HP eNews Update | 29 January 2019

www.menopause.org.au 29 Jan 2019
HP eNews

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.

In this edition


January 2019

Misinterpretation of WHI results decreased use of hormones, even in women not at risk

A study analyzed SWAN data to document decrease in hormone therapy initiation and continuation; many younger symptomatic women needlessly went without relief

Few studies have been as responsible for changing the course of treatment of menopause symptoms to the extent that the Women's Health Initiative (WHI) did. The number of women taking hormones dramatically dropped as a result of the study, leaving many women to needlessly abandon a treatment that offered symptomatic relief...

...Although this study is not the first to document the decline in HT use as a result of the initial WHI findings, it differs by distinguishing between the declines in initiation versus continuation. It also is one of the only known studies to document reasons for discontinuation, concluding that many symptomatic women forego HT because of concerns about study findings that are not truly applicable to them. This specific group includes women aged in their 50s when VMS symptoms, such as hot flashes, are most prevalent, but the risks of HT are lower. 

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HRT tablets increase risk of blood clots in women

Women who use certain types of hormone replacement therapy (HRT) [now known as MHT - menopausal hormone therapy] are at a higher risk of developing potentially life-threatening blood clots, new research has confirmed.

The study, undertaken by researchers at The University of Nottingham and published in the BMJ, found that the risk of developing blood clots was only increased for women using HRT in tablet form and was slightly higher for higher dosages.

The experts hope the results will help to provide clearer, detailed information for patients and doctors about the relative risks of blood clots for all HRT treatments and enable them to make good treatment choices.

Hormone replacement therapy (HRT) is used to relieve symptoms such as hot flushes and night sweats and reduce the risk of certain health conditions in women going through the menopause.

There are a range of different HRT treatments available, depending on the symptoms experienced. Some women require a drug based only on the oestrogen hormone, while others may need a combination of oestrogen and another hormone, progesterone. HRT can also be taken in different forms - by tablets, patches, gels or creams.

Although all treatments are effective in managing menopausal symptoms, an increased risk of venous thromboembolism (blood clots) is a rare, but serious, known side effect. A recently issued guideline from the National Institute for Health and Care Excellence (NICE) stressed that research results from studies trying to estimate the risk of developing blood clots as a result of HRT are still not clear, and that findings to date were not a reliable basis for decision-making by doctors or patients.

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Hormone therapy may be best defense against knee osteoarthritis

There is an ongoing debate regarding the relationship between knee osteoarthritis and hormone therapy (HT), with small-scale studies providing mixed results. A new large-scale study from Korea shows that women receiving HT had a significantly lower prevalence of symptomatic knee osteoarthritis compared with women who did not take hormones. Study results are published online in Menopause, the journal of The North American Menopause Society (NAMS).

Osteoarthritis is the most common musculoskeletal disorder in older persons and is the leading cause of pain and physical disability. Caused by degenerative changes in the joints, it affects more women than men, and its incidence is particularly elevated in menopause. Because estrogen has an anti-inflammatory effect at high concentrations, it has been hypothesized that hormone changes in women, especially decreasing estrogen levels, may lead to an increase in osteoarthritis after menopause.

Because the knee is the most commonly affected joint, knee osteoarthritis has been the focus of a number of studies relative to the effectiveness of HT. The most common treatments for knee osteoarthritis include surgery or nonsteroidal anti-inflammatory drugs, both of which are associated with risks such as surgical complications or gastrointestinal disorders.

Several small studies have shown that HT not only reduces histologic changes in the cartilage involved in osteoarthritis, but it also reduces the chronic pain. To date, however, no large-scale studies have examined symptomatic knee osteoarthritis and HT. This latest study out of Korea is based on data from nearly 4,800 postmenopausal women. It concluded that the prevalence of knee osteoarthritis was significantly lower in participants using HT than those not taking hormones. The authors did note, however, that additional research is warranted to adjust for such other variables such as age and body mass index.

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Persistent hot flushes may lead to increased risk of breast cancer

A study followed women from the Women's Health Initiative trials for nearly 18 years to examine association between persistent vasomotor symptoms and breast cancer incidence and mortality 

Studies examining the association between vasomotor symptoms (VMS) and breast cancer are not new, but results have been inconsistent. A new larger-scale study concludes that women participating in the Women's Health Initiative (WHI) trials who had persistent VMS are more likely to be diagnosed with breast cancer than women who never experienced VMS. 

Data was gathered from more than 25,000 women who participated in the WHI for this latest study that sought to identify an association between VMS (which includes symptoms such as hot flushes and night sweats) and breast cancer. Through 17.9 years' follow-up of these women, 1,399 incident breast cancers were seen. Women with persistent VMS (defined as symptoms that lasted 10 or more years) had a higher breast cancer incidence than women who never experienced VMS.

Although breast cancer-specific mortality was higher in women with persistent VMS, the difference was not statistically significant, which meant that persistent VMS did not influence breast cancer survival rates.

The possible link between VMS and breast cancer continues to be studied because of a common association with hormones. Specifically, hormone therapy has proven to be the most effective treatment for VMS, whereas sex hormone levels also are related to postmenopause breast cancer risk.

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IMS Menopause Live: Neuroendocrine aging precedes perimenopause – any practical implications?

Perimenopause marks the initiation of the transition into female reproductive senescence. It is well known that in general, the age at onset and duration of the menopause transition are associated with heritage on the one hand, but with many environmental, socioeconomic, lifestyle and other extrinsic factors on the other hand (1). Entering natural menopause at an early age carries potential long-term higher risks for chronic diseases, such as coronary heart disease and osteoporosis. Thus, prediction of the age at menopause might be important, allowing those with a forecast for premature or early menopause to be well prepared for such a scenario (2). What seems to be more challenging is whether we can manipulate the time sequence and delay menopause transition in women prone to early ovarian failure and the resultant rapid decline in estrogen production. The human genome, our basic genetic code, is largely static within an individual, yet chemical changes to the DNA and histone proteins may occur frequently as a result of what is defined as epigenetic alterations. This means that epigenomic deviations can result in changes to the structure of chromatin and to the function of the genome. To note, the epigenome can be dynamically altered by environmental conditions. A new study in rats claimed that understanding the hypothalamic neuroendocrine derangements which occur prior to the appearance of early signs of oocyte exhaustion could lead to the development of active interventions that will impact these complex mechanisms and delay the menopause by maintaining the normal hormonal milieu... 

Advances in Our Understanding of the Etiology/Mechanisms of Vasomotor Symptoms

Dr Thurston discusses the science behind vasomotor symptoms.

Dr Rebecca Thurston, Director of the Women’s Biobehavioral Health Laboratory and Professor of Psychiatry, Psychology, Epidemiology, and Clinical and Translational Science at the University of Pittsburgh.

Dr Thurston discusses the science behind vasomotor symptoms.

European Menopause and Andropause Society (EMAS)

AMS is an affiliate of EMAS. See a copy of the EMAS Newsletter January 2019

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