Current management of pelvic organ prolapse in aging women: EMAS clinical guide
Amsterdam, 12 March, 2018 – A new clinical guide by the European Menopause
and Andropause Society (EMAS) published in the journal Maturitas summarises the
evidence on current management of pelvic organ prolapse in aging women after the
Nearly 50% of women will develop some form of pelvic organ prolapse (POP). It is expected that the burden of POP will escalate as women are living longer. The symptoms and severity of POP increase significantly across the menopausal transition, adversely affect quality of life and may be associated with urinary and fecal incontinence. Falling estrogen levels after the menopause may be involved in its etiology and hormone replacement therapy (HRT) may improve symptoms. However HRT is ineffective in its prevention or treatment. Physical therapies and surgery are therefore the mainstay of treatment.
POP should not be ignored because of the adverse effects on long term health and quality of life. Healthcare professionals in the field of menopause are in a key position to identify the problem, to characterize it, and either to manage it themselves or to refer women appropriately. Management may be challenging and requires advanced skills, particularly when surgery is required. Women need to be informed of the available treatments and their benefits and risks. The options range from weight loss, pelvic floor exercises and pessaries to reconstructive or obliterative surgery or laser treatments. Women should participate actively with their healthcare professional in making management decisions to ensure that the treatments are suitable for them.
EMAS recommends that all healthcare professionals dealing with menopause should be knowledgeable on POP. As surgery is challenging and requires urogynecological expertise, complex cases need to be referred to and managed by multidisciplinary referral centers. Clinical services should be able to offer up-to-date non- surgical and surgical options in order to satisfy treatment demands for this growing problem and to help women enjoy their later years.
The complete statement can be found in ‘Current management of pelvic organ prolapse in aging women: EMAS clinical guide by Andrea Giannini and others. DOI: https://doi.org/10.1016/j.maturitas.2018.02.004
It is published in Maturitas, published by Elsevier.
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Calcium in the prevention of postmenopausal osteoporosis: EMAS Clinical Guide
Amsterdam, October 11, 2017 – Osteoporosis is common and affects 1 in 3 women.
Calcium is vital for strong healthy bones and worldwide scientific societies have issued
guidance about the daily requirements from childhood to old age. The European
Menopause and Andropause Society (EMAS) has issued a new clinical guide with the
aim of raising awareness of the importance of calcium in lowering the risk of
The recommended daily intake of calcium after menopause varies between 700 and 1,200 mg, depending on the endorsing society. It is uncertain whether excessive intake can cause harm. Some epidemiological studies have raised concern about possible cardiovascular risk, dementia or even, paradoxically, fracture.
Calcium may be obtained from food or supplements containing calcium salts. Most people should be able to get enough calcium through healthy eating, but this is not always the case. Diets in Southern European have less dairy products than in Northern countries. Data from the NHANES database in the USA showed that less than one third of women aged 9 to 71 consumed enough calcium. Supplements are poorly tolerated and therefore not usually taken long term. Another reason for concern are the rates of over prescription of supplements above the recommended upper level of 2,000 mg/day. For example, one study found that 29% of supplements were over prescribed.
EMAS confirms that calcium is an essential part of the diet from childhood to old age, and that an approximate assessment of intake should be part of routine health checks. Women need to be more calcium-aware and mindful of calcium-rich foods. But more is not better, and women should be warned that intakes above the recommended levels may be useless or, although still debated, may cause harm.
The complete statement can be found in “Calcium in the Prevention of Postmenopausal Osteoporosis : EMAS Clinical Guide” by Antonio Cano et al. DOI: http://dx.doi.org/10.1016/j.maturitas.2017.10.004 It appears in Maturitas, published by Elsevier.
Osteoporosis management in patients with breast cancer
Amsterdam, 9 November, 2016 – A new position statement by the European
Menopause and Andropause Society (EMAS) published in the journal Maturitas
summarises the results of many clinical trials of antifracture therapy in women with
early-stage breast cancer and discusses current guidelines for the management of
osteoporosis in women with breast cancer. It also examines the evidence about the use
of bisphosphonates or denosumab in an adjuvant setting in women with early breast
Breast cancer remains the most frequent cancer in women and its incidence is increasing. However, the mortality rate has stabilized due to progress in treatment. In premenopausal women with hormone receptor-positive breast cancer, the goal of adjuvant treatment is to inhibit the impact of estrogen on the breast, either by blocking the estrogen receptors (with the use of tamoxifen) or by suppressing ovarian function (through surgical oophorectomy or treatment with luteinizing hormone- releasing hormone (LHRH) agonist). In postmenopausal women, blocking the estrogen receptors or inhibiting the aromatase-induced synthesis of estrogen are standard treatment options. While aromatase inhibitors (AIs) are the first-line recommended standard of care for postmenopausal estrogen receptor-positive breast cancer their profound suppression of estrogen levels increases the risk of osteoporotic fracture.
EMAS recommends that careful baseline evaluation of the risk of fracture should be undertaken in all premenopausal women with breast cancer and in postmenopausal women about to start treatment with aromatase inhibitors as part of their cancer treatment. There is a consensus that bisphosphonates, which may also have an anticancer effect, should be used to prevent the bone loss induced by cancer treatment, especially in women at intermediate or high risk of fracture. The use of denosumab could also be considered, although there is currently no specific guideline regarding this agent. Osteoporotic treatment should be continued at least until the adjuvant breast cancer treatment programme is complete or for even longer in those women with the highest baseline risk of fracture.
"This useful clear summary will help women with breast cancer and their health professionals in their conversation to reach a healthcare choice with regard to osteoporosis", Prof Margaret Rees, EMAS Executive Director.
The complete statement can be found in "Osteoporosis management in patients with breast cancer: EMAS position statement" by Florence Tremollieres and colleagues.
It is published in Maturitas, volume 95, pages 65-71 (2017), published by Elsevier.
Journal Maturitas Publishes New Model of Care for Healthy Menopause and Ageing
Amsterdam, July 12, 2016 –A new position statement by the European Menopause
and Andropause Society (EMAS) published in the journal Maturitas provides a holistic
model of care for healthy menopause.
In the article, the researchers argue that the core team around menopausal womenshould consist of a lead clinician, specialist nurse(s) and the woman herself, supported by an interdisciplinary network of medical experts and providers of alternative/complementary medicine. Lead clinicians should provide specialist expertise that is both comprehensive and integrated for the care of midlife women. The core team should also be responsible for structuring and optimizing processes in primary and secondary care.
As the lifespan of women in developed countries continues to increase, menopause can now be considered to be a midlife event. Although not all women will experience short- or long- term problems related to menopause, the high prevalence of hot flushes and vaginal atrophy, which can last for many years, as well as osteoporosis (1 in 3 women are at risk of an osteoporotic fracture), makes caring for ageing women a key issue for health professionals.
EMAS recommends that Europe needs more specialist teams, as the number of women currently entering menopause is on the rise. Furthermore, caretakers should follow EMAS’ conceptual framework for healthy menopause and ageing should be used. It is a holistic model of care covering physical, psychological and social functioning and incorporating disease and disability. It also reflects the need of midlife women to at least maintain if not improve their quality of life, which is an integral component of contemporary healthcare.
Professor Margaret Rees, Executive Director of EMAS, commented: “This straightforward model of care and health promotion for midlife women will help empower them to make positive choices for their post-reproductive health and wellbeing.”
These and other recommendations presented in EMAS’ position statement are published in the article “A model of care for healthy menopause and ageing: EMAS position statement” (doi: 10.1016/j.maturitas.2016.06.018), Maturitas published by Elsevier.
New Care Pathway Advises Health Professionals on Postreproductive Health
Amsterdam, May 12, 2016 –A new position statement by the European Menopause
and Andropause Society (EMAS) published in the journal Maturitas provides a pathway
with the latest post-reproductive health strategies, with the aim of optimizing care at an
international scale. The pathway will assist healthcare professionals to provide up-to-
date evidenced-based information so that women seeking advice about menopausal
health should not suffer in silence and be able to make informed choices.
Menopause can cause disruptive symptoms in women, who usually enter this phase in their late 40s or early 50s. Life expectancy continues to rise, and it has been estimated that by 2025, there will be 1.1 billion postmenopausal women worldwide.* Menopausal women run the risk of conditions like osteoporosis, cardiovascular disease, cognitive decline, dementia and sarcopenia. As a result, entering the menopause can be considered as an opportunity to address musculoskeletal and cardiovascular health, smoking, alcohol use and cancer screening.
EMAS recommends that assessment should be holistic and include menopausal symptoms, personal and family history, cardiovascular and osteoporotic risk factors as well as gynaecological and breast health. Strategies to maintain postreproductive health include optimising diet and lifestyle, menopausal hormone therapy and non- estrogen-based options for climacteric symptoms and skeletal conservation.
‘This easy-to-follow care pathway will help all health professionals provide a personalised approach to postreproductive health and inform women of the strategies available to them during menopause’, Prof Margaret Rees, EMAS Executive Director.
The complete pathway can be found in ‘Maintaining postreproductive health: a care pathway from the EuropeanMenopause and Andropause Society (EMAS),’ by Eleni Armeni, Irene Lambrinoudaki, Iuliana Ceausu, Herman Depypere, Alfred Mueck, Faustino R. Pérez- López, Yvonne T.van der Schouw, Levent M. Senturk, Tommaso Simoncini, John C. Stevenson, Petra Stute, Margaret Rees (doi: 10.1016/j.maturitas.2016.04.013). It is published in Maturitas, volume 89 (2016), published by Elsevier.
Recommendations for Workplace Conditions for Menopausal Women
Amsterdam, December 21, 2015 –Journal Maturitas today announced the
publication of a position statement by the European Menopause and Andropause
Society (EMAS) covering conditions in the workplace for menopausal women.
Many women will be working throughout their menopausal years. For some women the menopause presents considerable difficulties in daily life with symptoms also impacting their work performance. To address the issue EMAS offers recommendations for working conditions for menopausal women. The guidance should be helpful not only for the women themselves, but also line managers and healthcare practitioners.
EMAS recommends that there should be greater awareness among employers, together with sensitive and flexible management can be helpful for women at this time. Working conditions should be assessed to consider the specific needs of menopausal women and ensure that the working environment will not make their symptoms worse. Particular strategies might include: fostering a culture whereby employees feel comfortable disclosing health problems, allowing flexible working, reducing sources of work-related stress and reviewing workplace temperature and ventilation. Information about the menopause and strategies for coping with symptoms at work should also be provided. This can come from both formal (provided by employers and occupational health departments) and informal networks of working women who have experienced the menopause.
These and other recommendations presented in EMAS’ position statement are published in the article “EMAS recommendations for conditions in the workplace for menopausal women” (doi:10.1016/j.maturitas.2015.12.005), Maturitas published by Elsevier.
Journal Maturitas Publishes Position Statement on Testosterone Replacement Therapy in the Aging Male
Amsterdam, November 18, 2015 –Journal Maturitas today announced the publication of a position statement by the European Menopause and Andropause Society (EMAS) covering testosterone replacement therapy in the aging male.
Late-onset hypogonadism (LOH) represents a common clinical entity in older men. It is characterized by the presence of symptoms (most usually of a sexual nature, such as decreased libido, decreased spontaneous erections and erectile dysfunction) in combination with low serum testosterone concentrations. Whether testosterone replacement therapy (TRT) should be offered to those individuals is still under extensive debate because of the uncertainties regarding risk of cardiovascular disease and prostate cancer. The position statement provides a practical guide to the use of testosterone replacement in older men.
The overall conclusion is that a general policy around offering TRT to all aging men with low testosterone concentrations is not recommended. It is always advisable to encourage older men with LOH to undertake lifestyle modifications, including weight loss, increasing exercise, stopping smoking and reducing alcohol intake before considering starting TRT. The assessment procedure should include individual evaluation of co-morbidities and careful risk versus benefit estimation; TRT should be very carefully weighed up in testosterone deficient older men with or without pre-existing heart disease, until evidence from large randomized prospective trials regarding cardiovascular safety becomes available.
Older men should be able to discuss testosterone replacement therapy with their health professional so that shared and informed decisions can be made.
These and other recommendations presented in EMAS’ position statement are published in the article “EMAS position statement: Testosterone replacement therapy in the aging male” (http://dx.doi.org/10.1016/j.maturitas.2015.11.003) in Maturitas published by Elsevier.
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About European Menopause and Andropause Society (EMAS)
EMAS promotes the study of midlife health through its journal, congresses, schools and website and encourages the exchange of research and professional experience between members.
Using a range of activities and through its affiliates, EMAS aims to guarantee and provide the same standard of education and information throughout Europe on midlife health in both genders. Recognizing the issues arising from increased longevity the society also provides articles, patient information, web resources, and referrals for healthcare providers in the field and keeps its members up-to-date. For more information go to: http://www.emas-online.org
Maturitas is an international multidisciplinary peer reviewed scientific journal of midlife health and beyond, publishing original research, reviews, consensus statements and guidelines. The scope encompasses all aspects of postreproductive health in both genders ranging from basic science to health and social care. http://www.maturitas.org/
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