Elsevier announced today the publication of two further important position statements from the European Menopause and Andropause Society (EMAS) in the journal Maturitas (http://www.maturitas.org/ ) on common management problems in the post-reproductive health of women.
EMAS is providing clear guidance in its position statements covering both hormone and non hormone therapy (HT) options as well as complementary and alternative therapies . The latest two position statements cover the management of the menopause in the context of Cardiovascular disease (CVD) including coronary heart disease (CHD) and Osteoporosis. These are common conditions affecting the expanding ageing female population. Each statement has summary recommendations as a quick aid for the busy clinician.
Cardiovascular disease (CVD) including coronary heart disease (CHD) and stroke is the most common cause of female death. Premenopausal CHD is very rare but when women enter the menopause the incidence of CHD increases markedly. CHD presents 10 years later in women than in men. The reason is still unclear but the protective effects of estrogens have been suggested. Based on long term randomized placebo-controlled studies hormone therapy (HT) is not recommended for the primary or secondary prevention of CHD in postmenopausal women. In most countries the only indication for HT is the treatment of menopausal symptoms. Women with known CHD or with many coronary risk factors seeking HT because of troublesome climacteric symptoms should be evaluated for their individual baseline risk of developing breast cancer, venous thromboembolism and CHD recurrence. The same applies to non hormone therapy-based treatments where long term clinical studies are lacking. Risks should be weighed against expected benefit from symptom relief and improved quality of life. The lowest effective estrogen dose should be used during the shortest possible time. Transdermal administration is preferred if risk factors for VTE exist. Different progestogens might differ in their cardiovascular effects. Observational studies suggest that micronized progesterone or dydrogesterone may have a better risk profile than other progestogens with regard to thrombotic risk.doi:10.1016/j.maturitas.2010.10.005
Osteoporosis and its consequent fractures is a major public health problem. Osteoporosis is still an often under-recognized disease and considered to be an inevitable consequence of ageing. The morbidity of osteoporosis is secondary to the fractures that can occur in the spine, hip, forearm and proximal humerus. These fractures, especially hip fractures, lead to high morbidity and mortality, as well as an increase in direct costs for health services. Bone densitometry has an important role in screening postmenopausal women for osteoporosis. For higher sensitivity and specificity, there may be a stronger case for screening in later life, depending on the extent to which risk factors add to the value of bone mineral density tests.
Integrating social determinants of health to enhance heart failure risk prediction