News
Updated menopause toolkit to help doctors provide better care
The toolkit includes new advice and therapies for assessing and treating menopause-related health issues
An updated toolkit that guides health professionals in treating menopause health issues has been published in an effort to improve care for women globally.
Endorsed by the International, Australasian and British Menopause Societies, the Endocrine Society of Australia and Jean Hailes for Women’s Health, the 2023 practitioner’s toolkit for managing the menopause is designed to be used anywhere in the world.
The toolkit, published originally in 2014, has been updated with new advice and therapies based on a systematic review of the latest menopause research and best practice.
The new version includes bone health guidance, such as recommendations about when menopause hormone therapies might be needed to prevent bone loss and osteoporosis in asymptomatic women.
The update also incorporates new medications including fezolinetant for hot flushes, ospemifene for painful sex, and vaginal DHEA for vaginal dryness.
First author and Monash University women’s health research programme head professor Susan Davis, who also led development of the toolkit in 2014, said the update included some new therapies but did not support menopause hormone therapies for cognitive symptoms or clinical depression.
“Clinical trials have not shown a benefit of menopause hormone therapies for cognitive function,” she explained.
“The most robust studies have shown it to be no better than placebo.”
She added: “Regarding depression, menopause may cause symptoms such as low mood, anxiety, irritability, and mood swings, but clinical depression needs to be assessed and managed in its own right.
“Menopause might exacerbate underlying depression but should not be assumed to be the cause of clinical depression.”
Davis said the advice was now much clearer around preventing bone loss and fracture.
“To our knowledge this is the only document that provides guidance for using hormone therapy to prevent fracture. Other recommendations have been vague such as ‘can be used to prevent bone loss/fracture’ or ‘use to treat osteopenia’.”
The author said it was important for women to see their GP if they experienced troubling physical or mental health symptoms.
“We have updated this as part of an NHMRC Grant to upskill GPs and to embed the care algorithms into GP practice software in the MenoPROMPT study programme, which aims to improve care for women who need it. This is a very important feature of this update.”
Senior author Dr Rakib Islam, from the Monash University School of Public Health and Preventive Medicine women’s health research programme, said the updates would make a difference for many.
“The 2023 practitioner’s toolkit is the most up-to-date evidence-based practical guidance for health care providers to menopause care globally,” he said.
The paper’s authors said the recommendations needed to be applied in the context of local availability and the cost of investigations and drug therapies.
“Most importantly, the toolkit provides the full spectrum of available options and therefore can be used to support shared decision making, and patient-informed care,” they added.
Diagnosis
Lung cancer drug shows breast cancer potential
Ovarian cancer cells quickly activate survival responses after PARP inhibitor treatment, and a lung cancer drug could help block this, research suggests.
PARP inhibitors are a common treatment for ovarian cancer, particularly in tumours with faulty DNA repair. They stop cancer cells fixing DNA damage, which leads to cell death, but many tumours later stop responding.
Researchers identified a way cancer cells may survive PARP inhibitor treatment from the outset, pointing to a potential way to block that response. A Mayo Clinic team found ovarian cancer cells rapidly switch on a pro-survival programme after exposure to PARP inhibitors. A key driver is FRA1, a transcription factor (a protein that turns genes on and off) that helps cancer cells adapt and avoid death.
The team then tested whether brigatinib, a drug approved for certain lung cancers, could block this response and boost the effect of PARP inhibitors. Brigatinib was chosen because it inhibits multiple signalling pathways involved in cancer cell survival.
In laboratory studies, combining brigatinib with a PARP inhibitor was more effective than either treatment alone. Notably, the effect was seen in cancer cells but not normal cells, suggesting a more targeted approach.
Brigatinib also appeared to act in an unexpected way. Rather than working through the usual DNA repair routes, it shut down two signalling molecules, FAK and EPHA2, that aggressive ovarian cancer cells rely on. FAK and EPHA2 are proteins that relay survival signals inside cells. Blocking both at once weakened the cells’ ability to adapt and resist treatment, making them more vulnerable to PARP inhibitors.
Tumours with higher levels of FAK and EPHA2 responded better to the drug combination. Other data link high levels of these molecules to more aggressive disease, pointing to potential benefit in harder-to-treat cases.
Arun Kanakkanthara, an oncology investigator at Mayo Clinic and a senior author of the study, said: “This work shows that drug resistance does not always emerge slowly over time; cancer cells can activate survival programmes very early after treatment begins.”
John Weroha, a medical oncologist at Mayo Clinic and a senior author of the study, said: “From a clinical perspective, resistance remains one of the biggest challenges in treating ovarian cancer. By combining mechanistic insights from Dr Kanakkanthara’s laboratory with my clinical experience, this preclinical work supports the strategy of targeting resistance early, before it has a chance to take hold. This strategy could improve patient outcomes.”
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