Highlights From the 14th World Congress on Menopause

Learning about early menopause, weight gain and metabolism in mid-life at the World Congress on Menopause

I just had the pleasure of participating in this terrific meeting, the 14th World Congress on Menopause, which was held in Cancun, Mexico, May 1-4. With a past President from South Africa, an incoming President from Scotland, and a President Elect from Australia, there’s no question this is a truly international society!

I attended a number of outstanding presentations and discussions, and here are some of my personal highlights.

The Henry Burger Prize at the World Congress on Menopause

Frank Stanczyk, Ph.D., won this prize given to the investigator judged as having published the most significant contributions to the field of menopause in basic science of clinical studies over the past two years. Dr. Stanczyk is a dedicated researcher who has devoted his career to performing top-quality measurements of hormones, and he gave an excellent talk on the different bioavailabilities of various forms of progesterone.

He clearly showed large differences in tissue, blood, saliva and urinary progesterone after giving progesterone as a capsule, a gel applied to the skin, a vaginal gel, and a troche. This is an important reminder for women who are considering alternative forms of progesterone administration, especially when measuring hormone levels in saliva as proof of adequate dosing.

Dr. Stanczyk’s data convincingly demonstrates that some of these hormone delivery methods produce sky-high concentrations of progesterone in saliva with almost no increase in blood levels! This makes it doubtful that the hormone is getting where it needs to go to do the job of protecting the uterus.

Ovarian aging, reproductive hormones & health in mid-life women

At the World Congress on Menopause I had the pleasure of delivering this talk on how the hormonal changes associated with the transition into menopause may influence short- and long-term health for women. For example, hormones such as AMH (anti-Müllerian hormone), which is produced by the ovary only when eggs are present, may be associated with protection against arteriosclerosis, or ‘hardening of the arteries.’

Since this hormone is gone after menopause, it may be one of the missing links to understanding the complex relationship between menopause and risks of heart disease in women.

Weight gain and metabolism in mid-life and its effects on women’s health

One of my co-speakers, Mary Lumsden (incoming society President), delivered a riveting talk on this topic. She showed some sobering data on the global epidemic of obesity and the huge predicted increases in disease burden (diabetes and hypertension) for women in Latino and Southeast Asian countries. Literally, tens of millions more diabetics are being created every year by the strain that obesity places on the pancreas.

The impact of early menopause on women’s health

The other co-speaker, Rodney Baber, President Elect of the Society, gave this talk. He described the stresses placed upon women who suffer idiopathic early menopause (no known cause), as well as those who undergo risk reducing surgical menopause, such as women with hereditary cancer genes undergoing ‘Angelina Jolie surgery.’ We do not yet know the full impact of early menopause on these women, nor do we know for sure whether giving back estrogen is beneficial enough to prevent some of the consequences.

Ovarian cancer at the World Congress on Menopause

I had the privilege of chairing this session. Viola Heinzelmann (Switzerland) discussed again the issue of early removal of the ovaries in women with BrCA mutations, and a very lively debate ensued. There is clearly no consensus among the international community as to whether or not it is preferable to treat these women with hormones or if hormone therapy increases their risks after the ovaries have been removed.

Robert Bast of the U.S. presented some electrifying new data discussing the use of proteomics, biomarkers and sophisticated early detection methods for finding ovarian cancer in its earliest stages, when it is most likely to be curable. Finally, Curt Burger of the Netherlands presented his findings on stem cells from the end of the fallopian tube that contribute to a specific type of ovarian cancer in an animal model. There is an increasing appreciation that cancers that we have previously blamed on the ovary actually originate from the tube, and women who have their ovaries out to reduce cancer risk should also have their tubes removed.

Do hot flashes reflect an increased inflammatory state in women who have them?

A paper presented by Dr. Maria Wender of Brazil raised this question. Dr. Wender studied about 100 Brazilian women, half of whom reported hot flashes and half did not, and compared their levels of key inflammatory regulators and cell adhesion molecules. She did not find any differences between her two groups of women, but some methodological issues exist that may have made it difficult to interpret the data.

Rebecca Thurston, a U.S.-based investigator with whom I have collaborated, has convincingly shown some key differences in adipocytokines (inflammatory and immune system mediators produced by adipose tissue) in women who report the worst hot flashes from the SWAN Study, which is a much larger sample. Dr. Thurston’s data suggest strongly that these adipocytokines are higher in women with hot flashes and that hot flashes are, indeed, a pro-inflammatory state. Should her findings be correct, then we may need to direct our hot flash therapies more towards treatments that will soothe these inflammatory processes.

Diving in underground caverns

Finally, Cancun is just a beautiful place to be and I got to go to the meeting with my husband, who planned a day trip for us to dive in the cenotes, which are spectacular underground caverns that were sacred places to the ancient Mayans. The rock formations were glorious, as the cenotes used to be undersea coral reefs but as the oceans rose, they became an underground network of rivers, with limestone deposits creating stalactites and stalagmites and even columns among the caves.

Even though we are experienced divers, diving where you are completely enclosed and cannot surface is pretty unsettling. Fortunately, the amazing natural beauty and awe carried us through without problems, and our flashlights worked perfectly throughout!