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The following transcript has been edited for clarity, style, and length.

: I’d like to start by saying that Lisa and I are longtime friends, and we’ve had many conversations about this. We’re both strong proponents of estrogen therapy. So, let me be clear: we are not abandoning estrogen for these new medications, even though they are fabulous. The NK3 and NK1 receptor antagonists are groundbreaking, both in their biochemistry and their clinical results.

That said, these drugs are primarily for women who can’t or won’t take estrogen. They offer a fantastic option, particularly for patients who don’t tolerate estrogen or for whom it’s contraindicated. For example, in my oncology clinic, I see many breast cancer survivors devastated by vasomotor symptoms and sleep disturbances. These medications can be life-changing for them.

Lisa, as the immediate past president of the Menopause Society, can you talk about the society’s updated guidelines on hormonal and non-hormonal therapies? I’d also encourage our viewers to visit the Menopause Society’s website, 

, where you can access the 2022 hormonal therapy guidelines and the 2023 non-hormonal therapy guidelines for free.

: Absolutely. I strongly encourage everyone to read these guidelines, as they represent the gold standard for managing menopause.

As Dr Minkin said, we’ve both been shaped by the evolution of menopausal hormone therapy (MHT) over our careers. Unfortunately, many primary care clinicians, particularly those who entered the field after the 2002 Women’s Health Initiative (WHI) data, were taught to avoid hormone therapy entirely. For over two decades, there’s been a lack of education and a pervasive fear of hormones, stemming from concerns about stroke, heart attack, breast cancer, and dementia listed on package labels.

I recently saw a patient whose primary care doctor told her they ran a “hormone-free practice.” This highlights how misunderstood hormone therapy still is. However, today in 2024, we’ve gained a far better understanding of who benefits from hormone therapy, its advantages, and its risks.

Here’s what the current guidelines emphasize: for symptomatic women close to the menopause transition, MHT should be the first-line treatment. It’s highly effective for vasomotor symptoms, sleep issues, and more. Yet, fewer than 5% of appropriate candidates are even offered hormone therapy. That’s a huge disservice to these women.

Now, we do have exciting new non-hormonal drugs, but they’re primarily for women who can’t or won’t take hormones. While drugs like elinzanetant show promise for vasomotor symptoms and sleep, we don’t yet know their effects on other critical outcomes like cardiovascular risk, bone health, sexual function, or cognitive health. These areas remain unanswered.

So, for the majority of women, MHT remains the gold standard for managing menopausal symptoms. The guidelines make that clear.

: I agree, and to expand on Lisa’s point, there are other menopausal symptoms that estrogen helps with, even if they’re not part of the official indications. Let’s recap the primary indications for MHT: moderate to severe vasomotor symptoms, vaginal dryness, osteoporosis protection, and, for women with premature ovarian failure, comprehensive hormone replacement.

But estrogen benefits go beyond these. For example, many women report relief from joint aches and other discomforts. Vaginal dryness, bladder symptoms, and other aspects of genitourinary syndrome of menopause (GSM) are also areas where estrogen excels. These new drugs, while effective for hot flashes and sleep, don’t address GSM, bladder health, joint pain, or improvements in skin and hair.

So, while these medications are valuable, they don’t replace estrogen’s broader benefits. It’s about finding the right balance for each patient.

One final thought: menopause care takes time. These are complex conversations that require careful discussion with patients. You may not get rich as a menopause specialist, but you’ll make a real difference in your patients’ lives. And that’s what matters most.

Panelists discuss key considerations for women taking hormonal therapy, emphasizing the importance of individualized treatment plans and shared decision-making to evaluate the risk-benefit profile of therapy.

The lesion on this 6-year-old boy occupies almost the entire left side of his nose. The mother attributed it to an injury her son had sustained 2½ weeks earlier, when he was hit in the face by a baseball.

Is this lesion the result of an injury, as the boy’s mother suspected, or something else?

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Scaly Plaque on the Nose

Although reported cases remain high, there are signs the sexually transmitted infection (STI) epidemic in the US is slowing down after nearly 20 years of increases, the CDC announced on Tuesday.

According to the agency’s annual STI report, cases of chlamydia, gonorrhea, and 

 totaled 2.4 million in 2023, marking a 1.8% decrease from the more than 2.5 million cases reported in 2022.

Chlamydia remained the most common nationally notifiable STI in the US in 2023, with over 1.6 million reported cases. Data showed that rates did not change substantially between 2022 and 2023 (<1.0% change; from 495 to 492.2 per 100 000).

Data also showed that for the second year in a row, 

 cases decreased. Between 2022 and 2023, rates declined 7.2% to 601 319 cases after dropping by 8.7% from 2021 to 2022. The CDC noted that this marked a decrease to pre-pandemic levels.

Between 2022 and 2023, the number of reported cases of syphilis (all stages) increased 1.0%, although the rate of reported cases per 100 000 persons was relatively stable (<1% change, 61.1 to 61.3 per 100 000). Stage-specific data showed there were 53 007 cases of primary and secondary (P&S) syphilis in 2023 — a 10.2% decrease from 2022 — and 53 573 cases of early nonprimary nonsecondary syphilis, which was a 5.9% decrease from 2022.

Rates of congenital syphilis, however, continued to increase, rising 2.9% between 2022 and 2023 (from 102.8 cases per 100 000 live births to 105.8 cases per 100 000). Although this increase remains a concern, the CDC noted it was a significantly lower increase than the roughly 30% increase reported in previous years.

“I see a glimmer of hope amidst millions of STIs,” Jonathan Mermin, MD, MPH, director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, said in a November 12, 2024, press release.

“After nearly 2 decades of STI increases, the tide is turning. We must make the most of this moment.”

While the new report is encouraging, disparities persist. In 2023, 48.2% of reported cases of chlamydia, gonorrhea, and syphilis (all stages) were among 

Also, gay, bisexual, and other men who have sex with men (MSM) were found to be disproportionately impacted by STIs, including gonorrhea and P&S syphilis. In 2023, MSM accounted for 32.7% of all P&S syphilis cases and approximately half of gonorrhea cases occurred in MSM. Furthermore, coinfection with HIV among MSM was common, with 37.2% of MSM with P&S syphilis diagnosed with HIV in 2023, according to the report.

The CDC data also showed that in 2023, 32.4% of all reported cases of chlamydia, gonorrhea, and P&S syphilis were among non-Hispanic Black individuals, even though they made up only 12.6% of the US population. Rates of both P&S syphilis and congenital syphilis were highest among American Indian or Alaska Native persons in 2023.

“It is important to note that these disparities are unlikely to be fully explained by differences in sexual behavior and may reflect differential access to quality sexual health care, as well as differences in sexual network characteristics,” wrote the agency in the report.

More than 2.4 million STIs were reported in the US in 2023 — a 1.8% decrease from 2022, according to the CDC's annual STI report. 

STI Epidemic in US Shows Signs of Slowing, According to New CDC Report

Navin M. Amin, MD

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