Susan R Davis

Monash University (Australia) · School of Public Health and Preventive Medicine

Importance Whether dehydroepiandrosterone (DHEA) supplementation improves cognitive performance in older women is uncertain. Nonetheless, DHEA supplements are readily available over the counter in several countries and are potentially being used to prevent cognitive decline and dementia. Objective This systematic review was conducted to evaluate t...

Background: This study determined the prevalence of bothersome menstrual symptoms and their association with workability in naturally menstruating women not using hormonal contraception. Materials and Methods: A representative sample of community-dwelling Australian women aged 18-39 years selected from two large national electronic databases respon...

Objective: We investigated whether low sex hormone concentrations are associated with depression in older women. Study design: This was a cross-sectional study of Australian women, aged at least 70 years, not taking medications modulating sex hormone levels. Associations between hormones, measured by liquid chromatography-tandem mass spectrometr...

Background: Whereas symptomatic endometriosis may affect work performance, the impact of endometriosis in the general community is not known. Aims: The associations between endometriosis and each of sick leave and work ability, were investigated in a large sample of non-healthcare seeking women. Materials and methods: This community-based, cro...

Objective The contribution of testosterone to depression in older women is uncertain. This review was conducted to investigate the association between endogenous testosterone blood concentrations and depression in postmenopausal women. Methods We searched Ovid MEDLINE, EMBASE, PsycINFO, and Web of Science databases for observational studies with a...

Objective: The role of circulating sex hormones on structural brain ageing is yet to be established. This study explored whether concentrations of circulating sex hormones in older women are associated with the baseline and longitudinal changes in structural brain ageing, defined by the brain-predicted age difference (brain-PAD). Design: Prospec...

Background: The early onset of menopause is associated with increased risks of cardiovascular disease and osteoporosis. As a woman's circulating anti-Müllerian hormone (AMH) concentration reflects the number of follicles remaining in the ovary and declines towards the menopause, serum AMH may be of value in the early diagnosis and prediction of ag...

Importance: The associations between endogenous dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS), and depression in older women are uncertain. However, DHEA supplements are widely available over the counter in some countries, and some people may be taking DHEA with the hope of positive mood effects. Objective: This systematic review aimed...

Objective: To explore the associations between endogenous testosterone blood concentrations and muscle mass, strength and performance in community dwelling women. Design, patients, and measurements: Online databases, including Ovid MEDLINE, EMBASE and Web of Science, were searched for observational studies, with at least 100 female participants,...

Background Vasomotor symptoms (hot flushes and night sweats) are experienced by more than two-thirds of women with breast cancer taking oral adjuvant endocrine therapy. Safe and effective treatments are lacking. Q-122 is a novel, non-hormonal compound that has shown promise for reducing vasomotor symptoms by modulation of oestrogen-responsive neuro...

Every woman who lives past midlife will experience menopause, which, by definition, is complete cessation of ovarian function. This process might occur spontaneously (natural menopause) or be iatrogenic (secondary menopause), and can be further classified as 'early' if it occurs before the age of 45 years and 'premature' if it occurs before the age...

Sir, It has been suggested by Mahboobifard et al. (2022) that a short-coming of our paper exploring the substitution of serum anti-Müllerian hormone (AMH) levels for polycystic ovary morphology (PCOM) for making the diagnosis of PCOS (Bell et al., 2021) was that we did not use age-specific AMH cut-offs for the participants aged 18–39 years, but use...

Background Blood testosterone concentrations in women decline during the reproductive years and reach a nadir in the seventh decade, after which concentrations increase and are restored to those of reproductive-aged women early in the eighth decade. We aimed to establish the association between the concentration of testosterone in the blood and ris...

STUDY QUESTION Can serum anti-Müllerian hormone (AMH) replace polycystic ovary morphology (PCOM) determined by ultrasound as a diagnostic component of polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Despite good correlations between serum AMH and PCOM, the use of a high serum AMH as a proxy for PCOM resulted in the reclassification of PCOS in 5%...

Menstrual cyclicity is a marker of health for reproductively mature women. Absent menses, or amenorrhea, is often the initial sign of pregnancy—an indication that the system is functioning appropriately and capable of generating the intended evolutionary outcome. Perturbations of menstrual regularity in the absence of pregnancy provide a marker for...

Workplace policies regarding women’s reproductive and menopausal health are garnering global attention. The peri‐ and post‐menopause stages may be turbulent times for many women, with some experiencing debilitating symptoms and some none at all. While the symptoms of menopause should be recognised by employers due to their various impacts, the impl...

Objective To document associations between anti-Müllerian hormone (AMH) and circulating androgens in nonhealthcare-seeking premenopausal women. Design Community-based, cross-sectional study. Setting Eastern states of Australia. Participants Women aged 18–39 years not using systemic hormones, not pregnant or breastfeeding within 3 months, and not...

Objective This study aimed to explore Australian health-care providers’ knowledge of menopause and its consequences, and their views about menopause-related health care. Methods This was a cross-sectional qualitative study of Australian general practitioners (GPs), gynecologists (GYs) and pharmacists (PHs). Recruitment was ultimately achieved thro...

Objective: Genitourinary symptoms, such as vaginal dryness and pain with sex, are commonly experienced by postmenopausal women. Comparing treatments for these genitourinary symptoms are restricted by the use of different outcome measures in clinical trials and the omission of outcomes, which may be relevant to women. The aim of this project was to...

Objective: Vasomotor symptoms (VMS) (hot flashes and night sweats) affect most women over the menopause transition. Comparing the safety and effectiveness of treatments for vasomotor symptoms is limited by the use of inconsistent outcome measures, and uncertainty as to which outcomes are most important to symptomatic women. To address this, we hav...

STUDY QUESTION Does the application of reference ranges for sex steroids and the modified Ferriman-Gallwey (mFG) scale established in the community from which the study sample was drawn, combined with the most conservative polycystic ovary morphology (PCOM) criteria to the recognised diagnostic criteria for polycystic ovary syndrome (PCOS) improve...

Aim To provide a clinical practice guideline for the use of testosterone including identification of patients, laboratory testing, dosing, post-treatment monitoring, and follow-up care in women with hypoactive sexual desire disorder (HSDD). Methods The International Society for the Study of Women's Sexual Health appointed a multidisciplinary panel...

Background The Global Consensus Position Statement on the Use of Testosterone Therapy for Women (Global Position Statement) recommended testosterone therapy for postmenopausal women with hypoactive sexual desire disorder (HSDD). Aim To provide a clinical practice guideline for the use of testosterone including identification of patients, laborator...

Background: The Global Consensus Position Statement on the Use of Testosterone Therapy for Women (Global Position Statement) recommended testosterone therapy for postmenopausal women with hypoactive sexual desire disorder (HSDD). Aim: To provide a clinical practice guideline for the use of testosterone including identification of patients, laborat...

Objective: Premenopausal risk-reducing bilateral salpingo-oophorectomy (RRBSO) may impair sexual function, but the nature and degree of impairment and impact of estrogen therapy on sexual function and sexually related personal distress after RRBSO are uncertain. Methods: Prospective observational study of 73 premenopausal women at elevated risk...

Objective To compare the performance of two anti‐Mullerian (AMH) assays over a range of concentrations, in samples collected from young women Design A cross‐sectional method‐comparison study of 168 non‐healthcare‐seeking women. Participants Included women were aged 18‐39 years, not recently pregnant, breast feeding or using systemic hormones. Me...

Premature ovarian insufficiency (POI) results in both estrogen and testosterone insufficiency. Whether testosterone therapy may be of benefit for women with POI is uncertain. Presently, the only evidence-based indication for testosterone therapy for women is for the treatment of postmenopausal women with low sexual desire with associated personal d...

The role of testosterone in women and its potential as a therapeutic agent continue to attract controversy. The clinical trials of testosterone therapy for women primarily have focused on treatment of female sexual dysfunction, with the largest placebo-controlled studies being of transdermal testosterone in postmenopausal women. Based on the cumula...

Objective Sex steroid levels in women vary with increasing age from the age of 70 years (70+). Whether this reflects change within individuals with age or a survival advantage is not known. This study aimed to determine the stability of circulating sex steroids and SHBG over time in individual women aged 70+. Design A prospective cohort study. Pa...

Case and principles of management: The case of a symptomatic, postmenopausal woman is presented and a full discussion of the approach to her management is discussed. Pertinent guidelines and scientific evidence are emphasized as support for the recommendations.

Background: Despite the high prevalence of depression among adult women, the proportion of reproductive-aged women with moderate or severe depressive symptoms is uncertain, as is the proportion taking antidepressant medication. We report the prevalence of depressive symptoms in young Australian women, risk factors for depressive symptoms, and psych...

Objective: This study was undertaken to examine whether the prevalence of low sexual desire, sexually related personal distress, and epidemiological hypoactive sexual desire disorder (eHSDD) differed between midlife Australian and Iranian married women. Methods: Cross-sectional, community-based studies of women aged 40 to 65 years conducted in Aus...

Background Although clinicians often measure the serum concentration of androgens in premenopausal women presenting with sexual dysfunction, with some women given testosterone or dehydroepiandrosterone as treatment if their concentrations are low, whether androgens are determinants of sexual function in women of reproductive age is uncertain. We ai...

Background Although hypoactive sexual desire dysfunction (HSDD; low sexual desire with personal distress) negatively impacts well-being, contemporary life-course prevalence data for HSDD are lacking. Aim To document, in an epidemiologic study, the prevalence of low sexual desire with associated distress (epidemiological HSDD [eHSDD]), and associat...

The physiological, clinical and therapeutic aspects of testosterone in women’s health are still a matter of controversy and debate. Quality evidence data of clinical trials favors the use of transdermal testosterone in postmenopausal women with female sexual dysfunction causing distress. Doses of testosterone should approximate physiological testos...

Background This study was undertaken to determine women’s knowledge of menopause and its consequences, and their menopause-related health-care experiences. Methods Participants were recruited to this cross-sectional qualitative study from a nationally, representative sample of Australian women. Recruitment was stratified by age to achieve groups o...

Accurate measurement of very low circulating estradiol (E2) (<5 pg/ml) in post-menopausal women and in mice is essential to investigating sex steroid action in target tissues. However, direct immunoassays are too inaccurate and conventional mass spectrometry-based measurement too insensitive at these serum E2 levels. We report application of an ult...

Importance After menopause estradiol (E2) is predominately an intracrine hormone circulating in very low serum concentrations. Objective To examine determinants of E2 concentrations in women beyond 70 years. Design and setting A cross-sectional, community based, study. Participants 5325 women, mean age 75.1 (± 4.2) years, not using any sex stero...

The North American Menopause Society (NAMS) organized the Workshop on Normal Ranges for Estradiol in Postmenopausal Women from September 23 to 24, 2019, in Chicago, Illinois. The aim of the workshop was to review existing analytical methodologies for measuring estradiol in postmenopausal women and to assess existing data and study cohorts of postme...

The recent Collaborative Group on Hormonal Factors in Breast Cancer (CGHFBC) publication calculated the attributable risk of breast cancer from use of estrogen alone and estrogen plus a synthetic progestogen for <5 to ≥15 years of use. This CGHFB report calculated attributable risk based on their findings of relative risk from pooled data from 58 s...

Context An important element of the diagnosis of polycystic ovary syndrome is hyperandrogenism. Objective To determine the distribution of modified Ferriman-Gallwey (mF-G) scores, as a measure of facial and body hair growth, and associations between the mF-G scores and serum androgen concentrations, including 11-oxygenated androgens. Design Cross...

Introduction: Testosterone has been studied for its benefits on sexual health for decades. The research regarding testosterone in women has produced evidence that this is a potential treatment for women suffering from female sexual dysfunction. There are several limitations of the testosterone trials that can affect their interpretation and challe...

Objective: To document the prevalence of female sexual dysfunctions (FSDs) and factors associated with FSDs and sexually related personal distress in premenopausal women. Design: Community-based cross-sectional study. Setting: Eastern states of Australia. Participants: Women aged 18-39 years. Interventions(s): Not applicable. Main outcome...

Background: GATA-binding protein 4 (GATA4) and Friend of GATA 2 protein (FOG2, also known as ZFPM2) form a heterodimer complex that has been shown to influence transcription of genes in a number of developmental systems. Recent evidence has also shown these genes play a role in gonadal sexual differentiation in humans. Previously we identified fou...

This Position Statement has been endorsed by the International Menopause Society, The Endocrine Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, The International Society for the Study of Women's Sexual Health, The North American Menopause Society, The Federacion Latinoamericana de Sociedades de...

This Statement is being simultaneously published in the journals Climacteric, Maturitas, Journal of Sexual Medicine, and Journal of Clinical Endocrinology and Metabolism on behalf of the International Menopause Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, and The Endocrine Society, respectiv...

Importance There is a lack of understanding of what is normal in terms of sex steroid levels in older women. Objective To determine whether sex steroid levels vary with age in and establish reference ranges for women beyond 70 years. Design and setting Cross-sectional, community based, study Participants 6392 women, aged 70 years and older. Mai...

Importance Whether serum androgens identify women with ‘androgen insufficiency’ or ‘androgen excess’ is unresolved, as what constitutes normal remains uncertain. Objective To determine whether androgens, including 11-oxygenated C19 steroids, vary with age, menstrual cycle or body mass index (BMI) during the reproductive years. Design and setting...

Objective: Little is known of depressive symptoms in Iranian women at midlife. This population-based study was undertaken to document the prevalence of, and factors associated with, depressive symptoms using validated questionnaires. Methods: A total of 1,520 community-dwelling women, aged 40 to 64 years, residing in Sari, Northern Iran, were re...

Background: The benefits and risks of testosterone treatment for women with diminished sexual wellbeing remain controversial. We did a systematic review and meta-analysis to assess potential benefits and risks of testosterone for women. Methods: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science f...

Background: In Australia many hormonal contraceptives are not Pharmaceutical Benefits Scheme (PBS) supported, hence the use of different formulations have not been quantified. Objectives: To document the use of hormonal contraceptives and factors associated with their use. Materials and methods: Cross-sectional, online questionnaire-based stud...

Background Although serum ferritin is considered a reliable indicator of iron stores, there are little data documenting the prevalence of low ferritin in representative samples of young women. Aims To estimate the prevalence of low ferritin and to identify factors associated with low ferritin in young Australian women. Methods Women, aged 18‐39 y...

Prior studies suggest androgen levels decline with age in women across the reproductive years. The aims of this study were to verify this, and report on traditional androgens as well as the more recently described 11ketoandrostenedione (11KA) and 11 ketotestosterone (11KT), measured by liquid chromatography, tandem mass spectrometry (LC-MS/MS) by a...

Objective: To describe the challenges in recruitment of a national sample of young Australian women for a study of their physical and psychological wellbeing. Methods: Women, aged 18 to 39 years, were invited by email to complete an online questionnaire and, if not using systemic hormones, pregnant or breast feeding, to provide a blood sample. Resu...

Context 11β-hydroxyandrostenedione (11OHA4) and 11β-hydroxytestosterone (11OHT), produced by the adrenals from androstenedione and testosterone respectively, and their peripheral derivatives, 11-ketoandrostenedione (11KA4) and 11-ketotesosterone (11KT), have been implicated in androgen-related physiopathology in children and adults. Little is known...

Background Testosterone therapy for women is in widespread use, primarily in the form of compounded preparations and off-label use of formulations for men. The benefits and risks of such therapy remain uncertain. This review will identify and evaluate studies that have examined the effects of testosterone therapy for women on a range of outcomes in...

Objective: This study aims to determine the prevalence and severity of menopausal symptoms in older postmenopausal women and, hence, the need for treatment options for women of this age. Methods: This is a cross-sectional questionnaire-based study conducted between October 2013 and March 2014 among 2,020 women aged 40 to 65 years and living inde...

Importance Intra-vaginal testosterone (IVT) is a potential treatment for vulvovaginal atrophy (VVA) associated with aromatase inhibitor (AI) use. Objective To investigate the effects of IVT on sexual satisfaction, vaginal symptoms and urinary incontinence (UI) associated with AI use. Design Double-blind, randomized, placebo-controlled trial. Set...

Context: High-quality evidence from Western countries has shown a positive, bidirectional association between menopausal vasomotor symptoms (VMS) and depressive symptoms. Information on the prevalence, and risk factors of moderate to severe depressive symptoms in Iran is lacking. Objective: We examined whether moderate to severe VMS are associated...

Context: Menopausal symptoms may differ across ethnic and cultural groups. Little is known of the prevalence, severity, and management of vasomotor symptoms (VMS) in Iranian women. Objective: This study documented the prevalence of, and factors associated with VMS among Iranian women at midlife. The prevalence of sexual problems and the use of horm...

Context: High-quality evidence from Western countries has shown a positive, bidirectional association between menopausal vasomotor symptoms (VMS) and depressive symptoms. Information on the prevalence, and risk factors of moderate to severe depressive symptoms in Iran is lacking. Objective: We examined whether moderate to severe VMS are associated...

Background We investigated whether metformin prevents tamoxifen‐induced endometrial changes and insulin resistance (IR) after a diagnosis of breast cancer. Methods This was a single centre, randomized, double‐blind, placebo‐controlled, parallel group trial. Postmenopausal women with hormone receptor‐positive breast cancer taking tamoxifen were ran...

Background: Polycystic ovary syndrome (PCOS) prevalence estimates vary when different diagnostic criteria are applied. Lack of standardization of individual elements within these criteria may contribute to prevalence differences. Objective and rationale: A systematic review of studies reporting prevalence of PCOS, using at least one of the Natio...

Sexual well-being frequently declines following the menopause transition and can be associated with significant personal and relationship distress. This distress is the hallmark of female sexual dysfunction (FSD). FSD is highly prevalent in postmenopausal women. The prevalence of sexual problems increases with age, but conversely this is associated...

Objective To determine the prevalence of, and risk factors for, sub-types of urinary incontinence (UI) in a nationally representative sample of midlife Bangladeshi women. Methods Bangladeshi women, aged 30–59, recruited by multi-stage cluster sampling, completed the Questionnaire for the Diagnosis of Urinary Incontinence. The prevalence and the fa...

Objective: We have reported that one-third of Bangladeshi women aged 30-59 have symptomatic pelvic floor dysfunction, with one-quarter having urinary incontinence (UI). We now report the prevalence of, and risk factors for, different types of UI in a nationally representative sample of Bangladeshi women. Methods: 1590 Bangladeshi women, aged 30-59...

Objective: The objective of this consensus document is to broaden the perspective on clinical management of genitourinary syndrome of menopause to include androgens. Methods: A modified Delphi method was used to reach consensus among the 14 international panelists representing multiple disciplines and societies. Results: Menopause-related geni...

Objectives: Although pessimistic beliefs about back pain are associated with low back pain and disability, our understanding of their role in the natural history of the condition is limited. This study examined the association between beliefs about back pain and the development and progression of low back pain and disability over a 2-year period i...

Endogenous androgen production is essential for women’s reproductive function and nonreproductive health. The primary sources of androgens are the ovaries and the adrenal glands. The amount of androgen produced by these sources varies across a woman’s life span. It is well documented that circulating androgen levels decline with age from the middle...

While low back pain significantly impacts on an individual’s well-being, our understanding of the role of well-being in the natural history of low back pain is limited. This cohort study aimed to investigate the association between psychological and general well-being and the development and progression of low back pain and disability in community-...

The International Society for the Study of Women's Sexual Health process of care (POC) for management of hypoactive sexual desire disorder (HSDD) algorithm was developed to provide evidence-based guidelines for diagnosis and treatment of HSDD in women by health care professionals. Affecting 10% of adult females, HSDD is associated with negative emo...

Objectives: Intravaginal testosterone has emerged as a potential treatment for vulvovaginal atrophy (VVA) in women, in general, and women taking an aromatase inhibitor (AI). A systematic review of the literature was undertaken to determine whether available clinical trial data support efficacy and safety of intravaginal testosterone for the treatm...

Introduction: Women may experience different menopausal symptoms across different cultures around the world. The purpose of this study was to determine the prevalence and contributing factors of depression in midlife women in the Middle East. Methods: Electronic databases including PubMed, Medline, PsycINFO, CINAHL, Web of Science, SCOPUS, and Goog...

Background: Little is known of the prevalence and severity of menstrual dysfunction, climacteric symptoms, pelvic floor disorders, sexual problems, and psychological wellbeing after lung transplantation in women. Materials and methods: Adult female lung transplant recipients, attending the Alfred Hospital Lung Transplant Service in Melbourne, Au...

Background: The menopausal transition may have significant consequences for respiratory health, risk of chronic respiratory disease and management strategies. Objective: To systematically summarize the literature regarding the impact of menopause status on respiratory health outcomes. Methods: PubMed was searched systematically to identify pop...

Background: Little is known of the impact of aromatase inhibitor (AI) therapy on sexual and pelvic floor function. Aim: To document the prevalence of, and factors associated with, low desire, sexually related personal distress, hypoactive sexual desire dysfunction (HSDD), and pelvic floor dysfunction in women 10 years after breast cancer diagnos...

Objective: Review evidence to guide management of menopausal signs and symptoms in women after breast cancer and make recommendations accordingly. Evidence: Randomized controlled clinical trials, observational studies, evidence-based guidelines, and expert opinion from professional societies. Background: Symptoms and clinical problems associat...

Objective: This systemat