Here’s the Latest in Menopause Medicine and What It Means for Women

This October, we headed to Orlando for The Menopause Society annual conference for the fifth year in a row(!) and per usual, it did not disappoint. Elektra Co-Founder and CEO Jannine Versi, Chief Medical Officer Nora Lansen, MD and several of our clinicians attended for a packed week of presentations on cutting-edge research developments and conversations with friends in the space. Here are our top takeaways and what they mean for women in perimenopause and beyond.

1. Oral progesterone is still the best way to protect against endometrial cancer.

For people with a uterus, progesterone is an essential part of a menopause hormone therapy regimen because it protects the endometrium from growing, which can happen while taking estrogen. Without this hormone, long-term estrogen use can put people at greater risk of endometrial cancer.

Recently, there has been a lot of buzz around alternative administration routes, such as topical progesterone and vaginal progesterone, for the purpose of minimizing side effects associated with oral progesterone.

Unfortunately, the science just isn’t there to support this alternative. A conference presentation by Genevieve Neal-Perry, M.D. PH.D that underscored we don’t have enough data to say how much topical progesterone, for instance, would be required to provide adequate endometrial protection.

2. Treatment of vasomotor symptoms may help with neurocognition.

We’ve known for some time that perimenopause does have an impact on neurocognitive function (hello brain fog!). Research presented by ​​researcher Pauline M. Maki, PhD suggested that for people suffering from both neurocognitive symptoms and hot flashes/night sweats, treating the hot flashes may also help with neurocognition.

The interesting thing is, it doesn’t appear to matter whether that treatment for hot flashes is hormonal or non-hormonal — what matters is that the hot flashes are being managed. This may come as a relief for women who aren’t candidates for hormone therapy and are tired of being told online that they’re missing out (which is a whole other subject for another day).
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RELATED: 9 Foods (& Drinks) That Help With Menopausal Brain Fog

3. Sleep matters. A LOT.

One theme that came up again and again throughout this year’s conference was sleep. We obviously know we need it, but many of us don’t realize just how critical a factor it is for navigating the hormonal fluctuations and decline of estrogen and progesterone during perimenopause. From cardiovascular health to hot flashes to mood, sleep touches everything, which is why it’s one of the first things our clinicians discuss when meeting with a patient.

RELATED:

• Menopausal Insomnia Keeping You Up? CBT-I Can Help.
• Is Menopausal Anxiety Responsible for My Insomnia?
• Trouble Sleeping During Menopause? These Natural Sleep Aids May Help.

4. Sometimes, the best treatment is contraception.

Given the vast amounts of discourse on menopause hormone therapy circulating on social media, it’s no wonder many people believe it to be the best or even only treatment for menopause. But for people in perimenopause struggling with the debilitating symptoms associated with hormonal fluctuation, hormonal contraception can sometimes be the best option, as discussed by conference presenter Andrew M. Kaunitz MD, FACOG, MSCP.

Hear us out: during perimenopause, hormones are particularly out of whack — and low dose menopause hormone therapy may not be enough to stabilize those crazy fluctuations and resultant symptoms. Combined oral contraceptives can help with irregular periods and also mitigate hot flashes and night sweats. Plus, the use of combined oral contraceptives (aka the combination pill) may significantly reduce risk of ovarian and endometrial cancer.

RELATED: What To Know About Birth Control In Perimenopause

And About That Study…

You may have noted a seemingly urgent advisory on social media that all women should start menopause hormone therapy (MHT) 10 years prior to their final period, so around age 40. That viral piece of misguided information was based on an interesting poster presentation at the conference, with a suggestion that we do more research on the topic, but without impact on current guidelines.

It’s important to understand that a poster presentation is not the same as a formalized study presented at a large conference. Posters are gathered into a designated area where conference attendees can wander at their own pace. As the name suggests, information is presented on posters (think, science project style). Researchers stand with their posters and chat through their findings with those who stop by.

Formal research, on the other hand, is typically detailed, lengthy, and rigorously reviewed. It is usually published in a scientific journal. This is the type of research that shapes and changes clinical guidelines. Posters present information that suggest topics to consider studying more formally, as is the case with the poster presentation in question at the Menopause Society conference.

The research presented in this poster was purely observational and didn’t involve an actual clinical trial. That’s not a bad thing — in fact, this type of observational study is an important part of scientific discovery — but it doesn’t involve the same level of analysis and consideration necessary to draw meaningful conclusions.

The takeaway? There remains a vast expanse of uncharted territory in peri/menopause medicine and Elektra’s clinical team is staying close to the research. But for now, this study doesn’t actually change anything for evidence-based menopause care.