The opening panel of the conference was a reminder that we need to change the mind-set around menopause. In Asia, menopause is celebrated as the Second Spring, whereas often in our culture we dread it and tend to set our minds for a negative outcome. We need to start by dispelling myths as a baseline to move forward.

Below, I’ve briefly summarised the key areas that were discussed. While they were addressed in general terms throughout, all of these issues can of course be relevant to hair and scalp health.

HRTs: it was acknowledged that evidence is lacking because of how little research there is in this area. However, in menopause, primary prevention of chronic disease is vital, eg bone health, stroke, heart health, dementia, mental health. But there is a time-period within which HRT is useful; if a woman has been oestrogen-deficient for more than 10 years then to re-introduce it can reduce the benefits/accentuate the risks. (NB the speaker suggested referring to The Timing Hypothesis (Robert Langer) for more on this).

Pregnenolone and DHEA, known as the mother hormones, will go where needed but get stolen if needed to make more cortisol. It was suggested that while women won’t feel much difference when pregnenolone is prescribed, it’s a key neuro-steroid that’s important for the brain. It can be preventative as well, as an anti-ageing hormone. Currently doctors test for DHEA but rarely for pregnenolone.

Progesterone intolerance – approximately 1 in 20 women are progesterone-intolerant. Utrogeston can be an issue – Femoston or Mirena may be better tolerated in these cases. Progesterone intolerance can contribute to post-natal depression, problems sleeping, emotional issues and PMDD. There tends to be less intolerance with body-identical HRT. (Similarly, some contraceptives make symptoms worse in younger progesterone-intolerant women).

There was discussion around oestrogen and mitochondrial DNA – mitochondria are the batteries of the cell, producing metabolic energy. We have oestrogen receptors on the mitochondria, and oestrogens can directly affect/promote mitochondrial function.

Cancer treatment resulting in forced menopause; in these cases there is no gradual falling off of the hormones and so symptoms appear suddenly. Symptoms relating to menopause are rarely discussed in depth as of course practitioners are focusing on the cancer diagnosis/prognosis etc.

In other cases, when a patient has survived gynaecological cancer and goes into menopause later in life, is it too risky to take HRT? There is an un-met need for guidelines here, as there is a lack of information on how to manage menopause in patients who have previously had gynaecological cancers. It was discussed that NICE guidelines are needed.

Regarding the skin, oestrogen is anti-inflammatory so when low there can be an explosion of inflammatory conditions such as rosacea. Furthermore, women lose 30% of collagen in the first 5 years of menopause. This is an intrinsic issue, but practitioners can use extrinsic agents to treat this, for instance retinoids to treat the skin barrier, polynucleotides and exosomes. Collagen supplements can potentially lead to the up-escalation of collagen production in the skin.

Regarding exosomes, an increasing number of aesthetic practitioners are using these; claims include that they stimulate hair follicles to grow new hair and reduce inflammation and oxidative stress, increasing blood supply to hair follicles.

Topical Estradiol is sometimes used on skin, but there is no efficacy or safety data.

There was a brief mention of selective oestrogen receptor modulators; but not enough is known about which receptors are switched on and which off by these modulators.

As a final note, for anyone planning to attend the MIA conference in the future, the conference was conducted in a panel format. While this can be more engaging than individual speakers supported by slide presentations, because of the number of panels throughout the day and the number of speakers on each panel I found that subjects were not covered in as much depth as they might have been. However, I felt it had been worthwhile attending and it was a great way of starting conversations around this vital subject