Reacción a "Reactions: review highlights lack of menopause studies "

This review provides an update on the biological determinants, symptomatic impact and health threats of menopause. The quality of the study is high, as it updates the scientific evidence on a universal phenomenon for women, with variants including primary ovarian insufficiency, also called early menopause, and surgical menopause.  

As features to highlight, the article draws attention to the prevalence of the phenomenon, which occurs at an early age considering the current life expectancy of women globally, not only in developed countries' societies.  

The biological basis is the programming of the ovary to cease its hormonal activity at a time that now, not in the past when life expectancy was shorter, is mid-life. The abrupt loss of the main ovarian hormone, oestrogen, has a number of implications for different organs and systems, as oestrogen receptors are distributed in most tissues of the body. Therefore, in addition to genital symptoms, essentially atrophy of the vaginal mucosa and in part of the vulvar epithelium, there are bone effects (postmenopausal osteoporosis), cardiovascular effects (acceleration of arteriosclerosis, with impact on coronary heart disease and stroke, and the very frequent vasomotor symptoms, the so-called hot flushes), cerebral (brain fog, mood alterations), sleep disorders, changes in weight and body structure, etc., which means a deterioration in the quality of life of many women.  

This set of symptoms and biological changes do not occur in all women and, when they do, they do not occur to the same extent, but they make up an entity that has received little attention, so that a large part of the pathophysiology is still unknown. All this is well described and supported by current scientific evidence in the article by Susan Davis and colleagues. 

The article provides an excellent update, with the latest evidence is reflected in each section. The authors, Professors Davis, Pinkerton, Santoro and Simoncini are at the forefront [of this research field] worldwide. They have provided a thoughtful analysis of many issues that have been treated with much confusion over the years, largely because the evidence has been misinterpreted by many physicians, and because of the lack of training of physicians, particularly those specialising in gynaecology or endocrinology. Specialists in training touch very casually on these issues and lack solid training on the subject, which has a negative impact on the care given to patients. This is now a priority issue in scientific societies such as the European Menopause and Andropause Society (EMAS). A frequent confounding factor in these assessments is the effect of age, which overlaps with the hormonal effect itself.  

This is a practical issue of universal concern in the field of women's health. It should be required reading for health professionals in clinical practice. There is a wide range of solutions available, including healthy lifestyle habits or, if necessary, drugs, where hormone therapy stands out, or other drugs mentioned in the article, such as selective oestrogen receptor modulators, complementary alternative therapies such as cognitive behavioural therapy, or psychotropic drugs, such as selective serotonin reuptake inhibitors.  

Of note is the recent emergence of neurokinin receptor antagonists, which constitute a specific non-hormonal therapy for vasomotor symptoms. Fezolinetant, the first drug to be marketed in this field, is a therapeutic novelty because of its efficacy, even in areas other than hot flushes, such as sleep or quality of life, and because it is the first marketed drug from a new therapeutic group. It is of particular interest to women who cannot take hormone therapy, such as breast cancer survivors, or who do not wish to do so, because they reject the option of using them, or because of adverse effects such as bleeding or other symptoms.