medcan women’s health forum it’s the menopause! wilfred m steinberg md frcsc university of...
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Medcan Women’s Health Forum
It’s The Menopause!Wilfred M Steinberg MD FRCSC
University of TorontoSt Michael’s Hospital
It’s a New World
What Does it All Mean?
What Does it All Mean?
When Does It Start? Or End?
Perimenopause…not a disease
What Changes Occur in the Menopause ?
Smith T, et al. J Soc Obstet Gynaecol Can 2001
Urogenital atrophy
Menopausal symptoms
• Vasomotor symptoms
• Mood disturbances
Bone loss and fractures
Cardiovascular disease
Alzheimer’s disease
Breast cancer
Colon cancer
Progression of Symptoms
Are you aware?
Cognitive Changes
Body Changes
Range of Emotions
Anyone you Know?
Menopausal Changes?
Some Weird Changes
Unappreciated Symptoms
Can I Still Get Pregnant?
Fertility Rates & Age
Who are you going to trust?
Does this resonate for you?
Be an Intelligent Consumer
Plants for menopausal Rx Isoflavones
Have estrogen-like effects, so …be aware.. Black Cohosh, Wild Yam Soy
Herbs: Traditional and Chinese
Myth #1: “Natural Hormones are Safer :
Myth #2: Compounded Bioidentical Hormones Work Better than
Brand Rx Hormones.
There is no scientific support for an advantage of these compounds over common commercially produced preparations.
Mary M. Gallenberg, M.D Mayo Clinic
Natural Hormones-FDA H&W Approved
Newton KM, et al. Ann Intern Med 2006;145:869-79. Reproduced with permission.
Multibotanical + soy
Multibotanical
HT**
8
7
6
5
4
3
2
1
0
Baseline 3 mo 6 mo 12 mo
Va
so
mo
tor
Sy
mp
tom
s P
er
Da
y
* **
Placebo
Black cohosh
What really works? 351 women What really works? 351 women
Adjusted mean number of vasomotor symptoms per day, by study group
My Favourite Natural Treatment
Non Hormonal Remedies
• Significantly reduced the number of hot flushes compared with placebo
• 66.6% reductions from baseline • Hot flush severity and number of nighttime
awakenings were significantly reduced
American Journal of Obstetrics & Gynecology, February 2009
Myth #3: Since Compounded Bioidentical Hormones Are Natural,
They are Safer Than Other Hormones.”
They're produced in doses and forms that differ from those in FDA-approved products BUT..with no quality assurance standards
KEEPS: Kronos Early Estrogen Prevention Study 2012
Estrogen and progestogen therapy started soon after menopause, not only relieve symptoms, but appear safe. •No increase in blood pressure, no effects on atherosclerosis, •No increase in breast cancer or uterine cancer,•No effects on blood clots associated with stroke and myocardial infarction.
Options :Menopausal SymptomsOptions :Menopausal Symptoms
Lifestyle changes:.some benefit Regular exercise, diet, nonsmoking, moderate alcohol, BMI <32
Herbal remedies:..minimal benefit Dong quai, ginseng, black cohosh, soy isoflavones, red clover, Goji
j
Medical therapies:major benefits Estrogen, progestin, gabapentin, clonidine SSRI / SNRIs
7-year ET*
5 years of CCEPT use
10 years of CCEPT use
15 years of CCEPT use
Late menopause (10-year delay)
Body mass index (BMI) (10 kg increase)
Alcohol consumption (2 drinks/day)
Lack of regular exercise
Weight gain after menopause (20 kg or more)
*
Risks for Breast Cancer in Perspective
*
Baseline no HT use 45/1,000 women 50–60 years†
Addit
ional ca
nce
rs p
er
1,0
00
wom
en
0
20
30
10
40
50
Healthy is the New Sexy
Healthy is the New Sexy
In postmenopausal women, the quality of the relationship and the presence of sexual problems in the partner are probably as important as are hormonal change in the maintenance of sexual interest and response.
What Else May be Going On?
•urinary incontinence,• depression, •dementia, •arthritis,•stroke and •breast cancer •Family crisis
Menopause or Depression?
•loss of or diminished sex drive•lowered sexual desire and sexual activity•loss of energy•fatigue•lethargy•tiredness•lack of concentration
Vaginal Atrophy
Thick, healthy, well-estrogenized
lining of the vagina
Thin, dry lining of vaginadue to menopause
(after estrogen loss)
superficial
parabasal
intermediate
The North American Menopause Society. Menopause. 2007;14:357-369
Most Important Sex Organ in Women
Most Important Sex Organ in Women
What happens 5 years after menopause?
Testosterone For Post Menopausal Women?
Androgel Off Label Use in Women
• AndroGel contains testosterone, a Schedule III controlled substance as defined by the Anabolic Steroids Control Act.
• AndroGel is supplied in non-aerosol, metered-dose pumps. .
• AndroGel is also supplied in unit-dose aluminum foil packets in cartons of 30
Hot Then(1959) Still Hot Now (2014)