Menopause and Metabolic Bone Disease Unit

Toulouse, France

Menopause and Metabolic Bone Disease Unit

Toulouse, France
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PubMed | Instituto Palacios, Carol Davila University of Medicine and Pharmacy, Menopause and Metabolic Bone Disease Unit, DIATROS and 12 more.
Type: Journal Article | Journal: Maturitas | Year: 2015

With increased longevity and more women becoming centenarians, management of the menopause and postreproductive health is of growing importance as it has the potential to help promote health over several decades. Women have individual needs and the approach needs to be personalised. The position statement provides a short integral guide for all those involved in menopausal health. It covers diagnosis, screening for diseases in later life, treatment and follow-up.


Lambrinoudaki I.,National and Kapodistrian University of Athens | Ceasu I.,Carol Davila University of Medicine and Pharmacy | Ceasu I.,Dr I Cantacuzino Hospital | Depypere H.,Ghent University | And 7 more authors.
Maturitas | Year: 2013

Introduction: There is increasing evidence that life-style factors, such as nutrition, physical activity, smoking and alcohol consumption have a profound modifying effect on the epidemiology of most major chronic conditions affecting midlife health. Aims: To provide guidance concerning the effect of diet on morbidity and mortality of the most frequent diseases prevalent in midlife and beyond. Materials and methods: Literature review and consensus of expert opinion. Results and conclusions: A healthy diet is essential for the prevention of all major chronic non-communicable diseases in midlife and beyond, both directly, through the effect of individual macro- and micronutrients and indirectly, through the control of body weight. Type 2 diabetes mellitus is best prevented or managed by restricting the total amount of carbohydrate in the diet and by deriving carbohydrate energy from whole-grain cereals, fruits and vegetables. The substitution of saturated and trans-fatty acids by mono-unsaturated and omega-3 fatty acids is the most important dietary intervention for the prevention of cardiovascular disease. Obesity is also a risk factor for a variety of cancers. Obese elderly persons should be encouraged to lose weight. Diet plans can follow the current recommendations for weight management but intake of protein should be increased to conserve muscle mass. The consumption of red or processed meat is associated with an increase of colorectal cancer. Adequate protein, calcium and vitamin D intake should be ensured for the prevention of osteoporotic fractures. Surveillance is needed for possible vitamin D deficiency in high risk populations. A diet rich in vitamin E, folate, B12 and omega-3 fatty acids may be protective against cognitive decline. With increasing longevity ensuring a healthy diet is a growing public health issue. © 2012 Elsevier Ireland Ltd. All rights reserved.


Dreisler E.,Copenhagen University | Poulsen L.G.,Copenhagen University | Antonsen S.L.,Copenhagen University | Ceausu I.,Carol Davila University of Medicine and Pharmacy | And 9 more authors.
Maturitas | Year: 2013

Introduction Invasive as well as non-invasive methods are available for assessment of the endometrium. Aims The purpose of this clinical guide is to provide evidence-based advice on endometrial assessment in peri and postmenopausal women. Material and methods Literature review and consensus of expert opinion. Results and conclusions Presuming speculum examination and cervical cytology are assessed, transvaginal ultrasound should be undertaken initially as it is non-invasive and will not only measure endometrial thickness, but will also detect other pelvic pathology such as leiomyomas and ovarian tumours. The main indication for invasive methods is to obtain endometrial tissue to diagnose or exclude the presence of endometrial cancer or pre-malignancies. Biopsy is mainly undertaken as an outpatient procedure, but sampling is 'blind'. Hysteroscopy is used when focal lesions affecting the uterine cavity are suspected such as endometrial polyps or sub-mucous fibroids. None of the available methods are perfect. Ultrasound evaluation is dependent on the experience of the examiner, the equipment and the quality of visualization. Hysteroscopy too is dependent on the examiner and fibroids may obstruct visualization. Blind endometrial biopsy procedures often miss focal lesions. Thus re-examination is necessary when symptoms persist and no explanation for these has been identified. This clinical guide will evaluate the different methods of endometrial assessment, their indications and limitations. Guidance is also given about dealing with inconclusive investigations and persistent symptoms. © 2013 Elsevier Ireland Ltd.


Perez-Lopez F.R.,University of Zaragoza | Ceausu I.,Carol Davila University of Medicine and Pharmacy | Ceausu I.,Dr I Cantacuzino Hospital | Depypere H.,Ghent University | And 7 more authors.
Maturitas | Year: 2013

Introduction: Vulvar lichen sclerosus (LS) is a chronic inflammatory disease which affects genital labial, perineal and perianal areas, producing significant discomfort and psychological distress. However there may be diagnostic delay because of late presentation and lack of recognition of symptoms. Aims: The purpose of this clinical guide is to provide advice on early recognition and treatment. Material and methods: Literature review and consensus of expert opinion. Results and conclusions: The etiology of LS in peri and postmenopausal women is unknown, although autoimmune, genetic and infectious factors have been implicated. Definitive diagnosis of non-malignant disorders depends on the histology of biopsied tissue. LS associated with cellular atypia should be classified as intraepithelial neoplasia. Topical corticosteroids are the most effective treatment, although prolonged treatment may be associated with dermal atrophy. Topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, may be a safe and effective alternative treatment without risk of corticosteroid-related vulvar atrophy since they do not affect collagen synthesis. LS recurrences are frequent, and can lead to significant physical discomfort and emotional distress that affect mood and sexual relationships. Anatomical changes may require surgical management. © 2012 Elsevier Ireland Ltd.


Rees M.,John Radcliffe Hospital | Perez-Lopez F.R.,University of Zaragoza | Ceasu I.,Carol Davila University of Medicine and Pharmacy | Ceasu I.,Dr I Cantacuzino Hospital | And 7 more authors.
Maturitas | Year: 2012

Vaginal atrophy is common in postmenopausal women. This clinical guide provides the evidence for the clinical use of vaginal estrogens for this condition focussing on publications since the 2006 Cochrane systematic review. Use after breast cancer, before assessment of cervical cytology and prolapse surgery is also discussed. © 2012 Elsevier Ireland Ltd. All rights reserved.


Perez-Lopez F.R.,University of Zaragoza | Brincat M.,Materials Dei Hospital | Erel C.T.,Istanbul University | Tremollieres F.,Menopause and Metabolic Bone Disease Unit | And 7 more authors.
Maturitas | Year: 2012

Introduction: There is emerging evidence on the widespread tissue effects of vitamin D. Aims: To formulate a position statement on the role of vitamin D in postmenopausal women. Materials and methods: Literature review and consensus of expert opinion. Results and conclusions: Epidemiological and prospective studies have related vitamin D deficiency with not only osteoporosis but also cardiovascular disease, diabetes, cancer, infections and neurodegenerative disease. However the evidence is robust for skeletal but not nonskeletal outcomes where data from large prospective studies are lacking. The major natural source of vitamin D is cutaneous synthesis through exposure to sunlight with a small amount from the diet in animal-based foods such as fatty fish, eggs and milk. Vitamin D status is determined by measuring serum 25-hydroxyvitamin D [25(OH)D] levels. Optimal serum 25(OH)D levels are in the region of 30-90 ng/mL (75-225 nmol/L) though there is no international consensus. Levels vary according to time of the year (lower in the winter), latitude, altitude, air pollution, skin pigmentation, use of sunscreens and clothing coverage. Risk factors for low serum 25(OH)D levels include: obesity, malabsorption syndromes, medication use (e.g. anticonvulsants, antiretrovirals), skin aging, low sun exposure and those in residential care. Fortified foods do not necessarily provide sufficient amounts of vitamin D. Regular sunlight exposure (without sunscreens) for 15 min, 3-4 times a week, in the middle of the day in summer generate healthy levels. The recommended daily allowance is 600 IU/day increasing to 800 IU/day in those aged 71 years and older. Supplementation can be undertaken with either vitamin D2 (ergocalciferol) or vitamin D3 (cholecalciferol) with monitoring depending on the dose used and the presence of concomitant medical conditions such as renal disease. © 2011 Elsevier Ireland Ltd. All rights reserved.


Palacios S.,Palacios Institute of Womans Health | Brincat M.,Materials Dei Hospital | Erel C.T.,Istanbul University | Gambacciani M.,University of Pisa | And 7 more authors.
Maturitas | Year: 2012

Osteoporosis and the resulting fractures are major public health issues as the world population is ageing. Various therapies such as bisphosphonates, strontium ranelate and more recently denosumab are available. This clinical guide provides the evidence for the clinical use of selective estrogen modulators (SERMs) in the management of osteoporosis in postmenopausal women. © 2011 Elsevier Ireland Ltd.


Depypere H.,Ghent University | Desreux J.,CHR de la CITADELLE | Perez-Lopez F.R.,University of Zaragoza | Ceausu I.,Carol Davila University of Medicine and Pharmacy | And 8 more authors.
Maturitas | Year: 2014

Introduction Breast cancer is the most prevalent cancer in women, with slightly more than ten percent developing the disease in Western countries. Mammography screening is a well established method to detect breast cancer.Aims The aim of the position statement is to review critically the advantages and shortcomings of population based mammography screening.Materials and methods Literature review and consensus of expert opinion.Results and conclusion Mammography screening programmes vary worldwide. Thus there are differences in the age at which screening is started and stopped and in the screening interval. Furthermore differences in screening quality (such as equipment, technique, resolution, single or double reading, recall rates) result in a sensitivity varying from 70% to 94% between studies. Reporting results of screening is subject to different types of bias such as overdiagnosis. Thus because of the limitations of population-based mammography screening programmes an algorithm for individualized screening is proposed. © 2014 Elsevier Ireland Ltd. All rights reserved.


Perez-Lopez F.R.,University of Zaragoza | Ornat L.,University of Zaragoza | Ceausu I.,Carol Davila University of Medicine and Pharmacy | Ceausu I.,Dr I Cantacuzino Hospital | And 7 more authors.
Maturitas | Year: 2014

Introduction Uterine fibroids (also termed leiomyomas or myomas) are the most common tumors of the female reproductive tract. Aim The aim of this position statement is to provide and critically appraise evidence on the management of women with uterine fibroids. Methods Literature review and consensus of expert opinion. Results and conclusions Many uterine fibroids are asymptomatic and require no intervention, although it is advisable to follow up patients to document stability in size and growth. Fibroid-associated symptoms include heavy menstrual bleeding and pain or pelvic discomfort. The association between infertility and fibroids increases with age. Fibroids do not increase the risk of malignant uterine disease and leiomyosarcomas are extremely rare (less than one in 1000). It is unknown at present whether leiomyosarcoma represents de novo growth or malignant transformation from benign uterine fibroids. Treatment options for symptomatic fibroids include pharmacologic, surgical and radiologically guided interventions. The range of medical treatments allows flexible management of fibroid-related symptoms; the options include tranexamic acid, non-steroidal anti-inflammatory drugs, contraceptive steroids, gonadotropin-releasing hormone analogs, antiprogesterone, and selective progesterone receptor modulators. However, these medical options do not remove the tumors and symptoms may return when treatment is stopped. Surgical and radiologically guided procedures may be tailored to age, general health, and individual patient wishes. Hysterectomy is the most effective treatment, although in some cases myomectomy may be sufficient to control symptoms. Alternatives to surgery include uterine artery embolization, myolysis and ablation by high-intensity focused ultrasound (guided with magnetic resonance imaging or ultrasound). The choice of treatment depends on fibroid size, the underlying symptoms and their severity and the woman's desire for subsequent fertility and pregnancy, as well as efficacy and need for repeated interventions. © 2014 Elsevier Ireland Ltd.


Mintziori G.,Aristotle University of Thessaloniki | Lambrinoudaki I.,National and Kapodistrian University of Athens | Goulis D.G.,Aristotle University of Thessaloniki | Ceausu I.,Carol Davila University of Medicine and Pharmacy | And 7 more authors.
Maturitas | Year: 2015

Aim: To review non-hormonal therapy options for menopausal vasomotor symptoms. The current EMAS position paper aims to provide to provide guidance for managing peri- and postmenopausal women who cannot or do not wish to take menopausal hormone therapy (MHT). Material and methods: Literature review and consensus of expert opinion. Results: Non-hormonal management of menopausal symptoms includes lifestyle modifications, diet and food supplements, non-hormonal medications and application of behavioral and alternative medicine therapies. There is insufficient or conflicting evidence to suggest that exercise, supplements or a diet rich in phytoestrogens are effective for vasomotor menopausal symptoms. Selective serotonin-reuptake inhibitors (SSRIs), serotonin norepinephrine-reuptake inhibitors (SNRIs) and gabapentin could be proposed as alternatives to MHT for menopausal symptoms, mainly hot flushes. Behavioral therapies and alternative medicine interventions have been tried, but the available evidence is still limited. Conclusions: A number of interventions for non-hormonal management of menopausal vasomotor symptoms are now available. For women who cannot or do not wish to take estrogens, non-hormonal management is now a realistic option. © 2015 Elsevier Ireland Ltd. All rights reserved.

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