Editorial Post Reproductive Health 2015, Vol. 21(2) 43–44 ! The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2053369115590113 prh.sagepub.com
Editorial Heather Currie and Eddie Morris Editors, Post Reproductive Health
As we approach the Conference that marks the 25th Anniversary of the BMS it is only right that our editorial marks this occasion. Twenty-five years of a specialist society is a significant event, especially if you reflect on what has happened in the field of the management of the menopause over that time. When the society was founded in 1989 with Tony Parsons as the founder chairman with Pat Paterson and Margaret Upsdell as the key staff members, who would have thought we would have seen such a major upset in our understanding of the care of women from the perimenopausal years and beyond? In the early years of research into the menopause, way before the formation of the BMS, there was an urge to know more detail about the changes in the female body as a consequence of the physiological decline of hormones. When the BMS was formed, the logic of replacing available hormones was by then well understood. It also appeared quite straightforward, especially when relatively simple yet groundbreaking research from the 1970s and 1980s established that hormone replacement all but eliminated the suffering from hot flushes and night sweats, prevented bone loss, but most of all improved the overall quality of life of the many women enrolled in these early studies. There is little doubt that the BMS and its founders were part of the global rush to establish whether hormone replacement was doing more than just improving quality of life and bone mineral density for the woman in her post reproductive years. In the early 1990s, when we joined the society, there was the infectious prospect from basic science research that hormone replacement had the potential to improve cardiovascular health, reduce cardiovascular morbidity and prevent early deaths. Such was the quality of the data that many units set up specialist clinics involving menopause experts working alongside cardiologists. The possible risks of long-term use of HRT inevitably started to appear as long-term observational studies published their results. The risk that seemed to attract most attention was breast cancer. We know now that in the late 1990s the available data tended to confuse professionals and public alike, yet those of us practising in a pragmatic fashion would warn
women of a small potential increase in risk, yet to be determined. At this point it was pretty clear that individual women had to make individual choices guided by a doctor’s interpretation of their particular circumstances. The good news, it seemed to many, was that during the early 1990s the ‘definitive’ study was starting in the USA. This, the Women’s Health Initiative, was designed to be the definitive study to answer all our questions. It was a multi-million dollar study and was randomised, blinded and recruited over 68,000 women. What could possibly go wrong? We do not plan to argue the thousands of pro- and anti-WHI points here but suffice it to say the WHI study has not only done a huge amount to help post reproductive healthcare, but we feel has also done a massive disservice to thousands of women. In a nutshell, we feel that because the initial reporting was, with the benefit of hindsight, overly sensationalist and because the headline risk calculations have seemingly changed over the years, the interpretation of its findings have confused all but the stalwarts in the specialty. When the impact of the WHI is combined with the impact of the Million Women Study, there has been an enormous effect on women’s health. Whether the effect has arisen out of negative media coverage, confused patients, unsure healthcare professionals or non-evidence-based statements from the world’s regulatory authorities, what we do know is that the high numbers in both these studies will influence for decades any meta-analyses and systematic reviews. This means that the harmful legacies from these widely criticised studies will live on for decades. In the United Kingdom, later this year NICE will produce guidelines into the management of the menopause. We very much hope that these guidelines will highlight a wider acceptance of the fact that highquality intervention in the early years of the menopause with or without HRT is the vital element of preventative medicine in post reproductive health. Whilst lifestyle changes are a key part of these interventions, there are many studies (the WHI included) that show that early intervention with HRT can save lives – even taking into account the increased incidence of the various potential other risks with HRT.
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44
Post Reproductive Health 21(2)
What we have lost though is not the identification of the population but the willingness of the population to come through the door. The publication of the NICE guidance will nudge many more women to come, but will this be sustained? We feel that it is important for all of us to look towards mechanisms to keep women coming. The BMS will lobby the NHS and the government to make the ‘MOT’ at the menopause an integral part of UK healthcare. We are now at a significant crossroads – we need to plan for the next 25 years of the BMS. We have long wished for the ultimate UK research study into the
right population (i.e. early postmenopausal women) receiving estradiol-based HRT. The problem is that the WHI pulled the rug from under our feet such that it is going to be nigh impossible to find the funding for this type of study. Perhaps, rather than a solely HRT-based study, we should commission a much more holistic longitudinal study into the management of women as they enter the menopause that follows women through the journey, rather than substantially altering the path that they take.
Downloaded from min.sagepub.com by guest on November 15, 2015
Editorial Heather Currie and Eddie Morris Editors, Post Reproductive Health
As we approach the Conference that marks the 25th Anniversary of the BMS it is only right that our editorial marks this occasion. Twenty-five years of a specialist society is a significant event, especially if you reflect on what has happened in the field of the management of the menopause over that time. When the society was founded in 1989 with Tony Parsons as the founder chairman with Pat Paterson and Margaret Upsdell as the key staff members, who would have thought we would have seen such a major upset in our understanding of the care of women from the perimenopausal years and beyond? In the early years of research into the menopause, way before the formation of the BMS, there was an urge to know more detail about the changes in the female body as a consequence of the physiological decline of hormones. When the BMS was formed, the logic of replacing available hormones was by then well understood. It also appeared quite straightforward, especially when relatively simple yet groundbreaking research from the 1970s and 1980s established that hormone replacement all but eliminated the suffering from hot flushes and night sweats, prevented bone loss, but most of all improved the overall quality of life of the many women enrolled in these early studies. There is little doubt that the BMS and its founders were part of the global rush to establish whether hormone replacement was doing more than just improving quality of life and bone mineral density for the woman in her post reproductive years. In the early 1990s, when we joined the society, there was the infectious prospect from basic science research that hormone replacement had the potential to improve cardiovascular health, reduce cardiovascular morbidity and prevent early deaths. Such was the quality of the data that many units set up specialist clinics involving menopause experts working alongside cardiologists. The possible risks of long-term use of HRT inevitably started to appear as long-term observational studies published their results. The risk that seemed to attract most attention was breast cancer. We know now that in the late 1990s the available data tended to confuse professionals and public alike, yet those of us practising in a pragmatic fashion would warn
women of a small potential increase in risk, yet to be determined. At this point it was pretty clear that individual women had to make individual choices guided by a doctor’s interpretation of their particular circumstances. The good news, it seemed to many, was that during the early 1990s the ‘definitive’ study was starting in the USA. This, the Women’s Health Initiative, was designed to be the definitive study to answer all our questions. It was a multi-million dollar study and was randomised, blinded and recruited over 68,000 women. What could possibly go wrong? We do not plan to argue the thousands of pro- and anti-WHI points here but suffice it to say the WHI study has not only done a huge amount to help post reproductive healthcare, but we feel has also done a massive disservice to thousands of women. In a nutshell, we feel that because the initial reporting was, with the benefit of hindsight, overly sensationalist and because the headline risk calculations have seemingly changed over the years, the interpretation of its findings have confused all but the stalwarts in the specialty. When the impact of the WHI is combined with the impact of the Million Women Study, there has been an enormous effect on women’s health. Whether the effect has arisen out of negative media coverage, confused patients, unsure healthcare professionals or non-evidence-based statements from the world’s regulatory authorities, what we do know is that the high numbers in both these studies will influence for decades any meta-analyses and systematic reviews. This means that the harmful legacies from these widely criticised studies will live on for decades. In the United Kingdom, later this year NICE will produce guidelines into the management of the menopause. We very much hope that these guidelines will highlight a wider acceptance of the fact that highquality intervention in the early years of the menopause with or without HRT is the vital element of preventative medicine in post reproductive health. Whilst lifestyle changes are a key part of these interventions, there are many studies (the WHI included) that show that early intervention with HRT can save lives – even taking into account the increased incidence of the various potential other risks with HRT.
Downloaded from min.sagepub.com by guest on November 15, 2015
44
Post Reproductive Health 21(2)
What we have lost though is not the identification of the population but the willingness of the population to come through the door. The publication of the NICE guidance will nudge many more women to come, but will this be sustained? We feel that it is important for all of us to look towards mechanisms to keep women coming. The BMS will lobby the NHS and the government to make the ‘MOT’ at the menopause an integral part of UK healthcare. We are now at a significant crossroads – we need to plan for the next 25 years of the BMS. We have long wished for the ultimate UK research study into the
right population (i.e. early postmenopausal women) receiving estradiol-based HRT. The problem is that the WHI pulled the rug from under our feet such that it is going to be nigh impossible to find the funding for this type of study. Perhaps, rather than a solely HRT-based study, we should commission a much more holistic longitudinal study into the management of women as they enter the menopause that follows women through the journey, rather than substantially altering the path that they take.
Downloaded from min.sagepub.com by guest on November 15, 2015
![[On the 25th anniversary of the PAPPS ].](/assets/img/hold.png)
