalized patients (mean age 75.1 ± 10.8 years, 78% women) with known or suspected osteoporosis.
  • Sarcopenia was assessed according to the revised definition of the European Working Group on Sarcopenia in Older People (EWGSOP2).
  • Low BMD was defined according to the World Health Organization (WHO) recommendations as a T-score < -1.0 and osteosarcopenia was diagnosed when both low BMD and sarcopenia were present.
Main findings
  • Low BMD was prevalent in 76% and the prevalence of sarcopenia was 9%, with 90% of the sarcopenic patients showing the overlap of osteosarcopenia (8% of the entire population).
  • Conversely, only few patients with low BMD demonstrated sarcopenia (11%).
  • Osteosarcopenic patients were older and frailer and had lower BMI, fat, and muscle mass, handgrip strength, and T-score compared to non-osteosarcopenic patients.
  • Osteosarcopenia is extremely common in sarcopenic subjects.
  • Considering the increased risk of falls in patients with sarcopenia, they should always be evaluated for osteoporosis.

Dziedzic EA, Smyk W, Sowińska I, Dąbrowski M, Jankowski P. Serum Level of Vitamin D Is Associated with Severity of Coronary Atherosclerosis in Postmenopausal Women. Biology (Basel). 2021;10(11):1139.

Postmenopausal women experience rapid progression of coronary artery disease. Vitamin D deficiency appears to be a modifiable risk factor for cardiovascular diseases.

To analyze the impact of 25-hydroxyvitamin D3 (25(OH)D) level on the severity of coronary atherosclerosis and its potential cardioprotective effect in postmenopausal women.

  • The was a prospective study that recruited 351 women in postmenopausal age undergoing coronary angiography.
  • The severity of coronary atherosclerosis was assessed using the Coronary Artery Surgery Study Score (CASSS). A level of 25(OH)D was measured with electrochemiluminescence.
Main findings
  • Women with more severe coronary atherosclerosis have significantly lower 25(OH)D serum level (p = 0.0001).
  • Vitamin D (β = -0.02; p = 0.016), hypertension (β = 0.44; p = 0.025), age (β = 0.02; p = 0.003), and history of MI (β = 0.63; p < 0.0001), were shown as CASSS determinants.
  • Age, hyperlipidemia, and history of MI were found to determine the level of vitamin D (all p < 0.05).
  • Women with a three-vessel disease hospitalized due to ACS, with a history of MI, hyperlipidemia and hypertension presented the lowest vitamin D level.
Take-home message
Lower serum 25(OH)D in postmenopausal women is associated with more significant stenosis in the coronary arteries; therefore, low vitamin D levels can be considered as a potential risk factor for coronary artery disease.


Wang L, Zhu L, Yao Y, Ren Y, Zhang H. Role of hormone replacement therapy in relieving oral dryness symptoms in postmenopausal women: a case control study. BMC Oral Health. 2021;21(1):615.

To evaluate the efficacy of hormone replacement therapy in relieving oral symptoms in postmenopausal women presenting with genitourinary symptoms along with oral dryness.

  • This was a case-control study conducted after selecting 60 postmenopausal women.
  • Oral dryness status of all the patients was evaluated with the help of questionnaire related to oral dryness.
  • These subjects were divided into case group and control group on the basis of response to questionnaire of oral dryness.
  • Unstimulated saliva samples were obtained and analyzed for estimation of salivary estradiol levels by enzyme linked immune sorbent assay technique.
  • After analyzing the result of salivary estradiol levels, case group was subjected to hormone replacement therapy (HRT).
  • The patients were followed up for their response towards oral dryness as well as salivary estradiol levels after the therapy.
Main findings
  • The mean salivary estradiol level before HRT was significantly more among control group as compared to case group (p value < 0.001).
  • Most of the patients complained of dry mouth (26 out of 30); reduced amount of saliva in the mouth (25 out of 30); dry mouth at night (28 out of 30); dry mouth during the day (25 out of 30) before HRT.
  • These complains were significantly reduced after the therapy.
  • The mean salivary estradiol in the case group levels increased significantly after HRT (p value < 0.001).
Take-home messages
  • The salivary estradiol levels were reduced in postmenopausal women with the complain of xerostomia as compared to those without the complain of xerostomia.
  • Further these levels can be recovered with the help of hormone replacement therapy.