What's New In Menopause Management?

At ENDO 2017, Cynthia Stuenkel, MD, University of California San Diego told MD Magazine, that experts in the menopause field didn’t really understand as much as they had thought they did about some of the very simple and straightforward symptoms of menopause including the hot flash and vaginal symptoms.

The exciting news in the last year regarding hot flashes has been the idea that they can begin up to 10 years before menopause, and even extend at least another decade after menopause.

Stuenkel said that learning this can help individualize care for women, recognize some of the differences and patterns of hot flashes, and attempt to be sensitive to the challenges for women for whom hot flashes can start very early or continue for a very long time.

The question Steunkel and team had emphasized when they did our endocrinology clinical practice guidelines and treatment of symptoms of menopause was that women needed to be assessed for the particular risks and benefits for each treatment. For example, many women now are obese, may have metabolic syndrome, and may have some other concerns that make clinicians a little more hesitant for the use of oral hormone therapy. Instead, the recommendation for those women would probably recommend either transdermal estrogen therapy with lower doses than standard use or an alternative prescription therapy to help with their hot flashes.

Stuenkel suggested that the clinician should think about contraindications for hormone therapy, carefully evaluate cardiovascular risk using the AHA/ACC risk calculator, try to quantify breast cancer risk, and combine these things to question whether hormone therapy makes sense.

Stuenkel explained there are more unanswered questions in menopause than there are questions answered. But, one of the key questions she’s happy is beginning to become addressed is, “What is the menopausal hot flash and what are the central neuro-endocrine events that contribute to that hot flash?” She believes answering this question will allow experts to pinpoint areas for therapy, particularly relevant to hot flashes and vasomotor symptoms. The other thing about hot flashes that is being increasingly evaluated is whether or not it’s just a nuisance symptom or if there might be a component of cardiovascular risk associated with a vasomotor symptom considering it may be a reflection of endothelial dysfunction.