MREF Post Reproductive Health summary: Vol 29, Issue 23, Sept 2023.
What’s in this month’s Post Reproductive Health? We’ve taken a look and summarised the best bits for you.
- Picking the best estrogen for patients at risk of hypertension – From ‘News and Views.’
A Canadian study published in Hypertension of 112240 women found that oral estrogen-only HT use was associated with an increased risk of hypertension in women. Oral estrogen was associated with a higher risk of hypertension compared with both transdermal (HR, 1.14 [95% CI, 1.08-1.20]) and vaginal (HR, 1.19 [95% CI, 1.13-1.25]) estrogens. Conjugated equine estrogen (CEE) was associated with an increased risk of hypertension compared with estradiol (HR, 1.08 [95% CI, 1.04-1.14]) but not estrone (HR, 1.00 [95% CI, 0.93-1.10]). Duration of estrogen exposure and cumulative dose of estrogen was positively associated with risk of hypertension.
Post-menopausal women perform worse than their pre-menopausal or peri-menopausal counterparts when it comes to muscle strength, muscle endurance, cardiovascular endurance, static and dynamic balance as well as gait speed. The authors said these factors are important for preventing falls and fragility factors and recommended they be part of any assessment to help inform best care in the community with advice given on exercise, lifestyle and HRT where appropriate.
- Standard tools are needed to diagnose urogenital atrophy to improve patient care.
How do you assess your patient for urogenital atrophy? A literature review of 1469 papers, whittled down to a final eight, concludes there are no validated clinical assessment tools and there is an inconsistent use of those that are available. The authors argue this not only affects research but diagnosis and access to treatment for those affected by it. They call for the development of diagnostic criteria for primary practice.
- Your questions answered: App support for GPs delivering menopause care.
The rise in interest in menopause has meant many practitioners are having to upskill fast, so to meet demand a group of menopause experts in Ireland were brought together on the telegram messaging app to provide support to GPs. Doctors were invited to attend and 800-1000 signed up. The authors said 98% agreed the group gave them confidence and support in their HRT prescribing and 90% agreed it helped improved HRT access for women.
- Could group consultations on menopause be useful in general practice?
General practices are under pressure but one GP has tried a novel approach to meet demand for menopause appointments. Modelled on group diabetes consultations, Dr Sally Rushton, a GP with an interest in women’s health, has run session with peri and post-menopausal women for around six months and reports that while some of the patients were initially apprehensive to join, they have found the sessions that were regarded overwhelmingly as helpful with many of the women going on to create their own peer-support groups externally. Between 6-8 women took part in these sessions and were required to sign confidentiality agreements. Dr Rushton believes nurses trained in menopause oversee these group sessions.
Abstracts from the BMS 32nd annual conference
- Testosterone isn’t just about libido: a longitudinal study looking at 3302 women enrolled in the SWAN study, funded by Vira Health, shows that higher testosterone levels were associated with not just higher reported sexual desire but also lower reported severity of headaches but higher depressive symptoms, higher frequency of heart racing and more severe vasomotor symptoms.
- What goes in the vagina stays in the vagina: A small UCLH study provides some reassurance for doctors prescribing topical HRT to women who have had cancer who are using tamoxifen or letrozole. 12 women using 10mcg vaginal oestradiol pessaries for atrophy symptoms had their serum oestrodiol levels measured at the start of treatment, at 6 and 12 months of use. None had a serum level >44pmol/L at any of the visits, suggesting no significant systemic absorption of the oestrodial. Further study is required.
For further information on abstracts click here.
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