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Memory and hormone therapy after menopause

Contrary to popular belief, taking estrogen after menopause may not affect the memory and thinking abilities of healthy women no matter when the treatment is started. The study is among the first large, long-term clinical trial to examine the cognitive effects of estradiol, a type of estrogen, on women both close to and long after menopause.

Millions of women take estrogen to treat hot flushes, night sweats and other symptoms caused by menopause. Estradiol is the main type of estrogen produced by women in their reproductive years. Previously, researchers thought estradiol benefitted memory and thinking in women soon after menopause but not later, called the "timing hypothesis". Prior studies testing the theory have not found consistent results.

"This study fails to confirm the timing hypothesis," said study author Dr Victor W. Henderson of Stanford University School of Medicine in California and a Fellow of the American Academy of Neurology. "Our results suggest that healthy women at all stages after menopause should not take estrogen to improve memory. At the same time, women need not particularly be concerned about negative effects of postmenopausal estrogen supplements on memory when used for less than five years."

For the study, 567 healthy women between the ages of 41 and 84 were classified into early and late groups. The early group was within six years of menopause and the late group was at least 10 years postmenopausal. Participants took beta-estradiol every day or a placebo pill. The women also used a progesterone vaginal gel or placebo gel, unless they had a hysterectomy. The average treatment duration was nearly five years. Cognitive tests were performed at the beginning of the trial, 2.5 years and five years to measure thinking skills including verbal memory.

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Young Researchers: Sambrook award - applications close 15th July

The Philip Sambrook travel award is open for applications until 15th July.

Osteoporosis Australia is aiming this year to encourage interest from researchers who have received their research qualification within the last 5 years.

The award is open to both clinical and lab-based researchers, and up to $10,000 is offered to cover registration, travel and expenses for an overseas meeting.

If you know of anyone who is eligible/interested, please pass on this information.

pdfSambrook_award_flyer_2016611.05 KB

 

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Are women suffering in silence? - UK survey

New survey puts spotlight on significant impact of menopause despite recent guideline

Findings presented at the British Menopause Society’s annual conference show only half of women surveyed in Great Britain (who are currently experiencing or who have experienced menopausal symptoms within the past ten years) consult a healthcare professional for any of their menopause symptoms

A new survey conducted by Ipsos MORI on behalf of the British Menopause Society (BMS) has revealed that one in two women in Great Britain (aged 45-65 who are currently experiencing or who have experienced menopausal symptoms within the past ten years) go through the menopause without consulting a healthcare professional.1 This is despite women surveyed reporting on average seven different symptoms and 42% saying their symptoms were worse or much worse than expected.[1]

More than 200 leading women’s health experts from around the world gathered at the BMS’s annual conference to discuss recent advances in menopause research, and the impact of the National Institute of Health and Care Excellence (NICE) guideline on addressing the often overlooked needs of women experiencing the menopause.

It was hoped that the recently published NICE guideline on the diagnosis and management of the menopause would encourage more women to seek help and access to safe and effective treatments. Worryingly however, only 3% of those surveyed had heard of the guideline.[1]

The online survey found that:

  • Among those who have not consulted a healthcare professional for their menopause symptoms, more than a third (35%) believe it is something they should have to put up with [1]
  • The majority of women surveyed experienced hot flushes (79%) or night sweats (70%), but many experienced symptoms they did not expect1
    • 22% of women surveyed experienced unexpected sleeping problems / insomnia, 20% difficulty with memory / concentration and 18% joint aches1
    • It is also interesting to note that 35% said they experienced vaginal dryness, with 18% of those experiencing this symptom saying it was unexpected1
  • *For a full list of symptoms experienced, please see footnote below.
  • The impact of these symptoms has been widespread with half of women surveyed saying their menopause symptoms have affected their home life, their social life (36%), and work life (36%) [1]
    • 50% of women surveyed also reported that their sex life was affected, experiencing reduced libido (32%), reduced sex life (22%), painful or uncomfortable sex (16%) and 10% stopped having sex altogether. [1]

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Endocrine Society encourages clinicians to avoid prescribing compounded hormones

A new Scientific Statement issued by the Endocrine Society advises clinicians to avoid using compounded hormone medications to treat menopausal symptoms, female sexual dysfunction and other hormone conditions.

Sometimes called bioidentical compounded hormones, these products are typically a mixture of hormones. Compounded hormone medications are prepared by licensed professionals or facilities specifically for an individual's use. Compounded medications are meant to be an alternative when an individual does not have access to or has an adverse reaction to a medication approved by the U.S. Food & Drug Administration.

See comment from Australasian Menopause Society here

Compounded hormone medications can be unsafe when inappropriate practices are used. More than 60 people died from cases of fungal meningitis attributed to compounded medications in a 2010 case.

"In extreme cases, advertisers have marketed compounded products as being able to prevent the ravages of aging and implied they are risk free," said Nanette Santoro, MD, and the chair of the Society task force that developed the statement. "Few, if any, of these claims are supported by science."

Widely available hormone treatments that are 100 percent chemically identical to the native hormones found in the body and that are approved by the U.S. Food & Drug Administration (FDA) offer effective and safe options for people with hormone disorders, and those approved treatments should be prescribed whenever possible, Santoro said.

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FDA Approval of Flibanserin - Treating Hypoactive Sexual Desire Disorder

In a Perspective article in the New England Journal of Medicine the US Food and Drug Administration (FDA) offer an explanation regarding the approval Flibanserin. It opens as follows:

Was the Food and Drug Administration (FDA) approval of flibanserin (Addyi) for treatment of hypoactive sexual desire disorder (HSDD) in premenopausal women long overdue? Or was it an error? In the face of divergent views, we at the FDA think it's important to clarify why flibanserin was approved after being rejected twice.

Read the full article here: http://www.nejm.org/doi/full/10.1056/NEJMp1513686#t=article

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HRT - more on risks and benefits

Two articles have appeared recently examining the risk benefit ratio of menopausal hormone replacement. The first, which constitutes Level 1a evidence, is a meta-analysis of 43 randomised controlled trials of HRT v placebo and effect on mortality [Benkhadra et al J Clin Endocrinol Metab 100: 4021–4028, 2015). This analysis found no effect on menopausal HRT overall on mortality. The authors’ conclusion is that current evidence suggests that HRT does not affect the risk of death from all causes, cardiac death and death from stroke or cancer. In 5 of the 43 trials, menopausal HRT was started at a younger age, i.e. less than 60 years or within 10 years of menopause. The meta-analysis of these 5 RCTs showed a reduction of mortality with HRT (RR 0.70 [95% CI 0.52–0.95]).

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Hormone replacement therapy may benefit the kidneys

Hormone replacement therapy may help protect kidney health, according to a study that will be presented at ASN Kidney Week 2015 November 3-8 in the US.

The effect of hormone replacement therapy on kidney function in postmenopausal women is unclear. To investigate, Andrea Kattah, MD, Vesna Garovic, MD (Mayo Clinic), and their colleagues studied 2217 postmenopausal women who participated in the Family Blood Pressure Program, a multi-network study aimed at analyzing the genetics of hypertension. A total of 673 women were taking hormone replacements and 1544 were not.

The researchers found that the prevalence of two markers of kidney disease - microalbuminuria and decreased estimated glomerular filtration rate - was significantly lower in women who were taking hormone replacement therapy as compared with women who were not. After adjusting for known risk factors for kidney and cardiovascular disease, the use of hormone replacement therapy remained significantly associated with lower levels of microalbuminuria.

"The risks and benefits of hormone replacement therapy in postmenopausal women are still an area of active debate, and the effect of hormone replacement therapy on the kidney has shown variable results," said Dr Kattah. "Clarifying the role of hormones on kidney function may have implications for explaining gender differences in chronic kidney disease, counseling women on the use of hormone replacement therapy, and future therapeutic targets for patients with chronic kidney disease," said Dr Kattah.

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'Natural' hormones hurting women - doctor

Dr Anna FentonNew Zealand's Dr Anna Fenton, Past President of the Australasian Menopause Society and co-editor in chief of the journal of the International Menopause Society, specialises in women's health, and says she sees at least one patient every day suffering side effects from dodgy hormone treatments.

Dr Fenton also said many doctors are seeing the same trend.

Listen to the interview on New Zealand Radio Nine to Noon

http://www.radionz.co.nz/national/programmes/ninetonoon/audio/201774902/dodgy-natural-hormone-treaments-making-women-sick

Read the article 'Natural' hormones hurting women - doctor

http://www.radionz.co.nz/news/national/287174/%27natural%27-hormones-hurting-women-doctor 

 

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Pharmacy Board of Australia has released new FAQs on the compounding of medicines

2 Mar 2015

The Pharmacy Board of Australia (the Board) has released new guidelines and other tools for registered pharmacists who compound medicines.

Pharmacists who regularly compound medicines are urged to read the:

  • Guidelines on compounding of medicines
  • Background on the regulation of compounding by pharmacists, and
  • Professional practice profile for pharmacists undertaking complex compounding.

The Guidelines on compounding of medicines were subject to wide-ranging consultation and will take effect on 28 April 2015.

The guidelines have been published now so pharmacists can become familiar with their content before implementation.

They replace Guideline 5 Extemporaneous dispensing (compounding) from the Board's Guidelines for dispensing of medicines published on 12 August 2010.

Board Chair, Adjunct Associate Professor Stephen Marty, said the intent of the new guidelines is to provide detailed guidance to pharmacists who compound medicines to ensure product quality, safety and efficacy.

Additionally, the new guidelines provide guidance on compounding medicines of a more complex nature ('complex compounding') which requires or involves specific competencies, equipment, processes and/or facilities to manage the higher risks associated with the preparation and dispensing of these medicines.

'A significant enhancement of the original guidelines, the guidance released today aims to minimise the associated risks for patients, pharmacists and other pharmacy staff,' he said.

'Improved patient outcomes and patient safety is also an aim and expectation.'

Two other tools now released are the:

  1. Background on the regulation of compounding by pharmacists a.Contains information on the requirements of other authorities under their specific legislation, which relate to compounding. Each jurisdiction has separate requirements which may be specified in legislation and guidelines for these purposes.
  2. Professional practice profile for pharmacists undertaking complex compounding a.Outlines the required competencies of pharmacists undertaking complex compounding. It can assist pharmacists to acquire and maintain the required competence for any type of complex compounding and can also be used by course providers to develop training programs.

The circumstances under which pharmacists may compound and supply extemporaneously prepared medicines in and from different types of premises, or require a manufacturing licence from the Therapeutic Goods Administration (TGA), can be accessed on the Therapeutic Goods Administration website.

The TGA is in the final stages of consultation about possible changes to the regulation of compounded medicines. The Board will further consider its guidance upon publication of a revised legal framework by the TGA to ensure that it is aligned with any new requirements and continues to provide protection of the public.

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Short-term use of hormone replacement therapy (HRT) and ovarian cancer risk

hormone replacement therapyA meta-analysis of 52 epidemiological studies, involving a total of 21488 women with ovarian cancer, almost all from North America, Europe and Australia, was published in The Lancet on 13 February 2015 (see About the study). The findings from the study suggest that taking hormone replacement therapy (HRT) for the menopause, even for just a few years, is associated with an increased risk of developing ovarian cancer.


Comment from AMS

Dr Anna FentonDr Anna Fenton BHB, MBChB, PhD, FRACP
AMS President

"This recent meta-analysis from the Collaborative Group raises the possibility of an increased risk of ovarian cancer with use of estrogen or combined estrogen-progestogen therapy.

The data is heavily influenced by the Million Women Study which is widely acknowledged to have significant flaws. There has been no correction for the BMI of the women, their previous use of the contraceptive pill or age at menopause.

In the days since the study was released examination of the relative and absolute risk calculations have shown them to be incorrect. The revised absolute risk increase appears to now sit at just under 1 extra case per 10,000 women per year; somewhat less than the study initially suggested.  

Ovarian cancer is a rare condition but all the risks and benefits of hormone therapy need to be carefully considered when treating women at menopause.

Women should not stop hormone therapy based on this study but if they are concerned they should discuss the findings with their doctor." 

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