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Most up to date info on Menopause by Dr Karen Morton

Posted on July 9, 2018 at 11:05 am

I love going to school. I did all those years ago and I still do. I am obliged by my College and my hospital to stay up to date and to accumulate a certain number of Continuing Professional Development (CPD) points per year. Of course, good doctors are continually reading and attending meetings so it is not a chore, but it does take time, and that is time not spent with patients; so it needs to be worthwhile!

The BMS Annual Conference never disappoints. It always has the right balance of cutting edge home-grown and International speakers, blended with topical practical discussions, and a good deal of humour.

This year the motion in the debate:

‘This house believes that menopausal women receiving HRT should be advised to undergo hysterectomy to benefit from oestrogen only HRT instead of combined HRT,’

was proposed by my old friend Joan Pitkin. Joan and I worked together at Queen Charlotte’s Maternity Hospital too many years ago to remember, and the truth is she hasn’t changed one bit. She was passionate about her subject and the picture of kindness and professionalism then, but dressed in full scrubs with green plastic apron and wielding a carving knife to declare her blood-thirsty surgical bent was hilarious, and even though the majority did not agree with her conclusion, she won many of us over with her performance.

So what messages did I come home with?

* That there are new products in the pipeline such a Neurokinin 3; watch this space

* There may be ways of preserving or even reinvigorating egg production from stem cells placed in otherwise exhausted ovarian tissue.

* Anti-Mullarian Hormone (AMH) is useful in determining who will be successful with IVF but pretty useless at predicting how long a woman can wait before trying for a baby

* Micronised progesterone should be taken at night because it is a good hypnotic and may have all sorts of other benefits and its metabolite allopregnanelone can do great things to GABA receptors

* There is a new product taken orally to treat vulvovaginal atrophy

* Then the best talk of the conference, Professor Peyman Hadji from Frankfurt with great data on osteoporosis prevention rather than treatment; and that the FRAX scoring system which uses neck of femur rather that vertebral body T-score bone density, dangerously underestimates bone thinning. Also the majority of fractures occur in osteopenic bone, not osteoporotic bone. Women should take vitamin D. Older women need only a small amount of oestrogen to maintain bone.

* Some other things…… but my final favourite was another old friend of mine from when we were Senior Registrars together at St Thomas’. That was a great time with wonderful bosses and at the centre of the world…. Or at least that is how it felt as the sun rose onto the Thames and the Houses of Parliament. Michael always was a gentleman and his talk on Friday was measured and informative, even though I suspect that most of the audience thought they knew everything there was to know about ‘Lifestyle’. Diet, exercise, not smoking, not drinking too much alcohol or caffeine. But there was more to it than that. I had known for a long time that the preconception environment let alone the in-utero environment is really important. But this is the phrase I really liked. Paraphrased,

‘Don’t only think about the food you eat, but also think about the food that the food you eat, eats.’

* He gave the example of a spear of asparagus, but I can fully understand how this applies across the board. Food for thought as one might say!

So that was my conference. HRT is safe for the vast majority of women, for as long as they like. Probably oestrogen gel with oral utrogestan is the safest of all, but that doesn’t mean it suits everyone.


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