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The FDA upped the recommended rate of liver blood tests for patients initiating fezolinetant on the basis of a post-marketing case report involving serious liver injury.

FDA updates warning for liver injury due to fezolinetant

At the 2024 Annual Meeting of The Menopause Society, the positive safety and efficacy data of fezolinetant against sleep disturbances from the SKYLIGHT 1 and 2 trials was presented.

SKYLIGHT trials confirm safety and efficacy of fezolinetant against sleep disturbances

The phase 3 OASIS trial presented at the 2024 Annual Meeting of The Menopause Society displayed significant improvements in the frequency of moderate-to-severe vasomotor symptoms among patients receiving elinzanetant.

Elinzanetant displays positive phase 3 safety and efficacy data against VMS

Low rates of hormone therapy use have been reported among midlife women, stagnating after decreases in the immediate aftermath of the Women’s Health Initiative.

The Menopause Society reports low rates of hormone therapy usage

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Supplement: Closing the Gap in Cervical Cancer Screening

Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

Why vNOTES Make Sense for My Patients

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Chronic pelvic pain can be defined as cyclic or non-cyclic pain of six or more months in duration that localises to the anatomical pelvis and is severe enough to cause functional disability and require medical or surgical treatment.

Chronic Pelvic Pain

A 27-year-old woman presents with an 18-month history of vulvar irritation. She is otherwise healthy except for episodes of depression. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole. She used oral steroids but developed knee pain. Tacrolimus has not helped. A biopsy revealed lichen simplex chronicus. Immunofluorescent studies were negative.

A 27-year-old woman presents with an 18-month history of vulvar irritation. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole without relief. What's your diagnosis?

Vulvar irritation in a 27-year-old woman

Saying "obstetrician-gynecologist" is a mouthful for most people, and it's probably the most abbreviated specialty in medicine, both spoken and written. However, there doesn't seem to be a consensus on how to pronounce OB-GYN. First, is it the two-syllable "O-B" or the monosyllabic "Ob"? Second, is it "gin" or "gyne" (like "Lyme")? I wonder if you have a preference. I know I do.

Almost nobody says "obstetrician-gynecologist" when speaking about these specialist physicians. But what's the "correct" way to pronounce OB/GYN?

Is It Ob-Gin or Ob-Gyne?

A recent study suggests that women who experience physical intimate partner violence may face a faster decline in working memory performance, a cognitive function essential for tasks such as recalling a phone number, according to study authors. These findings were presented at the 2024 Annual Meeting of The Menopause Society in Chicago, from September 10-14.

Memory impairment is often seen as a natural part of aging. However, this study highlights how certain factors, such as intimate partner violence, can exacerbate the decline. According to the research, 1 in 3 women will experience some form of intimate partner violence in their lifetime, which can have significant short- and long-term health effects, such as impaired cognitive function

The study, which included data from more than 1,700 participants in the Study of Women's Health Across the Nation (SWAN), focused on whether physical violence experienced during pre- or early-perimenopause is linked to a steeper decline in cognitive performance. Researchers adjusted their analysis for factors such as race/ethnicity, education, financial strain, depressive symptoms, sleep disturbances, and bodily pain.

Researchers assessed a total of 1,713 women who experienced physical IPV before or during early perimenopause. The study examined scores from 3 cognitive tests: the Symbol Digit Modalities Test, the East Boston Memory Test, and the Digit Span Backwards (DSB) test, with cognitive outcomes assessed 6 times between SWAN follow-up visits 7 and 15.

At the SWAN baseline, 3.1% of participants reported experiencing physical IPV within the prior year. After adjusting for variables such as race/ethnicity, education, financial strain, depressive symptoms, sleep disturbances, and bodily pain.

The findings revealed that women who reported experiencing physical violence in the year before their SWAN baseline interview exhibited a significantly greater decline in working memory over time, compared to those who had not experienced such violence. These results align with previous research, according to the authors, reinforcing the association between intimate partner violence and negative cognitive outcomes.

"This analysis underscores the importance of further research into intimate partner violence, which may be an under-recognized source of unfavorable cognitive aging," said lead researcher Jillian Baker, MPH, BA, a PhD student from the University of Michigan.

Stephanie Faubion, MD, MBA, medical director of The Menopause Society, also emphasized the importance of these findings. "It's important for healthcare providers to understand the association between physical violence and mental health," she said. " The high incidence of intimate partner violence should further prompt healthcare professionals to open the conversation about this sensitive issue with their patients."

Baker J, Greendale GA, Hood MM, Karlamanga AS, Harlow SD. Experiences of physical intimate partner violence and longitudinal cognitive performance in midlife women: findings from the Study of Women’s Health Across the Nation (SWAN). Presented at: 2024 Annual Meeting of The Menopause Society. Chicago, Illinois. September 10-14, 2024.

A study presented at the 2024 Annual Meeting of The Menopause Society, found that women who reported physical intimate partner violence also demonstrated decreased working memory performance over time.

Clinical

Physical intimate partner violence linked to decreases in cognitive performance

A new study revealed that women veterans with probable post-traumatic stress disorder (PTSD) are twice as likely to experience early menopause and its associated health challenges. The findings, which are being presented at the 2024 Annual Meeting of The Menopause Society in Chicago from September 10-14, highlight the long-term physical consequences of PTSD in female military personnel, particularly those who served in the Persian Gulf War.

The study, which included over 2,000 women veterans, sought to understand the relationship between military exposure and early menopause. Researchers focused on whether the stressors these women experienced could lead to premature ovarian aging, as well as an increased menopause symptom burden. Early menopause, which occurs before the age of 45, can have serious health implications, including fertility loss, higher risk of cardiovascular disease, osteoporosis, sexual dysfunction, depression, and even premature death.

The study concentrated on Persian Gulf War (GW) women veterans, whose unique experiences—such as exposure to burn pits, oil fires, and the associated Gulf War Illness (GWI)—are linked to various health issues. GWI is characterized by joint pain, gastrointestinal issues, headaches, and rashes, alongside mood disturbances. These health problems, combined with psychological stressors like military sexual trauma (MST), have compelled researchers to explore whether such factors contribute to early menopause.

The Gulf War Longitudinal Study, conducted by the VA Office of Health Outcomes Military Exposures, surveyed 2,013 women veterans from both Gulf War-deployed and Gulf War-era cohorts. At baseline in 1995, the average age of participants was 31.39 years, with a majority being non-Hispanic White (61.1%). Of those surveyed, 65% reported environmental exposures, 61% suffered from Gulf War Illness, and 22% experienced military sexual trauma. Additionally, 27% met the criteria for probable PTSD, which was determined by the PTSD Checklist–Civilian Version (PCL-C). The results revealed that just over 5% of participants had experienced early menopause, defined as occurring before age 45 years.

Researchers also found that probable PTSD was strongly associated with early menopause, with an odds ratio (OR) of 1.83 (95% CI 1.13-2.96), meaning that women with PTSD were almost twice as likely to undergo early menopause compared to those without the disorder. Other military-related factors, including Gulf War deployment, environmental exposures, Gulf War Illness, and military sexual trauma, were not significantly linked to early menopause.

Results of the study showed that women veterans with probable PTSD were found to have nearly double the odds of experiencing early menopause. Importantly, there were no significant associations between Gulf War deployment, Gulf War exposures, Gulf War illness, or military sexual trauma and early menopause, suggesting that PTSD itself plays a critical role.

Caitlin Elizabeth Haas, the study’s lead researcher from the San Francisco VA Health Care System, stated, “This work adds to the growing body of literature implicating PTSD in adverse menopause and reproductive health outcomes across the lifespan. One possible explanation is that PTSD is indicative not just of trauma but of symptom burden, possibly prolonging the biological sequalae associated with the stressful event."

Stephanie Faubion, MD, MBA, medical director for The Menopause Society, stressed the need for heightened awareness of these factors in clinical care. "This study, among other things, highlights the need for healthcare professionals to thoroughly review their patients' histories and be aware of any external stressors that could impact their menopause experience and related symptoms.”

Haas CE, Gibson CJ, Cao G, et al. Military Exposures and Early Menopause: Findings from the Gulf War Cohort Study. Presented at: 2024 Annual Meeting of The Menopause Society. Chicago, Illinois. September 10-14, 2024.

Female veterans with PTSD are twice as likely to experience early menopause and related health risks, according to a study presented at the 2024 Annual Meeting of The Menopause Society. 

PTSD in female veterans associated with early menopause

The risk of heart disease is increased among women experiencing nocturnal hot flashes during the second half of the night when REM sleep typically occurs, according to a recent study presented at the 2024 Annual Meeting of The Menopause Society.

A sharp decline in women’s hormone levels during the perimenopausal period often leads to the onset of hot flashes and other menopause symptoms. Of symptoms experienced among women transitioning to menopause, nocturnal hot flashes are one of the most common.

During the perimenopausal period, women also experience a significant increase in cardiovascular disease risk, possibly caused by fluctuating hormone levels. Estrogen helps keep the blood vessels open and relaxed, as well as managing cholesterol levels and reducing the risk of plaque buildup in the arteries, but this hormone declines during menopause.

Blood vessels may be vulnerable as estrogen levels decline, and the arteries may be at risk of plague buildup. This increases the risks of heart attack, stroke, and coronary heart disease.

The risk of heart disease is also significantly increased when REM sleep, also known as the deepest sleep when dreams often occur, is disrupted. Data has indicated REM sleep mainly occurring in the second half of the night and thermoregulation being reduced during this time.

Information about heart health among women is vital, as according to Natalie Bello, MD, MPH, FACC, heart disease is the leading cause of death among women.

 However, awareness about this fact has decreased among women between 2009 and 2019.

Declines in awareness are greater among younger women and those who are Hispanic or non-Hispanic Black, despite these groups being at an increased risk of heart disease. Approximately 80% of heart disease cases can be prevented by identification and treatment of risk factors, making knowledge of these factors crucial.

Currently, data about whether hot flashes occur more often during the first or second half of the night is lacking.

 However, this information may be key to understanding the impact on cardiovascular disease risk.

In a recent study, investigators evaluated differences in objectively measured hot flashes in the first vs second half of the night among 60 participants. These participants included healthy, perimenopausal women aged 43 to 54 years without heart disease and not taking hormone therapy or other medications that impact hot flashes.

Objective measuring of hot flashes was performed using sternal skin conductance. Forty-one percent of hot flashes experienced by participants occurred during the first half of the night, while 59% occurred during the second half. This indicates a higher prevalence of hot flashes during the second half of the night, increasing cardiovascular disease risk.

Sarah Witkowski, PhD, MS, BS, whose lab led the study, noted that this data is preliminary and obtained from a small sample. Witkowski also recommended additional research about the association between hot flashes, sleep disruptions, and cardiovascular risk.

Further details will be discussed at the 2024 Annual Meeting of The Menopause Society during the presentation, “Potential implications for cardiovascular disease in perimenopausal people: Investigating differences in nocturnal hot flashes in the first vs. second half of the night."

"The results of this small study are interesting as hot flashes are one of the most common symptoms of menopause," said Stephanie Faubion, MD, MBA, medical director for The Menopause Society. "Further research into the potential association between sleep disruption and an increased risk of developing cardiovascular disease will be important to women and their healthcare professionals."

Timing of nocturnal hot flashes may affect risk of heart disease for perimenopausal women. The Menopause Society. September 10, 2024. Accessed September 10, 2024. 

https://menopause.org/press-releases/timing-of-nocturnal-hot-flashes-may-affect-risk-of-heart-disease-for-perimenopausal-women

Krewson C. Exploring the intersection of heart health and women's health. Contemporary OB/GYN. February 12, 2024. Accessed September 10, 2024.

In a recent study presented at the 2024 Annual Meeting of The Menopause Society, 59% of nocturnal hot flashes occurred during the second half of the night, a time linked to increased cardiovascular disease risk.

Hot flashes disrupting REM sleep linked to heart disease risk

This middle-aged woman has pelvic pain and vaginal discharge. What is your diagnosis based on these ultrasound images of the uterus?

endometrial polyp with degenerative changes

Tarek A. Gelbaya, MD

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