MENOPAUSE UPDATE

By: Red Hot Mamas

Published: November 9, 2016

Contributed by by Dr. Verna Brooks McKenzie- Red Hot Mamas Medical Expert

The North American Menopause Society convened it’s 2016 Annual Meeting in Orlando Florida. It was an excellent meeting where participants networked and danced at the president’s reception while participating in scientific presentations delivered by experts in their field. Here are some highlights.

Cardiovascular Disease

Stroke and coronary heart disease(CHD)  are the leading killers in the US. Statistically 80% of cardiovascular disease (CVD) events can be prevented. Women have substantially worse outcomes than men and are undertreated for known CVD risk factors. CHD is a complex disease and assessment of risk is essential. The coronary microvasculature is the key regulator of blood flow to heart muscle. Coronary artery atherosclerosis is a late manifestation of CHD and traditional risk factors for atherosclerosis are not associated with coronary microvascular disease in women with chest pain in the absence of obstructive coronary disease.  Many tools such as Framingham exist to assess cardiovascular risk but it may underestimate risk in women since it does not include family history, pregnancy-related problems such as preeclampsia and other emerging risk factors. Breast arterial calcification on digital mammography has been found to correlate with coronary CT calcium score and provides a unique opportunity to take advantage of routinely performed imaging to further enhance our ability to identify high risk women.

Menopause Symptoms

The frequency of symptoms associated with menopause varies within and across populations. 40-80% of women in the menopause transition have vasomotor symptoms (hot flashes, night sweats) and  objective hot flashes were essentially not different across cultures. The median duration of hot flashes is 7.4 years and lasts 3 years longer in African American women and 3 years shorter in Chinese American women. 90% of women develop hot flashes after a surgical menopause (both ovaries removed) which often affect their ability to function. Increased disease risk and mortality rates have been reported. Major public health education is needed to disseminate accurate information and treatment recommendations.

Hormone therapy (HT)

HT is the most effective treatment for vasomotor symptoms, bone loss/fracture prevention and genitourinary syndrome of menopause (GSM) – signs and symptoms during the menopause transition affecting all the genito pelvic anatomic structures. Treatment initiated before age 60 and/or within 10 years of menopause (timing hypothesis) is shown to decrease CHD and all cause mortality. Treatment should be individualized to maximize benefits and minimize risk. Absolute risks for stroke, venous thromboembolism (VTE)/ pulmonary embolism are lower in younger postmenopausal women. Increased breast cancer risk with 3-5 years of estrogen and progesterone treatment in women with a uterus is rare (1:1000). Tissue selective estrogen complex (TSEC) offers an alternative to the use of a progestogen for endometrial protection. Women with premature  surgical menopause can be treated for menopause symptoms until at least the median age of menopause (age 52), if there are no contraindications.  ACOG committee endorsed low dose vaginal estrogen for breast cancer survivors with GSM. Fear is driving our decision to make progress.

Dr. Verna Brooks McKenzie is an Obstetrician and Gynecologist and is Certified by the North American Menopause Society as a Menopause Practitioner. She has over 30 years of experience in training , lecturing and public speaking. She is an advocate for women’s health and is a board member for Red Hot Mamas. 

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