Selección de Resúmenes de Menopausia
Semana del 2 al 8 de febrero 2022
María Soledad Vallejo. Clínica Quilín. Universidad de Chile
Korean J Fam Med. 2022 Jan;43(1):69-76. doi: 10.4082/kjfm.21.0110. Epub 2022 Jan 20.
The Association between Treatment with Bisphosphonates and the Risk of Atrial Fibrillation: A Meta-Analysis of Observational Studies
Ji-Hyun Park 1, Hae-Jin Ko 1
Background: Osteoporosis is one of the most common diseases of the skeletal system, particularly occurring in older adults. Bisphosphonates are frequently used to treat osteoporosis and prevent bone fractures. Studies evaluating the association between treatment with bisphosphonate and the risk of atrial fibrillation have reported conflicting results. This meta-analysis of observational studies was performed to assess this association. Methods: Databases were searched to find relevant observational studies, and the identified articles were selected according to the selection criteria. Sensitivity and subgroup analysis based on various confounding factors were performed. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of atrial fibrillation were estimated using a random-effects model. Results: We selected 12 studies, including four case-control and eight cohort studies, for the meta-analysis. Assessment of the estimated effect size yielded an OR of 1.171 (95% CI, 1.011-1.356; P=0.035), with substantial heterogeneity (I2 =84.74%, P<0.001). When the studies were excluded one-after-another, the pooled OR remained unchanged in only six studies. In addition, subgroup analyses found that treatment with bisphosphonates was positively associated with the risk of atrial fibrillation in studies performed in Western countries (OR, 1.263; 95% CI, 1.092-1.462) and lower-quality studies (OR, 1.214; 95% CI, 1.035-1.423). No publication bias was observed. Conclusion: This meta-analysis showed that treatment with bisphosphonates may be associated with an increased risk of atrial fibrillation. Therefore, bisphosphonates should be carefully prescribed to patients at a high risk of atrial fibrillation.
Acta Oncol. 2022 Feb 7;1-9. doi: 10.1080/0284186X.2022.2033316. Online ahead of print.
Association between menopausal hormone therapy use and mortality risk: a Swedish population-based matched cohort study
Johanna Simin 1 2, Habiba Khodir 3 4, Romina Fornes 1, Rulla M Tamimi 5, Nele Brusselaers 1 2
Background: The net effect of menopausal hormone therapy on the risk of death is understudied, and current evidence is conflicting. Our aim was to investigate the association between menopausal hormones and risk of all-cause, cardiovascular, and cancer-specific mortality, based on the Swedish Prescribed Drug Registry and National Patient Registry. Methods: This Swedish population-based matched cohort study included all women, 40 years or older, who had received at least one prescription of systemic menopausal hormone therapy between 2005-2014 (n = 290,186), group level matched 1:3 to non-users (n = 870,165). Multivariable conditional logistic regression models estimated the relative risk of all-cause and cause-specific mortality, adjusting for several clinical factors and comorbidities. Results: Ever-use of menopausal hormones was associated with a slightly lower overall odds of all-cause (OR = 0.97, 95%CI 0.95-0.98) and cardiovascular (OR = 0.97, 95%CI 0.95-0.99) mortality, whilst 30% lower overall odds of cancer-related mortality (OR = 0.70, 95%CI 0.68-0.72) was shown. The odds of all-cause and cancer-related mortality were consistently reduced among women who began menopausal hormone therapy ≤60 years, whereas the association with cardiovascular mortality was inconsistent. In contrast, oestrogen-only therapy was associated with elevated odds of all-cause (OR = 1.14, 95%CI 1.11-1.16) and cardiovascular mortality (OR = 1.04, 95%CI 1.01-1.06) among women who began treatment at ≥70 years. Among current users, oestrogen-only therapy was associated with higher odds of all-cause (OR = 1.48, 95%CI 1.44-1.52) and cardiovascular mortality (OR = 1.24, 95%CI 1.20-1.28), whereas past use of oestrogen-only therapy suggested lower odds of mortality. Conclusions: Our generalisable data suggest that early menopausal hormone treatment initiation does not increase the odds of mortality. However, the role of oestrogens in particularly cardiovascular mortality remains to be investigated.
Maturitas. 2022 Jan 18;S0378-5122(21)00344-3. doi: 10.1016/j.maturitas.2021.12.001. Texto complete FREE,
The essential menopause curriculum for healthcare professionals: A European Menopause and Andropause Society (EMAS) position statement
Margaret Rees 1, Kathy Abernethy 2, Gloria Bachmann 3, Silvia Bretz 4, Iuliana Ceausu 5, Fatih Durmusoglu, et al.
Introduction: The menopause, or the cessation of menstruation, is a stage of the life cycle which will occur in all women. Managing perimenopausal and postmenopausal health is a key issue for all areas of healthcare, not just gynecology. Aim: To provide recommendations for the curriculum of education programs for healthcare professionals 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.
Atherosclerosis. 2022 Jan 22;344:13-19. doi: 10.1016/j.atherosclerosis.2022.01.016. Online ahead of print.
Menopausal hormone therapy and risk of cardiovascular events in women with prediabetes or type 2 diabetes: A pooled analysis of 2917 postmenopausal women
Yilin Yoshida 1, Zhipeng Chen 2, Robin L Baudier 3, Marie Krousel-Wood 4, Amanda H Anderson 3, et al.
Background and aims: The effect of MHT on cardiovascular disease (CVD) risk among women with prediabetes or type 2 diabetes (PreDM or T2DM) is unclear. We examined the association between ever or early use MHT and CVD risk in postmenopausal women with PreDM or T2DM, and the potential modifying effect of race. Methods: 2,917 postmenopausal women with PreDM or T2DM were pooled from 3 prospective CVD cohorts (the Atherosclerosis Risk in Communities, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study). Ever (yes vs no) or early use of MHT (MHT initiated ≤5 vs > 5 years since menopause), and their associations with ischemic stroke, coronary heart disease (CHD), and atherosclerotic cardiovascular disease (ASCVD) were assessed using Cox proportional hazards models. Results: During a median follow-up of 15 years, 264 stroke, 484 CHD, and 659 ASCVD events were observed. In fully adjusted models, ever use of MHT was associated with reduced risk of stroke (hazard ratio 0.86, 95% CI 0.76-0.98), CHD (0.85, 0.74-0.98), and ASCVD (0.83, 0.73-0.95) in white women with PreDM or T2DM. Early use of MHT was associated with reduced risk of stroke (0.82, 0.72-0.95), CHD (0.85, 0.74-0.98), and ASCVD (0.82, 0.70-0.96) in the white group. No risk reduction with ever or early use of MHT was found for black women with PreDM or T2DM. Conclusions: MHT is associated with statistically reduced CVD risk among white but not black women with PreDM or DM. Race is an effect modifier in the association between MHT use and CVD.
Climacteric. 2022 Feb 3;1-10. doi: 10.1080/13697137.2021.2022644. Online ahead of print.
The impact of micronized progesterone on cardiovascular events - a systematic review
L M Kaemmle 1, A Stadler 1, H Janka 2, M von Wolff 3, P Stute 3
Biologically identical menopausal hormone therapy (MHT) including micronized progesterone (MP) has gained much attention. We aimed to assess the impact of MP in combined MHT on venous and arterial thromboembolism (VTE/ATE) (e.g. deep venous thrombosis/pulmonary embolism, myocardial infarction [MI] and ischemic stroke). Articles were eligible if they provided endpoints regarding cardiovascular events and use of exogenous MP. Literature searches were designed and executed for the databases Medline, Embase, CINAHL, the Cochrane Library, ClinicalTrials.gov and interdisciplinary database Web of Science. Twelve studies consisting of randomized controlled trials (RCTs), case-control studies and prospective or retrospective cohort studies were included, and risk of bias was assessed. Only a minority assessed thromboembolic events as a primary endpoint, showing that in contrast to norpregnane derivatives, primary and recurrent VTE risk was not altered by combining estrogens with MP, which was also true for ischemic stroke risk. Similarly, in placebo-controlled RCTs assessing VTE/ATE as adverse events there were no significant intergroup differences. Studies on MI as a primary endpoint are missing. In conclusion, while available data suggest that MP as a component in combined MHT may have a neutral effect on the vascular system, more RCTs investigating the impact of MP alone or in combined MHT on vascular primary endpoints are needed.
Med Mex. 2021;157(5):484-493. doi: 10.24875/GMM.M21000603.
Relationship of vitamin D blood concentration with muscle mass and cognitive function in postmenopausal women
Sebastián Carranza-Lira 1, Melissa López-Chávez 2, Alejandra Díaz-de León-de Luna 2, Sergio Rosales-Ortiz, et al.
Introduction: Low levels of vitamin D have been associated with muscle mass loss and cognitive function alteration. Objective: To find out the relationship of vitamin D blood levels with muscle mass and cognitive function in postmenopausal women. Materials and methods: Ninety-nine postmenopausal women aged ≥ 50 years were studied. Calf circumference, and tricipital, bicipital, subscapular and suprailiac skinfolds were measured. Arm muscle area, bone-free arm muscle area, and muscle mass were calculated. The short physical performance battery (SPPB) was performed, and the sarcopenia rapid diagnostic questionnaire (SARC-F), as well as the Mini Mental State Examination (MMSE) were applied. A blood sample was taken to measure vitamin D blood concentration. For statistical analysis, Mann-Whitney's U-test and Spearman's correlation analysis were used.Resul ts: It was found that, the older the age, the higher the vitamin D levels, as well as higher SARC-F score. Vitamin D levels were negatively correlated with grip strength and SPPB. There was a negative correlation between vitamin D levels and MMSE global score. Conclusions: Vitamin D did not have a positive influence on muscle mass. A better MMSE performance was observed in those with lower vitamin D levels.
Curr Psychiatry Rep. 2022 Feb 1. doi: 10.1007/s11920-022-01322-7. Online ahead of print.
Pharmacotherapy for Sexual Dysfunction in Women
Jeong Hoo Lee 1, Jenny E Lee 1, Veronica Harsh 1, Anita H Clayton 2
Purpose of review: This review article discusses the controversy in the DSM-5 conceptualization and diagnostic criteria for female sexual dysfunction (FSD). An overview of recent studies on available treatments for hypoactive sexual desire disorder (HSDD), female sexual arousal disorder (FSAD), and genitopelvic pain/penetration disorder (GPPD) is provided. Recent findings: Include delineation of the process of care for pre- and postmenopausal women with HSDD; release of global position statement on testosterone therapy in women; updates on efficacy and safety of vaginal estrogen for genitourinary syndrome of menopause and bremelanotide for HSDD; removal of flibanserin alcohol REMS; and development of new technology to enhance bioavailability and brain delivery of treatments. The DSM-5 revision combining HSDD and FSAD into one diagnostic category is a less accurate characterization of these separate disorders and may hinder access to demonstrated effective treatments for the women with these conditions. There are a wide range of pharmacological, other physiological, and psychological treatment options available for women with FSD, which can be offered based on their specific symptoms, potential benefits/risks, and preferences.
Menopause. 2022 Jan 31. doi: 10.1097/GME.0000000000001945. Online ahead of print.
Different regimens of menopausal hormone therapy for improving sleep quality: a systematic review and meta-analysis
Zhuo Pan 1, Shu Wen, Xiaoyong Qiao, Meina Yang, Xiaoyang Shen, Liangzhi Xu
Importance: Long-term sleep disturbances in menopausal women are closely related to cardiovascular disorders, metabolic disorders, and cognitive impairment. At present, hormone therapy (HT) is a standard treatment for menopausal symptoms. However, it remains unclear whether HT can improve sleep quality. Objective: We did a systematic review and meta-analysis to assess the effects of different HT regimens on menopausal sleep quality. Evidence review: We systematically searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, and Web of Science for randomized controlled trials of menopausal HT on sleep disturbances up to June 14, 2021. Information about ongoing and unpublished trials was collected by searching WHOICTRP and ClinicalTrials.gov. Our primary outcome was sleep quality with objective measurements. We estimated the standardized mean difference (SMD) using random-effects models. Findings: We identified a total of 3,059 studies and finally included 15 studies in the meta-analysis. Compared with placebo, HT improved self-reported sleep outcomes (SMD = -0.13; 95% CI, -0.18 to -0.08, P < 0.00001 and I2 = 41%), but not sleep parameters measured by polysomnography. Subgroup analyses according to the regimen of HT showed that 17β-estradiol (17β-E2) (SMD = -0.34; 95% CI, -0.51 to -0.17, P < 0.0001, and I2 = 0%) and conjugated equine estrogens (SMD = -0.10; 95% CI, -0.12 to -0.07, P < 0.00001, and I2 = 0%) improved sleep quality. Moreover, transdermal administration (SMD = -0.35; 95% CI, -0.64 to -0.06, and P = 0.02) was more beneficial than oral (SMD = -0.10; 95% CI, -0.14 to -0.07, and P < 0.00001). In addition, the combination of estrogen and progesterone had a positive effect on sleep disturbance (SMD = -0.10; 95% CI, -0.13 to -0.07, P < 0.00001, and I2 = 0%), while estrogen monotherapy did not. The results showed that estrogen/micronized progesterone (SMD = -0.22; 95% CI, -0.37 to -0.06, P = 0.007, and I2 = 0%) and estrogen/medroxyprogesterone acetate (SMD = -0.10; 95% CI, -0.13 to -0.07, P < 0.00001, and I2 = 0%) could alleviate sleep disturbance. Conclusions and relevance: HT has a beneficial effect on sleep disturbance to some extent, and the formulations and routes of administration of hormonal agents influence the effect size.