Menopause Society Research Articles

Plasma estrogen concentrations after oral and vaginal estrogen administration in women with atrophic vaginitis

In this open-label, randomized, multiple-dose, two-treatment crossover study, 24 postmenopausal women with moderate to severe atrophic vaginitis received 0.3 mg conjugated estrogens daily for 14 days: 7 days orally (0.3 mg tablet) and 7 days vaginally (0.5 g cream). Steady-state plasma concentrations of E2 and estrone were one-third lower after vaginal versus oral administration of conjugated estrogens.

North American Menopause Society's 2010 Position Statement on Postmenopausal Hormone Use

The North American Menopause Society (NAMS) has updated its 2008 recommendations (JW Womens Health Jul 31 2008) for use of postmenopausal hormone

Position statement of the Menopause Society of Sri Lanka on estrogen and progestogen use in peri- and post-menopausal women and some other management options

DOI: 10.4038/sljog.v31i2.1759 Sri Lanka Journal of Obstetrics and Gynaecology 2009; 31 : 128-135

Estrogen and progestogen use in postmenopausal women

To update for both clinicians and the lay public the evidence-based position statement published by The North American Menopause Society (NAMS) in July 2008 regarding its recommendations for menopausal hormone therapy (HT) for postmenopausal women, with consideration for the therapeutic benefit-risk ratio at various times through menopause and beyond. An Advisory Panel of clinicians and researchers expert in the field of women's health was enlisted to review the July 2008 NAMS position statement, evaluate new evidence through an evidence-based analysis, and reach consensus on recommendations. The Panel' s recommendations were reviewed and approved by the NAMS Board of Trustees as an official NAMS position statement. Also participating in the review process were other interested organizations who then endorsed the document. Current evidence supports a consensus regarding the role of HT in postmenopausal women, when potential therapeutic benefits and risks around the time of menopause are considered. This paper lists all these areas along with explanatory comments. Areas that vary from the 2008 position statement are noted. A suggested reading list of key references published since the last statement is also provided. Recent data support the initiation of HT around the time of menopause to treat menopause-related symptoms; to treat or reduce the risk of certain disorders, such as osteoporosis or fractures in select postmenopausal women; or both. The benefit-risk ratio for menopausal HT is favorable for women who initiate HT close to menopause but decreases in older women and with time since menopause in previously untreated women.

2010 NAMS Recommendations for Managing Osteoporosis in Postmenopausal Women

The North American Menopause Society (NAMS) has updated its evidence-based position statement on osteoporosis in postmenopausal women. Osteoporosis is

Building Translation Science With Interdisciplinary Research: Why a Special Issue on the Proceedings of a Research Conference?

In answer to the question posed for this editorial: a Special Issue on the Proceedings of a Research Conference: Building Translation Science with Interdisciplinary Research? The answer is simple. The presentations of the conference held April 15, 2009, were thoughtful and eloquent about two topics critical to nursing and to in today's world. They addressed complex issues and challenges facing health care providers and scientists. The ideas were captured in the articles collected for this special issue so that they might be shared with the nursing community as well as our interdisciplinary colleagues. It is exciting to read these articles and envision ways that nursing can provide leadership in improving the health of the nation. As we began our planning activities for the conference, we had multiple objectives. First, we aimed to highlight the interdisciplinary research and translational supported by the Michigan Center for Nursing Intervention (P30 NR0090000). Our other objectives were to establish an ongoing forum for scientific inquiry among the faculty and students at the School and to disseminate our research among our colleagues within the School and across the University in order to forge lines of inquiry. As the National Institutes of Health roadmap initiatives have unfolded, interdisciplinary and translational have been emphasized as necessary for developing knowledge to solve today's complex health problems. We believed that a focus on strengthening our interdisciplinary collaborations and methods for building translational would be of high interest to the faculty. Many faculty at the School are actively engaged in interdisciplinary research and as nurses, all are committed to developing knowledge for use in practice. We believed, too, that learning about interdisciplinary and translational would benefit our early career investigators and doctoral students as they prepared for future careers in science. Dr. Nancy Fugate Woods, Professor and Dean Emerita of the University of Washington School of Nursing, was identified as the keynote speaker because of her longstanding history of collaborative, interdisciplinary research. Dr. Woods served as an investigator for the Women's Health Initiative Study and as President of interdisciplinary organizations, including the North American Menopause Society and the Society for Menstrual Cycle Research. She has participated in setting research agendas as a member of the National Institutes of Health Women's Health Task Force and Office of Women's Health Research Advisory Council. We invited her to build on this experience and present a paper entitled Translational Research: Why Interdisciplinary Collaboration Is Essential. Dr. Woods has produced an article that acknowledges past contributions of nursing to translational and delineates challenges and opportunities. She describes how scientists of all disciplines are working to learn ways of doing science as well as transitioning to a new social contract for how one does science (Woods, this issue). In explaining transdisciplinarity, Dr. Woods gives the benefits of creating perspectives that can cross the traditional boundaries of disciplines in finding solutions. She lists the skill sets needed for working in this paradigm. Importantly, Dr. Woods gives us compelling reasons why nurses need to lead in interdisciplinary, translational research and examples of how we can lead. We invited two School of Nursing faculty and their interdisciplinary colleagues to present an overview of a research study and describe the necessity of having an interdisciplinary team. Dr. Bernadine Cimprich, Associate Professor of Nursing, and her colleague, Dr. Douglas Noll, Professor and Chairperson of Bioengineering and Co-Director, fMRI Laboratory, presented An Interdisciplinary Focus on Altered Brain Function in Chemotherapy for Breast Cancer. …

Nursing Home Fractures: A Challenge and a Solution

Hip fracture occurrences in nursing homes are associated with high morbidity, mortality, and high health care costs in elderly people. In the United States, approximately 340,000 hip fractures occur each year, while more then 90% are associated with falls. Osteoporosis is a skeletal disorder causing impaired bone strength that increases the risk of fracture. In the United States alone, osteoporosis affects < 10 million individuals aged > or =50. The American Association of Clinical Endocrinologists (AACE), North American Menopause Society (NAMS), and National Osteoporosis Foundation (NOF) have developed recommendations for the identification of patients with osteoporosis who need therapy. Good nutrition with adequate supplements of calcium and vitamin D3 is considered one of the most important lifestyle factors for maintaining adequate bone mineral density. Only a combination of calcium and vitamin D therapy has been shown to increase the bone mineral density as well as a reduction in the nonvertebral fractures.

Third consensus meeting of Indian Menopause Society (2008): A summary

Third consensus meeting of Indian Menopause Society (2008): A summary

Management of osteoporosis in postmenopausal women

To update the evidence-based position statement published by The North American Menopause Society (NAMS) in 2006 regarding the management of osteoporosis in postmenopausal women. NAMS followed the general principles established for evidence-based guidelines to create this updated document. A panel of clinicians and researchers expert in the field of metabolic bone diseases and/or women's health was enlisted to review the 2006 NAMS position statement, compile supporting statements, and reach consensus on recommendations. The panel's recommendations were reviewed and approved by the NAMS Board of Trustees. Osteoporosis, which is especially prevalent among older postmenopausal women, increases the risk of fractures. Hip and spine fractures are associated with particularly high morbidity and mortality in this population. Given the health implications of osteoporotic fractures, the primary goal of osteoporosis therapy is to prevent fractures, which is accomplished by slowing or stopping bone loss, maintaining bone strength, and minimizing or eliminating factors that may contribute to fractures. The evaluation of postmenopausal women for osteoporosis risk requires a medical history, physical examination, and diagnostic tests. Major risk factors for postmenopausal osteoporosis (as defined by bone mineral density) include advanced age, genetics, lifestyle factors (such as low calcium and vitamin D intake, smoking), thinness, and menopause status. The most common risk factors for osteoporotic fracture are advanced age, low bone mineral density, and previous fracture as an adult. Management focuses first on nonpharmacologic measures, such as a balanced diet, adequate calcium and vitamin D intake, adequate exercise, smoking cessation, avoidance of excessive alcohol intake, and fall prevention. If pharmacologic therapy is indicated, government-approved options are bisphosphonates, selective estrogen-receptor modulators, parathyroid hormone, estrogens, and calcitonin. Management strategies for postmenopausal women involve identifying those at risk for fracture, followed by instituting measures that focus on reducing modifiable risk factors through dietary and lifestyle changes and, if indicated, pharmacologic therapy.

The Annual Conference of the British Menopause Society - June 2010

The Annual Conference of the British Menopause Society - June 2010

A warm welcome to Dr. Margery Gass as the new Executive Director of The North American Menopause Society

University of California, San Diego, La Jolla, California Financial disclosure/conflicts of interest: None reported.

Posicionamiento de la Asociación Española para el Estudio de la Menopausia sobre el uso clínico de la Cimicífuga racemosa en el climaterio

ObjectiveDue to an increasing interest in the symptoms related to menopause in western countries, the Spanish Menopause Society (SMS) has assessed the role of cimicifuga racemosa in relieving those symptoms based on the most reliable evidence available. Material and methodsA meeting was held with a panel of experts, health scientists and researchers specialised in the field of phytotherapy. The studies selected were obtained through electronic search which included INTERNET, MEDLINE (1985-May 2008), and the Cochrane Controlled Clinical Trials Register. ResultsMost studies published in recent years have been carried out using an isopropanol extract of cimicifuga racemosa. The dose most commonly studied was 40mg/day and was shown to result in a moderate decrease in hot flushes, particularly in those women with the most intense hot flushes, and an improvement in their mood. When recommended doses are used there is no significant risk to the hepatic system. Available data on the effect of cimicifuga racemosa on cardiovascular disease, bones, cognitive function or skin are scarce or non-existent. ConclusionsCimicifuga racemosa is an effective treatment for relief of vasomotor symptoms, at least within a suitable population of peri- and postmenopausal women. Nevertheless, more accurate clinical trials which include sufficient numbers of patients and a longer follow-up are required.

20th Annual Meeting of The North American Menopause Society September 30-October 3, 2009, San Diego, CA

Menopause: November 2009 - Volume 16 - Issue 6 - p 1231-1266 doi: 10.1097/gme.0b013e3181c02a50

Use of Antidepressants for Management of Hot Flashes

A growing body of evidence suggests that antidepressant therapies, particularly selective serotonin reuptake inhibitors and venlafaxine, are effective in the management of hot flash symptoms. Several of these agents have the support of the American College of Obstetricians and Gynecologists and the North American Menopause Society. To review the literature on antidepressants for the treatment of hot flashes in women, we searched the PubMed, International Pharmaceutical Abstracts, and MEDLINE databases from inception through May 2009. All publication types that included human participants and that were published in English were eligible for review. These articles, relevant abstracts, and additional references were used to collect pertinent data. Although initial small pilot trials were conducted solely in breast cancer survivors, additional studies have been conducted both in breast cancer survivors and in relatively healthy menopausal women. Data on the benefits with many of these agents are conflicting. Venlafaxine and paroxetine have been studied more extensively than any of the other antidepressants and are more consistent in effectively reducing the frequency and severity of hot flashes, based on these study results. Desvenlafaxine, sertraline, fluoxetine, and citalopram should be considered second- or third-line options if patients fail therapy with or cannot tolerate venlafaxine or paroxetine, based on the current published data. Duloxetine, escitalopram, fluvoxamine, and mirtazapine should be reserved as last-line therapy until more rigorous studies are conducted assessing their use in the management of hot flashes.

Report on the 8th European Congress on Menopause

The 8th European Congress on Menopause (EMAS), held 16-19 May 2009 in London, UK, was organized by the European Menopause and Andropause Society and hosted by the British Menopause Society (BMS). The Congress invited speakers from a range of European countries as well as some from the USA, Ecuador, Chile, Australia and South Africa, and attracted 1470 participants from over 70 countries as far afield as the Americas and East Asia.

An Observational Study on the Adherence to Treatment Guidelines of Osteopenia

Osteopenia/low bone mineral density (BMD) can lead to osteoporosis and is far more prevalent than osteoporosis. The National Osteoporosis Foundation (NOF) has recommendations for prevention and treatment of low BMD; however, the condition remains underrecognized and undertreated. We assessed practice patterns between physician knowledge of low BMD and prescribing of additional pharmacological therapies as defined by the NOF guidelines. This is a retrospective, observational chart review of electronic medical records of 99 postmenopausal women aged > or =60 years with T-scores between -1.0 and -2.5 on baseline BMD done in 2003 at the Cleveland Clinic Women's Health Center. Counseling, advisement of weightbearing exercise, recommendation of calcium and vitamin D supplementation, and adequate pharmacological therapy in the form of bisphosphonates, hormone therapy, or selective estrogen receptor modulators (SERMs) were assessed. The management of bone specialists credentialed both by the International Society of Clinical Densitometry and the North American Menopause Society and non-bone specialists was also compared. Bone specialists were more likely than non-bone specialists to offer counseling in the form of letters, phone encounters, and follow-up office visits and recommend weightbearing exercises. Most physicians recommended calcium and vitamin D supplementation regardless of specialty. There is no significant difference in the prescribing of pharmacological agents vs. conservative measures for osteopenic postmenopausal women by non-bone specialists vs. bone specialists as defined by the NOF guidelines, such that non-bone specialists did not treat these women any less aggressively than did bone specialists. Osteopenia is adequately managed in our institution regardless of physician group. However, non-bone specialists should consider more direct counseling about bone health and consider advisement of weightbearing exercise.

The Diagnosis and Treatment of Primary Osteoporosis According to Current Guidelines: Living With a Dilemma

In principle it always makes sense to provide the colleagues at the coalface with a recommendation of how they might tackle the difficult pathology that is osteoporosis. Central to this are Professor Minne’s words, that every case of osteoporosis requires treatment, but also recommendations from the US (NAMS) www.guidelines.gov. However, difficulties arise if only those patients are to be treated who have a 30% risk of vertebral or femoral fracture over the coming 10 years. For example, women aged 50 to 60 whose T value is better than -4.0 will not receive treatment, although they are ill. Untreated osteoporosis is certain to advance, and these patients will end with a much lower T value over the following years. The treatment of osteoporosis is obviously rather costly if bisphosphonates are the only option under consideration. But the follow–on costs of osteoporosis related complications in Germany are in excess of five billion Euros per year. With regard to prophylaxis, the new recommendations of the International Menopause Society (www.imsociety.org) should be noted. I have personally been conducting DXA bone density scans since 1988 and unfortunately cannot confirm that treating of patients with T values of -4 yields sufficiently rapid improvements within a short time for a substantial reduction of the fracture risk to be expected. In heeding the DVO guidelines one has to live with the dilemma of conforming to the guideline and withholding treatment from patients and thus risking fractures that might have been prevented by early treatment.

Use of Gabapentin in Patients Experiencing Hot Flashes

Hot flashes occur frequently in menopausal women and in women with breast cancer, diminishing their quality of life. A report from the Women's Health Initiative published in 2002 raised concerns about the long-term safety of estrogen therapy. As a result, nonhormonal alternatives have emerged as preferred treatments. Gabapentin is an anticonvulsant that the United States Food and Drug Administration approved as an adjunct therapy for partial seizures and postherpetic neuralgia. Somnolence, dizziness, ataxia, fatigue, nystagmus, and peripheral edema are adverse effects commonly associated with gabapentin in the treatment of epilepsy and postherpetic neuralgia. The North American Menopause Society and the American College of Obstetricians and Gynecologists recommend the use of gabapentin as an option for managing hot flashes in women who are unwilling to take estrogen-containing supplements. To evaluate the efficacy and safety of gabapentin for the treatment of hot flashes in women with menopause and/or breast cancer, we performed a search of the MEDLINE database (1966-March 2008) and International Pharmaceutical Abstracts, as well as manually searching reference articles for relevant articles and abstracts; 10 clinical studies were identified. Although the studies were few, all showed gabapentin to be safe and effective in the treatment of hot flashes. At doses used to control hot flashes, gabapentin was well tolerated, with drowsiness as its most reported adverse effect. Gabapentin can be considered effective in the treatment of hot flashes and should be considered a reasonable alternative when estrogen therapy is not desired.

Proceedings of the Annual Meeting of the British Menopause Society: Oral presentations

Proceedings of the Annual Meeting of the British Menopause Society: Oral presentations

19th Annual Meeting of The North American Menopause Society September 24-27, 2008, Orlando, FL

19th Annual Meeting of The North American Menopause Society September 24-27, 2008, Orlando, FL