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Objectives: We describe here characteristics and clinical outcomes of women living with HIV attending an HIV menopause service. Methods: This was a retrospective case note review of women attending the monthly HIV menopause clinic from January 2015 to July 2018. Results: In all, 55 women attended the service. The overall mean age was 49 years; 50% were black and 20% had a previous AIDS-defining condition. All were on antiretroviral therapy (ART); the median CD4 count was 678 cells/µL; 93% had a viral load < 50 copies/mL; 7% had previous hepatitis C infection; 27% had a history of smoking; 45% had risk factors or existing cardiovascular disease; 24% had a mental health condition. The median duration of symptoms before clinic attendance was 18 months. Vasomotor symptoms (84%), menstrual cycle changes (62%), psychological (56%) and urogenital symptoms (29%) were reported. Twenty-two per cent had early menopause or premature ovarian insufficiency. The mean age at attendance of women diagnosed with menopause (n = 24) was 52 years. However, their average duration of symptoms prior to review was 28 months. A total of 61% had osteopenia/osteoporosis, 73% received menopausal hormone therapy (MHT), and 73% had symptomatic improvement, although 58% of these required higher doses of MHT. Median time on MHT was 10 months. Five patients had their ART modified. No serious MHT adverse effects were observed. Conclusions: Menopausal hormone therapy uptake was high, with most women observing an improvement in symptoms. Comorbidities were common, highlighting the need for integrated care based on a woman's needs. The long delay from initial symptoms to treatment demonstrates the need for better access to specialist advice for women experiencing menopause.

Premature ovarian insufficiency (POI) refers to the loss of ovarian activity before the age of 40 years, which leads to hypoestrogenism and amenorrhea. The diagnosis of POI in a young woman has potentially life-changing physical and emotional consequences for both the patient and her family. Therefore, it is very important that the diagnosis is correct and that it is made in a timely manner. Unfortunately, the diagnosis and therefore the effective treatment of POI are often delayed, which underlines the need for education of the broad medical community on the issue. A panel of menopause experts reviewed and critically appraised the literature, and present: (1) the diagnostic approach to POI, (2) the investigation of the etiology of this condition, (3) the therapeutic strategy regarding both hormone replacement therapy and fertility, and (4) the long-term follow-up and management for ensuring quality of life, as well as urogenital, cardiovascular, bone and mental health. The ultimate goal of this article is to provide a complete toolkit for the primary care physician to have easy access to all the information needed for the optimal management of women with POI, in the context of evidence-based and personalized medicine.HIGHLIGHTS Premature ovarian insufficiency occurs in 1% of the female population of reproductive age, yet the diagnosis is often delayed, with severe physical and emotional consequences for the patient. Primary care physicians should be aware of the possibility of premature ovarian insufficiency in young women presenting with menstrual irregularity. Prompt initiation of hormone replacement therapy ensures quality of life and prevents osteoporosis and cardiovascular disease. Women seeking fertility should be referred to specialists to discuss assisted reproduction options. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group and Elsevier B.V.

Premature ovarian insufficiency (POI) is an increasing public health problem with a prevalence now approaching 4%. POI results in adverse effects on the skeleton and central nervous system as well as disturbances of metabolic and cardiological factors that predispose to a major increased risk of cardiovascular disease (CVD). This article reviews the effects of the premature loss of ovarian function on lipids and lipoproteins, glucose and insulin metabolism, body composition, hemostasis and blood pressure, together with effects on the development of metabolic syndrome and diabetes mellitus. The article examines the effects of POI on vascular endothelial function and inflammation that result in arterial disease, and reviews the effects of hormone replacement therapy (HRT) on these various metabolic processes and on cardiovascular outcomes. It is essential that women with POI receive hormonal treatment to help prevent the development of CVD, and that this treatment is continued at least until the normal age of menopause. It appears that HRT has a more favorable effect than the combined oral contraceptive, but larger clinical trials are needed to establish the optimal treatment. Other therapeutic measures may need to be added to correct existing metabolic abnormalities and, in particular, attention to lifestyle factors such as diet and exercise must be encouraged.

This Statement is being simultaneously published in the journals Climacteric, Maturitas, Journal of Sexual Medicine, and Journal of Clinical Endocrinology and Metabolism on behalf of the International Menopause Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, and The Endocrine Society, respectively. This Position Statement has been endorsed by the International Menopause Society, The Endocrine Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, The International Society for the Study of Women's Sexual Health, The North American Menopause Society, The Federacion Latinoamericana de Sociedades de Climaterio y Menopausia, The Royal College of Obstetricians and Gynaecologists, The International Society of Endocrinology, The Endocrine Society of Australia, and The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. © 2019 Author

Background Hot flushes affect 70% of menopausal women and often severely impact physical, psychosocial, sexual, and overall wellbeing. Hormone replacement therapy is effective but is not without risk. Neurokinin B signalling is increased in menopausal women, and has been implicated as an important mediator of hot flushes. Methods This phase 2, randomised, double-blind, placebo-controlled, single-centre, crossover trial assessed the effectiveness of an oral neurokinin 3 receptor antagonist (MLE4901) on menopausal hot flushes. Eligible participants were healthy women aged 40–62 years, having seven or more hot flushes in every 24 h of which some were reported as being severe or bothersome, who had not had a menstrual period for at least 12 months, and who had not been taking any medication shown to improve menopausal flushes in the preceding 8 weeks. Participants received 4 weeks of MLE4901 (40 mg, orally, twice daily) and placebo (orally, twice daily) in random order separated by a 2 week washout period. Randomisation was completed by a central computer, and participants were allocated to treatment number in numerical order. The primary outcome was the total number of hot flushes during the final week of both treatment periods. Analyses were by intention to treat and per protocol using generalised linear mixed models and standard crossover analysis. All analyses were prespecified in the study protocol. The trial is registered at ClinicalTrials.gov, number NCT02668185. Findings 68 women were screened between Feb 3 and Oct 10, 2016, of which 37 were randomly assigned and included in an intention-to-treat analysis. 28 participants completed the trial and were included in a per-protocol analysis. MLE4901 significantly reduced the total weekly number of hot flushes by 45 percentage points (95% CI 22–67) compared with the placebo (intention-to-treat adjusted means: placebo 49·01 [95% CI 40·81–58·56] vs MLE4901 19·35 [15·99–23·42]; adjusted estimate of difference 29·66 [17·39–42·87], p

The International Menopause Society (IMS) has produced these new 2016 recommendations on women’s midlife health and menopause hormone therapy to help guide health-care professionals in optimizing their management of women in the menopause transition and beyond. The term menopause hormone therapy has been used to cover therapies including estrogens, progestogens and combined regimens. Menopausal hormone therapy today is the most effective treatment for vasomotor symptoms and urogenital atrophy.For the first time, the 2016 International Menopause Society recommendations now include grades of recommendations, levels of evidence and ‘good practice points’, in addition to section-specific references. Where possible, the recommendations are based on and linked to the evidence that supports them, unless good-quality evidence is absent. Particular attention has been paid to published evidence from 2013 onwards, the last time the International Menopause Society recommendations were updated. Databases have been extensively searched for relevant publications using key terms specific to each specialist area within menopause physiology and medicine. Information has also been drawn from international consensus statements published by bodies such as the International Menopause Society, the European Menopause and Andropause Society and the North American Menopause Society.The recommendations have been produced by experts derived mainly from the International Menopause Society, with the assistance of key collaborators where deemed advantageous. In preparing these international recommendations, experts have taken into account geographical variations in medical care, prevalence of diseases, and country-specific attitudes of the public, medical community and health authorities towards menopause management. The variation in availability and licensing of menopause hormone therapy and other products has also been considered., Международное общество по менопаузе (International Menopause Society) в 2016 году подготовило данные рекомендации по здоровью женщин зрелого возраста и менопаузальной гормональной терапии, чтобы помочь медицинским работникам оптимизировать тактику ведения женщин в период менопаузального перехода и в последующем.Термин «менопаузальная гормональная терапия» используется для обозначения различных видов лечения, включая применение эстрогенов, прогестагенов и комбинированных препаратов. На сегодня менопаузальная гормональная терапия является наиболее эффективным методом лечения вазомоторных симптомов и урогенитальной атрофии.В рекомендации Международного общества по менопаузе от 2016 года впервые включены степени рекомендаций, уровни доказательности и принципы надлежащей практики, в дополнение к отдельным спискам литературы для различных разделов. Там, где это возможно, рекомендации основаны на подтверждающих их доказательствах и связаны с ними, кроме тех случаев, когда доказательства хорошего качества отсутствуют. Особое внимание было уделено данным, опубликованным начиная с 2013 года, когда рекомендации Международного общества по менопаузе обновлялись в последний раз. Был проведен тщательный поиск соответствующих публикаций с использованием ключевых слов, специфичных для каждой области специализации, касающейся физиологии и медицины менопаузального периода. Также была взята информация из международных консенсусных заявлений, опубликованных такими органами, как Международное общество по менопаузе, Европейское общество по менопаузе и андропаузе (European Menopause and Andropause Society) и Североамериканское общество по менопаузе (North American Menopause Society).Данные рекомендации были подготовлены экспертами, являющимися преимущественно членами Международного общества по менопаузе, при поддержке ключевых соавторов там, где это было признано целесообразным. При подготовке этих международных рекомендаций эксперты принимали во внимание географические отличия в медицинской помощи, распространенности заболеваний и характерных для разных стран подходах к ведению менопаузального периода со стороны медицинского сообщества, органов здравоохранения и общественности. Также учитывались различия в доступности и статусе регистрации лекарственных средств для менопаузальной гормональной терапии и других лекарственных препаратов., Міжнародне товариство з менопаузи (International Menopause Society) в 2016 році підготувало дані рекомендації щодо стану здоров’я жінок зрілого віку і менопаузальної гормональної терапії, щоб допомогти медичним працівникам оптимізувати тактику ведення жінок в період менопаузального переходу і в подальшому.Термін «менопаузальна гормональна терапія» використовується на позначення різних видів лікування, включаючи застосування естрогенів, прогестагенів і комбінованих препаратів. Менопаузальна гормональна терапія на сьогодні є найбільш ефективним методом лікування вазомоторних симптомів і урогенітальної атрофії.До рекомендацій Міжнародного товариства з менопаузи від 2016 року вперше увійшли ступені рекомендацій, рівні доказовості та принципи належної практики, на додаток до окремих списків літератури для різних розділів. Там, де це можливо, рекомендації засновані на доказах, що їх підтверджують і пов’язані з ними, крім тих випадків, коли докази хорошої якості відсутні. Особливу увагу було приділено даним, опублікованим починаючи з 2013 року, коли рекомендації Міжнародного товариства з менопаузи оновлювалися востаннє. Був проведений ретельний пошук відповідних публікацій із використанням ключових слів, специфічних для кожної області спеціалізації, яка стосується фізіології та медицини менопаузи. Також була взята інформація з міжнародних консенсусних заяв, опублікованих такими органами, як Міжнародне товариство з менопаузи, Європейське товариство з менопаузи і андропаузи (European Menopause and Andropause Society) та Північноамериканське товариство з менопаузи (North American Menopause Society).Дані рекомендації були підготовлені експертами, які переважно є членами Міжнародного товариства з менопаузи, за підтримки ключових співавторів там, де це було визнано доцільним. Під час підготовки цих міжнародних рекомендацій експерти брали до уваги географічні відмінності в медичній допомозі, поширеності захворювань і характерних для різних країн підходах до ведення менопаузи з боку медичної спільноти, органів охорони здоров’я та громадськості. Також враховувалися відмінності в доступності та статусі реєстрації лікарських засобів для менопаузальної гормональної терапії й інших лікарських препаратів.

One of the main concerns from the large secondary and primary prevention cardiovascular trials such as the Heart and Estrogen/progestin Replacement Study and the Women's Health Initiative (WHI) study was that there appeared to be an increased risk of coronary events in the first years of usage. These findings were initially surprising bearing in mind that observational trials had previously shown benefit. Subsequent analyses have confirmed that the risks were primarily in the over-seventies age group. In the younger age groups (50-59 years), there was a trend towards reduction of risk and a significant reduction in all-cause mortality. Why did this occur? There are a number of possible reasons but, in the opinion of the author, the dose of estrogen was the overriding factor. Although 0.625 mg of conjugated equine estrogens is a standard dose for women in their early fifties, this was a relative overdose for women with an average age of initiation of 63 years (WHI). Inappropriately high doses of estrogen could have caused cardiovascular harm due to disturbances in thrombogenesis and vascular remodelling. Lower doses of hormone replacement therapy, or more accurately, more appropriately targeted doses for each age group, could avoid initial harm, thus allowing for long-term benefits to predominate.

Premature ovarian insufficiency (POI) is a life-changing condition that affects women in their reproductive age. The condition is not necessarily permanent but is associated with intermittent and unpredictable ovarian activity. Hence, spontaneous pregnancies have been reported to be 5-10%. However, pregnancy in patients with POI is still unlikely and rare. Although, there are reviews on POI in the literature, there is a lack of reports which focus on how to improve the reproductive outcome of these women who wish to conceive spontaneously or use assisted conception with their own oocytes. We found that there is no conclusive evidence of which treatment is optimal for women with POI who wish to conceive using their own gametes. However, one could surmise that it is important to lower gonadotropin levels into the physiological range before embarking on any treatment, even if natural conception is the only choice for the woman/couple. In the future, multi-center, randomized, double-blind, placebo-controlled trials should be carried out, which may entail recruitment of patients from various centers nationally and internationally to increase the sample size and therefore achieve a powered study. This may standardize the treatment of women with POI who wish to conceive and ultimately have their biological child.

The past decade has seen marked fluctuations in opinions concerning the merits and risks of postmenopausal hormone replacement therapy (HRT). In July 2002, menopause management faced a major turnin...