Effects of Hormone Levels on Cognition after Menopause
Posted by on January 2, 2014 - 11:23pm

Do hormone levels in postmenopausal women affect cognitive function? New research sheds light on the postmenopausal brain.

In a recently published study, researchers found that estrogen levels after menopause may have no impact on cognitive skills, but progesterone levels might. Progesterone had some association with global cognition and verbal memory among newly postmenopausal women.

643 healthy postmenopausal women were part of the study, ranging from 41 to 84 years old. Neuropsychological tests were done to assess cognition and memory, and hormone levels were determined including estradiol, estrone, progesterone, and testosterone. The findings showed no association between estrogen and cognitive skills. However, women with higher levels of progesterone had better outcomes on the verbal memory and global cognition tests, particularly in those who had started menopause less than six years prior. None of the hormones appeared to have any association with depression or mood either.

More research must be done to confirm the new findings regarding progesterone levels. Also, there is no way to directly measure hormone concentrations at the brain level, but this research implies that estrogen therapy may not have a significant effect on cognitive skills. To learn more about when hormone therapy is beneficial , visit Northwestern's menopause website here.

 

Source reference: Henderson VW, et al "Cognition, mood, and physiological concentrations of sex hormones in the early and late menopause" PNAS 2013; DOI: 10.1073/pnas.1312353110.

Hormones affecting Quality of Life during Menopause
Posted by on December 20, 2013 - 8:36pm

Women undergoing menopause experience symptoms including hot flashes, sleeplessness, depression, joint pain, and poor concentration, to name a few. Hormone therapy has proven to improve some of these symptoms in menopausal women, but new research shows that treatment may only improve quality of life in those who undergo a significant number of hot flashes.

A recently published study done in Finland, looked at use of hormone therapy in women who had recently gone through menopause. 150 women were divided into two groups, those with seven or more moderate to severe hot flashes per day, and those with three or fewer mild hot flashes per day. In each group, half the women used hormone therapy and half received only a placebo.

All women were asked to track their hot flashes as well as their additional menopausal symptoms. After six months, hormone therapy improved the overall health of women with moderate to severe hot flashes in symptoms including sleep, anxiety, memory and concentration, joint and muscle pain, and hot flashes. Hormone therapy made no difference in those with mild or no hot flashes.

Though the Finland study may not apply to women of other ethnicities, the research demonstrates how treatment must be personalized for women undergoing menopause. Physicians should take into account the different symptoms that a woman is experiencing when recommending treatment. Women should also always consider all the options in improving symptoms, from lifestyle to herbs to hormones. To read more about the different treatments available to minimize menopausal symptoms, visit http://menopause.northwestern.edu/

50 and Fabulous: New Menopause Website Empowers Women to Combat Menopausal Symptoms
Posted by on June 28, 2013 - 8:32am

Do you have questions about menopause? Are you ever curious about hormone therapy treatments? You’re not alone!  Every year over two million women in America alone enter into menopause, and most have questions.  The Women’s Health Research Institute wants to provide answers with the creation of a new website: menopausenu.org.  This new site is tailored to the needs of women, offering up-to-date information on menopause and symptom management.  The site even offers a personalized “Menopause Self Assessment,” which enables women to evaluate their own symptoms and health status that they can then print out and share with their healthcare providers.

Menopause marks the transition in every woman’s life when menstruation and fertility decline and eventually end.  Menopause symptoms affect women differently, so treatments vary from woman to woman.  The many stages of menopause may seem overwhelming, but women should find comfort in the numerous treatment options developed by leading researchers and clinicians.  Empowering women with educated choices regarding their health provides them with the tools to live longer and stronger in their journey during and after menopause. Click here to learn more about menopause and the different ways you can navigate your menopausal transition.

 

Why has Menopause Management become so Controversial?
Posted by on March 8, 2011 - 11:59am

Women, on average, live one-third of their lives post menopause.   Some women find menopause an easy transition. Other women are chronically bothered by persistent hot flashes and night sweats that impact their quality of life.   For years, hormone therapy was the answer but it has been shadowed by controversy as researchers learn more about estrogen and its long term impact on the body.    The Institute for Women's Health Research discussed this controversy in its March e-newsletter that is available at  ENewsletter March 2011final.

Hormone Therapy and Breast Cancer Risk
Posted by on February 10, 2011 - 2:24pm

Starting Hormone Therapy at Menopause Increases Breast Cancer Risk

Women who start taking menopausal hormone therapy around the time of menopause have a higher risk of breast cancer than women who begin taking hormones a few years later. The finding, from the Million Women Study (MWS)—a large observational study in the United Kingdom—adds to a growing body of evidence that the use of combined hormone therapy (estrogen plus progestin) to treat menopausal symptoms increases the risk of breast cancer and deaths from the disease. The results appeared in the Journal of the National Cancer Institute on January 28.

The pattern of increased breast cancer risk “was seen across different types of hormonal therapy, among women [in the MWS] who used hormonal therapy for either short or long durations, and also in lean and in overweight and obese women,” Dr. Valerie Beral of Oxford University and her colleagues wrote. Their findings support results from the Women’s Health Initiative (WHI), a randomized clinical trial that, in 2002, first reported evidence linking combined hormone use to breast cancer.

“The new findings underscore the idea that there’s really no safe window of time for women to take combined hormone therapy,” said Dr. Leslie Ford of NCI’s Division of Cancer Prevention and the Institute’s WHI liaison. After the initial WHI results were announced, she noted, some people had argued that hormones may be safer when started at the time of menopause. “The new findings refute that argument,” she added.

WHI and MWS investigators have both reported that breast cancer incidence rates declined rapidly once women stopped taking combined hormone therapy. “It is important for women to know that if they stop using hormones, the risk of breast cancer very quickly returns to where it was before hormone therapy began,” Dr. Ford said.

There has been a discrepancy between the WHI and MSW results to date as to whether estrogen-only therapy raises breast cancer risk in postmenopausal women. WHI reports have found little risk associated with this treatment, whereas the MWS investigators have observed a statistically significant increased risk.

Additional follow-up from the WHI estrogen-only intervention trial should help clarify this issue in the coming years, noted Drs. Rowan T. Chlebowski of Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and Garnet L. Anderson of the Fred Hutchinson Cancer Research Center in an accompanying editorial.

Hormone Therapy and Dementia
Posted by on December 17, 2010 - 6:04pm

Hormone Therapy Use May Increase Or Decrease Dementia Risk Depending Upon Timing

Compared to women never on hormone therapy, those taking hormone therapy only at midlife had a 26 percent decreased risk of dementia; while women taking HT only in late life had a 48 percent increased risk of dementia, according to Kaiser Permanente researchers.   Women taking HT at both midlife (mean age 48.7 years) and late life had a similar risk of dementia as women not on HT, according to the study which appears in the Annals of Neurology. The study was funded in part by the National Institutes of Health.

Although previous research has shown that initiation of postmenopausal estrogen hormone therapy in late life increases the risk of dementia, animal studies and some observational studies have suggested that midlife use of HT may be beneficial. This is the first observational, long-term study to directly compare the effect of hormone therapy status in both midlife and late life on risk of dementia.

"This study is unique because we had a group of women who were on HT in midlife only and could look at their dementia risk over time, and we found a modest, protective association. We also found that if you start HT late in life, you have a 50 percent increased risk of dementia, which is consistent with other studies," said study lead author Rachel Whitmer, PhD, a research scientist with the Kaiser Permanente Division of Research in Oakland, Calif. "Women should speak with their doctor about what's best for their individual situation, however it appears from this study that women who are on short-term HT in midlife may benefit from a modest protective association, while initiation in late-life can cause harm."

Adjustment for high cholesterol, hypertension and stroke did not reduce the magnitude of the effect of late life HT on increased risk of dementia, according to the researchers. It's also possible that in the group of women who used HT both in midlife and late life; the potential modest benefit of midlife use was counteracted by a negative effect of late life use, they explained.

This study is part of an ongoing body of research at Kaiser Permanente to better understand the modifiable risk factors for dementia.

Limitations of this most recent study include the fact that HT information in midlife was self-reported and therefore researchers do not know the dose or type of HT involved. Also, because the pharmacy database was initiated in 1994, researchers do not have information on the duration of midlife HT.

Source: Kaiser Permanente

More on Male Menopause
Posted by on September 10, 2010 - 10:54am

Our recent blog on male menopause has generated a number of questions, especially on the side effects of hormone treatments.   I went back to Dr. Robert Brannigan, a Northwestern University urologist,  who was quoted in our previous blog on the topic for guidance and he shared an article that was jointly prepared by the Practice Committee of the American Society for Reproductive Medicine and the Society for Male Reproduction and Urology entitled, "Androgen deficiency in the aging male" (Fertility and Sterility, Vol. 90, Suppl 3, November 2008).   It should be noted that although there are recommendations (see below) for androgen replacement therapy for older men, the data to support treatment protocols are based on a limited number of clinical trials. Furthermore, the long term health risks and benefits of androgen therapy in the older man are not well defined so it is important that anyone undergoing androgen therapy be carefully monitored.

All commercial androgen formulation currently available in the US are preparations of testosterone, an androgen that can be converted to estradiol.  The potential risks of androgen therapy in older men include fluid retention, gynecomastia, excessively elevated red blood cell mass, exacerbation of sleep apnea,  benign or malignant prostate disease, and an increase in risk for cardiovascular disease (CVD).

The Summary and Recommendations of the report state:

  • Androgen deficiency in the aging male may be associated with changes in mood, body composition, stamina, energy, and decreased sexual and cognitive function as well as loss of bone mineral density.   Such signs and symptoms may be relieved or eliminated with testosterone replacement therapy.
  • Serum testosterone should be evaluated only in men with signs or symptoms of androgen deficiency.
  • Androgen therapy should be considered for men who have symptoms of androgen deficiency and a low serum total testosterone concentration (<200 ng/dL).
  • Free or bioavailable testosterone levels or the free testosterone index should be evaluated in men who have symptoms of androgen deficiency and a borderline total serum testosterone concentration between 200 ng/dL and 400 ng/dL.
  • During androgen therapy, serum testosterone, PSA (prostate specific antigen), and hematocrit (level of red blood cells) should be monitored, and periodic digital rectal exam is recommended.
  • Limited data regarding the benefits and risks of testosterone replacement therapy do not permit specific treatment recommendations at this time and further research studies are needed to better define the effects of androgen replacement therapy in aging men.

Men considering androgen replacement therapy may want to consider participation in a clinical trial so that we can increase our knowledge in this area.