By David Sturdee. Menopause Clinic, Solihull Hospital, Heart of England NHS Foundation Trust, Solihull, UK
Stratford 2010 relived
Correspondence: David Sturdee, Menopause Clinic, Department of Women's Health, Solihull Hospital.
Our 20th anniversary meeting in Stratford-upon-Avon from 24 to 25 June 2010 was, by general acclamation, a very successful and happy occasion attended by 191 delegates and supported by eight trade exhibitors: Anglian, Bayer Schering, Ferring, Meda Pharma, Novo Nordisk, Novogen, Vitabiotics and Consilient Health. This is a far cry from the ‘good old days’ of the 1990s, but nevertheless it has proved that the BMS is alive and kicking and should remain a vibrant and active society that will hopefully grow with the slow resumption of hormone replacement therapy (HRT) prescribing.
The scientific programme had a distinctly different flavour to previous years with more about general health matters such as cardiovascular disease (CVD) risk, metabolic syndrome, migraine and quality of life than the more traditional HRT papers.
The meeting started with a now traditional and popular ‘Hot off the press’ session in which David Sturdee highlighted some of the recent papers of interest. One of particular clinical relevance was a study demonstrating that the use of paroxetine during tamoxifen therapy is associated with an increased risk of death from breast cancer, supporting the hypothesis that paroxetine can reduce or abolish the benefit of tamoxifen in women with breast cancer. 
One of the highlights was the Pat Patterson memorial lecture given by Professor Roger Francis (Professor of Geriatric Medicine, Newcastle-upon-Tyne, UK), a longstanding member of BMS. His paper on ‘New therapeutic options for the treatment of osteoporosis’ was very enlightening and, in particular, it was encouraging to learn of a change in attitude from the National Osteoporosis Society as to the uses of HRT. They now recommend that:
These recommendations are most welcome and were uniformly endorsed by the BMS audience.
This has been the first BMS annual meeting since Pat Patterson died and his presence was missed. However, it was good that his son Clive and sister June came especially to hear the lecture and to find out more about the society that he had been instrumental in creating and was such a major part of his life.
There were two particular innovations in the programme this year:
Our other principal guest speaker was Professor Anne Gompel, (Gynaecologist, Paris, France,) who brought us up-to-date on contraception in the perimenopause and especially the role of the levonorgestrel-releasing intrauterine system.
At the end of a busy first day, a debate is very British and an appropriate method of mixing science and humour, which Miss Joan Pitkin – dressed in suitable Shakespearean costume – and Professor John Studd did to great acclaim. Joan won support for her motion that ‘this house believes that dietary supplements and "natural" products are suitable alternatives to HRT’.
The very important and frequently unrecognized and under-treated problems of premature ovarian failure were well summarized by Professor Janice Rymer's colleagues, Dr Beth Cartwright (Research Fellow, London, UK) and Dr Jan Grace (Consultant in Reproductive Medicine, London, UK). Mr Nick Panay (BMS Chairman-Elect) clearly identified the concerns about the use of bioidenticals and the confusing statements from the manufacturers. After all, most women receiving HRT have an estradiol preparation that is identical to that produced by the premenopausal ovary, but compounding pharmacists have ‘borrowed’ the term to market their own unregulated products. They claim to be able to calculate the levels of hormone deficiencies from saliva and then to replace the precise amount of estrogen, progesterone and testosterone delivered by lozenges and creams. But hormone levels in saliva do not correlate with blood levels and this practice has not been validated by proper scientific studies of efficacy and safety like HRT. 
The CVD theme was started by Professor Mary Ann Lumsden (BMS Chairman), who identified the various risk factors that increase with age and the menopause. In particular, she emphasized the epidemic of obesity that is sweeping across the western world, and that hot flushes tend to be more prevalent in obese women and may be associated with underlying heart disease. She also discussed the disproportionate implications of a high normal blood pressure (140/90 mmHg) on the risk of stroke and CVD in women compared with men.
Dr Sovra Whitcroft (Consultant Gynaecologist, Guildford, UK) concentrated her discussion on the influence of insulin resistance on menopausal- and hormone-related symptoms and, again, highlighted the link to increasing childhood and adult obesity. She postulated that treating insulin resistance may improve estrogen deficiency symptoms without HRT, improve the response to HRT without a dose increase, reduce side-effects and risks associated with some HRT preparations and improve long-term health. She will be writing a review article on this topic soon.
Dr Anne MacGregor (Director of Clinical Research, City of London Migraine Clinic, London, UK) has spoken at several BMS meetings over the years and, as always, gave a very clear and practical presentation on migraine and the effects of the menopause and HRT. Many doctors are wary about giving HRT to migraine sufferers, but while migraine with aura is associated with an increased risk of ischaemic stroke, migraine with or without aura need not be a contraindication for prescribing HRT. This should be given at the lowest effective dose and preferably transdermal, which provides more stable blood levels than by the oral route. If aura develops or worsens then further dose reduction is advisable or consideration of non-hormonal options. 
Mr Philip Toozs-Hobson (Consultant Urogynaecologist, Birmingham, UK) gave an excellent summary of estrogens and the bladder. At least 40% of postmenopausal women are affected by urogenital atrophy and he confirmed the particular merits of local estrogen treatment. In addition to the well known vaginal symptoms, urinary tract infections and some aspects of urgency and urge incontinence are reduced by vaginal estrogen.
The prognosis for breast cancer sufferers is improving all the time and it was good to learn and see what can be done cosmetically following mastectomy. Miss Elaine Sassoon (Consultant Plastic, Reconstructive and Cosmetic Surgeon, Norfolk and Norwich Hospital, Norwich, UK) gave an inspiring presentation, followed by Professor Myra Hunter (Professor of Clinical Health Psychology at Guy's, Kings' and St Thomas' Hospitals, London, UK) who identified the tremendous impact that breast cancer has on women both psychologically and with the additional burden of menopausal symptoms so often provoked by their cancer treatment.
Next year our 21st annual conference will be in Leeds where hopefully the scientific and social programme will attract an even larger number of delegates to continue the resurgence of interest in matters menopausal.
David Sturdee, 2010.
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