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Tags >> Menopause
Mar 02, 2012

The North American Menopause Society (NAMS) has issued a new position statement related to recommendations for hormone therapy (HT) use in women. This topic has been debated intensely over the last decade since the publication of the Women's Health Initiative (WHI) research that was funded by the National Institutes of Health (NIH). Following this research, many women were instructed by their physician to stop taking their hormone therapy medication due to the increased risk of cardiovascular events. For more information about the background of the WHI, please click here.

 

This information is particularly relevant for the pelvic rehabilitation provider as many women in their perimenopausal years will experience pelvic symptoms related to a decline in hormone levels. The updated NAMS guidelines state that estrogen therapy (ET) is "...the most effective treatment of moderate to severe symptoms of vulvar and vaginal atrophy..." that may include vaginal dryness, pain with penetration, and atrophic vaginitis. Although the guidelines do not recommended hormone therapy for improving libido, use of local estrogen therapy may contribute to improvement in sexual function through improved lubrication, increased blood flow and increased sensation to vaginal tissues. Local estrogen has also been demonstrated to help some women who have overactive bladder or urinary tract infections, however, systemic hormone therapy may worsen symptoms of stress incontinence.

 

There are other important women's health topics in this position statement including potential benefits of hormone therapy for women who have or who are at risk for osteoporosis. The authors conclude that in healthy women ages 50-59 years old the absolute risks of HT are low. Older women who initiate use of HT or who use long-term HT are at higher risk for adverse effects. Successful implementation of hormone therapy for women depends on the route of administration, formulation of the hormones, and timing of the therapy. "Constructing an individual benefit-risk profile is essential..." when creating a plan of care for women according to the authors.

 

Unless it is within your scope of practice to prescribe medications such as hormones, the above choices will be made through patient discussions with the appropriate medical provider. We can alert a physician or medical provider if there is concern about the vaginal tissue health of a woman presenting to the clinic. We can also direct patients to these new guidelines developed by the NAMS group. It is helpful to note that many women do not have a medical provider who is actively managing her hormone issues, and simply asking her about HT can lead her to communicate more effectively with her medical providers.


Oct 15, 2011

In Menopause: The Journal of the North American Menopause Society, an article addressing the effects of menopausal symptoms that affect work is discussed. A cross-sectional sample of 208 Dutch women aged 44 to 60 years were evaluated using the Work Ability Index and the Greene Climacteric Scale. The conclusion of the study is this: "Menopausal symptoms are negatively associated with work ability and may increase the risk of sickness absence." When symptoms of menopause include hot flashes, sleep disturbances, mood swings, depression and anxiety, it is easy to consider how this could affect a woman's ability to perform her tasks with maximal success or to feel rested enough to attend work. 

 

I found it very interesting to read a study about "menopausal interventions" at a newspaper company in Japan. This company has 907 employees, and 98 of them are women. The employee's health is managed by 2 occupational health nurses (full-time) and an industrial medicine physician (part-time.) A gynecologist was consulted to assist in improving the workplace for women who reported menopausal symptoms. Not only were women included in some of the cases described in this study, but a male employee with concerns about his wife's health was brought to the attention of the nurse and physician. While I cannot comment with any authority about healthcare in Japan, I appreciate the fact that menopause was identified as an issue, and then the workplace was educated about the effects of menopausal symptoms (not simply in terms of work output reduction but also in terms of mental stress and depression) and then interventions were applied with success reported. 

 

What many healthcare advocates in the US have been hopeful towards is the development of a more proactive approach, and with healthcare dollars shrinking, shifting towards workplaces that assist in health management of employees may prove to be a part of that process. While the healthcare system is not a can of worms I aim to open, I would like to point out that many women suffering from menopausal symptoms are not getting the support needed to manage adverse symptoms. One of my favorite questions for a patient (this comes from Holly Herman, founding member of the Pelvic Rehab Institute) is, "Who is managing your hormones with you?" I recall the 56 year-old patient (who had a hysterectomy at 27!) saying, "well, I tried Premarin once after the surgery, and it didn't really help, so I stopped taking it." That was the extent of her assistance with hormonal management. Although hormone therapy is certainly not in the scope of practice of many therapist-rehab providers, asking such a question most certainly is. The patient can be encouraged to discuss any symptoms with her primary care or gynecologist, naturopath, or other provider who can discuss options for treatment. 


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