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The Hormone StoryTranscript
Healthy Ageing Hormone Story highlights - Sept 2022
[Image appears of text on a black screen: Co-branded slide, Highlights from our online event: The Secrets of Healthy Ageing – The Hormone Story, Professor Cassandra Szoeke, 1 Sept 2022]
[Image changes to show a new slide showing the Healthy Ageing Project and University of Melbourne logos and text appears: Secrets of Women’s Healthy Ageing, The Hormone Story, Professor Cassandra Szoeke]
Peggy Stasinos: So, today is the second webinar that we’re having around healthy ageing. The first one that we had back in March was a runaway success and due to popular demand, we have decided to host another one. This time, we’re talking about hormones. So, in today’s session, and in recognition of Women’s Health Week, Cassandra will discuss the importance of hormones in ageing and the hormonal impacts on the three leading causes of death, be they dementia, cardiovascular disease, and heart disease as well.
Prof Cassandra Szoeke: Thank you so much, Peggy, for that great introduction.
[Image changes to show a new slide showing text: Overview, Healthy Ageing, Beyond Bikini Health, Living Longer Living Better, Living Younger, Health/Mood, Hormones]
So, you know, as Peggy was saying, last time I talked about healthy ageing, beyond bikini health, living longer, living better, living younger, health and mood, and barely touched on hormones, because it’s a whole talk in itself.
[Image changes to show a new slide showing interconnecting circles showing the connection between the brain, body and heart, a diagram of S4 Lifestyle, and text appears: Overview, What are hormones, Menopause, Pre & Post Estrogen Health, Bone – Osteoporosis, Heart and Vessels – Heart Disease, Stroke, Brain – Dementia, Q & A]
So, today, I’m going to talk about the hormones. I’m going to, of course, talk about menopause, and really look at that pre and post estrogen health, specifically focussing on bone, heart and vessels, and brain, but I promise given the new guidelines, I will actually share with you the brand new 2022 guidelines that really cover more aspects of ageing than just these three big ones.
[Image changes to show a new slide showing text: Why don’t we know enough?]
Well, we just don’t know enough.
[Image changes to show a new slide showing a diagram of the average age of death over the centuries from the 17th to the 21st Century, and text appears: Ageing is relative]
It was only in the 20th Century, and really the 21st Century, now, 21st Century, we’re living a third of our lives in post-menopause. So, you know, again, when we talk about this natural menopause, at the time we had a natural menopause, people were not living in the post-menopause. When you’re living until 80 and a third of your life is post-menopause, it changes the whole equation of what we consider healthy ageing.
[Image changes to show a cartoon on the right showing different animals looking into a store named “One-Size Fits All Store”, and hormone therapy information and text appears: Hormones, 8, Hormones, Hormone Therapy – A Knowledge Frontier]
So, of course the other issue is, one size doesn’t fit all. We all know, in terms of hormones, there’s different hormones for all of us, and so given we have so little knowledge, then trying to tailor it for individuals becomes really complicated,
[Image changes to show a new slide showing text: Why is it worth finding out?]
and I really wanted to start with why, even though we don’t know this, why is it so important that we find it out? Why is it worth finding out?
[Image changes to show a new slide showing a graph of the leading causes of death, standardised death rates, 2009 – 2018, and text appears: Heart and Brain Disease]
Well, this is a graph from ABS showing the leading causes of death, and what you can see here is that actually we’re declining. So, ischemic heart deaths are declining, stroke deaths are declining, even cancer deaths are declining, although not as much. There is one thing on this chart that is going up, and it’s the green line, and it’s dementia.
[Images shows a line graph appearing on the right of the slide showing the deaths from cardiovascular disease]
[Image changes to show a new slide showing different articles about arthritis, stroke, Alzheimer’s, and text appears: Women over 50 have more chronic disease and disability than age-matched men, Women are more likely to have Depression, Heart Disease, Stroke, Dementia, Arthritis, Autoimmune Diseases, Asthma]
The other really important reason we look at this in women, and look at hormones, is the heart disease story. The other really important reason we have to look at this is, I told you the mean age of menopause is 52, so women over 50 have more chronic disease and more disability than age-matched men.
[Image changes to show a new slide showing text: Menopause]
So, what’s menopause?
[Image changes to show a new slide showing a woman on the left, and then symbols of menopause symptoms on the right, and text appears: Menopause Symptoms, Frequent Urination, Sleep Disorders, Weight Increase, Irregular Menstruation, Fatigue, Dry Eye, Reduced Libido, Hot Flushes, Changes of Mood]
And what you can see is, I know we often think of menopause as a very women’s bits disease, but even just on a random search, when you look at the menopausal symptoms, OK, the frequent urination, the menstrual irregularities, and reduced libido, could be associated with what we consider female sexual organs, but predominant symptoms are sleep disorders, fatigue, hot flushes, weight increase, dry eyes, and changes of mood.
[Image changes to show a new slide showing a line graph of FSH, LH, Estrone and Estradiol levels in menopause]
Basically, menopause is the time where estrogen goes to nothing. The FSH and LH hormones are actually higher-level hormones which control the production of estrogen.
[Image changes to show a new slide showing text: Estrogen, Lack of estrogen leads to Atrophy, Skin, Bone, Connective Tissue, Muscle, Brain, “The Change” – also changes the brain, Cognition and memory, Anxiety and Depression, Fatigue and Sleep]
Suffice to say that menopause causes estrogen deficiency because if you don’t have enough estrogen, you get atrophy. And that’s what I want to say, because yes, it means your skin’s thinner, yes it means your bones start melting, yes it means the connective tissue’s not so good, the muscle can actually shrink, the brain can actually shrink. But if you think of all of these things as estrogen leads to atrophy and that’s actually what’s going on.
[Image changes to show a new slide showing a brain at the centre, and then boxes linked to the brain showing different areas the brain is responsible for, and text appears in the boxes: Vasomotor symptoms and sleep disruption, Mood and cognitive functions – neuroendocrine activity, Urogenital symptoms, libido and sexual arousal, Skin ageing and hair changes, Bone remodelling, Muscle changes, Metabolic and cardiovascular changes]
OK, there’s the brain on estrogen, from Nature Review’s Endocrinology, that’s how complicated estrogen’s role is, just in the brain, just in the brain.
[Image changes to show a new slide showing text: Estrogen Deficiency (Level I and II Evidence, Fracture, Cardiovascular Disease, Heart failure, Diabetes, Bone loss, Dementia, Depression, Persistent VMS, Loss of fertility, Genitourinary symptoms, Sexual dysfunction, Cognitive decline, Mood changes, Poor quality of life, Open-angle glaucoma, Overall Mortality]
So, you know, in summary, you can see here, all at Level I and II levels of evidence, all of these diseases and risk factors are increased.
[Image changes to show a new slide showing text: Brain Health, 2, Brain – Health from the head down, Your brain is your control and command centre, It connects with everything else, Use it or lose it, What you eat and drink, and how you move affects your brain, Let it restore through sleep]
So, now I’m going to go into each of the kind of broad areas and try not to be too detailed.
[Image changes to show a new slide showing various articles about Alzheimer’s Disease]
So, you know, brain, I’m doing first, because that’s where I’m really going to get too detailed. Look, it is the leading cause of death in women, not just in Australia, it’s also the leading cause of death in UK and there’s been now, so many reports internationally by Alzheimer’s Association US and International, two thirds of all dementia cases are female.
[Image changes to show a new slide showing a line graph on the right, and text appears on the left: Duke University ADNI, Rate of decline in ADASCOG, men – 1.05 points per year, women 2.3 points per year, Adjusting for age, education, baseline, Mini Mental State Examination score, follow up time and ApoE4 status, the effect of gender on ADAS-Cog rate of change was significant (p=0.005)]
So, you know, there’s a real issue in women around cognitive decline after the menopause, but not before,
[Image changes to show a new slide showing a line graph on the right of the Collation of hormone and neuropathological timelines, and Alzheimer’s Disease articles on the left]
and this is what we published in the Sex and Gender Differences in Alzheimer’s Disease, that you know, I mean, I’m all for coincidences, but there’s something to be said for the fact, and this is this collation of two published works here, showing as your FSH and LH change, as your estrogen goes down at the same time amyloid’s going up, and brain metabolism is going down. So, you know, it could be a coincidence, but I’m not a big believer in coincidence.
[Image changes to show a new slide showing a line graph showing levels of Amyloid/TAU, Brain Activity, and Estadiol from Under 40 through to Over 60]
So, this is the simplistic diagram that we popped into the book, just showing, you know, x marks the spot of this final menstrual period.
[Image changes to show a new slide showing a review article of “Sex hormones, vascular factors and cognitions” in the Frontiers in Neuroendocrinology]
[Image changes to show a new slide showing an article from the JCEM Endocrine Society, and text appears highlighted in the article: “clearly showed that younger women and those close to menopause had a very beneficial risk-to-benefit ratio”]
So, look, you know, in summary, there’s a lot of people who’ve for some time now, been saying, there’s clearly a benefit in younger women,
[Image changes to show a new slide showing a diagram showing Age Range Observational Work]
and we’ve got to work out this risk-to-benefit ratio. We published in the Frontiers, this chart, which shows, if you commence hormone therapy around 45, you get these benefits to heart disease, benefits to cognitive decline, but if you commence it afterwards, you’re getting these risks more than benefits,
[Image changes to show a new slide showing articles from the JCEM about HRT and menopause]
and so really, the timing, the initiation and the individual risk is really important, and these are the studies that talk about the cancer risk, and show looking at worldwide evidence, it’s actually a really small risk. So, what is the position statement, and then I’ll open for questions.
[Image changes to show a new slide showing text: Recommendations (2022), NAMS Position Statement, The 2022 hormone therapy position statement of The North American Menopause Society]
[Image changes to show a new slide showing information about hormone replacement therapy in women under 52, and text appears: In the absence of contraindications, hormone therapy is recommended, at least until average age of menopause (approximately 52), with an option for use of oral contraceptives in healthy younger women (Level II), Results of the WHI trials in older women do not apply to women with POI or premature or early menopause (Level II), In women with BO before average age of menopause early initiation of ET, with endometrial protection if the uterus is preserved, reduces VMS, genitourinary symptoms, risk for osteoporosis and related fractures, and likely CVD and overall mortality, with benefit seen in observational studies for CV mortality and cognitive impairment or dementia (Level II)]
In the absence of contraindications, hormone therapy is recommended, at least until average age of menopause (approximately 52),
[Image changes to show a new slide showing graphs explaining the CEE Trial and the CEE + MPA Trial]
but that recommendation doesn’t extend if you’re older, because they’re saying everyone’s got to have a different ratio of risk.
[Image changes to show a new slide showing a photo of Cassandra Szoeke, and text appears: Thank you for your attention, https://medicine.unimelb.eduau/research-groups/medicine-and-radiology-research/royal-melbourne-hospital/health-ageing-program/healthy-ageing-project]
Thanks so much for your attention.
[Image changes to show a new slide showing a programme for the series, and text appears: Co-branded slide, Join us for more event in the Healthy Ageing Series, Secrets of Healthy brain, Secrets of Healthy skin, bones and balance, Secrets of healthy nutrition, Secrets of healthy hearts]