Objectives This study aimed to describe treatment patterns among naturally menopausal women from the USA, the UK and Germany. Methods Using health claims (the USA) and electronic health records (the UK and Germany), women aged 40–65 years with a first record of natural menopause (index date) from 2009 to 2022 were identified. Women with a history of bilateral oophorectomy, total hysterectomy, endocrine therapy for breast cancer or hormone/non-hormone therapy for menopausal symptoms were excluded. Treatments evaluated following the index date were hormone therapy, benzodiazepines, antidepressants, anticonvulsants and the antihypertensive clonidine. Results In total, 1,260,742 (the USA), 214,374 (the UK) and 124,542 (Germany) women were included, and treatments were recorded in 38.8%, 33.4% and 28.8%, respectively. Among these, the majority received one treatment class, mostly hormone therapy (44.2% for the USA, 41.1% for the UK, 92.6% for Germany), benzodiazepines (25.3% for the USA, 6.8% for the UK, 2.2% for Germany) and antidepressants (18.6% for the USA, 33.5% for the UK, 4.1% for Germany). Discontinuation rates at 6 months from starting initial treatment were 75.0–88.0% for hormone therapy, 65.0–85.0% for antidepressants and ≥98% for benzodiazepines. Treatment switches occurred in 25.4% (the USA), 21.8% (the UK) and 1.7% (Germany). Conclusions Continuation rates with current treatments for women experiencing natural menopausal symptoms are low, indicating an unmet need for effective and acceptable therapies.

Objective This study aimed to investigate the association between the severity of vasomotor symptoms (VMS) and the burden of the condition in the real-world setting within Japan. Methods The cross-sectional survey study was administered as a web-based questionnaire involving perimenopausal and postmenopausal women. Respondents were female at birth, 40–64 years old and had ≥1 episode of VMS in the prior 12 months. The primary objective was to understand the treatment landscape related to mild to severe VMS. Secondary objectives were to understand attitudes to VMS, opinions on available treatments and impact of VMS on quality of life (QoL). Results The target population included 2188 respondents. Only 219 (10.0%) respondents visited a medical facility for VMS, and 123 (5.6%) women consulted a doctor when visiting for other treatment. Being able to cope with symptoms was the most common reason for not attending a medical institution. More than half who received treatment were prescribed traditional Chinese medicine (181/325 [55.7%] respondents) and one-third received hormone therapy (108 [33.2%] respondents). Severe VMS were associated with lower QoL, worse sleep quality and reduced work productivity. Conclusions Women in Japan with VMS do not typically visit medical institutions or receive appropriate medical intervention even when they are aware of VMS and feel some burden.

Maintaining fitness throughout menopause is crucial for sustaining functional capacity and supporting healthy aging. Declines in physical activity and changes in physiology threaten cardiovascular health in menopause. Aerobic capacity is an indicator of current health status that can be measured directly, by maximal rate of oxygen uptake (V̇O2 max), or using submaximal predictive methods that require fewer resources. This study aimed to establish the validity of these predictive methods for midlife women. Forty-four women (age 52 ± 4 years) completed three predictive cycle ergometer protocols (YMCA, Astrand-rhyming and Ekblom-Bak) and an incremental cycle ergometer V̇O2 max test. Predicted V̇O2 max scores were compared for agreement with directly measured V̇O2 max. All methods evidenced moderate correlations with V̇O2 max. The mean V̇O2 max value derived from the YMCA (35.6 ± 9.7 ml·kg−1·min−1) and Astrand-Rhyming (35.5 ± 8.8 ml·kg−1·min−1) tests was no different to measured V̇O2 max (34.5 ± 7.2 ml·kg−1·min−1), but the Ekblom-Bak test (37.5 ± 7.2 ml·kg−1·min−1, p < 0.01) overpredicted V̇O2 max. All methods showed wide limits of agreement, suggesting variability in the accuracy of predictions. When measuring aerobic capacity or prescribing exercise using these predictive methods, the results should be interpreted with caution. Where possible, direct measurement of aerobic capacity should be utilized for prescription of exercise intensity in menopausal women.

The effectiveness of various exercise types in improving sleep quality in menopausal women remains controversial. This network meta-analysis was designed to evaluate and rank the efficacy of five exercise modalities on sleep quality in peri-postmenopausal women. Five English databases and three Chinese databases were searched for randomized controlled trials (RCTs) published from inception to July 2024. Pairwise meta-analysis and frequentist network meta-analyses were performed based on the random effects model. The analysis revealed that younger menopausal women (age ≤55 years) (standardized mean difference [SMD] = −2.00; 95% confidence interval [CI] [–2.70, –1.31]), those with sleep disorders (SMD = –2.29; 95% CI [–2.79, –1.78]) and those from Asia (SMD = −2.50, 95% CI [–3.62, –1.38]) were able to derive greater health benefits. Flexibility exercise (low certainty) and aerobic exercise (low certainty), combined exercise (moderate certainty) and mind–body exercise (moderate certainty) significantly improved sleep quality. Combined exercise showed the highest efficacy (surface under the cumulative ranking curve [SUCRA] = 93.5%), followed by flexibility exercise (SUCRA = 76%), and these exercises also showed a positive effect on women’s quality of life (SMD = 0.49; 95% CI [0.13, 0.84]; p = 0.007). Future research should develop more acceptable exercise intervention models and use combined and flexibility exercises to explore the optimal parameters of exercise for menopausal women.

Objective This study aimed to determine whether live birth affects the age at menopause (AAM), explore the relationship between different characteristics and AAM, and develop a model to project the AAM in middle-aged women. Method A cross-sectional study was conducted with 630 postmenopausal women in Cyprus between January 2022 and June 2022. Postmenopausal women between ages 40 and 90 years completed a 90-question questionnaire that assessed reproductive, socio-demographic, familial, lifestyle and newborn/childhood parameters. Linear regression analysis was used to determine the associations related to AAM, which was questioned in the questionnaire. Multiple linear regression analysis was applied to determine the effect of potential associations on AAM. Results The mean AAM was 48.7 years. In univariate analysis, the strongest associations observed were the positive correlation between AAM and the number of grown-up children and live births. Other reproduction-related parameters were mildly correlated with AAM. In the multivariable analysis, the effect of reproduction became less critical, including live birth. The strongest associations with AAM were the years of marriage before the AAM, relationship quality with the partner, the participant’s mother’s AAM and the average AAM of any sisters. A formula including parameters strongly associated with AAM contributed to a 26.7% variation in AAM between women (p < 0.001). Conclusions As the AAM can be determined to an extent, we can separate early and late AAM groups and prepare for the high-risk conditions related to later or earlier AAM to increase longevity.

Objective This study aimed to investigate the potential causal relationship between 731 immune cell traits and age at natural menopause (ANM), a measurable endpoint for ovarian aging. Methods Based on variant ANM data from the ReproGen Consortium, two-sample Mendelian randomization (MR) analyses were conducted in a European population to identify significant immune cell traits associated with menopausal timing using inverse variance weighting (IVW) methods as the primary strategy. The study performed additional scrutiny to test the robustness of the significant associations via weighted median and MR-Egger as complementary methods, heterogeneity and pleiotropy analyses, the Steiger test and reverse MR for testing directionality, and leave-one-out analysis for biased and dominant variants. Replication analyses were also carried out using an independent dataset for ANM from UK Biobank. Results After false discovery rate (FDR) correction, 10 significant immune cell traits were identified, suggesting putative causal associations with menopausal timing. Six immunophenotypes were associated with earlier ANM including CD39+ activated regulatory T cell (Treg) %activated Treg, NK% CD3− lymphocyte and CD27 on four B cell types (IgD−CD38dim B cell, memory B cell, unswitched memory B cell, switched memory B cell). Four immunophenotypes were associated with later ANM: CD39+ resting Treg absolute count, HLA DR+ CD4+ %lymphocyte, CD24 on IgD−CD38dim memory B cell and HVEM (Herpesvirus Entry Mediator, also named as TNFRSF14) on CD4+ T cell. These results were validated in the replication dataset from UK Biobank. No reverse causation was found. Conclusion This study demonstrates a causal relationship between 10 immune cell traits and menopausal timing, thereby expanding our knowledge about reproductive aging from the perspectives of inflammaging.

It was a true honor to be invited as President to deliver the Pieter Van Keep oration at the 2024 International Menopause Society (IMS) Congress in Melbourne, Australia. There was never any doubt that the topic of my lecture would be premature ovarian insufficiency (POI). POI is a condition which has been neglected for far too long given its greater global prevalence than originally estimated and its implications to the sufferers, both in terms of quality of life and long-term well-being. The hope is that we are now entering a new era of awareness given the recent update of the European Society of Human Reproduction (ESHRE) POI guideline, achieved through a partnership of the ESHRE, American Society for Reproductive Medicine (ASRM), Centre for Research Excellence in Women’s Health in Reproductive Life (CRE WHiRL) at Monash University and IMS with support from numerous global stakeholder organizations. Whilst as a minimum the update of the guideline is expected to improve clinical management of this condition, the process has also identified key areas of much-needed research, where currently only practical guidance can be given due to the lack of data. The aim of my Pieter Van Keep lecture, and therefore this article, was not to replicate the extensive work already conducted to systematically review the literature for the guideline. The aim was to provide a state-of-the-art commentary highlighting the key controversial topics regarding this distressing condition, and how these are being addressed, or should be addressed in the future, for the sake of sufferers and their families.

Objective This study aimed to examine differences in premature and early menopause across various regions in low and middle-income countries (LMICs). Methods Data for 55 LMICs from the Demographic and Health Surveys (2013–2023) were classified into nine regions. Proportions of premature (aged <40 years) and early (aged <45 years) menopause were calculated. Logistic regressions adjusted for covariates were also run. Results The proportion of women in premature menopause ranged from 1.58% in the European and Eastern Mediterranean regions to 6.87% in Southern Africa. For early menopause, proportions ranged from 4.92% in the Eastern Mediterranean region to 15.21% in the Americas. The Eastern Mediterranean region had systematic lower odds across menopause categories, even after the adjustments for relevant covariates. Conclusion Significant variation exists in the proportion of the different age at menopause categories within LMIC regions. Higher proportions of premature and early menopause were found in all LMIC regions compared to those reported in current literature from high-income countries. A global health perspective on menopause is urgently needed, especially in relation to the increased disease risks with early and premature menopause, such as cardiovascular disease.

Menopause is commonly viewed as a hormone deficiency and a risk factor for chronic illness, but it also represents a biological transition and profound social role change for women. This narrative review synthesises evidence on how women in sub-Saharan Africa conceptualise and experience menopause and ageing, and examines how research has captured these dimensions. Databases including SCOPUS, Science Direct, Mendeley Data, Web of Science, PubMed, Medline African Medical Index, and the National Library of Medicine were searched using the terms ‘menopause’, ‘ageing/aging’ and ‘sub-Saharan Africa’. Forty-two qualitative and quantitative studies in English and French were included. The review found that while many studies emphasise biological markers, symptoms, and the links between menopause and chronic disease, a significant number also highlight women’s own interpretations of menopause as a social transition, sometimes associated with enhanced status and autonomy. In some contexts, menopause is linked to stigma or loss of femininity, while in others, it enables greater autonomy and decision-making power. Few women report awareness or acceptance of biomedical interventions such as menopause hormone therapy, tending to view menopause as a natural process rather than a medical condition. These findings underscore the importance of culturally sensitive public health interventions and clinical strategies that address both the biomedical and sociocultural dimensions of menopause, to promote healthy ageing and reduce the burden of chronic disease among women in sub-Saharan Africa.