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The Mumbai Obstetric & Gynecological Society

The Mumbai Obstetric and Gynaecological Society www.mogsonline.org mogs




The International Menopause Society website features useful resource material on professional and patient education including powerpoints, statements and an e-book titled “The Facts of Hormone Therapy”.


The website of the North American Menopasue Society offers plenty of downloads and position statements on issues related to menopause health and hormone therapy.


The highlights of this website are the extensive FAQs and patient information sources. The material on the Indian Menopause Society website has been written with the Indian woman in mind and printable pages can be passed on to patients.


A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms.

Lindh-Åstrand L, Bixo M, Hirschberg AL, Sundström-Poromaa I, Hammar M.

Menopause. 2009 Aug 11. [Epub ahead of print]

From the 1Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University Hospital, Linköping; 2Department of Clinical Science, Obstetrics and Gynecology, Umeå University, Umeå; 3Department of Woman and Child Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm; and 4Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.

OBJECTIVE:: The aim of this study was to investigate whether tapering down of combined estrogen plus progestogen therapy (EPT) reduced the recurrence of hot flashes and resumption of therapy compared with abrupt discontinuation. A secondary aim was to evaluate whether health-related quality of life (HRQoL) was affected after discontinuation of EPT and to investigate the possible factors predicting resumption of EPT.

METHODS:: Eighty-one postmenopausal women undergoing EPT because of hot flashes were randomized to tapering down or abrupt discontinuation of EPT. Vasomotor symptoms were recorded in self-registered diaries, and resumption of hormone therapy (HT) was asked for at every follow-up. The Psychological General Well-being Index was used to assess HRQoL.

RESULTS:: Neither the number nor the severity of hot flashes or HRQoL or frequency of resumption of HT differed between the two modes of discontinuation of EPT during up to 12 months of follow-up. About every other woman had resumed HT within 1 year. Women who resumed HT after 4 or 12 months reported more deteriorated HRQoL and more severe hot flashes after discontinuation of therapy than did women who did not resume HT.

CONCLUSIONS:: Women who initiate EPT because of hot flashes may experience recurrence of vasomotor symptoms and impaired HRQoL after discontinuation of EPT regardless of the discontinuation method used, abrupt or taper down. Because, in addition to severity of flashes, decreased well-being was the main predictor of the risk to resume HT, it seems important to also discuss quality of life in parallel with efforts to discontinue HT.

Assessment of bone mineral density should be considered earlier in perimenopausal women with vasomotor symptoms.

Tural A, Yoldemir T, Erenus M.

Int J Gynaecol Obstet. 2009 Aug 8. [Epub ahead of print]

Marmara University School of Medicine, Department of Obstetrics and Gynecology, Altunizade, Uskudar, Istanbul, Turkey.

OBJECTIVE: To investigate the relationship between vasomotor symptoms (hot flashes) and osteopenia or osteoporosis in perimenopausal women.

METHOD: In this cross-sectional study 79 perimenopausal women aged between 45 and 55years and seen at the Gynecology or Menopause Outpatient Clinic of Marmara University School of Medicine were allotted to one of 2 groups according to the presence or absence of hot flashes. The groups were then compared for bone mineral density (BMD) of the lumbar vertebrae, as measured by dual energy X-ray absorptiometry.

RESULTS: The mean BMD measurement for vertebrae L2 to L4 was 0.32+/-0.19 for the group with no hot flashes and -0.53+/-0.21 for the group with hot flashes (P=0.007). In the former, 6.1% of the women and in the latter, 32.6% of the women had a BMD value less than a 1.5 standard deviation from the mean (P=0.005).

CONCLUSION: Women with vasomotor symptoms are more prone to have osteopenia or osteoporosis.

Bazedoxifene/conjugated estrogens and quality of life in postmenopausal women

Utian W, Yu H, Bobula J, Mirkin S, Olivier S, Pickar JH.

Maturitas. 2009 Aug 20;63(4):329-35. Epub 2009 Jul 31.

Rapid Medical Research, Cleveland, OH, USA. Utian@menopause.org

OBJECTIVE: To assess the effects of bazedoxifene/conjugated estrogens (BZA/CE) on sleep parameters and health-related quality of life (HR-QOL).

METHODS: This was a 12-week, multicenter, double-blind, placebo-controlled phase 3 study. Postmenopausal women with an intact uterus and experiencing >or=7 moderate-to-severe hot flushes daily were randomized to BZA 20 mg/CE 0.45 mg, BZA 20 mg/CE 0.625 mg, or placebo. In these secondary efficacy analyses, the Medical Outcomes Study (MOS) sleep scale and Menopause-Specific Quality of Life (MENQOL) questionnaires and the Menopause Symptoms Treatment Satisfaction Questionnaire (MS-TSQ) evaluated measures of sleep, menopausal symptoms, and satisfaction with treatment, respectively.

RESULTS: A total of 318 subjects (mean age, 53.4 years) received >or=1 dose of study drug. At Week 12, BZA 20 mg/CE 0.45 and 0.625 mg showed significant improvements over placebo in the MOS sleep scale for time to fall asleep, sleep adequacy, sleep disturbance, and sleep problems indexes I and II (P<0.001). A reduction in hot flush frequency was significantly associated with improvement in sleep parameters (P<0.05) based on linear regression and responder analyses. Both BZA/CE doses showed significantly greater improvements over placebo in vasomotor function and total MENQOL score (P<0.001).

Results of the MS-TSQ showed that subjects treated with BZA/CE versus placebo reported significantly greater overall satisfaction with treatment (P<0.05), as well as greater satisfaction with sleep quality, ability to control hot flushes during the day and night, effect on mood/emotions, and tolerability.

CONCLUSION: Symptomatic postmenopausal women treated with BZA/CE experienced significant improvements in sleep parameters and overall HR-QOL.



Alternatives to HRT for the Management of Symptoms of the Menopause Scientific Impact Paper No. 6 - September 2010


Menopausal Quality of Life: A RCT of Yoga, Exercise and Omega-3 Supplements

Objective : Determine efficacy of three non-hormonal therapies for improving menopause-related quality of life (QOL) in women with vasomotor symptoms (VMS).

Methods : 12-week 3×2 randomized, controlled, factorial design trial. Peri- and postmenopausal women, ages 40-62 years, were randomized to yoga (n=107), exercise (n=106), or usual activity (n=142), and also randomized to double-blind comparison of omega-3 (n=177) or placebo (n=178) capsules. Interventions: 1) weekly 90-minute yoga classes with daily at-home practice; 2) individualized facility-based aerobic exercise training 3 times/week; and 3) 0.615 gram omega-3 supplement, 3 times/day. Outcomes: Menopausal Quality of Life Questionnaire (MENQOL) total and domain (VMS, psychosocial, physical and sexual) scores.

Results : Among 355 randomized women, average age 54.7 years, 338 (95%) completed 12-week assessments. Mean baseline VMS frequency was 7.6/day and mean baseline total MENQOL score was 3.8 (range 1-8 from better to worse) with no between-group differences. For yoga compared to usual activity, baseline to 12-week improvements were seen for MENQOL total -0.3 (95% CI -0.6 to 0.0, p=0.02), and VMS (p=0.02) and sexuality (p=0.03) domain scores. For exercise and omega-3 compared to controls, improvements in baseline to 12-week total MENQOL scores were not observed. Exercise showed benefit in the MENQOL physical domain score at 12-weeks (p=0.02).

Conclusion : All women become menopausal and many seek medical advice on ways to improve quality of life; little evidence-based information exists. We found, among healthy sedentary menopausal women, yoga appears to improve menopausal QOL - the clinical significance of our finding is uncertain due to modest effect.


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The Mumbai Obstetric & Gynecological Society

C-14, 1st Floor, Trade World, D-wing Entrance,
S. B. Marg, Kamala City, Lower Parel (W), Mumbai 400013.

Tel. : 022-24955324 / 24975035 • email: mogs2012@gmail.com

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