Odds and ends from the World Congress on Menopause

Check out this trio of short, sharp updates on menopause-related issues.

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The 19^th World Congress on Menopause, organised by the International Menopause Society last month, saw over thousands of healthcare professionals and researchers descend on Melbourne for four days of lectures, symposia and debates.

Enjoy this selection of bite-sized takeaways from the congress!

Uncovering a genetic basis for premature ovarian insufficiency

There have been over 100 different genes linked to premature ovarian insufficiency. But, according to Dr Elena Tucker, a geneticist from the Murdoch Children’s Research Institute in Melbourne, the underlying genetic cause of POI cannot be identified in many patients through traditional genetic testing.

However, through whole exome sequencing, Dr Tucker and her collaborators have identified new genes and gene variants associated with POI.

One example of Dr Tucker’s work in this space came from a set of twin sisters, one of whom had primary amenorrhea and the other who had only three periods before experiencing secondary amenorrhea. Both sisters started to lose their hearing after they turned 24 and had a history of chronic kidney disease.

Exome sequencing revealed a variant in the MPRL50 gene, which encodes a protein in one of the subunits of the mitochondrial ribosome. Further testing, including making a fruit fly genetic knockout, confirmed the variant was associated with ovarian deficiency.

The variant has since been included in sequencing lists, which means other patients with the genetic mutation can be identified long before they begin to experience symptoms.

“Because this gene is now captured in diagnostic lists, we’ve identified a new patient. She’s only four years of age, and we can predict that in her future she’ll be likely to experience ovarian decline,” said Dr Tucker.

“The benefit of knowing this early is that she can get prompt hormone replacement therapy to ensure her long-term bone and heart health. There might [also] be the potential to preserve fertility before it’s all lost.

“We believe genetic testing really does have the potential to improve patient outcomes, but it needs to be done in a very careful way with genetic counselling and proper variant curation to make sure that we’re not giving inaccurate diagnoses, and that the patient’s aren’t shocked or disturbed by any potential genetic findings.”   

Depression in (peri)menopause is not the same as major depressive disorder

Speaking as part of a panel on managing mental health symptoms in menopause, Professor Jayashri Kulkarni, a Melbourne-based psychiatrist, discussed the differences between perimenopause depression differed from other types of depression.

“Let’s get that out on the table,” the director of the HER Centre Australia and the Monash Alfred Psychiatry Research Centre told delegates.

“It is unfortunately a very big myth that is out there in the general community and among health professionals.”

While the symptoms of perimenopausal depression – muscle pain, weight gain, low energy levels, decreased self-esteem, feelings of isolation, cognitive impairment and decreased libido – do overlap with the symptoms of major depressive disorder, there are important differences that need to be considered.

Perimenopausal depression is typically milder than other depressive disorders, where the primary system profile involves anger, irritability and paranoia rather than sadness. The duration of these episodes may also be much shorter (minutes to hours) and resolve spontaneously.

Professor Kulkarni and colleges developed the Meno-D rating scale – a 12-item questionnaire assessing the key factors of self, sexual symptoms, somatic symptoms, cognitive symptoms and sleep – to ensure perimenopausal women experiencing these milder depressive symptoms weren’t missed by other clinically used screening tools.

“The traditional major depressive rating scales are excellent for men with depression and for women in younger age groups… but they’re not good for this kind of depression. They will miss the subtle symptoms, which is why there are difficulties [regarding the true prevalence of perimenopausal depression],” Professor Kulkarni explained.

Alternatives to long-term low-dose antibiotics in recurrent UTIs

Dr Lynsey Hayward, a gynaecologist from Middlemore Hospital in New Zealand, told delegates at a symposium on postmenopausal pelvic floor health that she was “really concerned” about the antibiotic resistance profiles she was beginning to see in patients with recurrent UTIs, who are typically treated with long-term low-dose antibiotics.

The number one alternative Dr Hayward prescribed was Hiprex, which was recently shown to be non-inferior to low-dose antibiotics in reducing the incidence of recurrent UTIs. Hiprex, which acidifies and sterilises urine by converting hexamine into formaldehyde, is occasionally paired with vitamin C (which further acidifies the urine).

“I can’t tell you whether that’s particularly helpful or not, but it is something that they do because it seems to make sense if we think about the pathogens within the urinary tract,” Dr Hayward commented.

D-mannose and cranberry juice were cautiously recommended, with Dr Hayward noting it was “almost impossible to pick out what is helpful and not helpful” due to the large number of products available on the market.

Dr Hayward also recommended two vaccines – Uromune and Uro-Vaxom – citing studies that proved their effectiveness in reducing the rate of urinary tract infections compared to placebo.

The IMS World Congress on Menopause was held in Melbourne from 19-22 October.