HealthDay News — Age, race, and education are the most prevalent disparities associated with menopausal hormone therapy (MHT) prescribing, according to research presented at the annual meeting of the North American Menopause Society, held from September 27 to 30 in Philadelphia.

Danette Conklin, PhD, from University Hospitals in Cleveland, and colleagues conducted a scoping review of real-world studies to examine health care disparities in MHT prescribing based on demographic or clinical characteristics. The scoping review included 20 studies conducted from 1973 through 2015.

The researchers found that age, race, and education were the three most prevalent disparities associated with MHT. In 13 studies, age was associated with MHT disparities, with older women being prescribed, using, or being counseled on MHT more often than younger women in seven studies. In four studies, older women were prescribed, used, or were counseled on MHT less than younger women, while mixed results were seen in one study. Ten studies reported race disparities; all reported that Black women used, were prescribed, or were counseled less than their White, Mexican, Latina, or Asian counterparts. Compared with all other races, White women received/used MHT more often, with the exception of vaginal estrogen, which was prescribed to White women less than Hispanic menopausal women in one study. Six studies demonstrated educational disparities, with menopausal women with less versus more education counseled less and using or prescribed less MHT.

“This study reinforces that health care professionals must ask patients about their specific menopause symptoms so they can discuss the options that could help them improve their quality of life,” Stephanie Faubion, MD, medical director of the North American Menopause Society, said in a statement. “Black women should have the same access as White women to the available treatment options.”

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The order “will direct the most comprehensive set of executive actions ever taken to expand and improve research on women’s health,” the White House said in a news release announcing the move. “These directives will ensure women’s health is integrated and prioritized across the federal research portfolio and budget, and will galvanize new research on a wide range of topics, including women’s midlife health.”

While women comprise half of the US population, research into their health is lacking. In fact, the federal government only began mandating women be included in federally funded medical research in the 1990s, the Associated Press reported.

“We still know too little about how to effectively prevent, diagnose and treat a wide array of health conditions in women,” Dr Carolyn Mazure, head of the White House initiative on women’s health, told the AP.

The move comes as women’s reproductive rights across the country are being threatened following the Supreme Court’s overruling of Roe v. Wade.

President Biden and First Lady Jill Biden, who announced an initial $100 million in funding last month for women’s health, plan to announce the latest measures at a Women’s History Month reception at the White House on Monday. The measures will include the launch of a new effort at the National Institutes of Health (NIH) that will direct $200 million in 2025 to fund new, interdisciplinary women’s health research.

The NIH effort will also focus on identifying and rectifying research gaps in studying menopause and the treatment of menopausal symptoms, White House adviser Jennifer Klein told the AP.

The NIH tends to fund a lot of biomedical research, which helps doctors figure out how medications affect the human body and how to dose drugs safely, but that equation differs depending on gender.

Some conditions have different symptoms for men and women, such as heart disease. Others are more common in women, like Alzheimer’s disease, and some are unique to women, such as endometriosis, uterine cancers and fibroids found in the uterus. Regardless, it all needs to be studied further, Mazure said.

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The Office on Women’s Health has more on women’s health.

SOURCE: White House, news release, March 18, 2024; Associated Press

Cynthia A. Thomson, PhD, RD, from the Mel and Enid Zuckerman College of Public Health at the University of Arizona in Tucson, and colleagues examined long-term health outcomes among postmenopausal women in the Women’s Health Initiative CaD trial involving 36,282 women with no history of breast or colorectal cancer. Participants were randomly assigned to receive 1000mg calcium carbonate with 400 IU vitamin D₃ daily or placebo.

The researchers found that after a median cumulative follow-up of 22.3 years, women randomly assigned to CaD vs placebo had a reduction in cancer mortality (hazard ratio, 0.93), and an increase in CVD mortality (hazard ratio, 1.06). No overall effect was seen on other measures, including all-cause mortality. There was considerable variation observed in estimates of cancer incidence when stratified by whether participants reported supplement use before randomization, while no variation was seen for estimates in mortality, except for CVD mortality.

“Effects of vitamin D supplementation for cancer prevention may depend on achieving serum vitamin D concentrations above 50nmol/L,” the authors write. “Given the study design, we could not disentangle the added benefit or harms of supplementation with CaD in combination vs vitamin D alone, a topic worthy of future study.”

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HealthDay News — Uninterrupted transdermal nitroglycerin (NTG) therapy does not offer sustained benefit for hot flashes, according to a study published online June 5 in JAMA Internal Medicine.

Alison J. Huang, MD, from the University of California in San Francisco, and colleagues randomly assigned 141 perimenopausal and postmenopausal women who experienced at least 7 hot flashes per day to either uninterrupted daily use of transdermal NTG (participant-directed dose titration from 0.2 to 0.6mg/hour) or identical placebo patches.

The researchers found that over 5 weeks, the estimated change in any hot flash frequency associated with NTG was −0.9 (95% CI, −2.1 to 0.3) episodes per day vs placebo, while change in moderate-to-severe hot flash frequency was −1.1 (95% CI, −2.2 to 0) episodes per day. Treatment with NTG did not significantly decrease the frequency of any hot flashes (−0.1 episodes per day; 95% CI, −1.2 to 0.4) or moderate-to-severe hot flashes (−0.5 episodes per day; 95% CI, −1.6 to 0.7) vs placebo at 12 weeks. Two-thirds of NTG users (67.1%) and 5.6% of placebo participants reported headache, which decreased to one participant in each group at 12 weeks.

“The findings of this trial do not support daily uninterrupted use of transdermal NTG as a nonhormonal treatment for menopause-associated vasomotor symptoms,” the authors write.

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Elinzanetant is an investigational dual neurokinin-1,3 (NK-1,3) receptor antagonist designed to modulate the KNDy neurons, a group of estrogen sensitive neurons in the hypothalamus region of the brain. The KNDy neurons become hypertrophic due to decreases in estrogen. This leads to hyperactivation of the thermoregulatory pathway that results in vasomotor symptoms. 

The double-blind, randomized, placebo-controlled, multicenter OASIS 1 and 2 studies (ClinicalTrials.gov Identifier: NCT05042362, NCT05099159, respectively) evaluated the efficacy and safety of elinzanetant in a total of 796 postmenopausal women 40 to 65 years of age with moderate to severe vasomotor symptoms. Study participants were randomly assigned to receive elinzanetant 120mg orally once daily for 26 weeks or placebo orally once daily for 12 weeks followed by elinzanetant 120mg for 14 weeks.

Results from both studies showed that treatment with elinzanetant met all 4 primary endpoints demonstrating statistically significant reductions in the frequency and severity of moderate to severe vasomotor symptoms from baseline to week 4 and 12 compared with placebo. Statistically significant improvements in the frequency of vasomotor symptoms from baseline to week 1, sleep disturbances, and menopause-related quality of life (3 key secondary endpoints) were also observed with elinzanetant vs placebo. 

According to Bayer, full study findings will be presented at upcoming scientific congresses. Results from the phase 3 OASIS 3 study (ClinicalTrials.gov Identifier: NCT05030584) evaluating elinzanetant for the treatment of vasomotor symptoms over 52 weeks are expected in the coming months. 

HealthDay News — There are hormone-dependent changes in levels of calcitonin gene-related peptide (CGRP) among women with episodic migraine (EM), according to a study published online February 22 in Neurology.

Bianca Raffaelli, MD, from Charité-Universitätsmedizin Berlin, and colleagues studied CGRP concentrations in plasma and tear fluid in women with EM and regular a menstrual cycle (RMC), with EM using combined oral contraception (COC), and with EM in postmenopause. The corresponding groups of age-matched women without EM were used as controls. Data were included for 180 female participants (30 in each group).

The researchers found that compared with women without migraine, those with EM and RMC had significantly higher CGRP concentrations in plasma and tear fluid during menstruation. In contrast, CGRP levels were similar in the migraine and control groups among women using COC and in postmenopause. For participants with EM and RMC, significantly higher tear fluid, but not plasma, CGRP concentrations were seen during menstruation compared with those with EM using COC.

“This elevated level of CGRP following hormonal fluctuations could help to explain why migraine attacks are more likely during menstruation and why migraine attacks gradually decline after menopause,” Raffaelli said in a statement. “These results need to be confirmed with larger studies, but we’re hopeful that they will help us better understand the migraine process.”

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