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
Early age menstrual periods increases risk of premature and early menopause
Helping to head off fractures during menopause
A Randomised Trial on MonaLisa Touch for Postmenopausal Vulvovaginal Symptoms
Menopause and work
Cosmetics and women's health
Our Menopause World January 2017
NAMS Menopause e-Consult
Professor Gita Mishra from the University of Queensland said the study found women who had their first period before the age of 11 were 80 per cent more likely to experience premature or early menopause.
"This is important information because we know these women have a higher risk of developing chronic conditions like cardiovascular disease, type 2 diabetes and osteoporosis," Professor Mishra said. Nearly one in 10 women experience premature menopause (a final menstrual period before the age of 40), or early menopause (final period between the ages of 40 and 44 years). UQ School of Public Health researcher Professor Mishra said the risk of early or premature menopause was doubled in women who did not have children compared to those who had two or more children.
"The combination of an early period and childlessness led to a five-fold increase in the risk of premature menopause and a two-fold increase in the risk of early menopause, compared to those who started their periods after age 12 and had two or more children." The study considered childlessness as an indicator of underlying fertility issues because the women involved were from an era when general fertility was high and there was little access to infertility treatments.
Bone fragility has long been a worrisome condition affecting women as they age.
"It's been considered a silent disease," says Karl Jepsen, PhD, associate chair of research and professor of orthopaedic surgery at Michigan Medicine, noting, "One of the biggest challenges when you're looking at age-related bone fragility is to identify people who will fracture."
Jepsen is the lead author on the study, Femoral Neck External Size but not aBMD Predicts Structural and Mass Changes for Women Transitioning through Menopause, that examined the bone traits of 198 midlife women transitioning through menopause for 14 years. The goal: identifying women who will experience bone fragility well in advance of fracture. "Current identification for bone fragility takes place when the patient is around 65 years of age."
"We were hopeful that this study would give us an opportunity to identify those patients as early as 30 years before they fracture based on their bone traits. That means we would have an opportunity to intervene before the fracture happens, instead of after the fact." Jepsen adds that understanding how bone structure and bone mass change during aging is not well understood on an individual basis.
Do you have eligible patients who may be interested?
The Royal Hospital for Women is inviting eligible patients to be part of the MonaLisa Touch trial.
MonaLisa TouchTM (MLT) is a new treatment for women with vulvovaginal symptoms that involves treatment of the vaginal lining with tiny pin-point laser applications with the aim of restoring the skin to a state similar to that prior to the menopause. The aim of this trial is to examine the effectiveness of MLT for the treatment of vulvovaginal symptoms and provide high quality information to guide women with vulvovaginal symptoms as to their best treatment options.
If the study proves that MLT is a safe and effective treatment for vulvovaginal symptoms, all women in the placebo group will be offered MLT after the conclusion of the study. There will be no charge to any study participants for the MLT treatment.
Further details: here
See exclusive commentary on studies such as:
Menopause is a normal life event for women and so it is not an illness or a medical condition. This often means that the symptoms of the menopause are too often under recognized, undervalued and not taken seriously. The psychological symptoms associated with the menopause such as loss of self-confidence, low self-esteem, anxiety and depressive symptoms are the ones that often affect women the most.
On average, women spend nearly one-third of their life being postmenopausal. The retirement age is increasing and elderly people are far more active, both physically and mentally, than they were in the past. Symptoms of the menopause last far longer than most women anticipate; the average length of time is 4 years and many women still have some symptoms for longer than 10 years.
Around 3.5 million women aged between 15 and 65 years are currently in employment in the UK. The employment rate for women in the UK has actually increased in the past few decades and women now represent nearly a half of the UK labor force. This means that many more women are being affected by symptoms of their menopause, often to the detriment of their families, work and life in general. Clearly, the symptoms vary between women with around 25% of women suffering severe symptoms. Not only can this have a significant impact on the individuals, but also on their work colleagues.
As many women still do not recognize that it is the menopause (or perimenopause) causing their symptoms, they will not talk about it and, more importantly, they will not ask for help. In addition, if their colleagues do not know enough about the menopause, then it potentially makes it very hard for women to talk about symptoms they are experiencing at work...
Cosmetics. Everyone uses them, women and men alike. Cosmetics include many different materials with various roles that determine the activity, texture, color and smell of the final product. People are not aware of the fact that, unlike medications, cosmetics are not tested as rigorously by the regulatory authorities and the included chemicals may be harmful. The external placement and targets for use should not distract us from investigating potential systemic ill-effects. For example, ingredients in cosmetics may have an effect on a variety of hormonal pathways. A recent review, which analyzed possible associations with age at menopause, concluded that there is lack of data on the relevant risk outcomes of cosmetic use ...
...Another interesting aspect of potential harm relates to molecules with estrogen-mimicking properties and breast cancer risk. The breast may be exposed to a range of estrogenic chemicals applied as cosmetics to the underarm and breast area . These cosmetics are left on the skin allowing a more direct dermal absorption route for breast exposure to estrogenic chemicals...
Lobo RA, Pickar JH, Stevenson JC, Mack WJ, Hodis HN. Back to the future: Hormone replacement therapy as part of a prevention strategy for women at the onset of menopause. Atherosclerosis 2016;254:282-90
In the late 1980s, several observational studies and meta-analyses suggested that hormone replacement therapy (HRT) was beneficial for prevention of osteoporosis, coronary heart disease, dementia and decreased all-cause mortality. In 1992, the American College of Physicians recommended HRT for prevention of coronary disease. In the late 1990s and early 2000s, several randomized trials in older women suggested coronary harm and that the risks, including breast cancer, outweighed any benefit. HRT stopped being prescribed at that time, even for women who had severe symptoms of menopause. Subsequently, re-analyzes of the randomized trial data, using age stratification, as well as newer studies, and meta-analyses have been consistent in showing that younger women, 50–59 years or within 10 years of menopause, have decreased coronary disease and all-cause mortality, and did not have the perceived risks including breast cancer. These newer findings are consistent with the older observational data. It has also been reported that many women who abruptly stopped HRT had more risks, including more osteoporotic fractures. The current data confirm a 'timing' hypothesis for benefits and risks of HRT, showing that younger women have many benefits and few risks, particularly if therapy is predominantly focused on the estrogen component. We discuss these findings and put into perspective the potential risks of treatment, and suggest that we may have come full circle regarding the use of HRT. In so doing, we propose that HRT should be considered as part of a general prevention strategy for women at the onset of menopause.
The January 2017 Menopause e-Consult features commentary on these questions and cases:
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