Rakibul M. Islam

Background: Perimenopause is formally diagnosed by menstrual bleeding patterns. This study investigated whether symptoms in the late reproductive stage (LRS), characterised by changed menstrual flow, differ from earlier premenopause or from perimenopause in the absence of vasomotor symptoms (VMS). Methods: The Australian Women’s Midlife Years Study (2023–2024) was a nationally representative cross-sectional study of 8096 women aged 40–69 years, who completed the Menopause-specific Quality of Life Questionnaire (MENQOL). The prevalence of moderate-to-severe symptoms in participants without VMS was analysed using generalised linear models with Gamma log link and modified Poisson regression with robust variance, respectively. Results: The analysis included 1039 respondents without VMS, of which 63.5% (n=660) had regular menses with no change in menstrual flow, 20.1% (n=209) had regular menses with changed flow, and 16.4% (n=170) were perimenopausal (cycle variation at least 7 days). Premenopausal participants with unchanged flow were less likely to report poor memory (adjusted prevalence ratio (aPR) 0.60, 95% CI 0.43 to 0.83, p=0.043), ‘accomplishing less than used to’ (aPR 0.65, 95% CI 0.50 to 0.85, p=0.014), ‘feeling tired or worn out’ (aPR 0.78, 95% CI 0.68 to 0.90, p=0.009) and bloating (aPR 0.63, 95% CI 0.49 to 0.80, p=0.004) compared with LRS participants. The other 18 individual MENQOL symptoms did not differ between premenopausal LRS and early perimenopause. Conclusions: Premenopausal women with regular menstrual cycles reporting changed menstrual flow but no VMS differ little from those without VMS and no change in menstrual flow. This indicates that change in flow alone is not a clear indicator of commencement of the menopause transition.

The study aimed to systematically review the evidence on the association between smoking and the risk of diabetic neuropathy, with a particular emphasis on

This study aimed to report the prevalence of menopausal hormone therapy (MHT) usage in symptomatic postmenopausal women in Australia. The Australian Midlife Years Study is a nationally representative, cross-sectional questionnaire-based study of women aged 40-69 years that included current MHT usage and menopausal symptoms. Data were collected during October 2023-March 2024. Of 8086 participants, 10.8% of postmenopausal respondents reported MHT use. Further analysis was limited to 2503 potential MHT users (postmenopausal with vasomotor symptoms; 77.5%, n = 1941) or current users (22.5%; n = 562). The absolute number of MHT users was greatest amongst those aged 50-59 years (n = 309/1304, 24%), but the greatest proportion of use was amongst those aged 40-49 years (96/319, 30%). MHT use was less likely for participants who had body mass index (BMI) of 18.5 kg/m² or ≥30 kg/m² versus BMI of 18.5-29.9 kg/m² (p < 0.05 for all), were smokers (p < 0.001), were unemployed but seeking work versus in paid employment (p = 0.003) or were of non-European ancestry (p < 0.05). Education beyond high school (p = 0.002) and past hysterectomy and/or oophorectomy were associated with greater likelihoods of MHT use (p < 0.001). Fewer than one-quarter of symptomatic postmenopausal Australian women were using MHT, with socio-demographic variables predicting use. The overall use remains similar to that reported a decade ago.

Following a rigorous systematic review of the literature, the International Menopause Society (IMS) has produced detailed new recommendations and key messages on women's midlife health, menopause and menopause hormone therapy (MHT) to help guide healthcare professionals to optimize their management of women at this critical stage of life. The term MHT has been used to cover therapies including estrogens, progestogens and combined regimens. This guidance provides a summary of the recommendations and key messages generated from the systematic review process. The longer version, including the detailed text, key meta-analyses, references, figures and supplementary materials, will be published simultaneously online and can be accessed via the IMS website (https://www.imsociety.org/statements/ims-recommendations/). The quality of evidence and the strength of recommendations used in this guideline are based on the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) and the Appraisal of Guidelines for Research & Evaluation II (AGREE II) approaches. The new recommendations now include levels of evidence, grades of recommendations, good practice points and key messages. The recommendations were developed by a body of 38 authors and 26 support team members derived from the IMS and other organizations. Global stakeholder surveys, targeted at both healthcare providers and consumers, were initially conducted to identify the key questions. A Publication Steering Committee (PSC) provided oversight of the process through regular meetings and ensured consistency of methodology. By the end of the process, 30 completed sections were submitted by the authors to individual lead reviewers selected from the PSC to provide peer review and finally endorsed by the PSC, IMS board and stakeholders. Overall, 341 recommendations (285 supported by research data and 56 good practice points) and 38 key messages have been formulated. These span a diverse range of health topics, including lifestyle, midlife body changes, vasomotor symptoms, genitourinary syndrome of menopause, osteoporosis, cardiometabolic health, dementia, premature ovarian insufficiency and various malignancies. A new section addresses the often-overlooked topic of sarcopenia which requires urgent attention. Current controversial topics, such as the influence of the media, the role of the pharmaceutical industry and publication ethics, are also explored. The overall aim of these recommendations and guidelines is to provide the blueprint for the management of women's midlife health and menopause, given the latest available evidence. In preparing these international recommendations, experts have endeavored to consider geographical variations in medical care, prevalence of diseases/conditions, symptom severity, availability and licensing of MHT and alternatives, and country-specific attitudes of the public, medical community and health authorities toward menopause management.

Testosterone may have a role in brain health. Whether older women who exhibit a decline in blood testosterone are at an increased risk of cognitive decline is uncertain. A subset of Australian female participants in the Aspirin in Reducing Events in the Elderly (ASPREE) trial had testosterone concentrations measured by liquid chromatography-tandem mass spectrometry and underwent a comprehensive cognitive test battery at baseline and study year 3. Cognitive decline was defined as a lower test score at year 3 compared with baseline. The mean change (baseline to year 3) of testosterone concentration was examined by paired-sample t-test. Stable or increased (reference) versus a decline in testosterone concentration was used to investigate the association with cognitive decline using logistic regression. A total of 395 women (median [interquartile range] age 78.1 [73.7-82.3] years) provided data for analysis. In total, 154 women (39%) had a decline in blood testosterone which was not associated with a decline in any cognitive measure (Modified Mini-Mental State Examination: odds ratio [OR] = 0.96, 95% confidence interval [CI] 0.63 to 1.49, p = 0.86; Hopkins Verbal Learning Test - Revised: Immediate Recall, OR = 0.71, 95% CI 0.44 to 1.13, p = 0.151 and Delayed Recall, OR = 1.42, 95% CI 0.89 to 2.26, p = 0.14; Controlled Oral Word Association Test: OR = 0.79, 95% CI 0.49 to 1.25, p = 0.31; and Symbol Digit Modalities Test: OR = 0.83, 95% CI 0.53 to 1.29, p = 0.40). Limiting the analysis to 237 women aged 70-79 years (74.5 [interquartile range 72.2-77.1] years), no association was observed between a decline in blood testosterone and any cognitive outcome. : A decline in blood testosterone concentrations over 3 years was not associated with a decline in cognitive function in community-dwelling Australian women aged 70 years and older.

This study aimed to document the prevalence of sexual difficulties, sexually-related personal distress, sexual dysfunction and associated factors among refugee women in Australia. The cross-sectional study included refugee women aged 18-63 years. Sexual difficulties were defined as selecting 'always' or 'very often' on the Profile of Female Sexual Function, while distress was a score of at least 11 on the Female Sexual Distress Scale - Revised. Female sexual dysfunction (FSD) combined these scores. Participants also completed the Woman Abuse Screening Tool and the Bristol Female Lower Urinary Tract Symptoms questionnaire. Among 299 participants (median age 41 years), sexual difficulties, sexually-related personal distress and FSD were present in 39.3%, 33.2% and 7.0%, respectively. Perimenopausal/postmenopausal status (adjusted odds ratio [aOR] = 2.8, 95% confidence interval [CI]: 1.4-5.6, p = 0.003) and sexual activity (aOR = 0.2, 95% CI: 0.1-0.4, p < 0.001) predicted sexual difficulties. Intimate partner abuse (aOR = 5.9, 95% CI: 2.4-14.5, p < 0.001) and urinary incontinence (aOR = 4.5, 95% CI: 1.5-13.0, p = 0.006) were associated with sexually-related personal distress. Perimenopausal/postmenopausal status and sexual inactivity were associated with sexual difficulties, while intimate partner abuse and urinary incontinence were associated with sexually-related distress, highlighting the importance of proactive screening for psychosocial and physical health issues in sexual health assessments among refugee women.