Scientific Society Symposium

Minimising hormone therapy intolerance

Nick Panay (GB)

[Panay] Imperial College London

We should be continually striving to optimise the benefits and maximise tolerance of hormone therapy. Following the publication of the WHI study, much development of new menopause products came to a grinding halt. Ongoing research and development of further body-similar or body-identical estrogen and progesterone is essential as is further development of local progesterone/progestogen delivery systems. New products such as conjugated estrogens/bazedoxifene mitigate the side-effects and risks of progestogens altogether. Another area of interest is whether this combination may actually have a protective effect on breast cancer risk. Ongoing research into the development of newer types of estrogen such as estetrol is also a further positive step towards reducing adverse effects. There is also a neglected need for androgenic products which are licensed and optimised for female usage for those women with sexual desire and arousal disorders. Targeted agents continue to be developed that are able to switch on receptors in tissues where this is desirable and avoid receptors in tissues such as the breast and endometrium. Newer SERMs such as ospemifene are beneficial for the urogenital system but still do not address the problem of vasomotor symptoms. The ideal SERM (selective estrogen receptor modulator) which would be agonistic in the bone, cardiovascular system and urogenital tract and antagonistic in the endometrium and breast, whilst at the same time alleviating vasomotor and other menopause symptoms, does not yet exist. Research should now focus on fully understanding the processes that regulate the activity of the different estrogen receptor co-regulators. This will facilitate the development of SERMs with improved functional selectivity. Pharmacogenomic approaches will identify women with different requirements based on identification of genetic variants in enzymes involved in hormone metabolism and impacting hormone targets. Could personalized management of menopause based on genomics become a reality?  This will enable health-care professionals to select the right preparation, at the correct dosage, at the right time, for each individual in order to maximize effectiveness and minimize side-effects. However, the mechanisms by which environmental and biological factors also affect symptoms, possibly through epigenetic mechanisms, will need to be unraveled.