Last month I enjoyed the opportunity to attend and speak at the European Society of Gynaecology (ESG) 2019 conference in Vienna.

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At this year’s conference, a number of topics were covered. These included contraception and fertility, sexuality and ethics, and menopause and endocrinology. Gynaecologists presented conclusions from studies, delegates discussed and debated best practices, and consensus statements were shared on specific therapies. A number of pharmaceutical companies also took the stage to showcase their innovations.  

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I came away from the conference reflecting on three particular points:

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1. Women continue to be afraid of hormones 

The fear of hormone extends across different areas, e.g., menopause, with women often choosing treatments only to avoid hormonal preparations. This area was surfaced in many of the talks at the conference, for example by Professor Johannes Bitzer of the University of Basel, who used the phrase “Hormonophobia” to describe the phenomenon. He argued that the global media had had a significant role to play in many women disregarding methods with favourable benefit/risk profiles and raised the issue about helping women make more informed decisions regarding their needs. 

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We have also seen this pattern in much of our research.  In our recent 7-country study on contraception, for instance, we found that 40% of women, in the age group 18-60 years, strongly agreed that they were concerned about the effects of hormonal contraceptives on their bodies and minds. [1]

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2. Innovations with a focus on safety

It was also interesting to note the number of innovations presented at the conference with a focus on safety.  One particularly intriguing new class of drugs introduced was NEST™, or ‘Native Estrogen acting Selectively in Tissues’. 

 

NESTs™ have some similarities to other classes in terms of their tissue selectivity and, based on data presented at the conference, seem to have a favourable side effect profile compared to other oestrogens. This includes a reduced VTE risk profile, lower breast stimulation and a low risk of drug-drug interactions. 

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The pharmaceutical company Mithra made presentations at the conference about their compound Estetrol (E4), the first in the NEST™ class. Estretol is the key ingredient in three of Mithra’s products: Estelle®, a 5th generation oral contraceptive, PeriNestaTM, a complete oral treatment for perimenopause and Donesta®, a next generation hormone therapy for VMS in menopause.  These products are currently in development, with Estelle® notably having recently successfully finished its Phase III clinical study in Europe and Russia and USA and Canada. [2]

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Another company introducing a product in this area was Exeltis who, in 2018, received acceptance from the FDA for the filing of Slinda® a Drospirenone-only oral contraceptive [3]. Drospirenone is a synthetic progestin which is believed to reduce the cardiovascular risk associated with other Combined Hormonal Contraceptives (CHCs). It also is shown to contribute to an improved bleeding profile and shows no decrease in efficacy in the case of a missed pill.

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3. A medical unmet need in female sexuality

As one of the ‘Opening Lectures’ of the conference, the chief of divisional medicine at University Hospitals Cleveland Medical Center, Sheryl Kingsberg, introduced the topic of female Hypoactive Sexual Desire Disorder (HSDD) labelling this, ‘a significant area of unmet medical need’. This theme prevailed throughout the conference, with other talks discussing the disorder and debating the role of certain therapies for its treatment. 

 

In the talk by Sherly Kingsberg, and during a subsequent symposium led by Rosella Nappi of The University of Pavia, we learned specifically about the RECONNECT study, a programme designed to evaluate the efficacy of bremelanotide (BMT) in the treatment of the disorder among premenopausal women [4]. In this study, women using BMT were shown to have significantly increased scores on FSFI-D vs placebo, indicating an increase in desire, and a significantly reduced score of FSDS-DAO vs placebo, indicating a reduction in distress linked to low desire. BMT was also associated with an increase in secondary outcomes relating to FSFI total score as well as individual domains such as arousal. 

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This topic of HSDD among postmenopausal women was also discussed widely at the conference, specifically regarding the role of androgen therapy in its treatment. Nick Panay, Secretary General of the International Menopause Society, for example, delivered the first international consensus statement on the use of this therapy in this cohort of patients [5]. This consensus specifically stated that, “Testosterone can be effective at improving sexual wellbeing for postmenopausal women with HSDD” and that, “benefits include improved sexual desire, function and pleasure, together with reduced concerns and distress about sex”.

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Overall, the ESG was a great opportunity to hear about some of the salient issues in the area of gynaecology.  To learn more about the presentation we made on contraception choices in Europe, South and Central America, please do not hesitate to get in touch with me on genevieve.hall@insightdojo.com.

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[1] Insight Dojo, 7 Country contraception survey, June 2019, n = 719

[2] https://www.mithra.com/en/estetrol 

[3] https://www.exeltis.com/fda-accepts-filing-new-estrogen-free-oral-contraceptive-developed-exeltis

[4] https://www.jsm.jsexmed.org/article/S1743-6095(17)31025-1/fulltext

[5] https://www.ncbi.nlm.nih.gov/pubmed/31474158

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