MDNG Primary CareDecember 2010
Volume 12
Issue 12

//Medical Websites

Unraveling the Complexities of Menopause Management

Though this CME activity is expired, the educational material, of which there is a good amount, remains relevant and fresh. The eight presentations are: Critical Issue of Disentangling Menopause From Aging; Applying an Understanding of the Mechanisms of Action of Estrogen and SERMs to Patient and Treatment Selection in Clinical Practice; Putting the WHI into Clinical Perspective; Are All SERMs the Same?; Selecting Candidates for Fracture Prevention Based on Risk Prediction; Efficacy and Safety Profiles of New and Emerging Menopause Treatments; Future Treatment Strategies for Menopausal Symptom Management; Starting and Stopping Hormone Therapy.

International Menopause Society Educational Slide Kit

Though the impetus behind the IMS Educational Slide Kit was the IMS Workshop in Budapest during February of 2007, only eight of 13 sections are currently available for download. All focus on various aspects of caring for women with menopause and were put together with the


Menopause Math

Did you know that menopause could be considered an extremely rare reproductive disorder? Out of the entire animal kingdom, humans and two species of whale are the only ones that share the experience of going through menopause. Science Online News Editor David Grimm discusses why, in addition to whether parasites can lower your IQ and astrobiologists’ hopes of finding extraterrestrial life.

Menopause Real Lives: Marian Child

Created by Kathryn Colas after having survived her own “hormonal anarchy,” Simply Hormones seeks to help guide women through “the pit-falls that can be experienced during ‘the change.” She’s lately been adding podcasts, the fifth in the series being an interview with a woman name Marian Child who discusses the experience of going through menopause at the early age of 43.

//Online CME

Management of Osteoporosis in Postmenopausal Women

Credits: 2.00

Fee: None

Expiration Date: January 15, 2011

Multimedia: None

The North American Menopause Society has designated their 2010 position statement on the management of osteoporosis in postmenopausal women a CME activity that they intend will educate physicians on “the effect of menopause and aging on bone health…risk factors that contribute to fracture risk…how to rule out secondary causes of osteoporosis…nonpharmacologic and lifestyle approaches to prevent bone loss and fractures…the effects of various therapeutic agents on preventing osteoporotic fracture [and] their effects on bone density and turnover…developing treatment strategies to reduce morbidity and quality of life…and understanding the clinical effects of discontinuing different antiresporptive and anabolic therapies.”

Midlife Menopause Mangement: Assessing Risks and Benefits, Individualizing Strategies

Credits: 2.50

Fee: None

Expiration Date: May 3, 2011

Multimedia: None

This activity comprises four articles, each of which focus on “assessing benefits and risks of hormone therapy…highlights from the latest WHI publications and the latest North American Menopause Society position statement on use of menopausal hormone therapy…nonhormonal approaches to menopausal management…[and] putting the latest data into practice.”


Determinants of Short-term Memory: Is there a Difference between Young Adults and Postmenopausal Women?

Journal: Minerva Medica (October 2010)

Authors: Di Blasio A, Di Donato F, D’Angelo E, et al

Purpose: Researchers were attempting to identify “the main determinants of the short-term memory among anthropometric, dietary and performance variables in a sample of healthy women.” They also examined whether age plays a role. “Participants were analyzed for Digit Span, blood pressure, body composition, aerobic fitness and dietary habits.”

Results: Of the 45 “healthy overweight women” recruited for the study, “22 were postmenopausal.” The authors found that “in postmenopause, vitamin D daily intake is important not only for skeletal, but also for cognitive health,” though overall the “young adults and post-menopausal women did not differ for health status.”

The Impact of Menopause on Vocal Quality

Journal: Menopause (October 27, 2010)

Authors: D’haeseleer E, Depypere H, Claeys S, et al

Purpose: Researchers wanted to “describe the effect of menopause on vocal characteristics” and did so “by comparing premenopausal and postmenopausal women (not taking hormone therapy [HT]).”

Results: Despite “significant differences in aerodynamic parameters…vocal range…and acoustic parameters” between the two groups, the authors concluded that “postmenopausal women not taking HT had a good overall vocal quality. However, in comparison with premenopausal women, they showed a lower habitual fundamental frequency in continuous speech.”

Factors Associated with Non-compliance with Hormone Therapy Cessation before Screening Mammography

Journal:Climacteric (October 27, 2010)

Authors: Newton K, Anderson M, Reed S, et al

Purpose: Conducted at “Group Health, a health plan in Washington State,” this study randomized 1704 women to one of three groups (no cessation and 1-month or 2-month cessation) and had them to self-report certain data “before the study mammogram, including symptoms and compliance,” as well as “complete baseline and follow-up questionnaires.”

Results: While “most participants were using unopposed estrogen (63.3%) and intended to continue HT (90%),” and “9.6% were non-compliant with HT cessation,” participants more likely to be non-compliant were of younger age, lower BMI, symptom severity and use of unopposed estrogen.” The authors insist that “alternatives for menopause symptom management are needed to assist women with HT cessation.”

A “Window of Opportunity:” The Reduction of Coronary Heart Disease and Total Mortality with Menopausal Therapies is Age- and Time-dependent

Journal:Brain Research (October 25, 2010)

Authors: Hodis H, Mack W

Purpose: The authors analyzed reams of data in order to identify “the ‘window of opportunity’ for reducing coronary heart disease (CHD) and overall mortality” for women undergoing menopausal therapies.

Results: “The totality of data” indicates that “initiation of hormone therapy within 6 years of menopause and/or before 60 years of age…reduces CHD risk and overall mortality…and substantially increases quality-adjusted life-years (QALYs) by 1.5 QALYs and is highly cost-effective at $2438 per QALY gained.”

//Clinical Trials

The Role of Vitamin D in Menopause: Relationship to Menopausal Symptoms in Body Composition

Study Type:Interventional

Age/Gender Requirements:40-55 years (female)

Sponsor:Kaiser Permanente

Purpose:This study was put together with three specific goals: 1) “To compare effects of Vitamin D supplementation to usual care on symptoms in women transitioning to early postmenopause and determine the associated effect size in order to conduct a power analysis for a future RCT”; 2) “To compare effects of Vitamin D supplementation to usual care on body composition…in overweight/obese women transitioning to early postmenopause and determine the associated effect size for a power analysis for a future RCT”; 3) “To estimate the proportion of overweight/obese middle-aged women who achieve sufficiency by 1 month versus 2 or more months and to determine if achieving sufficiency by 1 month varies by baseline characteristics.”

Mesafem Capsules in the Treatment of VMS

Study Type:Interventional

Age/Gender Requirements:40 years (female)

Sponsor:Noven Therapeutics

Purpose:Over the course of 24 weeks, women with moderate to severe vasomotor symptoms associated with menopause will be randomly assigned a regimen of Mesafem capsules or a placebo control in order to measure the “mean change in frequency & severity of moderate to severe vasomotor symptoms from baseline” and “change from baseline in total number of awakenings due to hot flashes.”

Pharma Focus

S-equol (4',7-isoflavandiol)

//Clinical Trials

Efficacy and Safety of S-Equol on Vasomotor Symptoms in Menopausal Patients

Study Type:Interventional

Age/Gender Requirements:40 years (female)

Sponsor:Ausio Pharmaceuticals, LLC

Purpose:Participants in this study will be given either a 150mg, 50mg, or 10mg dose of S-equol in order to determine “the efficacy, safety, and acceptability of 3 doses of S equol to placebo in menopausal patients with vasomotor symptoms.”

Equol Improves Menopausal Symptoms in Japanese Women

Journal: The Journal of Nutrition (July 2010)

Authors: Takeshi A

Purpose: To report on a group of studies which tested the hypothesis that “high intake of soy isoflavones in the traditional Japanese diet” explains the “well documented” phenomenon of fewer hot flashes and night sweats among Japanese women than Western women.

Results: In three randomized clinical trials, it was shown “that a daily dose of 10 mg of natural S-equol improved menopausal symptoms.” A confirmation study demonstrated that “menopausal women who were equol nonproducers who consumed 10 mg/d of natural S-equol for 12 wk had significantly reduced severity and frequency of hot flashes as well as a significant reduction in the severity of neck or shoulder stiffness. The equol-ingesting group also showed trends of improvement in sweating and irritability and a significant improvement in the somatic category symptoms.” Takeshi concludes that this body of data supports “the supplement containing natural S-equol…as an alternative remedy in the management of menopausal symptoms.”

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