When I was in medical training, I always enjoyed journal club — a time set aside to discuss recently published research and consider how it might affect the way we practice medicine. In September we had our first Hot Flash journal club, and I’m excited to bring it back today.
Similar to last time, I’ll share a few articles from the journals I regularly follow to stay up to date on research developments regarding hormonal health. Sometimes these articles contain exciting developments that might change our lives or have important implications for public policy. Sometimes they provide us with practical tips we can start applying in our lives today. Sometimes they are just too fun to keep to myself.
Today, of three publications, one outlines a promising test for predicting when you will have your last menstrual period. One may inform your experience of menopause based on whether you live in an urban, suburban, or rural area. And one might just get you dancing into menopause.
A new way to predict when menopause starts
One of the most common questions I get from both readers and patients is about predicting when menopause will occur. In the past, I have not always had a good answer. We know that if you have gone more than 60 days without a period, you are likely to have your last menstrual period in the next 12 to 36 months. Similarly, an undetectable level of anti-Mullerian hormone (AMH) can also help predict menopause timing, but not with the precision most of us would prefer.
But soon we may have a better answer. As part of the longitudinal Study of Women’s Health Across the Nation (SWAN), several hundred women collected their urine during several different menstrual cycles at specific points during those menstrual cycles. Researchers determined the levels of several hormones in the urine samples, including follicle-stimulating hormone (FSH), luteinizing hormone, estrogen metabolites, and pregnanediol glucuronide (PDG). They then followed the women for years — SWAN is in its third decade — to see when they had their last menstrual period.
We know that FSH rises and PDG falls as women approach their final menstrual period. But PDG has not historically been used to predict a woman’s last menstrual period.
The authors of this recent paper used the data from more than 1,300 of the women’s urine samples collected in two different menstrual cycles — one group collected urine earlier, the other collected urine closer to their last menstrual period. The researchers wanted to see if by running the samples through a particular type of mathematical modeling, any of the hormone levels in the urine individually or in combination more accurately predicted a woman’s last menstrual period than current methods.
What they found was that PDG levels in the urine are highly predictive of a woman’s last menstrual period. This was true even when they controlled for FSH and AMH levels. The ability to predict the timing of a woman’s last menstrual cycle would be particularly useful in younger women with low AMH at risk for primary ovarian insufficiency and early menopause.
Unfortunately, you can’t walk into your doctor’s office and request a PDG test yet. Further, validation of the new model will be needed before the test is ready for routine clinical use. But it’s an exciting step in the right direction.
Where you live can influence how you experience menopause
As a physician, this statement seems obvious. In urban areas, there are often doctors of all types on every corner, but in more rural areas, finding specialists and gaining access to them is often much more challenging. Still, it is important not to assume that differences exist but to quantify them. A recently published study does just that.
The paper uses data from an online survey conducted in 2019 that was completed by more than 1,500 women. The authors asked women about 18 different menopause symptoms, including classic symptoms like hot flushes but also mental health symptoms such as brain fog and mood changes; sexual function; and metabolic changes including weight gain.
The women were also asked how they received their health information, if they had sought treatment for their symptoms, and if they were currently being treated for their symptoms. The authors reported survey results based on whether the women lived in urban, suburban, or rural areas.
They found that in general, symptom burden (meaning that many women were experiencing a lot of symptoms) was high, especially among those women in late perimenopause. More than 70% of women surveyed were experiencing hot flushes, and 60% of women were having night sweats. But women who lived in rural areas had an increased symptom burden. In particular, women living in rural areas were more likely to have muscle aches, pain, and panic attacks. Sleep-related complaints were higher among women in rural and suburban areas.
Many of the women were aware of treatment options for perimenopausal symptoms, though they got their information from different sources. Women in urban and suburban areas were more likely to get their information from the internet, while women in rural areas were more likely to get their health information from their medical providers.
Despite the high symptom burden, the number of women using hormone therapy was similar across all groups and quite low considering the high symptom burden the women reported. All groups reported fears regarding increased cancer risk and heart disease as the main reason they did not pursue treatment with hormone therapy.
I would like to believe that in the five years since this survey was conducted (the new article used data from an existing survey, which is common practice in medical science), the increased conversation regarding menopause in the media may have resulted in more women seeking treatment for their perimenopausal symptoms. The data tells us that you may need to be more proactive in seeking treatment for your perimenopausal symptoms, particularly if you live in a rural area.
Dancing into menopause
This one is for those of you who have wondered if all exercise is created equal, or whether exercise has to be unpleasant to reap real benefits from it. In a charming little study, 71 postmenopausal women were randomized to participate in two weekly 60-minute jazz dance classes taught by a professional for 16 weeks or to continue with their current activity.
The participants had their sleep score, fitness level, muscle strength, and body composition assessed before, during, and after the intervention. The researchers found that the women in the jazz dancing group improved their cardiorespiratory fitness even 12 months after the intervention ended. Sleep quality improved for as long as six months after the intervention ended, but body composition was unchanged.
My takeaway from this trial is that exercise can take a lot of different forms, including some that might be more appealing than others, and still be effective. If you love dancing, it can be a great way to increase your fitness level. But if dancing is not your thing, find an activity that you enjoy. You will be much more likely to stick with an exercise routine that you find enjoyable.
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