Menopause news

Highlights from International Menopause Society conference

October 2005

October 2005, Buenos Aires,
Argentina.

HRT was the subject of many presentations at the recent International Menopause
Society conference in Buenos Aires, where finer details of the highly publicised
Women’s Health Initiative trial and Million Women study were examined.
Despite initial reporting of results suggesting significant risks of HRT, it
is now becoming clearer that the use of HRT for control of menopausal symptoms
in the early menopausal years is likely to provide significant benefits with
minimal risk. It is likely that there is a “window of opportunity” when,
if HRT is commenced early in the menopausal transition, it may provide protection
for cardiovascular disease and dementia as well as osteoporosis. Regarding breast
cancer and HRT, there does appear to be better survival of women who develop
breast cancer while taking HRT compared to those developing breast cancer not
on HRT. This is probably because HRT affects differentiation of cells leading
to less aggressive tumours. Research into the use of newer, lower doses of HRT
was described and it appears that very low doses of oestrogen provides good control
of symptoms with reduced side effects and perhaps reduction of some risks.

With
the recent adverse publicity surrounding HRT, many women have turned to the
use of alternative therapies, which were described at the conference in great
detail. It appears that very few preparations, with the possible exception
of Black Cohosh, have been shown to be any better than placebo in controlling
menopausal symptoms, yet continue to be used extensively. Also used increasingly
are “bioidentical
hormones” which are synthetically engineered hormones. Of concern is that
they are generally not subject to the rigorous standards that are required for
the production of hormones produced by pharmaceutical companies, their effect
is unproven and risks are unknown.

Another aspect of menopause management, which
continues to be controversial and was discussed at several presentations, was
the role of testosterone therapy. It appears that some women do experience
symptoms from reduced androgens which may cause low libido, persistent fatigue
and low well-being but there is little correlation between blood levels of
testosterone and symptoms. It may occur in women who have had their ovaries
removed and in women who are taking tablet form of HRT (other than tibolone)
or thyroxine since both oral oestrogen and thyroxine can cause a reduction
in androgen production. Some women may therefore benefit from some form of
testosterone therapy as well as oestrogen but the best form is currently unclear.
Tibolone may be helpful since it can increase androgen levels.

Much attention
was given at the conference to the importance of diet and exercise, particularly
at the time of the menopause when energy metabolism changes, leading to increased
deposition of fat; menopausal women who do not make some lifestyle changes
are very likely to gain weight each year. Exercise can be simple but it must
be given priority; many women do not feature exercise on the top of their “to do” list!

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