Conference Report From the 10th World Congress on the Menopause

Professor Lorraine Dennerstein, AO MBBS, PHD, DPM, FRANZCP

Disclosures

July 03, 2002

In This Article

Summary and Clinical implications

  • Randomized controlled trials and cohort studies provide complementary information about a given problem under investigation. Any analysis of longitudinal hormone data must take into account the level of each hormone in the prior year.

  • Both the mean age of menopause and the length of the menopausal transition were shown to differ according to the length of the follow-up in population-based studies.

  • A 7-stage model for the menopausal transition consists of early, peak, and late reproductive phases; early and late menopausal transition phases; and early and late postmenopausal phases.

  • FSH begins to rise during the early menopausal transition; the steepest rise occurs about 1 year before FMP during the late menopausal transition. The rise in FSH seems to be driven by a fall in the level of inhibin B and to some extent estradiol. FSH levels stabilize at an elevated level during the early postmenopause, while estradiol levels stabilize at low levels during the same phase.

  • A population-based study found that total testosterone levels did not change with the menopausal transition or with the 8 years of follow-up. However, the amount of bioavailable testosterone increased as a result of a corresponding fall in SHBG. DHEAS was not affected by the menopausal transition but showed a steady decline with age.

  • Characteristic of approaching FMP is an increasing cycle irregularity and length, rising above 35 days during the last 10 cycles. Once the difference between longest and shortest cycles becomes ≥ 42 days, the FMP can be expected within 1 year for those with FSH > 20 IU/L and who perceive themselves to be in the menopausal transition.

  • The most important predictor of any woman's sexual functioning seems to be her functioning level in the prior year. Additional factors that may have major effects on a woman's sexual functioning are any change in partner (marital) status, feelings toward her partner, and the level of estradiol. The use of HRT (by elevating estradiol levels) may have a positive effect on both sexual responsiveness (including libido) and vaginal dryness/dyspareunia.

  • The role of androgens in the sexuality of menopausal women is unclear but seems to be very minor in one population-based study.

  • For clinicians, the major focus for reducing cardiovascular risk factors remains that of lifestyle factors. Reducing weight, increasing exercise, and cessation of smoking will all have favorable effects.

  • A population-based study indicated that with respect to hormones, only estradiol level has a significant effect on BMD. The level of estradiol needed to maintain BMD can be estimated, which should allow clinicians to better calculate the minimum amount of estrogen replacement needed to maintain BMD and prevent further bone loss. There seem to be differences between ethnic groups with regard to BMD, and adjustment should be made for BMI.

  • A study found that joint aches and pains were the most prevalent bothersome symptom reported by mid-aged women both at baseline and at 8-year follow-up, exceeding even vasomotor symptoms as a complaint.

  • Clinicians need to be aware of the potential for an adverse effect of HRT in diabetic women.

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