The link among resilience, sexual function, and quality of life in menopausal women

by The North American Menopause Society

Credit: Pixabay/CC0 Public Domain

The ability to overcome adverse situations (otherwise known as resilience) has been shown to have positive effects on overall health and quality of life. A new study found that resilience is also linked to sexual health and a better quality of life during the menopause transition. Study results are published online today in Menopause.

29 JAN 2022--The menopause transition may be considered an adverse situation for most women because it involves a long process of adaptations that can cause negative feelings and a depressed mood. The transition to menopause involves physical, psychological, and social changes that can have a severe effect on a woman's overall quality of life. In addition, menopausal women are also more vulnerable to sexual dysfunction as a result of changes within their bodies during the transition.

Female sexual dysfunction (FSD) can be defined as the inability of women to participate in a sexual relationship as they would wish. It is a multifactorial problem that may include lack of satisfaction with sexual activity, reduced sexual desire, pain with sexual activity, poor arousal, or difficulty reaching orgasm. Previous studies have shown that sexual satisfaction is associated with overall quality of life in menopausal women, with lower general well-being in sexually dissatisfied women.

This new study involving 101 symptomatic menopausal women, however, represents the first time that research has focused on the effect of sexual health on the resilience scores of menopausal women and their quality of life. It found that resilience scores were significantly higher in women with high sexual function scores and demonstrated that menopause-related quality of life was significantly worse in low-resilient women.

As a result, the researchers concluded that a woman's resilience is linked with her sexual health as well as her qualify of life during the menopause transition.

Study results are published in the article "Resilience and sexual health among menopausal women: a cross-sectional study."

"This study highlights the potential protective effects of resilience as it relates to sexual health in menopausal women. This capability enables individual women to adapt to change, resist the negative effect of stressors, and return to normal function more quickly after adverse events. Fortunately, this skill set can be strengthened, potentially representing another tool that clinicians can use to help women with sexual dysfunction," says Dr. Stephanie Faubion, NAMS medical director.

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More information: Resilience and sexual health among menopausal women: a cross-sectional study, Menopause (2022). DOI: 10.1097/GME.00000000000001935

Estrogen for vaginal symptoms OK for breast cancer survivors: experts

23 feb 2016—Women who've battled or survived an estrogen-dependent form of breast cancer often encounter vaginal symptoms linked to their treatment, especially around the time of menopause.
Now, new guidelines from the American College of Obstetricians and Gynecologists (ACOG) advise that the use of symptom-relieving estrogen therapy is warranted for these patients.
"These new recommendations are especially important and helpful because they provide the patient with the information needed to make an informed decision with the input of her health care provider," Dr. Diana Nancy Contreras, chair of ACOG's Subcommittee on Gynecologic Oncology, said in a college news release.
One expert in women's health explained that patients with an estrogen-dependent breast cancer often suffer vaginal symptoms linked to treatment.
"Many estrogen-dependent breast cancer treatments may bring about and exacerbate vaginal atrophy," said Dr. Jill Rabin, who's with Women's Health Programs-PCAP Services, Northwell Health, in New Hyde Park, N.Y.
"Vaginal and urologic symptoms range from mild to severe and can include vaginal dryness, pain, bleeding, bacterial infections and dyspareunia [painful sex]," she noted. "These symptoms—which may arise for many women in menopause—may be multiplied for these patients in treatment and can worsen over time.
"These symptoms can have a huge impact on a woman's quality of life—for all affected women and especially for breast cancer survivors," Rabin added. In fact, up to a fifth of breast cancer patients"terminate or consider terminating therapies due to the severe detrimental effect that vaginal atrophy poses on their quality of life," she said.
There's been a concern, however, about the safety of estrogen-based therapies for women who are battling or who have survived an estrogen-linked breast tumor.
Specifically, there have been concerns about a possible link between topical (cream or lotion) estrogen therapy and recurrence of estrogen-linked breast cancers. However, current research has not confirmed such a connection, the experts at ACOG stated.
So, in its new recommendations, the group recommends that non-hormonal therapies for vaginal symptoms still be the first choice for women with estrogen-dependent breast cancer or a history of such a cancer.
However, topical estrogen therapy can now also be considered for estrogen-dependent breast cancer survivors who do not respond to non-hormonal therapies, ACOG said.
Dr. Eva Chalas is chief of gynecological oncology at Winthrop-University Hospital, in Mineola, N.Y. She said she agreed with the new recommendation.
"Non-hormonal management should be the first course of action," Chalas said. "However, the most effective treatment remains estrogen.
"Quality of life, which includes an opportunity for sexual intimacy, is an important aspect of cancer survivorship," Chalas explained. "Women should address the severity of symptoms with their physicians and participate in selection of therapy which yields the best quality of life. This [ACOG] document provides safe guidelines which could enhance post-treatment sexual function in many breast cancer survivors."

The new guidelines will be published in the March issue of Obstetrics & Gynecology.
More information: The U.S. National Cancer Institute discusses menopausal hormone therapy and cancer.

Update on menopausal symptoms and treatment options published

Credit: Mary Ann Liebert, Inc., publishers

The vast majority of women going through the period of menopausal transition, or perimenopause, will seek medical help coping with symptoms that can significantly impact their health and quality of life, such as hot flashes, poor sleep, depression, and vaginal dryness. The pattern of common perimenopausal symptoms, how they often interact to worsen the effects of each, and current hormonal and non-hormonal therapeutic options are examined in a comprehensive Review article published in Journal of Women's Health.

18 feb 2016--In "Perimenopause: From Research to Practice"), Nanette Santoro, MD, University of Colorado School of Medicine, Denver, describes the stages of reproductive aging in women, linking common symptoms to the late reproductive stages, the early and late menopausal transition stages, and the early postmenopause. Dr. Santoro discusses strategies for treating multiple symptoms with a single medication when possible. For women who experience the four main menopausal symptoms, hormone therapy is the most effective way to improve their quality of life, as long as hormone use is not contraindicated.
"This outstanding review integrates research findings with the clinical presentations of symptomatic perimenopausal women and treatment options," says Susan G. Kornstein, MD, Editor-in-Chief of Journal of Women's Health, Executive Director of the Virginia Commonwealth University Institute for Women's Health, Richmond, VA, and President of the Academy of Women's Health.

More information: Nanette Santoro. Perimenopause: From Research to Practice, Journal of Women's Health (2015). DOI: 10.1089/jwh.2015.5556


Provided by Mary Ann Liebert, Inc

More women turning to CAM for menopause without medical guidance

The use of complementary and alternative medicine (CAM) is increasing for the treatment of menopausal symptoms but often without the guidance of a clinician. That's according to a new study reported online today inMenopause, the journal of the North American Menopause Society (NAMS). As a result, the authors suggest that healthcare providers—in particular family medicine practitioners—need to be more aware of the various CAM therapies and take a more active role in guiding patients through their options to more safely and effectively coordinate their care.

12 jun 2015--Ongoing fear of the potential risks of hormone therapy is cited as a primary reason for the growing use of CAM among menopausal women (including pre-, peri- and postmenopausal) in recent decades. CAM is a general term for healthcare practices and products not associated with the conventional medical profession. Some of the more commonly accessed CAM practitioner groups include massage therapists, naturopaths/herbalists, chiropractors/osteopaths, and acupuncturists. The more popular self-prescribed CAM supplements/activities include vitamins/minerals, yoga/meditation, herbal medicines, aromatherapy oils and/or Chinese medicines.

Although there is still ongoing debate within the medical industry regarding the proven effectiveness of CAM alternatives, the point of this study was to confirm that most adults seeking treatment for their symptoms purchase CAM products or services without the guidance of a healthcare practitioner. It is estimated that 53 percent of menopausal women use at least one type of CAM for the management of such menopause-related symptoms as hot flashes, night sweats, anxiety, depression, stiff or painful joints, back pain, headaches, tiredness, vaginal discharge, leaking urine and palpitations.

This raises major safety concerns, according to the authors, since much of the use of self-prescribed CAM products is done without a medical consultation. The greatest safety concern relates to the large percentage of menopausal womenwho typically use CAM products concurrently with conventional medicine but who may be unaware of the possible herb-drug interactions.

'There is still much to be learned in the CAM arena and women need to understand that just because something appears natural does not necessarily mean it is without risk, especially for certain populations,' says NAMS Medical Director Wulf Utian, M.D., Ph.D., D.Sc. 'In the meantime, this study does a good job of alerting clinicians to the growing interest in CAM alternatives and of the critical role of health providers in helping educate patients on the potential risks and benefits of all options.'

More information: The article, 'Longitudinal analysis of associations between women's consultations with complementary and alternative medicine practitioners/use of self-prescribed complementary and alternative medicine and menopause-related symptoms, 2007-2010' will be published in the January 2016 print edition of Menopause.

Provided by The North American Menopause Society

The 10-point guide to the integral management of menopausal health

Elsevier journal Maturitas, today announced the publication of a position statement by the European Menopause and Andropause Society (EMAS) covering the ten- point guide to the integral management of menopausal health. This has been written to mark the 10th EMAS Congress in Madrid May 20-22, 2015.

17 mar 2015--With increased longevity and more women becoming centenarians, management of the menopause and post-reproductive health is of growing importance as it has the potential to help promote health over several decades. Women have individual needs and the approach needs to be personalized. The position statement provides a short integral guide for all those involved in menopausal health.

For most women the menopause is a natural and inevitable process due to ovarian ageing which usually occurs in women in their late 40s or early 50s. However, it can be induced earlier by medical intervention such as bilateral oophorectomy or iatrogenic ablation of ovarian function by chemotherapy, radiotherapy or treatment with gonadotrophin-releasing hormone analogues. Discussions with patients about the menopause are becoming more complex because of the wide range of therapeutic options, the controversies regarding menopausal hormone therapy and the increasing use of alternative and complementary therapies.

EMAS is therefore producing a simple ten point guide to help physicians and allied health professionals from all specialties deal with menopausal and post-reproductive health. It covers diagnosis, screening for diseases in later life, treatment and follow up.

It must be remembered that women have individual needs and the approach needs to be personalized.

These and other recommendations presented in EMAS' position statement are published in the article: "EMAS Position statement: the ten point guide to the integral management of menopausal health" (doi:10.1016/j.maturitas.2015.02.003) inMaturitas published by Elsevier.

Provided by Elsevier

Latest evidence on using hormone replacement therapy for treating menopausal symptoms

Hormone replacement therapy (HRT) is the most effective treatment for menopausal symptoms, in particular for younger women at the onset of the menopause, suggests a new review published today in The Obstetrician & Gynaecologist (TOG).

20 dec 2014--The review highlights that menopausal symptoms, including hot flushes and night sweats are common, affecting around 70% of women for an average of 5 years but may continue for many years in about 10% of women.

Every woman experiences the menopause differently; some experience one or two symptoms mildly while others have more severe symptoms. Menopausal symptoms can be debilitating and can adversely affect a woman's quality of life.

HRT is a medical treatment for the menopause. It provides low doses of the hormone estrogen, with or without progestogen, which a woman no longer produces.

The review notes that the risk-benefit ratio of HRT has always been debated and discusses previous studies examining the effects of HRT.

The Women's Health Initiative Study in 2003 examined the effect of HRT on healthy postmenopausal women with a particular interest in cardiovascular outcomes. The study reported an increase in breast cancer, stroke and venous thromboembolism. Consequently, an 80% reduction in HRT use was reported. However, the re-analysis in 2007 demonstrated that giving HRT to women within 10 years of the menopause was associated with fewer risks and a reduction in cardiovascular problems.

The Million Women Study in 2001 suggested that HRT use increased the risk of breast cancer significantly and the Cochrane Collaboration systematic review identified an increased risk of similar conditions.

However, the authors of the TOG review highlight that such studies failed to address the effect of HRT in symptomatic younger postmenopausal women and have not addressed the benefits of HRT given at the window of opportunity, for example, administrating HRT for symptom relief during the early phase of the menopausal transition.

Additionally, the review advises that any woman with relative contraindications should be offered the option of discussing this further with a menopause specialist. Women with premature ovarian sufficiency should be strongly advised to consider taking HRT until the average menopausal age of 51.4 years, state the authors.

The authors conclude that doctors should not be concerned about discussing the risks and benefits of HRT with women who have menopausal symptoms, or be hesitant to offer a trial of appropriate treatment. They also emphasise that HRT is a patient choice.

Shagaf Bakour, Honorary Senior Lecturer and Consultant Obstetrician and Gynaecologist at City Hospital, Birmingham, and co-author of the review said:

"Women are sometimes concerned about the increased risk of breast cancer related to HRT. However, this risk is much lower than that associated with other factors such as obesity, alcohol consumption and later maternal age.

"HRT is the most effective treatment for symptoms of the menopause and when HRT is individually tailored, women gain maximum advantages and the risks are minimised.

"There are various types and regimens of HRT and healthcare professionals will be able to advise on the suitability of HRT to any woman."

Jason Waugh, TOG Editor-in-chief added: "The use of HRT is an individual decision, which a woman can only make once she has been given correct information and advice from healthcare professionals.

"If women have any concerns about menopausal symptoms or HRT, they should talk to their doctor who will be happy to discuss treatment options further."

More information: S H Bakour, J Williamson. Latest evidence on using hormone replacement therapy in the menopause. The Obstetrician & Gynaecologist 2014; onlinelibrary.wiley.com/doi/10.1111/tog.12155/

Provided by Wiley

New term will banish stigma, educate providers on postmenopausal problems

Talking about genital, sexual, and urinary problems can be uncomfortable for postmenopausal women and their doctors. Having a term that doesn't carry stigma, isn't embarrassing to say, and is medically accurate could go a long way in helping women get the help they need and allowing them to make smarter healthcare decisions. That term is "genitourinary syndrome of menopause" or GSM, developed and endorsed by The North American Menopause Society (NAMS) and the International Society for the Study of Women's Sexual Health (ISSWSH). The article about the term's development is published online today in the NAMS journal Menopause.

26 aug 2014--Various terms have been used to refer to the genital problems women can have when estrogen drops after menopause, including "atrophic vaginitis" and "vulvovaginal atrophy." The first implies infection or inflammation, which isn't the main problem. The second uses "vaginal," which is embarrassing for many to say. And "atrophy" implies that something is wasting away from disuse,—a misperception that doesn't account for the many women who want to continue their sex lives free of pain after menopause. What's more, the terms ignore the urinary symptoms that come along with these genital changes, including urgency (that "gotta go" problem), painful urination, and recurring urinary tract infections.

The vagina; the area around it (the "vestibule"), which includes the urethra; and the lower end of the bladder (the "trigone") all have the same embryologic origin and are rich in estrogen receptors. The vestibule is also rich in androgen receptors. In these areas, the low hormone levels after menopause result in thinning tissue, loss of elasticity, fewer blood vessels, dryness, and physical changes that can make intercourse painful and the urethra easily irritated.

A panel of NAMS and ISSWSH menopause experts met at a consensus conference to scrutinize all that's known about the changes in these tissues after menopause and to hash out a term that fits that knowledge, doesn't stigmatize women who face these changes, and isn't embarrassing to say publicly. The panel decided the term should include both genital and urinary changes ("genitourinary"), show that it is a whole group of signs and symptoms ("syndrome"), and link the changes to their principal cause ("menopause"). With members' support, both the NAMS and ISSWSH boards endorsed the term.

Although GSM affects about half of all postmenopausal women, many don't know that it is hormonal and that treatments are available, such as vaginal moisturizers, vaginal estrogen, and an oral medication that acts like estrogen in the vagina. In addition, because women are so uncomfortable talking about these problems, only a small percentage bring them up with their healthcare providers, and only about 1 in 10 providers brings up the symptoms with patients, surveys show.

"The term 'GSM' will make discussing the problems so much easier, similar to the way 'ED' changed our ability to talk about impotence,'" says NAMS Executive Director Margery Gass, MD, a member of the consensus conference panel of NAMS and ISSWSH menopause experts.

The panelists have also begun to develop a tool to help standardize a physical examination to look for these changes. That means not only will patients and healthcare providers be able to talk about these problems more easily, but also that providers will be able to make the diagnosis swiftly and accurately to get women the treatment they need.

More information: The article "Genitourinary Syndrome of Menopause: New Terminology for Vulvovaginal Atrophy from the International Society for the Study of Women's Sexual Health and The North American Menopause Society" will be published in the October 2014 print edition of Menopause.

Provided by The North American Menopause Society

Heart disease linked with dementia in older postmenopausal women

Heart disease may put older postmenopausal women at higher risk for decreased brain function such as dementia, according to new research in Journal of the American Heart Association.

07 jan 2014--"Our study provides further new evidence that this relationship (between heart disease and dementia) does exist, especially among postmenopausal women," said study author Bernhard Haring, M.D., M.P.H., clinical fellow in the Comprehensive Heart Failure Center and the Department of Internal Medicine I at the University of Würzburg in Germany. "And many different types of heart disease or vascular disease are associated with declining brain function."

Researchers, conducting neurocognitive exams on nearly 6,500 U.S. women ages 65-79 who had healthy brain function at the start of the study, found:

• Postmenopausal women with heart disease or vascular disease were 29 percent more likely to experience cognitive decline over time compared with women without heart disease.
• The risk for cognitive decline was approximately double among women who had a heart attack compared with those who had not had a heart attack.
• Women who had heart bypass surgery, carotid endarterectomy (surgical removal of a blockage in a neck artery) or peripheral artery disease were at greater risk for cognitive decline.
• Risk factors such as high blood pressure and diabetes increased risk for cognitive decline over time.
• Obesity didn't notably increase cognitive decline in elderly women.

"Women with heart disease—in particular women who have had a heart attack, bypass surgery, heart failure, atrial fibrillation, peripheral vascular disease or carotid endarterectomy—should be monitored by their doctors for potential cognitive decline," Haring said. "It is also very important to adequately manage heart disease risk factors such as high blood pressure and diabetes."

Dementia is an increasingly significant problem in developed countries, so researchers said more study is warranted on how preventing cardiovascular disease may preserve cognitive health.

Provided by American Heart Association

Experts lay out options for menopause symptoms

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Evidence grows that antidepressants can help, new guidelines say.

24 dec 2013—Women bothered by hot flashes or other effects of menopause have a number of treatment options—hormonal or not, according to updated guidelines from the American College of Obstetricians and Gynecologists.

It's estimated that anywhere from 50 percent to 82 percent of women going through menopause have hot flashes—sudden feelings of extreme heat in the upper body—and night sweats. For many, the symptoms are frequent and severe enough to cause sleep problems and disrupt their daily lives. And the duration of the misery can last from a couple years to more than a decade, says the college, the nation's leading group of ob/gyns.

"Menopausal symptoms are common, and can be very bothersome to women," said Dr. Clarisa Gracia, who helped write the new guidelines. "Women should know that effective treatments are available to address these symptoms."

The guidelines, published in the January issue of Obstetrics & Gynecology, reinforce some longstanding advice: Hormone therapy, with estrogen alone or estrogen plus progestin, is the most effective way to cool hot flashes.

But they also lay out the growing evidence that some antidepressants can help, said Gracia, an associate professor of obstetrics and gynecology at the University of Pennsylvania in Philadelphia.

In studies, low doses of antidepressants such as venlafaxine (Effexor) and fluoxetine (Prozac) have helped relieve hot flashes in some women. And two other drugs—the anti-seizure drug gabapentin and the blood pressure medication clonidine—can be effective, according to the guidelines.

So far, though, only one non-hormonal drug is actually approved by the U.S. Food and Drug Administration for treating hot flashes: a low-dose version of the antidepressant paroxetine (Paxil).

And experts said that while there is evidence some hormone alternatives ease hot flashes, none works as well as estrogen and estrogen-progestin.

"Unfortunately, many providers are afraid to prescribe hormones. And a lot of the time, women are fearful," said Dr. Patricia Sulak, an ob/gyn at Scott & White Hospital in Temple, Texas, who was not involved in writing the new guidelines.

Years ago, doctors routinely prescribed hormone replacement therapy after menopause to lower women's risk of heart disease, among other things. But in 2002, a large U.S. trial called the Women's Health Initiative found that women given estrogen-progestin pills actually had slightly increased risks of blood clots, heart attack and breast cancer.

"Use of hormones plummeted" after that, Sulak noted.

But research since then has suggested that hormone therapy is safer for relatively younger women who start using it soon after menopause, the report notes. Women in that landmark study were in their early 60s, on average—whereas U.S. women typically hit menopause at around age 51.

Experts now say that women should not take hormones to prevent any chronic ills. But when it comes to hot flashes, hormone therapy remains the most effective option.

Another ob/gyn agreed that doctors and women alike are often reluctant to consider hormones. "Since the [Women's Health Initiative], we've been like little fishes swimming upstream," said Dr. Jill Rabin, of Long Island Jewish Medical Center in New Hyde Park, N.Y.

To help minimize any risks, she said, it's important to keep the hormone dose at the lowest level needed to relieve a woman's symptoms.

Sulak agreed. "I'm an estrogen minimalist," she said. "I'm going to start you at a low dose, and that's enough for most women."

Women who should not try hormones, she noted, include those who've ever had breast cancer or a blood clot.

Hot flashes and night sweats are the most common menopause complaint. But vaginal dryness and pain during sex are also issues for many women.

The guidelines say that estrogen applied directly to the vagina—in the form of creams, tablets or rings—is effective. "Very little" of that estrogen gets into the bloodstream, Sulak said, so the risk of side effects is considered small.

And just this year, the FDA approved a new option for treating painful sex in postmenopausal women. It's a pill called ospemifene (Osphena), and it has estrogen-like effects on the lining of the vagina.

As for "natural" remedies, such as soy and black cohosh, studies have failed to prove they're effective for hot flashes and night sweats, the guidelines say.

However, Rabin said that some women who try supplements do feel better—even if it's by a "placebo effect."

There are some "common sense" tactics any woman can use to help ease hot flashes, the guidelines say. Those include dressing in layers, keeping the thermostat lower at home and drinking cool beverages.

But for women who need more than that, Gracia advised talking to your doctor about the benefits and risks of all your options. "Therapy should be individualized, since one therapy may not be optimal for allwomen."

More information: The U.S. National Institute on Aging has more on menopause.

Depression in postmenopausal women may increase diabetes and cardiovascular disease risk

Postmenopausal women who use antidepressant medication or suffer from depression might be more likely to have a higher body mass index (BMI), larger waist circumference and inflammation—all associated with increased risk for diabetes and cardiovascular disease, according to a study led by University of Massachusetts Medical School investigator Yunsheng Ma, PhD, MD, MPH, and published in the June 13 issue of the American Journal of Public Health.

16 jun 2013--The UMass Medical School study investigated whether elevated depressive symptoms and antidepressant use are associated with biomarkers for glucose dysregulation and inflammation, BMI and waist circumference. The three main findings indicate that both elevated depressive symptoms and antidepressant use are each significantly associated with higher BMI and waist circumference; elevated depressive symptoms are associated with increased levels of insulin and insulin resistance; and antidepressant use is associated with increased C-reactive protein (CRP) levels, a marker of inflammation, which increases the risk of type-2 diabetes and cardiovascular disease.

"It may be prudent to monitor post-menopausal women who have elevated depression symptoms or are taking antidepressant medication to prevent diabetes and cardiovascular disease," said Dr. Ma, associate professor of medicine, who with UMMS colleagues analyzed data from the landmark Women's Health Initiative (WHI).

Postmenopausal women were recruited into the WHI from 1993 to 1998, and data for this analysis were collected at regular intervals through 2005. Using data from 1,953 women who completed all relevant WHI assessments, the study found that elevated depressive symptoms were found to be significantly associated with increased insulin levels and measures of insulin resistance. Significantly, throughout the entire 7.6 years on average that women were enrolled in the WHI, those who had elevated depressive symptoms or were using antidepressants had higher average BMI and waist circumference than did women not using antidepressants or without depressive symptoms among 71,809 women. However, the associations were stronger for waist circumference.

Analysis of data from 2,242 women showed that both elevated depressive symptoms and antidepressant use was associated with higher CRP levels, a marker of inflammation.

"Identifying these markers in women is important for diabetes prevention because they can be monitored for possible action before progression to full-blown diabetes," said Ma.

Few studies have examined the association of BMI, waist circumference and biomarkers of glucose dysregulation and inflammation with depression, antidepressant medication use, or both. The UMMS study included a large, racially and ethnically diverse sample of post-menopausal women. Because the analysis was epidemiological, it could not determine a causal relationship, so further study is needed to confirm the results through clinical trials.

"Given that diabetes and cardiovascular disease can be effectively prevented or delayed in high-risk individuals with lifestyle modifications or pharmacological interventions, our findings indicate the prudence of monitoring BMI, waist circumference, along with established biomarkers for diabetes and cardiovascular risk including serum glucose, insulin resistance, and CRP among women with elevated depression symptoms, or who are taking antidepressant medication, to prevent diabetes and cardiovascular disease," adds Simin Liu, MD, MS, MPH, ScD, professor of epidemiology and medicine at Brown University, a WHI investigator and study coauthor. "Further intervention trial is needed to confirm our findings and identify the specific patterns of change associated with diabetic and cardiovascular disease risk markers and individual antidepressants and depression."

Provided by University of Massachusetts Medical School

Soy-rich diets may not prevent hot flashes in most menopausal women

Study suggests natural plant estrogens aren't effective for menopause symptoms.

24 nov 2012—Consuming soy products doesn't prevent hot flashes and night sweats in most women, a large study suggests.

Imagine sitting down for a job interview and suddenly feeling very warm and starting to noticeably perspire. Or consider how it feels to frequently lose sleep from drenching night sweats. Of all the symptoms of menopause, women say hot flashes and night sweats often are the most annoying.

The symptoms are caused by fluctuating or decreasing levels of the female hormone estrogen.

Many women are not willing or able to take supplemental estrogen to control hot flashes and night sweats, known as "vasomotor" symptoms, related to widening and narrowing of blood vessels. Some women opt to add dietary soy products like tofu and soy milk to their diet. Also called phytoestrogens, they have a chemical structure similar to estrogen and are thought to mimic the effect of the female hormone in the body.

The study was published online recently and will appear in the March 2013 print issue of the journal Menopause.

"We were interested in finding ways to help women control their own health, and we were hopeful that soy products would prove to be a good alternative to hormone therapy," said lead study author Ellen Gold, professor and chairwoman of the department of public health sciences at the University of California, Davis. Unfortunately, she said, soy "doesn't seem, on average, to prevent these unpleasant symptoms before the onset of menopause."

The study analyzed data from a nationwide study that followed more than 3,000 women who were beginning to experience changes associated with menopause or had not yet begun to have symptoms of menopause. Their ages ranged from 42 to 52 years old at the start of the study.

Participants answered detailed surveys about their dietary habits and fiber intake before they were involved in the study, then at five- and nine-year follow-up points. Fiber was of interest to the researchers because it is thought to increase the impact of estrogen. The women also were asked annually about their menopausal symptoms, including hot flashes and night sweats.

The study found no significant correlation between the intake of dietary phytoestrogens or fiber and the beginning of menopausal symptoms in women who had not yet experienced menopause when they started the study.

Gold said that a randomized, placebo-controlled trial with a diverse range of women would be necessary to prove any ability of dietary phytoestrogens or fiber to prevent hot flashes and night sweats, but she believes the results of this study suggest that it is unlikely a significant effect would be seen.

Although other studies have looked at dietary soy and menopausal symptoms, this study included more women and followed them for a longer period of time than others did, the researchers said. The study also included people representing a broader range of racial and ethnic groups, including black, Hispanic, Chinese and Japanese women.

Although Asian women tend to report fewer vasomotor symptoms than other women, the typical Eastern diet, thought to be high in phytoestrogens, does not seem to be associated with fewer hot flashes and night sweats.

Gold said she believes there may be subsets of women, due to genetic and metabolic factors, who may benefit more from phytoestrogens than others. And she doesn't discourage women from taking soy products. "If women try it and it works for them, fine," she said.

The study has some limitations.

Dr. Wilma Larsen, chief of the division of gynecology at Scott & White Healthcare in Temple, Texas, is concerned that the study used data the women had written down or remembered.

"Any time you're relying on patients to self-report you're not certain what they're actually doing," Larsen said.

Although Larsen said the study contributes new information specifically about whether soy products are helpful in preventing hot flashes and night sweats before they occur, she doesn't think it will change what women do or what physicians recommend.

"I think this isn't going to prevent me from talking about a healthy diet with patients or the value of phytoestrogens," Larsen said. "And I'm certainly not going to be reassuring women that they'll go through menopause without having to take any prescription medicines."

The study was supported in part by the U.S. National Institutes of Health.

More information: Visit the U.S. Centers for Disease Control and Prevention to learn more about menopause.

Soy: No effect on menopausal hot flashes

04 nov 2012—A team of investigators led by UC Davis found that eating soy products such as soy milk and tofu did not prevent the onset of hot flashes and night sweats as women entered menopause.

Unlike previous studies investigating the relationship between soy and these menopausal symptoms, the current study included a very large population over a long period of time: more than 1,600 women over 10 years.

The article, titled "Phytoestrogen and Fiber Intakes in Relation to Incident Vasomotor Symptoms: Results from the Study of Women's Health Across the Nation," was published online today in Menopause: The Journal of The North American Menopause Society and will appear in the March 2013 print issue of the journal.

"Given that most women experience unpleasant symptoms, particularly hot flashes and night sweats, during menopause, we were hopeful that certain dietary intakes would provide good alternatives to hormone therapy," said Ellen Gold, lead author of the study and professor and chair of the UC Davis Department of Public Health Sciences. "Unfortunately, based on our study, soy-related foods did not turn out to be the 'magic bullet.'"

The study analyzed data from the Study of Women's Health Across the Nation (SWAN), which followed more than 3,000 premenopausal and early perimenopausal women with annual visits for 10 years. Women answered detailed questionnaires of their dietary habits at baseline, year five and year nine, and in each year were asked about the frequency of various menopausal symptoms, including hot flashes and night sweats.

The new study focused on the 1,651 women who had not yet had hot flashes and night sweats (called vasomotor symptoms) at the beginning of the study, because the investigators wanted to specifically evaluate the effect of dietary factors on preventing the onset of these symptoms.

The main dietary factor of interest in this study was phytoestrogens, also known as plant-based estrogens. Predominantly found in tofu, soy milk and other soy-containing foods, phytoestrogens have a chemical structure similar to estrogen and are believed to mimic the effects of the female hormone in the body. Since estrogen levels drop during menopause, the investigators hypothesized that a diet high in phytoestrogens would reduce menopause symptoms. They also evaluated the participants' consumption of fiber, because it is thought to increase the availability of estrogens in the body.

The study found no consistent correlations between dietary phytoestrogens or fiber and the onset of menopausal symptoms in women who were not yet postmenopausal when they started the study.

Although other studies have examined similar hypotheses, the outcomes have been somewhat inconsistent. Most previous studies evaluated women who were already postmenopausal and having symptoms. Also, a clear dose-response relationship—showing that the more phytoestrogens or fiber women consumed, the less likely they were to develop symptoms—has not been consistently found.

The authors conceded that to determine conclusively if a relationship exists between such dietary intakes and the onset of menopausal symptoms, a large, randomized, placebo-controlled trial would be needed with many years of follow-up. However, they stated that such a study would be costly and difficult, and their results indicate that finding a clinically significant or large effect would be unlikely.

The study had many advantages over earlier studies. It included detailed dietary information on a large number of women from across the U.S. who were followed over the course of a decade. SWAN also included women from different racial and ethnic groups, including white, African-American, Hispanic, Chinese and Japanese women.

"In general, women of Asian ancestry report fewer menopausal hot flashes than do women of European backgrounds," said Gail Greendale, a specialist in geriatric medicine with UCLA Health System and the UCLA principal investigator of the SWAN Phytoestrogen Study. "The 'Eastern' dietary pattern, which is high in phytoestrogens, has been one of the proposed explanations for the ethnic differences in hot flash occurrence. Our findings do not support the theory that higher phytonutrient intakes are associated with lower hot flash rates."

"This study contributes to the discussion about the effects of phytoestrogens on symptoms at menopause," added Gold, who was principal investigator of the UC Davis/Kaiser Permanente site of the SWAN study. "But it is not the final word. Other advantages to these compounds may exist, or it may be that a subset of women will benefit from phytoestrogen intake because of their genetic makeup, which could affect their metabolism of these dietary factors."

Led by UCLA, the SWAN Phytoestrogen Study investigators are also studying the effects of phytoestrogens on bone density and cognition, as well as whether the ability to produce a metabolite called equol when digesting phytoestrogens may have an effect. Equol appears to have greater biological potency as an estrogen mimic than other breakdown products of phytoestrogens, and Asians are more likely to be equol producers than non-Asians.

Provided by UC Davis

Panel rules against HRT for preventing chronic disease

23 oct 2012—Postmenopausal women should not use hormone replacement therapy to prevent chronic medical conditions such as heart disease, according to updated recommendations from the U.S. Preventive Services Task Force.

For the update, published online Oct. 23 in the Annals of Internal Medicine, the independent panel of experts reviewed more than 50 articles published since 2002 about estrogen-progestin therapy and estrogen alone for prevention of heart disease, dementia, osteoporosis and other chronic conditions. It recommends against their use for all because of the increased risk of other conditions including stroke.

However, the statement does not address use of hormone replacement therapy, or HRT, for short-term relief of menopausal symptoms such as hot flashes and vaginal dryness.

"The task force does not address treatment, so we do not make recommendations about menopausal symptoms," said Dr. Virginia Moyer, chair of the task force.

The report essentially echoes the task force's 2005 guidelines, while taking into account the more recent research. "It was updated as part of our routine to make sure the data were current," Moyer said.

The debate about the risks and harms of hormone therapy is ongoing. Years ago, hormone therapy was often prescribed to prevent chronic conditions such as osteoporosis and cardiovascular disease. But initial results of the Women's Health Initiative study, published in 2002, found harmful effects for estrogen-plus-progestin therapy. These included increased risk of heart disease and multiple other problems.

Two years later, serious concerns about estrogen-only therapy—often used after a hysterectomy— were also raised.

Here are highlights of the current report:

• Although hormone therapy is of moderate benefit in reducing the risk of osteoporosis-related fractures, that benefit is outweighed by the harms, including an increased risk for stroke, gallbladder disease and urinary incontinence.
• Convincing evidence connects hormone therapy with a small increased risk of breast cancer, and blood clots in the limbs and lungs.
• Estrogen and progestin combined increased risk for probable dementia.
• Hormone therapy appears to have no protective effect against heart disease and likely increases the risk, the task force said.

The updated recommendations are in line with those of many major health organizations, including the American Heart Association, the American Congress of Obstetricians and Gynecologists and the American Academy of Family Physicians.

One expert said the updated recommendations reflect current practice and won't change how he counsels patients.

"We currently aren't using it for chronic disease," said Dr. Michael Nimaroff, vice chair of obstetrics and gynecology at North Shore University Hospital of the LIJ Health System in Great Neck, N.Y., who was not involved with the report.

For certain chronic conditions, he said, hormone therapy may do more harm than good.

For women seeking short-term hormone therapy to relieve symptoms, he said, "we try the lowest dose possible to treat the symptom."

Nimaroff said he and many doctors believe taking hormone therapy for short-term symptom relief for less than five years is reasonable. "But we can't say that it is without risk," he added.

"We really try to discourage women from taking it for long periods of time," he said. "There is clearly a dose response."

Moyer said other experts are researching effective management of menopausal symptoms. That information is expected out in the near future. 

More information: To learn more about the recommendations, visit the U.S. Preventive Services Task Force.

Early menopause linked to higher risk of osteoporosis, fracture and mortality

Women who go through the menopause early are nearly twice as likely to suffer from osteoporosis in later life, suggests new research published today (25 April) in BJOG: An International Journal of Obstetrics and Gynaecology.

30 april 2012--The Swedish study looked at the long-term effects of early menopause on mortality, risk of fragility fracture and osteoporosis.
In 1977, 390 white north European women aged 48 were recruited in the Malmo Perimenopausal Study, an observational study where women were followed from age 48 onwards.
The women were divided into two categories; women who started the menopause before 47 and women who started the menopause at age 47 or later.
The women's bone mineral density (BMD) was measured. At the age of 77, all eligible women were re-measured for BMD. At this point, 298 women were still alive while 92 had died. One hundred out of the 298 women still alive had relocated or declined further participation, leaving 198 women to attend the follow-up measurement.
The study found that at the age of 77, 56% of women with early menopause had osteoporosis, in comparison with 30% of women with late menopause.
Women who started the menopause early were also found to have a higher risk of fragility fracture and of mortality. The mortality rate was 52.4% in the early menopause group compared to 35.2% in the late menopause group. The fracture incidence rate was 44.3% in the early menopause group compared to 30.7% in the late menopause group.
Ola Svejme, orthopaedic surgeon at the Skåne University Hospital, Malmo, Sweden and main author of the paper said:
"The results of this study suggest that early menopause is a significant risk factor for osteoporosis, fragility fracture and mortality in a long-term perspective. To our knowledge, this is the first prospective study with a follow-up period of more than three decades."
BJOG Deputy Editor-in-Chief, Pierre Martin-Hirsch, added:
"The study's strength is the length of time the women were observed.
"The higher mortality rate in women with an early menopause needs to be explored further as many other factors could affect this such as medication, nutrition, smoking and alcohol consumption."

More information: Svejme O, Ahlborg H, Nilsson J, Karlsson M. Early menopause and risk of osteoporosis, fracture and mortality: a 34-year prospective observational study in 390 women. BJOG 2012; DOI: 10.1111/j.1471-0528.2012.03324.x
Provided by Wiley

International experts clarify hormonal changes of menopause

A panel of US and international experts met in September 2011, in Washington, DC, to review the latest scientific data on the hormonal changes that mark reproductive aging in women and to reach consensus on defining the reproductive stages in a woman's life from pre-menopause to the late postmenopausal period. STRAW+10 represents an update to the landmark STRAW (Stages of Reproductive Aging Workshop) system put into place ten years ago that paved the way for international studies that have led to a greater understanding of reproductive aging in women.

25 feb 2012--The new report includes the following revisions:

• Simplified bleeding criteria for the early and late menopausal transition
• Modified criteria for the late reproductive and early post-menopause stages
• Recommended application of this staging system to a wider range of women without limitation by age, ethnicity, body size or lifestyle characteristics

The STRAW+10 report is published in the Menopause, Journal of Clinical Endocrinology and Metabolism, Climacteric, and Fertility and Sterility.

The symposium was co-sponsored by The National Institute on Aging (NIA), The Office of Research on Women's Health (ORWH), as well as The North American Menopause Society (NAMS), The American Society for Reproductive Medicine (ASRM), The International Menopause Society (IMS), and The Endocrine Society.

Dr. Margery Gass, Executive Director of The North American Menopause Society comments: "The North American Menopause Society convened a group of experts from key medical societies around the world to update our understanding of the stages women go through from adolescence to menopause and beyond. This new update has broader application to more women and provides additional details for determining where a woman is in these reproductive stages".

Provided by The North American Menopause Society (NAMS)

Heart Disease Risk Factors May Increase With Menopause

Researchers advocate increased surveillance of woman's risk factors before and after last period

20 dec 2009-- The risk factors for coronary heart disease increase in women in the year before and the year after their final menstrual period (FMP), making that transition a crucial time to monitor lipid profiles and lifestyle risk factors, according to a study in the Dec. 15/22 issue of the Journal of the American College of Cardiology.

Karen A. Matthews, Ph.D., of the University of Pittsburgh, and colleagues used data on 1,054 minority (African-American, Hispanic, Japanese, or Chinese) and Caucasian women from the Study of Women's Health Across the Nation (SWAN) to compare models for coronary heart disease risk assessment within a year before and after the occurrence of their FMP.

Across all ethnic groups, the researchers found that total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B showed substantial increases in the year before and the year after FMP, which is consistent with menopause-induced changes. Other risk factors were in line with a linear model, which was indicative of chronological aging.

"This study underscores the need to closely monitor lipid profiles of premenopausal and perimenopausal women, and the importance of emphasizing proven lifestyle measures and therapeutic interventions before the menopause transition to counter and possibly prevent this adverse change in lipids associated with menopause itself," the authors write.

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Editorial

Postmenopausal women with higher testosterone levels

Chevy Chase, MD, 08 nov 2009— Postmenopausal women who have higher testosterone levels may be at greater risk of heart disease, insulin resistance and the metabolic syndrome compared to women with lower testosterone levels, according to a new study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM). This new information is an important step, say researchers, in understanding the role that hormones play in women's health.

"For many years, androgens like testosterone were thought to play a significant role in men only and to be largely irrelevant in women," said Anne Cappola, MD, of the University of Pennsylvania School of Medicine in Philadelphia. "It is now largely accepted that premenopausal women with polycystic ovary syndrome, a condition in which androgens are elevated, have increased health risks. However, the clinical relevance of testosterone in women over the age of 65 had remained uncertain until this recent study."

In this study, researchers measured levels of testosterone in 344 women, aged 65-98 years. They found that women with the highest testosterone levels — in the top 25 percent of this study group— were three times as likely to have coronary heart disease compared to women with lower testosterone levels. These women were also three times as likely to have a group of metabolic risk factors called the metabolic syndrome compared to women with lower testosterone levels.

The connection between higher levels of testosterone and these health risks may be explained by the researcher's finding of a greater degree of insulin resistance in women with the highest testosterone levels. Insulin resistance is a metabolic disturbance in which the body does not use insulin efficiently and is itself a risk factor for the metabolic syndrome and cardiovascular disease.

"Because of the observational aspect of this study, we cannot discern if testosterone is a marker or mediator of cardiovascular disease in this population," said Cappola. "Further studies are needed to determine if a causal relationship exists between testosterone and insulin resistance and to provide more insight into the role testosterone plays in the pathogenesis of cardiovascular disease in women."

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Other researchers working on the study include Shrita Patel, Sarah Ratcliffe, Muredach Reilly and Rachel Weinstein of the University of Pennsylvania in Philadelphia; Shalender Bhasin of Boston University in Massachusetts; Marc Blackman of the Veterans Affairs Medical Center in Washington, D.C.; Jane Cauley and Kim Sutton-Tyrrell of the University of Pittsburgh in Pennsylvania; and Linda Fried of Columbia University in New York, N.Y.

The article, "Higher Testosterone Levels Are Associated with Insulin Resistance, Metabolic Syndrome, and Cardiovascular Disease in Older Women," will appear in the December 2009 issue of JCEM.

Sexually satisfied women have better general well-being and more vitality

Older women have higher well-being scores than younger women

30 sept 2009--Pre- and post-menopausal women who self-rated themselves as being sexually satisfied had a higher overall psychological well-being score and scores for "positive well-being" and "vitality," compared with sexually dissatisfied women in a study of 295 women sexually active more than twice a month. The study, published today in The Journal of Sexual Medicine, also uncovered a positive association between age and well-being, but a negative association for general health.

The most commonly reported sexual problems in the area of consensual sexuality in women relate to sexual desire and interest, pleasure and satisfaction, and for most women these are part of the overall sexual experience, and are inextricably related. In contrast to studies of interventions for male erectile dysfunction, benefit of treatment in women with sexual dysfunction cannot be measured simply by the frequency of sexual events, as women frequently continue to be sexually active despite a high level of sexual dissatisfaction. Thus the frequency of self-reported satisfactory sexual events has been used as the primary outcome in recent studies.

To assess whether there was a correlation between sexual satisfaction and well-being, the team of Australian researchers recruited women from the community aged 20-65 who self-identified as being satisfied or dissatisfied with their sexual function. Participants were also asked questions which identified whether they were pre- or post menopausal, with recruitment closed when there was an equal number of women in each of the four subgroups.

"We wanted to explore the links between sexual satisfaction and wellbeing in women from the community, and to see if there was any difference between pre- and postmenopausal women," said lead author Dr Sonia Davison, of the Women's Health Program at Monash University, Australia. "We found that women who were sexually dissatisfied had lower well-being and lower vitality. This finding highlights the importance of addressing these areas as an essential part of women's healthcare, because women may be uncomfortable discussing these issues with their doctor."

"The problem with interpreting this finding is that it is impossible to determine if dissatisfied women had lower well-being because they were sexually dissatisfied, or if the reverse is true, such that women who started with lower well-being tended to secondarily have sexual dissatisfaction," added Davison. "As such, pharmacotherapies aimed to treat sexual dysfunction may have secondary effects on well-being, and the reverse may be true."

As over 90% of women in this study reported their sexual activity involved a partner, and was initiated by the partner at least 50% of the time, the sexual activity of the women may have been affected by partner presence (or absence), partner health, and sexual function, which were not addressed in this study. "The fact that women who self-identified as being dissatisfied maintained the level of sexual activity reported most likely represents established behaviour and partner expectation," said Professor Susan Davis, senior author of this study, also based at the Women's Health Program at Monash University, Australia. "It also reinforces the fact that frequency of sexual activity in women cannot be employed as a reliable indicator of sexual well-being."

"We are proud to publish this extremely important study in women's sexual health" said Dr. Irwin Goldstein, Editor-in-Chief of The Journal of Sexual Medicine. "This large study performed in the community emphasizes the role and importance of women's sexual health in women's overall health and well-being. Previous criticism equated physicians' efforts to improve a woman's satisfaction with her sexual life as medicalization. Dr. Davison's and co-workers' research will help health care professionals appreciate the need for overall women's healthcare to include women's sexual health care."

Botanicals have no effect on hot flashes or cognition: Study

Two studies conducted by researchers at the University of Illinois at Chicago and Northwestern University have found that commonly used botanicals do not have an effect on hot flashes or on cognitive function in menopausal women.

11 aug 2009--The studies appear online and will be published in an upcoming issue of Menopause, the journal of The North American Menopause Society.

In the first study, the botanicals black cohosh and red clover were compared to the standard of care -- hormone therapy -- and to placebo for the treatment of hot flashes.

The researchers enrolled 89 women with moderate to severe hot flashes in a four-arm, randomized, double-blind clinical trial. The women, who experienced at least 35 hot flashes and night sweats per week, were followed for 12 months. They kept diaries to record the number of hot flashes per day as well as the intensity.

The researchers found that the average number of hot flashes per week decreased over time across all groups -- black cohosh decreased 34 percent, red clover 57 percent, placebo 63 percent and hormone therapy 94 percent.

"The important message is that all women improved, but there was a large placebo effect, and the botanicals did not work significantly better than placebo," said Stacie Geller, the G. William Arends Professor of Obstetrics and Gynecology at UIC and lead author of the study. "As expected, hormone therapy, considered the gold standard, significantly reduced hot flashes when compared with placebo," Geller said.

"We also found that the botanicals were safe -- which is important, since many women will still continue to use them."

Geller and colleagues from the UIC/National Institutes of Health Center for Botanical Dietary Supplements Center reported no significant differences between botanical treatments and placebo for any of the safety parameters, including breast and endometrial safety, liver enzymes, complete blood count, or lipid profiles.

In a second study, UIC and Northwestern researchers enrolled 66 women from the parent trial to determine whether the botanic treatments had an effect on cognitive abilities, particularly verbal memory. It is the first study to evaluate the cognitive effects of black cohosh.

The women completed baseline cognitive testing before receiving treatment and again during the 12-month treatment to measure the recollection of words and short stories. They also wore monitors that measured changes in skin conductance during a hot flash. Both subjective and objective hot flashes were recorded during a 24-hour period.

The study, like the main trial, found that none of the botanicals had either a beneficial or a detrimental effect on memory. The specific hormone therapy used in the trial, Prempro, had a slight negative impact on memory.

"Together, these two studies demonstrate that compared to botanicals, only hormone therapy had a beneficial effect on vasomotor symptoms, but this benefit was at the cost of a slight decrease in memory," said Pauline Maki, UIC associate professor of psychiatry and psychology and lead author of the cognition study. The focus of ongoing research at UIC, Maki said, is to identify a safe and effective treatment for hot flashes that is either neutral or beneficial to memory functioning.

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Norman Farnsworth, who heads the UIC/NIH Botanical Center, notes that the center continues to study botanicals for their safety and efficacy in maintaining women's health and well-being. The center is supported by a grant from the NIH Office of Dietary Supplements, the NIH National Center for Complementary and Alternative Medicine, UIC, and the UIC College of Pharmacy. Additional support for the clinical trial came from the Naturex, Inc. of Hackensack, N.J. and Pharmavite LLC of Mission Hills, Calif.

7 out of 10 women too embarrassed to discuss vaginal dryness and pain with their physician

Results from a new international survey presented today at the European Congress on Menopause in London

19 may 2009--The majority of post-menopausal women are uncomfortable talking about vaginal dryness and pain and are reluctant to seek medical help, according to results from a new international survey presented today at the European Congress on Menopause in London. Results from the survey show that over a third (39 percent) of post-menopausal women experience these symptoms of vaginal atrophy and 40 percent of women who have recently experienced vaginal dryness and pain said it interferes with their sex life, yet seven out of ten would not discuss the problem with their physician (only 30 percent of women would consider talking to a gynaecologist, and only 29 percent would consider talking to a GP).

This reluctance to discuss the problem means a quarter would wait for over a year before finally contacting their physician. Additionally, more than a third of those surveyed did not know there are local treatments available.

"The results of this survey really highlight my experiences of treating menopausal women and in my practice in Italy it is even worse. I see many women who have vaginal dryness and pain post-menopause, and the most alarming aspect is that they wait for so long, with only 17 percent of surveyed women taking a treatment to counteract these symptoms." said Dr. Rossella Nappi, Director of the Gynecological Endocrinology & Menopause Unit at the Maugeri Foundation, University of Pavia, Italy. "In addition to the physical pain that affects the women, there is an emotional impact on them and their partner as well, and it is difficult for physicians to break the ice on such a sensitive issue. There is definitely a taboo factor involved as the survey shows that, of those who have experienced vaginal dryness and pain, 47 percent would rather speak to a female physician than a male physician about the problem."

Local symptoms such as painful intercourse, vaginal dryness, itching, burning, and soreness are caused, like other menopausal symptoms, by the gradual decline of oestrogen production in ovaries.

Despite the survey highlighting that so many women delay seeking treatment, it does show that 67 percent of those who have had or are currently taking treatment experience improvements, including an improved quality of life, a return to normal sexual activity, and an improvement in the relationship with their partner.

"The survey results highlight the need for doctors to be pro-active in addressing this taboo head-on by discussing vaginal health with their patients. In addition, I also strongly urge women experiencing vaginal dryness and pain to discuss the issue, as ignoring these symptoms may also lead to more serious long-term urogenital problems. Vaginal dryness and pain don't need to be considered as a natural part of growing older and effective treatment options, such as vaginal oestrogen tablets, pessaries, creams or rings are available and can easily be prescribed by their healthcare professional." said Professor Henry Burger, Consultant Endocrinologist, Jean Hailes Foundation for Women's Health, Melbourne, Australia.