AMS HP eNews Bulletin 30 March 2016


  Australasian Menopause Society  
Health Professionals eNews30 March 2016
  Welcome to AMS HP eNews for doctors and other healthcare professionals who have a special interest in women's health. The content covers information and resources relevant to menopause, midlife and the promotion of healthy ageing.


AMS in the media

The Australasian Menopause Society is contacted regularly by the media to comment on menopausal and women's health issues. AMS President Prof Bronwyn Stuckey was contacted with regard to the use, or lack of use, of menopausal hormone therapy (MHT) in Australia for an article in the Australian Women’s Weekly (AWW) April 2016 edition. Her comments appear on page 86 and 88 and are shown below. 


Other experts in the article include Assoc Prof John Eden - Head Sydney Menopause Centre, Royal Hospital for Women; Dr Andrew Pesce - AMA; Prof Karen Canfell - Cancer Council NSW


The article is a balanced read and before you place the AWW in your waiting room it may be worth a look.


Menopause - AWW April 2016 Why just 8 % on hrt   


The Australian Women’s Weekly April 2016 edition has four pages on:

Is HRT safe?

Over the past 14 years, the number of Australian women using hormone replacement therapy has plummeted amid fears of a heightened risk of breast cancer. Is HRT really a poison or is it a panacea for menopause? We investigate.


aww article 2016

Prof Stuckey's quote




Global Consensus Statement on Menopausal Hormone Therapy

mht consensusIt has been two years since the International Menopause Society released the Global Consensus Statement on Menopausal Hormone Therapy.


Given the consumer media article above it may be timely to review these concise recommendations.

  1. MHT is the most effective treatment for vasomotor symptoms associated with menopause at any age, but benefits are more likely to outweigh risks for symptomatic women before the age of 60 years or within 10 years after menopause.
  2. MHT is effective and appropriate for the prevention of osteoporosis-related fractures in at-risk women before age 60 years or within 10 years after menopause.
  3. Randomized clinical trials and observational data as well as meta-analyses provide evidence that standard-dose estrogen-alone MHT may decrease coronary heart disease and all-cause mortality in women younger than 60 years of age and within 10 years of menopause. Data on estrogen plus progestogen MHT in this population show a similar trend for mortality but in most randomized clinical trials no significant increase or decrease in coronary heart disease has been found.
  4. Local low-dose estrogen therapy is preferred for women whose symptoms are limited to vaginal dryness or associated discomfort with intercourse.
  5. Estrogen as a single systemic agent is appropriate in women after hysterectomy but additional progestogen is required in the presence of a uterus.
  6. The option of MHT is an individual decision in terms of quality of life and health priorities as well as personal risk factors such as age, time since menopause and the risk of venous thromboembolism, stroke, ischemic heart disease and breast cancer.
  7. The risk of venous thromboembolism and ischemic stroke increases with oral MHT but the absolute risk is rare below age 60 years. Observational studies point to a lower risk with transdermal therapy.
  8. The risk of breast cancer in women over 50 years associated with MHT is a complex issue. The increased risk of breast cancer is primarily associated with the addition of a progestogen to estrogen therapy and related to the duration of use. The risk of breast cancer attributable to MHT is small and the risk decreases after treatment is stopped.
  9. The dose and duration of MHT should be consistent with treatment goals and safety issues and should be individualized.
  10. In women with premature ovarian insufficiency, systemic MHT is recommended at least until the average age of the natural menopause.
  11. The use of custom-compounded bioidentical hormone therapy is not recommended.
  12. Current safety data do not support the use of MHT in breast cancer survivors.

See the full publication on the AMS website



Health and Social Media: are there benefits?      

Twitter, Facebook and other social media platforms can be useful tools for helping patients with rare medical diseases exchange knowledge and build communities, research from the University of Leicester has found.


Patient experiences shared on digital platforms are also becoming a point of reference for other patients, sometimes in isolation of traditional medical sources, the study entitled 'Health Activism and the Logic of Connective Action. A Case Study of Rare Disease Patient Organisations' suggests.


The research examined online interactions in rare disease patient organisations in order to interpret how and to what extent patient organisations exploit online networking structures to provide alternative platforms for people to find information on and discuss health issues.


The study suggests that digital media eases one-way, two-way and crowdsourced process of health knowledge sharing; provides personalised routes to health-related public engagement; and creates new ways to access health information - particularly where patient experiences and medical advice are both equally valued. 




Fragility Fractures and Treatment Options      

fragility fracturesDr Risa Kagan discusses Fragility Fractures and Treatment Options with Dr Marla Shapiro in the fourth installment of the North American Menopause Society (NAMS) video series series for clinicians about important midlife health topics.


Dr Kagan is a Certified Clinical Densitometrist, and Clinical Professor, Department of Obstetrics/Gynecology and Reproductive Sciences at The University of California in San Francisco.


Patient version: 


Health professional version:


Note: The Australasian Menopause Society does not necessarily endorse the medical and scientific information provided in these videos. 


The Use of Vaginal Estrogen in Women With a History of Estrogen-Dependent Breast Cancer      

Vaginal Estrogen in Women With a History of Estrogen-Dependent Breast Cancer

The American College of Obstetricians and Gynecologists (ACOG) outlines a new Committee Opinion, "The Use of Vaginal Estrogen in Women with a History of Estrogen-Dependent Breast Cancer," with the options and treatments for female-specific survivorship issues. 

One particular challenge for providers to understand and address is vaginal symptoms of menopause, whether naturally occurring or treatment-induced.


Many therapies that treat estrogen-dependent breast cancer cause vaginal atrophy and increase symptoms of vaginal dryness, bleeding, bacterial infections and painful sex. These symptoms may worsen over time and, as women live longer, may pose significant challenges. It is estimated that up to 20% of all patients terminate or consider terminating therapies due to the severe detrimental effect that vaginal atrophy poses on their quality of life.


According to the new Committee Opinion, for women with estrogen-dependent breast cancer or a history of estrogen-dependent breast cancer, non-hormonal options for vaginal atrophy should be the first choice. However, health practitioners may now consider topical estrogen therapy for patients with a history of estrogen-dependent breast cancer who are unresponsive to non-hormonal remedies. Although there is controversy related to the risk of topical estrogen therapy and breast cancer recurrence, the Committee Opinion notes that data show there is no increased risk of cancer recurrence with the use of topical vaginal estrogen. 




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See exclusive commentary on studies such as:  


The benefits and harms of alcohol consumption in women: cardiovascular aspects

Alcohol consumption has been associated with both benefits and harms, but most studies investigated men rather than women, or analyzed data from mixed cohorts composed of males and females, with necessary adjustments for age and sex. Also, most studies focused on one alcohol-related outcome or on a single group of related diseases rather than seeing the entire spectrum of human health. Despite a wealth of information on the outcomes of drinking alcohol, there is still inconsistency on some bottom-line guiding messages related to consumption patterns (quantity, frequency, and stratified combinations), and types of alcohol consumed. Ethnicity, socio-economical features, age and gender may be factors that influence disease protection or risk...


2016 IMS Recommendations on women's midlife health and menopause hormone therapy

The International Menopause Society (IMS) has produced these new 2016 recommendations on women's midlife health and menopause hormone therapy (MHT) to help guide health-care professionals in optimizing their management of women in the menopause transition and beyond. The term MHT has been used to cover therapies including estrogens, progestogens and combined regimens. For the first time, the 2016 IMS recommendations now include grades of recommendations, levels of evidence and 'good practice points', in addition to section-specific references. Where possible, the recommendations are based on and linked to the evidence that supports them, unless good-quality evidence is absent. Particular attention has been paid to published evidence from 2013 onwards, the last time the IMS recommendations were updated. Databases have been extensively searched for relevant publications using key terms specific to each specialist area within menopause physiology and medicine.


More information about the comprehensive recommendations will be provided in coming eNews editions...


Focus on OTC medications, dietary supplements and complementary/alternative medicine

More older adults used multiple medications and dietary supplements, and taking them together put more people at increased risk for a major drug interaction, according to a new study.

Most older adults in the United States use prescription and over-the-counter medications and dietary supplements. There is increased risk among older adults for adverse drug events and polypharmacy... 


Does menopause start earlier in smokers?

Paula and colleagues in 2013 conducted a cross-sectional study to investigate the association between smoking and early onset of menopause. The study included 1222 female employees on the campuses of Rio de Janeiro university. All participants were aged over 35 years. Smoking status was determined by questioning whether the participant had smoked at least 100 cigarettes during her lifetime, and whether she currently smoked. Women were classified as current smokers, former smokers or women who had never smoked. The researchers used a Cox proportional hazards model to investigate the data and the correlations between smoking status and age at the onset of menopause...


Does quitting smoking decrease the risk of midlife hot flushes? 

The effect of quitting smoking on hot flushes in women aged 45–54 years of age at baseline followed for 1–7 years was examined by Smith and his colleagues [1] in a longitudinal analysis published recently. A cohort study of hot flushes among women 45–54 years of age was conducted starting in 2006 among residents of Baltimore and its surrounding counties...

Climacteric E-alert - Volume 19, Number 2

EDITORIAL: Estrogen, menopause and joints
Nick Panay and Anna Fenton
Menopause is associated with the onset of diffuse muscle and joint aches. Women frequently comment about arthralgia affecting, in particular, their hand joints. The editorial this month examines the role of estrogen loss and menopause hormone therapy in the pathogenesis of these symptoms....

Our Menopause World March 2016 

Black D, Messig M, Yu CR, et al. The effect of conjugated estrogens/bazedoxifene therapy on body weight of postmenopausal women: pooled analysis of five randomized, placebo-controlled trials. Menopause 2015 Nov 25. Epub ahead of print

[This study is in line with many other randomized, controlled trials that have shown, in contrast to common belief, that hormone therapy does not alter body weight. Amos Pines.]


2016 ams congress 1

  Australasian Menopause Society
PO Box 511, Inverloch VIC 3996
Tel: +61 3 9428 8738

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