In this section, The North American Menopause Society (NAMS) features the latest research news, along with expert commentary that places the news into perspective.
NAMS requests commentary from experts in the clinical practice and research communities on subjects of interest to its constituents. Oversight for First to Know® is provided by Holly L. Thacker, MD, Chair-Elect, 2007-2008 NAMS Professional Education Committee. Unless specifically stated otherwise, the comments contained on this Web page are opinions or information of the authors and not necessarily the opinions or information of The North American Menopause Society, its officers, agents, trustees, or Dr. Thacker. Disclosures are available upon request.”
These items are first sent to NAMS members in the First to Know monthly e-newsletter, a valuable benefit of membership. After members receive the issue, the items are posted here.
To view the monthly contents, click on each posted date.
You need Acrobat Reader software to view these news items.
Find help downloading Acrobat Reader.
Monoclonal antibody denosumab significantly increases bone mineral density
Bone HG, Bolognese MA, Yuen CK, et al. Effects of denosumab on bone mineral density and bone turnover in postmenopausal women. J Clin Endocrinol Metab 2008;93:2149-2157. Level of evidence: I.
Does testosterone improve sexual satisfaction in premenopausal women?
Davis S, Papalia M, Norman RJ, et al. Safety and efficacy of a testosterone metered-dose transdermal spray for treating decreased sexual satisfaction in premenopausal women: a randomized trial. Ann Intern Med 2008;148:569-577. Level of evidence: I.
Oophorectomy at young age associated with increased risk of metabolic syndrome and Framingham
risk score
Dorum A, Tonstad S, Liavaag AH, Michelsen TM, Hildrum B, Dahl AA. Bilateral oophorectomy before 50 years of age is significantly associated with the metabolic syndrome and Framingham risk score: a controlled, population-based study (HUNT-2). Gynecol Oncol 2008;109:377-383. Level of evidence: II-2.
Alendronate use and risk of atrial fibrillation
Heckbert SR, Li G, Cummings SR, Smith NL, Psaty BM. Use of alendronate and risk of incident atrial fibrillation in women. Arch Intern Med 2008;168:826-831. Level of evidence: II-2.
Menopause transition is not associated with worsening urinary incontinence
Waetjen LE, Feng WY, Ye J, et al, for the Study of Women’s Health Across the Nation. Factors associated with worsening and improving urinary incontinence across the menopausal transition. Obstet Gynecol 2008;111:667-677. Level of evidence: II-2.
Nurses’ Health Study finds increased risk of stroke with hormone therapy
Grodstein F, Manson JE, Stampfer MJ, Rexrode K. Postmenopausal hormone therapy and stroke: role of time since menopause and age at initiation of hormone therapy. Arch Intern Med 2008;168:861-868.
Level of evidence: II-2.
Death from causes other than breast cancer more likely in certain survivors
Chapman JA, Meng D, Shepherd L, et al. Competing causes of death from a randomized trial of extended adjuvant endocrine therapy for breast cancer. J Natl Cancer Inst 2008;100:252-260. Level of evidence: I.
Higher levels of DHEAS associated with better cognitive function
Davis SR, Shah SM, McKenzie DP, Kulkarni J, Davison SL, Bell RJ. Dehydroepiandrosterone sulfate levels are associated with more favorable cognitive function in women. J Clin Endocrinol Metab 2008;93:801-808. Level of evidence: II-3.
Low-fat dairy, dietary calcium, and vitamin D may lower hypertension risk
Wang L, Manson JE, Buring JE, Lee IM, Sesso HD. Dietary intake of dairy products, calcium, and vitamin D and the risk of hypertension in middle-aged and older women. Hypertension 2008;51:1073-1079.
Level of evidence: II-2.
Combined hormone therapy results in avoidable mammogram abnormalities and breast biopsies, with compromised diagnostic results
Chlebowski RT, Anderson G, Pettinger M, et al, for the Women’s Health Initiative Investigators. Estrogen plus progestin and breast cancer detection by means of mammography and breast biopsy. Arch Intern Med 2008;168:370-377. Level of evidence: I.
Benign proliferative breast disease grows with unopposed estrogen
Rohan TE, Negassa A, Chlebowski RT, et al. Conjugated equine estrogen and risk of benign proliferative breast disease: a randomized controlled trial. J Natl Cancer Inst 2008;100:1-9. Level of evidence: I.
Calcium supplements found to raise risk of cardiovascular events in older women
Bolland MJ, Barber PA, Doughty RN, et al. Vascular events in healthy older women receiving calcium supplementation: randomized controlled trial. BMJ 2008;336:262-266. Level of evidence: I.
Hormone therapy increases leptin, maintaining body composition; tibolone decreases leptin levels and
body fat
Dedeoglu EN, Erenus M, Yoruk P. Effects of hormone therapy and tibolone on body composition and serum leptin levels in postmenopausal women. Fertil Steril Feb 2;[Epub ahead of print]. Level of evidence: II-1.
Change in hormone levels associated with menopause related to change in adipo-cytokines and
ghrelin levels
Sowers MFR, Wildman RP, Mancuso P, et al. Change in adipocytokines and ghrelin with menopause. Maturitas 2008;59:149-157. Level of evidence: II-2.
Findings from two European randomized controlled trials are in conflict
Holmberg L, Iversen OE, Rudenstam CM, et al, on behalf of the HABITS Study Group. Increased risk of recurrence after hormone replacement therapy in breast cancer survivors. J Natl Cancer Inst 2008;100:475-482.
Level of evidence: I.
Some risks associated with estrogen plus progestin extend beyond their use
Heiss G, Wallace R, Anderson GL, et al, for the WHI Investigators. Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA 2008;299:1036-1045. Level of evidence: I.
Low-dose vaginal estradiol tablets relieve symptoms of vaginal atrophy
Bachmann G, Lobo RA, Gut R, Nachtigall L, Notelovitz M. Efficacy of low-dose estradiol vaginal tablets in the treatment of atrophic vaginitis: a randomized controlled trial. Obstet Gynecol 2008;111:67-76. Level of evidence: I.
Adding vitamin D to calcium supplementation reduces risk of falling in elderly women
Prince RL, Austin N, Devine A, Dick IM, Bruce D, Zhu K. Effects of ergocalciferol added to calcium on the risk of falls in elderly high-risk women. Arch Intern Med 2008;168:103-108. Level of evidence: I.
Moderate doses of vitamin D2 as effective as D3 in maintaining serum 25-hydroxyvitamin D levels
Holick MF, Biancuzzo RM, Chen TC, et al. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab 2008;93:677-681 Level of evidence: I.
Serotonin-norepinephrine reuptake inhibitor desvenlafaxine relieves hot flashes
Speroff L, Gass M, Constantine G, Olivier S, for the Study 315 Investigators. Efficacy and tolerability of desven-lafaxine succinate treatment for menopausal vasomotor symptoms: a randomized controlled trial. Obstet Gynecol 2008;111:77-87. Level of evidence: I.
Million Women Study: Higher BMI increases cancer incidence and mortality
Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D, for the Million Women Study Collaboration. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ 2007;335:1107-1108. Level of evidence: II-2.
Liquid Pap no more sensitive than conventional Pap in cervical cancer screening and prevention
Arbyn M, Bergeron C, Klinkhamer P, Martin-Hirsch P, Siebers AG, Bulten J. Liquid compared with conven-tional cervical cytology: a systematic review and meta-analysis. Obstet Gynecol 2008;111:167-177. Level of evidence: III.
Premenopausal women with major depression have high prevalence of low bone mineral density
Eskandari F, Martinez PD, Torvik S, et al, for the Premenopausal, Osteoporosis Women, Alendronate, Depression (POWER) Study Group. Low bone mass in premenopausal women with depression. Arch Intern Med 2007;167:2329-2336. Level of evidence: II-1.
Women with hysterectomy at significant risk for lower physical functioning
Sowers M, Tomey K, Jannausch M, Eyvazzadeh A, Nan B, Randolph J Jr. Physical functioning and menopause states. Obstet Gynecol 2007;110:1290-1296. Level of evidence: II-2.
Time since menopause determines effect of estrogen on vascular endothelial function
Vitale C, Mercuro G, Cerquetani E, et al. Time since menopause influences the acute and chronic effect of estrogens on endothelial function. Arterioscler Thromb Vasc Biol 2008;28:348-352. Level of evidence: II-2.
Recurrence of postmenopausal bleeding low in women with thin endometrium
Van Doorn HC, Timmermans A, Opmeer BC, et al, for the Dutch Study in Postmenopausal Bleeding. What is the recurrence rate of postmenopausal bleeding in women who have a thin endometrium during a first episode of postmenopausal bleeding? Acta Obstet Gynecol Scand 2008;87:89-93. Level of evidence: II-2.
Combined hormone therapy for 3 or more years significantly increases risk of lobular and ductal-lobular breast cancer
Li CI, Malone KE, Porter PL, et al. Relationship between menopausal hormone therapy and risk of ductal, lobular, and ductal-lobular breast carcinomas. Cancer Epidemiol Biomarkers Prev 2008;17:43-50. Level of evidence: II-2.
Simpler model estimates breast cancer risk as well as Gail model
Chlebowski RT, Anderson GL, Lane DS, et al, for the Women’s Health Initiative Investigators. Predicting risk of breast cancer in postmenopausal women by hormone receptor status. J Natl Cancer Inst 2007;99:1695-1705. Level of evidence: I.
Algorithm developed to predict risk of hip fracture using clinical risk factors
Robbins J, Aragaki AK, Kooperberg C, et al. Factors associated with 5-year risk of hip fracture in postmeno-pausal women. JAMA 2007;298:2389-2398. Level of evidence: II-2.
Low-fat diet may reduce ovarian cancer risk
Prentice RL, Thomson CA, Caan B, et al. Low-fat dietary pattern and cancer incidence in the Women’s Health Initiative Dietary Modification Randomized Controlled Trial. J Natl Canc Inst 2007;99:1534-1543.
Level of evidence: I.
More respiratory symptoms found among women in menopause transition
Real FG, Svanes C, Omenaas ER, et al. Lung function, respiratory symptoms, and the menopausal transition. J Allergy Clin Immunol 2008;121:72-80. Level of evidence: II-3.
Editor’s picks: highlights from the January-February 2008 issue of Menopause
Thurston RC, Bromberger J, Chang Y, et al. Childhood abuse or neglect is associated with increased vasomotor symptom reporting among midlife women. Menopause 2007;15:16-22.
In postmenopausal women with lupus, no increase in vascular thrombotic events with HT use
Fernandez M, Calvo-Alen J, Bertoli AM, et al, for the LUMINA Study Group. Systemic lupus erythematosus in a multiethnic US cohort (LUMINA L II): relationship between vascular events and the use of hormone replacement therapy in postmenopausal women. J Clin Rheumatol 2007;13:261-265. Level of evidence: II-2.
Uterine artery embolization less expensive alternative to hysterectomy for uterine fibroids
Wu O, Briggs A, Dutton S, et al. Uterine artery embolisation or hysterectomy for the treatment of symptomatic uterine fibroids: a cost-utility analysis of the HOPEFUL study. BJOG 2007;114:1352-1362. Level of evidence: II-2.
Panic attacks may be risk factor for cardiovascular events in postmenopausal women
Smoller JW, Pollack MH, Wassertheil-Smoller S, et al. Panic attacks and risk of incident cardiovascular events among postmenopausal women in the Women’s Health Initiative Observational Study. Arch Gen Psychiatry 2007;64:1153-1160. Level of evidence: II-2.
Test for human papillomavirus DNA more sensitive than Pap test in detecting cervical cancer
Mayrand M-H, Duarte-Franco E, Rodrigues I, et al, for the Canadian Cervical Cancer Screening Trial Study Group. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med 2007;357:1579-1588. Level of evidence: I.
Hormone therapy significantly improves sexual function in postmenopausal women
Cayan F, Dilek U, Pata O, Dilek S. Comparison of the effects of hormone therapy regimens, oral and vaginal estradiol, estradiol + drospirenone and tibolone, on sexual function in healthy postmenopausal women. J Sex Med 2007. Level of evidence: II-2.
Microdose of transdermal 17ß-estradiol effectively relieves hot flashes
Bachmann GA, Schaefers M, Uddin A, Utian WH. Lowest effective transdermal 17ß-estradiol dose for relief of hot flushes in postmenopausal women: a randomized controlled trial. Obstet Gynecol 2007;110:771-779. Level of evidence: I.
Oral contraceptive use has no impact on breast cancer mortality
Wingo PA, Austin H, Marchbanks PA, et al. Oral contraceptives and the risk of death from breast cancer. Obstet Gynecol 2007;110:793-800. Level of evidence: II-2.
Vitamin E supplementation may reduce risk of venous thromboembolism
Glynn RJ, Ridker PM, Goldhaber SZ, Zee RYL, Buring JE. Effects of random allocation to vitamin E supplementation on the occurrence of venous thromboembolism: report from the Women’s Health Study. Circulation 2007;116:1497-1503. Level of evidence: I.
Panoramic dental radiographs may be useful early screening tool for osteoporosis
Vlasiadis KZ, Skouteris CA, Velegrakis GA, et al. Mandibular radiomorphometric measurements as indicators of possible osteoporosis in postmenopausal women. Maturitas 2007;58:226-235. Level of evidence: III.
Bone density screening in younger women increases osteoporosis prevention behaviors
Sedlak CA, Doheny MO, Estok PJ, Zeller RA, Winchell J. DXA, health beliefs, and osteoporosis prevention behaviors. J Aging Health 2007;19:742-756. Level of evidence: I.
Editor’s picks: highlights from the November-December issue of Menopause
Mueck AO, Genazzani AR, Samsioe G, Vukovic-Wysocki I, Seeger H. Low-dose continuous combinations of hormone therapy and biochemical surrogate markers for vascular tone and inflammation: transdermal versus oral application. Menopause 2007;14:978-984.
Hormone therapy improves skin
Sator PG, Sator MO, Schmidt JB, et al. A prospective, randomized, double-blind, placebo-controlled study on the influence of a hormone replacement therapy on skin aging in postmenopausal women. Climacteric 2007;10:320-334. Level of evidence: I.
Zoledronic acid associated with lower rates of new fractures and death from all causes
Lyles KW, Colón Emeric CS, Magaziner JS, et al, for the HORIZON Recurrent Fracture Trial. Zoledronic Acid and Clinical Fractures and Mortality after Hip Fracture. N Engl J Med 2007 Sep 26;[Epub ahead of print].
Level of evidence: I.
Reports of serious adverse drug events increasing
Moore TJ, Cohen MR, Furberg CD. Serious adverse drug events reported to the Food and Drug Administration, 1998-2005. Arch Intern Med 2007;167:1752-1759. Level of evidence: III.
Oophorectomy before menopause increases the risk for cognitive impairment
Rocca WA, Bower JH, Maraganore DM, et al. Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause. Neurology 2007;69:1074-1083. Level of evidence: II-2.
Total hip bone mineral density most reliable predictor of fracture risk
Leslie WD, Lix LM, Tsang JF, Caetano PA, for the Manitoba Bone Density Program. Single-site vs multisite bone density measurement for fracture prediction. Arch Intern Med 2007;167:1641-1647. Level of evidence: II-2.
Elevated levels of inflammatory cytokines significantly associated with risk for diabetes in postmenopausal women
Liu S, Tinker L, Song Y, et al. A prospective study of inflammatory cytokines and diabetes mellitus in a multiethnic cohort of postmenopausal women. Arch Intern Med 2007;167:1676-1685. Level of evidence: II-2.
Estrogen therapy does not adversely affect body composition
Thorneycroft IH, Lindsay R, Pickar JH. Body composition during treatment with conjugated estrogens with and without medroxyprogesterone acetate: analysis of the women’s Health, Osteoporosis, Progestin, Estrogen (HOPE) trial. Am J Obstet Gynecol 2007;197:137.e1-137.e7. Level of evidence: I.
Increased adiposity and weight gain are strong risk factors for psoriasis
Setty AR, Curhan G, Choi HK. Obesity, waist circumference, weight change, and the risk of psoriasis in women: Nurses’ Health Study II. Arch Intern Med 2007;167:1670-1675. Level of evidence: II-2.
Reproductive profile affects risk factors for CVD
Feng Y, Hong X, Wilker E, et al. Effects of age at menarche, reproductive years, and menopause on metabolic risk factors for cardiovascular diseases. Atherosclerosis 2007 Aug 3; [Epub ahead of print]. Level of evidence: II-3.
Trends in breast cancer incidence parallel changes in patterns of mammography screening and use of hormone therapy
Glass AG, Lacey JV Jr, Carreon D, Hoover RN. Breast cancer incidence, 1980-2006: combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status. J Natl Cancer Inst 2007;99:1152-1161. Level of evidence: III.
Downturns in incidence of breast cancer attributed to saturation in rates of screening mammography and reduced use of hormones
Jemal A, Ward E, Thun MJ. Recent trends in breast cancer incidence rates by age and tumor characteristics among U.S. women. Breast Cancer Res 2007;9:R28. Available online at http://breast-cancer-research.com/content/9/3/R28. Level of evidence: II-3.
Nonfasting triglyceride levels associated with risk for future cardiovascular events in women
Bansal S, Buring JE, Rifai N, Mora S, Sacks FM, Ridker PM. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA 2007;298: 309-316. Level of evidence: II-2.
Phytoestrogen genistein prevents bone loss in postmenopausal women with osteopenia
Marini H, Minutoli L, Polito F, et al. Effects of phytoestrogen genistein on bone metabolism in osteopenic postmenopausal women: a randomized trial. Ann Intern Med 2007;146:839-847. Level of evidence: I.
Hormone levels and mammographic density are each independently associated with risk for breast cancer
Tamimi RM, Byrne C, Colditz GA, Hankinson SE. Endogenous hormone levels, mammographic density, and subsequent risk of breast cancer in postmenopausal women. J Natl Cancer Inst 2007;99:1178-1187.
Level of evidence: III.
SSRIs but not TCAs increase hip bone loss in older women
Diem SJ, Blackwell TL, Stone KL, et al. Use of anti-depressants and rates of hip bone loss in older women: the Study of Osteoporotic Fractures. Arch Intern Med 2007;167:1240-1245. Level of evidence: II-2.
NAMS offers guidance on use of vaginal estrogen for treatment of vaginal atrophy
The North American Menopause Society position statement. The role of vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society. Menopause 2007;14:357-369. Level of evidence: III.
Increased risk for cardiovascular and thromboembolic events seen with hormone therapy in older postmenopausal women—results from WISDOM
Vickers MR, MacLennan AH, Lawton B, et al. Main morbidities recorded in women’s international study of long duration oestrogen after menopause (WISDOM): a randomised controlled trial of hormone replacement therapy in postmenopausal women. BMJ 2007 July 11;[Epub ahead of print]. Level of evidence: I.
WHI: Calcium and vitamin D supplementation may slightly inhibit postmenopausal weight gain
Caan B, Neuhouser M, Aragaki A, et al. Calcium plus vitamin D supplementation and risk of postmenopausal weight gain. Arch Intern Med 2007;167:893-902. Level of evidence: I.
Higher calcium and vitamin D levels protect against breast cancer in premenopausal women: data from the Women’s Health Study
Lin J, Manson JE, Lee I-M, Cook NR, Buring JE, Zhang SM. Intakes of calcium and vitamin D and breast cancer risk in women. Arch Intern Med 2007;167:1050-1059. Level of evidence: II-2.
Framingham Offspring Study promulgates algorithm of DM risk using simple clinical measures
Wilson PWF, Meigs JB, Sullivan L, Fox CS, Nathan DM, D’Agostino RB Sr. Prediction of incident diabetes
mellitus in middle-aged adults: the Framingham Offspring Study. Arch Intern Med 2007;167:1068-1074.
Level of evidence: II-2.
Less calcification in coronary arteries of postmenopausal women who received estrogen at a younger age: the WHI Coronary-Artery Calcium Study
Manson JE, Allison MA, Rossouw JE, et al, for the WHI and WHI-CACS Investigators. Estrogen therapy and coronary-artery calcification. N Engl J Med 2007;356:2591-2602. Level of evidence: I.
No association between age at menopause or menarche and breast cancer risk in BRCA1/2 carriers
Chang-Claude J, Andrieu N, Rookus, M, et al, for the Epidemiological Study of Familial Breast Cancer (EMBRACE), Gene Etude Prospective Sein Ovaire (GENEPSO), Genen Omgeving studie van de werkgroep Hereditiair Borstkanker Onderzoek Nederland (GEO-HEBON), the International BRCA1/2 Carrier Cohort Study (IBCCS) collaborators group. Age at menarche and menopause and breast cancer risk in the International BRCA1/2 Carrier Cohort Study. Cancer Epidemiol Biomarkers Prev 2007;16:740-746. Level of evidence: II-2.
Once-yearly infusion of bisphosphonate zoledronic acid reduces risk of fracture
Black DM, Delmas PD, Eastell R, et al, for the HORIZON Pivotal Fracture Trial. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 2007;356:1809-1822. Level of evidence: I.
Parathyroid hormone reduces vertebral fractures in osteoporotic women
Greenspan SL, Bone HG, Ettinger MP, et al, for the Treatment of Osteoporosis with Parathyroid Hormone Study Group. Effect of recombinant human parathyroid hormone (1-84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis: a randomized trial. Ann Intern Med 2007;146:326-339.
Level of evidence: I.
Estrogen does not improve endothelial function in older women with CAD
Yeboah J, Reboussin DM, Waters D, Kowalchuk G, Herrington DM. Effects of estrogen replacement with and without medroxyprogesterone acetate on brachial flow-mediated vasodilator responses in postmenopausal women with coronary artery disease. Am Heart J 2007;153:439-444. Level of evidence: I. |