Highlights from the 2018 North American Menopause Society
By: Taryn Smith, MD • Posted on October 24, 2018
October is Menopause Awareness Month
October is Menopause month, and the North American Menopause Society (NAMS) is an organization dedicated to “Promoting women’s health at midlife and beyond.” Every year hundreds of physicians, allied health providers and researchers gather to discuss the latest ground-breaking news in the following fields:
Exciting Updates From the 2018 Annual Meeting
The first thing that women must understand is that weight loss does not equal weight loss maintenance. Weight loss typically occurs over a finite period of time. Weight loss requires a negative energy balance which can usually be achieved by consuming fewer calories than you burn. Maintaining weight loss on the other hand requires altering long-term habits, typically through physical activity and maintaining behaviors for months to years. The National Weight Control Registry identified the following common characteristics of people who lose weight and maintain their weight loss:
- Eating a daily breakfast
- High levels of physical activity for at least 1 hour a day
- Limited fat intake
- Self-monitoring of dietary intake and activity
- Consumption of low/no calorie sweeteners
- Regular self-monitoring of weight (at least once a week)
- Limit television viewing to less than 10 hrs/week
Menopausal Hormone Therapy and Long-term All-Cause and Cause Specific Mortality
Evaluate the relationship between the use of hormone therapy and the risk of long-term all-cause mortality (any cause of death) and cause specific mortality (from cardiovascular disease, cancer or other causes).
Close to 26,800 women from the initial Women’s Health Initiative were eligible for evaluation. Results showed that among these postmenopausal women, use of conjugated equine estrogen (Premarin) in combination with Medroxypregesterone acetate (MPA) for an average of 5.6 years or use of Premarin alone for an average of 7.2 years was not associated with any increase risk of death. This is very reassuring to women, and in subgroups there was improved longevity.
Bremelanotide: Treatment for FSD
Bremelanotide is a budding new treatment for female sexual dysfunction. It is a melanocortin neuropeptide, meaning it works at the level of the brain to stimulate sexual desire in women. This is not an aphrodisiac and will not make a woman want to have sex with an undesired partner.
It is an on demand, auto-injector that can be self-administered prior to sexual activity.
Potential Side Effects
Bremelanotide is generally well tolerated, but there are some side effects, including:
Bremelanotide is currently under review by the FDA and is NOT yet commercially available.
Osteopenia: Start Treating Sooner Rather than Later
What is osteopenia and osteoporosis? Osteopenia and osteoporosis describe varying degrees of decreased bone mineral density or bone thinning. Osteoporosis is more severe than osteopenia and is more commonly associated with fractures even with low impact injuries.
Many studies have shown the benefit of treating women with osteoporosis with medications, particularly bisphosphonates, can reduce the risk of fracture. However, studies have also shown that a moderate amount of fragility fractures occur before a women even enters the osteoporosis range of bone mineral density.
A recent study showed that treating women with osteopenia decreased the incidence of fragility fractures over time when compared to placebo.
There are many options to prevent and treat bone thinning, including:
- Menopausal hormone therapy
- ERAA like Evista/Raloxifene
- Designer hormones
- Treatment agents for osteoporosis such as Prolia/Denosumaub
- Anabolic agents such as Tymlos/Abaloparatide and Forteo/Teriperatide
Sexual Dysfunction in Cancer Survivors
The final highlight from this year's NAMS meeting is addressing sexual dysfunction in cancer survivors. These recommendations were developed to manage sexual dysfunction and adverse effects that occur as a result of cancer diagnosis and/or treatment.
- While Addyi/Flibanserin has been approved to treat Hypoactive Sexual Desire Disorder in pre and post menopausal women, it has not been specifically studied in cancer survivors.
- Lubricants and moisturizers (such as Replens) are first line for vaginal dryness.
- Low dose vaginal estrogen may be considered after risk benefit discussion.
- Clinicians may offer vaginal DHEA for women with a history of breast cancer.
Here you have it! Updates from the North American Menopause Society’s 2018 annual conference which resonates with our mission to:
Be Healthy. Be Strong. Be in Charge!
-Taryn Smith, MD