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Hormonal health

Different menopausal hormone treatments pose different risks

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The largest and most comprehensive study of currently prescribed hormone treatments has found that the risk of blood clots, stroke and heart attack differ depending on the active substance and how the medicine is taken.

Researchers  analysed the effects of seven different hormone treatments for menopausal symptoms on the risk of blood clots, stroke and heart attack. The study involved around one million women aged between 50 and 58.

“There is concern among women that menopausal hormone therapy increases the risk of cardiovascular disease,” said lead author Therese Johansson of Uppsala University.

“This concern is based on older studies conducted more than 20 years ago that only looked at one type of treatment. Since then, many new preparations have been introduced and our study shows that the previous conclusions do not apply to all types of treatments.”

Most women go through menopause between the ages of 50 and 60. Levels of the hormone oestrogen fall sharply, increasing the risk of osteoporosis. The low levels can also contribute to health problems such as hot flushes, mood swings and difficulty sleeping.

To counteract these health effects, women may be prescribed hormone replacement therapy involving medicines containing hormones or hormone-like substances.

In Sweden alone, hundreds of thousands of women currently use hormone replacement therapy and this type of treatment has been available since the 1970s. At that time, there was only one type of hormone replacement therapy and when a major study in the 1990s showed that it increased the risk of cardiovascular disease, its use rapidly declined.

Since then, new preparations have entered the market, and following this, the use of hormone replacement therapy in connection with menopause has increased significantly in recent years.

In the new study, the researchers looked at seven different types of currently used hormone replacement treatments, administered via tablets, hormone patches or hormone-releasing IUDs. The study is based on all prescriptions for hormone replacement therapy in Sweden from 2007 to 2020 and covers nearly one million women aged 50 to 58.

The women were monitored for two years after starting hormone replacement therapy. The risk of blood clots and cardiovascular disease was compared between women who had and had not collected a prescription medicine for hormone replacement therapy.

The results show clearly that the risks of hormone replacement therapy vary depending on the type of treatment.

For example, the synthetic hormone tibolone, which mimics the effects of the body’s natural hormones, was linked to an increased risk of both heart attack and stroke, but not to an increased risk of blood clots. The risk of heart attack or stroke due to tibolone is estimated at one in a thousand women.

Combined preparations containing both oestrogen and progesterone instead increase the risk of blood clots, including deep vein thrombosis. Blood clots form in the veins and can break loose and travel with the circulation to the lungs, leading to pulmonary embolism. The researchers estimate that the risk of deep vein thrombosis resulting from this combined preparation is about seven per thousand women per year.

“It is important that both doctors and women are aware of the risks of menopausal hormone therapy and, in particular, that the existing drugs carry different risks of blood clots and cardiovascular disease,” said senior author Åsa Johansson.

Tibolone in particular was associated with an increased risk of stroke and heart attack. Tibolone is used in Europe but is not approved in countries such as the United States. We hope that our study will lead to the drug being withdrawn from use here as well.”

During the period of the study, 2007 to 2020, an increase in the use of hormone patches of about 50 per cent was observed, and these preparations were not linked to the same higher risk. The increased use of safer alternatives, such as patches, is an important step forward in reducing the risk of cardiovascular disease among menopausal women.

“The next step in our research will be to develop strategies to identify which women are at increased risk of certain diseases in connection with using hormonal drugs. In this way, we can guide patients to the most appropriate medicine for each individual and drastically reduce the number of side effects,” Johansson said.

News

Relaunched women’s health strategy aims to tackle ‘medical misogyny’

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Health secretary Wes Streeting has relaunched England’s women’s health strategy, vowing to stop women being “gaslit” by doctors.

Speaking before publication of the renewed strategy, the health secretary said the NHS was “failing women” and set out measures to help them access the healthcare they need.

The government said the strategy would include a new standard of care to ensure women were offered pain relief for invasive procedures, such as fitting a contraceptive coil and hysteroscopies.

Feedback would be directly linked to provider funding through a new trial, giving women more power to affect change if they have a poor experience.

Action would also be taken to ensure women no longer face long waits for diagnoses for conditions such as endometriosis, which can take a decade to diagnose.

Streeting said: “[Women] have for so long been let down by a healthcare system that too often gaslights women, treating their pain as an inconvenience and their symptoms as an overreaction.

“Whether it’s being passed from one appointment to another for conditions like endometriosis and fibroids, or a lack of proper pain relief during invasive procedures, through to having to navigate symptoms for years before receiving a diagnosis, it’s clear the system is failing women.

“Women’s voices must be central to delivering effective, respectful and empathetic care. We need to hit medical misogyny where it hurts – the wallet.

“Today’s renewed strategy will tackle the issues women face every day and ensure no woman is left fighting to be heard.”

A report last month by the women and equalities committee found that gynaecological and menstrual health had not been “sufficiently prioritised” by the government.

MPs said parts of the 10-year women’s health strategy, launched in 2022 by the Conservatives, were at risk of being scaled back or discontinued under wider changes to the NHS.

These included initiatives that had reduced waiting lists and improved women’s access to healthcare, such as women’s health hubs.

Sarah Owen, chair of the committee and a Labour MP, said: “This would be a disaster for girls’ and women’s menstrual healthcare, when it is in dire need of more support.

“It is a national scandal that nearly half a million women are on hospital gynaecology waiting lists when there are effective treatments that could be administered in primary and community care, if only they could access them.”

The report said women faced “medical misogyny” and were left to “suck it up” and suffer in pain for years because of a lack of awareness of women’s health conditions.

A redesign of clinical pathways for some women’s health issues will aim to speed up diagnosis and treatment, and there will be a review of support for families who experience repeated baby loss.

The government also promised a “single referral point” to ensure women were directed to the right place the first time they sought help.

Dr Sue Mann, NHS England’s women’s health director, said too many women were dismissed for “serious symptoms” that affected every part of their lives.

“The renewed women’s health strategy will build significantly on the work the NHS has been doing to ensure women are heard and get the specialist care they need,” she said.

Women’s health groups cautiously welcomed the renewed strategy. Emma Cox, chief executive of Endometriosis UK, said decisive action would be vital to improve women’s healthcare in England.

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Menopause

Watchdog bans five ads for women’s heath claims

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Five adverts for supplements claiming to treat menopause and other women’s health issues have been banned by the Advertising Standards Authority (ASA).

Ads for 222 Balance Me, Lunera, Minerva and Nova Menopause Vitality all claimed their products could prevent, treat or cure the symptoms of the menopause.

An advert and website for PolyBiotics implied its food supplements could prevent, cure or treat polycystic ovary syndrome, or PCOS.

ASA investigations manager Catherine Drewett said when it comes to women’s health, ‘people deserve clear and accurate information’.

She added: “Ads making misleading claims about treating symptoms of the menopause, PCOS and other hormonal conditions can cause real harm and today’s rulings hold advertisers to account.’

“We’ll continue to monitor this sector closely and we encourage anyone with concerns about an ad they’ve seen to get in touch.”

The ASA said it had taken a close look at adverts that might prey on people’s health worries, emotional concerns or financial pressures.

The regulator said it had used AI to analyse health claims in online adverts, which revealed emerging and ongoing issues around misleading claims and informed its rulings on the supplements.

The ASA said many of the claims in the adverts were ‘unacceptable’ and had not only broken a number of its rules but risked misleading vulnerable people, or steering those who needed it away from appropriate medical advice.

222 Collective accepted that wording in its adverts may have ‘inadvertently implied’ its product could ‘treat or relieve symptoms such as PMS, menopause-related symptoms, anxiety, bloating, heavy bleeding, or mood disorders’.

The company said it was a new, founder-run small business and still learning about the requirements of advertising regulations and was working with Trading Standards to ensure it did not make explicit or implied disease or symptom treatment claims.

Lunera said it accepted its claims would be understood by consumers to attribute a medicinal property to a food supplement and should not have appeared.

PolyBiotics told the ASA it accepted references to PCOS, ovulation, fertility, cycle regulation, insulin resistance and related symptoms constituted disease treatment or symptom-management claims, which were not permitted for food supplements.

Minerva and Nova did not respond to the ASA’s enquiries.

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Menopause

Non-hormonal menopause pill approved for NHS use

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A new daily menopause pill approved for NHS use could bring relief to women with debilitating hot flushes and night sweats.

Around 500,000 women are expected to be eligible for the treatment, which experts say could help those unable to take hormone replacement therapy, or HRT.

The drug, fezolinetant, also known as Veoza, is a daily non-hormonal tablet designed to target the brain signals that trigger some of the most disruptive menopause symptoms.

In final draft guidance published today, the National Institute for Health and Care Excellence recommended the 45mg tablet for women experiencing moderate to severe hot flushes and night sweats.

More than two million women in the UK are thought to suffer these symptoms during menopause, often beginning during the earlier stage known as perimenopause.

For many, the effects are severe, disrupting sleep, affecting concentration and straining relationships. In some cases women are even forced to cut back on work.

An estimated 60,000 women in the UK are currently out of work or on long-term sick leave due to severe menopause symptoms, costing the economy roughly £1.5bn a year.

Research also suggests one in 10 women has left the workforce entirely because of a lack of support.

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