Elsevier announced today the publication of four important position statements from the European Menopause and Andropause Society (EMAS) in the journal Maturitas
) on common management problems in the post-reproductive health of women. The statements cover the management of the menopause in the context of obesity, epilepsy, endometriosis and premature ovarian failure. Each statement has summary recommendations as a quick aid for the busy clinician.
"The expanding ageing female population means that clinicians increasingly have to deal with post-reproductive health problems," said Professor Serge Rozenberg, President of EMAS. "EMAS has risen to the challenge and is providing clear guidance on the position statements covering both hormone and non hormone therapy (HT) options, as well as complementary and alternative therapies."
The statements were published in the July 2010 issue and are summarized as follows:
(1)Obesity: Obesity affects about 20% of the adult world population and 44% of postmenopausal women. Obesity is a major risk factor for many diseases including diabetes mellitus, dyslipidemia and hypertension resulting in cardiovascular disease, as well as venous thromboembolism and breast and endometrial cancer. Thus transdermal (patch, gel) HT is preferred over oral tablets because of the reduced risk of venous thromboembolism. (doi:10.1016/j.maturitas.2010.03.025)
(2)Epilepsy: Women with epilepsy may undergo the menopause 3- 5 years early and can be at increased risk of osteoporortic fracture depending on their antiepileptic drug use. If HT is used, these women need to be closely monitored by specialists. Calcium and vitamin D supplements should be considered. Herbal preparations should be avoided as their efficacy is uncertain and they may interact with anti epileptic drugs. (doi:10.1016/j.maturitas.2010.03.026)
(3)Endometriosis: Endometriosis is a debilitating gynaecological condition frequently associated with infertility and abdominal pain. A major concern with HT is disease recurrence and the authors conclude that, although the available data are limited, it may be safer to prescribe either continuous combined estrogen-progestogen hormone therapies or tibolone in both hysterectomised and non-hysterectomised. Women not needing or not wanting HT or those who are advised against should be offered alternative treatment for climacteric symptoms or skeletal protection. (doi:10.1016/j.maturitas.2010.04.018)
(4)Premature ovarian failure: Premature ovarian failure (POF) is the menopause before the age of 40 which may occur naturally or after surgery or chemotherapy. Untreated, it increases the risk of osteoporosis, cardiovascular disease, dementia, Parkinsonism, and general cognitive decline. Therefore, the statement clearly recommends the use of HT until the average age of the natural menopause, i.e. the early 50s. (doi:10.1016/j.maturitas.2010.04.011)