Abstract
The 6th Malaysian Congress on Menopause, ‘The Return of Hormonal Therapy’, was held in Kuala Lumpur, Malaysia between the 6th and 8th April, 2007. The Scientific Programme Committee developed a varied, interesting and scientifically based programme. The congress definitely provided a well informed and updated education on cutting-edge science. The extensive program covered all aspects of climacteric medicine over 3 days. Both Malaysian and foreign speakers had the opportunity to share expert knowledge and the attendees were given the chance to participate in the discussion. Thanks to the effort of the Organizing Committee, and particularly of Raman Subramaniam, Chairman of the Scientific Programme Committee, Premitha Damodaran, Vice President of the Malaysian Menopause Society and Nik Nasri the President of the Society, the program was outstanding. The presentations were given from speakers with a profound background in reproductive endocrinology. The most important topics were the epidemiology of menopause in the Asia–Pacific Region, and the effects of HRT on general wellbeing in Asian, and particularly Malaysian, women. The title of the congress, ‘The Return of Hormonal Therapy’ was also the subject of almost all the presentations. After the scare induced by the interpretations of the Women's Health Initiative trial, the return of HRT in clinical practice during the presentations was considered more than welcome for the wellbeing of all postmenopausal Malaysian women, as for all women around the world.
In the President's Lecture 2007, ‘Menopause Management in Malaysia An overview’, Nasri highlighted the attitudes, needs and preferences of Malaysian women during the climacteric. Yeap Swan Sim (President, Malaysian Society of Rheumatology) gave an important lecture on musculoskeletal problems in the menopause. The importance of hypertension and diabetes in the menopause, particularly in Malaysia, was presented by David Quek. Urogenital problems and pelvic organ prolapse (Loh Chit Sin and Seri Suniza, Malaysia), as well as the bleeding in postmenopause (SK Khoo, Betty Byrne Henderson Women's Health Research Centre, Brisbane, Australia) were also discussed. Khoo also discussed the topic of ‘Hormones and the menopausal woman: new evidence on the heart and brain’, including all the new evidences of the beneficial effects of HRT in young, healthy perimenopausal women. These topics were further analyzed by Delfin Tan (United Doctors' Medical Center, Quezon City, Philippines) in two different lectures on ‘Cardiovascular system and the menopause’ and ‘Practical HRT: why, when and how?’, which underlined the concept of the window of opportunity for HRT prescription in perimenopausal women suffering from estrogen-deprivation-related symptoms. Reviewing almost all the guidelines available around the world, released by different menopuase societies, it emerged that HRT should be prescribed whenever indicated: menopause per se is not a disease, it does not need a therapy. Hormones are not drugs meant to cure diseases, but they can (and should) be replaced if needed. As was underlined in different presentations, including those by Marco Gambacciani (Pisa University Hospital, Pisa, Italy), this is not merely semantic. Definitions do reflect meanings and interpretations. The use of hormones in early menopause and up to age 60 years has a very minor potential for harm, but may carry substantial benefits. Hormone administration for symptom relief started during perimenopause is different from hormone initiation 10 or more years beyond menopause for non-symptom-related indications. In addition, HRT cannot be regarded as one single entity, as under this wide definition is included a wide range of hormonal products that share some common features, but have different strengths, routes of administration, specific characteristics and, thus, different clinical indications and risk:benefit ratios. Women should decide annually if they wish to continue with treatment after consultation with their caregivers. Psychological problems after the menopause (Rabin Gonzaga, Malaysian Mental Health Association, Petaling Jaya, Malaysia) and the effects of hormones on the brain (M Gambacciani) were discussed. All these aspects that can affect the quality of life and general well-being of women undergoing menopause and HRT were also presented by Ruban Nathan (Kuala Lumpur, Malaysia) and Khoo. Gambacciani also covered the topic of breast and the menopause. During the lecture and the discussion, it was underlined that the incidence of breast cancer varies in different countries, and thus currently available data cannot necessarily be generalized. The lecture concluded that there is no scientific evidence for estrogens to cause breast cancer. Similar points were raised by Rodney Baber (Royal North Shore Hospital, Sydney, Australia) on other cancers in post-menopausal women, mainly in relation to hormone use. As for the general effects of HRT on a woman's body, the major conclusion was that the effects of HRT on the breast can not be considered as a class effect. In particular, Baber, in his presentation ‘The choice of menopause therapy and cancer risks’, reviewed the data on tibolone, suggesting that different hormones can have different tissue selectivity and, thus, different ultimate actions on organs and systems.
During this meeting, a particular emphasis has been devoted to new HRT products that can improve patients compliance and minimize the possible side effects. New data were presented on drospirenone, the novel progestin derived from spirolactone with anti-aldosterone activity. Unlike other progestogens already available, drospirenone is a potent aldosterone antagonist that blocks the antimineralocorticoid receptor and hence has the potential to offset fluid retention. Gambacciani presented data showing that, when used in association with estradiol to treat symptomatic post-menopausal women, drospirenone induces a small decrease in body weight and blood pressure, as well as an improvement in quality of life. Drospirenone may also provide a blood-pressure-lowering effect in women with elevated blood pressure. Thus, with its unique pharmacological profile, drospirenone has the potential to prevent weight gain and reduce blood pressure, and this may result in better compliance with HRT.
The take-home message of the 6th Malaysian Congress on Menopause was: clinical guidelines should be developed by expert clinicians and Scientific Societies. All the relevant scientific societies should campaign to recreate culture and sound clinical practice in menopausal medicine as the Malaysian Menopause Society did.