AMS HP eNews Bulletin 30 November 2016



  Australasian Menopause Society  
Health Professionals eNews30 November 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 Annual Report 2016 

AMA Annual Report 2016The AMS Annual Report 2016 was recently launched at the AMS Annual General Meeting on 19 November. The Annual Report outlines how the AMS achieved its mission and objectives in 2015-16 and provides members and the broader community with details about our activities, finances and plans for 2017.


Highlights of 2016 include:

  • that AMS is increasingly being recognized as a leading voice for women’s healthcare at midlife;
  • redevelopment of the AMS website;
  • providing four Menopause Essentials Updates to nearly 250 healthcare providers;
  • a successful Annual Congress in Canberra in 2015;
  • developing and revising eight AMS Information Sheets; and
  • good governance and financial management.



Benefit of MHT on Bone Density and Microarchitecture Persists After its Withdrawal  

Study reveals bone density and structure benefits persist after treatment ends.


Women who undergo hormone therapy for menopausal symptoms such as hot flashes can not only increase bone mass, but also can improve bone structure, according to a study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.


Previous studies have revealed the positive impact of menopausal hormone therapy (MHT) on bone mineral density. The new study is the first to show MHT also can improve bone mass and structure, and that the bone health benefits persist for at least two years after women stop treatment... 


...The researchers found higher Trabecular Bone Scores in current MHT users compared to past users or women who had never used MHT. All bone mass density values were significantly higher in current users compared to past users or participants who had never used MHT. Past users of the therapy exhibited higher bone mass density and a trend for higher bone microarchitecture values compared to women who had never used MHT. The researchers note that the duration of MHT had no effect on bone health. 



US Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis - 2016  

American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis - 2016


Recommendations with an A grade are based on the most convincing evidence from multiple gold-standard clinical trials. A-grade recommendations include:

  • Providing counselling on reducing risk of falls, particularly among the elderly.
  • Strongly recommending medications for patients with osteopenia or low bone mass and a history of a fragility fracture of the hip or spine. (Osteopenia refers to bone density that is lower than normal peak density but not low enough to be classified as osteoporosis. A fragility fracture is a fracture that results from a fall from a standing height or less).
  • Prescibing medications that reduce the risk of fractures including alendronate (Fosamax®), risedronate (Actonel®), zoledronic acid (Zometa®) and denosumab (Prolia® and Xgeva®).
  • Treatment with teriparatide (Forteo®) should be limited to two years.
  • Successful treatment of osteoporosis is defined as stable or increasing bone mineral density with no evidence of new fractures or fracture progression.

The initial therapy should be guided by the patient's fracture risk and the presence or absence of prior fragility fractures.




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Smell identification, cognition and hormone therapy

The study of cognitive impairment by Devanand and colleagues is one of several similar ones showing that low performance in smell testing correlated with a higher risk of cognitive impairment [1]. In a recent study among 1430 cognitively normal participants (mean age 79.5 ± 5.3 years, 49.4% men, mean 3.5 years of follow-up), there were 250 incident cases of minimal cognitive impairment (MCI). An association between decreasing olfactory identification, as measured by a decrease in the number of correct responses in Brief Smell Identification Test score, and an increased risk of MCI was established [2]. The same was demonstrated in patients with Parkinson's disease: worse baseline olfaction was associated with long-term cognitive decline [3]. Interestingly, even a simple test, using a container of 14 g of peanut butter, which was opened and moved up 1 cm at a time during the participant's exhale-until-odor detection, while measuring the distance between the subject's nostril and container, appeared to be a sensitive and specific test for probable Alzheimer's disease [4]. A nice overview on the influence of age on the olfactory system and pathways mentioned that the magnitude of olfactory deficits, which occur in neurodegenerative and neurodevelopmental diseases, appears to be associated with the relative damage to the basal cholinergic system [5]. Perhaps the link between cognition and olfactory function involves the apolipoprotein E É›4 allele (ApoE) that has been associated with increased cognitive and olfactory deficits [6]...


Recent studies on natural alternatives to hormone therapy 

Have you noticed the increased number of publications on natural remedies for menopausal symptoms in good-quality journals? The reason for these studies, in in Pines' view, is not only the alleged problematic benefit–risk balance of hormone therapy (HT) or other approved medications, but the higher awareness of women to achieve better quality of life during midlife and beyond. This may be more prominent in developing countries where traditional medicine is popular, but is certainly valid in the Western world too. The willingness of Editors of journals with a medium to high impact factor to accept such papers, provided that these meet the quality standards of the aforementioned journals, gives a tail wind to this trend...


HRT, dry eyes and other ocular manifestations

From time to time, we have to remind ourselves and the healthcare providers that estrogen and the other sex steroids are actually involved in all the body organs, and that their physiological effects are not limited to fertility, treatment of menopausal symptoms, or cardiovascular and bone protection. Menopause Live has addressed in the past the effects of estrogen on other tissues and bodily functions, such as the skin, the voice or hearing. This time, the eye and sight are put into this context. A small, but double-blind, placebo-controlled study (n = 40, age 63.9 ± 5.1 years, 13.2 ± 6.3 years postmenopause) investigated the outcomes of estrogen, testosterone or their combination in hysterectomized women with dry eyes [1]. The results demonstrated estrogen-related worsening in dryness intensity after 8 weeks of estradiol gel 1 mg/g as compared to placebo; 1% testosterone cream showed a neutral effect, but a combination of the two hormones led to a significant increase in tear secretion...

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