Menopause and Common Dermatoses: A Systematic Review

This study aimed to assess the association of menopausal status and menopausal hormone therapy (MHT) with cardiovascular risk factors (CVRF) prevalence. We analyzed data from women aged 40 to 70yo, without previous cardiovascular disease, enrolled in the prospective CARVAR 92 cohort study conducted in the Hauts-de-Seine department, France, between 2010 and 2023. CVRF were assessed through blood analysis and medical check-up results. Menopausal status and hormone therapy use were self-reported. Of the 16,879 subjects included in CARVAR 92, 7395 women were analyzed including 2607 non-menopausal and 4788 menopausal women. After adjusting for age, menopausal women were at higher risk of obesity (OR, 1.44 [95% CI, 1.21, 1.70]; p<0.001), waist obesity (OR, 1.33 [95% CI, 1.17, 1.53]; p<0.001), hypertension (OR, 1.17 [95% CI, 1.01, 1.36]; p=0.049), diabetes mellitus (OR, 1.84 [95% CI, 1.31, 2.61]; p<0.001), and dyslipidemia (OR, 1.74 [95% CI, 1.49, 2.03]; p<0.001) compared to non-menopausal women. However, menopausal women using MHT did not show significant differences in the prevalence of CVRF compared to non-menopausal women. These findings remained robust across various models. Menopausal women exhibited an increase in all modifiable CVRF compared to non-menopausal women. MHT use may have a beneficial effect on the prevalence of these risk factors. These findings highlight the importance of considering menopausal status and MHT use when assessing and managing cardiovascular risk in women.

Menopausal symptoms and hormone therapy in women with multiple sclerosis: A baseline-controlled study

Overview: Lipoprotein(a) (Lp(a)) is a risk factor for atherosclerotic coronary artery disease (CAD). Little is known about menopausal status and hormone therapy in racial/ethnic-specific associations of elevated Lp(a) with CAD. We investigated this in an age- and racially-diverse cohort of women from the U.S.’s largest integrated healthcare system. Methods: We extracted structured cross-sectional electronic health record data for 2831 women with a laboratory result for Lp(a) between 1999-2023 in the Veterans Health Administration. We designated menopausal status (pre, surgical, natural), use of hormone contraception or menopausal hormone therapy (HT), and history of CAD as of the Lp(a) test date. Elevated Lp(a) was Lp(a) &gt;125 nmol/L. Using multivariate logistic regression with correction for multiple comparisons, we estimated association of elevated Lp(a) with prevalent CAD adjusted for age, race/ethnicity, menopausal status, and HT. Within menopausal subgroups, we conducted analogous multivariate logistic regressions. We tested for interaction between Lp(a) and menopausal status and between HT and race/ethnicity. Results: Elevated Lp(a) was associated with prevalent CAD among all women (OR=1.5, 95% CI [1.2, 1.9], p&lt;0.002). In subgroup analysis by menopause status, elevated Lp(a) was associated with prevalent CAD only for women over 60 with natural menopause (OR=2.1, 95% CI [1.5, 3.0], p&lt;0.001). An interaction model between elevated Lp(a) and menopause status on prevalent CAD was assessed with premenopausal women under 60 without elevated Lp(a) as the reference group. Premenopausal women under 60 with elevated Lp(a) had an OR of 1.4 (95% CI [0.8, 2.5] p=0.274). Women over 60 with natural menopause and without elevated Lp(a) had an OR of 4.9 (95% CI [3.4, 7.3], p&lt;0.001). Women over 60 with natural menopause and elevated Lp(a) had the highest OR of 10.4 (95% CI [6.7, 16.0], p&lt;0.001). Relative excess risk due to interaction (RERI) of 5.1 (95% CI [2.2, 9.7]) supports an additive interaction of menopausal status over/under age 60 with Lp(a) on risk of prevalent CAD. The p-value for multiplicative interaction was 0.22. In smaller-sized menopausal subgroups, no observations were observed between race/ethnicity and HT on risk of elevated Lp(a) or on prevalent CAD. Conclusions: Menopausal status over age 60 and elevated Lp(a) (&gt;125 nmol/L) interacted to modify the risk of prevalent CAD. HT use as a possible effect modifier, by race/ethnicity, warrants further exploration.

Hormone therapy may be prescribed to support individuals experiencing symptoms of menopause due to a decline in estrogen in the body. Menopausal symptoms may vary in frequency and intensity, and commonly include vasomotor symptoms (VMS) (often referred to as hot flashes or night sweats), sleep disruption, and mood changes, and may include impacts to bone or heart health and overall quality of life. For individuals seeking support managing these symptoms, menopausal hormone therapy (MHT) with estrogen (or a combination of estrogen and progesterone) is an established treatment. Various routes of administration (ways to take estrogen) are available for MHT with estrogen, including oral (taken as a pill) or transdermal (absorbed through the skin), but the comparative clinical efficacy, effectiveness, and safety of these administration routes are unclear. Decision-makers are interested in whether transdermal estrogen should be considered for public reimbursement (funding) as a first treatment option (first-line option), as an alternative to oral estrogen for MHT. We evaluated the evidence of the clinical efficacy, effectiveness, safety, and cost-effectiveness (value from a human or health system perspective) of transdermal versus oral estrogen in MHT using a rapid review approach. We searched for evidence-based guidelines on the use of transdermal or oral estrogen in MHT. We identified 7 systematic reviews, 4 primary studies, and 3 clinical practice guidelines relevant to this review. No relevant health technology assessment (HTA) reports or cost-effectiveness studies were identified. The included studies suggest that transdermal estrogen may reduce VMS, improve sleep, and have a lower risk of blood clots compared to oral estrogen. Both transdermal and oral MHT may improve bone health and have similar safety risk profiles for breast and gynecological cancers. Furthermore, transdermal MHT may be a safer choice for those at risk of developing blood clots; however, there are inconsistent results related to the risk of heart disease and stroke. The included studies suggest oral MHT is more effective at improving cholesterol levels but may raise triglyceride levels. In contrast, transdermal MHT has mixed effects on cholesterol levels, though it also raises triglyceride levels. Guideline recommendations consider transdermal MHT over oral MHT for addressing specific individual concerns related to sexual well-being and reducing risk for gallstones, blood clots, stroke, and heart disease. There is limited evidence comparing transdermal and oral MHT, particularly for managing VMS, health-related quality of life, and sleep quality. However, some studies suggest transdermal MHT may have a lower risk of venous thromboembolism (VTE) (blood clots in the veins). Given these safety considerations, policymakers may consider reimbursement for transdermal MHT, but additional research is needed to inform consideration for efficacy and cost-effectiveness.

Simple SummaryMany epidemiological studies have examined the relationship between cutaneous malignant melanoma (CMM) and both endogenous oestrogen exposure (e.g., age at menarche and parity) and exogenous hormone use (e.g., oral contraceptives (OCs) and menopausal hormone therapy (MHT)). Though a previous meta-analysis investigating the relationship between characteristics of female endocrine status and CMM risk found no significant association, the potential role of THERAPY AS oral contraceptive (OC) and hormonal replacement therapy (MHT) use still remains controversial. Since then, several studies have been published about the therapy with contrasting results, while CMM incidence continues to increase with a significant gender divergence. The therapy of OC and MHT may play a role in CMM and the removal of this could be useful as emerging therapeutics in melanoma. Therefore, we conducted this systematic review and meta-analysis to summarize the evidence and derive a more accurate estimation of exogenous hormone factors in women and CMM.The influence of exogenous female hormones on the risk of developing malignant melanoma in women remains controversial. The aim of our review and meta-analysis is to summarize the evidence and derive a more accurate estimation of the association between oral contraceptives (OCs) or menopausal hormone therapy (MHT) and the risk of developing malignant melanoma in women. PubMed, Web of Science, and Scopus database were searched for studies published up until October 2021. The PRISMA statement and MOOSE guidelines were followed. Studies were pooled using a random effects model. Heterogeneity was explored with the chi-square-based Cochran’s Q statistic and the I2 statistic. Publication bias was assessed with Begg’s test and Egger’s test. Forty-six studies met the eligibility criteria. The pooled analysis (26 studies) on OC use and the risk of developing cutaneous malignant melanoma (CMM) showed no significant association, but demonstrated significant association for cohort studies (OR 1.08, 95% CI 1.01–1.16; I2 = 0.00%, p = 0.544). The pooled analysis (16 studies) showed a significantly increased risk of CMM in association with MHT (OR 1.15, 95% CI 1.08–1.23; I2 = 25.32%, p = 0.169). Stratifying the results by study design showed that a significant increased risk of CMM was associated with MHT in the cohort studies (OR 1.12; 95% CI 1.04–1.19; I2 = 0%, p = 0.467). No significant publication bias could be detected. Further studies are needed to investigate the potential association with formulation, duration of use, and dosage of use, and to better understand the role of possible confounders.

Prescribing postmenopausal hormone therapy to women in their 50s in the post-Women's Health Initiative era

Introduction: Evidence from clinical trials and observational studies on the relationship between menopausal hormone therapy (MHT) and cardiovascular disease (CVD) risk has been discordant. Hypothesis: We hypothesized that the association between MHT and risk of CVD might be affected by both age at menopause and age when initiated MHT. Methods: We harmonised and pooled individual-level data from 15 studies across five countries/regions (Australia, Scandinavia, USA, Japan, and UK). Postmenopausal women who had reported their MHT status (user or non-user) and CVD status (occurred or not, including coronary heart disease (CHD) and stroke) were included. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for the association between MHT use and incident CVD. We stratified the analyses by age when initiated MHT and age at natural menopause to examine the interaction between MHT, age initiated MHT, and age at menopause on incident CVD. Results: Overall, 190 625 postmenopausal women were included. We identified 10 601 incident CVD events, including 7615 CHD and 3543 strokes. Around 39% (74 585) women were MHT users. Compared to non-users of MHT, women who were MHT users had 10% higher risk of incident CVD (HR 1.10, 95% CI 1.06-1.14), with HR (95% CI) of (1.15, 1.10-1.20) for CHD and (1.02, 0.96-1.09) for stroke. After stratifying by age at natural menopause, women who experienced menopause after age 45 years and took MHT had around 15% higher risk of CHD, while the significant association with incident stroke was only observed in women who had menopause after 55 years (1.16, 1.01-1.33). After a further stratification by age initiated MHT, we found the significant associations between MHT users and incident CVD were only observed in women who experienced menopause after age 45 years and took MHT at age 60 years or old (Table 1). Conclusions: Postmenopausal women who experienced natural menopause after age 45 years and took MHT after age 60 years had increased risk of incident CVD.

IntroductionThe female sex steroids estrogen and progesterone are important in breast cancer etiology. It therefore seems plausible that variation in genes involved in metabolism of these hormones may affect breast cancer risk, and that these associations may vary depending on menopausal status and use of hormone therapy.MethodsWe conducted a nested case-control study of breast cancer in the California Teachers Study cohort. We analyzed 317 tagging single nucleotide polymorphisms (SNPs) in 24 hormone pathway genes in 2746 non-Hispanic white women: 1351 cases and 1395 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by fitting conditional logistic regression models using all women or subgroups of women defined by menopausal status and hormone therapy use. P values were adjusted for multiple correlated tests (PACT).ResultsThe strongest associations were observed for SNPs in SLCO1B1, a solute carrier organic anion transporter gene, which transports estradiol-17β-glucuronide and estrone-3-sulfate from the blood into hepatocytes. Ten of 38 tagging SNPs of SLCO1B1 showed significant associations with postmenopausal breast cancer risk; 5 SNPs (rs11045777, rs11045773, rs16923519, rs4149057, rs11045884) remained statistically significant after adjusting for multiple testing within this gene (PACT = 0.019-0.046). In postmenopausal women who were using combined estrogen-progestin therapy (EPT) at cohort enrollment, the OR of breast cancer was 2.31 (95% CI = 1.47-3.62) per minor allele of rs4149013 in SLCO1B1 (P = 0.0003; within-gene PACT = 0.002; overall PACT = 0.023). SNPs in other hormone pathway genes evaluated in this study were not associated with breast cancer risk in premenopausal or postmenopausal women.ConclusionsWe found evidence that genetic variation in SLCO1B1 is associated with breast cancer risk in postmenopausal women, particularly among those using EPT.

Menopause and menopausal hormone therapy in women: cardiovascular benefits and risks

Objective: To evaluate whether menopausal status and symptoms among female gynecologists would influence their clinical behavior related to menopausal hormone therapy (MHT).Methods: Female gynecologists of 11 Latin American countries were requested to fill out the Menopause Rating Scale and a questionnaire containing personal information and that related to MHT use.Results: A total of 818 gynecologists accepted to participate (86.4%). Overall, the mean age was 45.0 ± 10.7 years, 32.2% were postmenopausal, and 17.6% worked in an academic position; 81.8% reported that they would use MHT if they have symptoms, regardless of menopausal status. Academic gynecologists favor personal MHT use at a higher rate (p = 0.04) and have a higher MHT prescription rate as compared to non-academic ones (p = 0.0001). The same trend was observed among post- as compared to premenopausal ones (p = 0.01) and among those who had hysterectomy alone as compared to those experiencing natural menopause (p = 0.002). The presence of menopausal symptoms did not influence their MHT prescription. Current use of MHT and alternative therapy was higher among post- than premenopausal gynecologists (both, p = 0.0001) and among those who had undergone hysterectomy than those experiencing natural menopause. A 38.5% perceived breast cancer as the main risk related to MHT, and a high proportion prescribed non-hormonal drugs (86.4%) or alternative therapies (84.5%).Conclusion: Most female gynecologists in this survey would use MHT if menopausal symptoms were present. Postmenopausal physicians use MHT and prescribe it to their symptomatic patients at a higher rate than premenopausal physicians.

Objective Menopause is a significant and natural phase in a woman’s life, representing a transition that requires early understanding to manage its effects and promote overall well-being. This study aimed to evaluate the awareness, understanding and perceptions of menopause and menopausal hormone therapy (MHT) among premenopausal women in southern China. Methods A cross-sectional design was employed to enroll women aged 18–40 years (n = 1631) from August 2022 to January 2023 at a public hospital in Fujian, China. A structured questionnaire, developed from existing research and the Climacteric Scale, was used to assess women’s menopausal symptoms and MHT knowledge. Face-to-face interviews were conducted to identify factors correlated with menopausal knowledge levels. Results More than 50% of women demonstrated a comprehensive understanding of menopause. Education level was a significant predictor of menopause knowledge (p < 0.001), with women holding higher education (college degree or above) demonstrating greater knowledge than those with lower education (high school or below). High awareness of common menopausal symptoms, including irritability, sleep disturbances, fatigue, difficulty concentrating and hot flashes, was observed. Although most participants lacked detailed knowledge of MHT, they agreed on the importance of managing menopausal symptoms and recognized the usefulness of MHT for symptom management. Conclusions Premenopausal women in southern China possess a basic understanding of menopause but lack sufficient knowledge about MHT. This highlights the need for educational initiatives and targeted counseling to increase awareness of menopause and MHT, especially regarding its implications and treatment options.

Disclosure: D. Bechenati: None. R. Castaneda: None. R.D. Rivera Gutierrez: None. M.A. Espinosa: None. J.L. Villamarin: None. E. Tama: None. J.L. Meek: None. S. Faubion: Era Women’s Health Platform, PriMed, AiCME, MedAll, Medscape, Weight Watchers. C. Shufelt: Bayer Pharmaceutics. T. Rajjo: None.Given the metabolic changes associated with menopause (increased abdominal fat, decreased muscle mass, altered energy expenditure), menopause hormone therapy (MHT) may influence weight loss outcomes. Although semaglutide studies suggest a potential benefit of MHT on weight loss in postmenopausal women, the impact of tirzepatide (TZP) remains unclear. This real-world study investigates whether TZP efficacy differs between postmenopausal women using MHT (+MHT) and those not using MHT (-MHT) in the treatment of overweight or obesity. This retrospective cohort study included postmenopausal women prescribed TZP for the treatment of overweight or obesity, with or with MHT. Exclusion criteria were <12 months of TZP use, prior bariatric surgery, active malignancy, and concomitant anti-obesity medication. MHT consisted of transdermal or oral estrogen, with or without progesterone. Data, collected through November 1, 2024, were obtained from electronic medical records. To minimize confounding, 1:2 propensity score matching was used, matching each +MHT participant to two -MHT controls based on age, BMI, age at menopause, menopause type, and diabetes status. Primary endpoints were total body weight loss percentage (TBWL%) at 3, 6, 9, 12, and 15 months, and at last follow-up. Secondary endpoints included the percentage of participants achieving ≥5%, ≥10%, ≥15%, and ≥20% TBWL. Data was non-normal distributed, as such results are presented as median [interquartile range (IQR)], and group comparisons used the Wilcoxon rank-sum test. After propensity score matching of 400 postmenopausal women, 120 were included in this analysis: 40 in the +MHT group (56 [53-58] years, BMI 34 [31-37] kg/m²) and 80 in the -MHT group (57 [53-61] years, BMI 33 [29-36] kg/m²). Baseline characteristics and adiposity-related comorbidities were similar between groups. The median follow-up duration was 18 [15-22] months for the +MHT group and 18 [16-22] months for the -MHT group, with no significant difference between the groups (p=0.4). At the last follow-up, the +MHT group achieved significantly greater TBWL compared to the -MHT group: 17% [11-25] vs 14% [8-18] (p=0.01). Additionally, by the last follow-up, a higher proportion of women in the +MHT group achieved ≥20% TBWL (45% vs. 18%, p=0.001) compared to the -MHT group. In postmenopausal women with overweight or obesity treated with TZP, the use of MHT is associated with superior weight loss outcomes. Further studies with larger sample sizes are needed to confirm these findings and to explore the mechanisms driving this differential weight loss response.Presentation: Saturday, July 12, 2025

Menopausal hormone therapy (MHT) is a supplemental treatment with exogenous estrogen for women with ovarian failure to solve health problems related to low sex hormone. It is no doubt that MHT is beneficial for relieving menopausal symptoms, treating genitourinary atrophy of menopause, and preventing osteoporosis. MHT has undergone nearly 80 years of development, and understanding of its benefits and risks has been changing over time. Particularly, the publication of the report of mid-term research of Women's Health Initiative that is a randomized controlled trial in 2002 largely influenced the application of MHT globally. It was reported that the use of conjugated equine estrogens(CEE) and medroxyprogesterone acetate(MPA) was associated with increased risks of cardiovascular disease and breast cancer in old women, which reencouraged the exploration of benefits and risks of MHT to menopausal women in the past 18 years. Today, it is widely accepted that the effects of MHT are related to several factors, including age at which MHT is started, age when menopause occurs, the type, dosage and route of MHT, duration of treatment, health status, and whether MHT is standardized and well-managed. This article discussed the benefits and risks of MHT based on various guidelines, consensus and articles on MHT published in the past ten years.

Does exposure to menopausal hormone therapy (MHT) in mid-aged women alter their risk of cardiovascular disease (CVD) mortality and all-cause mortality? MHT soon after menopause is unlikely to increase the risk of CVD mortality or all-cause mortality and may have a protective effect for women with hysterectomy/oophorectomy. The balance of benefits and risks of MHT are currently unclear and may differ according to when treatment starts and whether women have an intact uterus. A total of 13 715 participants from the mid-aged population-based cohort (born 1946-1951) of the Australian Longitudinal Study on Women's Health (ALSWH) were followed from 1998 to 2013. The measures included cardiovascular and all-cause mortality, exposure to MHT and menopausal status (based on 3-yearly self-reports). Electronic prescriptions data on MHT were also available from mid-2002 onwards. At each follow-up survey wave, participants were classified as: an existing user of MHT, an initiator of MHT or a non-initiator of MHT. After adjusting for confounding variables, existing users of MHT had a reduced risk (hazard ratio 0.63; 95% CI, 0.43-0.92) of CVD mortality compared with non-initiators. Insufficient evidence of an association was identified for initiators of MHT (0.66; 0.35-1.24). For all-cause mortality, risks were reduced for both initiators (0.69; 0.55-0.87) and existing users (0.80; 0.70-0.91). In a subgroup analysis, women with hysterectomy/oophorectomy had lower risks of CVD mortality for both initiators (0.14; 0.02-0.98) and existing users (0.55; 0.34-0.90), but no evidence of an association was found for women whose MHT commenced during or after menopause. Similarly for all-cause mortality, only the women with hysterectomy/oophorectomy had lower risks for both initiators (0.47; 0.31-0.70) and existing users (0.69; 0.58-0.82). Limitations include the observational nature of the study, the small number of deaths, MHT use being self-reported and the classification of menopausal status also being based on self-reported information. Women considering MHT soon after menopause can be reassured that the treatment is unlikely to increase their risk of CVD mortality or all-cause mortality. The Australian Longitudinal Study on Women's Health is funded by the Australian Department of Health. G.D.M. is funded by the Australian Research Council Future Fellowship. L.C. was funded by a China scholarship council (CSC) graduate scholarship. All authors report no conflict of interest. N/A.

Global Consensus Statement on menopausal hormone therapy