Use of MHT in women with cardiovascular disease: a systematic review and meta-analysis.

This systematic review assesses the effect of menopausal hormone therapy (MHT) on cardiovascular outcomes and risk factors in postmenopausal women with cardiovascular disease (CVD). The Medline, Embase and Cochrane databases were searched from inception to December 2022 for randomized controlled trials (RCTs) and observational studies using methodology from a previous Cochrane review. Quality assessment used the Cochrane risk of bias tool and Newcastle-Ottawa scale, respectively. From 5647 studies identified, 29 (23 RCTs and six observational studies) were included. Most studies were conducted in North America or Europe and investigated oral estrogens. Participants were older with varying frequency of cardiac risk factors and underlying CVD. No significant difference was observed between MHT users and controls regarding primary outcomes of non-fatal myocardial infarction, cardiovascular death or stroke. No difference in frequency of angina, heart failure and transient ischemic attacks was observed. Inconsistent effects of MHT on angiographic progression were seen and varied with glycemic status. Estradiol had a positive effect on flow-mediated dilatation. Limited studies identified differing effects of MHT on cardiac risk factors, varying with estrogen preparation. This study confirms no benefit of MHT for secondary CVD prevention, highlighting evidence limitations and the importance of shared decision-making when managing menopausal symptoms in women with CVD.

Women's perspectives of early menopause: development of a word cloud.

Objective: Early menopause (EM), menopause aged <45 years, occurs spontaneously or secondary to medical treatments and is associated with multiple health impacts. A word cloud is an image where the word size reflects the frequency of use. We aimed to assess the perspectives of women with EM using a word cloud.Methods: Women diagnosed with EM, recruited from clinics/community, completed a survey including the open-ended question 'What words do you associate with EM?'. Demographics and medical history were collected. Data analysis included descriptive statistics, identification of word themes/stems/synonyms, word frequency, and chi-square test. A word cloud was constructed from words used by two or more women using 'Wordle' (www.wordle.net).Results: Responses were obtained from 190/263 participants. The mean age was 54 ± 11 years, with EM diagnosed at age 38 ± 5 years. The cause of EM was unknown (30% of women), bilateral oophorectomy (27%), cancer therapy (25%), or autoimmune/genetic/metabolic (17%). The commonest words reported were hot flushes (36.8% of women), mood swings (20.5%), and infertility (16.8%), which varied with age and cause of EM. Few women reported neutral/positive words.Conclusion: Most words that women associate with EM have negative connotations and refer to symptoms. A word cloud is a novel way to illustrate women's perspectives.

Knowledge and attitudes of health professionals regarding menopausal hormone therapies.

OBJECTIVE: To evaluate the knowledge and attitudes of Australian health professionals (HPs) including general practitioners (GPs), gynecologists and endocrinologists, to menopausal hormone therapy (MHT). METHODS: Participants were recruited from medical societies/colleges and a national GP conference. An online survey containing devised and previously published questions was used. Data analysis included frequencies, ANOVA, χ2 and regression analysis. RESULTS: A total of 745/888 responses were analyzed. Fewer HPs (52%) reported being knowledgeable regarding non-hormonal therapies compared with menopause physiology or MHT (72%), with no significant knowledge differences between specialties. Most HPs (91%) would offer MHT to symptomatic menopausal women. The combined oral contraceptive pill (52%) was preferred for women with premature menopause. Transdermal MHT was preferred for women >50 years, although differences were observed between specialties (p = 0.005). HPs varied regarding duration of MHT for women with premature menopause (p = 0.009) and women over 50 years (p = 0.001). Menopause society members were more likely to prescribe MHT and for longer duration (p < 0.05). Consumer concern regarding breast cancer was considered the main barrier in prescribing MHT. CONCLUSIONS: Although most HPs will recommend MHT, when indicated, for symptomatic menopausal women, variations exist between specialties in prescribing practices. HPs' knowledge gaps and perceived consumer concerns are barriers to prescribing MHT.