Plácido Llaneza

EMAS position statement: The ten point guide to the integral management of menopausal health

With increased longevity and more women becoming centenarians, management of the menopause and postreproductive health is of growing importance as it has the potential to help promote health over several decades. Women have individual needs and the approach needs to be personalised. The position statement provides a short integral guide for all those involved in menopausal health. It covers diagnosis, screening for diseases in later life, treatment and follow-up.

Soy isoflavones, Mediterranean diet, and physical exercise in postmenopausal women with insulin resistance.

Objective: The aim of this study was to evaluate whether a standard dose of 40 mg of soy isoflavones prescribed in routine clinical practice for treatment of menopausal symptoms has some influence on glucose homeostasis in postmenopausal women with insulin resistance (IR). Methods: A total of 116 postmenopausal women with IR were randomly assigned to a group of Mediterranean diet and physical exercise (control group) or a group of Mediterranean diet, physical exercise, and daily oral ingestion of 40 mg of soy isoflavones (soy isoflavones group). Anthropometric measures, Kupperman Index values, Cervantes Scale score, and blood samples for glucose, insulin, lipid profile, creatinine, uric acid, homocysteine, folic acid, vitamin B12, selenium, and estradiol were determined at baseline and at intervals of 6, 12, 18, and 24 months. Results: Mean homeostasis model assessment of IR (HOMA-IR) values remained unchanged from the baseline in the control group but steadily decreased in the soy isoflavones group at 6 months (P = 0.042). There were no statistically significant differences between both groups in mean HOMA-IR scores at baseline, but statistically significantly lower values were found in the soy isoflavones group at 6 months (P = 0.009), 12 months (P = 0.011), 18 months (P = 0.018), and 24 months (P = 0.012). Changes in HOMA-IR values were also clearly related to body mass index (P < 0.001), abdominal circumference (P < 0.001), and treatment (P = 0.044) when a linear regression analysis was carried out. Conclusions: Daily intake of 40 mg of soy isoflavones together with a Mediterranean diet and exercise reduced IR in postmenopausal women who had IR in the first place. It was significantly better than lifestyle changes alone. If corroborated, this may be a useful intervention for these women.

Resilience, depressed mood, and menopausal symptoms in postmenopausal women

ObjectiveThis study aims to assess resilience, depressed mood, and menopausal symptoms in postmenopausal women. MethodsIn this cross-sectional study, 169 postmenopausal women aged 48 to 68 years were asked to fill out the Wagnild and Young Resilience Scale (WYRS), the Center for Epidemiologic Studies Depression Scale (CESD-10), the Menopause Rating Scale (MRS), and a questionnaire containing personal and partner sociodemographic data. ResultsThe median [interquartile range] age of participating women was 54 [10.0] years. Among the women, 55.6% had increased body mass index, 76.9% had a partner, 17.8% were current smokers, 14.2% had hypertension, 25.4% used psychotropic drugs, and 13.0% used hormone therapy. Forty-five percent of the women had depressed mood (CESD-10 scores ≥10), and 34.9% had severe menopausal symptoms (total MRS scores ≥17). Less resilience (lower WYRS scores) correlated with depressed mood (higher CESD-10 scores) and severe menopausal symptoms (higher total, psychological, and urogenital MRS scores). Multiple linear regression analysis determined that WYRS scores positively correlated with exercising regularly and inversely correlated with CESD-10 scores (depressed mood). CESD-10 scores positively correlated with somatic and psychological MRS subscale scores and inversely correlated with WYRS scores (less resilience). ConclusionsIn this postmenopausal sample, depressed mood and participation in regular exercise correlate with lower and higher resilience, respectively. Depressed mood is associated with the severity of menopausal symptoms (somatic and psychological).

2013 Up-date of the consensus statement of the Spanish Menopause Society on postmenopausal osteoporosis.

Postmenopausal osteoporosis is a major female health problem that increases morbidity, mortality and healthcare system costs. Considering that gynecologists are the primary health practitioners involved in the treatment of women with osteoporosis in our country, a panel of experts from the Spanish Menopause Society met to establish a set of criteria and procedures for the diagnosis and treatment of this disease based on the best available evidence and according to the model proposed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to elaborate clinical practice guidelines and to classify the quality of the evidence and the strength of the recommendations. These recommendations should be a reference to gynecologist and other health professionals involved in the treatment of postmenopausal women.

Soy isoflavones improve insulin sensitivity without changing serum leptin among postmenopausal women

Objective To investigate the effect of a soy isoflavone extract over insulin sensitivity and plasma leptin levels. Methods Eighty postmenopausal women were randomly assigned to participate for 24 months either to a physical exercise and Mediterranean diet program (Control group: CG) or this intervention plus a daily oral intake of a soy isoflavone extract (Soy isoflavone group: SIG). Anthropometry, body composition analysis, blood biochemistry, menopausal symptoms and health-related quality of life were assessed at baseline and every 6 months. Results Sixty-five women completed the protocol with no differences found among groups at baseline in age and time since the menopause. At month 24, body mass index (BMI) was lower in the SIG as compared to the CG. Fat mass, glucose, insulin, HOMA-IR, tumor necrosis factor-α (TNF-α), Kupperman Index and Cervantes Scale values significantly decreased in the SIG as compared to baseline and to CG values. Kupperman scores and serum TNF-α levels significantly decreased in both studied groups. No changes in plasma leptin levels were observed after 24 months within and between groups. When analysis was stratified according to BMI values, changes in the aforementioned parameters displayed a similar trend; however, the impact over glucose, insulin and HOMA-IR values was more evident among obese women assigned to the SIG. Conclusion Diet, physical exercise and a daily oral intake of soy isoflavones exerted a beneficial effect on the homeostatic model in postmenopausal women which was not related to significant changes in plasma leptin levels, despite a decrease in TNF-α, fat mass and Kupperman values.

Benefits of physical exercise in postmenopausal women

Physical inactivity not only places womens health at risk during menopause, but also increases menopausal problems. Abundant evidence links habitual physical exercise (PE) to a better status on numerous health indicators and better quality of life and to the prevention and treatment of the ailments that typically occur from mid-life onwards. We can infer that PE is something more than a lifestyle: it constitutes a form of therapy in itself. A panel of experts from various Spanish scientific societies related to PE and menopause (Spanish Menopause Society, Spanish Cardiology Society, Spanish Federation of Sports Medicine) met to reach a consensus on these issues and to decide the optimal timing of and methods of exercise, based on the best evidence available.

Spanish Menopause Society position statement: use of tibolone in postmenopausal women.

AbstractTibolone is a drug with complex tissue-specific action that exhibits a combination of estrogenic, progestogenic, and slight androgenic activity. Its variable profile explains its clinical effects, depending on the target tissue where it is metabolized, its metabolites’ affinity for and potency in hormone receptors, and probable enzymatic activity modulation.In recent reviews and clinical trials, the effectiveness of tibolone in alleviating different hot flush menopause symptoms, mainly in mood and sexuality disorders, has been noted. In Spain, tibolone is the most prescribed hormonal treatment, and one of the most common complaints among postmenopausal women is change in sexual drive. For such reason, a panel of experts from the Spanish Menopause Society met to develop usage recommendations based on the best evidence available.

Assessment of menopause-related symptoms in mid-aged women with the 10-item Cervantes Scale

OBJECTIVE To develop a short 10 item version of the original menopause Cervantes Scale (CS) in order to assess menopausal symptoms in a large cohort of mid-aged Colombian women. METHODS Reliability of the new short tool was assessed through internal consistency determination (Cronbachs alpha values) and intra-class correlation coefficient (ICC) analysis. Ten items out of the 31 composing the original CS were selected according to their clinical relation with menopausal symptoms. Subsequently the short tool was used to assess menopausal symptoms and related factors among 1739 mid-aged women. RESULTS The CS-10 displayed a mean (±SD) ICC value of 0.45 (±0.06) and a Cronbachs alpha of 0.778 suggesting good internal reliability. For the entire sample median [interquartile range] CS-10 global scores were 10.0 [12.0], and for pre-, peri- and postmenopausal women: 8.0 [9.2], 9.0 [9.0] and 14.0 [14.0], respectively. Median global CS-10 scores significantly increased with menopausal status, marital status and ethnicity. Multiple linear regression analysis determined that higher global CS-10 scores (worse quality of life) correlated with age, parity, years since menopause, body mass index, ethnics (black) and smoking habit. CONCLUSION The CS-10 seems to be a simple instrument that may aid everyday clinical consultation and help at performing an accurate diagnosis of menopause-related symptoms. Further studies are needed to confirm our preliminary findings.

Position of the Spanish Menopause Society regarding the management of menopausal symptoms in breast cancer patients

Breast cancer is the most common female cancer in Spain. Its high prevalence, its high survival rate, and its incidence are the reasons treatment is increasingly sought for common problems by young women who have survived it. Besides the contraception and fertility issues, many breast cancer survivors develop sexual disorders and menopausal symptoms, whether as a consequence of treatment-induced menopause or side effects of treatment. For such reasons, a panel of experts from the Spanish Menopause Society has met to develop usage recommendations for the relief of vasomotor symptoms and for sexual and reproductive health in patients with breast cancer based on the best evidence available.

Insulin resistence and health-related quality of life in postmenopausal women

Health-related quality of life (HR-QOL) was similar between the menopausal women with and without Insulin Resistance (IR). However, when IR women with Metabolic Syndrome were considered, a higher level of problems on the HR-QOL global score was found and the difference was mainly due to Health and Sexuality domains.