Clinical review: Updates on Menopause

Here is a roundup of the latest research on Menoapuse.

In this article:

Early menopause ups the risk of developing type 2 diabetes

Women who have an early natural menopause have 2.5 times the risk of developing type 2 diabetes as compared to women who have normal menopause reports the results of a large population based study published online July 18, 2017 in Journal Diabetologia.

https://obgynupdated.blogspot.com/2017/07/early-menopause-ups-risk-of-developing.html

Oophorectomy during premenopausal hysterectomy: Evaluating the prevalence

Nearly 1 in 3 women undergo oophorectomy during premenopausal hysterectomy in absence of appropriate indication, reports a study published ahead of print May 8, 2017 in North American Menopausal Society (NAMS) journal Menopause.

https://obgynupdated.blogspot.com/2017/06/oophorectomy-during-premenopausal.html

Loss of estrogen in postmenopausal women puts them at high risk for lumbar disc degeneration.

Declining estrogen levels during perimenopausal and menopausal years is associated with severe lumbar disc degeneration reports a study published online June 12, 2017 in journal Menopause, the journal of The North American Menopause Society (NAMS).

https://obgynupdated.blogspot.com/2017/06/loss-of-estrogen-in-postmenopausal.html

ACP updates guideline for treating Osteoporosis.

According to International Osteoporotic Foundation (IOF), 1 in 3 women over age 50 will experience osteoporotic fractures and nearly 200 million women suffer from osteoporosis worldwide.

https://obgynupdated.blogspot.com/2017/05/acp-updates-guideline-for-treating.html

Polycystic ovarian syndrome increases the risk of subsequent early ovarian aging later in life.

Women with polycystic ovarian syndrome (PCOS) have 8.64-fold increase in risk of developing premature ovarian failure as compared to women who did not have PCOS according to a population based study in forthcoming issue of Journal Menopause. Metformin was found to be effective in reducing such risk.

https://obgynupdated.blogspot.com/2017/05/polycystic-ovarian-syndrome-increases.html

New natural (bioidentical) 17ß-estradiol-progesterone combination available as single soft gel capsules effective in treating postmenopausal symptoms: News from ENDO17

An innovative, investigational combination of 17ß-estradiol and progesterone in a single, oral softgel, was found effective for the treatment of moderate to severe vasomotor symptoms (VMS) due to menopause. The results of the study were presented at the ENDO 2017, the annual meeting of the Endocrine Society in Orlando, Florida, April 1-4.

https://obgynupdated.blogspot.com/2017/04/new-natural-bioidentical-estrogen.html

New class of drug effective in targeting menopausal symptoms: News from Endocrine Conference 2017.

A new class of drug Neurokinin 3 (NK3) receptor antagonists is highly effective and low risk alternative to hormone replacement therapy(HRT) for treatment of menopausal hot flashes according to a study presented at the ENDO 2017, The endocrine society annual meeting from April 1–4, 2017, in Orlando, FL.

https://obgynupdated.blogspot.com/2017/04/new-class-of-drug-effective-in.html

Menarche ≤11 years and Nulliparity is a risk factor for Premature and Early Menopause.

Women who had their first period at or before the age of 11 are at increased risk for premature and early menopause and the risk is further amplified if the woman is nulliparous according to a large observational study published on January 25, 2017 in Oxford Journal of Human Reproduction.

https://obgynupdated.blogspot.com/2017/03/menarche-11-years-and-nulliparity-is.html

Early menopause ups the risk of developing type 2 diabetes

Women who have an early natural menopause have 2.5 times the risk of developing type 2 diabetes as compared to women who have normal menopause reports the results of a large population based study published online July 18, 2017 in Journal Diabetologia.

Taulant Muka, MD, PhD, of Erasmus University Medical Center, Rotterdam, Netherlands, and colleagues write, "In this large population-based study of postmenopausal women free of type 2 diabetes at baseline, we showed that early onset of natural menopause is associated with an increased risk of type 2 diabetes, independent of potential intermediate risk factors for type 2 diabetes (including body mass index [BMI], glucose, and insulin levels) and levels of endogenous sex hormones and SHBG [sex hormone-binding globulin]."

Menopause is a major transition point in women’s life and declining estrogen levels predispose her to increase risk of cardiovascular disease. But, few studies have examined the association between age at menopause and risk of developing type 2 diabetes. Few cross-sectional studies have yielded conflicting results because beside declining hormonal levels, menopausal weight gain, increase in visceral fat and impaired glucose metabolism may also play a part.

This study examined data from Rotterdam study and recruited 3639 women in the final analysis. The Rotterdam Elderly Study is a prospective cohort study in the Ommoord district in the city of Rotterdam, the Netherlands aimed to investigate the risk factors of cardiovascular, neurological, ophthalmological and endocrine diseases in the elderly.

All the women in the current study have attained natural menopause and did not have diabetes at the time of enrollment. The mean age at of woman  was 66.9 (9.6) years, the mean age at natural menopause was 50.0 (4.4) years with median time elapsed since menopause was 15.0 years. The women were stratified into 4 groups according to age at menopause: premature (< 40 years), early (40–44 years), normal (45–55 years), or late (> 55 years).

An analysis of the study cohort showed that 348 women (9.6%) developed type2 diabetes during a median follow up of 9.2 years after adjusting for confounders like age, BMI, glucose and insulin levels, smoking, HRT and genetics. Late menopause is a significant protective factor as compared to premature and early menopause.

Women with late menopause were protected against developing diabetes, and the risk increased as the age at natural menopause decreased. The risk was nearly 4 times higher in women with premature menopause (HR, 3.7)  twice   in women with early menopause (HR, 2.4) and 60% more in women with normal menopause (HR, 1.6; P < 0.001) .

For each 1year delay in onset of menopause, the risk of developing diabetes was lowered by 4% (HR, 0.96).

The authors could not account for the mechanism linking age at natural menopause with development of type 2 diabetes. Earlier data have shown that natural early menopause is a sign of not only reproductive aging but also early somatic aging and all its cardiometabolic consequences. Hence, early menopause can be a good predictor of future general health including type 2 diabetes.

But, the results remained the same after adjusting for the shared genetic factors, so the pathophysiology is unclear and requires more studies in future.

The authors concluded,” The Early onset of natural menopause is an independent marker of type 2 diabetes risk in postmenopausal women. Future studies are needed to examine the mechanisms behind this association and explore whether the timing of natural menopause can add value to diabetes prediction and prevention.”

The full text can be accessed here.

Menarche ≤11 years and Nulliparity is a risk factor for Premature and Early Menopause.

courtesy: youtube.com

Women who had their first period at or before the age of 11 are at increased risk for premature and early menopause and the risk is further amplified if the woman is nulliparous according to a large observational study published on January 25, 2017 in Oxford Journal of Human Reproduction.

It is already known that premature menopause and early menopause are at high risk for CHD, CVD and all-cause mortality. These women can be benefited by pharmacological and life style interventions to prevent the increased all-cause mortality and CVD risk they are put at due to accelerated reproductive aging.[1]

This was a pooled analysis of data of 51,450 postmenopausal women from observational studies that contributed to The International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE) project.[2]

InterLACE) project is a global research collaboration that aims to advance understanding of women's reproductive health in relation to chronic disease risk by pooling individual participant data from several cohort and cross-sectional studies.

Age at menarche was categorized into ≤11, 12, 13, 14 or more years and parity as nulliparous, 1 or 2 children. Premature Menopause is defined as Final Menstrual Period (FMP) before the age of 40 years and Early menopause is when FMP is between 40–44 years.

After multivariate regression analysis, it was seen that:

Median age at menopause was 50 years. About 2% of women had early menopause and nearly 8% women had premature menopause.

Women with first period at ≤11 years of age were 1.39 times the risk early menopause, 1.8 times the risk of premature menopause as compared to women who had first period after ≥12 years of age of age.  

Nulliparous women were at 1.32 times the risk of early menopause 2.26 times the risk of premature menopause.

Women who were nulliparous and had menarche at ≤11 years of age were 2 times the risk for early menopause and 5 times the risk for premature menopause as compared to those who had menarche ≥12 years and had one or more children.

The study supports the finding that women at risk of premature/early menopause can be identified  by history and can be  benefited by pharmacological and lifestyle interventions to prevent the increased all-cause mortality and CVD risk they are put at due to accelerated reproductive aging.

Complex relationship exists between cardiovascular health and accelerated reproductive aging and further research is needed to clarify the issue.

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[1] https://obgynupdated.blogspot.com/2016/09/premature-or-early-onset-menopause-is.html

[2] https://www.ncbi.nlm.nih.gov/pubmed/27621257