This talk will discuss two topics in the management of the menopause.
Hot flushes affect up to 70% of menopausal women and can significantly impair their quality of life. Menopausal Hormone therapy (MHT) is the most effective therapy for the management of vasomotor symptoms associated with the menopause. MHT however is contraindicated for some women including those with a history of oestrogen-dependent malignancy. The KNDy (Kisspeptin-Neurokinin B-Dynorphin) neurons of the hypothalamus which express Neurokinin B are now understood to play a major role in the aetiology of hot flushes. These neurons innervate the thermoregulatory centre and undergo hypertrophy in postmenopausal women as a result of declining oestrogen. The Neurokinin 3 receptor antagonists are a novel, non-hormonal treatment for hot flushes. Early studies have shown them to be effective in relieving both severity and frequency of hot flushes. They represent an exciting future therapeutic option for women for whom MHT is contraindicated.
Progestogens are an essential component of MHT for women with an intact uterus to prevent endometrial hyperplasia and malignancy. They vary in their clinical structure an interact with other steroid receptors to varying degrees, thereby causing unwanted side effects. The use of micronized progesterone and dydrogesterone has become widespread in recent years with evidence suggesting lower rates of breast cancer compared to synthetic progestogens. Whether standard doses of micronized progesterone provides adequate endometrial protection, particularly at higher doses of oestrogen, has recently been a contentious topic of discussion. The safety and side effect profile of the different progestogens will be reviewed.