EMAS 2019 has been a congress filled with compelling content and inspiring insights into Women’s Health. Having had time to digest the information, we look back on the congress in this special edition of the blog that summarises the key messages and highlights over the past 3 days.
1. Menopausal symptoms should not always be attributed to menopause
Symptoms of migraines, abnormal bleeding and hot flashes are typical symptoms experienced by women of menopausal age and are therefore easy to attribute to menopausal transition. However, these same symptoms can be caused by secondary underlying conditions that should be investigated if the presentation of these symptoms is unusual e.g. high in intensity, severity or disruptive to quality of life.
2. The understanding of menopause and menopausal treatments are continually evolving
Since the introduction of hormone replacement therapy (HRT) to treat menopausal symptoms in the 1950’s, the benefit-risk ratio of HRT for patients has been hotly debated. However, during this time, our understanding of menopause and HRT has vastly improved; timing intervention and treatment personalisation are key when it comes to treating each patient and ongoing research aims to optimise these treatment strategies in the future.
3. Abnormal uterine bleeding (AUB) must be managed effectively
The treatment goals for managing AUB should include regulating of menstrual cycles, minimising blood loss and importantly, improving quality of life; therefore, diagnoses must be accurate to identify the cause and interventions must be appropriate to help women feel more in control of their AUB and in turn, their daily lives.
4. Sexual dysfunction after menopause can be addressed by both medical and psychotherapeutic treatments
Sexual dysfunction after menopause is commonplace and the cause can be multifactorial. Medical treatments can improve vaginal dryness and urogenital symptoms while psychotherapeutic treatments should focus on the primary factors affecting sexual dysfunction that are most distressing to the patient. All-in-all, treatment should be individualised to ensure the root causes are addressed effectively.
5. HRT could be effective in treating psychological symptoms in premature ovarian insufficiency (POI)
HRT can certainly treat the menopausal symptoms of POI and potentially have a protective role in preventing cardiovascular disease and osteoporosis. While HRT may not have a direct effect on psychological symptoms, reducing the menopausal symptoms may help to support other psychological interventions as part of a holistic treatment plan.
6. Chronic pain can be managed during menopause
Changes to the endocrine environment during menopause can create low level inflammation causing chronic pain in joints, muscles and fat tissue. Good gut health, HRT and androgen replacement may not only reduce pain, but also improve mood and sexual function, and increase vitality.
7. Different stages of menopause are associated with different symptoms that can be treated differently
During perimenopause and early menopause, vasomotor symptoms (VMS) are most likely to occur and during late postmenopause, there are increasing symptoms of urogenital atrophy. HRT can be an effective treatment to address symptoms such as VMS, vulva and vaginal atrophy, and joint pain. HRT can also reduce the risk of cardiovascular disease and stroke. Topical and vaginal oestrogens can treat recurrent urinary tract infections but currently there is no definitive treatment for cognitive decline and dementia.
8. HRT can be used in patients who experienced myocardial infarction, stroke or (some) cancers
Although current evidence suggests that HRT can be tolerated patients who experienced myocardial infarction or stroke, long-term, large-scale longitudinal studies are needed to determine the true impact of HRT in these patients. Cancer patients may also be able to use HRT but you should consider the oestrogen dependence of the tumour (e.g. HRT should not be used in patients with uterine sarcomas), patient age, indication and comorbidities.
9. The public health impact of the Women’s Health Institute (WHI) study has been significant
A significant drop in the use of HRT followed the publication of the now-debunked WHI study and resulted in 50,000 to 60,000 additional deaths since then. However, we now know that HRT can assist with VMS, help prevent cardiovascular disease and support treatment of sexual dysfunction, where the benefits clearly outweigh the risks. Further education for women and healthcare professionals can support treatment decisions when it comes to HRT, so history does not repeat itself.