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Medcan Women’s
Health Forum
It’s The Menopause!
Wilfred M Steinberg MD FRCSC
University of Toronto
St Michael’s Hospital
It’s a New World
What Does it All Mean?
What Does it All Mean?
When Does It Start? Or End?
Perimenopause…not a disease
What Changes Occur in the Menopause ?
Alzheimer’s disease
Menopausal symptoms
• Vasomotor symptoms
• Mood disturbances
Breast cancer
Cardiovascular disease
Bone loss and fractures
Colon cancer
Urogenital atrophy
Smith T, et al. J Soc Obstet Gynaecol Can 2001
Progression of Symptoms
Are you aware?
Cognitive Changes
Body Changes
Range of Emotions
Anyone you Know?
Menopausal Changes?
Some Weird Changes
Unappreciated Symptoms
Can I Still Get Pregnant?
Fertility Rates & Age
Who are you going to trust?
Does this resonate for you?
Be an Intelligent Consumer
Plants for
menopausal
Rx
Isoflavones
Have estrogen-like effects, so …be aware..
Black Cohosh,
Wild Yam
Soy
Herbs: Traditional and Chinese
Myth #1: “Natural Hormones are Safer :
Myth #2:
Compounded Bioidentical Hormones Work Better than
Brand Rx Hormones.
There is no scientific support for an advantage of
these compounds over common commercially
produced preparations.
Mary M. Gallenberg, M.D Mayo Clinic
Natural Hormones-FDA H&W Approved
What really works?
351 women
Placebo
Vasomotor Symptoms Per Day
8
Black cohosh
Multibotanical
7
6
Multibotanical + soy
*
*
HT
5
4
3
2
1
0
*
*
*
Adjusted mean number of vasomotor symptoms per day, by study group
Baseline
3 mo
6 mo
Newton KM, et al. Ann Intern Med 2006;145:869-79. Reproduced with permission.
12 mo
My Favourite Natural Treatment
Non Hormonal Remedies
• Significantly reduced the number of hot flushes
compared with placebo
• 66.6% reductions from baseline
• Hot flush severity and number of nighttime
awakenings were significantly reduced
American Journal of Obstetrics & Gynecology, February 2009
Myth #3:
Since Compounded Bioidentical Hormones Are Natural,
They are Safer Than Other Hormones.”
They're produced in doses and forms that differ from those in FDAapproved products BUT..with no quality assurance standards
KEEPS:
Kronos Early Estrogen Prevention Study 2012
Estrogen and progestogen therapy started
soon after menopause, not only relieve
symptoms, but appear safe.
•No increase in blood pressure, no effects on
atherosclerosis,
•No increase in breast cancer or uterine cancer,
•No effects on blood clots associated with stroke
and myocardial infarction.
Options :Menopausal Symptoms
Lifestyle changes:.some benefit
 Regular exercise, diet, nonsmoking, moderate alcohol, BMI <32
Herbal remedies:..minimal benefit
 Dong quai, ginseng, black cohosh, soy isoflavones, red clover, Goji
j
Medical therapies:major benefits

Estrogen, progestin,
 gabapentin, clonidine
 SSRI / SNRIs
Additional cancers per 1,000 women
Risks for Breast Cancer in Perspective
50
7-year ET*
5 years of CCEPT use
10 years of CCEPT use
40
15 years of CCEPT use
Late menopause
(10-year delay)
30
Body mass index (BMI)
(10 kg increase)
Alcohol consumption
(2 drinks/day)
20
Lack of regular
exercise
Weight gain after
menopause
(20 kg or more)
10
0
*
*
Healthy is the New Sexy
Healthy is the New Sexy
In postmenopausal women, the quality of the relationship and the presence
of sexual problems in the partner are probably as important as are
hormonal change in the maintenance of sexual interest and response.
What Else May be Going On?
•urinary incontinence,
• depression,
•dementia,
•arthritis,
•stroke and
•breast cancer
•Family crisis
Menopause or Depression?
•loss of or diminished sex drive
•lowered sexual desire and sexual activity
•loss of energy
•fatigue
•lethargy
•tiredness
•lack of concentration
Vaginal Atrophy
superficial
intermediate
parabasal
Thick, healthy,
well-estrogenized
lining of the vagina
The North American Menopause Society. Menopause. 2007;14:357-369
Thin, dry lining of vagina
due to menopause
(after estrogen loss)
Most Important Sex Organ in Women
Most Important Sex Organ in Women
What happens 5 years after
menopause?
Testosterone For Post Menopausal Women?
Androgel Off Label Use in Women
• AndroGel contains testosterone, a Schedule III controlled
substance as defined by the Anabolic Steroids Control Act.
• AndroGel is supplied in non-aerosol, metered-dose pumps. .
• AndroGel is also supplied in unit-dose aluminum foil packets
in cartons of 30
Hot Then(1959)
Still Hot Now (2014)