Episode 10: Insights from the World Congress on Menopause
In this week’s episode, we’re diving back into the conversation around Menopausal Hormone Therapy (MHT) with fresh insights from the recent 19th World Congress on Menopause in Melbourne.
Dr Peta Wright and Dr Thea Bowler are here to share the latest findings, practical takeaways, and a few myth-busting updates on menopause care.
If you’re curious about what the world’s top experts are saying on MHT, lifestyle impacts, and menopause brain health, this is an episode you won’t want to miss.
🎧 Listen in to hear:
🌿 New perspectives on MHT – Dr Peta and Dr Thea revisit last week’s discussion to explore whether MHT should be used to prevent chronic conditions like cardiovascular disease or if it’s best reserved for symptom relief. Hear why the latest research still favours a balanced, symptom-first approach.
🌿 Lifestyle choices that matter – Discover why some lifestyle changes, like movement and stress management, can be just as powerful as hormone therapy for long-term health and vitality.
🌿 What’s happening with menopause brain health – The latest research sheds light on how menopause affects the brain, including why “brain fog” is often temporary and may even be part of an adaptive, natural rewiring.
🌿 Testosterone and menopause – Get the facts on why testosterone has a limited impact on symptoms like low libido and fatigue, and why a holistic, whole-body approach may be the best way to support wellness at this stage.
Join us for this follow-up episode as Dr Peta and Dr Thea connect cutting-edge research with practical advice that helps you make empowered, personalised choices for your health.
Additional resources mentioned in this episode:
Last week's episode – Ep 9: Menopause and Hormone Therapy – Myths, Facts and Choices.
We would love to hear from you.
If you have any questions about MHT or menopause that you’d like us to answer on a future episode of the podcast, please email them to hello@verawellness.com.au or contact us on Instagram @verawellness.com.au.
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Episode transcript:
Ep 10: Insights from the World Congress on Menopause
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Hello, I'm Dr. [00:01:00] Peta Wright and I'm Dr. Thea Bowler. Today, we're going to do a little bit of a, an update on our last week's episode because we've both just been to the International Menopause Conference, which is in Melbourne. So we've just come back from that last night. Yeah.
So I think we really wanted to update you all with the recommendations about what we actually know about What we don't know in order to help inform you about making choices regarding menopausal hormonal therapy. Because I think, well, there's, there's so much out there at the moment in the media and social media portraying menopause as a hormone deficiency that needs to be addressed. Replaced on a lifelong basis and that women should be taking HRT to prevent chronic disease. And we said, I would say we see that a lot in our patients as well – people coming in feeling worried that they need to be on hormones in order to maintain their cardiovascular bone and brain health. [00:02:00]
And so we wanted to delve into that today sort of with respect to all the things we learned over the weekend. So as per our episode last week, we've sort of, explained why breast cancer risk isn't a thing with the newer hormones that we use and that generally speaking for women who have symptoms menopausal hormone therapy is, is really great if that's the direction that they want to go more.
Benefits and harms, but this whole question of using menopause hormonal therapy as a primary prevention for things like heart disease Alzheimer's, dementia general wellbeing is something that we kind of see on social media. We see it being said that. With blanket statements like HRT decreases our risk of cardiovascular disease and death and decreases our risk of dementia and [00:03:00] this kind of panic that we need to get it in in this window of opportunity, which is within the 10 years of menopause.
And I guess it's well, well, there is some elements of truth to some of those things that actual evidence doesn't really support, well actually doesn't support, HRT for everybody as primary prevention and we want to talk about why. Yeah. So perhaps if we start with cardiovascular disease. Mm hmm.
Yeah, so, I think most of the studies show that there are improvements in cardiovascular health for women who are taking estrogen and who are taking a certain type of progestin, so either natural progesterone or a non-androgenic progesterone. Synthetic progestin and these benefits in cardiovascular health have been shown to be greater when the hormones are [00:04:00] started sort of closer to the last menstrual period.
But I think it's really important to note that there haven't been any studies that directly compare. lifestyle changes so that directly compare you know, Mediterranean diet, stress reduction, good sleep directly with the use of hormone replacement therapy. And I think that's really important because if we're just looking at the effect of the hormones and suggesting that all women take a hormone for the rest of their life.
It really, we're not being accurate when we're not thinking about the changes they could be making within their own lives. And there is evidence that estrogen affects our blood vessels and may decrease like plaque formation in our blood vessels, but there are, again, the studies are not. All saying the same thing.
So, you know, some studies that are looking particularly, there was a study called the KEEPS study, [00:05:00] looking particularly at this time, the, the, in the last few years of of the last menstrual period and using hormone therapy versus placebo in those women. And they actually did not find a a benefit to women taking hormones with their cardiovascular health.
Other studies that. Uh, like the big WHI study did show that there was a decrease in cardiovascular disease and all cause mortality or death. But not all of the the studies support it. But as a rule, I guess what we can say from all of the evidence is that it's unlikely to be, it's not going to be harmful and if there is a benefit, it's likely to be within that 10 years of menopausal perimenopausal time.
And so for women who are wanting to take or requiring. Hormones for their menopausal symptoms were likely to see that cardiovascular benefit, you know, as a side effect. Yeah, but the I would still say that there isn't data to suggest that it is better than the things that we actually know [00:06:00] help our cardiovascular disease risk.
So, they would be the most important things in terms of primary prevention. So diet, exercise, stress reduction. We, if we move to bone health or osteoporosis because currently recommendations are that HRT is safe for symptom relief and helps improve women's quality of life if that's what they choose and has a role in prevention of osteoporosis for women who are at risk.
However, even when we look at the data for HRT and osteoporosis yes, it shows that oestrogen therapy reduces osteoporosis and fracture risk. But when they did look, so there was a great study that was a randomized control study where they looked, which is the best kind of study, where they gave some people oestrogen, some people did Exercise, resistance training, weight loss exercise, and then they had another group that had both, so they exercised and were given the HRT, and the group that [00:07:00] had the biggest effect on their bone density was the exercise group, and there was not an additional benefit for those women in taking HRT.
So they'd be the kind of studies that would be really important to see for, say, cardiovascular disease. Exactly. Like whether there was a cumulative benefit or not. Exactly. So then, yes. And so then thinking about brain health, which is another really big one. And it was really fascinating because Pauline Maki, who is like the world expert on menopause and brain health was talking about the remodeling that occurs in the brain during menopause and that menopause is a time – transition point, as we know, a neuroendocrine transition point where the brain is actually changing the way that it communicates between hemispheres and really increasing its efficiency of communication, both within the hippocampus and between the two hemispheres, rather than relying. more heavily on, on one side of the brain and [00:08:00] that during that time of almost like rewiring of the brain, women are more likely to experience cognitive symptoms, which is primarily a reduction in like verbal memory.
So recalling words subjectively often described as brain fog but that this is a temporary thing and our brain is doing a wonderfully, it's a really clever and adaptive thing in in changing the way it works in response to the lowering estrogen that's occurring naturally at the time of menopause.
And then when we come through that transition, when our hormones level out at the other end, our brain is rewired and cognitive symptoms return to normal. She talked about the fact that there's a really small proportion of women who might have persistent cognitive impacts, probably around 5 to 10%.
And that, you know, these tend to be more associated with people who have higher risk factors for cerebrovascular and cardiovascular disease. So not exercising, sedentary lifestyle, [00:09:00] not eating well, all those sorts of things. And also that there seems to be a potential increase in cognitive decline with women who have severe hot flushes and vasomotor symptoms and that treatment of.
Women with those kinds of symptoms potentially with estrogen may help their cognitive decline. But then we also have to think about some of the risk factors for severe hot flushes. So like smoking, alcohol, stress, depression mood. It's really interesting when you think, when you think about it that way, because.
They talked about exactly that, so that the risk factors for cognitive or the associated menopausal symptoms that went along with cognitive symptoms were for sleep, vasomotor symptoms and anxiety and depression. And we know that there are so many lifestyle factors that can exacerbate those things as well.
Hmm. So I think it's not just as simple as I'm like, I'm having those severe hot flushes, just the [00:10:00] estrogen that may play a role, especially if your hot flushes are affecting your ability to have good quality sleep and your mood. And that, that helps to resolve that. I guess there are things that you need to tease out with cognition, sleep hot flushes.
And we'll be talking about all of the holistic approaches in another episode. So, yeah, but I think it is really important to think estrogen may play a role, but then the things that we really know can help are some of the things we'll be talking about in that next episode. And she also talked about the fact that really estrogen's effective for treating those symptoms.
So hot flushes and, and sleep disturbance primarily and, and mood often but that estrogen. Just for brain fog. So if someone's only got brain fog and nothing else, the estrogen actually doesn't do anything, which is which is interesting because a lot of women, that's the thing that they're coming in saying they want treatment for, but then I think we can really reassure those women and say, this is going to be a temporary thing is going to improve.
And it was beautiful to see her brain scans of showing the. [00:11:00] Premenopausal, perimenopausal, postmenopausal brain and all of the connectivity, the greater connectivity and the lines between everything, which was just, it almost felt like a visual representation of the getting of wisdom. That's right. It was.
It was wisdom and she referred to it as that. It was really cool. And then she also talked about her approach to managing brain fog which was really all about. Improving cardiovascular health. So doing exercise, eating well obviously not smoking, not drinking alcohol, but then lots around, you know, challenging your brain.
So staying mentally active whether that's with work or, you know, in your community and really the importance of lots and lots of social interaction was the other thing. So making sure we're remaining socially engaged. And interestingly, she did say that that increased brain connectivity post menopausally, that was associated with lower estrogen levels, because there we've gone through that transition and we have the lower estrogen levels, whereas the randomized control trials giving [00:12:00] estrogen just for cognitive decline and brain fault showed no benefit and really like it's the opposite of what you would think.
That's right. So through that transition, brain function is different and potentially improved in areas. Absolutely. Yeah. Absolutely. And then we also listened to a talk about Alzheimer's and menopause. And again, I think that was really reassuring in that, I guess this is the area for which there is the most conflicting data and ongoing research, yeah, yeah.
And lots and lots of people are doing lots of research, but I think what they spoke about was the fact that You know, there are lots of conflicting studies about dementia risk and menopause and whether or not hormones help, but that for women who have a really strong family history of Alzheimer's disease and who also have the APOE4 gene, which is one of the genetic mutations that can predispose to developing dementia, but certainly does not always do so, [00:13:00] that these women may benefit from.
Estrogen if taken early in the menopause transition and that if it's taken later in life more than 10 years after the menopause transition, that it actually potentially can be detrimental. Again, they emphasize the fact that really treating the symptoms at this point is still the way to go and not using it as primary prevention but that it's unlikely to be harmful for women who need to take it to help manage their menopausal symptoms.
They also spoke in that lecture a lot about. You know, other things that impact brain health looking at sleep and diet and exercise and all those sorts of things and found that, you know, even after one night of disrupted sleep that we see changes in the way that the brain is working in the way that the neurons are working that, you know, uh, often if, if prolonged and untreated can be a precursor to Alzheimer's as well.
Hmm. And then, Oh, testosterone. Yes. So I think [00:14:00] that's something for which, you know, many women come to see me and they were like, they, they want to know, okay, do I need to take testosterone? So I guess what we know is that testosterone has some evidence based benefit for improving desire, libido, arousal in perimenopausal postmenopausal women.
Who are reporting a low libido. I think we need to do a whole episode on libido, which we will, but basically like it's more than just how low your testosterone is. I think probably to go back to that, the thought that again, that menopause is a hormone deficiency and this idea that, you know, Testosterone deficiency is a syndrome that happens at menopause, is not based on anything either.
So some really great information was presented by Professor Susan Davis, who's like the guru in the testosterone field. That number one, testosterone levels, like underpinning all of it, interestingly, [00:15:00] testosterone levels in the female range, which is like less than three, uh, notoriously, uh, not very accurate.
No, that we actually don't have a really, really good way of measuring low levels of testosterone as it is. So, you know, that kind of makes, it's just important to think about everything else that I say next to the grain of salt, given that, uh, our testing values is probably likely to be inaccurate but that women's testosterone levels actually probably peak in our 20s and then start to decline, so not at menopause and not at perimenopause and then, interestingly, in our like late 60s and 70s, the many women may start to increase.
So it isn't like menopause isn't a disease is characterized by a drop off the cliff of testosterone like we think about with estrogen. And that, so the one thing that's proven and when we say proven. It is likely to improve women's having like one extra [00:16:00] satisfying sexual event per month. One per month.
One per month. So, so that is it in terms of like the increased. efficacy of libido and libido is ridiculously complex. And we will do a whole episode about that. And it's much, much more than just testosterone in terms of these claims that we need testosterone for general wellbeing, for mood, for energy, for joint aches and pains.
I think you hear a lot about that. And women thinking, God, I do feel tired. I do feel, Like brain foggy and not very well. And like, I think that I need testosterone cause everyone's telling me that that's what I need at this point in time. But the studies actually don't support that at all. So there's no evidence that it increases general wellbeing, improves depression.
Energy. Energy. There was, there's also been some claims around improvements in cardiovascular disease from testosterone and they were not borne out in the data either. [00:17:00] Although they did say that women with lower, with higher testosterone seem to be. had better cardiovascular outcomes, but replacing it didn't help.
So naturally occurring higher testosterone levels. And when you think about that, things that we can do to increase our testosterone levels naturally, uh, exercise, people who tend to be healthier do tend to have slightly higher levels of testosterone. So maybe it's just measuring the fact that women who are healthier have lower cardiovascular risk because they exercise may have high testosterone.
And particularly weights like that's been actually shown to improve To increase growth hormone and testosterone. Exactly. So again, like you have to be very careful when you see these studies and, uh, and you're not interpreting it through that wider context of the society we live in and all of the other risk factors.
Cause I just think it's incredibly unhelpful to be like viewing. something through a straw, which may not even be accurate when we're looking at hormone levels. That's right. And I think when you think about what's underpinning it all, like if we're like having, like you say, this really narrow [00:18:00] focus of like this one particular symptom and this one particular drug and what is the effect there.
Whereas if you zoom out and you have a whole lifestyle approach and a holistic approach, Actually, you see improvements across the board in all the symptoms and you don't need these really specialized drugs, whether they're hormones or whether they're the, you know, anti osteoporosis drugs or whatever else the lipid lowering drugs and all those sorts of things.
You don't need those if across the board, a person is healthier. And really the best way of achieving that is through lifestyle change. And we acknowledge that that's hard in the society that we live in that's incredibly sick which we spent the entire time at the conference being like, but we're developing all these drugs to help improve people's health within the confines of an incredibly sick society and not tackling the, you know, fact that our supermarket shelves are laden with ultra processed food, that we don't have time to take care of ourselves.
And, and the, the, In this world, it is really difficult for people to take care of themselves because of the way we're working, [00:19:00] because of our stress levels, because of the need to work five jobs so that you can afford to feed your family or whatever, you know?
Are there any other key takeaways? I think in the sexuality talk, which I've received a summary about, the focus was, as you say, so much more on libido being incredibly complex and not really well treated with a single approach like a drug and that much of the pharmaceutical companies just lost and really looking at, you know, connection and well being and stress and sleep and all of those things was actually the stuff that worked.
Yeah, and I think just the overwhelming feeling of you know, I mean, there was some really great talks, but we were at a conference that's funded by drug companies who make all these hormones and also that it's really difficult to do studies in the real world that are looking at lifestyle modification because they're really expensive. Who's going to pay for them? And we are living in a [00:20:00] society that makes it difficult for people.
So I think whenever we read any of these studies that such and such drug has this much percentage decrease or increase in certain parameters, we always have to be viewing it through the fact that it is a study. It's not the real world. They're not comparing it to a whole host of other interventions. So I just really encourage everybody to kind of zoom out and consider the context.
And so in summary, testosterone very small effect for libido. Not enough evidence to recommend hormone therapy as a primary prevention for cardiovascular disease, Alzheimer's or dementia. And a focus on the other lifestyle things is probably more important at this stage. And, you know, treatment of your menopausal symptoms if they're distressing, which may Include hormone replacement therapy.
That's which is safe. That's right. If you, if you want or need to take hormones for your menopausal symptoms, that it's very safe. Mm-Hmm. And if anything, may confer benefits. Yeah. And [00:21:00] Lastly, I think lots and lots of patients find that their body changes in menopause and often inquire about whether or not taking hormones will help with weight loss.
Was there anything about that? Yes. So basically there's no evidence that taking hormone therapy mitigates that weight gain. Some women who take it lose weight, some women who take it put on weight, but there's no evidence that it. It stops that and it's because weight gain at midlife is again complex and it is, yes, about our changing metabolism, which does have something to do with our hormones changing, but it's also about the fact that often women have lost muscle mass that metabolism shifts because of that more sedentary life.
More stress. More stress. Yep. Exactly. Less sleep. So yes, you know, when you think theoretically, if you have bad symptoms that are stopping you from getting sleep cause we know that poor quality sleep does have [00:22:00] a bigger effect on insulin resistance and metabolism, that potentially for those women HIT might theoretically help with their, with, with sleep.
They're way too, but there is no direct evidence that suggests that HRT does help. And yes, and I think anecdotally, like people often find that if their hot flushes are better and they're sleeping more, they have more energy to be able to actually engage in exercise and those sorts of things. But estrogen as a weight loss medication, no evidence that it helps. No. Okay. Thank you.
So, thank you again for listening and please share this if it has been illuminating in any way, because I know it can be really confusing and you don't know who to listen to. But we feel happy that this was coming from some of the world experts who are, who are doing the research right now.
And please go to our Instagram, so verawellness. com. au, send us any questions from this [00:23:00] episode as well to our email, hello at verawellness. com. au and we will see you soon. See you next time.
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This podcast is for information and educational purposes only and is not intended as a substitute for medical advice, diagnosis, or treatment.
