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NAMS Annual Meeting 2017

NAMS 2017

The North American Menopause Society (NAMS) Annual Meeting was held in Philadelphia, USA October 11-14. A selection of the pre-conference information released about the presentations is shown here.

Note: The Australasian Menopause Society does not necessarily endorse the medical and scientific information shown. As the medical and scientific information shown here might not be relevant to a particular person's circumstances and you should always discuss your health with your own healthcare provider. 

How serious is postmenopausal bleeding?

11 October 2017

North American Menopause Society (NAMS) Annual Meeting

Presentation on approaches for evaluating diagnostic and treatment options

If you're postmenopausal, you shouldn't be bleeding. The very definition of menopause is having gone more than 12 months without a period. So if you're still bleeding, something is wrong. Determining the seriousness of the problem and treating it, is not always evident. 

A number of conditions can lead to postmenopausal bleeding. Some of these conditions have few health consequences, while others could lead to cancer of some kind. Cancer of the endometrium is the most common type of gynecologic cancer in the US. In 2017, more than 60,000 cases of this cancer will occur, causing an estimated 10,470 deaths. Vaginal bleeding is the primary symptom in more than 90% of postmenopausal women with endometrial cancer, although the cause of bleeding for most postmenopausal women will be something much more benign, such as thinning of the vaginal walls or uterine lining as a result of fluctuating hormone levels. Depending on risk factors, 1-14% of women with postmenopausal bleeding will have endometrial cancer.

With such high stakes, there is a need to establish a standard of care that strives for 100% accuracy in correctly diagnosing the cause of the bleeding. In the past 25 years, the standard has changed substantially as new diagnostic techniques have been introduced, although no single method has proven appropriate for all patients.

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Long-term treatment of osteoporosis clarified

11 October 2017

North American Menopause Society (NAMS) Annual Meeting

Confusion about long-term treatment of osteoporosis clarified

Osteoporosis is a common disorder among postmenopausal women which results in an increased risk of fractures. While several therapies improve bone strength and reduce the risk of spine and hip fracture, there is no cure for osteoporosis, and long-term treatment is needed. An upcoming presentation at The North American Menopause Society (NAMS) Annual Meeting in Philadelphia October 11-14 is scheduled to present new evidence about the long-term effectiveness and safety of treatment with bisphosphonates and denosumab.

Bisphosphonates and denosumab are the most commonly prescribed treatments for osteoporosis. Protection from fractures occurs within the first few months of treatment and persists as long as treatment is continued. Upon stopping bisphosphonate therapy, protection from fractures is gradually lost over three to five years. Treatment for more than three years has been associated with an increasing risk of unusual or "atypical" fractures of the femur (thigh bone). After five years of treatment, the risk of these atypical fractures is about 20 per 100,000 patients and increases to about 1/1,000 patients after eight to ten years of treatment.

The combination of increased risk of atypical fracture along with a relatively slow offset of the protection from fractures due to osteoporosis led to the confusing concept of a "bisphosphonate holiday." The American Society for Bone and Mineral Research has recently provided clear recommendations about "bisphosphonate holidays." After three to five years of bisphosphonate treatment, a patient's risk of fracture should be reevaluated. For patients remaining at high risk of fracture (those with previous hip, spine, or multiple other fractures or with bone density values remaining in the osteoporosis range), continuing treatment or changing to a different drug like denosumab is important. For patients whose risk of fracture is lower, stopping treatment for two to three years (the "holiday") can be considered but is not mandatory.

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Women remain sceptical of hormones at menopause

11 October 2017

North American Menopause Society (NAMS) Annual Meeting

Postmenopausal women more likely to use alternatives other than hormone therapy

Women today have more options than ever before for treating their menopause symptoms, although hormone therapy still ranks as the most effective treatment for debilitating symptoms such as hot flashes. A new study demonstrates, however, that women remain sceptical regarding the safety of hormone therapy and prefer less proven options. The study results will be presented during The North American Menopause Society (NAMS) Annual Meeting in Philadelphia, October 11-14.

Hot flashes (including night sweats) occur in up to 75% to 80% of all women in the US with some of them considered debilitating and lasting for many years after the end of menstrual cycles. Despite the fact that hormone therapy has proven to be the most effective treatment for hot flashes and other bothersome menopause symptoms, women and their healthcare providers still question their safety which has led to a decreased number of prescriptions and usage of hormones. This was one of the first studies to examine women's beliefs and attitudes toward menopause in general and hormone therapy specifically.

Among the many findings, the survey results showed that participants were significantly less willing to use hormones for hot flashes and instead used exercise, diet, herbal supplements, acupuncture, or meditation. This was despite the fact that participants strongly agreed that hormone therapy could effectively reduce hot flashes.

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WHI data to confirm vaginal oestrogen does not increase risk of heart disease, breast, or endometrial cancer

11 October 2017

North American Menopause Society (NAMS) Annual Meeting

Women can breathe sigh of relief when using vaginal oestrogen to treat menopause symptoms

Hot flushes aren't the only bothersome symptom of the menopause transition. Many postmenopausal women also experience sexual dysfunction and urinary problems that don't require oestrogen pills but, rather, can be alleviated by vaginally administered oestrogen. A new study shows that, despite previous misperceptions, this treatment option is not only effective, but also safe. 

Vaginal oestrogen in the form of a cream or suppository is highly effective in managing an array of sexual and urinary problems collectively referred to as the genitourinary syndrome of menopause. Despite its proven effectiveness, the use of vaginal oestrogen has been restricted by concerns of women and their healthcare providers regarding its potential link to such serious health issues as coronary heart disease, breast cancer, stroke, and others. Examination of the data from the Women's Health Initiative (WHI) Observational Study of more than 45,000 participants showed, however, that the use of vaginal oestrogen does not significantly increase the risk of heart disease or cancer, including breast, colorectal, and endometrial cancer. Nor is it related to an elevated risk of such other concerns as stroke, pulmonary embolism, hip fracture, or death.

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Transdermal oestradiol shows promise in treating and preventing perimenopausal depression

11 October 2017

North American Menopause Society (NAMS) Annual Meeting

Study demonstrates greatest improvements in mood in women reporting more stressful life events

Did you know you're two-to-four-times more likely to suffer from depression during the menopause transition? A new study suggests that transdermal estradiol could be the key to not only treating existing perimenopausal depression, but also possibly preventing it, and the chances that it will benefit your mood are greater the more stress you're under. 

It's no secret that depression is a commonly reported symptom of the menopause transition. Several small trials have previously suggested that transdermal estradiol therapy (i.e., an estrogen patch) effectively treats perimenopausal depression. But this is the first study to examine its effectiveness in preventing the onset of perimenopausal depression among women who were previously not depressed. Estradiol is the primary estrogen (female sex hormone) that is produced during a woman's reproductive years, impacting reproduction as well as sexual function.

A 12-month intervention conducted by Drs David Rubinow and Susan Girdler and their team at the University of North Carolina at Chapel Hill demonstrated that transdermal estradiol was more effective than placebo in maintaining a more positive mood and in preventing the emergence of clinically significant depression particularly among women in the early menopause transition (as opposed to women in the late menopause transition or postmenopausal period). The effectiveness of treatment on mood was also stronger in women who reported a greater number of stressful events in the six months preceding enrollment.

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Misperception from WHI prevent women from benefiting from hormone therapy

11 October 2017

North American Menopause Society (NAMS) Annual Meeting

Study suggests additional education needed for clinicians so women can safely get relief from hot flashes and other menopause symptoms

More than a decade after the Women's Health Initiative (WHI) clinical trials, lingering misperceptions regarding hormone therapy (HT) still prevent many women from getting relief from their menopause symptoms. A new study from the University of Virginia Health System uncovers knowledge gaps of clinicians treating postmenopausal women and identifies need for additional education. 

Despite the fact that published evidence from the WHI suggests that HT is a relatively safe, viable solution for symptomatic menopausal women under age 60 or within 10 years postmenopause, the number of women being prescribed and using hormones continues to decline. To counteract ongoing skepticism amongst medical professionals regarding the safety of hormones, a new medical education program was shared with 1,087 physicians, nurse practitioners (NPs), and physician assistants (PAs).

Participants were asked a series of questions before and after reviewing the educational program to identify knowledge gaps relative to hormone safety and determine if additional education would help to overcome misperceptions. Among physicians, the average percentage of participants who correctly answered test questions related to outcomes of the WHI trials was 57% pre-activity and 70% post-activity; for NPs, the average percentage answering correctly was 49% pre-activity and 68% post-activity; and for PAs, 52% and 70% respectively.

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Painful sex and bladder problems take toll on women's libido during menopause

11 October 2017

North American Menopause Society (NAMS) Annual Meeting

Study provides added insights as to why women become less sexually active as they age

As women age, sexual activity typically declines. But that doesn't necessarily mean they are no longer interested in sex. The problem for many is physical. A new study demonstrates the impact on sexual activity of postmenopausal women as a result of vulvovaginal atrophy and lower urinary tract problems. 

In recent years the medical community adopted the terminology "genitourinary syndrome of menopause" (GSM) to more accurately refer to the collective vaginal and bladder problems that affect many women during menopause. In simpler terms, GSM includes symptoms of painful sex as a result of a thinning of the vaginal walls, along with bladder problems that can lead to urine leakage during sexual activity, as well as during other unpredictable times. As part of this new study, researchers assessed the impact of these symptoms on a woman's ability to be sexually active and enjoy the sexual experience.

More than 1,500 women completed a questionnaire regarding their sexual activity. While both vulvovaginal atrophy and bladder problems negatively impacted sexual enjoyment and frequency of activity, the fear of experiencing pain during sex was reported as a reason for avoiding or restricting activity more often (?20%) than bladder problems, such as fear of wetting the bed or having to interrupt activity to go to the bathroom (?9%).

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Getting a good night's sleep and feeling better could be all in your head

11 October 2017

North American Menopause Society (NAMS) Annual Meeting

Study demonstrates effectiveness of cognitive behavioural therapy for menopausal insomnia on depressive symptoms

For the thousands of peri- and postmenopausal women who struggle to sleep and battle depression, help can't come soon enough. Although physical changes during the menopause transition are often the cause of these problems, a new study from the University of Texas suggests that cognitive behavioural therapy might provide the relief these women seek. 

Insomnia is a frequently cited problem, affecting 30-60% of peri- and postmenopausal women. Depressive symptoms are nearly equally prevalent, affecting 25-40% of this female population. Over the years, medical professionals have proposed a number of treatment options to relieve one or both of these menopause symptoms. Cognitive behavioural therapy for insomnia is one alternative that has shown tremendous potential in treating menopausal insomnia. This new study, however, is the first to examine the effects of this same therapy on depressive symptoms. Cognitive behaviour therapy for insomnia is a type of psychotherapy which targets negative thoughts and behaviours contributing to insomnia.

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Hormone therapy may benefit migraine sufferers without increased risk of heart disease

11 October 2017

North American Menopause Society (NAMS) Annual Meeting

Study reviews WHI data to demonstrate lack of association between migraines, cardiovascular disease and hormone therapy; opens door to increased use of hormones to treat migraines

Migraine headaches are common among women, but due to various health risks can be challenging to treat in the elderly. While hormone therapy is effective in relieving many menopause symptoms, its safe use in women with migraines was unconfirmed. A new study based on data from the Women's Health Initiative (WHI) demonstrates its safety for this population. 

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