A super exciting week was had by all at the 2024 Menopause Society annual meeting held this September. In fact, due to unprecedented interest, the meeting was sold out! General themes included how artificial intelligence (AI) is being applied in clinical practice including in the menopause space, in addition to the latest scoop on hot flashes, hormone therapy and other novel management tools for menopause symptoms, as well as other helpful pearls and pitfalls in the clinical management of menopause and related issues.
Zoom in on Hot Flashes
Cognitive Behavioral Therapy (CBT) and Clinical Hypnosis Are All the Rage
Data was presented suggesting CBT as a clinically useful tool for the management of vasomotor symptoms of menopause. Research trials found that clinical hypnosis significantly reduced the frequency of hot flashes when compared to no treatment. In addition, a recent review compared CBT with hypnosis, indicating better efficacy from hypnosis for both hot flash frequency and severity. Other symptoms that improved were quality of life, sleep and mood. Finally, using virtual reality (VR) as a tool to administer these interventions was showcased and met with significant interest. VR could potentially increase access to both CBT and hypnosis for those dealing with the vasomotor symptoms of menopause.
Hormone Therapy Use in the U.S. Remains Low
The Women’s Health Initiative (WHI) study originally reported a notable increase in the risk of breast cancer and stroke for certain hormone replacement therapy users leading to plummeting use of hormone therapy due to fear of these side effects. Since that time, trials have suggested high safety and efficacy leading to The Menopause Society guidelines recommending hormone therapy as first line treatment for hot flashes and night sweats. Despite this, rates of use assessed through insurance data suggests usage has not increased in the past twenty years and has remained below 4%, which means it's been stagnant from 2007-2023.
Novel Non-Hormonal Drugs for the Vasomotor Symptoms of Menopause
Veozah Labeling Change
Fezolinetant (Veozah) is a novel drug recently approved by the FDA as a non-hormonal pharmacologic option for vasomotor symptoms of menopause. Veozah was even popularized in Superbowl ads over the last two years. The FDA has now recommended a change from its original prescriber labeling to include more frequent liver function testing at initiation of use as well as at 1, 2, 3, 6 and 9 months, after post-use studies suggest necessity for this.
Elizinetant Studies
A newer drug called Elizinetant is coming down the pike. Multiple trials suggest this to be an additional non-hormonal pharmacologic option for safe and effective management of the ]vasomotor symptoms of menopause, as well as supporting the improvement in quality of life due to symptom management.
Menopause Goes High-Tech
Get Your Vision Pro
Practitioners in California are assessing virtual reality (VR) platforms to help manage chronic pain in those who suffer from inflammatory bowel disease and other pain conditions. These short sessions, shown as videos at the conference, were heartwarming to watch and provided so much hope for those suffering with otherwise intractable chronic pain conditions. Even though pain conditions are not specifically related to menopause, there is promise for VR in the space.
There's an App for That
Another incredible presentation demonstrated how AI can be used to better diagnose disease and enhance radiological study interpretation. An app was even showcased in the process of being used to predict the success of vaginal delivery to better personalize care.
Precision Medicine and Risk Reduction for Breast Cancer
The WISDOM trial was highlighted as an ongoing study to investigate how best to survey women for breast cancer based on risk. Here is some information on how one might participate.
Menopause is Not Just Hot Flashes
Muscles and Joints Matter
One lecture focused on the multiple facets of the musculoskeletal syndrome of menopause and bone health. Since more than 47 million women worldwide enter menopause annually, with more than 70% of them experiencing musculoskeletal symptoms and 25% being disabled by them, taking preventative measures is vital and include diet, exercise, fall precautions and medication.
Declining levels of estradiol leads to:
- inflammation
- sarcopenia, or muscle loss of 0.6% muscle mass per year
- inability to gain muscle easily
- decreased bone mineral density and risk of osteoporosis
- arthritis and associated joint pain
Hair Loss in Menopause Matters
Female pattern hair loss is a super common complaint during menopause with widening of the part and generalized thinning of the hair most notable. After medical causes are ruled out, such as low iron, altered thyroid function or excess testosterone for example, oral or topical minoxidil is commonly recommended therapy.
Frontal fibrosing alopecia is a distinct type of hair loss which typically presents as a receding hair line. Referral to a dermatologist is recommended for this condition since if left untreated, hair loss can be permanent.
Weight Management, Diet and the 'Oh, So Popular' Weight Loss Medications
Once again, the Mediterranean diet emerges as the clear winner. This cardioprotective, naturally low glycemic diet relies on lean meat in moderation, plant-based protein, plenty of fresh fruits and vegetables, low salt and olive oil for overall health benefits and weight control.
Intermittent fasting or time restricted eating may be effective for some mostly due to the caloric restriction entailed. GLP-1s are truly miraculous for many; however, compounded formulations should be avoided.
Interesting Factoid About the Voice
Testosterone supplementation, not FDA approved in women but often used off label for low libido, has potential side effects including acne and hair growth. Another lesser-known side effect is deepening of the voice. Note: this change can be permanent!
Sources
- Clinical hypnosis vs. cognitive behavioral therapy: What's better for managing hot flashes? The Menopause Society. September 10, 2024. Accessed September 9, 2024.
- The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause: The Journal of The North American Menopause Society. 2023;30(6):573-590. doi:10.1097/GME.0000000000002200
- https://www.contemporaryobgyn.net/view/the-menopause-society-reports-low-rates-of-hormone-therapy-usage?utm_medium=email&_hsenc=p2ANqtz--0TFGNcXjCMRVMDrpHiHHLd-4oXFK8iBx8_ja5R5FiCD5jmWZuBsn3jLXTbGR3nbr0wwV3hTIM_54pR_dd3P1ahxeIQQ&_hsmi=324578820&utm_content=324578820&utm_source=hs_email
- https://www.medpagetoday.com/meetingcoverage/tms/111948
- https://www.fda.gov/drugs/drug-safety-and-availability/fda-adds-warning-about-rare-occurrence-serious-liver-injury-use-veozah-fezolinetant-hot-flashes-due
- https://www.contemporaryobgyn.net/view/elinzanetant-displays-positive-phase-3-safety-and-efficacy-data-against-vms?utm_medium=email&_hsenc=p2ANqtz--qLBuqOBXTGb79JuFQ2p_2DL5jMpQlaB3QsO69TjVqSwRy8lRcOC2-dH6Qc6_Z1KjNop2al-ZiTxt6XNev6TYl78_4CQ&_hsmi=324578820&utm_content=324578820&utm_source=hs_email
- https://www.tandfonline.com/doi/full/10.1080/13697137.2024.2380363#d1e160
