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Members receive a complimentary subscription to this quarterly e-mail newsletter featuring issues with clinical questions and cases commonly seen in a menopause specialist’s practice. After the quarterly issue is e-mailed to members, it's posted here for all to view.
This complimentary e-newsletter from The North American Menopause Society (NAMS) presents clinical questions and cases, and recognized experts in the field provide their opinions and practical advice. Robert A. Wild, MD, PhD, MPH, the Editor of Menopause e-Consult, encourages your suggestions for topics to be addressed in future issues.
Note that the opinions expressed in the commentaries are those of the authors and are not necessarily endorsed by NAMS.
Quarterly postings of Menopause e-Consult® are listed below. To view the contents, click on each posted date.
Question: How should a perimenopausal woman with prehypertension be managed and how can menopause affect the progression and management of hypertension?
--Answered by James A. Underberg, MD, MS, FACPM, FACP, FNLA, NCMP
Case: In my office, I recently saw a 48-year-old perimenopausal woman who was experiencing severe vasomotor symptoms during the day and night, along with other typical menopause-related symptoms. Of more concern, however, was that she was feeling “dizzy” on a regular basis. How would I go about the workup for dizziness in a peri- or postmenopausal woman?
--Discussed by Kristi M. Saunders, MS, MD, NCMP
Question: Given the risk of rapid bone loss following the discontinuation of hormone therapy (HT), should a bisphosphonate be recommended for postmenopausal women as prophylactic therapy after stopping HT?
--Answered by Risa Kagan, MD, FACOG, CCD, NCMP
Case: We recently saw a physically active and mentally alert 70-year-old woman similar to the patient discussed in the January 2009 Menopause e-Consult.1 She presented with severe postmenopausal symptoms and was counseled not to restart hormone therapy (HT). What are the options to treat her severe postmenopausal symptoms, considering she is already taking gabapentin and a serotonin-norepinephrine reuptake inhibitor (SNRI)?
--Discussed by Chrisandra Shufelt, MD, MS, NCMP
Question: Does exercise attenuate or prevent the weight gain that occurs during peri- and postmenopause?
--Answered by Wendy M. Kohrt, PhD
Case: During her office visit, a perimenopausal woman says that she recently read in Fitness Magazine that if she were to increase her vitamin D intake that it will not only benefit bone health but will also reduce risk of upper respiratory tract infections and possibly reduce her risk of developing deadly cancers of the colon and breast. Is there any truth to these claims? And, if so, how much vitamin D should she take in order to obtain these additional health benefits of vitamin D?
--Discussed by Michael F. Holick, MD, PhD
Question: Which women should take aspirin for the primary prevention of cardiovascular disease? What factors should be considered in decision making about aspirin?
--Answered by JoAnn E. Manson, MD, DrPH, and Elizabeth Fay Brigham
Case: A very physically active and mentally alert 70-year-old woman was recently referred to our office for persistent, severe postmenopausal symptoms. She was having hourly hot flashes as well as bothersome night sweats, which affected the quality of her sleep. The poor sleep quality was negatively influencing her quality of life. The woman has been taking hormone therapy (HT) intermittently since she was 60 years old but discontinued in 2002 after the initial information from the Women’s Health Initiative came out. After starting and stopping twice more, she was prescribed a lower dose of HT in 2003, which she continued until 2006. Still suffering from severe symptoms in 2008, she wished to discuss restarting therapy. Her present medical history was being well controlled for hypothyroidism (levothyroxine), hypertension (valsartan and metoprolol), and depression (venlafaxine). Among the medications she is taking for other medical conditions are a daily dose of baby aspirin for her heart and 600 mg gabapentin for restless leg syndrome (RLS). Should she restart HT?
--Discussed by Wen Shen, MD, MPH
Question: How long should postmenopausal women continue to take bisphosphonate therapy for osteoporosis?
--Answered by Paul D. Miller, MD
Case: A 56-year old woman presented with hair shedding and thinning over the vertex scalp for the last few years, particularly since reaching spontaneous menopause at the age of 51. She stopped taking her hormone therapy (HT) 1 year ago after the news reports of the risks associated with this medication. She has a positive family history for pattern hair loss (PHL) and has not tried any treatments. What is needed for workup and what are her treatment options?
--Discussed by Wilma F. Bergfeld, MD, FAAD, and Shannon Harrison, MBBS, Med, FACD
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