Menopause: The Journal of The North American Menopause Society最新文献

{"title":"Menopausal hormone therapy combined with antiresorptive therapy for skeletal outcomes in postmenopausal women: a systematic review and network meta-analysis of randomized controlled trials.","authors":"Xiaochun Wang, Xiaorong Hu, Jianhong Chen","doi":"10.1097/GME.0000000000002924","DOIUrl":"https://doi.org/10.1097/GME.0000000000002924","url":null,"abstract":"<p><strong>Importance: </strong>Postmenopausal bone loss is a major contributor to osteoporosis, fracture-related morbidity, loss of independence, and mortality. Although systemic menopausal hormone therapy (MHT), antiresorptive therapy, and combination regimens improve bone mineral density (BMD), their comparative skeletal benefits and safety profiles remain incompletely defined.</p><p><strong>Objective: </strong>The study aims to compare the therapeutic and preventive skeletal effects of systemic MHT, antiresorptive therapy, and combined MHT plus antiresorptive therapy on site-specific BMD, fracture outcomes, and selected safety outcomes in postmenopausal women.</p><p><strong>Evidence review: </strong>PubMed, Embase, Scopus, and the Cochrane Library were searched from database inception until April 14, 2026, for randomized controlled trials evaluating systemic MHT, bisphosphonate therapy, calcitonin therapy, or MHT combined with antiresorptive therapy in postmenopausal women. Eligible comparators included placebo, no active bone-specific therapy, or another eligible randomized treatment arm. Study selection and data extraction were performed using predefined eligibility criteria and standardized extraction forms. Treatment effects were synthesized using frequentist random-effects network meta-analysis.</p><p><strong>Findings: </strong>Sixteen randomized controlled trials, including 2,861 postmenopausal women, were included. Compared with control, all active treatment nodes were associated with greater increases in lumbar spine BMD. The largest estimates were observed for MHT plus calcitonin therapy (mean difference [MD], 12.24%; 95% CI, 7.46-17.01) and MHT plus bisphosphonate therapy (MD, 9.71%; 95% CI, 6.99-12.42), although calcitonin-based estimates were informed by limited evidence. Across hip-region outcomes, MHT plus bisphosphonate therapy showed the most favorable BMD profile, including at the femoral neck (MD, 4.87%; 95% CI, 2.66-7.07) and femoral trochanter (MD, 6.65%; 95% CI, 5.12-8.17). MHT alone and MHT plus bisphosphonate therapy were associated with higher risks of mastalgia and vaginal spotting or bleeding. MHT plus bisphosphonate therapy was associated with a lower risk of any fracture compared with control (risk ratio, 0.51; 95% CI, 0.28-0.93), but fracture events were sparse and were often not prespecified efficacy outcomes.</p><p><strong>Conclusions and relevance: </strong>In postmenopausal women, systemic MHT, bisphosphonate therapy, and their combination improved BMD compared with control. Combination MHT plus bisphosphonate therapy showed the most favorable hip-region BMD profile; however, current evidence is insufficient to establish superior fracture prevention or long-term safety.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative assessment of neurokinin receptor antagonists in menopausal hot flashes: a model-based meta-analysis.","authors":"Shuting Wang, Yinghua Lv, Junchao Chen, Juan Yang, Ling Xu, Jihan Huang, Fang Yin, Qingshan Zheng, Lujin Li","doi":"10.1097/GME.0000000000002909","DOIUrl":"https://doi.org/10.1097/GME.0000000000002909","url":null,"abstract":"<p><strong>Importance: </strong>Neurokinin 3 receptor antagonists (NK3-RAs) represent a novel class of nonhormone agents for the treatment of hot flashes in women with menopause.</p><p><strong>Objective: </strong>This study aims to quantitatively evaluate treatment efficacy by developing a pharmacodynamic model and to assess the clinical value of the intervention by indirect comparisons with hormone and nonhormone therapies using previously published model-based meta-analysis data.</p><p><strong>Evidence review: </strong>PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were systematically searched through October 30, 2025, for placebo-controlled randomized trials evaluating NK3-RAs in menopausal women with hot flashes. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Data were analyzed using a maximum drug effect model. Develop a time-effect model to characterize the changes in the pure effect of the drug over time after accounting for the placebo response.</p><p><strong>Findings: </strong>These studies evaluated two NK3-RAs: fezolinetant and elinzanetant. Both agents demonstrated a rapid onset of action, with efficacy reaching a plateau shortly after initiation, and exhibited clear dose-response relationships. When the dose of fezolinetant was increased from 15 to 180 mg, the reduction in hot flash frequency increased from 10.2% to 33.4%; similarly, increasing the dose of elinzanetant from 40 to 300 mg also demonstrated a dose-dependent reduction in hot flash symptoms. At the recommended doses, fezolinetant (45 mg) and elinzanetant (120 mg) achieved reductions of 20.6% and 19.6%, respectively. Model-based indirect comparisons using previously published efficacy estimates suggested that these effects were greater than those reported for paroxetine (14.8%) and corresponded to ∼52% and 49% of the effect observed with estradiol at 12 weeks. Placebo responses in NK3-RA trials were higher than those reported in other non-hormone therapy studies and were comparable to those observed in hormone therapy trials. The larger overall treatment effects observed in NK3-RA studies may have been influenced, in part, by the elevated placebo responses reported in these trials.</p><p><strong>Conclusions and relevance: </strong>Fezolinetant (45 mg) and elinzanetant (120 mg) demonstrated comparable efficacy for menopausal hot flashes. Model-based indirect comparisons provided clinical context for interpreting their efficacy relative to other hormone and nonhormone therapies. This study provides quantitative evidence to inform medication selection and pharmacoeconomic evaluations in women with menopausal hot flashes.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Premature menopause and risk of type 2 diabetes among postmenopausal women: findings from the Women's Health Initiative.","authors":"Yu Du, Erin S LeBlanc, Aladdin H Shadyab, Longjian Liu, Hailey R Banack, Robert A Wild, Nazmus Saquib, Cassandra N Spracklen, Christina Ludema, Juhua Luo","doi":"10.1097/GME.0000000000002907","DOIUrl":"https://doi.org/10.1097/GME.0000000000002907","url":null,"abstract":"<p><strong>Objective: </strong>The association between premature menopause (age below 40 y) and subsequent risk of type 2 diabetes (T2D) is not fully understood. Sex hormone fluctuation due to ovarian function, hormone therapy (HT), and menopause-related changes in body composition may likely modify or mediate this relationship, which is the focus of this study.</p><p><strong>Methods: </strong>We included 136,759 postmenopausal women aged 50-70 years from the Women's Health Initiative. Menopausal age and type (natural vs. surgery-associated) were determined using self-reported reproductive history, surgeries, menopausal symptoms, and postmenopausal HT use. T2D incidence was determined through self-reported initiation of diabetes treatment. Multivariable Cox models assessed the association between premature menopause and T2D, adjusting for demographic, lifestyle, reproductive, and health-related factors. Interaction terms were used to evaluate effect modification by HT use. Mediation analysis quantified the contribution of body mass index (BMI) to this association.</p><p><strong>Results: </strong>Premature menopause (n=13,230; 9.7%) was associated with a higher risk of T2D compared with menopause at ages 50-54 (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 1.05-1.16). Among women with natural menopause, HT use modified the relationship between premature menopause and T2D (Pinteraction=0.047). Elevated risks were observed among women who never used HT (HR: 1.24; 95% CI: 1.08-1.42) or used estrogen plus progestogen (HR: 1.35; 95% CI: 1.09-1.68), but not among estrogen-only users. BMI mediated (indirect effect: 27.9%; 95% CI: 19.0%-45.8%) of the association.</p><p><strong>Conclusions: </strong>Premature menopause was modestly associated with an increased T2D risk; this association varied by HT use and was partially mediated by BMI.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness of physical activity interventions on non-physiological symptoms of menopause: a systematic review and meta-analysis.","authors":"Simone Saidel, Rebecca Hardy, Lexi He, Roopal Desai, Kate Robinson, Aimee Spector","doi":"10.1097/GME.0000000000002827","DOIUrl":"https://doi.org/10.1097/GME.0000000000002827","url":null,"abstract":"<p><strong>Importance: </strong>Women in the menopause transition (MT) commonly experience mood disturbances, anxiety, cognitive complaints, and reduced quality of life (QoL). Yet access to pharmacological or psychological treatments may be limited or unsuitable for some. Identifying and accessing non-pharmacological interventions is therefore an important clinical and public health priority.</p><p><strong>Objective: </strong>To synthesize evidence from randomized controlled trials (RCT) evaluating the effectiveness of physical activity (PA) interventions for improving depression, anxiety, mood, cognition, stress, and QoL in women during the MT.</p><p><strong>Evidence review: </strong>A systematic search of Medline, PsycINFO, Web of Science, Cochrane Library, and CINAHL was conducted from inception to April 2025. RCTs including women aged 40-65 years in peri and early postmenopause were eligible. PA interventions were compared with alternative PA or treatment as usual. Outcomes were pooled using random-effects meta-analysis, with subgroup analyses by menopausal stage (peri and early postmenopause) and intervention types (aerobic-based [ABI] and mind-body [MBI]). Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.</p><p><strong>Findings: </strong>Twelve RCTs involving 1,003 women were included. PA significantly improved depression (g=-1.37, 95% CI [-1.96 to -0.79], mood (g= 0.84, 95% CI [0.40-1.29]), psychological QoL (g=0.66, 95% CI [0.19-1.13]), and overall QoL (g=1.10, 95% CI [0.32-1.88]). Significant reductions in depression were found in both perimenopause (g=-1.57, 95% CI [-2.58 to -0.56]) and early postmenopause (g=-1.14, 95% CI [-1.48 to -0.79]), with other outcomes improving in early postmenopausal women. ABIs improved (g=-1.07, 95% CI [-1.35 to -0.78]), mood (g=1.05, 95% CI [0.52-1.58]), and overall QoL (g=1.41, 95% CI [0.12-2.69]), whereas MBIs improved psychological QoL (g=0.80, 95% CI [0.43-1.16]). Sensitivity analyses largely supported these findings.</p><p><strong>Conclusions and relevance: </strong>PA may seem to improve depression, mood, and QoL in women in the MT. Both ABIs and MBIs may be beneficial, supporting the integration of PA into clinical care for menopausal women. Further high-quality trials with clearer menopause staging are needed to strengthen the evidence base.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of adherence to a Mediterranean diet on body weight in postmenopausal women: a systematic review.","authors":"Lorena Araujo Silva Dias, João Victor Silva Correia, Igor Oliveira","doi":"10.1097/GME.0000000000002922","DOIUrl":"https://doi.org/10.1097/GME.0000000000002922","url":null,"abstract":"<p><strong>Importance: </strong>The Mediterranean diet (MedDiet) is characterized by high consumption of whole grains, fruits, vegetables, olive oil, and fish, and adherence has been recognized as a strategy for improving metabolic health. The postmenopausal period is associated with a decline in estrogen levels, contributing to increased cardiometabolic risk, weight gain, and reduced quality of life.</p><p><strong>Objective: </strong>To assess the efficacy of adherence to the MedDiet on weight loss in postmenopausal women.</p><p><strong>Evidence review: </strong>A systematic literature search was performed in PubMed, Embase, and the Cochrane Library for studies published up to January 2026. Search terms included \"Mediterranean diet,\" \"postmenopausal women,\" and \"postmenopausal.\" Randomized controlled trials and observational studies relating to the MedDiet and postmenopausal women were included. Screening, data extraction and analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the inclusion and exclusion criteria.</p><p><strong>Findings: </strong>Three studies (two randomized controlled trials and one observational), including 282 participants, were analyzed. The studies differed in design, intervention protocols, participant characteristics, and follow-up duration. Thus, these methodological and clinical differences were considered when interpreting the findings and may have contributed to the heterogeneity observed in the studies.</p><p><strong>Conclusions and relevance: </strong>The different design, limited number of studies and their small sample sizes may have limited the strength of evidence, making the detection of long-term benefits difficult. In qualitative synthesis, the included studies showed mixed findings, with no consistent superiority of MedDiet across weight, fat mass, or lean mass outcomes. MedDiet counseling alone, without explicit energy restriction or other structured weight-management strategies, should not be assumed to produce clinically meaningful reductions in body weight or fat mass.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends of menopausal hormone therapy across Canadian provinces in 2018-2023.","authors":"Armin Farahvash, Jessica Riad, Lara Ali, Shanzeh Chaudhry, Mina Tadrous, Iliana C Lega","doi":"10.1097/GME.0000000000002925","DOIUrl":"https://doi.org/10.1097/GME.0000000000002925","url":null,"abstract":"<p><strong>Objectives: </strong>Menopausal hormone therapy (MHT) is guideline-recommended as the first-line treatment for vasomotor symptoms in women without contraindications. Despite this, use of MHT remains low with persistent concerns about safety following the Women's Health Initiative. Contemporary population-level data on the trends of MHT use in Canada over the years, as well as differences across provinces, are limited. This study examines recent trends and interprovincial variation in MHT expenditure among Canadian provinces.</p><p><strong>Methods: </strong>We conducted a retrospective time-series study of MHT dispensing trends across Canadian provinces (December 2017-November 2023) using IQVIA CompuScript. Use was standardized to defined daily dose (DDD) as set by the World Health Organization. The purchasing data is shown as DDD per 1000 women per day, normalized by provincial population of women aged 45-65 years for oral, transdermal, and vaginal MHT.</p><p><strong>Results: </strong>National MHT use increased from 59.1 to 83.4 DDD/1000 women/day during the study period. Growth was driven by vaginal (14.9-29.2) and transdermal MHT (18.4-26.8) formulations, while use of oral MHT remained stable (25.8-27.3). In 2023, Quebec had the highest rate of MHT dispensing at 162 DDD/1000 women/day, followed by British Columbia and Nova Scotia (84.3 and 83.1 DDD/1000 women/day, respectively).</p><p><strong>Conclusions: </strong>MHT use in Canada is increasing but remains modest and variable across formulations and provinces. Markedly higher use of MHT in Quebec may be partly explained by a more comprehensive drug coverage. Our findings highlight gaps in uptake of guideline-recommended therapy and provide a foundation for future research and policy considerations.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regular physical activity is associated with lower odds of bodily pain in midlife women.","authors":"Eugenio Arteaga, Juan Enrique Blümel, Alejandra Martinez-Garcia, María Soledad Vallejos, Marcela López, Félix Ayala, Ascanio Bencosme, Andrés Calle, Lucia Costa-Paiva, Maribel Dextre, Karen Díaz, Alejandra Elizalde-Cremonte, Santiago Elizalde-Cremonte, Carlos Escalante, María T Espinoza, Ircania García, Gustavo Gómez-Tabares, Hugo Gutiérrez-Crespo, Juan Matzumura-Kasano, Paolo Meza, Álvaro Monterrosa-Castro, Mónica Ñañez, Eliana Ojeda, Claudia Rey, Ana Lucia Ribeiro Valadares, Doris Rodríguez-Vidal, Marcio A Rodrigues, Javier Saavedra, Carlos Salinas, Lida Sosa, Konstantinos Tserotas, Margot Acuña-San Martín, Marcela S Aguirre","doi":"10.1097/GME.0000000000002895","DOIUrl":"https://doi.org/10.1097/GME.0000000000002895","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between regular physical activity and bodily pain domain of the SF-36 in midlife women, considering pharmacological and physical factors.</p><p><strong>Methods: </strong>This cross-sectional study included 3,523 women aged 40 to 60 years. Participants reported whether they had generalized body pain, physical activity, menopause status, menopause hormone therapy (MHT) use, psychotropic medication use, and comorbidities. Multivariable logistic regression was used to identify independent predictors of bodily pain.</p><p><strong>Results: </strong>Women reporting regular physical activity (n=1806; 56.3%) had 34% lower odds of bodily pain (OR 0.66; 95% CI: 0.58-0.76), independent of BMI, menopause status, psychotropic drug use, and comorbidities. MHT use showed an even stronger association (OR 0.50; 95% CI: 0.41-0.61). Conversely, obesity (OR 1.61; 95% CI: 1.36-1.92), postmenopause status (OR 1.45; 95% CI: 1.26-1.68), psychotropic drug use (OR 1.45; 95% CI: 1.24-1.70), and comorbidities (OR 1.52; 95% CI: 1.31-1.77) were associated with increased pain risk.</p><p><strong>Conclusions: </strong>Regular physical activity is independently associated with lower odds of bodily pain in midlife women. Exercise programs, in combination with MHT, may contribute to optimizing pain management in this population and warrant further prospective investigation.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of psychosocial supports and stressors with cognition in midlife women.","authors":"Emily Oken, Sheryl L Rifas-Shiman, Hadine Joffe, JoAnn E Manson, Janet Rich-Edwards, Rebecca E Amariglio, Kathryn V Papp, Jorge E Chavarro","doi":"10.1097/GME.0000000000002888","DOIUrl":"https://doi.org/10.1097/GME.0000000000002888","url":null,"abstract":"<p><strong>Objectives: </strong>Psychosocial supports and stressors can influence neurocognitive function, but associations are understudied among women in midlife.</p><p><strong>Methods: </strong>Among 492 parous women in the longitudinal Project Viva cohort, we surveyed several psychosocial supports and stressors in 2019-2022. At subsequent in-person visits (2022-2024) we performed the Montreal Cognitive Assessment (MoCA), which assesses global cognition, and four scales of the Cambridge Neuropsychological Test Automated Battery (CANTAB) that assess episodic memory, working memory, executive functioning, and attention. We examined associations using multivariable linear regression adjusted for age, education, spoken English, race, and ethnicity.</p><p><strong>Results: </strong>Mean (SD) age was 55.5 (4.9) years, 71% were postmenopausal, and 20% scored below 26 on the MoCA, a threshold for cognitive impairment. In age-adjusted analyses, associations with both MoCA and total CANTAB were in the hypothesized directions (higher scores with supports, lower scores with stressors). For MoCA, adjustment for demographics resulted in attenuation of all associations to null. However, financial and food insecurity measures remained associated with several CANTAB scales in adjusted models, for example, having difficulty paying bills was associated with lower executive functioning (-0.37; 95% CI: -0.69 to -0.06), attention (-0.42; 95% CI: -0.66 to -0.18), and total CANTAB (-0.19; 95% CI: -0.35 to -0.03) internal z-scores. Measures of social support, perceived stress, and everyday discrimination were not associated with total CANTAB or its subscores. Adjustment for menopause status had negligible effect.</p><p><strong>Conclusions: </strong>Financial and food insecurity, but not social support, perceived stress, or discrimination, were associated with poorer memory, executive function, and attention in midlife women.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of neurokinin receptor antagonists on sleep disturbance in menopausal women: a systematic review and meta-analysis of randomized controlled trials.","authors":"Maria Julia Lemos, Iaci Luisa Lopes de Mattos, Andrew M Kaunitz","doi":"10.1097/GME.0000000000002903","DOIUrl":"https://doi.org/10.1097/GME.0000000000002903","url":null,"abstract":"<p><strong>Importance: </strong>Sleep disturbance is a common and burdensome symptom among perimenopausal and postmenopausal women with moderate to severe vasomotor symptoms (VMS). Although neurokinin (NK) receptor antagonists have demonstrated efficacy for reducing VMS, their effects on sleep disturbance remain incompletely characterized.</p><p><strong>Objective: </strong>To evaluate the effects of NK receptor antagonists on sleep disturbance in perimenopausal and postmenopausal women with moderate to severe VMS.</p><p><strong>Evidence review: </strong>A systematic review and meta-analysis of randomized controlled trials was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane recommendations. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception through May 2026. Eligible studies enrolled perimenopausal or postmenopausal women with moderate to severe VMS and compared NK receptor antagonists with placebo. The outcome of interest was change in the Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Short Form 8b scores at 4, 12, and 24 weeks. Random-effects meta-analyses were performed using standardized mean differences (SMDs) and 95% CIs. Risk of bias was assessed using Risk of Bias 2, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Trial sequential analysis was performed to assess the robustness of cumulative evidence.</p><p><strong>Findings: </strong>Seven randomized controlled trials involving 3,184 women were included. NK receptor antagonists were associated with significant improvements in sleep disturbance compared with placebo at 4 weeks (SMD: -3.94; 95% CI: -5.71 to -2.16; 5 studies; 2,869 participants), 12 weeks (SMD: -3.11; 95% CI: -4.60 to -1.61; 5 studies; 2,869 participants), and 24 weeks (SMD: -2.04; 95% CI: -3.93 to -0.15; 4 studies; 1,798 participants). Subgroup analyses demonstrated significant benefits for both elinzanetant and fezolinetant, with a greater magnitude of effect observed for elinzanetant (P < 0.001). All included studies were judged to have low risk of bias. However, certainty of evidence was rated as low because of substantial unexplained heterogeneity. Trial sequential analysis demonstrated that the accumulated evidence crossed monitoring boundaries and reached the required information size for all primary outcomes.</p><p><strong>Conclusions and relevance: </strong>NK receptor antagonists significantly improved patient-reported sleep disturbance among perimenopausal and postmenopausal women with moderate to severe VMS. These findings support NK receptor antagonists as a promising nonhormone treatment option for VMS-associated sleep disturbance, although the magnitude of benefit should be interpreted cautiously because of substantial heterogeneity and low-certainty evidence.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early menopause as a female-specific prognostic marker after acute coronary syndrome in women aged 60 years or younger: a real-world multicenter registry analysis.","authors":"Kristina Marić Bešić, Jozica Šikić, Diana Delić Brkljačić, Davorka Lulić, Maja Banović, Mira Stipčević, Duška Glavaš, Ivana Jurin","doi":"10.1097/GME.0000000000002896","DOIUrl":"https://doi.org/10.1097/GME.0000000000002896","url":null,"abstract":"<p><strong>Objective: </strong>Early menopause is an established female-specific risk enhancer for incident cardiovascular disease, but its prognostic value after acute coronary syndrome (ACS) remains uncertain. We evaluated whether menopause before age 45 years was associated with long-term ischemic/cardiovascular outcomes after ACS in midlife women.</p><p><strong>Methods: </strong>We analyzed a multicenter registry of women hospitalized with ACS from February 1, 2020 through February 28, 2025. The primary cohort included women whose menopause preceded or coincided with the index event. Menopausal age was obtained from structured registry/clinical history fields. The primary outcome was a prespecified ischemic/cardiovascular major adverse cardiovascular event.</p><p><strong>Results: </strong>Among 1,039 records, 857 had valid menopausal age data and 728 met temporal criteria. Menopause before age 45 years was present in 124 women; median follow-up was 3.52 years. Crude post-index event rates were higher with early versus later menopause for the primary outcome (21.1% vs. 13.3%), death (8.9% vs. 4.6%), and the composite outcome (25.2% vs. 15.3%). In the primary clinical Cox model, early menopause was associated with the primary outcome (hazard ratio [HR], 1.78; 95% CI, 1.11-2.85), death (HR, 2.57; 95% CI, 1.18-5.57), and the composite outcome (HR, 1.87; 95% CI, 1.21-2.89). Associations attenuated in extended exploratory models including previous vascular disease, surgical menopause, and hormone therapy.</p><p><strong>Conclusions: </strong>Menopause before age 45 years identified a higher risk post ACS phenotype. Findings extend incident risk evidence into secondary prevention and support routine recording of menopausal age; causality cannot be inferred.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}