Dr. Santoro highlights just some of the content from the scientific program, including cardiovascular disease, the effect of menopause on vasomotor symptoms; genitourinary syndrome of menopause; and hormones of menopause, including a look into FSH as an active driver of menopause.

All presentations have been pre-recorded and now are available for on-demand viewing beginning Sept. 28 through Sept. 21, 2021. Live Q&A sessions will be held from Oct. 5 to Oct. 9. The full program can be found 

Videos

NAMS

In this video, Senior Editor Angie DeRosa interviews Nanette Santoro, MD, Chair of the 2020 Scientific Program Committee for the Virtual Annual Meeting of the North American Menopause Society (NAMS). 

Highlights from NAMS 2020 Virtual Annual Meeting

This article is based on information presented at the 2020 Virtual Annual Meeting of the North American Menopause Society (NAMS). According to NAMS, all presentations have been pre-recorded and now are available for on-demand viewing beginning Sept. 28 through Sept. 21, 2021. For more information, click 

The findings are independent of sleep risk factors and depressive symptoms.

“I have a longstanding interest in understanding how trauma is related to poor sleep and health,” said first author Karen Jakubowski, PhD, a postdoctoral scholar in psychiatry at the University of Pittsburgh in Pennsylvania. 

“Although some past studies have found that trauma is connected to poor sleep, these studies measured sleep at only one time point. We realized there was a gap in our knowledge of whether trauma is related to poor sleep measured at multiple points over time, particularly in midlife women.”

The investigators used both objective and self-report measures of sleep, “which makes this research even more novel and exciting,” Dr. Jakubowski told 

The ongoing study, which is being conducted at the University of Pittsburgh, consists of a cohort of midlife women, aged 40 to 60 at baseline, who had participated in a previous study on menopausal hot flashes and cardiovascular health from 2012 to 2015.

The women were invited to return to the laboratory 5 years later for a follow-up visit between 2017 and 2020.

Of the 296 women assessed at baseline, 72% were White and 28% Black, with an average age of 54. For the follow-up visit, 166 women were evaluated.

At both baseline and follow-up, women reported adult trauma (Brief Trauma Questionnaire), demographics, depressive symptoms, sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and apnea.

They also provided physical measures of height/weight, as well as a 3-day objective sleep assessment via actigraphy: duration and wake after sleep onset (WASO).

At baseline only, women reported childhood trauma (Child Trauma Questionnaire).

Linking childhood trauma (any/none) and adult trauma (any/none) at baseline with poor sleep (duration <7 hours, WASO ≥31 minutes, PSQI >5) across both baseline and follow-up visits were then assessed.

At baseline, 44% of women reported childhood trauma, compared to 60% who reported adult trauma.

Persistently poor sleep duration, WASO and sleep quality was observed in 61%, 60%, and 33% of women, respectively, at both baseline and follow-up visits.

Childhood trauma was related to persistently poor WASO: odds ratio (OR) 2.32; 95% confidence interval (CI): 1.11 to 4.84 (

Adult trauma also was connected to persistently poor sleep quality: OR 2.13; 95% CI: 1.01 to 4.52 (

However, trauma was unrelated to persistently poor sleep duration.

“We were surprised that trauma was unrelated to women’s sleep duration,” Dr. Jakubowski said. “Our results suggest that trauma history is more connected to disrupted and poor-quality sleep in midlife women, rather than how long women are sleeping.”

To improve sleep quality in this population, Dr. Jakubowski said she believes it is important that women allow themselves time to wind down at night, prior to going to bed. “This may involve doing an activity that they find restful or relaxing, without phones or screens if possible, to help promote the transition from our busy lives to sleep,” she said.

The authors hope that their work inspires further research on the lasting effects of trauma on sleep and health in midlife women, “and aids in the development of future interventions that can tailor and improve sleep in women who have experienced trauma,” Dr. Jakubowski said.

Dr. Jakubowski reports no relevant financial disclosures.

Articles

Poor sleep occurs frequently among midlife women, which is significantly linked to childhood and adult trauma, according to a prospective study presented at the 2020 Virtual Annual Meeting of the North American Menopause Society (NAMS).

Trauma’s relation to poor sleep and health in midlife women

Using cannabis for menopause symptom management is common, at least in a sample of midlife women veterans from across California.

The study, which was presented at the 2020 Virtual Annual Meeting of the North American Menopause Society (NAMS), found that among 231 women with a mean age of 55.95 years, 27% reported that they currently or previously used cannabis for managing menopause symptoms, including hot flashes, night sweats, insomnia, and genitourinary symptoms.

An additional 10% of participants expressed interest in using cannabis in the future to manage their menopause symptoms.

Principal investigator Carolyn Gibson, PhD, MPH, a psychologist and health services researcher at the San Francisco Veterans Affairs (VA) Health Care System, said, “These findings come from a larger study I conducted to examine the experience of menopause and menopause-related care among midlife and older women veterans, which is an understudied population that comprises over half of the women we serve in the VA.”

Dr. Gibson was inspired to add questions about cannabis use for menopause symptom management because, over the past several years, popular press articles about its use started appearing regularly in her newsfeed.

“It seems apparent that as cannabis use becomes increasingly mainstream, a growing number of midlife and older women are interested in or using cannabis to help manage menopause symptoms,” Dr. Gibson said. “However, we had no data on actual numbers, or if use is helping or harming women.”

Cross-sectional data were gleaned from the Midlife Women Veterans Health Survey, which was an observational study of women veterans, aged 45 to 64, who were enrolled in VA health care across Northern California. Data were collected between March 2019 and May 2020.

Cannabis use was more frequently reported among women reporting hot flashes (67% vs. 50% for non-users; 

But there were no differences observed for other menopause symptoms between the two groups.

“I was expecting some women to report cannabis use for menopause symptom management, but was a little surprised to see a rate approaching 30%,” Dr. Gibson said. “This is in comparison to 19% of women in the sample who reported menopausal hormone therapy use.”

Dr. Gibson also expected to find some differences, such as cannabis use for menopause symptoms being more common among women who were younger or less engaged in VA care, but this was not the case.

The study did not address frequency of use and/or potency of the cannabis.

“Patients may not always disclose cannabis use, especially in the VA health care system, where cannabis is considered illegal under federal guidelines, regardless of state laws,” Dr. Gibson said. “Nonetheless, providers should be aware that their perimenopausal and postmenopausal patients may be using cannabis to manage their menopause symptoms.”

There is much to be learned about the potential benefits and harms of cannabis use, particularly related to menopause and aging, she said. “However, existing evidence raises concerns about its impact on cognition, cardiovascular health and mental health,” she said.

Future areas of research include who is using cannabis for menopause symptom management, what type of cannabis products they are using, what symptoms they are targeting and whether cannabis is actually effective.

“We also need to know whether our numbers would look the same outside of Northern California, and how typical patterns of use impact health and functioning among perimenopausal and postmenopausal women,” Dr. Gibson said.

Dr. Gibson reports no relevant financial disclosures.

This article is based on information presented at the 2020 Virtual Annual Meeting of the North American Menopause Society (NAMS). According to NAMS, all presentations have been pre-recorded and now are available for on-demand viewing beginning Sept. 28 through Sept. 21, 2021.

Cannabis for managing menopause symptoms

Markers of mitochondrial function in perimenopausal and postmenopausal women correlate to numerous measures of cognitive performance, according to a study presented at the 2020 Virtual Annual Meeting of the North American Menopause Society (NAMS).

These measures are verbal learning, verbal memory, organizational strategies that support verbal learning and memory, verbal fluency and spatial ability.

“Evidence, largely from animal studies, suggests there is a change in mitochondrial function from the premenopause to the perimenopause, and the change is a deleterious one resulting in brain dysfunction,” said co-principal investigator Pauline Maki, PhD, a professor of psychiatry, psychology and ob/gyn at the University of Illinois at Chicago. “This change in mitochondrial function would indicate a critical change in the way that the brain generates and uses energy as women age.”

Dr. Maki and her colleagues were inspired by a 2017 study in 

 that identified a mitochondrial biomarker (an Alzheimer’s bioenergetic phenotype) in the brain and periphery of perimenopausal and postmenopausal women. “We wanted to expand the range of mitochondrial biomarkers in the human work,” Dr. Maki told 

The current MsBrain study enrolled 110 perimenopausal and postmenopausal women living in and around Pittsburgh (mean age 58.56, 77.3% White) who were assessed over the past 3 years.

The women completed a cognitive test battery, including tests of verbal learning and memory, spatial reasoning, working memory, verbal recall and global cognition.

Extracellular flux analysis was used to obtain measures of nonmitochondrial oxygen consumption, baseline respiratory rate, maximal respiratory capacity, basal glycolytic rate, proton leak, mitochondrial oxidation production, and adenosine triphosphate (ATP)-linked respiration in circulating platelets.

“We discovered a range of mitochondrial biomarkers significantly related to cognitive function in cognitively normal postmenopausal women,” Dr. Maki said. “Many of the biomarkers were related to the ability of women to use helpful strategies when learning new material.”

Higher non-mitochondrial oxygen consumption, baseline respiratory rate, maximal respiratory capacity, basal glycolytic rate, proton leak, ATP-linked respiration in circulating platelets and mitochondrial oxidant production were each associated with better performance on a range of cognitive test scores: verbal learning (

 < 0.01); organizational strategies to enhance learning (

 < 0.05); California Verbal Learning Test (CVLT) short delay (

Dr. Maki said one way to learn new material is rote or simple memorization. “But the other involves deep processing of the material,” she said. “Mitochondrial markers were notably related to the extent to which women used the more helpful of the two strategies, which is related to function of the prefrontal cortex.”

The investigators were surprised by the number of associations found between mitochondrial markers and cognition at midlife. “Our results are encouraging,” Dr. Maki said.

The cross-sectional study, however, was unable to address whether these are causal connections. “Although the findings might be related to menopause, we cannot state that, because the women in our study were postmenopausal,” she said. “We also do not know if these same relationships might also exist in men of similar ages.”

Study outcomes in general indicate that the mitochondria, which control energy production in the brain, are associated with cognitive function. “This is a new mechanism that can be targeted in future longitudinal studies to examine changes in mitochondria markers and changes in cognition through the menopause transition,” Dr. Maki said.

Dr. Maki has been a paid consultant to Pfizer, Abbvie and Balchem.

This article is based on information presented at the 2020 virtual annual meeting of the North American Menopause Society (NAMS). According to NAMS, all presentations have been pre-recorded and now are available for on-demand viewing beginning Sept. 28 through Sept. 21, 2021. 

Cognition decline after menopause transition

The meeting will include the latest information on menopause and midlife women’s health with a focus on reaching new heights in menopause care.

Registration will open on September 28 and fees vary. Participants will be provided with 12-month access to the Plenary Symposia, special lectures, Menopause 101 course, Pre-Meeting Symposium, Live Q&A sessions, a Virtual Exhibit Hall, abstract presentations, a Poster Session, and Product Theater.

For those already registered for the in-person meeting, NAMS will automatically refund the registration fees paid. See 

for additional details and updates on this year’s NAMS Annual Meeting.

The North American Menopause Society (NAMS) has announced its decision to host the 2020 Annual Meeting virtually from September 30 to October 3.

NAMS 2020 Virtual Annual Meeting

A series of presentations at the 43rd AAGL Global Congress on Minimally Invasive Gynecological Surgery explored the challenges of diagnosing and treating chronic pelvic pain. Erin Teeter Carey, MD, of the Center for Pelvic Pain and Sexual Health at University at Kansas Medical Center in Overland Park gave a presentation entitled "A Systematic Approach to the Evaluation of Chronic Pelvic Pain."

Chronic pelvic pain is not only debilitating but also frustrating for patients and practitioners. When evaluating patients with chronic pain, OB/GYNs need to consider the physical sources of pain as well as the psychosocial issues that go hand-in-hand with pelvic pain.

In her presentation, Carey reviewed:
- The definition of chronic pelvic pain (CPP).
- How pertinent history and physical exam findings relate to the etiology of the pain.
- The process to evaluate and manage chronic pelvic pain.
- How to understand the psychosocial issues associated with chronic pelvic pain.

Chronic pain is described by ACOG as pain in the lumbosacral back, abdomen (below the umbilicus), or the pelvis that lasts 6 months or longer and results in disability or in a patient's seeking out medical care. The condition is common, may be accompanied by dysmenorrhea or dyspareunia, and could affect as many as 38 of every 1000 women.

Dr Carey explains that practitioners shouldn't expect all chronic pain to result from one particular diagnosis but instead to treat the pain as a diagnosis in and of itself. OB/GYNs should also assess the entire person, considering any unique history, biopsychosocial situations, and the possibility of pain being from several contributors.

Further, Dr Carey points out that evaluating chronic pain is time consuming and may require help from prior physicians, as well as any reports from previous surgery or hospitalizations. The mnemonic "OPQRST-ASPN," if you can remember it, can be helpful in taking a history:

ssociated Symptoms (gastrointestinal, genitourinary)
- 

Listen to the patient, but also ask deeper questions. Ask the patient to describe the pain, including what it feels like (is it pulling, cramping, stabbing), how intense it is (daily, cyclic, or are there pain-free times), whether there are any triggers (such as food, stress, or sex), and what time of day it is present. If the pain was treated in the past surgically or medically, determine if any treatments were helpful. Query about involvement of other organ systems and whether there are bowel or bladder symptoms, headaches, or head and neck pain. Physical history should include medical, surgical, family, social, psychiatric, sleep, and sexual history.

Carey explains that multiple diagnoses and providers at the outset of treatment can result in fragmented care. The start of treatment typically starts with centrally acting medication, lifestyle changes, and physical therapy. The outcome when pelvic pain is managed with surgery remains unclear, but treatment should begin with an evaluation of multiple organ systems. Chronic pelvic pain requires a multidisciplinary approach and is costly to diagnose and treat, but appropriate and timely interventions can lead to effective management and a restoration of quality of life.

Erin Teeter Carey, MD, MSCR. Didactic: No Pain, No Gain. A Systematic Approach to the Evaluation of Chronic Pelvic Pain. 43rd AAGL Global Congress on Minimally Invasive Gynecology. ANAT-702. Available in: 

http://mobile.aagl.org/api/v1/modules/documents/files/pelv609.pdf

AAGL

Chronic pelvic pain is costly to diagnose and treat, but appropriate and timely interventions can lead to a restoration of quality of life.

Evaluating Chronic Pelvic Pain

Is knowledge about retroperitoneal anatomy the Achilles' heel of gynecologic surgeons? No matter the specialty, the core skills for any surgeon include knowledge of the applicable anatomy and the ability to safely expose that anatomy. These basic skills are necessary for surgeons to reveal anatomy without having an effect on either the structure or the function of the organs involved.

In a series of presentations at the 43rd AAGL Global Congress on Minimally Invasive Gynecological Surgery in November 2014, Jaime B. Long, MD, Chief of Urogynecology at Reading Health System in West Reading, PA, discussed several techniques aimed to bridge the knowledge gap and instruct gynecologic surgeons in proper surgical techniques.

The three objectives of Long's presentation were to teach the attendees to:

1. Use dissection techniques to expose anatomy safely.

2. Understand the purpose of dissection maneuvers.

In her talk, Long points out that good technique can empower a surgeon faced with a complex scenario, cut down on complications, and result in faster surgeries. Without technical skill, surgeons can't expect favorable outcomes for their patients. Students who understand and apply good techniques during their procedures should be able to progress into competent surgeons.

The 6 techniques included in Long's presentation include millimeter by millimeter, grasp and tent, push and spread, traction-counter-traction, gentle wiping/teasing, hydrodissection, and skeletonizing. The "millimeter by millimeter" approach allows for the correct orientation and direction of dissection, ongoing evaluation of instruments and techniques, safe exploration of the anatomy, and limiting the potential of injury.

With the "grasp and tent" procedure, surgeons can move the peritoneum or other tissues away from the vital organs before making an incision. Visualization is improved because the tissue contained in the grasp is thinned. In "push and spread," which might also sometimes be called "poke and open," tissue is thinned out even more, releasing scarring.

"Traction-counter-traction" can be done with assistance from a surgical team member and is used to gently pull tissues. The field of dissection is better visualized because this technique thins visceral connection tissues. "Gentle wiping/teasing" is applied slowly, millimeter by millimeter. This technique thins tissues, clears blood, and can help reveal tissue planes. Long advises against using blunt or quick strokes, which could lead to damage.

Hydrodissection, the process of injecting sterile fluid to tent and thin out connective tissues can open potential spaces and is helpful in vaginal dissection. In laparoscopy, CO

 gas might also be used instead of fluid to dissect open spaces. To separate adhesions, clean connective tissue, or for broad ligament dissection, skeletonizing is used. This technique is done by gently brushing the tissue with an open pair of scissors or a fine cutting instrument.

Long also suggests that students start with easy dissections and progress to difficult ones; remain flexible; act quickly on warning signs of bleeding; perform techniques the same way each time they're used; and make use of lighting, retraction, and hemostasis to better visualize the surgical field.

Source: Jaime B. Long, MD. Didactic (Live Cadaveric Demo): Fulfill Your Destiny as a MIG Surgeon, You Must. The Way of the Jedi Master, Surgical Anatomy, It Is. The Art and Practice of Expert Surgical Dissection. 43rd AAGL Global Congress on Minimally Invasive Gynecology. ANAT-702. 

These tips for implementing good technique in laparoscopic surgeries can help reduce complications and result in faster surgeries.

Dissection of Retroperitoneal Anatomy

The underlying causes of spontaneous preterm birth are still largely unknown. There are various risk factors for spontaneous preterm birth, but the primary risk factor is a previous preterm delivery. The sex of the unborn baby also seems to play a role in the process of being born prematurely, according to research presented last week in San Diego at The Pregnancy Meeting, the Society for Maternal-Fetal Medicine’s annual meeting.

The research was based on nearly 2 million (1,947,266) singleton births by white women between 1999 and 2010 involving a live fetus at the onset of labor. Cases with congenital anomalies or unknown fetal sex were excluded. The relative risk ratios for gender per week of gestation were assessed, as was gender-related risk on adverse neonatal outcomes. These outcomes were perinatal mortality and a composite of neonatal morbidity, including neonatal intensive care admission, sepsis, meconium aspiration, necrotizing enterocolitis, respiratory distress syndrome, and intraventricular hemorrhage.

Onset of labor was categorized as spontaneous with intact membranes, prelabor rupture of membranes (PROM), and induction of labor or elective c-section.

When looking at spontaneous preterm birth with intact membranes, male fetuses were 50% more likely than female fetuses to be born prematurely, with a peak between 28 and 31 weeks' gestation (RR, 1.5; 95% CI, 1.3-1.7). In addition, male fetuses were at increased risk for PPROM between 26 and 37 weeks' gestation (RR 1.2; 95 CI, 1.16-1.23). The sex of the fetus had no effect on medically indicated preterm birth.

Neonatal mortality was similar between male and female fetuses with comparable gestational ages at birth. However, male fetuses were more likely than female fetuses to have a composite neonatal morbidity when born on or after 29 weeks' gestation, with a peak at 37 to 38 weeks' gestation (RR, 1.4; 95% CI, 1.2-1.5). Plainly speaking, if a boy and girl are born with comparable gestational ages, the boy is more at risk for becoming seriously ill than the girl.

“This study provides important insight into the differences in risk factors based on gender,” explained Myrthe Peelen, MD, one of the researchers of the study and who is affiliated with the Academic Medical Center in Amsterdam. “Patients with a history of preterm birth should be monitored, particularly if they’re having boys now after a preterm birth of a girl,” added Peelen.

Peelen M, Kazemier B, Ravelli A, et al. Impact of fetal gender on the risk of preterm birth. Abstract no 80.

The Pregnancy Meeting, the Society for Maternal-Fetal Medicine’s annual meeting; February 7, 2015; San Diego, Calif.

SMFM

SMFM 2015: New research shows that fetuses of a certain sex are at increased risk for spontaneous preterm birth.

Does Fetal Gender Affect Risk of Preterm Birth?

Noninvasive prenatal testing (NIPT) has become popular with many physicians in screening pregnant patients. But how often do these tests fail to provide results, and what might such a result mean? Researchers helped answer this question last week in San Diego at The Pregnancy Meeting, the Society for Maternal-Fetal Medicine’s annual meeting, when John Turocy, MD, presented research on the high rate of chromosomal abnormalities in patients in whom noninvasive prenatal testing fails to provide results.

To help answer these questions, researchers offered high-risk women (per ACOG guidelines) noninvasive prenatal tests, which were conducted at an outside laboratory between October 2012 and June 2014 as part of the Kaiser Permanente Northern California Regional Prenatal Screening Program. Test results were reported as low risk, high risk, or redraw request (RR) if no result was obtained. The incidence of chromosomal abnormalities in the RR group was compared with that of the entire cohort.

Noninvasive prenatal tests were performed in a total of 4446 pregnancies. Of those, 102 (2.3%) resulted in an initial result of RR, with 63 of the women choosing to redraw the test and 39 declining. Of the 63 women who were retested, 32 (51%) were low risk, 5 (8%) were high risk, and 26 (41%) once again received the result RR.

Overall, a total of 65 (1.5%) of the 4446 tests had no final result after either one or two blood draws, 4219 (94.9%) had low-risk results, and 162 (3.6%) had high-risk results. Of the 65 women whose test failed to yield a result, 43 (66.2%) opted for no chromosomal analysis, 13 (20%) discovered their fetus had normal chromosomes, and 9 (13.8%) learned their baby had chromosomal abnormalities (3 had triploidy, 3 had T18, 1 had T13, 1 had T20, and 1 had 45,X). In cases where results were not obtained because insufficient fetal cfDNA, 7 (13%) of 52 had abnormal chromosomes. In cases with no result because of high variance in cfDNA counts, 2 (15%) of 13 had abnormal chromosomes.

The rate of chromosomal abnormalities in patients with no final result was significantly higher than the rate of chromosomal abnormalities in the overall cohort (9 [13.8%] of 65 vs 108 [2.4%] of 4446, respectively; 

These findings show that there tends to be a high rate of chromosomal abnormalities on repeat testing after a failed NIPT result. In addition, nearly half of tests again will fail on subsequent NIPT attempts.

“This is important information for patients and providers and requires clear understanding on how to interpret test results and appropriate follow-up,” explained Turocy.

Turocy J, Norem C, Blumberg B, et al. Chromosomal abnormalities detected in patients with failure to obtain test results using non-invasive prenatal testing. Abstract no 65. Presented at: 

The Pregnancy Meeting, the Society for Maternal-Fetal Medicine’s annual meeting; February 6, 2015; San Diego, Calif.

SMFM 2015: A failed result on noninvasive prenatal testing (NIPT) may provide insight into what subsequent tests may find, research reveals.

Interpreting Failed Results on NIPT

A study of mothers and daughters found that low birth weight and preeclampsia tended to reoccur in the next generation.

Preeclampsia, which can lead to the life-threatening condition eclampsia, remains an unpredictable condition of pregnancy with no known cause. However, a recent study presented February 6th at The Pregnancy Meeting, the Society for Maternal-Fetal Medicine’s annual meeting held this year in San Diego provides insight into an association between low birth weight and preeclampsia in mothers and daughters.

The study was based on information from 2314 triads of mothers, daughters, and grandchildren. The daughter group included women who gave birth in a tertiary medical center between 1991 and 2012. Specifically, the study included 1493 mothers, 1619 daughters, and 2314 grandchildren. Low birth weight in mothers, after adjusting for maternal age, placental pathology, preeclampsia, and parity, was a significant predictor of low birth weight in offspring (OR, 1.7; 95% CI, 1.1-2.6; 

=0.012). Likewise, preeclampsia was a significant intergenerational risk factor after adjustments for maternal age and parity (adjusted OR, 2.9; 95% CI, 1.5-5.7; 

“Pregnant women with maternal family history of low birth weight or preeclampsia should be informed regarding these outcomes and should be monitored more closely,” stated Yehonatan Sherf, MD, one of the study researchers and presenter of the findings.

Careful surveillance among high-risk pregnancies may be helpful in early detection of complications such as preeclampsia as well as neonatal low birth weight.

The study was conducted at Soroka University Medical Center, Beer-Sheva, Israel.

Sherf Y, Sheiner E, Vardi IS, et al. Like mother like daughter-low birthweight and preeclampsia tend to re-ocurre at the next generation. Abstract no 47. Presented at: The Pregnancy Meeting, the Society for Maternal-Fetal Medicine’s annual meeting; February 6, 2015; San Diego, Calif.

New research from SMFM 2015 shows women whose mothers had preeclampsia or low birth weight are more likely to have the condition in pregnancy.

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