Ten Takeaways from the Menopause Society Meeting

Statins, ovarian cancer screening, dementia and more

Last week, I attended the annual conference of the Menopause Society. I’ve already written about the great lecture on colon cancer screening, which you can find here. Here, I’ve compiled a list of key takeaways from the meeting. It’s a bit of a broad menopause tour because the information crosses many different aspects of health, you know, like menopause.

(Please note that when the speakers mentioned studies, I went back to read those studies to make sure their slides and the notes I took matched the data, but sometimes what they said was expert opinion, and so I had to accept their expertise).

Statins Work for Women

Statins are lipid-lowering medications that reduce illness and save lives for those at high risk for cardiovascular disease. However, there is a common myth that statins only work for men. I’ve certainly heard this and sometimes wondered if it were true, as I have seen it seemingly everywhere. But that is yet another example of the illusory truth effect; we ALL mistake repetition for accuracy. Even doctors who are obsessed with dispelling misinformation! After hearing the lecture Updates on Management of Hypertension and Dyslipidemia in Midlife Women, I learned that it is a myth and that statins work for women.

It’s true that women are underrepresented in studies that address cardiovascular disease, and fewer women have been in trials. Still, enough women have been studied to know that statins work for them. The false notion that statins don’t work for women at risk for cardiovascular disease seems to be a myth along the lines of the disinformation about vaccines.

Statins save lives, and myths like this harm women.

Statin Side Effects are Far Less Common than People Think

A lot of people don’t take statins because they are worried about side effects. A lot of placebo-controlled trial data tells us side effects are on par with placebo, but it’s hard to get people to believe it. We heard about an elegant study that was designed to tackle this lingering misinformation about statin side effects. In this study, people who had previously stopped statins due to intolerable side effects were given 12 bottles, one for each month. Four bottles contained a statin, four contained a placebo, and four contained no pills. The participants were randomly assigned to the order in which they used the bottles, and for a year, they recorded whether they took a pill or not and their symptoms. Side effects were as common with the statin as they were with the placebo pill. Taking a pill produced the side effects, not taking an active medication (meaning the statin). The lowest risk of side effects was when people did not take any pills. The nocebo effect, which is a negative side effect related to negative expectations, was the cause of the side effects, not the actual drug.

Statins are well tolerated, which is important information as statins save lives.

Interventions to Reduce Breast Density

Breast density was a big discussion at the meeting, understandable as it’s a major risk factor for breast cancer. Denser breasts are more likely to get cancer and are harder to screen with mammography, so it’s unfortunately a double whammy. The speakers didn’t always agree on the optimal follow-up after dense breasts are identified on mammograms, which was frustrating. I need to do a lot more reading before I can write about this intelligently (I have dense breasts, so I’m personally invested). What I did learn was both obesity and alcohol use were associated with denser breasts, and so these are potentially modifiable factors. A study looking at weight loss after bariatric surgery showed an impressive reduction in breast density. Regarding alcohol, specifics about the impact weren’t given, so I did some research, and it seems one drink a day may be associated with up to a 12% increase in breast density. Numbers weren’t given about the impact of reducing or stopping alcohol intake on breast density, but like weight loss, it was presented as a modifiable risk factor.

I used to have about an average of a drink a day, and over the past year, it’s been more like a drink a week, if that. I just had my mammogram today, so I’m super curious to see if there has been any effect. It will totally be an N of one, so any improvement or lack thereof is only anecdotal.

Cervical Cancer Screening

Cervical cancer screening can be stopped at age 65 with a previously negative history of screening. However, there was a great discussion about women who may have new partners over the age of 65. This stopping at 65 has always bugged me because it assumes women over 65 couldn’t possibly be sexually active with a new partner. Men get Viagra, and women are, I guess unfuckable? Le big sigh.

A case was made for continuing cervical cancer screening for women who aren’t with a long-term partner or restarting screening for someone with a new partner after they finished screening. Also, the speaker did not feel that the human papillomavirus (HPV) vaccine would help someone with their current HPV infection, but most definitely could protect them against the HPV strains they haven’t previously had.

Ovarian Cancer is NOT a Silent Disease

We’re often told it’s a silent disease, but that’s not the case. In fact, 90% of people with ovarian cancer have at least one symptom; the most common are abdominal pain, bloating, and changes in bowel movements. In this case, an ultrasound is recommended. This is a diagnostic ultrasound, meaning it evaluates symptoms or investigates potential signs of illness.

The speaker presented information that answered the question I’ve always had about how oral contraceptive pills reduce ovarian cancer, considering we now believe that the most common type of ovarian cancer starts in the oviducts (Fallopian tubes). The abnormal cells start in the oviducts and are shed onto the ovary (and into the belly). Ovulation is associated with inflammation, and after the egg is released, the inflammatory pocket left behind may enhance the ability of these abnormal cells to settle on the ovary and become cancerous. Hence, reducing ovulation reduces that possibility. (Obviously, there are other factors as well).

There is No Effective Screening Test for Ovarian Cancer…Yet

Many people think that regular ultrasounds of the ovaries combined with a blood test called CA-125 is an effective screening test for ovarian cancer, meaning it can be used to pick up ovarian cancer early when there are no symptoms, but it performs poorly. In fact, it may even be harmful because it can lead to false positives (meaning masses that turn out not to be cancer). In one study, 15% of women with a false positive screen for ovarian cancer experienced a surgical complication. Right now, the best we can offer are strategies to prevent ovarian cancer: oral contraception (reduces the risk) and risk-reducing surgery (removing the oviducts or removing the uterus, oviducts, and uterus) depending on age, family history, and genetic factors. People with concerns about being at increased risk due to family history should talk with their provider and a genetic counselor. Meeting with a genetic counselor can be very important in determining genetic risk, which might then affect decisions about risk-reducing surgery.

There is exciting research looking at screening for ovarian cancer with Pap smear-type samples, samples from the lining of the uterus, and blood testing. Hopefully, we are going to see more here soon.

Weight Loss and Menopause

The speaker brought up how many women are distressed by their midlife weight gain, especially weight gain around the middle, which is also a metabolic risk factor. I also know that not everyone wants to hear about weight loss, but it’s one of the most common questions I get asked. If you aren’t interested in this information, just skip to the next section.

I asked the speaker specifically about time-restricted eating and/or ketogenic diets, which are often advertised in various books and platforms as especially advantageous in menopause. The speaker said they don’t provide any specific benefits and that weight loss comes down to calorie restriction, and if any of those diets help someone lose weight, it is because they are in a calorie deficit. If they work for you, then great, but they don’t offer anything special (as long as you are mindful about your LDL, which the speaker pointed out can rise with some ketogenic diets).

The speaker concluded that “diet, exercise, and behavioral therapy” were the “backbone of obesity treatment,” but they don’t always work long-term for people. She said the most effective tool for “long-term treatment of obesity” was bariatric surgery, but the new medications (glucagon-like peptide-1 receptor agonists) were a close second. Obesity was defined as a BMI ≥ 30. This doesn’t mean people must have surgery or take medications, and these approaches may not be medically appropriate for people without obesity (a lower BMI) but who still want to lose weight. It seemed to me that the speaker wanted to acknowledge that the “backbone of obesity treatment” doesn’t work long-term for many people with obesity (although they are a very important part of both surgery and medication).

(I’ve added some clarification to the paragraph above as a few people have had questions).

Menopause Hormone Therapy is NOT Indicated for the Prevention of Dementia

This was reinforced by several speakers (and something known to long-time readers of The Vajenda). However, some exciting research will be forthcoming from the KEEPS trial about dementia and MHT. We actually heard some of the data, but the speaker asked us not to publish it as the article is in press (I respect this because it’s not peer-reviewed until it’s peer-reviewed!). But watch this space!

We were reminded that 40% of cases of dementia are technically preventable. Here is the slide that broke the factors down, percentage-wise:

It’s clear that some of these factors are more preventable than others. We can move more, reduce alcohol intake, and control our blood pressure, but air pollution isn’t a modifiable factor for most of us.

No Benefit to Oral DHEA

I’m often asked about taking the hormone dehydroepiandrosterone or DHEA; the literature says it provides no benefit. This was confirmed at the meeting not even a benefit for women with primary ovarian insufficiency. It’s a common functional medicine/naturopathic scam, so when you hear if pushed for menopause, you know to block and run!

Exercise is Very Effective Medicine for a LOT of Things in Menopause

I often think if the positive effects of exercise could be put into a pill, we’d all want it, and Pharma would be charging $40,000 a month. So it was no surprise when speaker after speaker reinforced the benefits of exercise in protecting bones, preventing dementia, improving mood, preventing loss of muscle mass, protecting the heart, reducing the risk of diabetes, and even as a treatment for high blood pressure (apparently it’s as good as some medications for high blood pressure).

Next Up: Getting started menopause hormone therapy: deciding on the estrogen and the route of delivery. With Duavee back on the market, there are more variables to consider!