Succinate-Based Dietary Supplement for Menopausal Symptoms: A Pooled Analysis of Two Identical Randomized, Double-Blind, Placebo-Controlled Clinical Trials

Background. To evaluate the efficacy of a succinate-based dietary supplement (SBDS; Amberen) in symptomatic menopausal women using a larger sample size derived by pooling data from two identical trials. Methods. Raw data were pooled from two identical randomized, multicenter, double-blinded, placebo-controlled, 90-day clinical trials. Women aged 42-60 years with mild to moderate vasomotor and psychosomatic menopausal symptoms were included (114 in the treatment group and 113 in the placebo group). Symptoms were assessed by the Greene Climacteric Scale and State-Trait Anxiety Inventory. Changes in body mass index, body weight, waist and hip circumferences, and plasma levels of follicle stimulating hormone, luteinizing hormone, estradiol, leptin, and apolipoproteins A1 and B were also evaluated. Results. SBDS use resulted in significant improvements in several endpoints including alleviation of 16 of 21 menopausal symptoms (p≤0.05, Greene Scale) and a decrease in anxiety (p<0.0001, State-Trait Anxiety Inventory) when compared to placebo. Significant reductions were observed in weight, body mass index, and waist and hip circumferences in the supplement cohort. Evaluation of physiological parameters showed a significant increase in serum estradiol levels compared to baseline (p<0.0001) among users of the SBDS. Levels of follicle stimulating hormone and luteinizing hormone decreased slightly in both groups, without significant differences between the groups. Leptin levels decreased with statistical significance in the SBDS cohort compared to placebo (p=0.027). For those with initial leptin concentrations above the reference range, leptin decreased significantly in the SBDS group compared to the baseline (p<0.0001) and to placebo (p=0.027). Conclusions. The pooled analysis reaffirms the outcomes from the individual trials. A nonhormonal, succinate-based dietary supplement is shown to relieve menopausal symptoms when compared to a placebo regimen in a randomized, double-blinded clinical trial. © 2019 Viktor E. Radzinsky et al

Legal aspects of contraceptive implants

Key message points - There has been litigation in relation to the three types of harm associated with contraceptive implants: non-insertion, deep insertion and nerve injury. - Recommendations for safe clinical practice can be derived from analysis of legal cases and published case reports. - Nerve injury has invariably been caused by clinicians without upper limb surgical skills attempting difficult removals. - The launch of the updated single-rod implant (Nexplanon®) may hold the best possibility for harm reduction. - Litigation in relation to side effects can lead to the withdrawal of safe and effective contraceptive products, so reducing choice for wome