Managing menopause: Hormone therapy is back
Hot flashes, night sweats and sleep disturbances are common symptoms of menopause that can affect health, quality of life and work productivity. A new review published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.221438 recommends menopausal hormone therapy, historically known as hormone replacement therapy (HRT), as first-line treatment in people without risk factors.
Menopausal symptoms may occur up to 10 years before the last menstrual period and can last more than 10 years, with negative effects for many people.
"Menopause and perimenopause can be associated with distressing symptoms and reduced quality of life," writes Dr. Iliana Lega, Women's College Hospital and the University of Toronto, Toronto, Ontario, with coauthors. "Menopausal hormone therapy is the first-line treatment for vasomotor symptoms in the absence of contraindications."
The review summarizes the latest evidence for diagnosing and treating menopausal symptoms as well as the risks and benefits of therapies to help clinicians and patients manage the condition.
"Although many treatments exist for menopausal symptoms, fears around the risks of menopausal hormone therapy and lack of knowledge regarding treatment options often impede patients from receiving treatment," write the authors.
Benefits of menopausal hormone therapy include
- reduced hot flashes in as many as 90% of patients with moderate to severe symptoms;
- improved blood lipid levels and a possible reduced risk of diabetes; and
- fewer fragility fractures of the hip, spine and other bones.
What about the risks?
- Although previous evidence has shown an increased risk of breast cancer, the risk is much lower in people aged 50–59 years and in those who start menopausal hormone therapy in the first 10 years of menopause.
- Some studies show an increased risk of ischemic stroke in women older than 60 years who start therapy 10 years after the start of menopause, but the risk is low for those younger than 60.
For people with risk factors or those who do not want to take menopausal hormone therapy, nonhormonal therapies, such as some selective serotonin reuptake inhibitors (SSRIs) and other medications, can help alleviate symptoms.
"Despite early concerns of an increased risk of cardiovascular events with menopausal hormone therapy after the Women's Health Initiative trial, increasing evidence shows a possible reduction in coronary artery disease with menopausal hormone therapy among younger menopausal patients, specifically those who start menopausal hormone therapy before age 60 years or within 10 years of menopause," write the authors.
They emphasize that it's important for clinicians to ask about symptoms before and during menopause and to discuss treatments with patients based on their personal preferences and potential risk factors.
JOURNAL
Canadian Medical Association Journal
METHOD OF RESEARCH
Literature review
SUBJECT OF RESEARCH
People
ARTICLE TITLE
A pragmatic approach to the management of menopause
ARTICLE PUBLICATION DATE
15-May-2023
Severe hot flashes after menopause increase metabolic syndrome risk in women
Reports and ProceedingsSevere hot flashes after menopause increase metabolic syndrome risk in women
Women who experience more severe hot flashes after menopause are more likely to develop metabolic syndrome and high blood pressure, according to research presented at the 25th European Congress of Endocrinology in Istanbul. The findings of this long-term study highlight the importance of using hormone replacement therapy for menopause in these women.
Metabolic syndrome is a group of three or more conditions that occur together, which increase the risk of heart disease, stroke and type 2 diabetes. These conditions include high blood pressure, high blood sugar, excess body fat around the waist and abnormal cholesterol or triglyceride levels. After menopause, women are at a higher risk of developing metabolic syndrome and cardiovascular disease.
In this study, researchers from the National and Kapodistrian University of Athens examined 825 healthy women aged 40-65 years, who had recently gone through menopause, at Aretaieion University Hospital Athens in Greece. They monitored these women over the course of 15 years, between 2006 and 2021, and found that those with moderate to severe hot flashes were more likely to develop hypertension and metabolic syndrome. Additionally, women who developed hypertension or metabolic syndrome were diagnosed earlier when experiencing more severe hot flashes compared to those who had no or milder cases of hot flashes.
Previous studies have also shown an association between hot flashes and cardiovascular health risk; women experiencing hot flashes have a higher risk of developing different types of conditions that affect the heart and blood vessels. However, this association has never been studied in women with varying degrees of symptoms on such a large scale. “Our long-term study is carefully designed, in which we matched a carefully selected group of women according to the severity of hot flashes and their age, and followed them for up to 15 years,” said lead researcher Dr Elena Armeni.
Symptoms like hot flashes and night sweats can start around the time of menopause and can last up to 10 years. However, hormone replacement therapy – medication that contains hormones which the body can no longer make after menopause – can be used to treat menopausal symptoms and protect long-term health, especially in women who have moderate to severe hot flashes. “Our results re-emphasise the role of cardiovascular prevention strategies, such as the use of hormone replacement therapy, which should be implemented shortly after menopause,” said Dr Armeni. “This healthy group of women who are already candidates for hormone replacement therapy should be encouraged to opt for this treatment.”
The researchers are now interested in whether these accumulated health risk factors cause heart conditions. “Our study shows that the most symptomatic women after menopause have more prevalent cardiovascular risk factors, but it is unclear if they are also more likely to develop heart disease, type 2 diabetes, or have a stroke," said Dr Armeni. “If so, women with more disturbing symptoms will require appropriate health education to ensure they will remain fit and healthy in old age.”
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The study “The severity of hot flashes is associated with the risk for incident metabolic syndrome and new-onset hypertension after the menopause” will be presented on Sunday 14 May 2023 at the European Congress of Endocrinology at the Halic Congress Center in Istanbul, Turkey. See the full scientific programme here.
The European Society of Endocrinology (ESE) provides a platform to develop and share leading research and best knowledge in endocrine science and medicine. By uniting and representing every part of the endocrine community, we are best placed to improve the lives of patients. With over 5,000 individual members and through the 51 National Societies involved with the ESE Council of Affiliated Societies (ECAS), ESE represents a community of over 20,000 European endocrinologists. We inform policy makers on health decisions at the highest level through advocacy efforts across Europe.
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