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New Treatments for Menopause

Menopause is an essential phase that every woman is going to pass through. It is defined as 12 consecutive months of amenorrhea due to the lack of ovarian function and it’s associated with the inability to reproduce. It is estimated there will be some 35,000,000 women alone passing through the menopause this year. So we as OB-GYN physicians and other health care professionals, have an obligation to learn all about the menopause.

It’s a vicious cycle, so as women develop more and more vasomotor symptoms, we also see that carry through into other changes that affect concentration, one may be having anxiety attacks, memory changes, particularly short term memory changes that affects mood and irritability, and then loss of libido becomes an issue as well. This is kind of a complicated slide, but very important because it’s the basis for a lot of current research. What we know is that as the active estrogen drops, that affects the neurochemistry of the brain, and in particular, it affects tryptophan and serotonin which we know is the hormone associated with depression.

So there have been many studies looking at sleep patterns, at memory, at different quality of life issues in women during this time and it has clearly been found that the addition of estrogen as well as estrogen and progesterone clearly enhance rem sleep, giving longer REM cycles and more restful sleep, so that a woman feels better, so that in term adds to overall well being.

Then we talk about mood and fatigue, and once again, we see women who have been treated with an estrogen or estrogen progesterone combination who have reported less anxiety, less depression, and overall better sense of well being. What about the urogenital tract, we know as the levels of active estrogen begin to decrease, we see changes in the urogenital tract and this may occur as early as the 40s before a woman actually progresses into her menopausal years.

Sexual functioning, although the studies are very limited, and they are based on very short term treatment with estrogen, has been found to increase estrogen replacement therapy in an oral form has been found to increase lubrication of this area and has enhance arousal and sexual response.

Cardiovascular disease, this is one of the long term consequences of being in the menopause. Cardiovascular disease is by far the most common cause of death in the postmenopausal woman, accounting for over 500,000 deaths each year. As you can see based on this pie graft, that it accounts for 45% of deaths versus breast cancer with which women are very concerned.

There are certain things that we can do to change the risks for cardiovascular disease, however, things such as age, family history, race and ethnicity are something we can’t do much about, but smoking, alcohol use, the use of more than two alcoholic beverages on a daily basis, life style such as sedentary life style and weight loss are very important counseling tools for our patient’s in the prevention of cardiovascular disease. Some treatable medical conditions such as diabetes, hypertension, and dyslipidemia, elevation of the LDL and the triglycerides.

Overall survival, in studies looking at women who are at risk for cardiovascular disease or have early signs of cardiovascular disease that are treated with an estrogen replacement over a 10 year period, they have an overall increased chance of survival versus those who have been treated with a placebo. Now, there was a recent study called the Hearse study in which woman were enrolled who already had advanced cardiovascular disease, and we found a lot of problems with that study as well as many of the breast cancer studies that are now emerging into the media, one of which is that the population that was studied was very advanced in their heart disease, perhaps beyond anything that many medications can do for them.

Osteoporosis, another major cause of problems for women in the menopause, it is the major cause of morbidity in women, affecting millions of women, causing millions of fractures each year and costing billions of dollars to treat. It is estimated 25% of all Caucasian women will fracture their spines, 33 will fracture their hips sometime in their life time. These are very dramatic statistics, and we expect them to continue to increase based on the fact that the younger generation are not taking in the same quantities of calcium.

There are various agents that can be used, by far the golden standard, if a woman can take it, would be estrogen, estrogen is not only useful in decreasing or preventing bone loss, but in treatment of bone loss. Fosamax is a very potent agent, an anti-resorptive agent that is useful in decreasing bone loss as well as treating bone fracture and further preventing bone fractures.