Symptoms Of Treatment-Induced Menopause In Breast Cancer Patients Eased By Non-Drug Treatments

September 1st, 2014

Main Category: Breast Cancer
Also Included In: Menopause;  Psychology / Psychiatry
Article Date: 23 Mar 2012 – 1:00 PDT

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Researchers from The Netherlands have found that the menopausal symptoms caused by giving chemotherapy or hormonal therapy to younger women with breast cancer can be ameliorated considerably through the use of cognitive behavioral therapy (CBT)[1] and physical exercise (PE). These interventions can be effective in dealing with such distressing symptoms as hot flashes, night sweats, vaginal dryness, weight gain, urinary incontinence and sexual problems, a researcher told the 8th European Breast Cancer Conference (EBCC-8).

The researchers studied 422 breast cancer patients with an average age of 48 years recruited from 14 hospitals from the Amsterdam and Rotterdam regions of the Netherlands. They were randomly assigned to four groups – CBT alone, PE alone, CBT and PE combined – and a control group. Compared with the control group, all those patients who received one or both interventions showed an overall decrease in the levels of menopausal symptoms, in addition to reporting an increase in sexuality and an improvement in physical functioning. These positive effects were still apparent after six months.

“To our knowledge, this is the first study to investigate the efficacy of these two interventions specifically in women who have experienced acute, treatment-induced menopause,” Dr. Marc van Beurden from The Netherlands Cancer Institute, Amsterdam, The Netherlands, will say. “This is a very important issue for the quality of life of younger breast cancer patients. Unlike healthy women starting the menopause, they are unable to take hormone replacement therapy to alleviate their symptoms. There are other drugs available, but they are only moderately effective and have troublesome side-effects.”

The CBT programme consisted of six weekly group sessions of 90 minutes each, including relaxation exercises. The primary focus of the CBT was on hot flushes and night sweats, but other symptoms were also addressed. The PE programme was a 12-week, individually tailored, home-based and self-directed exercise programme of two and a half to three hours per week. Initial training and follow-up was provided by physiotherapists. The goal was to exercise at an intensity level that achieved a target heart rate.

The researchers believe that the CBT reduces stress levels and helps women cope effectively with the symptoms they are experiencing. Physical exercise is intended to reduce hot flushes through an effect on the thermoregulatory system. “There was already evidence that both interventions were effective in women undergoing the natural menopause,” says Dr. van Beurden’s colleague, Dr. Hester van Oldenburg. “We are pleased to have established that they also work in women with induced menopause, which is significantly more difficult for patients to deal with both because it is caused by cancer treatment, which is distressing in itself, and because the symptoms often come on so quickly that there is little or no time to get used to them.”

Patients said that participation in the CBT programme made them more aware of their symptoms and how to deal with them. “Before, I more or less accepted them unconsciously. Now I’m more alert about my symptoms, their effect, and possible ways to cope with them. By sharing my experiences with others, I’ve learned to put my symptoms in perspective and to cope with them,” said one participant.

While the evidence that the interventions worked was convincing, compliance with them was poor, the researchers say. In the case of CBT, it was difficult to schedule the group sessions at a time that was convenient for women who often had both work and parenting responsibilities. The frequency and intensity of the PE programme was also a challenge for many women.

“We think that we have made an important step forward in improving the quality of life of these patients,” Dr. van Beurden will say. “Based on input from patients, we are now developing an internet-based version of the CBT programme. We hope that this will further increase the accessibility and convenience of the interventions and lead to more women benefiting from their results.”

Professor David Cameron, from the University of Edinburgh (Edinburgh, UK), and chair of EBCC-8 said: “Menopausal symptoms can often be an added burden of side effects for younger women undergoing treatment for breast cancer. This study is important as it offers evidence that there is a way to intervene to make this less of a problem for women, thus allowing them to get on with their lives after curative therapy for breast cancer.”

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Originally posted 2012-03-24 03:13:19. Republished by Blog Post Promoter

Source: http://www.medicalnewstoday.com/releases/243246.php

PMS, menopause and hot flashes

August 29th, 2014

Having premenstrual syndrome (PMS) before menopause does not mean women will be troubled by hot flashes afterward. But they may face more menopause complaints other than hot flashes, such as trouble with memory and concentration, finds a new study published online in Menopause, the journal of The North American Menopause Society (NAMS).

The research team at the Helsinki University Central Hospital and Folkhälsan Research Institute in Helsinki, Finland, are the first to show a link between PMS and a worse quality of life after menopause. They uncovered the link by asking 120 healthy postmenopausal women who had not taken hormones to answer standard questionnaires about the premenstrual symptoms they had had and about their current health. The investigators also had the volunteers keep a diary of their hot flashes, recording how many they had and the severity of each.

Nearly 90% of the women recalled having PMS. For half of these women, the symptoms interfered with work, home or social life, and about 40% of these women rated their PMS as moderate or severe. But the analysis showed that hot flashes and their severity had no significant relationship to PMS. The symptoms were, however, linked with depression, poor sleep, feeling less attractive, and especially with memory and concentration problems after menopause.

Whether these results mean that PMS and menopause complaints other than hot flashes have a common cause, such as a similar change in regulation of the autonomic nervous system or genes that predispose to both, are topics for future research.

Meanwhile, says NAMS Executive Director Margery Gass, MD, “Women who are troubled by PMS can be reassured that it doesn’t mean bothersome hot flashes are inevitable later.”

Source: http://www.medicalnewstoday.com/releases/277201.php

Scientists map risk of premature menopause after cancer treatment

August 27th, 2014

Women treated for the cancer Hodgkin lymphoma will be able to better understand their risks of future infertility after researchers estimated their risk of premature menopause with different treatments.

The findings, set out in the Journal of the National Cancer Institute, are based on the experience of more than 2,000 young women in England and Wales treated for the cancer over a period of more than 40 years.

Previous research has suggested that women with Hodgkin lymphoma who receive certain types of chemotherapy or radiotherapy are at increased risk of going through the menopause early – but there was insufficient information to provide patients with detailed advice.

But the new study, led by scientists at The Institute of Cancer Research, London, provides precise estimates of risk for women depending on which treatment types and doses they received and at what age – allowing doctors to give them detailed advice about their risks of future infertility.

The research was largely funded by Breakthrough Breast Cancer and involved researchers from across the UK at more than 50 universities and hospitals.

The research team followed-up 2,127 women who had been treated for Hodgkin lymphoma in England and Wales between 1960 and 2004, and who had been aged under 36 at the time. All had received treatment with chest radiotherapy, sometimes alongside other treatments.

Some 605 of the women in the study underwent non-surgical menopause before the age of 40. This was a large enough number for the researchers to estimate accurate risks of menopause at different ages, depending on the mixture and doses of treatments they received and the age they received them.

The researchers produced a risk table which could help improve the advice that clinicians are able to give to women who have undergone treatment for the disease. Several of the treatments caused a sharp increase in premature menopause risk.

For example, a woman who had received six or more cycles of a standard chemotherapy regimen in her late 20s, but without receiving radiotherapy to the pelvic area, had a chance of around 18 per cent of undergoing menopause by the age of 30, or 58 per cent by age 40.

Overall, risk of premature menopause was more than 20-fold raised after ovarian radiotherapy, and also after some specific chemotherapy regimens. Risk of menopause by age 40 was 81 per cent after receiving ovarian radiotherapy at an overall dose of 5 or more Grays, and up to 75 per cent after chemotherapy, depending on the type, although only one per cent after receiving a chemotherapy regimen called ABVD.

Study leader Professor Anthony Swerdlow, Professor of Epidemiology at The Institute of Cancer Research, London, said:

“Hodgkin lymphoma often affects younger women, and although fortunately most survive the disease, treatments including certain types of chemotherapy and pelvic radiotherapy can lead to premature menopause.

“We hope our study will help women to understand better, in consultation with their doctors, their risks of future infertility following treatment for this malignancy. By looking in a much larger group of women than previous studies of this type, we were able to produce age and treatment specific risk estimates that we hope will be of practical use to individual women. I’m extremely grateful to the patients and doctors who made it possible for us to produce this information.”

Source: http://www.medicalnewstoday.com/releases/281462.php

Menopause Qs you’re not asking

August 26th, 2014

Editor’s note: Dr. Deepali Patni is a board-certified OB/GYN at Kelsey-Seybold Clinic in Houston.

(CNN) — Menopause: the permanent end of fertility (and periods!) that commonly happens to women in their late 40s and 50s. For many women, just saying the word “menopause” can increase anxiety levels.

Change is never easy, especially as we get older. And although menopause symptoms — night sweats, mood swings, sleep problems, weight gain — make it seem like a daunting time in a woman’s life, there are many things that your gynecologist can do to help you through this transition.

One of the issues I find in my own practice is that there is plenty of misinformation about menopause, making it hard to separate myth from fact. Talking with your gynecologist about this very important change can help alleviate some of the confusion — and maybe even improve your symptoms.

Frequent questions that have come up in my practice include:

My sex drive isn’t what it used to be. Why?

There are many hormonal changes that a woman experiences in her transition to menopause. Estrogen and testosterone levels may drop, causing a decreased interest in sex or vaginal dryness, which can make sex uncomfortable.

If loss of libido is an issue for you — or your partner — talk to your gynecologist. He or she can work with you to determine the most appropriate treatment plan. Sometimes the fix can be simple, such as increasing the time that it takes for you to become aroused before intercourse, or incorporating the use of a lubricant or moisturizer. Other times, a gynecologist will recommend hormone replacement therapy.

Although there aren’t any FDA-approved testosterone replacement products for women, in the appropriate patient, testosterone combined with estrogen replacement can have a beneficial impact. Keep in mind testosterone therapy can have significant side effects and the long-term risks have not been fully studied.

Menopause has made sex painful. What can I do?

If you’re one of the menopausal women who suffer silently from pain during intercourse, you are not alone. Many don’t realize that vulvovaginal atrophy is a common condition that happens as a result of the thinning and weakening of vaginal tissues due to a drop in estrogen after menopause.

Make an appointment to see your gynecologist to talk about the available treatment options, which range from vaginal moisturizers and water-based lubricants to topical or oral estrogen treatment.

Do I still need to worry about sexually transmitted illnesses?

Sexually transmitted illnesses are — and always will be — a concern for women, even menopausal women. If you are not in a mutually monogamous relationship, always use a condom to help protect against diseases that can be passed through sexual contact.

Sexually transmitted illnesses do not discriminate based on age, and I’ve seen menopausal women who have contracted chlamydia, gonorrhea, genital herpes, syphilis and HIV.

What about pregnancy?

Pregnancy in menopause does not happen, but there are some women who believe they have reached menopause and became pregnant, only to find out later that they were still perimenopausal. The general rule is that if you have not had your period in 12 months, then you are in menopause and unlikely to get pregnant. This can be confirmed with a simple blood test.

I’m feeling a lot of pressure down there. Is that bad?

Little alarm bells should ring if you are feeling constant pressure in your pelvic area. It doesn’t necessarily mean that something life threatening is happening, but now would be the time to make an appointment with a gynecologist to get it checked out.

If you have reached menopause, there are many things that could be causing pressure in the pelvic region, ranging from constipation and fibroid tumors to pelvic floor disorders and cancer. Do not let this symptom go unchecked.

Women who have questions about menopause should seek a trusted source for information. Your gynecologist is ready to help guide you through this next phase in your life.



Source: http://rss.cnn.com/~r/rss/cnn_health/~3/JYRv912hjSI/index.html

Depression less likely in women after the menopause

August 25th, 2014

Depression less likely in women after the menopause

BMJ Group News


What do we know already?

69x75_concerned_woman_3.jpg

Many of the symptoms women get during the menopause begin in the years leading up to it, when the levels of sex hormones in a woman’s body start to fall.

But there are lots of emotional changes, such as feeling low or depressed, which some women may experience during or after the menopause.

Researchers aren’t sure whether these emotional changes are caused by changes in hormone levels or whether there are other causes, such as ageing or the lifestyle changes that women may face at this time of life.

To find out more, researchers studied 203 women aged between 35 and 48 who hadn’t yet reached menopause when the study started. The researchers interviewed the women about their depression symptoms every nine months for several years before and after the menopause. From this the researchers worked out when a woman’s risk of depression is highest – before or after the menopause.

Slideshow: All about menopause and perimenopause

What does the new study say?

Women were more likely to have depression symptoms before the menopause than after.

The average age at which women in the study had their last period was 51. Ten years before their last period, about 40 in 100 women had depression symptoms who hadn’t had any symptoms before the start of the study. Eight years after the menopause, when women in the study were an average age of 59, this had fallen to about 8 in 100 women with depression.

The chance of getting depression fell by about 12 percent every year during the study. The risk also fell as a woman’s level of a sex hormone called follicle-stimulating hormone (FSH) fell. This suggests that the risk of depression in women during the menopause is linked to sex hormone levels.

How reliable is the research?

This is a small study so we can’t rely too much on its findings. We would need larger studies to be more confident that the results are reliable.

Because the researchers only asked about depression symptoms every nine months, they may have missed some women who had episodes of depression between interviews. The questionnaire the researchers used only suggests that women may have depression, but the researchers didn’t confirm this with a doctor.

What does this mean for me?

In this study the number of women who had depression symptoms dropped consistently, starting 10 years before they had their final menstrual period until eight years after.

This suggests that, for women who feel low or depressed as they get closer to menopause, these changes in mood may not be permanent. Women who have passed the menopause are much less likely to have symptoms of depression.

Originally posted 2013-11-20 03:15:04. Republished by Blog Post Promoter

Non-Western experiences discounted in standard approaches to menopause symptoms

August 24th, 2014

Dr Mwenza T. Blell of the University of Bristol interviewed 257 British Pakistani women aged 39-61 living in West Yorkshire and found that the standard checklist approach to studying menopause symptoms, which ignores women’s understanding of their own experience, leaves researchers and clinicians with gaps in their knowledge of the ‘true’ symptoms of menopause.

Many previous studies into the menopause have relied on standardised checklists, such as the Blatt-Kupperman index and the Menopause Symptom Checklist, that were derived from the clinical experiences of women living in New York and Chicago in the mid-twentieth century and so focus on a distinctly Western bio-medical model of menopause.

Dr Blell’s study explored the potential of using an alternative approach to better identify women’s beliefs about the experiences attributable to menopause. Information was gathered through interviews and in informal settings in order to gain a more rounded understanding of the variety of beliefs within the British Pakistani community. The findings suggest a considerable discrepancy between women’s understanding of menopausal symptoms and the assumptions made by previous research.

Dr Blell said: “The standardised checklists claim to tell the whole story of what menopause is when really we haven’t let everyone be part of the conversation. By adopting a more open-ended approach, instead of the standard checklist mode, useful data can be captured that specifically reflects varied beliefs and understandings of the experience of the menopause.”

For example, the use of a more open-ended approach highlighted that many of the study participants mentioned an increase in the size of the abdomen – which many standard checklists consider to be unrelated to menopause – as one of their symptoms.

This is an important finding as it suggests other populations may have a different understanding about the relationship between changes in body fat patterning and menopause that has not been fully explored in Western medicine due to the established assumptions surrounding the experience of menopause.

Dr Blell said: “The amazing thing is that this finding has come up before in other studies of women of South Asian origin and has just been swept under the carpet, assumed to be a mistaken belief women need to be educated out of, when that really isn’t the case.”

The research concludes that the symptom experience of non-Western groups has not had the opportunity to inform theoretical developments around menopause symptoms in the same way that the experience of Western groups has.

The understanding of other groups may indicate new directions for research such as the identification of change in body fat distribution, which seems to apply cross-culturally, and its relationship with the local understanding of menopause and its population-specific chronic disease risk.

Source: http://www.medicalnewstoday.com/releases/277602.php

Menopause: Qs you’re not asking

August 23rd, 2014

Editor’s note: Dr. Deepali Patni is a board-certified OB/GYN at Kelsey-Seybold Clinic in Houston.

(CNN) — Menopause: the permanent end of fertility (and periods!) that commonly happens to women in their late 40s and 50s. For many women, just saying the word “menopause” can increase anxiety levels.

Change is never easy, especially as we get older. And although menopause symptoms — night sweats, mood swings, sleep problems, weight gain — make it seem like a daunting time in a woman’s life, there are many things that your gynecologist can do to help you through this transition.

One of the issues I find in my own practice is that there is plenty of misinformation about menopause, making it hard to separate myth from fact. Talking with your gynecologist about this very important change can help alleviate some of the confusion — and maybe even improve your symptoms.

Frequent questions that have come up in my practice include:

My sex drive isn’t what it used to be. Why?

There are many hormonal changes that a woman experiences in her transition to menopause. Estrogen and testosterone levels may drop, causing a decreased interest in sex or vaginal dryness, which can make sex uncomfortable.

If loss of libido is an issue for you — or your partner — talk to your gynecologist. He or she can work with you to determine the most appropriate treatment plan. Sometimes the fix can be simple, such as increasing the time that it takes for you to become aroused before intercourse, or incorporating the use of a lubricant or moisturizer. Other times, a gynecologist will recommend hormone replacement therapy.

Although there aren’t any FDA-approved testosterone replacement products for women, in the appropriate patient, testosterone combined with estrogen replacement can have a beneficial impact. Keep in mind testosterone therapy can have significant side effects and the long-term risks have not been fully studied.

Menopause has made sex painful. What can I do?

If you’re one of the menopausal women who suffer silently from pain during intercourse, you are not alone. Many don’t realize that vulvovaginal atrophy is a common condition that happens as a result of the thinning and weakening of vaginal tissues due to a drop in estrogen after menopause.

Make an appointment to see your gynecologist to talk about the available treatment options, which range from vaginal moisturizers and water-based lubricants to topical or oral estrogen treatment.

Do I still need to worry about sexually transmitted illnesses?

Sexually transmitted illnesses are — and always will be — a concern for women, even menopausal women. If you are not in a mutually monogamous relationship, always use a condom to help protect against diseases that can be passed through sexual contact.

Sexually transmitted illnesses do not discriminate based on age, and I’ve seen menopausal women who have contracted chlamydia, gonorrhea, genital herpes, syphilis and HIV.

What about pregnancy?

Pregnancy in menopause does not happen, but there are some women who believe they have reached menopause and became pregnant, only to find out later that they were still perimenopausal. The general rule is that if you have not had your period in 12 months, then you are in menopause and unlikely to get pregnant. This can be confirmed with a simple blood test.

I’m feeling a lot of pressure down there. Is that bad?

Little alarm bells should ring if you are feeling constant pressure in your pelvic area. It doesn’t necessarily mean that something life threatening is happening, but now would be the time to make an appointment with a gynecologist to get it checked out.

If you have reached menopause, there are many things that could be causing pressure in the pelvic region, ranging from constipation and fibroid tumors to pelvic floor disorders and cancer. Do not let this symptom go unchecked.

Women who have questions about menopause should seek a trusted source for information. Your gynecologist is ready to help guide you through this next phase in your life.



Source: http://rss.cnn.com/~r/rss/cnn_health/~3/JYRv912hjSI/index.html

Menopause: What you’re not asking (but should!)

August 21st, 2014

Editor’s note: Dr. Deepali Patni is a board-certified OB/GYN at Kelsey-Seybold Clinic in Houston.

(CNN) — Menopause: the permanent end of fertility (and periods!) that commonly happens to women in their late 40s and 50s. For many women, just saying the word “menopause” can increase anxiety levels.

Change is never easy, especially as we get older. And although menopause symptoms — night sweats, mood swings, sleep problems, weight gain — make it seem like a daunting time in a woman’s life, there are many things that your gynecologist can do to help you through this transition.

One of the issues I find in my own practice is that there is plenty of misinformation about menopause, making it hard to separate myth from fact. Talking with your gynecologist about this very important change can help alleviate some of the confusion — and maybe even improve your symptoms.

Frequent questions that have come up in my practice include:

My sex drive isn’t what it used to be. Why?

There are many hormonal changes that a woman experiences in her transition to menopause. Estrogen and testosterone levels may drop, causing a decreased interest in sex or vaginal dryness, which can make sex uncomfortable.

If loss of libido is an issue for you — or your partner — talk to your gynecologist. He or she can work with you to determine the most appropriate treatment plan. Sometimes the fix can be simple, such as increasing the time that it takes for you to become aroused before intercourse, or incorporating the use of a lubricant or moisturizer. Other times, a gynecologist will recommend hormone replacement therapy.

Although there aren’t any FDA-approved testosterone replacement products for women, in the appropriate patient, testosterone combined with estrogen replacement can have a beneficial impact. Keep in mind testosterone therapy can have significant side effects and the long-term risks have not been fully studied.

Menopause has made sex painful. What can I do?

If you’re one of the menopausal women who suffer silently from pain during intercourse, you are not alone. Many don’t realize that vulvovaginal atrophy is a common condition that happens as a result of the thinning and weakening of vaginal tissues due to a drop in estrogen after menopause.

Make an appointment to see your gynecologist to talk about the available treatment options, which range from vaginal moisturizers and water-based lubricants to topical or oral estrogen treatment.

Do I still need to worry about sexually transmitted illnesses?

Sexually transmitted illnesses are — and always will be — a concern for women, even menopausal women. If you are not in a mutually monogamous relationship, always use a condom to help protect against diseases that can be passed through sexual contact.

Sexually transmitted illnesses do not discriminate based on age, and I’ve seen menopausal women who have contracted chlamydia, gonorrhea, genital herpes, syphilis and HIV.

What about pregnancy?

Pregnancy in menopause does not happen, but there are some women who believe they have reached menopause and became pregnant, only to find out later that they were still perimenopausal. The general rule is that if you have not had your period in 12 months, then you are in menopause and unlikely to get pregnant. This can be confirmed with a simple blood test.

I’m feeling a lot of pressure down there. Is that bad?

Little alarm bells should ring if you are feeling constant pressure in your pelvic area. It doesn’t necessarily mean that something life threatening is happening, but now would be the time to make an appointment with a gynecologist to get it checked out.

If you have reached menopause, there are many things that could be causing pressure in the pelvic region, ranging from constipation and fibroid tumors to pelvic floor disorders and cancer. Do not let this symptom go unchecked.

Women who have questions about menopause should seek a trusted source for information. Your gynecologist is ready to help guide you through this next phase in your life.



Source: http://rss.cnn.com/~r/rss/cnn_health/~3/JYRv912hjSI/index.html

Determining dosage of testosterone for women after menopause

August 20th, 2014

Testosterone supplementation for women is a hot topic. A new pharmacokinetics study of a brand of testosterone cream for women approved in Western Australia has been published online in Menopause, the journal of The North American Menopause Society (NAMS). For women after menopause, it took 5 mg, the lowest dose of this product, to raise testosterone back to a premenopause level.

“In the United States we do not yet have an approved testosterone product designed for women,” says NAMS Executive Director Margery Gass, MD. “As a result, American women sometimes rely on custom-compounded testosterone prescriptions that may deliver much higher doses than the Australian product and raise women’s testosterone to levels higher than normal, potentially producing untoward side effects.” According to Dr. Gass, there are no long-term studies of the effects of testosterone treatment on women’s overall health. We do know that too much testosterone in a woman’s body may result in excess body hair, acne, male-pattern hair loss, enlarged clitoris, deeper voice, liver damage, unhealthy changes in cholesterol, depression, aggression and more. And, the voice changes and clitoral enlargement may be irreversible.

Researchers from Monash University in Melbourne and the University of South Australia in Adelaide tested two different doses of the testosterone cream product known as AndroFeme (5 mg and 10 mg doses). After 21 days of daily administration, the 5-mg dose brought postmenopausal women’s peak blood levels of total testosterone right into the normal premenopausal range – with a peak slightly above the upper limit of the premenopause normal and 24-hour average to slightly below the limit. The 10-mg dose raised testosterone levels to a higher peak but only somewhat higher than the norm (50%) over 24 hours.

“Since custom-compounded formulations are not FDA approved and are not routinely checked for dose content, it is difficult to know how a given formulation will affect women’s testosterone levels. Women should be cautious about what dose of testosterone they are receiving and whether they really need it.” advises Dr. Gass.

Source: http://www.medicalnewstoday.com/releases/278105.php

Decision aids to simplify menopause consults and therapy

August 18th, 2014


Primary care physicians now have access to a “toolkit” of decision aids aiming to simplify the process of menopause diagnosis and management for the women who present concerns or symptoms.

The one-page flowchart algorithms were developed by researchers from Monash University in Victoria, Australia, who felt that a “void” needed filling amid the various guidelines on menopause that can run to dozens of pages in length.

The easy-to-use information should make effective menopause management more realistic within the short consultations women have with their primary care physicians.

The team was led by Prof. Susan Davis, of the School of Public Health and Preventative Medicine at Monash. She says: “There are many detailed guidelines available on menopause, but the reality is that most GPs don’t have the time to work through a 40-page report when they only have 5 or 10 minutes with a patient.”

Prof. Davis adds:

“With many recent medical graduates receiving little training in this area, we realised there was a clear need for simple and practical guidelines.”

The decision aids developed by the team are applicable globally after they trawled all the best available evidence and took account of the different therapies used around the world.

Crunching these details down into flowcharts, the team was aiming to remove the “widespread confusion, not only in how to determine when menopause starts but also prescribing appropriate treatment.”


“Half the world’s population will experience menopause as some point in their lives, yet there isn’t a commonly used diagnostic tool, and that’s creating confusion amongst women and doctors,” Prof. Davis says, adding:

“Many people think the menopause is the same for every woman but the reality is quite different. Every woman has her own individual experience of menopause and that sometimes makes it tricky to diagnose.”

The team published their resource in the journal Climacteric, and the authors write: “To our knowledge, this is the first clinical practice tool for the management of the menopause in primary care that has international application.”

The toolkit is available online for free, and the assessment and management algorithms – which can be assembled into a folded desktop reference with brief supporting text – include these flowcharts:

  • The woman’s symptoms and concerns
  • Menopause staging decision tool – to “accommodate women who may have amenorrhea” for other reasons (for example, they have stopped menstruating because of surgery)
  • Assessment – taking a history, doing a physical examination and ordering any tests
  • Treatment options (including hormonal and non-hormonal)
  • Symptom management – to address an individual woman’s specific problems.

Evidence-based resource on hormone therapy

The resource is the result of the team’s “detailed literature reviews and expert opinion, and provide evidence-based clinical practice guidance.”

The toolkit uses standardised questions for doctors to ask women who are potentially experiencing menopause, and includes flags for safety concerns. It lists all hormone therapies approved by regulators in different countries and “non-hormonal therapies that have evidence to support their use.”

mature lady
Dr. Fenton says menopause is an “area fraught with myths and misinformation.”

The decision aids help to weigh up the risks and benefits of menopausal treatment, Prof. Davis says, adding:

“Hormone therapy is commonly prescribed to women, but its success varies according to symptom type and severity, personal circumstances and medical background.


“This toolkit has the potential to change that because it’s designed to work as just as well for a 41-year-old woman in Madras as it will for the 48-year-old in Manhattan.”

The roll out of the globally applicable guidance is being promoted by the International Menopause Society (IMS).

The IMS says it is “the first to present structured practical advice” and its president, Rod Baber, says the toolkit builds on formal guidelines on menopause. He adds:

“This will ensure that each individual woman is well informed about what happens to her as she ages, about what options for treatment and monitoring are available and, lastly, what the menopausal hormone therapy options are.”

The researchers have also attracted the support of Dr. Anna Fenton, an endocrinologist and president of the Australasian Menopause Society.

Dr. Fenton says menopause is an “area fraught with myths and misinformation,” adding:

“Many women are confused and uncertain about how best to deal with the menopause. Doctors can also face uncertainty in how best to treat and support patients with menopausal symptoms. This toolkit has the potential to change that.”

In other menopause findings, according to researchers publishing in the journal Menopause in January 2014, smoking causes earlier menopause in some white women.

In June 2013, Brisdelle (paroxetine) became the first non-hormonal treatment for hot flashes to be approved by the FDA.

Written by Markus MacGill

Source: http://www.medicalnewstoday.com/articles/279225.php