2023 AMS Menopause Congress Highlights

Eleven WellFemme doctors made the trip to Queenstown, NZ for the annual Congress of the Australasian Menopause Society.

With so many brains in attendance we have an abundance of fantastic information to impart… but too much for one post! Here’s our first instalment, with more for you in coming months.

Sydney GP Dr Laura Wilson enjoyed the Congress as well as the skiing, scenery and nightlife of Queenstown:

Dr Laura Wilson

“This was my first AMS Congress and it was truly inspiring to see hundreds of health professionals interested in learning more about Womens Health during, leading up to and after the Menopause.

A focus for my practice going forward will be to encourage open and honest conversations with my patients about their symptoms. I’m hoping to reduce any stigma or embarrassment when talking about vaginas!

Our aim should be to continue to improve the quality of life for women in their journey towards the menopause and beyond. I now have more options in my toolkit to enable me to do this.”

One of our GP’s who travelled extra-far to New Zealand is West Australian Dr Alice Webb. Alice payed particular attention to the presentation about sleep… perhaps hoping to pick up some jetlag tips?

Dr Alice Webb

• Having a good night’s sleep after a flu vaccine increases its efficacy.
• The symptoms of sleep apnoea in women can be different and include insomnia, morning headache, fatigue, memory reduction, mood changes and passing urine overnight.
• Progesterone is a respiratory stimulant.
• Cognitive behavioural therapy (CBT) is very effective for sleep problems.
• The “Nothing Much Happens” podcasts and the like are good sleep aids.

Dr Katie Kent

Wollongong GP Dr Katie Kent was very interested to learn about dry eyes around menopause:

• It’s a common problem in perimenopause/menopause, and has an association with autoimmune conditions. Review by an optometrist is recommended exclude a sinister cause.
• First line treatment is Systane eye drops then try Hyloforte eye drops (discuss with your GP).
• Thera Tears or other lubricant eye drops can also be helpful. Avoid anything with preservatives in it!
• Oral omega 3 supplements also can be helpful.
• Blepharitis (eyelid inflammation) management can include Systane lid wipes, and hypochlor to clean lid margins and improve bacterial flora.
• Hot packs and massage are useful for meibomian gland dysfunction
• Other specialist care/ ophthalmologist treatment options: cyclosporin eye drops, topical steroids or punctal plugs.

Canberran Dr Lynda Newman not only enjoyed the Congress, but some incredibly beautiful hiking and sight-seeing during her stay.

“We had a lecture on nonhormonal treatment of menopause symptoms by [Endocrinologist and AMS Past President] Dr Sonia Davison. I am a great supporter of hormonal therapy but it was good to review the nonhormonal options, which I always go through with patients.

Dr Lynda Newman

Pearls of wisdom from this were that having extra weight is “like having a puffy jacket on all the time, it insulates you and you feel your hot flushes more”.

Psychological strategies can help hot flushes too, and Sonia suggested reading “Managing Hot flushes and night sweats” by Myra Hunter. I have not read this book but will order it – Sonia seemed to think it was terrific.

It was a great conference with eleven WellFemme doctors there! Probably more than any other women’s health group.”

Dr Helen Demetriou

Dr Helen Demetriou from Sydney took particular note of the cardiology presentation and the latest European cardiology guidelines. When to get a coronary calcium scan is always confusing, and she noted:

• Coronary calcium scoring is validated for screening in women, with a higher predictive value than in men [which means it can more accurately predict women at higher risk than men- KT]
• Coronary score recommended for symptomatic women and those at intermediate cardiovascular risk [5-10% risk on the Aus CVD Risk calculator- KT]
• Hypertension (high blood pressure) remains the most critical risk factor. Systolic BP (the top number) is the most important indicator of risk with ageing.
• Sodium (salt) sensitivity increases in the menopausal transition.
• People with autoimmune, endocrine and rheumatic disorders have an increased cardiovascular risk.
• Worse menopausal vasomotor symptoms (flushes and sweats) can be associated with unfavourable cardiovascular risk profile.
• Autonomic [nerve] dysfunction enhances heart rate variability after menopause [likely contributing to palpitations- KT]
• MHT (except vaginal oestrogen) is not recommended if high risk or already had a cardiovascular event.

Dr Michelle Cotellessa from Perth had some great take aways about contraception at menopause:

“MHT is NOT contraceptive!
We generally stop the combined contraceptive pill at age 50, however in women who are healthy with no risk factors (and after individual risk benefit discussion) it could be considered for another 6-12 months.

Stop depo-provera well before 50 years because of its effects on reducing bone density.

Dr Michelle Cotellessa

Other progesterone-only contraceptive methods can be continued after 50 though:

• Progesterone only pills
• Implanon
• Levonorgestrel IUCD ( mirena) and Kyleena

If inserted after the age of 45 years Mirena can be used for contraception until 55 (off-label for extended use), BUT Mirena if used for endometrial protection as part of menopause hormone therapy must be replaced after 5 years.

If you are under 50 years contraception is recommended until 2 years after the final period, and for over 50’s contraception is recommended until one year after the final period.

Most women can stop contraception at age 55 years

Don’t forget non-hormonal options: vasectomy, barrier methods like condoms (super-important for STI prevention with new partners) and the copper IUD, and salpingectomy (tubes removed).” [This is often considered at the time of other gynae surgeries- KT].

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