Menopause management complex but possible!
Posted by on October 7, 2011 - 6:10am

Recently, I attended the meeting of the North American Menopause Society (NAMS) in Washington DC along with 1500 other health professionals.    The bottom line:    Estrogen is not the devil, but it is not the panacea for all things female!

When the large Women's Health Initiative was halted in 2002 due to some unexpected findings in women on hormone treatment, the use of hormones significantly dropped.   However, many women found that their most bothersome symptoms returned and some went back on HT with a bit more concern.

The conference focused on new data, much of it refined to look at subsets of women.   It has become significantly clearer that all women are NOT alike when it comes to their health status at the time menopause begins, their age at onset, and the intensity of symptoms. Thus, generalizing outcomes to all women makes little sense.

Here are a few key points that were discussed at the meeting and are currently being studied by researchers:

  • Ill effects in the WHI  participants were more predominant in women who were 10 years post menopause when it came to heart disease.    The latest research suggests that estrogen can make atherosclerosis (one cause of heart disease) worse in women who already have it, but it may delay or prevent it in women who still have healthy arteries.
  • There is an increased risk of breast cancer in hormone users but the absolute numbers were small and were more prevalent among those who took HR that contained both estrogen and progesterone.   Women on estrogen alone had risks similar to placebo.   There is growing interest in the role certain types of progesterone  used in combination therapy play in breast cancer risk.
  • There is a major concern about osteoporosis and bone fractures among aging women whose estrogen levels are dropping.   As one researcher put it, "breaking a hip (in older women) can  kill you faster than breast cancer".   Approximately 50% of women over age 50 will have at least one fracture and we know that hormone therapy significantly reduces that risk. Understanding personal risk profiles for these two conditions should be part of the decision process.
  • While there are more drugs on the market to help maintain bone health, there is more long term data available  on their use that is indicating some alarming side effects with prolonged use. Some of these side effects may be worse than those related to hormone therapy.
  • Researchers are finding that the stages of the menopause transition are quite complex and there may be several levels of the transition that may need different interventions.
  • Vaginal atrophy in women including breast cancer survivors  can be devastating and reasonable treatment options are sorely needed.
  • Since the WHI, there are new treatment options available today for menopause symptoms using different drug formulas and different means of applications (pills, patches, creams, gels and sprays) that may have reduced risk profiles.

That's just a sampling of the many topics discussed at this conference.    Our Institute has been awarded a grant from the Evergreen Initiative at Northwestern Memorial Hospital Foundation to create a decision making tool for women who are menopausal and having bothersome symptoms.    As a result, we will be focusing on all aspects of menopause this year through our educational and fact finding events and I encourage you to follow our blog for our latest findings.

Male Menopause
Posted by on August 23, 2010 - 9:15am

No, you did not open the wrong page.   Yes, this blog is posted by the Institute for Women's Health Research at Northwestern. As an advocate for better  sex and gender based research, we support all avenues that increase our knowledge about sex differences and that includes  a better understanding of  hormone changes in women AND MEN.

Furthermore, women are generally the source of health information for their families and that includes their male partners! So, women and men, read on!

Low testosterone levels to blame for low libido, fatigue and weight gain

While most frequently associated with women’s health, age-related hormone changes, often dubbed menopause, can occur in men as well, causing symptoms of fatigue, mood swings, decreased desire for sex, hair loss, lack of concentration and weight gain. Experts estimate that more than 5 million men are affected, yet worry the number may be considerably higher since symptoms are frequently ignored.  Male hypogonadism, as it’s referred to in the medical community, occurs when the testicles do not produce enough testosterone, the hormone that plays a key role in masculine growth and development. When hormone levels drop, men can experience significant mental and physical changes.

“This is a highly prevalent disorder,” said Robert Brannigan, MD, urologist at Northwestern Memorial Hospital. “Unfortunately, we estimate that 95 percent of cases are undiagnosed and therefore untreated. When ignored, symptoms can seriously disrupt one’s quality of life.”

Brannigan explains hormone variations are a normal aspect of getting older. “In females, ovulation comes to an end and hormone production declines in a relatively quick period of time, whereas men experience hormone shifts more slowly, with testosterone levels dropping around one percent each year beginning in a man’s late thirties,” adds Brannigan. He goes on to explain that by age seventy, the reduction in a male’s testosterone level could be as high as fifty percent or more compared to baseline levels, but notes that aging men are not the only ones at risk. A number of genetic causes can impact males from birth and are usually diagnosed with failure to progress normally through puberty during the teenage years.

Treatment options for male hypogonadism include hormone replacement therapy (HRT) via absorbable pellet implants, topical gels, patches, and injections. Through HRT, doctors can restore sexual function and muscle strength. In addition, men often experience an increase in energy and an improved overall sense of well-being.

“We are seeing more men affected by male hypogonadism than we saw ten years ago,” said Brannigan. “However, many men continue to suffer in silence due to a lack of awareness surrounding the disorder. Because male hypogonadism can significantly impact the quality of one’s life, it’s important that men pay attention to their body and openly discuss symptoms with their physician in order to prevent overlooking the cause and avoid missing an opportunity for appropriate therapy.”

Although research to determine the exact association continues, doctors also warn that male hypogonadism has been linked to chronic medical conditions such as high cholesterol, diabetes and cardiovascular disease. It’s also closely associated with infertility.

“This disorder is not something that should be ignored,” said Brannigan, who is working to educate patients and physicians about the symptoms and treatments available in order to ensure therapies are made available to men in need.

Male hypogonadism is most commonly diagnosed through a simple blood test. Brannigan notes hormone replacement therapy is not appropriate for all patients especially those with history of prostate and breast cancer and men trying to conceive. He suggests consulting your doctor if you are experiencing symptoms.