Abstract
By the time you receive your June edition of Menopause International, the London EMAS meeting will be a thing of past and I hope it was a hugely enjoyable occasion. This meeting was the first time that the British Menopause Society had been the host to an EMAS conference and perhaps it has dispelled the notion that London is too expensive and too poorly served for conference facilities. At least the theatre, music and opera availability is better than anywhere else on the planet. Let us hope that the science was as good as many of the plenary lectures will appear as future review in this journal.
This month's journal begins with a ferocious but heartfelt attack on physicians who seem to be incapable of using estrogens to treat osteoporosis or various common types of depression in women, because they simply have not bothered to learn how to use gonadal hormones. When I enquired at an osteoporosis meeting last month how many more complications of bisphosphonates have to be reported before they stop using fosamax as first-choice therapy in women under the age of 60 years, the reply was ‘many more’. The news that estrogens, not bisphosphanates, protect the intervertebral discs had not reached them yet nor had the view, even from the women's health initiative (WHI) investigators, that estrogens, particularly without additional progestogen, are very safe in the under 60s. And these people would regard themselves as endocrinologists!
Stevenson gives a preliminary report on the February IMS meeting on cardiovascular disease in women and his views on the failure of cardiologists to use estrogens for the cardioprotective effects. It is interesting that although statin use carries the same breast cancer risk as estrogens and has little proven cardioprotection in women, cardiologists are happy to prescribe statins but not estrogens. Yes, estrogen to physicians really is like garlic to Dracula. Stevenson clearly makes the point that the 2002 WHI study has been superseded and the safety concerns from this paper should no longer be quoted except, I would add, to demonstrate how the National Institutes of Health and epidemiologists spending in excess of $800 million can get it so comprehensively wrong.
It is 20 years since the late Dr John Lee and his followers convinced the gullible public of the benefits of progesterone cream and the dangers of estrogen dominance even in women not taking hormone replacement therapy (HRT). He claimed that it improved all menopausal symptoms, prevented heart attacks and could produce an 18% increase in bone density in a year. Many studies have demonstrated that progesterone cream is barely absorbed but proper clinical trials have been lacking. In this edition, Benster and her colleagues report a very large randomized controlled trial that failed to find any symptomatic benefit from this therapy in what is a clear justification of the publication of negative trials. Results of the trial studying bone density and atheromatous plaque will appear in the next edition of the journal.
Brincat and his team in Malta have long stressed the importance of the response of collagen to estrogen deprivation at the menopause and estrogen replacement. Collagen is lost from the skin, bladder and the bone matrix with age but can be replaced within two years with HRT. They have now shown in a study with Muscat Baron that the intervertebral discs, which make up 25% of the length of the spine, are protected by HRT – with such treated postmenopausal women having a total disc height the same or greater than in premenopausal women. Bone physicians and rheumatologists please note.
Premature ovarian failure is becoming an increasingly common problem and two papers by Vujovic and Chase outline the diverse causes of this disorder, which will help us to both avoid and treat this sad event.
I am particularly grateful to Allesandra Graziottin and Audrey Serafini for producing such a well researched and balanced view of the treatment of depression in menopausal women, even accepting that there is a place for antidepressants as well as estrogens. It is a wise and a more diplomatic approach than mine that could persuade psychiatrists to come on board with combined therapy. Somehow, we have to prevent women being brutalized by 20 years of ineffective selective serotonin reuptake inhibitor and mood stabilizing drugs following postnatal depression in their 20s when transdermal estrogens would have been effective. Rosella Nappi and her colleagues have produced a valuable account of the use of estrogens for menopausal and menstrual migraine, which is yet another missed opportunity for physicians. It is an important lesson.
Finally, it is time for the men. Theodoraki and Bouloux in their review of testosterone therapy for men outline the effects of ageing on hormone levels, pathology, metabolism and sexuality. Does this therapy prevent us becoming impotent grumpy old men? Let us hope so, but it certainly needs more research.
I am leaving until last my thanks to Simon Brown who produces in each volume arguably the most readable and certainly the most up to date news for the readership. This is medical journalism of the highest quality.
The journal is coming along well but we always need more original articles and reviews. I also want to establish a feisty good tempered correspondence page as argument is a sure way of learning. It is not that there is nothing controversial within these pages! Have a good summer.