New study reassures postmenopausal women about safety of vaginal estrogen.

Postmenopausal women using vaginal estrogen are not at increased risk of cardiovascular disease and cancer reports the result of study published August 14, 2017 in Menopause.

This is another important study conducted using data from Women's Health Initiative(WHI) observational study which tracked the medical history and health habits of 93,676 women nationwide for 8-12 years. The current study recruited 45,663 women between 50-79 years of age, across 40 US clinical centers. These women did not use systematic estrogen and underwent a median follow-up of 7.2 years.

Results of this prospective observational cohort study showed that in women with intact uterus and using vaginal estrogen, the risk of cardiovascular event, pulmonary embolism, stroke, invasive breast cancer, endometrial and colorectal cancer does not exceed the risk faced by non-hormone users.

Women using vaginal estrogen had 32% lower risk of global index event (GIE), defined as time to first occurrence of coronary heart disease (CHD), invasive breast cancer, stroke, pulmonary embolism, hip fracture, colorectal cancer, endometrial cancer, or death from any cause as compared to non-users (GIE adjusted hazard ratio 0.68, 95% confidence interval 0.55-0.86).

Surprisingly, in Hysterectomized women the composite risk of GIE or individual event did not differ much among users and non-users (GIE adjusted hazard ratio 0.94, 95% confidence interval 0.70-1.26).

Based on the results of this trial, US FDA is considering a proposal to revise the warning labels on low dose estrogen packaging to incorporate the safety profile of vaginal estrogen.

Current labels were approved before any evidence was put forth about safety of vaginal estrogen and it may discourage patients from using topical estrogen which are safe and highly effective in treatment of genitourinary symptoms of menopause. 

Different formulations like topical creams, an intravaginal insert, and an intravaginal ring have the same safety and efficacy.

JoAnn Pinkerton, MD, executive director, North American Menopause Society (NAMS), said in a  position statement released by North American Menopause Society on August 17, “These findings should reassure women and their healthcare providers that low-dose vaginal estrogen, which keeps blood levels within the normal postmenopausal range, is effective and safe for postmenopausal women who need relief from only vaginal symptoms,” says Dr. JoAnn Pinkerton, NAMS executive director. “The boxed warnings about the risk of heart disease, stroke, blood clots, and cancer do not apply to these low-dose vaginal therapies. Instead, women who experience bleeding or those with breast cancer should include their healthcare providers and oncologists in deciding about this option.”

Access the Abstract, NAMS position statement.

Evidence link habitual physical exercise to proven health benefits in postmenopausal women.

Habitual physical exercise incorporated into daily life have proven benefits in improving many health parameters and quality of life in post-menopausal women. Multiple studies have beneficial impact on many organs and systems.

Members of the Spanish Menopause Society, Spanish Cardiology Society and Spanish Federation of Sports Medicine convened to formulate the recommendations on physical activity for older women and they also reviewed the quality of evidence for the various possible health benefits of exercise.

The new position statement was published in the forthcoming issue of Maturitas.

The panel concluded that resistance and weight training improves the bone health and also improves osteoporosis, benefits not seen by walking alone. But, walking is preferred by many postmenopausal women. In addition, it helps maintain the muscle mass, improves movements and flexibility.

Specific form of exercises like Pilates improves balance and thereby reduces the risk of fall and fractures, a major cause of morbidities in elderly.

Regular and intense exercise has been said to improve sleep quality, reduces anxiety and depression and decrease pain due to fibromyalgia and other chronic conditions. But it needs to be performed regularly and over extended period of time.

Dr. Wolfgang Kemmler of the University of Erlangen-Nuremberg in Germany told Reuters health via email “A plethora of randomized controlled studies determined the positive effect of 'exercise' on risk factors, diseases or complaints related to menopause or increased age. "However, 'exercise' is a rather comprehensive term: there are numerous variations of exercise regimen that may emphasize speed, strength, power, endurance, or coordination."

A British study found that women who are active 3-6 times a week, reaped cardiovascular and cerebrovascular benefits, including protection against blood clots.  Menopause is a good time of life to introduce exercise as a part of daily routine.  

He also opined that most postmenopausal women and elderly people in Germany and US do not do the recommended amount of exercise.

"Thus, the critical issue is much more, whether a single multi-purpose (weekly) exercise program conducted with reasonable exercise frequency (2-3 sessions) and duration (45-60 min) is effective in reducing the most important postmenopausal risk factors and complaints," he said.

The study author  Antonio Cano Sánchez quoted that "Thus, the critical issue is much more, whether a single multi-purpose (weekly) exercise program conducted with reasonable exercise frequency (2-3 sessions) and duration (45-60 min) is effective in reducing the most important postmenopausal risk factors and complaints." 

He also said that to guard against osteoporotic bone loss, a lot of muscle training and high endurance exercise needs to be put in, but some light physical exercise may protect against risk of falling which is as good as good bone density in the event of fragility fracture.

A group exercise class is very good for boosting mood, socializing and motivation to come to the gym daily.

So, mixing endurance, general coordination and resistance exercise is the best choice for postmenopausal women including a balancing aspect for older or less functional women.

 The study highlights by de Guevara, Nicolás Mendoza Ladrón et al are:

1. Physical exercise is a principal strategy for preventing and treating sarcopenia and its effects by increasing muscle mass and function.
2. Physical exercise improves flexibility, balance, and physical function, and corrects disability.
3. Physical exercise reduces the risk of cardiovascular disease in postmenopausal women.
4. Both aerobic exercise and strength exercises can partially or totally counteract the changes associated with metabolic syndrome in sedentary postmenopausal women.
5. Physical exercise is inversely related to the risk of dementia and improves the cognitive function of middle-aged women.
6. Physical exercise improves osteoarticular pain in postmenopausal women with fibromyalgia or breast cancer

References:

http://www.maturitas.org/article/S0378-5122(16)30096-2/fulltext

http://www.ncbi.nlm.nih.gov/pubmed/27137981

http://webcache.googleusercontent.com/search?q=cache:http://uk.reuters.com/article/us-health-fitness-post-menopause-idUKKCN0YB1Q0