New Approach to Hormone Therapy Hot Topic at NAMS Conference

Fran Lowry

September 28, 2016

ORLANDO, Florida — The draft of an updated position statement on hormonal therapy will be discussed during a plenary symposium here at the North American Menopause Society (NAMS) 2016 Annual Meeting.

"In the 2016 position statement, we are looking at all of the literature since 2012, and trying to provide evidence-based data on hormones so that women and providers can make informed, individual decisions," said JoAnn Pinkerton, MD, from the University of Virginia Health System in Charlottesville, who is executive director of NAMS.

"We are going to talk about the recommendations during the meeting, and then they will go through the board one more time, because we want to make sure we include all input before we finalize them," she told Medscape Medical News.

Unlike the 2012 position statement (Menopause. 2012;19:257-271), the 2016 version will focus on research showing that hormonal therapy might have more benefits than risks for women younger than 60 years who are within 10 years of menopause.

It will also have sections on hormonal therapy for women undergoing early menopause, either because of primary ovarian insufficiency or oophorectomy.

Addressing Complex Cases

"We now know, based on observational data, that there is an increased risk for heart disease, cognitive or mood changes, and Parkinson's disease in these women, so the recommendations would be, if appropriate, to take estrogen until at least a natural age of menopause," Dr Pinkerton explained.

Hormonal therapy for carriers of BRCA genes who have undergone oophorectomy and for women older than 65 years will also be addressed.

"We found no increased risk with hormonal therapy in observational studies of women with BRCA mutations who had had an oophorectomy, but again, this has to be individualized," she said.

The best decision has to be a shared and informed one between the provider and the woman herself.

In addition, "there is no absolute rule that hormonal therapy cannot be given to women over the age of 65, because there might be potential indications, such as continued bothersome hot flashes or bone loss," she noted. "The best decision has to be a shared and informed one between the provider and the woman herself."

During a translational science premeeting symposium, NAMS President Peter Schnatz, DO, from Thomas Jefferson University in Philadelphia, will discuss the appropriate dose, route, and duration of hormonal therapy.

"One of our goals is to help educate clinicians and patients about the safe and proper utilization of treatments for menopause," he told Medscape Medical News.

"There are so many new data coming out," Dr Schnatz explained. The updated position statement "is going to be very helpful for clinicians."

And a premeeting symposium on menopause and the brain will include talks on mood and cognitive changes, sleep disruption, and depression.

Menopause and Health at Midlife

"As is NAMS's policy, we have a very multidisciplinary program. We focus on menopause and health at midlife and beyond in several different systems," said Pauline Maki, PhD, from the University of Illinois in Chicago, who is chair of the NAMS 2016 scientific program committee.

"Our program ranges from talks on cardiovascular disease, to cognition, sexual function, breast cancer, and bone. There is something for everyone on the program," she told Medscape Medical News.

For attendees who like a good debate, there will be two such sessions, Dr Maki reported.

The first is on the medical management of ductal carcinoma in situ. Advocating for surgical treatment will be Monica Morrow, MD, chief of the breast service at Memorial Sloan Kettering Cancer Center and professor of surgery at Weill Cornell Medical College in New York City. Arguing for conservative nonsurgical management will be Shelley Hwang, MD, professor of surgery and chief of breast surgery at the Duke Cancer Institute in Durham, North Carolina.

The second is on the use of pharmacologic agents for hypoactive sexual desire disorder. Advocating for their use will be Sheryl Kingsberg, PhD, from the Case Western Reserve University School of Medicine in Cleveland. Arguing against their use will be Jonathan Huber, MD, from the University of Ottawa Optimal Sexuality Research Team in Ontario, Canada.

Research into the psychological and cognitive effects of the menopause transition will also be highlighted at the meeting.

Psychological and Cognitive Effects of Menopause

"These areas are often of interest, but tend to get less attention," said Dr Maki. However, many practitioners "don't know how to converse with women about whether these complaints are real or imagined," and are unaware of data that back up these complaints.

The neurobiology of these effects will be addressed by Neill Epperson, MD, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

NAMS is an important voice for women going through menopause, Dr Schnatz told Medscape Medical News.

"We believe that we are the premier source of menopausal information, for both clinicians and patients. For a menopause provider, the 2016 meeting is the place to be," he said.

In addition to getting information to patients and clinicians, NAMS also advocates on their behalf, he pointed out.

"We can be a voice for women who are going through menopause," Dr Schnatz explained. For example, "we are currently working with the FDA to see if we can help them revise the package-insert wording for vaginal estrogen, which for many years has caused fear among patients and providers."

"The exact same verbiage that is used for systemic estrogen is used for vaginal estrogen, even though we know that the amount of systemic estrogen arising from vaginal absorption is extremely small," he said. For some preparations, the science shows that systemic levels are no different in women using vaginal estrogen than in the average menopausal patient who is not using estrogen therapy.

"To have the same verbiage as for systemically absorbed estrogen, therefore, is unfortunate," he said.

Dr Pinkerton reports financial relationships with Pfizer, TherapeuticsMD, and Henry Stewart. Dr Schnatz has disclosed no relevant financial relationships. Dr Maki reports a financial relationship with Noven Pharmaceuticals.


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