Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Hurdity]

Members in US might be interested to read this - as might the rest of us! I haven't read it all yet - had a quick glance at the begininning but it came to me as an alert today so thought I'd pass it on:
http://www.menopause.org/docs/default-source/2017/nams-2017-hormone-therapy-position-statement.pdf

Hurdity x

[weathergirl]

Yes we've been waiting on this here in the US. Thanks Hurdity!

[Tempest]

Very interesting. I think everyone should have a read of this, and I am glad to see that it meets approval from the British Menopause Society.

I note that the advisory is still for the lowest effective dose, and risks of continuing HRT after the age of 60 mainly outweigh the benefits - so that still stands from what we knew before.

Points of interest for me are that HRT does not improve depression in women who are clinically depressed, nor does it improve depression in women who are post menopausal.  (Many women here struggle with issues regarding depression/anxiety, so this may help them to decide if they indeed need extra help via therapy and/or antidepressants).

Systemic HRT does not improve vaginal symptoms of estrogen deficiency. This will help women to decide if they wish to use systemic HRT or if their symptoms are copeable other than vaginal dryness/VA - in which case, vaginal estrogens would be an effective choice. I also notice that there was a statement confirming  small systemic uptake of vaginal estrogens - this is useful for women to know who have had or are at risk of estrogen positive breast/ovarian cancer.

I was also very glad to see that the position statement included findings specific to premenopausal women who receive surgery of bilateral salpingo oopherectomy and POI women regarding effects on QOL and long term risk of estrogen deficiency on health and morbidity. It seems that these risks (tying in with my other research and information I received from Professor Lumsden) largely apply to women who have surgery or who suffer POI at a younger age (i.e. before 40).

I will study this in further depth and may comment further on other points,  but these are issues that I personally wanted some further clarification on so thank you for sharing, Hurdity.

Having just had the result of my second DEXA  and finding that it is completely normal at present just over 2 years post surgery, I will also discuss further prevention of any future osteopenia/osteoporosis at my next specialist appointment with the information in this current statement in mind. xxxxx

[hoping4best]

"Systemic HRT does not improve vaginal symptoms of estrogen deficiency."

I was surprised to see this there because that has not been my experience at all, not that of many here, right? I have found I need systemic and local together for VA relief. Unless I'm reading it wrong.

As someone who lost an ovary at 38 and had the other almost immediately fail, I'm grateful to see the guidelines are clear for women in those situations.

[Maryjane]

REALLY do not agree that systemic HRT does not help VA , many ladies on here myself included only saw vast improvement when adding in the systemic.

Also specialists I have seen say the same also.

Mild VA is very different to what I have , and local just did not do the job on its own at all.

[Tempest]

I found that curious, hopingbest!

I'm also glad that POI/oopherectomy ladies are being recognised as a specific and seperate group with seperate considerations regarding long term health in younger women. About time! xxxxx

[Tempest]

Personally MJ, I think the whole area of VA is understudied. For women in whom it is mild and can be treated by local HRT, this is fine but you have clearly proven by sharing your experiences that this is not always the case.

By speaking out about your experience (well done on liasing with Dr. Newson by the way), I hope that this will kick start a whole new area of thought on research into these issues. Perhaps because it's been under reported and 'kept in the dark' by so many women embarrassed to seek treatment, this is why we have these type of statements appearing.

xxxxx

[Maryjane]

Yes Tempest 😊 It's been made so hush hush , and 🙈🙊🙉regards women's vaginal issues in general , we haven't helped ourselves by being embarrassed about an amazing part of our bodies that for me has delivered three wonderful daughters , my goal is to get onto radio/ TV discussing it.

I have broad shoulders re any idiots out there. Xxxx

[Hurdity]

Very interesting. I think everyone should have a read of this, and I am glad to see that it meets approval from the British Menopause Society.

I note that the advisory is still for the lowest effective dose, and risks of continuing HRT after the age of 60 mainly outweigh the benefits - so that still stands from what we knew before.

Points of interest for me are that HRT does not improve depression in women who are clinically depressed, nor does it improve depression in women who are post menopausal.  (Many women here struggle with issues regarding depression/anxiety, so this may help them to decide if they indeed need extra help via therapy and/or antidepressants).

Systemic HRT does not improve vaginal symptoms of estrogen deficiency. This will help women to decide if they wish to use systemic HRT or if their symptoms are copeable other than vaginal dryness/VA - in which case, vaginal estrogens would be an effective choice. I also notice that there was a statement confirming  small systemic uptake of vaginal estrogens - this is useful for women to know who have had or are at risk of estrogen positive breast/ovarian cancer.

I was also very glad to see that the position statement included findings specific to premenopausal women who receive surgery of bilateral salpingo oopherectomy and POI women regarding effects on QOL and long term risk of estrogen deficiency on health and morbidity. It seems that these risks (tying in with my other research and information I received from Professor Lumsden) largely apply to women who have surgery or who suffer POI at a younger age (i.e. before 40).

I will study this in further depth and may comment further on other points,  but these are issues that I personally wanted some further clarification on so thank you for sharing, Hurdity.

Having just had the result of my second DEXA  and finding that it is completely normal at present just over 2 years post surgery, I will also discuss further prevention of any future osteopenia/osteoporosis at my next specialist appointment with the information in this current statement in mind. xxxxx

I've had bit more of a look at this - it is very detailed - but this is for US and of course we do have our own NICE Guidelines - both the summary and the detailed research evidence, as well as the presumably equivalent paper (recommendations on HRT) by the British menopause Society and Women's Health Concern which was updated in 2016. great that it has been endorsed/supported by BMS as you say

I couldn't find the statement "Systemic HRT does not improve vaginal symptoms of estrogen deficiency". As I understand the paper it says that local/vaginal oestrogen is the preferred FIRST LINE OF TREATMENT over systemic HRT if symptoms of VA etc are the ONLY menopausal symptoms ( and as long as the woman is above average menopausal age otherwise oestrogen replacement is recommended ie POI or surgical meno). I don't think this differs from UK recs? What it doesn't go into are the recommendations for treatment if local oestrogen is insufficient to deal with VA.  It does say "Systemic HT does not improve urinary incontinence and may increase the incidence of stress urinary incontinence." and this means as first line of treatment. The BMS/WHC paper also does not go into detail about this either, although does say that local/vaginal oestrogen may be used in conjunction with systemic HRT.

Re the lowest effective dose - it does make this statement ( the NAMS paper): The concept of ‘‘lowest dose for the shortest period of time'' may be inadequate or even harmful for some women. A more fitting concept is ‘appropriate dose, duration, regimen, and route of administration.'' Therefore this is a step forward and akin to the UK view.

Re the risk for women over 60 - I don't think it says that the risks outweigh the benefits when taken or started over 60 or 65, just that the risks increase - which accords with the UK view - unless I have misread (it is pretty detailed - and reiterates and summarises points along the way). There seems to be quite a lot of discussion about age profile.

Maryjane - I am sure you will get on telly to discuss all of this, you sound so determined - good on you - and we all look forward to seeing you talking unashamedly about vaginas!!!

Hurdity x

[Annemaria]

Tempest,
The article states as quoted below; women who "initiate" not women who "continue" HT. Big difference.


"For women who initiate HT more than 10 or 20 years from menopause onset or are aged 60 years or older, the benefit-risk
ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venousthromboembolism,
and dementia. Longer durations of therapy should be for documented indications such as persistent VMS or bone loss."

[nearly50]

I take the or as meaning women over 60, regardless of what age they started hrt
 

[weathergirl]

My general sense about this is that if HRT is started greater than 10 years post-meno, there are possibilities for increased risks.  10 years post and beyond, arteries have started to perhaps harden/calcify more, any inherent genetic risk factors toward CHD have likely become more pronounced from cellular aging alone and the body has downregulated or adapted physiologically to the very low estradiol levels.  Arteries lacking as much elasticity, changes in the way receptors now respond to exogenous hormones, physiological aging, etc., may all impact the way the exogenous estradiol is processed and handled by the body.  These are only my own thoughts after reading what I have on HRT and the 'timing' hypothesis. 

It would make sense to me if the body has adjusted (to a great degree physiologically) to the decreased estradiol, perhaps reinstating it is some form 'shock' to the body??  As far as any risk factors in long-term continued use, it really bothers me that no new, randomised, LARGE studies have been done using current generation bioidentical HRT - transdermals specifically, and natural progesterone (not a progestagen).   Studies of long-term use via transdermal estradiol administration (oral progesterone) may yield different, long-term risk/use data.  So much of even the current recommendations are still based on the WHI study - which we all know has been seriously picked apart, reanalyzed and debated in terms of the validity of its conclusions for those in peri or recently post-menopausal seeking HRT.

I am not in this industry, but with women representing 50% of our population, and ALL women going through menopause, why are larger, newer studies not being pursued??

[Hurdity]

Great post weathergirl!!

I totally agree. There have been studies and trials since the WHI study - but not as large nor long term and especially for women taking this form of HRT into their 60's. There is the KEEPS study as well as others ( sorry - it's summer - I'm a bit lax in looking stuff up at the moment!) - but this used transdermal estradiol and micronised progesterone although mainly looking at efficacy. There have been other studies eg this small but very important Swedish study looking at the effect of different types of HRT on breast cancer genes:
https://www.sciencedaily.com/releases/2014/05/140502172035.htm
Also there was the FrenchE3N cohort study which looked at different types of HRT - but this was a longitudinal study rather than a trial:
https://academic.oup.com/ije/article/44/3/801/629731/Cohort-Profile-The-French-E3N-Cohort-Study

I think the NAMS statement generally accords with UK views with some small differences and emphases eg greater reference to bio-identical hormone therapy which is much more prevalent and promoted over there due to their different healthcare system.

Hurdity x