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Menopause treatments – Misinformation

Posted 08 September 2023

Here are some key excerpts from the review published in Cell (abstract below):

“Complementary and alternate medicines (CAMs) for menopausal symptoms have been frequently touted, are widely advertised, and have an overall dismal track record of efficacy when subjected to rigorous scientific study. The best studied of these are phyto (plant) estrogen supplements and black cohosh (Cimicifuga racemosa). Systematic reviews of phytoestrogens do not support benefits in the relief of VMS.122,123 In numerous trials, black cohosh, not to be confused with blue cohosh, which has known liver toxicity, has been shown to be safe with limited efficacy in some single-site clinical trials. However, the HALT study, which was the most rigorous and comprehensive clinical trial to date, consisting of 351 participants, demonstrated no improvement with black cohosh over placebo among perimenopausal women experiencing VMS.124 The dilemma that black cohosh poses to the clinician is a common one when dealing with herbal remedies or ”nutriceuticals” for menopausal symptoms. On the one hand, these treatments do not result in improvements beyond what is achieved with placebo. On the other hand, they are typically inexpensive and have low potential for harm.”

“There are a variety of non-hormonal medications that have demonstrated efficacy against VMS. Virtually all of these medications have been discovered incidentally, when patients who had been taking them for their primary purpose and who also had VMS noted that their VMS improved on the medication. This serendipitous discovery of non-hormonal treatments underscores the overall lack of knowledge of the fundamental pathophysiology of VMS, which has only recently been elucidated leading to new and better targeted treatments.”

“The benefit to risk ratio of hormone therapy has been the subject of extensive debate.”

“Although an array of MHT formulations is available to alleviate symptoms, information about the long-term efficacy and safety of MHT is limited to the preparations used in the WHI studies conducted in the US. There is an urgent need for longer term studies to establish the efficacy of non-oral estradiol on cardiometabolic and cognitive outcomes, and dose optimization of oral progesterone and other progestogens for endometrial protection. Equally needed are studies of the safety of these preparations with respect to breast cancer, VTE, and CVD risk.”

Misinformation preventing women from getting effective menopause treatment, study finds

Blanket fear that ‘hormones are dangerous’ driving many towards complementary therapies rather than regulator-approved treatments

Natasha May
Wed 6 Sep 2023 16.00 BST
https://www.theguardian.com/society/2023/sep/07/menopause-treatment-misinformation-hormones

Most women going through menopause are not receiving effective treatment for their symptoms, in part because of widespread misinformation, according to new research.

A comprehensive literature review led by Prof Susan Davis from Monash University in Australia and published on Thursday calls for more personalised treatment plans that address the greatly varying physical and mental symptoms of menopause.

After adverse affects were reported from the landmark 2002 Women’s Health Initiative study into menopausal hormone therapy (MHT), Davis said there was a blanket fear that “hormones are dangerous” and as a result, “menopause [treatment] just went off the radar”.

“Now there’s been this real surge of interest in menopause,” Davis said. The journal Cell invited Davis and her colleagues to provide a comprehensive summary of what is known about menopause, what’s not known and the challenges in the area.

“One of the challenges being most symptomatic women are not getting appropriate therapy,” Davis said.

More than 85% of women in high-income countries do not receive effective, regulator-approved treatment for their menopausal symptoms, according to the review, which examined over 200 sources going back 71 years.

“Midlife for women can be pretty tough,” Davis said. “They’ve got a lot of balls in the air. They’re balancing a lot of things in their life. And then you add into the mix sleep deprivation from hot flushes and night sweats, unexplained waves of anxiety, lack of confidence [and] vaginal dryness so you don’t want to have sex with your partner because it hurts.

“A whole lot of these symptoms are treatable. But you’re not being treated, and that really impairs your quality of life.”

In some cases, Davis said, hormone therapy is inappropriately prescribed when other treatments such as lowering blood pressure and correcting cholesterol would be more appropriate.

However, many ineffective therapies are advised as a result of persisting misinformation around menopausal hormone therapy, which is a medication that contains oestrogen, progesterone and sometimes testosterone used to manage the symptoms of menopause.

“On the wave of the fear factor [around MHT] came all the people who said you can take all these alternative herbs and spices and things that are going to make you better with no foundation. But because women were symptomatic and fearful of hormone therapy, if you’ve got terrible symptoms, you will take what you can get.”

While the paper found evidence-based nonhormonal interventions are also available for symptom relief, “the most effective treatment for bothersome menopausal symptoms is evidence-based, menopausal hormone therapy (MHT), which reduces bone loss and may have cardiometabolic benefits”.

While only 30% of women going through menopause will have moderate to severe symptoms, Davis said there are often silent changes in the body, such as loss of bone density.

Davis encouraged all people experiencing menopause to have a full health check because “optimising health at menopause is the gateway to healthy ageing for women”.

Prof Rodney Baber from the University of Sydney said the review provided an up-to-date account of the most important issues in the field in a “fair, evidence-based way”.

“One of the issues for many women is they will almost all try over-the-counter complementary therapies before they engage with a doctor to discuss hormones,” Baber said.

“When menopausal hormone therapy is used to alleviate symptoms in postmenopausal or perimenopausal women the benefits of the treatment in terms of alleviation of symptoms, cardiometabolic health and bone health are significant and the risks are in fact very low.

“This review shows us that there [are] still some aspects of the physiological changes in the perimenopause and postmenopause that require more research to understand what goes on,” he said.

Baber said the review also showed that most data is from women living in western countries and more information about women living in other countries was needed.

The research was published in the journal Cell.
~~~

Menopause-Biology, consequences, supportive care, and therapeutic options

Susan R. Davis,1,2,* JoAnn Pinkerton,3 Nanette Santoro,4 and Tommaso Simoncini5

https://www.cell.com/cell/pdf/S0092-8674(23)00905-4.pdf

1Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
2Department of Endocrinology and Diabetes, Alfred Health, Commercial Rd., Melbourne, VIC 3004, Australia
3Department of Obstetrics and Gynecology, Division of Midlife Health, The University of Virginia Health System, Charlottesville, VA, USA
4University of Colorado School of Medicine, Aurora, CO, USA
5Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

*Correspondence: [email protected]
https://doi.org/10.1016/j.cell.2023.08.016

SUMMARY

Menopause is the cessation of ovarian function, with loss of reproductive hormone production and irreversible loss of fertility. It is a natural part of reproductive aging. The physiology of the menopause is complex and incompletely understood. Globally, menopause occurs around the age of 49 years, with geographic and ethnic variation. The hormonal changes of the menopause transition may result in both symptoms and long-term systemic effects, predominantly adverse effects on cardiometabolic and musculoskeletal health. The most effective treatment for bothersome menopausal symptoms is evidence-based, menopausal hormone therapy (MHT), which reduces bone loss and may have cardiometabolic benefits. Evidence-based non-hormonal interventions are also available for symptom relief. Treatment should be individualized with shared decision-making. Most MHT regimens are not regulator approved for perimenopausal women. Studies that include perimenopausal women are needed to determine the efficacy and safety of treatment options. Further research is crucial to improve menopause care, along with research to guide policy and clinical practice.

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