canvas menopause study 2022

Transcript

1. English version Menopause Study © 2022 Vitalogue Health, Inc.
2. Introduction All women experience menopause. About one billion people (12% of the world population) are said to be facing menopause and it is estimated that the number will grow to 1.6 billion by 2050. Perimenopause heavily affects a woman’s life since it overlaps with important life events such as promotions and childcare. A survey from Health and Global Policy Institute (HGPI) revealed that the majority of people who suffer from menopausal symptoms answered they cannot perform even half what they once could because of heavy symptoms. According to a Japanese labor force survey in 2021, there were 7.35 million employed women between the ages of 45 and 54, which makes up about one fourth of the total female workforce, Though data from the Organisation for Economic Co-operation and Development (OECD) shows Japan’s perimenopausal population ranks among the highest in comparison with other countries, there is still a stigma for people to talk about menopause and menopausal symptoms out loud. Therefore, to understand menopause, to help women who suffer from menopausal symptoms, and to contribute to medical advancement, we created this report summarizing the data of canvas users. This report is unique as it consists of hormonal data not only about menopause but also about perimenopause (a period transitioning to menopause generally start in woman's late 40's). We believe our report will increase awareness of menopause throughout society and improve women’s lives. © 2022 Vitalogue Health, Inc. © 2022 Vitalogue Health, Inc.
3. Dynamics of menopause and hormonal states Menopause Study © 2022 Vitalogue Health, Inc.
4. Dynamics of menopause and hormonal states - 1 Menopause Menopause is the time that marks the end of your menstrual cycles. It's diagnosed after you've gone 12 months without a menstrual period. Perimenopause* refers to the time during which your body makes the natural transition to menopause. Though there are individual differences, many people struggle with symptoms due to hormonal imbalances. What is menopause and perimenopause? © 2022 Vitalogue Health, Inc. Perimenopause 45 - 55歳 * Precisely, according to STRAW+10, perimenopause refers to periods of “menopausal transition” and “one year after final menstrual period” . Menopausal transition is defined as a stage -2 and -1, marked by changes in menstrual cycle length accompanied by hormonal fluctuations and a variety of symptoms. Early perimenopause is equivalent to a stage -2, marked by a change of ≥7 days in the intermenstrual interval. In this report, we include “one year after final menstrual period” in “late perimenopause.” 0 10 20 30 40 50 60 70 Fluctuation E2 Age
5. Dynamics of menopause and hormonal states - 2 The ovaries usually secrete estrogen when the brain signals it. During ovarian dysfunction in perimenopause, however, ovaries do not respond to this signal well. Therefore, the brain strengthens the signal to maintain healthy estrogen levels. This can result in low or even high estrogen levels: the brain sends a stronger stimulus to induce more estrogen, but at times the ovaries respond too well, moving estrogen levels from very low to very high. This intense fluctuation causes hot flashes, insomnia, depression, irritation, and various other symptoms. If a woman feels uncomfortable or her daily life is disturbed by these symptoms, she has “menopausal disorder (commonly known as menopausal syndrome).” Causes of menopausal symptoms Before perimenopause Perimenopause Ovarian dysfunction ovaries respond ovaries don’t respond Well Brain send signals to ovaries for E2 Brain tries to stimulate ovaries for E2 Stiff shoulder Insomnia Hot flushes Irritation Fluctuation of hormones © 2022 Vitalogue Health, Inc.
6. Hormonal fluctuations The number of follicles decline Early perimenopause As explained earlier, perimenopause refers to the time during which your body makes the natural transition to menopause. Though there are individual differences, many people struggle with symptoms due to hormonal imbalances. Estrogen levels fluctuate when the number of ovarian follicles decline as a result of aging. When in transitioning to perimenopause, these hormonal fluctuations might trigger menopausal- like symptoms. Early Perimenopause Dynamics of menopause and hormonal states - 3 © 2022 Vitalogue Health, Inc.
7. Dynamics of menopause and hormonal states - 4 When E2 and FSH levels are in good balance, the body is in harmony. On the other hand, when FSH alone is high (or even when E2 is also low, the hormonal state of menopause), the body might be in distress. The repetition of these ups and downs is the biggest indicator of changing hormone levels in menopause. As a woman approaches menopause, her body gradually changes. One of these changes is a drop in estradiol (E2) and an increase in follicle-stimulating hormone (FSH). The fluctuation of these hormones results in a variety of symptoms. This is because the state of our brains and ovaries fluctuate, causing ups and downs in fluctuating hormone levels each day. What happens to hormones during perimenopause? Hormones during perimenopause Good Bad Menopause E2 FSH OK Low E2 FSH High Repetition of these ups and downs © 2022 Vitalogue Health, Inc.
8. canvas assesses hormone levels and menopausal symptoms. As previously mentioned, the hormonal status during perimenopause changes dramatically. Since serum hormone levels vary day by day, menopausal disorder is diagnosed by assessing hormonal status and symptoms. It should be noted that canvas users who are symptomatic but with normal hormone results will be advised to seek further medical consultation. What does canvas assess? Dynamics of menopause and hormonal states - 5 Hormone levels FSH TSH E2 ＋ Symptoms Hot flush Stiff shoulder Insomnia etc... © 2022 Vitalogue Health, Inc.
9. E2 level is low and FSH level is high during menstrual periods. Ovulation can still occur in this hormonal state, although the frequency is lower than in early perimenopausal state. FSH level can be high as a result of a relatively low level of E2 secretion from the ovaries. Marked hormonal imbalance and fluctuations can be seen in this state because of the beginning of ovarian dysfunction. This state is typical in “perimenopause”, and medical therapy might be necessary for those who suffer from menopausal symptoms. High luteinizing hormone (LH) levels or high testosterone (T) levels indicate PCOS (polycystic ovarian syndrome). Menstrual irregularity and ovulation disorders can occur due to these hormonal imbalances. High T levels can lead to masculinization, such as hairiness and the development of acne. FSH and LH are secreted from the brain. Malfunction of the hypothalamus can lead to low levels of FHS and LH, leading to low E2 levels. This can cause ovulation disorders. Stress, overexercise, and weight loss can trigger this hormonal status. Late perimenopause PCOS Early perimenopause Hypothalamic 
 amenorrhea Typical patterns of hormone levels FSH E2 FSH E2 Fluctuate Low E2 FSH High FSH LH E2 OK E2 FSH High OK OK E2 FSH LH（Luteinizing hormone） High OR T（testosterone） High Low Low Low E2 FSH LH © 2022 Vitalogue Health, Inc.
10. Results from canvas users Menopause Study © 2022 Vitalogue Health, Inc.
11. We recommended medical examinations to 65.7% of all canvas users. Of those who used the menopause kit, the ratio was up to 83.8%. Of the people who used the menopause kit, 30% had menopausal symptoms. However, when hormone levels and symptoms were analyzed together, more than 80% were recommended to seek medical care. We found that women’s hormone levels start to show change even before menopausal symptoms appear. Overall 
 results Overall results of people who used a canvas test Results of people who used a canvas menopause check immediate medical attention required medical followup advised 65.7% 83.8% © 2022 Vitalogue Health, Inc. © 2022 Vitalogue Health, Inc.
12. People who used 
 a canvas test Late perimenopause Early perimenopause PCOS Anovulation Other Reasons for 
 “medical followup advised,” and 
 “immediate medical attention 
 required.” Among users we recommended seek medical followup , 6.2% and 46.4% had late perimenopause and early perimenopause hormonal levels, respectively. 46.4 % Early perimenopause 6.2 % Late 
 Perimenopause Hormone 
 levels © 2022 Vitalogue Health, Inc.
13. Results by 
 age groups Regardless of the appearance of menopausal symptoms, more than half of users in their forties showed hormone levels specific to early perimenopause. Late perimenopause Early perimenopause PCOS Anovulation Other 10’s 20’s 30’s 40’s 50’s 100% 50% 0% 50.2 % Early 
 perimenopause 61.5 % Early 
 perimenopause 28.2 % Late 
 Perimenopause © 2022 Vitalogue Health, Inc. © 2022 Vitalogue Health, Inc.
14. Among all the people who used the canvas test, 16.3% had menstrual irregularities. Of those who had late perimenopause and early perimenopause hormone levels, the ratio was up to 20%. When approaching menopause, women often see changes in their periods in terms of regularity, amount of blood loss, and cycle intervals. Common observations are “the amount is less,” “the cycle is shorter,” and “the menstrual symptoms are milder.” However, changes in the cycle itself (menstrual irregularity) are reported less frequently. Therefore, we recommend women check hormone levels since their bodies are going through a gradual change before their periods become irregular. Irregular periods Late perimenopause Early perimenopause PCOS Anovulation Other 100% 50% 0% Irregular Regular © 2022 Vitalogue Health, Inc. © 2022 Vitalogue Health, Inc.
15. SMI : Simplefield Menopausal Index The Simplified Menopausal Index (SMI) is an index to score menopausal symptoms developed by Dr. Koyama for Japanese people. The higher the score, the more severe the symptoms are. This index can also be used for self-assessment or as an indicator to assess efficacy of treatments. Conditions such as osteoporosis and arteriosclerosis might be hidden even if the score is low. Note Symptoms Severe 　⇔ 　None score Hot flashes 10　　6　　3　　0 14　　9　　5　　0 Cold hands and cold waist 10　　6　　3　　0 12　　8　　4　　0 Sweating 14　　9　　5　　0 7　　5　　3　　0 Shortness of breath, palpitations 7　　4　　2　　0 7　　5　　3　　0 Sleeping problems 12　　8　　4　　0 7　　5　　3　　0 Glooming, melancholy Fatigability, tires easily Headache, dizziness, nausea Short temper, irritability Stiff neck, joint pain Assessment of sum score 0〜25 → No apparent abnormalities 26〜50 → Be careful about 
 food and exercise 51〜65 → Perimenopause; 
 medical examination 
 recommended 66〜80 → Need long-term 
 treatment 80〜100→ Need detailed 
 examination and 
 long-term treatment © 2022 Vitalogue Health, Inc. © 2022 Vitalogue Health, Inc.
16. Fatigue Fatigue Hot flushes Hot flushes Sweats Sweats Sleep 
 disruption Sleep 
 disruption Mood swings Mood swings Headache Brain fog Headache Brain fog Anxiety/
 depression Anxiety/
 depression Palpitations Palpitations Stiff shoulder
 back pain Stiff shoulder
 back pain Cold legs Cold legs 86.2 % 83.8 % 58.6 % 78.2 % 62.1 % 44.2 % 72.4 % 68.0 % 72.4 % 66.0 % 41.4 % 57.4 % 58.6 % 65.5 % 51.7 % 31.0 % 55.2 % 41.6 % 75.9 % 71.6 % Reported symptoms from users in late perimenopause Reported symptoms from users in early perimenopause Reported symptoms from users in other states Imbalance in autonomic nerves Imbalance in autonomic nerves Vasomotor system Vasomotor system Psychiatric system Psychiatric system Fatigue Hot flushes Sweats Sleep 
 disruption Mood swings Headache Brain fog Anxiety/
 depression Palpitations Stiff shoulder
 back pain Cold legs 74.5 % 70.9 % 36.4 % 64.7 % 56.3 % 54.8 % 65.7 % 27.2 % 32.1 % 70.9 % Imbalance in autonomic nerves Vasomotor system Psychiatric system © 2022 Vitalogue Health, Inc.
17. Symptoms in late perimenopause and early perimenopause Early perimenopausal users of canvas tend to have easier fatigability and autonomic imbalance symptoms compared to those who have normal hormone levels. We believe that this is due to the fluctuation of hormones mentioned previously. In addition, symptoms derived from low E2 levels, such as hot flushes, sweating, and palpitations, as well as sleeping problems that accompany those symptoms, were seen more in early perimenopausal users than in users with normal hormone levels. On the other hand, more late perimenopausal users had symptoms derived from low E2 levels than any other group. This aligns with an earlier report published in Japan.1 For women who tire easily, have severe shoulder stiffness, or have any menopausal symptoms, we recommend seeing a gynecologist and taking hormone tests and to find out if the symptoms are caused by the fluctuation of hormones or low E2 levels. © 2022 Vitalogue Health, Inc.
18. Self-care for early perimenopause Changing diet and exercise habits are recommended as part of good self-care for women in early perimenopause. Limiting processed food, salt, and sugar is recommended to minimize menopausal symptoms. Getting enough protein and healthy oil such as omega 3 into one’s diet is also advised.2,3 Daily exercise, such as walking, is proven to be effective in improving symptoms.4 Including enjoyable exercise in one’s daily life is important. Isoflavone and equol can help with fatigability and shoulder stiffness. A report from 126 women aged 45 to 60 showed that by taking equol for 12 weeks, shoulder stiffness improved.5 Traditional herbal medicine (Kampo) is also effective for menopausal symptoms. It does not just focus on the condition of diseased parts but supports the condition of the entire body and mind. Kampo facilitates the proper balance of all organ systems to recover health. In this sense, only personalized Kampo is recommended to maximize the effect.6 We recommend consulting a pharmacist or a medical practitioner to get a personalized prescription. We can overcome menopause by beginning self-care during early perimenopause. © 2022 Vitalogue Health, Inc.
19. Suddenly after my period stopped, I felt dizzy and had palpitations, and I tire easily. I feel nervous and can’t concentrate on my job. I think my memory is failing and I easily forget what I was asked. Sometimes I wake up at midnight. It’s hard to breathe and this increases my anxiety I always have shoulder stiffness and back pain. I get headaches on bad days. It's been hard to wake up recently. The amount of blood is increasing and I need to change my napkin so frequently. I have pain in my shoulders and the back of my neck. I don’t feel motivated. I feel frustrated, uneasy, and sad. My period is sometimes 
 short and sometimes long. I don’t feel like doing anything. I’m giving up. Before my period, I feel depressed, uneasy, tired, and sleepy. When my period starts, I suddenly feel good and happy. I’ve started to gain weight and my hair is becoming thin and falls out easily. Users in late perimenopause Users in early perimenopause User-reported symptoms during late perimenopause and early perimenopause © 2022 Vitalogue Health, Inc.
20. The ratio of people who got/are willing to get a medical 
 follow-up after the canvas test Of those for whom we recommended seeking medical follow-up, 36.1% answered “have already received” or “willing to get” it. We believe that we are achieving our vision of “encouraging those who are hesitant to visit gynecologists” with our self- check service. Resulting in “medical followup advised,” and “immediate medical attention required.” People who “got a medical follow-up” 
 or “are willing to get a medical follow-up” 65.7% 36.1% © 2022 Vitalogue Health, Inc.
21. APPENDIX Menopause Study © 2022 Vitalogue Health, Inc. © 2022 Vitalogue Health, Inc.
22. About canvas and Vitalogue Health Five features of canvas Testing at home at your convenience Accurate results available online Comments from Gynecologists Free consultations with community and medical practitioners Prescriptions (currently kampo only) Vitalogue Health is a health-tech startup founded by a team of a pharmacist and a gynecologist, aiming to achieve easier access for people to high-quality hormonal healthcare. Currently, we offer an at-home hormone testing service, “canvas," for women that have fertility and menopause concerns. In addition to the at-home testing service, we offer online consultation, traditional personalized medicine (Kampo), and clinic referrals. © 2022 Vitalogue Health, Inc. © 2022 Vitalogue Health, Inc.
23. Ayako was a management consultant at Accenture, with a focus on M&A and strategy for communications and pharmaceutical companies. Later, she joined the investment banking division at Goldman Sachs covering TMT/ healthcare clients. After working at Heart Driven Fund, an investment arm of Akatsuki Ltd., she founded Vitalogue Health. Ayako holds a BSc and MSc from the University of Tokyo, specializing in neuroscience and pharmacology. She also earned an MBA from London Business School. She is a certified pharmacist with a specialty in traditional herbal medicine. Founder and CEO of Vitalogue Health Ayako Hasegawa Yuto graduated from the University of Tokyo, Faculty of Medicine. He is a certified obstetrician and gynecologist. He did his junior residency at Kawasaki Municipal Hospital, and senior residency at Kobe City Medical Center General Hospital. Additionally, he had a perinatal fellowship at the National Center for Child Health and Development. He is currently in a Ph.D. course at the Department of Global Health Promotion, Graduate School of Tokyo Medical and Dental University. Medical supervisor of Vitalogue Health Yuto Maeda Leadership team © 2022 Vitalogue Health, Inc. © 2022 Vitalogue Health, Inc. © 2022 Vitalogue Health, Inc.
24. 1) Terauchi M et al. Subgrouping of Japanese middle-aged women attending a menopause clinic using physical and psychological symptom profiles: a cross-sectional study. 2014 2) Liu Zhao-min et al. Associations between dietary patterns and psychological factors: a cross-sectional study among Chinese postmenopausal women. 2016 3) Lucas, Michel. Effects of ethyl-eicosapentaenoic acid omega-3 fatty acid supplementation on hot flashes and quality of life among middle-aged women. 2009 4) Beate C Sydora.Can walking exercise programs improve health for women in menopause transition and postmenopausal? Findings from a scoping review. 2020 5) Aso T et al. A natural S-equol supplement alleviates hot flushes and other menopausal symptoms in equol nonproducing postmenopausal Japanese women. 2012 6) 寺内公一 更年期女性への漢方診療の実際 2018 Reference © 2022 Vitalogue Health, Inc.