Updates from the 2019 NAMS Annual Meeting
By: Taryn Smith, MD • Posted on November 21, 2019
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 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
- 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.
- 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
- The Buzz on Bio-identical Hormone Therapy
- Bioidentical Hormone Therapy: Clarifying the Misconceptions
- What’s New in Vaginal Rejuvenation? Newer treatment for vaginal and pelvic concerns in women
- Functional Medicine and Women’s Health
- The 10th Anniversary of the Infamous Women’s Health Initiative
- Non-Hormonal Interventions for Hot Flashes
- Experiencing Hot Flashes? It May Not Be Menopause
- NAMS Releases Its 2017 Hormone Therapy Position Statement
- Highlights from the 2018 North American Menopause Society
- Good News From The Menopause Meeting About Menopausal Hormone Therapy