Updates from the 2021 NAMS Annual Meeting – Part 1

By: Tara Iyer, MD • Posted on December 01, 2021

Each year in September, clinicians gather together in Washington DC for the North American Menopause Society (NAMS) Annual Meeting to learn about the latest menopausal updates and treatments. I was lucky enough to be able to participate in this year's NAMS meeting and I'll be sharing all the latest menopause news with you in my two-part column series.

In part-one of my column series, I will be discussing the latest on weight management, hair loss treatments and sleep problem treatments for menopausal women. And look for part-two of my column in just a few weeks where I'll be sharing more important menopause updates!

Weight Management Updates

The following factors have an affect on obesity:

1. Obesogens

Obesogens are defined as compounds which cause weight gain. Examples of obesogens are BPA found in plastics and tin cans.

2. Genetics/epigenetics

For example, DNA methylation may occur in response to childhood trauma which can lead to increased obesity.

3. Meal timing

Calories eaten earlier in the day are metabolized different than calories ingested later in the day, which may explain why eating predominantly earlier leads to less weight gain.

4. Gut microbiome

5. Medications

6. Circadian rhythm

Poor sleep is a huge risk factor in weight gain and it leads to increases in ghrelin and other hunger hormones.

7. Lack of exercise

Exercise is very important in weight maintenance
People who exercise while dieting lose less lean body mass than those who don’t

Dietary Studies: Does diet type matter?

Studies show that your diet type doesn’t necessarily matter with weight loss in head to head studies. While diet type does not matter, food choice does! Eating whole, unprocessed quality foods promotes weight loss.
Diet type may have an effect on mortality. Some studies suggest that the Mediterranean diet may reduce all-cause mortality, even in the absence of weight loss.
Some food types can reduce hunger more than others. A higher protein diet does promote satiety compared to lower protein (at least 80-100g per day).

Cardiovascular Disease Risk (CVD)

Liposuction and cryotherapy do not prevent CVD, whereas lifestyle modification does!
5-10 percent weight loss leads to lower hemoglobin A1c, blood pressure, total cholesterol, HDL cholesterol, and triglycerides

Sleep Issues in Menopausal Women

Women commonly experience sleep disturbances during midlife. Factors that may influence sleep in midlife women:

Psychosocial issues/mood issues
Vasomotor symptoms (hot flashes, night sweats)
Stress
Sleep-breathing disorders
Aging/comorbid conditions
Hormones: high follicle-stimulating hormone (FSH), low estradiol

Wake Time After Sleep Onset (WASO)

WASO is the cumulative number of minutes you are awake throughout the night after being awoken from sleep. The more nighttime awakenings you have whether due to night sweats or other causes, the more WASO you accumulate.

Why is WASO important?

WASO affects mood, well-being and metabolism!
The impact of sleep fragmentation in midlife women: Total sleep hours is associated with adverse health outcomes such as depression, poor well-being and weight gain

What can you do at home?

Relaxation/stress management strategies prior to bed can lead to less sleep fragmentation, less sleep awakening throughout the night and lower overall stress levels
If you continue to have symptoms, see your doctor to discuss other treatment strategies.

Updates in the Management of Hair Loss

Are there any medical problems that may be contributing to hair loss?

Disorders such as anemia, hormonal disorders, malnutrition, and vitamin/mineral deficiencies may contribute to hair loss.

To rule out these conditions your doctor may check the following:

CBC
Iron
Ferritin
Vitamin D
Zinc
TSH
DHEA-S
Testosterone free/total
Total protein

If your doctor is concerned that an autoimmune disease may be the cause of your hair loss, if you have scalp scarring, or if there is no obvious cause of hair loss, a scalp biopsy may be warranted.

What current treatments exist for hair loss in women?

Vitamins and Mineral Supplementation

Iron - Hair experts believe treatment of hair loss is optimized with higher ferritin levels (goal ferritin of at least 40 ng/mL, though ideally closer to 70 ng/mL)
Some hair experts recommend the use of certain over the counter products such as Viviscal and Nutrafol

Topical Treatments

Minoxidil 5% nightly foam is a first-line treatment for hair loss in women. Patients should be aware that there may be an initial period of increased hair shedding prior to hair growth

Oral Treatments

Premenopausal women:

Birth control pills with drospirenone (i.e., Yaz)
Spironolactone 100-200 mg daily

Perimenopausal and postmenopausal women:

Finasteride 2.5-5 mg daily
Oral minoxidil may also be used at varying doses

Intradermal Treatment

Platelet-rich plasma (PRP) injections can be helpful, but may be expensive

Photobiomodulation Treatment

Laser cap/headband with comb can be helpful, but may be expensive

Be Strong, Be Healthy, Be in Charge!
- Tara Iyer, MD, Center for Specialized Women’s Health Fellow

About Tara Iyer, MD

Dr. Tara Iyer is a NAMS-certified Menopause Practitioner and currently working as the Lead Physician at Brigham and Women's Menopause and Midlife Clinic in the Fish Center for Women’s Health and as a clinical instructor at Harvard Medical School. She is a board-certified family medicine physician, specializing in women's health, menopause care, and weight management medicine.

She received her M.D. from Rutgers Robert Wood Johnson Medical School and completed her residency with an obstetrics and women's health track at Saint Joseph Hospital Family Medicine Residency in Denver, Colorado. She then completed a two-year specialized women's health fellowship with me at Cleveland Clinic.

Dr. Iyer is also board-certified in Obesity Medicine and works as an attending physician at the Center for Weight Management and Wellness within the Endocrine Division of Brigham and Women's Hospital. She intends to foster stronger clinical and research partnerships between the Division of Women’s Health and the Center for Weight Management and Wellness, to create a more comprehensive and collaborative approach to the management of midlife women’s health issues.

menopause, women's health, perimenopause, postmenopause, aging, midlife, sleep, hair loss, weight management, weight loss, sleep problems

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