Menopause management complex but possible!
Posted by on October 7, 2011 - 6:10am

Recently, I attended the meeting of the North American Menopause Society (NAMS) in Washington DC along with 1500 other health professionals.    The bottom line:    Estrogen is not the devil, but it is not the panacea for all things female!

When the large Women's Health Initiative was halted in 2002 due to some unexpected findings in women on hormone treatment, the use of hormones significantly dropped.   However, many women found that their most bothersome symptoms returned and some went back on HT with a bit more concern.

The conference focused on new data, much of it refined to look at subsets of women.   It has become significantly clearer that all women are NOT alike when it comes to their health status at the time menopause begins, their age at onset, and the intensity of symptoms. Thus, generalizing outcomes to all women makes little sense.

Here are a few key points that were discussed at the meeting and are currently being studied by researchers:

  • Ill effects in the WHI  participants were more predominant in women who were 10 years post menopause when it came to heart disease.    The latest research suggests that estrogen can make atherosclerosis (one cause of heart disease) worse in women who already have it, but it may delay or prevent it in women who still have healthy arteries.
  • There is an increased risk of breast cancer in hormone users but the absolute numbers were small and were more prevalent among those who took HR that contained both estrogen and progesterone.   Women on estrogen alone had risks similar to placebo.   There is growing interest in the role certain types of progesterone  used in combination therapy play in breast cancer risk.
  • There is a major concern about osteoporosis and bone fractures among aging women whose estrogen levels are dropping.   As one researcher put it, "breaking a hip (in older women) can  kill you faster than breast cancer".   Approximately 50% of women over age 50 will have at least one fracture and we know that hormone therapy significantly reduces that risk. Understanding personal risk profiles for these two conditions should be part of the decision process.
  • While there are more drugs on the market to help maintain bone health, there is more long term data available  on their use that is indicating some alarming side effects with prolonged use. Some of these side effects may be worse than those related to hormone therapy.
  • Researchers are finding that the stages of the menopause transition are quite complex and there may be several levels of the transition that may need different interventions.
  • Vaginal atrophy in women including breast cancer survivors  can be devastating and reasonable treatment options are sorely needed.
  • Since the WHI, there are new treatment options available today for menopause symptoms using different drug formulas and different means of applications (pills, patches, creams, gels and sprays) that may have reduced risk profiles.

That's just a sampling of the many topics discussed at this conference.    Our Institute has been awarded a grant from the Evergreen Initiative at Northwestern Memorial Hospital Foundation to create a decision making tool for women who are menopausal and having bothersome symptoms.    As a result, we will be focusing on all aspects of menopause this year through our educational and fact finding events and I encourage you to follow our blog for our latest findings.

Soy not so 'hot' for menopause symptoms
Posted by on September 7, 2011 - 6:06am

Soy supplements do not help women in menopause, according to the findings of a two-year, $3 million study conducted at the Miller School of Medicine’s Osteoporosis Center. The study was funded by the National Institutes of Health to determine if the widely popular product could preserve bone health and ease symptoms in the first years of menopause. The results show that, contrary to popular belief, soy isoflavone supplements neither prevent bone loss nor reduce menopausal symptoms.

The findings of the SPARE Study, which stands for Soy Phytoestrogens As Replacement Estrogen, were published in the August 8 issue of the Archives of Internal Medicine.

“The consumption of soy foods and soy supplements has dramatically increased in the last few years, particularly among women who start taking various over-the-counter products around the time of menopause, believing that these products will provide all the benefits and none of the risks of menopausal hormone therapy,” said Silvina Levis, professor of medicine, director of the Osteoporosis Center, and principal investigator and lead author of the study. “Our study showed that soy phytoestrogen tablets do not provide any benefit, but fortunately do not cause any apparent harm either. The participants had the same rates of bone loss and menopausal symptoms, whether they were taking soy tablets or placebo tablets (sugar pills). The women on the soy tablets actually had more constipation and abdominal bloating.”

The participants, women aged 45 to 60 and within five years of menopause, were randomly assigned, in equal proportions, to receive either daily soy isoflavone tablets or the placebo and were not aware of which they were taking.

The women were followed for two years and underwent a bone density test (DXA) at the beginning and the end of the study to measure the rate of bone loss. The study showed no meaningful difference in the rate of bone loss between those taking the soy tablets and those taking the placebo. Additionally, those women taking the soy supplement reported no measurable improvement in the number or severity of menopausal symptoms such as hot flashes or in vaginal cytology or cholesterol levels.

While the study is not an endorsement of hormone therapy, it objectively demonstrated that women who take soy isoflavone supplements will not enjoy any clinical benefits.

Source:  University of Miami Veritas

Flaxseed Is Not Effective for Hot Flashes
Posted by on June 29, 2011 - 8:08am

Flaxseed provides no benefit in easing hot flashes among breast cancer patients and postmenopausal women, according to a Mayo Clinic and North Central Cancer Treatment Group (NCCTG) study. The randomized, placebo-controlled study was conducted on 188 women between October and December 2009 and found no statistically significant difference in mean hot flash scores between women taking flaxseed and those taking a placebo. Preliminary data published in 2007 by Mayo Clinic investigators suggested consuming 40 grams of crushed flaxseed daily might help manage hot flashes.

The researchers presented their new findings during the American Society of Clinical Oncology Annual Meeting in Chicago.

“Hot flashes are a common symptom during the menopause transition or following breast cancer treatment,” says Sandhya Pruthi, M.D., of Mayo Clinic’s Breast Diagnostic Clinic and a researcher with NCCTG. “While our preliminary data from our 2007 pilot study showed a reduction in hot flashes associated with the consumption of ground flaxseed, our new study did not result in a significant decrease in hot flashes with eating flaxseed compared to placebo.”

Flaxseed plant

Dr. Pruthi says patients shouldn’t give up flaxseed if they enjoy it. Flaxseed may be beneficial for people who want to add fiber and bulk to their diet to manage constipation, she says. Dr. Pruthi says more research is needed to identify whether flaxseed has any other health benefits.

Other study investigators include Rui Qin, Ph.D., Heshan Liu, Charles Loprinzi, M.D. and Regis Professor of Breast Cancer Research, and Debra Barton, R.N., Ph.D., all of Mayo Clinic.

Hot Flashes Associated with Lower Risk of Breast Cancer
Posted by on March 30, 2011 - 8:13am
Hot Flashes May be a Good Sign for Heart Health
Posted by on March 1, 2011 - 12:07pm

Study finds women who suffer from hot flashes when they begin menopause are at lower risk for cardiovascular events

You are enjoying a night out with friends when it starts; first you feel flush, then a sensation of warmth crawls down your body.  Soon you begin perspiring and you feel as if everyone around you can tell what is happening – another hot flash.  An estimated three out of four women experience hot flashes associated with menopause and nearly all would agree they are a nuisance, but experts say there could be an upside to having hot flashes.  New research released today in the online edition of the journal Menopause suggests that women who suffer from hot flashes and night sweats may be at lower risk for cardiovascular disease, stroke and death.

“While they are certainly bothersome, hot flashes may not be all bad,” said Emily Szmuilowicz, MD, endocrinologist at Northwestern Medicine and lead author of the study.  “Our research found that despite previous reports suggesting that menopause symptoms were associated with increased levels of risk markers for heart disease, such as blood pressure and cholesterol, the actual outcomes tell a different story.”

Szmuilowicz, who co-chaired the study along with JoAnn Manson, MD and Ellen Seely, MD from Harvard Medical School, reviewed medical information from 60,000 women who were enrolled in the Women’s Health Initiative Observational Study and followed for ten years, to determine the relationship between menopause symptoms and cardiovascular events.  Subjects were grouped into four categories – women who experienced hot flashes and night sweats at the onset of menopause, later in menopause, during both time periods, and not at all.

“We found that women who experienced symptoms when they began menopause had fewer cardiovascular events than those who experienced hot flashes late in menopause or not at all,” said Szmuilowicz. The results are significant since there has been concern that menopausal symptoms, which result from instability in the blood vessels in the skin, may put women at risk for other types of vascular problems as well.

“It is reassuring that these symptoms, which are experienced by so many women, do not seem to correlate with increased risk of cardiovascular disease,” said Szmuilowicz.

Szmuilowicz and team say more research needs to be done in order to understand the mechanisms behind the association, but say it’s good news for the millions of women who experience these troublesome symptoms at the time of menopause.

“Hot flashes will never be enjoyable, but perhaps these findings will make them more tolerable,” said Szmuilowicz.The paper titled “Vasomotor symptoms and cardiovascular events in postmenopausal women” is now available online and will be printed in the June issue of Menopause. For more information, visit .

Source:  Northwestern Memorial Hospital, Chicago

Antidepressant Effective for Hot Flashes
Posted by on February 3, 2011 - 10:24am

Women taking a low dose of the antidepressant escitalopram had fewer and less severe hot flashes than those taking a placebo, a new clinical trial reports.

Menopause is a transition that affects many women as they approach age 50. It marks the end of menstrual periods and fertility. It can also bring hot flashes, trouble sleeping, mood changes and other symptoms.

Menopausal hormone therapy has long been the predominant treatment for menopausal symptoms. However, its use has greatly declined since 2002, when a large NIH-funded study concluded that the overall risks of menopausal hormone therapy likely outweigh the benefits in certain groups of women.

No other treatments for menopausal hot flashes currently have FDA approval. Recent studies suggest that certain anti-depressant medications may be effective for relieving hot flashes, but the results have been inconclusive.

Dr. Ellen W. Freeman at the University of Pennsylvania School of Medicine and her colleagues enrolled over 200 healthy menopausal or postmenopausal women. The women were given either a daily dose of escitalopram or a placebo for 8 weeks. The researchers tracked the number, severity and irritation of their hot flashes. The trial was funded by NIH’s National Institute on Aging (NIA) and several other NIH components.

As described in the January 19, 2011, issue of the Journal of the American Medical Association the researchers found that women taking escitalopram had an average of nearly 50% fewer hot flashes after 4 weeks. In comparison, women taking the placebo had on average of 26% fewer hot flashes. The escitalopram treatment led to even further reductions in hot flashes after 8 weeks. Women taking the medication also reported a reduction in the severity and bother of their hot flashes.

An equal number of white and African American women participated in the study. Race had no significant effect on the treatment results.

While it is not clear exactly why antidepressants like escitalopram are effective for treating hot flashes, the study shows that these drugs could be a safe alternative to hormone therapy. Women taking escitalopram reported few adverse side effects during or after the clinical trial. Furthermore, a majority of the women said they were satisfied with the treatment and would like to continue taking escitalopram.

"Our findings suggest that among healthy women who were not depressed or anxious, a 10 to 20 milligram dose of escitalopram provides a non-hormonal, off-label option that is effective and well-tolerated in the management of menopausal hot flashes," Freeman says.

Source:   National Institutes of Health

Menopause Event, Date Change Due to Weather
Posted by on February 1, 2011 - 12:05pm

Due to the blizzard expected in Chicago today,  Hot Flash Havoc ---a film of menopausal proportions, will be rescheduled at Northwestern University and be shown on Thursday night, February 3.    The award winning film will be followed by a panel of experts from Northwestern who will be available to answer all your questions about menopause.     To register for the event, click HERE and go to  ' buy tickets'  $25 includes the film, parking, panel discussion and red boa reception!

Institute Presents Film and Panel on Menopause
Posted by on January 24, 2011 - 2:51pm

Hot Flash Havoc, a film on menopause, will be presented on February 2, 2011 in Chicago.  A panel of experts and a reception follow the film.  Click HERE.for information.

Evamist: Keep Children and Pets Away.
Posted by on August 26, 2010 - 2:57pm

A recent Food and Drug Administration (FDA) MedWatch Safety Alert warns women to make sure children and pets do not come into contact with Evamist that they have sprayed on their skin.    Evamist is a transdermal spray containing estradiol, a form of estrogen. It is sprayed inside of the forearm between the elbow and wrist to reduce hot flashes during menopause. Each squirt of spray delivers 90 mcL which contains 1.53 mg of estradiol and is FDA approved for this use.

The FDA has received reports of side effects in children who were unintentionally exposed to Evamist.   Side effects include:

  • nipple swelling and breast development in girls
  • Breast enlargement in boys

FDA has also received reports of unintentional exposure in pets, which may show signs of mammary/nipple enlargement and vulvar swelling.

The FDA recommends that you do not allow children to come in contact with area of the arm where Evamist was sprayed.  If a child is exposed to Evamist, wash the child's skin with soap and water as soon as possible.      Contact the child's health professional if nipple or breast swelling or breast tenderness occurs in girls, or breast enlargement occurs in boys.    Do not allow pets to lick or touch the arm where Evamist was sprayed.   Small pets may be especially sensitive to Evamist.   Contact a vet if your pet shows any signs of illness, including enlargement of the nipples or vulva.

Women who use Evamist should wear clothing that covers the arm sprayed with the drug if they cannot prevent accidental contact.

The FDA

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