International Dexeus Forum - 44th edition

GINECOLOGY > MENOPAUSE

“State of the art in menopausal care”

Susan Davis, Monash University (Australia)

Life expectancy of women in low and low-middle income countries has increased by over 10 years. Consequently, for the first time in history, women globally will live 1/3rd of their lives beyond menopause. State of the art care mandates identifying the symptoms and issues of greatest concern to the patient and evaluating psychosocial/biological factors that contribute to health risks.


State of the art in menopausal care

Since 1970 the life expectancy of women in low and low-middle income countries has increased by over 10 years. Consequently, for the first time in history, women globally will live 1/3rd of their lives beyond menopause.

Menopause results in immediate symptoms and through the pleiotropic effects of estrogen, estrogen depletion sets in train metabolic and inflammatory pathways that contribute to conditions that account for the greatest burden of disease. These include increased central abdominal fat (increases cardiovascular disease, diabetes, breast, uterine and colon cancer), anxiety and depression, urogenital atrophy (incontinence and infections), bone loss and muscle wasting (osteoporosis, sarcopenia, fragility fracture).

State of the art care mandates identifying the symptoms and issues of greatest concern to the patient and evaluating psychosocial/biological factors that contribute to health risks. One of the most neglected consequences of menopause is vulvovaginal atrophy (VVA), which VVA persists for the rest of a woman’s life.

Estrogen remains the most effective therapy for the treatment of menopausal symptoms and prevention of long term effects of estrogen depletion. VVA is simple and inexpensive to treat, yet few of women are prescribed vaginal estrogen. Increasingly clinicians are becoming aware that concerns about the safety of estrogen therapy have been overstated. This has been to the detriment of a generation of women who have been denied estrogen therapy to their detriment. A range of non-hormonal interventions are effective for the management of VMS, with new medications targeting central and peripheral processes involved in the generation of VMS undergoing clinical trials.

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