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Ask an Expert: Q&A – July 2022

Ask An Expert: Q&A | For health professionals 18 Jul 2022
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'Ask an Expert: Q&A' is a place for health professionals to ask our team of experts about cases seen in work and/or clinical practice.

Questions can cover a wide range of women’s health topics and will be answered by an expert in the multidisciplinary Jean Hailes health professional team. Read more about this series or learn how to ask a question here.

Answering your question for this edition of 'Ask an Expert: Q&A' is Jean Hailes endocrinologist Dr Sonia Davison.

Question 1

I am a Registered Nurse and this topic has been raised by a patient.

Should menopausal hormone therapy (MHT) be given if a woman is known to have a posterior meningioma? She is currently on a ‘wait and watch’ approach having yearly MRIs. Should she be referred to an endocrinologist or is it generally not advised? Any evidence for or against the use of MHT in this circumstance?

Jean Hailes endocrinologist Dr Sonia Davison

Answer

From Jean Hailes endocrinologist Dr Sonia Davison (pictured)

Meningiomas occur in around 5 in 100,000 people, and are two to three times more common in women, compared with men. They are mostly benign in nature but have been found to have hormone receptors present within the cellular tissue.

Around 70% express progesterone receptors, and less than 30% express oestrogen receptors. Meningiomas may also increase in size during pregnancy. Hence the question has been asked whether there is a relationship between meningioma and hormones in women.

What studies have shown is that there seems to be a slight increase in risk of meningioma in women who have used menopausal hormone therapy (MHT). However, there isn't a lot of research into the effects of hormone therapy on an existing meningioma. The literature points in the direction of avoiding hormone therapy in the presence of a known meningioma.

I suspect the best person to answer this question is the treating neurosurgeon, but an endocrinologist or other women's health expert may be able to give guidance as to what other treatments may be useful for the treatment of bothersome menopausal symptoms, if hormone therapy is to be avoided.

Question 2

I have had a few perimenopausal women who are Factor V Leiden heterozygotes but never had DVT/PE. Found because a family member tested positive. Do they need to see a haematologist prior to trialling MHT or would it be safe to trial some transdermal oestrogen plus oral progesterone?

Answer

From Jean Hailes endocrinologist Dr Sonia Davison

My approach for women with inherited thrombophilia is for them to see a haematologist, for several reasons, even if there is no history of VTE and if they are a carrier of a thrombophilia mutation. To discuss their own risks for VTE, given their age, their general health and other VTE risk factors, but also to talk about the need for screening other family members (for example children). Also it’s important to discuss advice about travel, what to do in the event of pregnancy or planned surgery, and also for discussions about use of hormonal contraception or menopausal hormone therapy (MHT).

Transdermal MHT has not been associated with an increase in VTE risk in research studies, and the combination of micronised progesterone and transdermal oestradiol has been associated with a very low VTE risk, as has Tibolone.

Low-dose MHT is also associated with a lower risk of VTE compared with higher doses.

However, for safety reasons I will refer these women to a haematologist, and if the woman has menopausal symptoms and is considering MHT use, I will be asking the haematologist to comment about VTE risks associated with MHT in addition to the other issues outlined above.

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