General Endocrinology, Reproductive Endocrinology CME ACCREDITED Watch Time: 95 mins

touchSATELLITE SYMPOSIUM Personalizing the road ahead for women experiencing vasomotor symptoms during menopause

Watch three experts present management strategies for menopausal vasomotor symptoms and discuss challenging case studies on this topic.

Mr Nicholas Panay

Imperial College Healthcare NHS Trust and Chelsea & Westminster Hospital NHS Foundation Trust, London, UK

CHAIR

Panelists:
Dr Marla Shapiro C.M. and Prof. Dr. med. Petra Stute
  • Video Chapters
CME ACCREDITED
Watch Time: 09:26

Chair Mr Nicholas Panay introduces the expert speakers for this symposium and provides an overview of the current clinical situation for menopause treatment.

 
Watch Time: 28:27

Dr Marla Shapiro C.M. outlines available menopausal hormonal therapies (MHT) to manage menopause symptoms, and reviews the most recent data supporting the use of MHT.

 
Watch Time: 16:41

Prof. Dr. med. Petra Stute reviews the data supporting current and emerging non-hormonal treatment options for menopause symptom management, with a particular focus on their efficacy in treating vasomotor symptoms.

 
Watch Time: 40:55

In this case-based discussion, the experts debate the management of four challenging menopause case studies and consider how treatment can be personalized for each patient.

 
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Overview & Learning Objectives
Overview

In this activity, menopause experts review the available hormonal and non-hormonal treatments to manage vasomotor symptoms and other debilitating effects of menopause. They discuss clinical cases involving patients with a history of breast cancer, elevated cardiovascular risk, endometriosis and early menopause.

This activity has been jointly provided by Oakstone and touchIME ENDOCRINOLOGY. Oakstone Publishing is accredited by the ACCME to provide continuing medical education to physicians. read more

Target audience

This activity has been designed to meet the educational needs of gynaecologists, primary care providers and endocrinologists who treat menopause based in the United States (US), Europe and Asia.

Disclosures

Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest were resolved for fair balance and scientific objectivity of studies utilized in this activity. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relevant commercial interests.

Faculty

Mr Nicholas Panay discloses: Grants/research support from Abbot/Mylan, Asarina, Mithra, Pharm Olam/NeRRe, PregLem, Sojournix and Yes. Consultant/Advisory Boards for Abbott, Bayer, Besins, Kora, Mithra, Mylan, Novo Nordisk, Pfizer, Roche, SeCur, Serelys and Shionogi. Speakers Bureau for Abbott, Bayer, Besins, Gedeon Richter, Glenmark, Kora, Mylan, Novo Nordisk, Pfizer, Shionogi and Theramex.

Dr Marla Shapiro C.M. discloses: Consultant/Advisory Boards for Amgen, Aspen, Astellas, BioSyent, Bayer, Duchesnay, GSK, Merck, Mithra, Pfizer, Searchlight, Sprout, Sunovion and TherapeuticsMD.

Prof. Dr. med. Petra Stute discloses: Grants/research support from DR. KADE/BESINS Pharma GmbH. Consultant/Advisory Boards for Astellas, DR. KADE/BESINS Pharma GmbH, Exeltis and Gedeon Richter. Speakers Bureau for DR. KADE/BESINS Pharma GmbH, Laropharm and Mylan.

Content Reviewer

Walter Murray Yarbrough, MD, FACP, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Hannah Fisher has no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Oakstone Publishing and touchIME. Oakstone Publishing is accredited by the ACCME to provide continuing medical education for physicians.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 Credit™ into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Oakstone Publishing designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Learning Objectives

After watching this activity, participants should be better able to:

  • Describe the most up-to-date, evidence-based recommendations for menopausal hormone therapy (MHT), including factors to consider when determining whether MHT is the most appropriate treatment option for different patient groups
  • Discuss alternatives to MHT, including non-hormonal treatment pathways on the horizon
  • Translate evidence-based knowledge into the personalized treatment of vasomotor symptoms in women going through menopause
Faculty & Disclosures
Mr Nicholas Panay

Imperial College Healthcare NHS Trust and Chelsea & Westminster Hospital NHS Foundation Trust, London, UK

Nicholas Panay, MBBS, is Consultant Gynaecologist at Imperial College Healthcare NHS Trust and Chelsea & Westminster Hospital NHS Foundation Trust, the UK. He is Honorary Senior Clinical Lecturer at Imperial College London and Guest Professor at Beijing Obstetrics and Gynaecology Hospital, Capital Medical University. read more

As Director of the Menopause & Premenstrual Syndrome (PMS) Centres at Queen Charlotte’s and Chelsea & Westminster Hospitals, Mr Panay leads a busy clinical and research team which publishes widely, presents at scientific meetings and trains health professionals at all levels.

Much of his team’s research has focused on improving the understanding and management of menopause, premature ovarian insufficiency, PMS, female sexual dysfunction and new therapeutic regimens.

Through his work with a number of councils and women’s groups, he campaigns actively for women’s health issues both nationally and internationally. Mr Panay is part of multiple health associations, and is currently President Elect of the International Menopause Society and Past Chairman of The British Menopause Society (BMS).

Mr Nicholas Panay discloses: Grants/research support from Abbot/Mylan, Asarina, Mithra, Pharm Olam/NeRRe, PregLem, Sojournix and Yes. Consultant/Advisory Boards for Abbott, Bayer, Besins, Kora, Mithra, Mylan, Novo Nordisk, Pfizer, Roche, SeCur, Serelys and Shionogi. Speakers Bureau for Abbott, Bayer, Besins, Gedeon Richter, Glenmark, Kora, Mylan, Novo Nordisk, Pfizer, Shionogi and Theramex.

Dr Marla Shapiro C.M.

University of Toronto, Toronto, Canada

Dr Shapiro holds a fellowship in family medicine and is currently Professor at the Department of Family and Community Medicine, University of Toronto, Canada. read more

Dr Shapiro is seen on CTV NewsChannel and is the medical consultant on CTV’s National News. She appears on special assignment for W5, Canada’s most watched investigative news show, and has completed several documentaries. She writes a weekly blog for CTV. She is the author of the book, Life in the Balance: My Journey with Breast Cancer.

Dr Shapiro is a member of several advisory boards, including the Terry Fox Research Institute. She sits on the Editorial Board of Menopause and Climacteric. She was President of the North American Menopause Society (NAMS) in 2017 and Scientific Chair of NAMS in 2019.

Dr Shapiro received an Award of Excellence from the College of Family Physicians of Canada, and was awarded the Excellence in Creative Professional Activity by the University of Toronto. She was also chosen in the top 10 of the 50 most powerful doctors in Canada by the Medical Post.

In 2015 Dr Shapiro was named a Member of the Order of Canada for her contributions as a family physician and trusted source of health information. One of Canada’s highest civilian honours, the Order of Canada recognizes outstanding achievement, dedication to the community, and service to the nation.

Dr Marla Shapiro C.M. discloses: Consultant/Advisory Boards for Amgen, Aspen, Astellas, BioSyent, Bayer, Duchesnay, GSK, Merck, Mithra, Pfizer, Searchlight, Sprout, Sunovion and TherapeuticsMD.

Prof. Dr. med. Petra Stute

University Hospital of Bern, Bern, Switzerland

Petra Stute is Deputy Director of the Department of Gynecologic Endocrinology and Reproductive Medicine, University Hospital of Bern, Switzerland. She is also Associate Professor at the University of Bern. read more

Prof. Dr. med. Stute has received numerous awards in recognition of her contribution to the field of gynaecology, as well as multiple research grants. She is currently Board Member and Treasurer for the German Menopause Society, President of the Swiss Menopause Society and sits on the Advisory Board for Europäischen Vereinigung für Vitalität und Aktives Altern e.V. (eVAA).

Prof. Dr. med. Stute is an editor of Gynecological Endocrinology and sits on the Editorial Board of Archives of Gynecology & Obstetrics. She is also Past President and Board Member of Soroptimist International Bern Arcadia, a worldwide organization that aims to create opportunities to positively change the lives of women and girls.

Prof. Dr. med. Petra Stute discloses: Grants/research support from DR. KADE/BESINS Pharma GmbH. Consultant/Advisory Boards for Astellas, DR. KADE/BESINS Pharma GmbH, Exeltis and Gedeon Richter. Speakers Bureau for DR. KADE/BESINS Pharma GmbH, Laropharm and Mylan.

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Question 1/5
The WHI investigated menopausal hormone therapy (MHT) in postmenopausal women aged 50–79 years. Which of the following statements regarding 18-year follow-up from the WHI is true?

WHI, Women’s Health Initiative.
Correct

In a cumulative follow-up of 18 years of the WHI, menopausal hormone therapy (with CEE plus MPA for a median of 5.6 years or with CEE alone for a median of 7.2 years) in postmenopausal women was not associated with risk of all-cause, cardiovascular or cancer mortality.1

CEE, conjugated equine estrogens; MPA, medroxy progesterone acetate; WHI, Women’s Health Initiative.

Reference
1. Manson JE, et al. JAMA. 2017;318:927–38

Question 2/5
Which of the following statements is true regarding the use of non-hormonal treatments for the management of vasomotor symptoms of menopause?

SNRI, selective serotonin-norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor.
Correct
  • Clonidine has significant side effects (hypotension, dizziness, xerostomia, constipation, potential hypertension if suddenly interrupted) which limit its use1
  • The anticonvulsants gabapentin and pregabalin may have more tolerability issues than the SSRIs/SNRIs1
  • SSRIs and SNRIs can reduce the intensity and frequency of hot flushes by 20–65%1
  • Oxybutynin is an anticholinergic which may also be an effective treatment1

SNRI, selective serotonin-norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor.

Reference
1. Biglia N, et al. Ecancermedicalscience. 2019;13:909.

Question 3/5
Which of the following effects have been observed in clinical trials of women receiving neurokinin receptor antagonists for vasomotor symptoms of menopause?
Correct

Significant reductions in the frequency and severity of hot flushes were observed in phase II studies of fezolinetant, an NK3 receptor antagonist,1 and NT-814, an NK1/3 receptor antagonist,2 in women with vasomotor symptoms of menopause.

NK, neurokinin.

References
1. Fraser GL, et al. Menopause. 2020;27:382–92.
2. Trower M, et al. Menopause. 2020;27:498–505.

Question 4/5
Your patient is a 56-year-old woman who is experiencing frequent and severe vasomotor symptoms and joint pain. She had her last menstrual bleed a year ago; her uterus is intact.

She is obese and has type 2 diabetes.

She is particularly distressed by the vasomotor symptoms she is experiencing, and wishes to try menopausal hormone therapy. What is the most reasonable recommendation for her?
Correct

Transdermal estrogen therapy should be the first choice in obese women suffering with symptoms.1 Women with an interact uterus using systemic estrogen therapy should also receive adequate progestogen.2,3

References
1. Baber RJ, et al. Climacteric. 2016;19:109–50.
2. de Villliers TJ, et al. Climacteric. 2016;19:313–5.
3. The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. Menopause. 2017;24:728–53.

Question 5/5
Your patient is 50 years old. She presents with night sweats, which are significantly disturbing her sleep, as well as poor memory and difficulty concentrating. Her last menstrual bleed was 3 months ago.

She was diagnosed with HR-positive, HER2-negative stage IA breast cancer at the age of 48. She underwent a lumpectomy and is currently taking tamoxifen.

Which of the following would be the most suitable treatment to help alleviate this patient’s menopause symptoms?

HER2, human epidermal growth factor receptor 2; HR, hormone receptor.
Correct

Systemic menopausal hormone therapy is not recommended for breast cancer survivors.1,2 If menopausal hormone therapy is contraindicated, SSRIs and SNRIs may be considered;1 however, paroxetine should be avoided during tamoxifen use as it is a potent inhibitor of CYP2D6.3

SNRI, selective serotonin-norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor.

References
1. de Villliers TJ, et al. Climacteric. 2016;19:313–5.
2. The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. Menopause. 2017;24:728–53.
3. Biglia N, et al. Ecancermedicalscience. 2019;13:909.

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