Adding Androgen to Postmenopausal Estrogen Therapy Can Yield Many Benefits

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Andrew Tamulevich, 212/265-9150
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ADDING ANDROGEN TO POSTMENOPAUSAL ESTROGEN THERAPY CAN YIELD MANY BENEFITS

Research presented at OB/GYN world congress shows added improvement in libido, vasomotor symptom relief and bone mineral density over estrogen alone

Copenhagen, Aug. 7, 1997 -- Adding small amounts of androgen to estrogen replacement therapy can restore failing libido, resolve persistent hot flashes and restore decreased bone density, all consequences of menopause that can affect the quality of life and health of postmenopausal women. These findings and others were presented at a symposium entitled "The Emerging Role of Estrogen-Androgen Therapy in the Care of the Postmenopausal Patient," at the XV World Congress of Gynecology and Obstetrics, in Copenhagen, Denmark today. Androgens are hormones produced in the ovaries and adrenal glands that act on the musculoskeletal, nervous, hepatic and vascular tissues. Women actually make more androgens than estrogens daily and convert the androgens to estrogens. In adult women, androgens have long been known to play a key role in sexuality and to prevent bone loss and increase bone density. Like estrogen, androgen production drops significantly after menopause. Yet the impact of postmenopausal androgen decline has been far less studied than that of estrogen. "Androgen, for some women, is the ëmissing hormoneí of their post-menopausal years," said Dr. Elizabeth Barrett-Connor, who moderated the symposium and is a world-renowned expert in menopause research and professor and chief of the division of epidemiology at the University of California, San Diego, School of Medicine. "These findings are exciting because they add to a growing body of research showing one-size doesnít-fit-all in hormone replacement therapy. Hormone therapy should be tailored to each individual according to symptoms, and combination estrogen-androgen therapy can be a significantly better option for some women than estrogen alone."

Loss of Libido a Common, Untreated, Symptom Many postmenopausal women experience a sharp drop in sex drive and the enjoyment and frequency of orgasm. "The decline of androgen levels after menopause is an important factor in the decline of sexual interest, yet libido remains a subject that many postmenopausal women -- and their doctors -- are uncomfortable discussing," said Dr. Alex Vermeulen, MD, Ph.D., professor of medicine, University of Ghent, Belgium. "But sexuality should be just as much a part of life after menopause as before." In his presentation, Dr. Vermeulen noted that because the ovaries continue to secrete minute amounts of androgens even after menopause, women who have undergone oophorectomy (surgical removal of the uterus and ovaries) have even lower androgen levels than do women in natural menopause. Surgically menopausal women -- frequently younger and less prepared for the onset of menopausal symptoms -- may go untreated. Dr. Vermeulen cited other potential benefits of estrogen-androgen therapy, including improvements in memory abilities, increase in lean body mass and prevention of bone loss.

Promising News About Osteoporosis Postmenopausal women are at increased risk for osteoporosis, a bone-thinning disease that can cause significant physical disability and shorten life expectancy. Estrogen taken after menopause has been proven to slow bone loss. But in several investigations of both postmenopausal and surgically menopausal women, estrogen plus androgen therapy was shown to not only slow bone loss, but also to stimulate bone formation. Oral estrogen-androgen therapy significantly increased bone mineral density in two, two-year studies, particularly in women who had not taken estrogen in the previous two years.

Broadened Spectrum of Menopausal Symptom Relief Dr. Philip Sarrel, professor of obstetrics and gynecology and psychiatry, Yale University School of Medicine, called for a re-evaluation of the role of androgens in the treatment of postmenopausal symptoms at the time of menopause, and continuing until ten years later, when androgen levels decline even further. "The notion that menopause is a one- or two-year ëeventí is an outdated way of looking at what is really a spectrum of symptoms, over as long as a decade, for many women," said Dr. Sarrel. "Androgen production, except in women undergoing surgical menopause, decreases gradually over the years leading up to menopause and for a decade later. As a result, symptoms due to androgen depletion, if any, are to be expected as the menopausal transition begins to persist into late menopause." According to Dr. Sarrel, these symptoms, observed in surgically menopausal women receiving estrogen replacement therapy, can include more severe and frequent hot flashes, more and longer-lasting symptoms due to urogenital atrophy and a greater frequency of psychologic difficulties, including mental depression and loss of libido. "Women who received estrogen plus androgen showed an improvement in sexual desire, fantasy, response and frequency and a decrease in dyspareunia compared with women who received estrogen alone," said Sarrel. Dr. Sarrel also discussed findings of a separate study of 252 women that showed 50 percent of women using estrogen-only therapy and women not taking any therapy both reported decreased libido. Also presented was a study showing improvement in symptom relief (hot flashes, insomnia and vaginal dryness) when androgens are added to estrogen regimens. "Estrogen in optimal doses provides adequate relief of hot flashes in most women, but a proportion of treated women remain dissatisfied with residual unresolved symptoms, even after taking estrogen," said Dr. Barrett-Connor. Treatment needs to be customized to each individual woman in order to obtain complete relief of persistent vasomotor symptoms. The symposium was sponsored by the University of California, San Diego, School of Medicine and was underwritten by an educational grant from Solvay Pharmaceuticals. The XV World Congress of Gynecology and Obstetrics was sponsored by the Federation International of Obstetrics and Gynecology (FIGO), London, U.K.

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