July 2018 Health Bulletin

Sexual well-being after menopause: An International Menopause Society White Paper

Each year the International Menopause Society releases a White Paper on a topic considered to be of international importance to women and health care providers. This year the topic is sexual wellbeing after menopause. An international team of co-authors worked together to prepare this document, led by Dr James Simon of the US, who is presently President of the International Society for the Study of Women’s Sexual Health.

The paper summarises the various forms of sexual difficulties women might experience (sexual desire, arousal, orgasm, and pain), what is known of the prevalence of these problems and how health care providers should assess women presenting with sexual concerns. The paper takes a biopsychosocial approach to assessment and care, highlighting the importance of general physical and psychological wellbeing and relationship factors. Importantly, sexual issues do not occur in a vacuum, and the authors discuss the importance of the reciprocal and dynamic nature of a couple’s sexual wellbeing. The authors discuss the available medical therapies, and treatments ‘in the pipeline’.

Many health care providers are apprehensive about starting the dialogue of sexual wellbeing as they feel unprepared. This paper provides clinicians with a frame-work and simple tools to start the conversion.

The paper can be accessed online at the journal Climacteric, with copies immediately available via:

J A Simon, S R Davis, S E Althof, P Chedraui, A H Clayton, S A Kingsberg, R E Nappi, S J Parish & W Wolfman.

“Why Should Clinicians Be Concerned About Prescribing Compounded Hormones for Menopausal Women?”

This is the title of a recent article published in the Journal of Women’s Health which highlights concerns about the widespread prescription of compounded hormones for women, as alternatives to tested and approved formulations of estrogen and progesterone/progestins for menopausal hormone therapy 1. Dr Pinkerton reported on a US study which showed that 20% of prescribing doctors were not certain that compounded hormone therapy was not approved by the US drug regulator, the FDA.

In Australia doctors may prescribe treatments that a pharmacy can prepare on an individual patient basis. However none of these formulations are tested for effectiveness or safety, and the doses are a best guess. No randomised clinical trials of compounded hormone therapy for women have been conducted.
Some major concerns are that women are paying excessive amounts for treatments such as estrogen and progesterone which they could receive at a lower cost as Therapeutic Goods Australia approved therapies; that women with a uterus may not be receiving sufficient progesterone to protect the lining of their uterus, putting them at risk of uterine cancer 2; that women are receiving excessive doses of hormone therapy inappropriately; and that women are receiving other hormones such as testosterone, DHEA and hydrocortisone in excessive amounts.

Importantly, most women who are prescribed compounded hormones are not aware that there are no studies to support their effectiveness, the doses prescribed, whether the prescribed cream, gel, capsule or troches is absorbed or that these treatments are not approved by any regulating body.  The treatments do not usually come with safety instructions or health warnings, such that they are often assumed to be safer than other hormone preparations, which is simply not correct.

The ability of doctors to prescribe a compounded formulation for patients with allergies or in need of specialised treatments is important, but consumers need to be aware of the potential health risks of using unregulated compounded products as part of routine care when approved alternatives are available.

  1. Pinkerton JV. Why Should Clinicians Be Concerned About Prescribing Compounded Hormones for Menopausal Women? J Womens Health (Larchmt). 2018.
  2. Eden JA, Hacker NF, Fortune M. Three cases of endometrial cancer associated with "bioidentical" hormone replacement therapy. Med J Aust. 2007;187(4):244-5.

Information provided might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.