Hotflash inc #116: Research, research, research
It's like March madness, except in October and with menopause
It’s that time of year: the North American Menopause Society is holding their annual meeting this week from Monday, October 12-15 in Atlanta, Georgia.
There is so much research to be presented that I wish I had a team of writers and the resources to publish their findings, but rest assured I’ll be following up on as many of these as I possibly can.
• One presentation that should bring a lot of things together in the area of hot flashes comes from Dr Susan Reed, professor and vice-chair of the department of obstetrics and gynecology at the University of Washington School of Medicine. She’s going to present on the status of developing treatments for vasomotor symptoms (VMS), both hormonal and non-hormonal, covering everything from pricing to how women can go about choosing their options. As has been covered in Hotflash inc previously, there is a new, non-hormone therapy for hot flashes currently awaiting FDA approval: neurokinin B (NKB) antagonists. Although the insane truth is that we still don’t really know why hot flashes happen, this medication has been developed based on a theory about it: that vasomotor physiology is controlled by a neuron complex in the hypothalamus called kisspeptin-neuokinin B-dynorphin – aka KNDy – and that is located right beside the body’s thermoregulatory center.
"This is an exciting time,” Dr Reed said in a NAMS release ahead of her talk. “There have been relatively few novel hormone therapies developed for VMS in the past decade, and there is only one FDA-approved nonhormone therapy for VMS that was ever approved, and that was in 2013. Within the next several years, however, we hope to see some major breakthroughs and multiple new options for menopausal hot flash management, including a new estrogen and two new nonhormone therapies.”
• We are also getting the first known study looking at whether menopause hormone therapy may help protect against adhesive capsulitis, aka frozen shoulder. Even though it was first diagnosed almost 100 years ago, no one really knows what causes it – and so it has been dubbed “ideopathic”; no real reason for it.
Since women ages 40 to 60 are most affected by this painful and movement-limiting condition, the researchers had a hunch reduced estrogen – which has a major role in the functioning of our entire musculoskeletal system – may be involved. Co-author, Dr Anne Ford of Duke University Medical Center, explains why this research has been such a long time coming.
"As a female orthopedic surgeon in a field that is 94% male, I feel it is important to study sex-specific factors and treatment strategies that may benefit women with adhesive capsulitis,” says Dr Ford. “A disease that has such a strong predilection for women is unlikely to be truly idiopathic."
Although more work is needed, the study gleaned enough from its 2,000 subjects to find that those not on hormone therapy had a greater chance of getting frozen shoulder, and that taking estrogen would help protect against it.
• Another first-known study looked at how the established association between poor sleep and women who suffer from migraines changes during peri/menopause. After looking at 2,000 women across three geographical areas, researchers found that the sleep-migraine association during the menopause transition can depend at what stage women are at. That means various other factors caused by fluctuating estrogen and/or diminishing progesterone and testosterone, like changes in body mass index, anxiety, depression and hot flashes, are also now playing a role.
“Given the rise of both migraine and sleep disturbances during the menopause transition, we were interested to see whether the relationship between these two entities changes as women advance through the reproductive stages, and that is exactly what we found,” explains Summer Ghaith, lead author of the study from the Mayo Clinic School of Medicine. “In contrast to the findings in premenopausal women, the association appears to be driven by other factors in perimenopausal women.”
• Becoming type 1 or 2 diabetic early in life leads to an early menopause, according to a new retrospective study of 11,000 women conducted at the University of Toronto. Researchers didn’t find a significant association between women who experienced gestational diabetes and menopause age.
“We hope our work lays the foundation for more research in this area so we can better understand and prevent the long-term impacts of diabetes on the human body and the reproductive system," explains lead author and medical student Dr Vrati Mehra.
Some other areas of research to watch involve disparities in the menopause experience, psychedelics, DHEA, lasers, the gut-bone relationship, the estrogen we never hear about and using mindfulness practices to boost libido. Here are a few of the topic titles and the people involved:
• Hormone Therapy for the Aging Transgender Woman – Dr Sarah R Pickle, Associate Professor of Family Medicine Associate Division Director, Medical Education Department of Family Medicine, University of Cincinnati College of Medicine Cincinnati, Ohio
• The Impact of Perimenopause and Menopause on Weight Status: Through the Lens of Equity – Dr Fatima Cody Stanford, Associate Professor of Medicine and Pediatrics, Obesity Medicine Physician‐Scientist, Equity Director, Endocrine Division, Department of Medicine Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
• Hormone Therapy in Chronic Medical Conditions and Comorbidities – Dr Jewel M Kling, Professor of Medicine, Chair, Women’s Health Internal Medicine, Associate Chair of Equity, Inclusion, and Diversity, Department of Medicine Mayo Clinic, Scottsdale, Arizona
• Psychedelics in Clinical Practice—From Stigma to Science – David Clements, Executive Director, Dimensions Health Research Collaborative Senior Advisor for Innovation Strategy and Policy, Queen's University Health Sciences, Adjunct Professor, Health Sciences, Carleton University Ottawa, Ontario, Canada
• Lasers and Technology in Genitourinary Syndrome of Menopause – Dr Cheryl B Iglesia, Director, Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center, Director, National Center for Advanced Pelvic Surgery, MedStar Health, Professor of Obstetrics
• Probiotics and the Vaginal Microbiome: Fact or Fiction? – Dr Caroline Mitchell, Associate Professor of Obstetrics, Gynecology, and Reproductive Biology Harvard Medicine School, Physician Investigator, Obstetrics and Gynecology, Mass General Research Institute, Boston, Massachusetts
• The Gut‐Bone Axis: How the Gut Microbiome Communicates With Bone – Dr Roberto Pacifici, Garland Herndon Professor of Medicine, Division of Endocrinology, Metabolism, and Lipids Division Director, Endocrinology and Metabolism, Emory University School of Medicine, Atlanta, Georgia
• Efficacy and Safety of Estetrol (E4), A Promising New Treatment for Menopausal Vasomotor Symptoms: Results of Two Phase 3 Randomized, Double‐Blind, Placebo‐ Controlled Trial – Dr Wulf H Utian, women’s health expert from South Africa and former medical director at the North American Menopause Society
• Beneficial Effects of Vaginal Prasterone (DHEA) on the Vaginal Histology of Women with VVA Treated or Not with Aromatase Inhibitors: A Breakthrough in the Understanding of the Role of Androgens in Vaginal Health – Dr Céline Bouchard, obgyn, Chicoutimi, Quebec
• Effect of Sleep Restriction on Insulin Sensitivity and Energy Metabolism in Postmenopausal Women – Dr Kara L Marlatt, Assistant Professor - Research Healthy Aging & Metabolism, Pennington Biomedical Research Center, Louisiana State University
• A Pilot Trial of a Virtually‐delivered Group Mindfulness Intervention for Midlife and Older Women With Low Libido – Dr Holly N Thomas, assistant professor of medicine, University of Pittsburgh Center for Research on Health Care
• Mindfulness and the Management of Low Desire and Vulvovaginal Pain in Women – Dr Lori A Brotto, Professor, Faculty of Medicine, Department of Obstetrics and Gynaecology Executive Director, Women’s Health Research Institute, Canada Research Chair in Women’s Sexual Health, The University of British Columbia, Diamond Health Care Centre Vancouver, BC, Canada
• Disparities in the Menopause Transition – Dr Makeba L Williams, Associate Professor and Vice Chair of Professional Development and Wellness Department of Obstetrics and Gynecology, Washington University, St. Louis, St. Louis, Missouri
• Experience of Menopause in the Workplace: Data from the Mayo Clinic Registry of Midlife Women – Ekta Kapoor, Consultant, Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic
• Menopausal Vasomotor Symptoms and White Matter Hyperintensities in Midlife Women – Dr Rebecca C Thurston, Pittsburgh Foundation Chair in Women's Health and Dementia and Professor of Psychiatry, Clinical and Translational Science, Epidemiology and Psychology
• Brain Function and Verbal Memory Positively Associated with Endogenous Estradiol in Postmenopause – Rachel Schroeder, Graduate Student, Behavioral Neuroscience Program, Psychiatry College of Medicine, University of Ilinois Chicago
• Psychosocial Factors and Menopause Symptoms are Associated with Hair Cortisol Levels in Midlife Latinas – Dr Yamnia I Cortés, Assistant Professor at the University of North Carolina at Chapel Hill (UNC-CH) School of Nursing
Hey there! The above article is an example of the kind of content I’ll be offering when the Hotflash inc paid subscription launches – soon. I’ll still send out the free newsletter on the weekend, although to be honest, it’s going to be a bit less extensive. The paid version will be perfect for anyone wanting to be kept abreast of all that is happening in this space and anyone who is working in it. Just letting you know in advance, in case you want to think about it or become a founding member.
• Do you ever wonder about all those Lyma ads you see on social media? (also btwfyi studies, white papers and surveys are a great trick for getting your product into mainstream media) Menopause Supplement Industry To Grow To $22.7 Billion By 2028 As Women Seek Out Alternative Treatments Forbes
• The incontinence and period product brand Essity has launched a new digital platform called Issviva, which offers forums, expert guides and a product guide that includes vitamins, minerals, supplements and intimate hygiene products Non-wovens Industry
Last week’s poll results: Anti-depressant use
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• Six easy to miss signs of perimenopause from a change in body odour to twitching eyes and tinnitus iNews
• Megan Daum (an American writer I adore) has a new project called The Unspeakeasy, and it’s all about creating a community for free-thinking women. In this same piece, we get an assertion by British feminist Louise Perry that cancel culture is really the extension of mean girl-dom. Maybe just maybe (and this assertion is mine) some of them are perimenopausal and focusing externally instead of making the necessary – and exhausting – changes the transition requires? Lean Out with Tara Henley via Substack
• The second 50 women over 50 list is out and one name jumps out: Kris Jenner Forbes
• This book is welcome in a week when I’ve been irritated at a new “bioresonance” test being launched in the UAE. I’m growing tired of wealthy people exploring every square inch of themselves to make sure they live forever. Also author Rina Raphael’s evolution as a journalist reporting on this industry sounds a lot like mine. The Gospel of Wellness: Gyms, Gurus, Goop, and the False Promise of Self-Care Salon.com
• Thank you for the shout-out! Women In Wellness: Andrea Donsky On The Five Lifestyle Tweaks That Will Help Support People’s Journey Towards Better Wellbeing Authority Magazine
• Most women in Canada are experiencing menopause symptoms and it’s not going that well: New national research report on menopause reveals the steep toll of silence and stigma on Canadian women Yahoo
• "I can't tell you how much that means when the person you care about makes an effort to learn about something that is happening to you, so that they can sympathize with you and understand it." Davina McCall spoke powerfully on men's role learning and supporting during menopause Good Housekeeping
• “Another, and possibly more potent way to frame the menopausal experience is to see it as a rite of passage that is present to the liminality of the experience.” Black Girls Guide to Surviving Menopause’s Omisade-Burney Scott writes: Not your mother’s menopause Ms Magazine
• Centering Menopause: Dr. Sharon Malone and Jennifer Weiss-Wolf on the Menopause Research Act of 2022 Ms Magazine
• There we are again, all up on the big screen – just like they always said no one would want us to be. Recently it was Michelle Yeoh in Everything Everywhere All at Once; today it’s Viola Davis in The Woman King and coming up its Dune: The Sisterhood prequel TV series set 10,000 years before the movie adds Emily Watson and Shirley Henderson as The Harkonnen Sisters The Daily Mail
• All I know is all my eyelashes fell out and I was falling apart and a naturopathic doctor put me back together. And now people are saying it’s not a thing, so maybe we should just stop worrying about what we are calling it? I get it, ‘Chronic burnout that makes you sick and anxious’ doesn’t have the same ring, does it? The Myth of Adrenal Fatigue. The “condition” could explain everything you’re feeling — if only it were real The Cut
• Triggers of perimenopause symptoms revealed, from stress at work to fatty foods OK Magazine
• Got joint pain? 40 percent of us do. Two suggestions to tackle it: Rose hip The Hippocratic Post or resveratrol Dr Mary Claire Haver via TikTok
In what seemed like a throwaway line on the Hotflash inc podcast this week, Durham, North Carolina compounding pharmacist Jennifer Burch told me that the way pharmacists can tell if medication doesn’t work is simple: people don’t refill their prescriptions. “We see that at the retail pharmacy all the time, they start Zoloft for a month or two and then they quit; they didn’t feel better, they didn’t see it work”. The fact that her level of acceptance of basic human behavior – the kind we ourselves may not understand or be struggling with – stood out to me, I think, speaks to the world we live in, where everyone is trying to argue with you about who you are and how you feel. This was illustrated further when a friend struggling with mood told me that they went off Zoloft after giving it four months, because the side effects were pronounced and there were no benefits – not one. The confusing part was the practioner, who said this: ‘You need to give it more time’.
Did they though? Over the years I’ve told doctors so many things they simply didn’t accept I’m over it: that medications didn’t work, that I didn’t like the contraception I was using (the pill or the vaginal ring); that this weight is not “overweight” for me. I’m all for sticking with something, but I’m also not a fan of being told something is working, or that it will work, or should work if only I stick to it, when it clearly is not working for me. Don’t we know ourselves better than anyone else? Shouldn’t we ultimately be the ones to decide when we’ve had enough, by now? AMx