If you’re in the New York City area on April 7-9, 2017 join me and colleagues at the The Westin NY at Times Square for our annual Survival Skills for Today’s Gynecologist program. It’s a great time to catch up with friends and hear discussions about the latest in gynecologic patient care. Each day starts with breakfast and includes time for Q&A to deepen the knowledge-share among us.

Along with Steven R. Goldstein, MD who serves with me as Program Co-Director, we have a terrific faculty who will present on leading-edge therapies and topical issues. You might be interested in the most recent recommendations about cervical cancer screening or are wanting more information about HPV education, VVA treatment, hysterectomy procedures, urogynecology, and much more.

On Friday, I will discuss the following topics:

  • Menopausal Hormone Therapy: Primary Prevention of Disease or Not?
  • Office Management of Female Sexual Dysfunction: You CAN do this.
  • Flashes, Flushes, and Night Sweats: New and Non-Hormonal Approaches

My topic for Saturday is Pelvic Floor Biofeedback/Physical Therapy: Should I Offer This in My Office?

The treatment of our patient population is ever-changing, as new treatments and options become available. The business of medicine is changing too. Don’t miss this great CME opportunity, learn some Survival Skills, and thrive in the years to come.

View the entire course or to Register at www.WorldClassCME.com or by phone at (888) 207-9105, M-F 8:30 am – 5 pm EST

Hope to see you there!

healthy middle aged woman stretching outdoors

In different ways, cultures around the world celebrate when young girls become women around the time of their first menstrual period, but few celebrate the milestone of menopause. Why is that? Perhaps because we focus on the negative aspects of menopause, the effects that leave some women experiencing hot flashes at inopportune moments, and so we view this process in a negative light. But it can be perceived and experienced positively, according to medical experts.

Understanding Study Outcomes
As clinical professor of obstetrics and gynecology at the George Washington University in Washington, DC, and a Past President of the North American Menopause Society (NAMS) I’ve studied these issues closely. I revisited the menopausal hormone therapy research in the Women’s Health Initiative (WHI) first reported in 2002, which was loosely translated to mean that all forms of estrogen, and all types of progesterone were risky for all women, always. But when looking more closely at the patient population in that study, it showed that some of the women were already at high risk health issues and underlying disease.

“Be aware that the findings for the two WHI hormone studies should not be compared directly because of differences in the women’s characteristics at the time of their enrollment. For example, those in the estrogen-alone study had a higher risk of cardiovascular disease than those in the estrogen-plus-progestin study. Women in the estrogen-alone study were more likely to have such heart disease risk factors as high blood pressure, high blood cholesterol, diabetes, and obesity,” according to the National Institutes of Health (NIH).

Mitigating Symptoms
In wanting to help my patients find helpful ways to treat their symptoms, I analyzed a database of 13 million patients to investigate whether two forms of estrogen (oral versus transdermal) differed in how patients experienced negative side effects, particularly focusing on heart attack, stroke and deep vein thrombosis (blood clots in the veins). I concluded that patients who used transdermal estrogens had significantly fewer: blood clots in their veins, pulmonary emboli, and heart attacks than those who took an oral estrogen pill. Stroke risks were also slightly lower for transdermal estrogens.

“The women who were using transdermal estrogens had a lower risk of blood clots in the legs deep vein thrombosis (DVT), had a lower risk of pulmonary embolism—those blood clots in the legs traveling up to the lungs—and a decreased risk of heart attacks” I said in a video on My Menopause Mag, run by Editor Mache Seibel, MD., former 20-year veteran of Harvard Medical School faculty. I caution though, that patients who are at risk for blood clots may need to talk with their doctor to weigh the benefits versus the risks of all estrogen therapies.

Questions to Ask Your Doctor

  • When does menopause begin?
  • How long does it last?
  • Should I take hormones?
  • What kind of hormones should I take and for how long?

Available Resources
Great online resources such as this website help educate women to know more about how menopause effects the whole person and how to navigate this new time in life.

“Women don’t learn about menopause until they are going through it. I think if we as young women know about it and understand it, then we’ll be much more equipped.” from the trailer for the movie, “Hot Flash Havoc” available on local PBS stations. I have a cameo appearance.

In addition, this website:  www.mymenopausemag.com answer a lot of these questions women have, understanding that there is no one-size-fits-all model for making the transition.

Understanding Perimenopausal Symptoms
Women commonly experience the following perimenopause symptoms:

  • Hot flashes
  • Lower sex drive
  • Irregular periods
  • Difficulty sleeping
  • Mood swings
  • And many others

Many of these symptoms often continue into menopause. Women in menopause may also experience:

  • Vaginal dryness
  • Urinary problems, including incontinence and/or urgency
  • Night sweats
  • Weight gain and slowing metabolism
  • Thinning hair
  • Loss of breast fullness
  • And others

Source

James A. Simon, MD, reproductive endocrinologist, menopausal medicine specialist and Clinical Professor at George Washington University in Washington, DC, has been treating women for gynecologic issues and seeks to re-educate women and the medical community about the importance of and safety of menopausal hormone therapy.

Dr. Simon wants to debunk the long-held belief that hormone therapy for women in the early menopausal years leads to breast cancer. It is not that simple. Women’s health status, breast cancer status, lifestyle, age and other factors contribute to the risk of cancer, including breast cancer. Estrogen, once lauded as providing great relief to women experiencing hot flashes and night sweats, became vilified when The Women’s Health Initiative hormone study appeared to demonstrate a cause and effect between menopausal use of hormone and the risk of breast cancer. About 8-10% of women are walking around with breast cancer and don’t know it. Either they haven’t had a mammogram or the cancer is still too small to be detected. According to Dr. Simon, when women who have undiagnosed breast cancer go on hormone therapy, and it shows up in the follow-up mammogram, some will attribute the cancer to the hormone therapy. But did the hormone therapy cause the cancer?

Estrogen alone may actually have a protective benefit from breast cancer while helping with all the uncomfortable symptoms of menopause, and yet estrogen plus synthetic forms of progesterone, like those used in the Women’s Health Initiative, may increase the apparent risk of breast cancer, but the drugs themselves are not carcinogenic.

Estrogen versus Estrogen Plus Progesterone
Joann Manson, MD, professor of Medicine, Harvard Medical School, Brigham and Women’s Hospital, and Past President of the North America Menopause Society, echoes Dr. Simon’s point about the efficacy and safety of estrogen alone. Dr. Manson has worked for more than 20 years in the field of menopause. In a video on MyMenopause.com Dr. Manson who was involved in the Women’s Health Initiative (WHI) study offers key learning points from the WHI study:

  • Estrogen, given alone, without a progestogen to women who have undergone hysterectomy, had no increase in the risk of breast cancer.
  • In women who had an intact uterus and needed a progestogen to protect the uterine lining, who also took estrogen, were at higher risk for breast cancer. However, cancer was not detected until around year 4 or 5, so doctors do not recommend taking the combined medication for a prolonged period.

“I think it’s important to understand that all medications do have risks. It really comes down to the balance of benefits versus risk,” said Dr. Manson. “In a woman in early menopause who is having moderate to severe symptoms—hot flashes, night sweats, really worsening her quality of life, really interrupting her sleep and interfering with her daily activities, in most cases the benefits of hormone therapy outweigh the risk,” she adds.

Estrogen Timing Matters: The Estrogen Window
Dr. Simon recently spoke about this issue at the 2016 Annual Meeting of The American Congress of Obstetricians and Gynecologists (ACOG) and also in a video with Dr. Mache Seibel, a gynecologic expert and Editor of MyMenopause.com.

“Early use of hormone therapy…and by early I mean 50’s, is of overall benefit to women’s health in a variety of ways…If they are outside of the window, or late, they get mostly risk for being on estrogen only or hormone therapy,” says Dr. Simon.

So women should take hormone therapy early, during their late 40’s, or as close to menopause as possible, to benefit the most and experience fewer risks.

Women with BRCA Mutations
A portion of the women going through menopause carry BRCA gene mutations, which already puts them at an increased risk for breast and ovarian cancer. Susan Domchek, MD, of the University of Pennsylvania spoke at the 2015 North America Menopause Society Annual Meeting regarding this issue. Dr. Domchek’s recommendation is for women who have had their ovaries or ovaries and fallopian tubes removed to offset the risk of ovarian cancer, to add estrogen therapy in order to mitigate the risk of breast cancer.

“It’s important to know that women know that this is an option for them and they need to talk to their doctor about it,” Dr. Domchek.

Who May Have BRCA 1 or BRCA 2 Mutations?

  • Women with family members (sister, mother, aunt, or even father) who had early onset breast cancer (before the age of 40)
  • Women with family members who have had ovarian cancer
  • Women of Ashkenazi Jewish descent whose family members have had early onset breast, ovarian or pancreatic cancer.

SIDEBAR
Hormone Therapy and Breast Cancer Risk

  • Combination (estrogen and synthetic progestogen) hormone therapy increases breast cancer risk by about 26%. This sounds like a tremendous increase, but it represents the difference between 3.3 cases of breast cancer/1000 women increased to 4.1 cases of breast cancer/1000 for each year of hormone therapy…less than one women/year/1000.
  • Estrogen-only hormone therapy increases the risk of breast cancer, but only when used for more than 10 years. In the Women’s Health Initiative, estrogen-only hormone therapy reduced the risk of breast cancer by a similar amount (23%).
  • Whether an increase or a decrease, the size of these changes are considered to be rare. (=1/10,000 and < 1/1,000; =0.01% to < 0.1%; between 0.1 and 0.9/1000).

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