Hot Flashes Research Articles

7985 Insights into the Menopausal Transition: A Comparative Analysis of Hypothalamic Reproductive Aging in Women and a Mouse Model of Menopause

Abstract Disclosure: J.C. Bloom: None. S.A. Pereira: None. E. Torres Jimenez: None. D.C. Page: None. V.M. Navarro: None. Menopause onset is the major determinant of reproductive lifespan in women and is characterized by the decline in estrogen production from the ovary. While much of our current understanding of the menopause transition in humans comes from a series of observational longitudinal studies initiated in the 1980s and 1990s, the mechanisms by which reproductive aging impacts healthy brain aging remains a profoundly under-studied aspect of women’s health. The hypothalamus, a hub of homeostatic and temperature regulation, is highly sensitive to changes in sex steroid levels. Recently, activation of the neurokinin 3 receptor (NK3R) by neurokinin B (NKB) has been linked to the onset of vasomotor symptoms (VMS) during menopausal transition. NKB is secreted by hypothalamic Kisspeptin, NKB, Dynorphin (KNDy) neurons in response to decreasing estradiol levels. Here, we present a comparative study of the expression trajectories of the KNDy genes (KISS1, TAC3, PDYN, respectively) and NK3R (TACR3) in hypothalamic samples of humans across menopause and a mouse model of peri- and post-menopause (short- and long-term ovariectomy (OVX), respectively). RNA-sequencing data of human and mouse hypothalamic samples revealed a high correlation in the expression profile of the KNDy/NK3R genes between both species. Further investigation has revealed a highly conserved pool of genes in human and mouse hypothalami that correlate with TACR3 upon decline of circulating sex steroids. Thus, by examining conserved gene expression patterns across this critical reproductive period, we have been able to identify novel candidate targets involved in menopausal transition which may serve to better elucidate the biology of menopause-associated conditions affecting the brain, such as VMS and cognitive decline. Presentation: 6/2/2024

Impact of Castration on the Sexual Life in Young Women at the National Institute of Oncology of Rabat, Morocco

Introduction: Castration, also referred to as hormonal suppression, is generally understood as the halt of hormone production by the ovaries in premenopausal women. This can occur through medical means, such as the administration of LH-RH agonists or antagonists that act reversibly on the hypothalamic- pituitary axis, or through surgical or radical methods that permanently eliminate hormonal production. Castration is primarily recommended for premenopausal women with hormone receptor-positive breast cancer. Regardless of the approach used, it produces side effects akin to those experienced during menopause, including hot flashes, anxiety, depressive disorders, and trophic changes that may affect sexual function. Thus, our study seeks to investigate the effects of castration on sexual life in our patients undergoing treatment for hormone receptor-positive breast cancer. Materials and Methods: This study was carried out at a day hospital to assess the effects of mainly medical, but also surgical and radical castration on couple dynamics in 50 patients, averaging 40 years of age, who are being treated for hormone receptor-positive breast cancer, regardless of whether it is localized or metastatic. Results: The majority of patients report experiencing side effects associated with castration, especially hot flashes, which affect nearly all patients, as well as depressive and anxiety disorders. However, it remains challenging to determine whether these issues are directly linked to the disease or its treatment. Additionally, many patients face sexual disturbances, including decreased libido and vaginal dryness, which significantly impact couple dynamics in almost 50% of cases. Conclusion: Investigating the effects of castration on sexuality, particularly regarding couple dynamics, highlights a significant yet sensitive topic. This issue, often considered taboo, represents a major side effect of prolonged treatment in long-term survivors. Therefore, it is essential to engage in regular discussions and collaborate with specialists, especially sexologists, to enhance tolerance and achieve lasting improvements in quality of life.

7053 Sex Differences in Endocrine-Related Pre-existing, COVID-19- and COVID-19 Vaccine-Related Health Conditions and Adverse Events

Abstract Disclosure: J. Knapp: Other; Self; Co-founder, Aseesa Inc. R. Karumanchi: None. C. Fee: None. S. Inslicht: None. A. Bhargava: Other; Self; Co-Founder, Aseesa Inc. COVID-19 illness-related symptoms and outcomes are highly variable, with reported sex differences. mRNA vaccines were deployed for the first-time on a large scale for COVID-19, and the endocrine effects of Pfizer’s and Moderna’s mRNA vaccines, remain to be elucidated. Associations between COVID-19 illness and/or COVID-19 vaccines and reproductive disturbances have been reported based on large nation-wide surveys and targeted studies. Yet, none of the studies have directly ascertained similarities and differences between reproductive adverse outcomes from COVID-19 illness in unvaccinated individuals versus COVID-19 mRNA vaccines in individuals without COVID-19 illness. Here, we report preliminary findings on endocrine systems from a global survey of ∼8,000-10,000 participants collected between February 2022 and October 2023. Approximately 62.5% of the participants were from the United States, and the remaining were international. Nearly 1.49% of respondents reported hospitalization after COVID-19, whereas 5.69% of the respondents reported hospitalization after vaccination in our cohort. SARS-CoV-2-related severe symptoms were reported by ∼9.3% of COVID-19 vaccinated versus 6.7% of unvaccinated individuals (p<0.001). Women reported more vaccine-related adverse events (AEs) than men; 30% of men and 19% of women reported no AEs after any vaccination dose. After the first dose, 60% women and 48% of men reported some AEs, whereas after the second dose, 46% of women and 40% of men reported experiencing several AEs. Sex differences were present in endocrine and autoimmune pre-existing health conditions, including thyroid disease (13%F vs 3%M), osteoporosis (6%F vs 1%M), elevated cholesterol (M>F), and hypertension (M>F). Nearly 5% of women reported pre-existing irregular menstrual cycle irregularities and hormonal changes, whereas only 2% of men reported hormonal irregularities. In unvaccinated individuals, after COVID-19 illness, nearly 6% of women reported experiencing hot flashes, whereas 7.5% reported irregular menstrual cycles. In COVID-19 vaccinated individuals without SARS-CoV-2 infection, 94.6% of men and 62.5% of women respondents reported no reproductive changes. Of those reporting reproductive AEs included hormonal changes in 5% of women and 3.5% men, hot flashes in 8.5% women and 1.9% men, heavy periods and/or dysmenorrhea in 16.7% of women, and irregular periods in17.1% of women. In summary, reproductive AEs in vaccinated individuals without COVID-19 illness were more frequent than in unvaccinated individuals with COVID-19 illness. A detailed and thorough follow-up is needed to better understand if pre-existing health conditions exacerbated vaccine-associated AEs. Presentation: 6/3/2024

7071 Cushing disease presenting with Dilated Cardiomyopathy

Abstract Disclosure: H. Majeed: None. C. Nguyen: None. R. Galagan: None. D. Lovre: None. Background: Hypercortisolism manifests with numerous ways due to the wide distribution of glucocorticoid receptors. Here we describe a case of Cushing’s disease presenting with reversible non-ischemic cardiomyopathy. Case Presentation: A 30-year-old male presented to ER with palpitations, dyspnea, and atypical chest pain. His exam was notable for a BMI of 30.26 kg/m2, HR 76 bpm and BP of 200/110 mm Hg. His EKG revealed Left ventricular hypertrophy. Echocardiogram (ECHO) showed an EF of 25-30% with diffuse hypokinesis. An angiogram demonstrated normal coronary anatomy. He was started on Lisinopril, Carvedilol, and Spironolactone for non-ischemic cardiomyopathy. He also complained of a 40 lb weight gain, loss of libido, hot flashes and breast tenderness. He was referred to endocrinology. Initial evaluation demonstrated total testosterone (TT) of 171 ng/dl (286-1511 ng/dl), FSH 3.8 IU/L (2-12 IU/L), LH 5.6 IU/L (2-9 IU/L) consistent with secondary hypogonadism. Further pituitary workup revealed AM cortisol level 31.22 mcg/dl (4.3-22.4mcg/dl), ACTH 79 pg/ml (7.2 - 63.3pg/ml), IGF-1 257 ng/mL (88-246 ng/mL), Prolactin 23.7 ng/dl (2.1- 17.7ng/dl), TSH 0.54 mIU/l (0.35-3.74mIU/l) and FT4 0.6 ng/dl (0.76-1.46 ng/dl). A 24hr urine cortisol was 167 ug(0-50ug/24h) and midnight salivary cortisol 0.160 ug/dl (<0.010-0.090 ug/dl). An overnight 1mg dexamethasone suppression test (DST) resulted in AM cortisol of 20.95 mcg/dl (<1.8mcg/dl) and 8mg DST cortisol fell from 34 mcg/dl to 4.16 mcg/dl. A pituitary MRI revealed a left 6 mm x 4 mm microadenoma. He was treated with levothyroxine pre-op for central hypothyroidism. He underwent transsphenoidal resection of the pituitary adenoma. Post-op AM cortisol was 1.1 mcg/dl. His steroid withdrawal syndrome was treated with a prolonged course of tapered hydrocortisone. Two months post-op ECHO showed EF of 55-60%. His BP normalized on carvedilol alone. Eighteen months post-op he no longer required any hormone replacement. Repeat ACTH 24.4 pg/ml, Total Testosterone 584ng/dl, TSH 0.57 mIU/l and FT4 0.93 and 24hr urine cortisol was 24ug/dl, MN salivary cortisol <0.10 ug/dl confirming remission of his cushing's disease and resolution of secondary hypogonadism and hypothyroidism. Conclusion: Prolonged hypercortisolism can cause abnormal cardiac remodeling resulting in cardiomyopathy. Surgical remission of Cushing’s disease reverses hypercortisolism which may restore normal cardiac function. Presentation: 6/2/2024

5142 Pheochromocytoma In The ICU- Hiding In Plain Sight

Abstract Disclosure: N. Chandrashekar: None. B. Arafah: None. Introduction: Pheochromocytomas are catecholamine-secreting tumors that are rare but dangerous and occur in <0.2% of patients with hypertension. Case: A 28 year old female with a 10 year history of hypertension and invasive stage 2b cervical cancer s/p chemoradiation presented to the hospital with circulatory shock from Takutsubo cardiomyopathy requiring intubation, vasopressors, CVVH, and ECMO. The endocrinology service was consulted due to a highly vascular, 3.6 cm, ∼23 Hounsfield units right adrenal mass evidenced on CT abdomen done months prior to admission. There were elevations in plasma normetanephrine to 15 nmol/L (ref <0.90 nmol/L), plasma metanephrine to 1.5 nmol/L (ref <0.50 nmol/L), urinary metanephrine to 565 ug/24-hours (ref 36 - 209 ug/24-hr), and urinary normetanephrine to 2580 ug/24-hr (ref 95 - 449 ug/24-hr). With her acute illness and recent use of vasopressors and quetiapine, these labs could not be accurately interpreted, and outpatient follow up was recommended. She was discharged home on metoprolol and hydralazine for hypertension management by her primary team. She was re-admitted to the CICU 2 days later for hypertensive emergency with flash pulmonary edema. With further questioning, she endorsed longstanding hypertension with episodes of headaches, palpitations, and vomiting. Her cancer therapy related menopause caused frequent nighttime hot flashes while inpatient. These episodes precipitated witnessed symptoms of catecholamine release with severe hypertension and palpitations. It was noted during her hospitalization that her symptoms were controlled during the day with frequent escape during the night despite continuous alpha and subsequent beta blockade every 6 hrs. Estrogen therapy would have been beneficial, however given a recent DVT, this was avoided and instead megestrol acetate and venlafaxine were used. With these additions, her adrenergic spells completely resolved. She then underwent a right adrenalectomy and had no significant fluctuations in her BP intraoperatively with complete resolutions of symptoms postoperatively. The pathology revealed a right 2.7 cm pheochromocytoma with no local invasion or distant metastasis. Conclusion: This is a case of pheochromocytoma crisis with cardiogenic shock followed by subsequent hypertensive emergency in the setting of inappropriate beta-blocker use. Confounders like vasopressors (increases catecholamines), intrinsic stress of critical illness (increases catecholamines), and quetiapine use (can increase normetanephrine levels) make it difficult to analyze labs. In these cases, a thorough history and imaging are key to establishing a diagnosis and initiating life-saving treatment. Another unique feature of this case is the control of the patient’s triggering menopausal hot flashes with megace and venlafaxine to preempt adrenergic spells during her admission. Presentation: 6/2/2024

8648 Association of isoflavone intake and age at natural menopause

Abstract Disclosure: M. Mitsunami: None. E.R. Bertone-Johnson: None. A. Eliassen: None. J.E. Chavarro: None. Introduction: Isoflavones, a type of phytoestrogens found mainly in soy and legumes, are structurally similar to estrogens and are consumed at a relatively high rate by Asian populations with an average intake of approximately 15-40 mg/d for isoflavone. They have been reported to alleviate menopausal symptoms, such as hot flashes, suggesting that isoflavones may be biologically active in a low-estrogen environment. Previous studies have reported inconsistent associations between the intake of soy and isoflavones and age at natural menopause. Therefore, our aim was to test the hypothesis that higher isoflavone intake is related to higher age at natural menopause. Methods: We followed 85,810 premenopausal women (mean [SD], 36.5 [4.7] year) who completed a previously validated food frequency questionnaire, had not been diagnosed with cancer, and did not undergo any menopausal hormone therapy as of 1991. Diet was assessed every 4 years. Isoflavone intake was estimated from these reports. Participants self-reported their menopausal status and the type of menopause (natural, surgical, and radiation or chemotherapy) every 2 years. We used proportional hazard regression models with age in months to evaluate the relation of isoflavone intake with age at natural menopause where natural menopause was the study outcome and menopause due to surgery, radiation, or chemotherapy were censoring events. We used restricted cubic splines to assess the possibility of non-linear relations between isoflavone intake and age at menopause using the U.S. average isoflavone intake (0.8mg/d) as a reference while adjusting for potential confounders, including age at menarche, BMI, race/ethnicity, smoking status, physical activity, parity, breastfeeding, time to regular menstrual cycle, energy intake, and two dietary factors identified by principal component analysis. Results: Over 1,079,608 person-years, we observed 37,438 cases of natural menopause. Soy products contributed approximately half of isoflavone intake. There was a non-linear association between isoflavone intake and age at natural menopause (p<0.001). Women with isoflavone intakes below the U.S. national average were more likely to experience earlier onset menopause. Conversely, in women with intakes above the national average, the risk of menopause decreased with increasing isoflavone intakes, albeit plateauing at intakes of approximately 3-4mg/d (90-95th percentile of observed distribution). There was a suggestion of a positive association between isoflavone intake and earlier onset menopause for intakes above the 99th percentile of the observed distribution (∼14 mg/d). Conclusion: This study suggests a non-linear relation between isoflavone intake and age at natural menopause with a potential later onset of menopause at intake levels higher than typical in the US diet but lower than those typically observed in East Asia. Presentation: 6/2/2024

8131 A Rare Case of Autoimmune Polyendocrine Syndrome; a Menopause Despite Replacement Therapy

Abstract Disclosure: M.E. Chacon Cruz: None. M. Sanchez Cordero: None. R.M. Roman Torres: None. G. Guerra Velazquez: None. Polyendocrinopathy is a heterogeneous group of disorders leading to dysfunction of multiple endocrine glands and other tissues. The syndromes can occur in patients from early infancy to old age and new components of a given syndrome can appear throughout life. APS can be classified into APS type 1 and APS2-4. APS-1 is a rare monogenic autosomal recessive autoimmune disorder consisting of the triad of chronic mucocutaneous candidiasis, hypoparathyroidism and adrenal insufficiency. APS2 require presence of Addison disease, autoimmune thyroid disorder and type 1 diabetes. APS 3 requires presence of Thyroid autoimmune disease associated with other autoimmune diseases. APS4 is a combination of organ specific autoimmune disease non included in a previous group. Autoimmune oophoritis is found in approximately 4 percent of females who presented with spontaneous primary ovarian insufficiency and may occur in type I and II syndromes of polyglandular autoimmune failure. This is the case of 44 year old female patient with history of hypertension, hypoparathyroidism diagnose at the age of 9 year old, vitiligo and premature ovarian failure diagnose at the age of 16 year old. Patient reported that started with multiple episodes of watery non bloody diarrhea and arthralgia. Patient went to her Pediatrician and they found hypocalcemia hyperphospathemia. Patient mineral was replaced with medication and then followed by pediatric endocrinologist. Patient continues with normal life, but menstrual periods had not started even at age 16th. Laboratory work up was done and premature ovarian failure was diagnosed after that, patient started with progesterone and estrogen to induce menstrual periods. Menstrual periods began regularly and monthly. Patient continues taking medication regularly, phoslo, calcitriol, progestin and estradiol without problem until this year that despite regular medication, started with signs and symptoms of menopause with irregular menstrual periods, palpitations hot flashes, sweating, anxiety and sleep problems. Patient met criteria for APS4 due to combination of organ specific autoimmune disease such premature ovarian failure, vitiligo and hypoparathryroidism. This case is extremely important since despite the fact that there is no family history of either endocrinological or autoimmune diseases, our patient debuts throughout her life with several autoimmune diseases, such as premature ovarian failure and vitiligo. Patient had Schedule appointment with gynecologist who increased the dose of progestin and estradiol. This case highlights the importance of being vigilant about new components of a syndrome developing at different times though a patient's life. As described, autoimmune diseases commonly are related to other diseases, but without a good clinical history and physical examination could be misdiagnosed affecting the quality of life of those patients. Presentation: 6/2/2024

8208 Unexpected And Significant Rise In TSH In The Setting Of Relugolix Use

Abstract Disclosure: A.Y. Groysman: None. A. Poloju: None. P. Majety: None. T. Abraham: None. Background: Relugolix is a gonadotropin-releasing hormone antagonist used as androgen deprivation therapy for metastatic and nonmetastatic castration-resistant prostate cancer that was FDA-approved in December 2020. Common side effects include hot flashes, increased glucose and triglycerides, and decreased hemoglobin. We report a case of Relugolix interference with the absorption of levothyroxine, which has not been reported in the literature. Case: A 79-year-old white man with high-risk, Gleason 9 prostate cancer and Hashimoto’s hypothyroidism presented for evaluation of elevated thyroid stimulating hormone (TSH) level- 52.87 mIU/L (0.28-4.10 mIU/L). He did not have cold intolerance, constipation, fatigue, or weight gain. He was diagnosed with hypothyroidism in 1998 and was on a stable dose of levothyroxine 88mcg daily from 2016 until the time of this presentation. He is adherent and reports following a routine of having breakfast with coffee soon after taking levothyroxine for many years. In June 2022, his TSH was 4.48 mIU/L. In July 2022, he started taking Relugolix along with levothyroxine. Following this, his TSH levels increased to 30.08 mIU/L (FT4: 0.67 ng/dL), 35.43 mIU/L (FT4: 0.57 ng/dL), 52.87 mIU/L (FT4: 0.48 ng/dL) on 2/24/23, 3/3/23, and 3/14/23, respectively. No new medications were reported. His other medications were atorvastatin, tamsulosin, and vitamin D, which he took at night. He did not take calcium or biotin supplements. He had gradual weight gain (8 lbs) over the last 9 months. Levothyroxine dose was increased from 88 to 125 mcg daily and he was instructed to separate Relugolix from levothyroxine so he started taking Relugolix at bedtime. Repeat TSH was low at 0.12 mIU/L. The levothyroxine dose was eventually titrated back to 88 mcg daily and TSH was 5.2 (appropriate for age). Conclusion: Several medications are known to interfere with the absorption of levothyroxine. Our case suggests that Relugolix may be one of them. The significant rise in TSH and levothyroxine requirements months after starting Relugolix and the ability to return to the previous dose of levothyroxine only by separating Relugolix from levothyroxine strongly suggests that there is an interference between these medications that has not been reported. Presentation: 6/2/2024

6694 A Case of an Extraneous Organ: A Uterus Found in a Genotypic and Phenotypic Male

Abstract Disclosure: R.A. Zielinski: None. S. Shteyman: None. A.G. Samat: None. Background: Persistent Mullerian Duct Syndrome (PMDS) is a rare entity that occurs when a phenotypic male is found to have female reproductive organs. In our case we describe an XY male who was found to have an abdominal mass consistent with a uterus on pathology. Clinical Case: Our patient is a 58-year-old male with hypertension, obesity, and obstructive sleep apnea who presented to the ED with 3 weeks of left upper quadrant pain. Abdominal CT showed two homogeneous enhancing oval lesions in the pelvis superior to the urinary bladder; 8.3 x 4.6 cm on the right and 3.6 x 3 cm on the left. Exploratory laparotomy was performed, and intraoperatively the mass was firm with a left satellite lesion and two fibrous bands that appeared similar in structure to round ligaments. Microscopically the tissue contained mullerian-type epithelium and smooth muscle with cystic degeneration. It was CK7 positive, estrogen receptor variable positive, and CK20 negative. Genetic testing confirmed the patient’s karyotype to be XY without genetic mosaicism. Our patient had two children spontaneously, regular spontaneous erections, and occasional hot flashes. Physical exam revealed an obese male (BMI 51) with bilateral gynecomastia and normal testicular size. He had no history of intra-abdominal or undescended testes requiring surgery. Labs showed increased total estrogen (283.7 pg/mL, n 60-190 pg/mL) and estradiol (39 pg/mL, n <= 29 pg/mL), decreased total testosterone (86 ng/dL, n 250-1,100 ng/dL), and normal free testosterone when corrected for SHBG (140 ng/dL, n 110-574 ng/dL). Testicular ultrasound was unrevealing. 3 years postoperatively his estradiol level normalized (34 pg/mL) and his total testosterone improved from 86 ng/dL to 223 ng/dL after losing 40 pounds on semaglutide. Discussion and Conclusion: Although the exact incidence of PMDS is unknown, it is a rare phenomenon. Only 200 cases between 1964 and 2000 and 34 cases between 2013 and 2017 have been reported. Mullerian ducts are embryologic structures present in both XY and XX fetuses until week 8 of life, when XY fetuses produce anti-mullerian hormone (AMH). In PMDS, the XY fetus either fails to produce AMH, or there is a defect in the AMH receptors, leading to the persistence of mullerian ducts. These ducts can then differentiate into a uterus, fallopian tubes, and/or the upper vagina. Our patient is a genotypical and phenotypical male with a uterus-like organ. The mild elevation in his estrogen level is likely secondary to his obesity. The estrogen could have increased the size of the uterus, causing the patient’s initial symptoms of abdominal pain which prompted his presentation to the hospital.

5092 Effect of Fezolinetant Treatment on Patient-Reported Outcomes: Data from Phase 3b study (DAYLIGHT) for Moderate-To-Severe Vasomotor Symptoms Associated with Menopause in Women Considered Unsuitable for Hormone Therapy

5092 Effect of Fezolinetant Treatment on Patient-Reported Outcomes: Data from Phase 3b study (DAYLIGHT) for Moderate-To-Severe Vasomotor Symptoms Associated with Menopause in Women Considered Unsuitable for Hormone Therapy

Addressing menopause symptoms in the primary care setting: opportunity to bridge care delivery gaps.

Menopause symptoms affect quality of life and financial well-being but are often unaddressed in primary care clinics. Therefore, we evaluated the extent of menopause symptom documentation in electronic health records (EHRs) by primary health care professionals. We retrospectively reviewed adult women who reported moderate or higher vasomotor symptoms on a Mayo Clinic survey conducted from March 1, 2021, through June 30, 2021. We then assessed adequacy of menopause symptom documentation in the EHRs of these women who had primary care visits during the survey period. We reviewed the percentage of documented vasomotor symptoms from May 1, 2019, through May 1, 2021. In the Mayo Clinic Health System-Northwest Wisconsin Region, 229 women self-reported moderate or higher vasomotor symptoms in the Mayo Clinic survey. Although only 23% of these women had vasomotor symptoms listed in the EHR clinical problem lists, 60% of these women had vasomotor symptoms documented in their clinic notes from the primary care visit. Approximately 6% of women reported hormone therapy use for management of menopause symptoms, and nearly 15% reported use of nonhormone prescription therapies for vasomotor symptoms. A greater proportion of women in our study had EHR documentation of bothersome menopause symptoms than those reported in other studies, but vasomotor symptoms remain generally untreated. We need better methods for identifying midlife women with bothersome menopause symptoms in primary care clinics so that appropriate treatment options, including hormone therapy, can be discussed and offered.

Effects of Progesterone on Vasomotor Symptoms in Postmenopausal Women (PROGEST) - a Prospective Multi-Center Randomized Double-Blind Placebo-Controlled Trial (RDPCT).

Introduction Monotherapy with progesterone for treatment of vasomotor symptoms (VMS) was more effective than placebo treatment of postmenopausal healthy women in a Canadian trial. The PROGEST-trial was initiated to fulfill FDA-approval criteria for the indication of treatment of postmenopausal VMS. Methods This prospective randomized, double-blind placebo-controlled clinical trial studied three doses of oral micronized progesterone (200 mg, 300 mg, 400 mg) and placebo for 12 weeks. Postmenopausal women with moderate to severe VMS (> 50 per week) were screened for one week for VMS frequency, then randomized to 200, 300 or 400 mg progesterone daily or placebo for a double-blinded trial of 12 weeks duration. Results 74 women were recruited in 12 study centers. 44 terminated the study as per protocol (PP). Moderate to severe hot flushes decreased by 7.4/d in the placebo arm, 7.7 VMS/d with 200 mg/d progesterone (P4), 8.3 VMS/d on 300 mg/d and 9.0 VMS/d on 400 mg/d P4, respectively by week 12. 32treatment emergent adverse events were documented in 18 participants, mostly minor AEs. The only SAE was a syncope requiring hospitalization on the day after treatment initiation, leading to discontinuation of the drug. Discussion Baseline VMS frequency was much higher in the German than in the Canadian study and the course of the placebo group had a markedly stronger decrease in VMS-frequency during the PROGEST study (-7.4/d) than in the Canadian trial (-1.4/d). Trial populations differed by age, BMI, the number of women with natural menopause, and comorbidities, mainly hypertension. Conclusion Premature discontinuation of the trial due to insufficient subject accrual rate led to only 55 randomized participants for analysis, therefore the study results lack statistical power. Still, a slight dose-dependent improvement in VMS was seen for all doses, while AE frequency did not increase with progesterone dose.

The Relationship between Physical Activity and Quality of Life in Postmenopausal Women: A Cross-Sectional Study.

Postmenopausal women frequently encounter a range of symptoms, including fatigue, diminished physical strength, reduced energy levels, vasomotor symptoms such as hot flushes, and vaginal atrophy, all of which adversely affect their overall quality of life. Engaging in physical activity and structured exercise may effectively alleviate these symptoms and enhance overall well-being. The present study aimed to investigate the relationship between physical activity and quality of life in postmenopausal Greek women. This cross-sectional clinical study included 219 postmenopausal women. Women with natural menopause for at least 12 consecutive months were enrolled in this descriptive, cross-sectional study. The female participants were asked to fill out the International Physical Activity Questionnaire-short form (IPAQ), the Hospital Anxiety and Depression Scale (HADS), and the EuroQol (EQ-5D-5L) instrument. Anthropometric measurements included weight, height, and waist circumference measurements. A total of 219 postmenopausal women with an age of 61.4 ± 6.1 years and body mass index (BMI) of 25.6 ± 3.7 kg/m2 were studied. Out of the total postmenopausal women studied, 64.8% were physically active. The mean value of MET-min/week was M = 1383.46 ± 1030.12. Physical activity among postmenopausal Greek women showed a strong correlation of PA with quality of life (r = 0.5; p ≤ 0.001) and age (r = 0.55; p ≤ 0.001) and a medium correlation with the HADS (r = 0.4; p ≤ 0.05). There was a 64.8% prevalence of physically active postmenopausal Greek women. The findings underscore the significance of fostering physical activity and quality of life among postmenopausal women to formulate efficacious therapeutic interventions. The results demonstrate a correlation between physical activity and the age of female participants, quality of life, and the HADS and can be used to improve postmenopausal women's physical activity levels, which is recommended as a strategy for improving the quality of life in postmenopausal women.

Substance use and menopausal symptoms among people with and without HIV in the US, 2008-2020.

The aim of the study is to assess associations between substance use and menopausal symptoms among US people living with and without HIV in a longitudinal cohort. We analyzed self-reported menopausal symptoms and substance use from biannual Women's Interagency HIV Study (WIHS) visits from 2008-2020. Substance use since the last visit or lifetime cumulative use included tobacco, alcohol, marijuana, crack/cocaine, and opioids. Logistic regression quantified associations between each substance use and menopausal symptom frequency (vasomotor, mood, and musculoskeletal), adjusting for other substance use, HIV status, demographics, comorbidities, and trauma. A total of 1,949 participants contributed early perimenopausal, late perimenopausal, or postmenopausal study visits. Across reproductive-aging stages, based on menstrual history, and among participants with and without HIV, participants reported frequent vasomotor (range 22-43%), mood (18-28%), and musculoskeletal (25-34%) symptoms. Many reported ever using tobacco (72%), heavy alcohol (75%), marijuana (73%), crack (50%), and opioids (31%). Current heavy alcohol use (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.10-1.37), cumulative marijuana use (OR: 1.15, 95% CI: 1.01-1.32), and cumulative tobacco use (OR: 1.06, 95% CI: 1.01-1.12) were associated with a higher frequency of vasomotor symptoms; current heavy alcohol use (OR: 1.20, 95% CI: 1.04-1.39) and current opioid use (OR: 1.13; 95% CI: 1.01-1.25) were associated with mood symptoms; and current opioid use (OR: 1.11, 95% CI: 1.00-1.23) was associated with musculoskeletal symptoms. All other associations were found to be null. Current and prior substance use may independently affect symptoms experienced during the menopausal transition and may indicate potential to benefit from additional intervention and referral to menopause specialty care.

6587 Circulating androgen and estrogen metabolites associated with self-reported sleep quality and vasomotor symptoms in the Women’s Health Initiative Observational Study

6587 Circulating androgen and estrogen metabolites associated with self-reported sleep quality and vasomotor symptoms in the Women’s Health Initiative Observational Study

Cognitive behavioural therapy for hot flushes and night sweats with breast cancer patients; a radiotherapy and clinical psychology collaboration

Cognitive behavioural therapy for hot flushes and night sweats with breast cancer patients; a radiotherapy and clinical psychology collaboration

Evaluation of the Usefulness of Byakkokaninjinto for Hot Flushes Caused by Rosacea

Evaluation of the Usefulness of Byakkokaninjinto for Hot Flushes Caused by Rosacea

КЛИНИЧЕСКАЯ ЭФФЕКТИВНОСТЬ НЕГОРМОНАЛЬНЫХ МЕТОДОВ ТЕРАПИИ ПАТАЛОГИЧЕСКОГО КЛИМАКТЕРИЧЕСКОГО СИНДРОМА У ЖЕНЩИН

The purpose of the study is to study the clinical effectiveness of the dietary supplement "Menophen" in comparison with β-alanine in the treatment of menopausal symptoms in women in the perimenopausal, menopausal and postmenopausal periods. Menopausal syndrome is a complex of vegetative-vascular, psycho-emotional, metabolic-endocrine, vaginal, sexual and other disorders. According to domestic authors, vasomotor disorders such as hot flashes, lability of blood pressure and pulse, increased sweating, chills, which significantly reduce the quality of life of patients and disrupt the circadian sleep-wake rhythm, come to the fore. Today, menopausal women continue to work actively, but hot flashes and sleep disturbances significantly reduce their level of performance and increase the number of absences from sick leave by 82%, compared to women without hot flashes. At the same time, 87.5% of women refuse to use and prescribe MHT, expressing doubts about the safety of their use; the main fears of patients are weight gain and the development of oncological pathology. Treatment with the dietary supplement Menofen leads to a decrease in the number and severity of psycho-emotional, metabolic-endocrine and neurovegetative disorders in menopausal women.

Estimation of Subfatin, Fetuin-A and other Parameters in Obese Menopause Women

Background: Menopause is an aging in women, it begins in most of them at 45 years old, the main reason of menopause is the decline of the Estrogen result from decline of ovaries function, it’s include many of symptoms such as nocturnal sweats, hot flashes, depression, elevated of anxiety, insomnia, sleep disturbance, genitalia include inflammation, dryness, urinary tract infections, painful urination, gaining weight, usually in the abdomen, hips and joint pain. Menopause leads to many disease include insulin resistance, atherosclerosis, chronic hearts disease, obesity, osteoporosis. The adipose tissue it's secretes active proteins such as subfatin which is adipocytokines regulates food intake. Fetuin-A is adipokines and hepatokiens that generated mainly by liver it serves to act as carrier of free fatty acid in circulation. Materials& Methods: Ninety women ages (50-65) participated in the study. (45) non-obese menopausal women with BMI (22.08±3.39) Kg/m2 as a control group. (45) obese women in the menopause with a BMI (35.38±2.52) Kg/m2 as the second group. أعلى النموذجResults: The results showed that there was a significant decrease at (P≤ 0.01) in the level of Subfatin and increase at (P≤ 0.01) in Fetuin-A in the second group compared to the control group. Conclusion: This study found significant negative correlation between Subfatin and lipid profile and significant positive correlation between Fetuin-A and lipid profile.

Beyond the Hot Flashes: Exploring the Holistic Approaches to Menopause Management – A Review

Beyond the Hot Flashes: Exploring the Holistic Approaches to Menopause Management – A Review