Updates from the 2019 NAMS Annual Meeting

By: Taryn Smith, MD • Posted on November 21, 2019

Updates from the 2019 NAMS Annual Meeting

The autumn is a focus on menopause. Many of our Center for Specialized Women’s Health physicians, fellows and alumna participated in the North American Menopause Society’s (NAMS) 2019 annual meeting. NAMS is an organization comprised of physicians, top researchers, advanced practice practitioners and allied health professionals dedicated to promoting women’s health in midlife and beyond.

Updates from the 2019 Annual Meeting

Probiotics

Probiotics are live bacteria that help support normal bodily functions particularly in the gut. Most oral probiotics contain natural gut bacteria which may not be effective for vaginal or urinary health. Lactobacillus is a bacteria naturally present in the vaginal microbiome of most healthy women.

Lactin V, a probiotic containing lactobacillus crispatus, is currently being studied for the prevention of vaginal/urinary infections. Clinical trials have shown the following for Lactin V:

  • Safe to use
  • Helps combat bacteria responsible for bacterial vaginosis and urinary tract infection (UTI) and can reduce the rate of recurrent UTI by 50%
  • If approved, Lactin V will offer vaginal delivery of vaginal strains of Lactobacillus

The VITamin D and OmegA-3 TriaL (VITAL)

The VITAL trial was designed to test whether Vitamin D 3 and/or omega-3 fatty acids reduce the risk of major cardiovascular events (heart attack, stroke etc) and invasive cancer. Results show:

Omega-3 fatty acids 1 gram per day

  • Cardiovascular risk was more likely to be reduced in African Americans, participants with low fish consumption and those with multiple risk factors for cardiovascular disease
  • There was no reduction in total invasive cancers with omega-3

Vitamin D 3 2,000 IU per day

  • There were no reduction in cardiovascular events
  • There was a small but significant reduction in cancer death but not overall cancer incidence

Recommendations

  • Adults should consume 2 or more servings of fish per week
  • Those with low fish consumption should consider omega-3 fatty acid supplementation
  • High risk patients (eg osteoporosis/osteopenia, malabsorption syndromes, minimal sun exposure, institutionalized) and those with low levels should consider vitamin D 3 supplementation with 2,000 IU Vitamin D3 per day

Emerging non hormonal treatment for hot flashes: Fezolinetant

Up to 80% of women will experience hot flashes and night sweats at menopause. It is believed that blocking certain signals to the brain can reduce the intensity and frequency of hot flashes, Fezolinetant (a neurokinin 3 receptor antagonist) was designed to do just that.

In a 12 week randomized controlled trial Fezolinetant

  • Reduced the frequency of symptoms by more than 50% in most women
  • Improved quality of life scores at 4 and 12 weeks
  • Was well tolerated

Fezolinetant could provide women with a well-tolerated, safe, non-hormonal treatment option for hot flashes and night sweats. Fezolinetant is not on the market yet.

Pellet/compounded unregulated hormone therapy

Many women favor using compounded “bioidentical” hormone therapy due to perceived increased safety. Compounding hormones allow physicians to customize treatment plans however, this bypasses safety and potency regulations set out by the Food and Drug Administration (FDA). One study, presented at NAMS, compared blood hormone levels in women treated with pellet hormone therapy (PHT) to women treated with FDA approved hormone therapy (FHT) treatment options.

Results showed:

  • Women on PHT were more likely to have hormone levels exceeding acceptable postmenopausal ranges
  • Women using PHT had more adverse side effects overall including mood swings, weight gain, acne, hair loss, breast tenderness and anxiety
  • 86% of women taking PHT were unaware that the treatment regimen was not FDA approved

Compounded bioidentical hormone therapy may be an option for women who are unable to tolerate FDA approved treatment options however, this option is neither approved or recommended by the FDA. However, women have an FDA approved bio-identical estrogen-progesterone oral option in the form of Bijuva ® (estradiol 1mg with 100mg of progesterone).

Testosterone in women

There are no clear indications for testosterone therapy in women however it has been used to treat a number of symptoms. A recent global consensus position statement (link) on the testosterone use in women showed:

  • Testosterone therapy (at doses within the normal range for women) can have beneficial effects on sexual function.
  • Systemic testosterone therapy can increase risk of acne and body hair in women.
  • Testosterone can have negative effects on cholesterol levels but not blood pressure or blood glucose.
  • Short term testosterone use does not increase breast cancer risk based on current data.
  • The only evidence based indication for testosterone use in women is for the treatment of hypoactive sexual desire disorder in postmenopausal women.

Be Healthy. Be strong. And Be in Charge!

-Taryn Smith, MD


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