Objective: The objective of this document is to generate a practice guideline for the management and treatment of symptoms of the menopause. Participants: The Treatment of Symptoms of the Menopause Task Force included six experts, a methodologist, and a medical writer, all appointed by The Endocrine Society. Evidence: The Task Force developed this evidenced-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned three systematic reviews of published data and considered several other existing meta-analyses and trials. Consensus Process: Multiple e-mail communications, conference calls, and one face-to-face meeting determined consensus. Committees of The Endocrine Society, representatives from endorsing societies, and members of The Endocrine Society reviewed and commented on the drafts of the guidelines. The Australasian Menopause Society, the British Men...

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Treatment of symptoms of the menopause: an Endocrine Society Clinical Practice Guideline

BACKGROUND
Advanced maternal age is associated with reduced fertility and adverse pregnancy outcomes. This review details recent developments in our understanding of the biology and mechanisms underlying reproductive ageing in women and the implications for fertility and pregnancy.

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The ageing ovary and uterus: new biological insights

Cognition and mood in perimenopause: a systematic review and meta-analysis.

Type 2 diabetes has reached epidemic proportions in the United States. Large, randomized controlled trials suggest that menopausal hormone therapy (MHT) delays the onset of type 2 diabetes in women. However, the mechanisms and clinical implications of this association are still a matter of controversy. This review provides an up-to-date analysis and integration of epidemiological, clinical, and basic studies, and proposes a mechanistic explanation for the effect of menopause and MHT on type 2 diabetes development and prevention. We discuss the beneficial effects of endogenous estradiol with respect to insulin secretion, insulin sensitivity, and glucose effectiveness; we also discuss energy expenditure and adipose distribution, both of which are affected by menopause and improved by MHT, which thereby decreases the incidence of type 2 diabetes. We reconcile differences among studies that investigated the effect of menopause and MHT formulations on type 2 diabetes. We argue that discrepancies arise from physiological differences in methods used to assess glucose homeostasis, ranging from clinical indices of insulin sensitivity to steady-state methods to assess insulin action. We also discuss the influence of the route of estrogen administration and the addition of progestogens. We conclude that, although MHT is neither approved nor appropriate for the prevention of type 2 diabetes due to its complex balance of risks and benefits, it should not be withheld from women with increased risk of type 2 diabetes who seek treatment for menopausal symptoms.

Menopausal Hormone Therapy and Type 2 Diabetes Prevention: Evidence, Mechanisms, and Clinical Implications.

(See the editorial commentary by Boccara and Cohen on pages 1729–31.)

Cardiovascular disease (CVD) is increased approximately 2-fold in human immunodeficiency virus (HIV) infection [1] and may have a unique relationship to sex in this population. Two large registry studies have recently shown that the relative increases in myocardial infarction rates are higher in HIV-infected vs non–HIV-infected women than in HIV-infected vs non–HIV-infected men [2, 3]. Worldwide, women account for a growing percentage of HIV-infected patients and more than half of all HIV infections [4]. Few studies have assessed CVD exclusively among HIV-infected women [5–7], and, to our knowledge, none have explored sex differences with respect to coronary atherosclerotic plaque.

In the context of HIV infection, CVD is probably related to the interplay between traditional CVD risk factors, effects of antiretroviral therapy (ART), and the proinflammatory and immune activation effects of HIV. Among HIV-infected men, Lo et al [8] previously demonstrated a higher prevalence of atherosclerotic plaque and in particular, noncalcified plaque. In more recent data from the same cohort, we also demonstrated that soluble CD163 (sCD163) levels are increased in HIV-infected men and are associated with noncalcified plaque [9]. CD163 is a monocyte-macrophage specific scavenger receptor cleaved from activated monocytes and macrophages during inflammation. Among non–HIV-infected patients, increased levels of sCD163 have been found to be associated with coronary artery disease [10]. These prior studies have not investigated indices of immune activation with respect to atherosclerotic plaque features among HIV-infected women. In the current study, we examined atherosclerotic plaque features and detailed indices of immune activation among HIV-infected women and investigated the relationships of age, sex, and HIV infection to these indices.

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M Sluss Patrick

Papers

Straw+10のエグゼクティブサマリー: 生殖年齢の評価における未完成の課題に対する取り組み