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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)