Severe menopausal symptoms linked to cognitive impairment: an exploratory study.

OBJECTIVE: To evaluate the association between menopausal symptoms and cognitive decline in postmenopausal women. METHODS: This was a subanalysis of a cross-sectional, observational study conducted among women attending gynecological consultations across nine Latin American countries. The survey involved late postmenopausal women who were asked to complete a general questionnaire and the Menopause Rating Scale (MRS) to assess menopausal symptoms, with the Montreal Cognitive Assessment used to evaluate cognitive function as an outcome. A Montreal Cognitive Assessment score of less than 21 was used to define women with mild cognitive impairment (MCI). RESULTS: The study included 1,287 postmenopausal women with a mean age of 55.5 years and a mean body mass index of 26.3 kg/m2. On average, participants had 13.8 years of education and 2.3 ± 1.8 children, with 72.8% reporting having a partner. Additionally, 36.7% ever used menopausal hormone therapy. Regarding lifestyle factors, 50.3% engaged in a sedentary lifestyle, whereas 70.5% had never smoked. 15.3% of women had MCI exhibited significantly more intense menopausal symptoms compared with those without MCI (MRS total score 15.24 ± 12.58 vs 10.53 ± 8.84, respectively, P < 0.001). Logistic regression analysis revealed a significant association between severe menopausal symptoms (MRS total score ≥14 points) and MCI (odds ratio [OR], 1.74; 95% CI, 1.25-2.42). Conversely, a lower body mass index (OR, 0.96; 95% CI, 0.95-0.98), sexual activity (OR, 0.70; 95% CI, 0.51-0.96), physical exercise (OR, 0.55; 95% CI, 0.39-0.76), menopausal hormone therapy use (OR, 0.36; 95% CI, 0.24-0.55), and higher educational level (OR, 0.31; 95% CI, 0.21-0.46) were associated with lower odds for MCI. CONCLUSION: Severe menopausal symptoms in postmenopausal women were associated with cognitive impairment. This study highlights the intricate interplay between hormonal, lifestyle, and sociodemographic factors and cognitive health.

Relationship Between Lipoprotein(a) Levels and Cardiovascular Outcomes in Postmenopausal Women: A Systematic Review.

Elevated lipoprotein(a) [Lp(a)] levels are independently associated with atherosclerotic cardiovascular disease, although this association is less explored in postmenopausal women. The main objective of this systematic review was to analyze the association between elevated Lp(a) levels and cardiovascular outcomes in posmenopausal women. Studies that evaluated this association were searched in the current literature. Ten studies including 157.690 women were considered eligible for this study. In total, 4 prospective cohorts, 3 cross-sectional studies, 2 nested case-control studies, and one post-hoc analysis from a randomized clinical trial were analyzed. The included studies showed different results regarding the association between Lp(a) levels and cardiovascular outcomes: a positive association (4 studies), no association (2 studies), or different results depending on the subgroups or outcomes evaluated (4 studies). The results were robust when evaluating coronary events. The reduction in coronary events attributed to a hormone replacement therapy-associated decrease in Lp(a) levels was controversial.

Metformin use is associated with a lower risk of osteoporosis in adult women independent of type 2 diabetes mellitus and obesity. REDLINC IX study.

Metformin may decrease cell senescence, including bone; hence we aimed at evaluating the association between metformin use and osteoporosis. This was a cross-sectional study carried out in 1259 Latin American adult women aged 40 or more who were not on anti-osteoporotic drugs, were on metformin and had a bone densitometry performed. Of the whole sample, 40.3% reported being on metformin (at least 1 year), 30.2% had type 2 diabetes mellitus and 22.6% had osteoporosis. Median (interquartile range) body mass index (BMI) for the whole cohort was 27.7 (4.6) kg/m2 and 30.2% had type 2 diabetes mellitus. Current use of hormone therapy, calcium, and vitamin D corresponded respectively to 10.7%, 47.7%, and 43.1% of all surveyed women. A logistic regression model was used to analyze the association of osteoporosis with various covariates incorporated into the model such as age (OR: 1.07, 95% CI: 1.05-1.09), BMI (OR: 0.92, 95% CI: 0.89-0.96) and metformin use (OR: 0.44, 95% CI: 0.32-0.59). Metformin use, regardless of the presence of type 2 diabetes or obesity, was associated with a lower risk of osteoporosis in adult women. We propose that one explanation for this observation could be the effect of the drug over cellular senescence.

Rol de la ultrabaja dosis en la terapia hormonal de reemplazo en el climaterio / Ultra low dose in hormone replacement therapy in menopause

La disminución progresiva de los estrógenos circulanes que se produce desde la transición a la menopausia determina la aparición de una variedad de síntomas prevalentes, como son los sofocos y la atrofia urogenital. Cerca del 75 al 80 % de las mujeres experimenta algún síntoma relacionado con la menopausia, lo cual produce en muchos casos un impacto negativo sobre su calidad de vida. Se calcula que a partir del año 2030, aproximadamente, 47 millones de mujeres entrarán en menopausia cada año. Los estrógenos, ya sea solos o con la asociación de progestágenos, han sido durante décadas la terapia hormonal de elección para el alivio de los síntomas menopáusicos, así como también para la prevención y el tratamiento de la osteoporosis. Sin embargo, el resultado de dos estudios randomizados doble ciego, sobre terapia hormonal de reemplazo, el Women´s Health Initiative Study (WHI) y el Heart and Estrogen/Progestin Replacement Study (HERS) han modificado la percepción de los riesgos y beneficios de su utilización y, en consecuencia el hábito prescriptivo de la comunidad médica. Como consecuencia de ello, el uso racional de la terapia hormonal (TH) ha sido analizado por diferentes sociedades científicas internacionales que han recomendado su utilización en mujeres en posmenopausia temprana, principalmente para el alivio los síntomas vasomotores urogenitales. A pesar de los resultados poco satisfactorios de los trabajos que evaluaron los riesgos y beneficios de la TH a largo plazo en mujeres posmenopáusicas, no se han encontrado alternatias terapéuticas que sean tan eficaces como el tratamieto estrogénico. Además, las dosis estándar utilizadas tradicionalmente en TH se han asociado con mayor incidencia de efectos adversos, tales como troboembolismo, accidente cerebrovascular, y con mayo riesgo de cáncer de mama en traamientos muy prolongados. Sin embargo, dichos riesgos parecerían ser dosis-dependientes...