8 New Things Women Should Know About Menopause
By: Sabrina K. Sikka, MD Posted on October 31, 2017
NAMS 2017 Highlights
The North American Menopause Society (NAMS) is an organization that is aimed at promoting the health and quality of life of women through the menopause transition and healthy aging. Every year, members of NAMS and women advocates from across the country gather to discuss the latest advancements in women’s health. As a women’s health fellow at the Cleveland Clinic, I get the opportunity to attend these conferences and sit for the NAMS Certified Menopause Practitioner (NCMP) exam, which allows providers to treat menopausal woman with hormone therapy.
At this year’s conference, they discussed the top articles published in the last year that all providers and women should know about in order to lead healthier lives.
8 top articles from 2017 that every women’s health physician and patient needs to know
AIM: To confirm the benefits of intravaginal DHEA (Prasterone), which is a precursor hormone for estrogen and testosterone in postmenopausal women with symptoms of dryness and painful intercourse.
OUTCOME: Over 12 weeks, intravaginal DHEA was proven to be better than placebo in increasing vaginal secretions and decreasing vaginal pH, thereby leading to improvement in dryness, pain, and overall vaginal health.
AIM: Neurokinin B is a peptide that is involved in a variety of human functions and pathways throughout the human body. Prior studies have implicated high levels of NKB in women with postmenopausal hot flashes. This study assessed the use of a NKB antagonist (MLE4901) in the treatment of postmenopausal hot flashes.
OUTCOME: Women who were given 2 weeks of MLE4901 had a 73% reduction in hot flashes at 4 weeks, versus 28% reduction in women given placebo. Women also had improvement in physical and psychosocial symptoms and the treatment was generally well tolerated.
AIM: This study aimed to explore the association between postmenopausal hormone therapy (HT) and Alzheimer’s disease (AD) in women in Finland from 1989 – 2009.
OUTCOME: Major outcomes showed short-term use (<1 year) had NO association between HT and the development of AD. Similar results were seen in women with long-term use (>10 years) if initiated early. The study does not provide strong evidence for protective effects of HT in development in AD and the 2017 NAMS position statement encourages providers to NOT prescribe HT for the sole purpose of AD prevention.
AIM: The goal of this study was to assess total mortality and mortality from cardiovascular disease and breast cancer in women who were enrolled in the Women’s Health Initiative after 18 years of follow up.
OUTCOME: Women with combined estrogen and medroxyprogesterone or estrogen alone for 5-7 years was NOT associated with an increased risk of death from cardiovascular disease or breast cancer. In fact, women who were started in their 50s, had a 31% lower risk of death when compared to women who did not take hormones. These findings continue to support the guidelines endorsing the use of hormone therapy for the management of menopausal symptoms.
AIM: Telomeres are protective caps on DNA strands and shortening of these strands is involved in the aging process, representing our biological age, as oppose to our chronological age. This study aimed to determine whether older women with a history of later maternal age at the last childbirth had a longer telomere length compared to women who gave birth younger than 29.
OUTCOME: Age at birth of the last child was significantly associated with telomere length. Women who were older than 33 years old were 2-3x more likely to have telomere length in the second and third tertiles rather than the first. This suggests that late maternal age could be a marker of longevity!
AIM: The examine health outcomes including heart disease, cancer, or suicide in women who had one or both ovaries removed at the time of hysterectomy for a benign disease.
OUTCOME: Patients who have preserved ovarian tissue at time of surgery had a lower risk of death from cardiovascular disease and cancer compared to women who had both ovaries removed. Additionally, more admissions to the hospital were seen in women who had both ovaries removed.
7. Safety of intravaginal testosterone cream vs estradiol ring in women being treated for breast cancer
AIM: To evaluate the safety of intravaginal testosterone cream (IVC) vs. estradiol ring in women being treated for breast cancer with an aromatase inhibitor (AI). Because of the concern for estrogen use in those whom are being actively treated for breast cancer, estrogen levels were measured at 4 weeks and 12 weeks with a safety cut off point of >10 on two consecutive readings.
OUTCOME: A total of 69 women completed 12 weeks of treatment of either IVC or the estradiol ring – both of which met the safety endpoint for estradiol. Vaginal dryness and sexual interest were improved with both, and the estradiol ring alone improved in sexual satisfaction.
AIM: Mice studies reveal that follicle-stimulating hormone (FSH) has a role in maintaining core body temperature and fat storing. The goal of this study was to examine the effects of subunits of FSH on fat storing in mice.
OUTCOME: Mice who were injected with the subunit of FSH had LESS subcutaneous fat and increased energy expenditure and an increase in lean muscle mass. Because this was performed in mice, more human studies are needed to understand its implication related to accumulation of abdominal fat and associated metabolic changes in postmenopausal women.
There you have it! These are the eight noteworthy articles to know about in 2017, as these studies will likely revolutionize the future of women’s health. Knowledge is power and the more we know, the better we can take care of our bodies and lead better lives!
Be Strong. Be Healthy. Be in Charge!
-Dr. Sabrina Sikka