Joint Relief with Estrogen
Posted by on October 19, 2013 - 1:01pm

Hormone therapy can be used to ease the many symptoms of menopause, including night sweats, hot flashes, and mood swings. New research indicates that hormone therapy, specifically estrogen, can also be used towards joint pain.

Estrogen therapy improves joint pain in post-menopausal women who have had a hysterectomy. Studies looking at the Women's Health Initiative (WHI) trial analyzed 10,000+ post-menopausal women. 77% of these women reported join pain and 40% experienced joint swelling. After just one year, frequency of joint pain was lower among women who received estrogen-only therapy, compared to women who were in the placebo group (76.3% s. 79.2%) After three years, the subset of women who received estrogen continued to have joint pain less frequently than the placebo group.

The difference was seen only in women who received estrogen alone, vs. women with intact uteruses who took estrogen-progesterone combination therapy. Regardless, these findings give light to the many potential therapeutic values of estrogen. Post-menopausal women who are thinking about estrogen to alleviate their joint pain should consult their healthcare providers, and they should still follow the lowest dose of estrogen for the shortest amount of time needed to achieve the therapeutic goals desired. To understand more of the potential benefits (and risks) of estrogen or estrogen-progesterone therapy, visit our menopause website here.

FDA Gives Hot Flashes a Chill Pill
Posted by on August 26, 2013 - 11:00am

The United States Food and Drug Administration recently approved the first non-hormonal solution to hot flashes associated with menopause; it is the drug Brisdelle.  Nearly 75% of menopausal women experience hot flashes, which are extreme feelings of warmth accompanied with redness and sweating.  While hot flashes can spread over the entire body, they are mostly concentrated in the face and neck. Hot flashes are the most common side effect of menopause, and while the exact cause of hot flashes is unknown, a great deal of research is conducted on alleviating this discomfort for women. This new drug Brisdelle offers a non-hormonal alternative to the hormone therapy options currently available.

Brisdelle contains paroxetine mesylate, a serotonin reuptake inhibitor, which differs from other FDA-approved hot flash treatments that contain the hormones estrogen and progestin. Brisdelle underwent two randomized, double-blind, placebo-controlled studies with 1,175 postmenopausal participants and was found to produce positive results compared to the placebo control. The drug is taken once a day and some side effects include nausea, vomiting, fatigue, and headache.  The director of the Division of Bone, Reproductive and Urologic Products in the FDA’s Center for Drug Evaluation and Research, Hylton V. Joffe, M.D., M.M.Sc., expressed that Brisdelle is a breakthrough product for women “who cannot or do not want to use hormonal treatments” for hot flashes associated with menopause. Brisdelle can now be added to the many treatment options available to women who experience symptoms related to menopause.

To read more about Brisdelle, click here.

 

Hot Flashes: Not Just During Menopause
Posted by on August 18, 2013 - 11:09am

We all know of hot flashes and night sweats as the most common and bothersome symptoms of menopause. Hot flashes can range from tolerable to debilitating, seconds to minutes, and infrequent to consistent. What most women don't know, however, is that hot flashes can happen during and before menopause, too.

A survey conducted by researchers at Group Health, a healthcare system located in the Pacific Northwest, asked a diverse group of women whether they have experienced hot flashes and/or night sweats. The women ranged from 45 to 65 years old, regularly menstruated (no skipped cycles), were not on exogenous hormones, and came from a variety of ethnic backgrounds.

In this survey, 55% of all women reported having hot flashes or night sweats. Native Americans and African Americans had the highest proportions reporting these symptoms, at 67% and 61%, respectively. 58% of Caucasian women reported symptoms, although this was not statistically significant in comparison to Native Americans and African Americans. Asian and Hispanic women were least likely to report symptoms (31% and 26%, respectively).

So don't be dismayed if you suspect you are having a hot flash before your menopause hits. This study helps women by showing that a large percentage of women experience menopause symptoms actually before menopause, and this is normal. If you want to know what other symptoms you may have during menopause, visit http://menopausenu.org/

Strong Bones with Calcium and Hormones
Posted by on August 13, 2013 - 8:50pm

After the age of 30, the creation of new bone cannot keep up with the rate of bone loss in your body. The estrogen depletion that comes with menopause results in an increased risk for low bone mineral density, osteopenia and osteoporosis. For 5-10 years after menopause, this bone density loss accelerates into a gradual weakening of your bones and can lead to an increase in the risk for fractures and other injuries.

Physicians and organizations left and right have tried to specify a regimen to  help slow down the weakening of bones in postmenopausal women. The National Osteoporosis Foundation states that both types of hormone therapy, Estrogen therapy and combined Estrogen and Progesterone therapy, reduce the risk of osteoporosis. But what about supplements?

This past February, the US Preventive Services Tasks Force (USPSTF) stated there was insufficient evidence regarding calcium and vitamin D supplementation for bone fracture prevention in postmenopausal women. Now, a new analysis shows the evidence that may very well alter this recommendation.

The North American Menopause Society conducted a trial with 27,347 postmenopausal women, of which 8,000 took supplemental calcium (1,000 mg) and vitamin D (400 mg) daily, and 8,000 took look-alike placebos. These women came from all the hormone groups in the study: on HRT combinations, those on HRT estrogen alone, and the rest on hormone look-alike placebos.

Researchers then studied the hip fracture incidents among women who took hormones and supplements, women who took hormones alone, and women who took neither one. Of the women on both hormones and supplements, there were 11 hip fractures per 10,000 women per year. Of the women solely on hormones, there were 18 hip fractures per 10,000 women per year. And of the women who took neither, there were 22 hip fractures per 10,000 women per year.

Although the researchers could not specify how much of calcium and vitamin D should be taken, they concluded that postmenopausal women taking hormone therapy should also take supplemental calcium and vitamin D to reduce the rate of bone loss. The benefits of calcium and vitamin D seem to increase with increasing total intake, but also depend on the side effects of too much calcium, such as constipation.

So consider taking calcium and vitamin D supplements in combination with your hormone therapy, but don't stop drinking your milk! Continue trying to meet your daily calcium needs with your diet. Furthermore, did you know that weight bearing exercise can also improve your bone health? To learn more about how you can manage your bone health and overall health in menopause, visit http://menopausenu.org/

 

Menopause and Memory: Women Know What They Do Not Know
Posted by on August 8, 2013 - 3:24pm

The need for health care varies greatly over a lifespan, with older adults having significantly more health-related needs and costs than younger individuals. Women, in particular, often face a myriad of health problems as they transition through menopause.  Sadly, despite the fact that every woman will go through menopause, very little is understood about the physical and mental changes that occur during this period of life.  In addition, women may struggle to find pharmaceutical solutions, which can safely provide proven relief without the worry that those available will increase their likelihood of other health and mental complications.

Much is misunderstood about menopause and the changes that are associated with the hormonal fluctuations. This is largely due to the fact this inevitable transition is rarely apart of the conversation, particularly in the context of health care. Further, menopause is expected to be merely “bothersome”; not something one could attribute real health problems to. Although maternity care and issues related to younger women are required in the Affordable Care Act as essential health benefits, nothing of legislative note will improve the knowledge and acceptance of this natural life progression.

Most insurance companies do not even cover basic medications associated with menopausal symptoms, and conflicting research has women scared about the potential long-term effects associated with hormone replacement therapy. Negative press, little medical literature and low financial assistance often leaves women to suffer through menopause silently, many of whom worry constantly about memory deficits they experience and potential long term changes.

A recent study focused on the memory complaints of midlife women has been receiving a lot of attention. The study, conducted at the University of Illinois- at Chicago (UIC), attempted to determine if women who are experiencing hot flushes during menopause were able to accurately predict their own memory performance.

According to the principal author, Lauren Drogos, “We found that a one-item question: ‘How would you rate your memory in terms of the kinds of problems that you have?’ was the best predictor of verbal memory performance on a list-learning task.  We also found that many complaints were related to mood symptoms.”

In the US, the average woman becomes postmenopausal around the age of 51.  Common symptoms that occur include hot flushes, sleep disturbances, mood changes and memory problems. However, until recently it was believed that women were unable to accurately describe the current state of their memory and the changes they experience as they progress through menopause.

Despite the difficulty in being taken seriously about the physical and mental challenges that menopause presents, this recent study from Drogos, along with other research, shows that woman are able to accurately describe their current memory abilities. Specifically, a group of sixty-eight women performed a series of memory tests and were then asked, to detail the types of memory problems they were experiencing. The study concluded that women were able to accurately rank themselves on a scale from no memory problems to severe problems.

Using recall of a short story, the deficits seen in memory did not indicate that women were suffering from dementia, nor were they experiencing shortfalls in memory that were impacting daily life. Instead, it was simply indicative that women who experienced memory deficits often recognized the changes occurring.

Previous research focusing on women’s transitions through menopause also found that hot flushes during the nighttime were the best predictors of memory performance in women. This leads researchers within the Women’s Mental Health Research Program at UIC, to believe that sleep disturbances and stress hormones may play integral roles in memory and hot flushes.

The good news for women concerned about the transition through menopause is that the cognitive decline that occurs appears to only be temporary, with performance rebounding early into post-menopause. Further, for those who want to keep both their minds and bodies at peak performance, research indicates that leading a non-sedentary lifestyle, keeping mentally active, and having a healthy diet can be the best preventers of cognitive decline.  To learn more about menopause, visit menopausenu.org, a new web site that helps women evaluate their overall health and menopause symptoms.

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.

 

Women who had childhood cancer may have earlier menopause
Posted by on December 24, 2012 - 5:06pm

When female childhood cancer survivors grow up, are they more likely to experience an earlier onset of menopause?  If so, what are the risk factors associated with early menopause?  These were the questions asked by researchers at the French public hospital organization (AP-HP), the Institute Gustave Roussy, and the Universite Paris-Sud.  Their study, published in the November 12th edition of Human Reproduction (http://humrep.oxfordjournals.org/content/early/2012/11/14/humrep.des391....) and summarized on the Science Daily  website, provides valuable answers.

Researchers looked at data from Euro2K, a French cohort of 3402 survivors of childhood cancer, who were under 18 at the time of diagnosis, between the years 1945 and 1986.  706 female survivors (32% had already reached the age of 40, and 7% were over 50 years old)  participated in this study and filled out detailed questionnaires about their health (age of first period, current menstrual status, etc.). Researchers studied the age at which each of these women started menopause and also took into account any possibly associated risk factors. All the data were self-reported, and researchers did not confirm the menopausal status of study participants with medical reports or hormonal tests.

Data analysis revealed that 97 women (13.7%) went through menopause at a median age 44 years.  This is 7 years earlier than the median age of menopause in the general European population, which is 52 years.  Menopause was surgically induced for a third of these women (36%).

Researchers concluded that the women most at risk for early menopause were survivors treated after the onset of puberty using alkylating agents (http://www.cancer.gov/dictionary?cdrid=45589 ) (with or without even a small dose of radiation to the ovaries).  They found that the primary risk factors linked to cases of early menopause include the dosage of alkylating agents received during bone marrow transplant, the radiation dosage received at the ovaries, and the older the patient is when receiving childhood cancer treatment.

While these results are in agreement with the results of earlier American studies, they differ with regard to the fact that the French research team did not find that women who had suffered from childhood cancer had a significantly increased chance of premature menopause (i.e. menopause that occurs before the age of 40).  Researchers suggest that a possible reason for this difference in findings is that patients from the French cohort were diagnosed with cancer at a lower median age than the participants in American studies (4 years old as opposed to 7 years old in a similar American study).  This could partially explain the lower incidence of premature menopause in the study population.

This study is significant because it provides us with additional information about the risk factors that affect the fertility window of female survivors of childhood cancer.  After assessing their risk of premature menopause, patients can make informed decisions regarding the timing of their family planning.  For example, women at high risk might consider trying to get pregnant at a younger age than women at low risk.

To learn more about fertility preservation before, during, and after cancer treatment, including which chemotherapy regimes are most likely to affect fertility, please visit SaveMyFertility.org (www.savemyfertility.org)

Author:   Cathryn Smeyers

'This Is Personal' Campaign for Women's Reproductive Rights
Posted by on September 27, 2012 - 9:55am

The 2012 election cycle has seen unprecedented coverage (and often misinformation) on women’s reproductive health care due to the Affordable Care Act’s immediate impact and nonstop campaign gaffes related to women’s health.

Last Thursday, the National Women’s Law Center (NWLC) launched a new campaign to improve access to women’s health information called This Is Personal. The mission of the campaign is to target, engage and inform younger women about reproductive rights and help disseminate information related to women’s health topics ranging from contraception, maternity care, and what Congress is presently voting on.

It is therefore vitally important that women get involved in the decision-making process to ensure that the women impacted by these deeply personal issues have real world input.  “Decisions about women’s reproductive health are personal. Period.” said NWLC Co-President Marcia Greenberger. “These decisions should be a woman’s to make with the important people in her life. The personal beliefs of lawmakers should not trump a woman’s ability to take care of her health.” Despite the private nature of decisions impacting reproductive health care, they are often made at the federal, state or local levels instead of the individual level.

The This Is Personal campaign hopes that through social media, celebrity involvement in videos and satire, young women (and men) will become increasingly active and interactive about reproductive rights. For example, through the new website’s interactive action tabs women can gather more information about state and federal health care decisions, sign petitions and contact legislators.

Decisions about women’s reproductive health care are greatly personal and deserve intimate involvement from women themselves. This Is Personal has a Facebook, Twitter and website with data and satirical videos which should be used as an educational tool and a place for women to educate themselves for the upcoming election. It is also a place where women can actively use their beliefs and knowledge to have their voices heard by decision makers.  Sharing of ideas and knowledge is the only way to put decision making into the hands of the women who will be affected by the policies of the 113th Congress.

Menopause film now available on the big screen
Posted by on March 27, 2012 - 3:42pm

A year ago our Institute hosted a private showing of Hot Flash Havoc, an award winning documentary on menopause.  The long awaited release of this film in U.S. theaters begins later this month.  To learn more about the sites and dates, visit the film website at:  http://www.hotflashhavoc.net/

Menopause Society Supports Extended Hormone Therapy
Posted by on March 5, 2012 - 10:27am

Menopausal hormone therapy doesn't have to follow "the lowest dose for the shortest time" strategy for all women anymore, the North American Menopause Society said today.   The group endorsed a flexible approach to duration that takes into account the type and timing of therapy and individual patient characteristics in a statement in its journal, Menopause.

For women in their 50s, the absolute risks are low; younger women without a history of breast cancer can use replacement hormones at least until the normal menopause age around 51, and longer if needed for symptom management, according to the guidelines.

"No 'one size fits all' approach is acceptable anymore," JoAnn E. Manson, MD, DrPH, NCMP, of Harvard, and president of the society, said in answer to a query from ABC News and MedPage Today.

Manson's position is somewhat surprising since she was a principal investigator for the Women's Health Initiative, the landmark randomized trial that derailed the hormone therapy movement when it reported a link between Premarin (estrogen/progestin) and increased risk of breast cancer and thromboembolic conditions.

The new guidelines loosen up on timing, agreed Michelle P. Warren, MD, NCMP, of Columbia Presbyterian Medical Center in New York City, who was also involved with the guidelines.   Women who need hormone therapy can use it for as long as needed, she said in an interview.    That shift should be reassuring for many women, Manson suggested.

When the Women's Health Initiative studies indicated elevated breast cancer and heart disease risk with hormone therapy in its postmenopausal population a decade ago, prescriptions dropped precipitously across the country.   Recommendations followed suit, urging cautious, sparing use of the drugs.

Fear of prescribing to women with any suggestion of heart disease, even the common symptom of palpitations, led to "a whole generation of women who were really suffering," Warren noted.

Now with longer-term follow-up available from that and other studies, perspectives are changing, explained Manson, who serves as an investigator with the ongoing Nurses' Health Study, an observational study that was once used to bolster use of hormone therapy.  Last summer, the Endocrine Society also called for rethinking the established line on menopausal hormone therapy, stating that risks and benefits vary by age and time since menopause.

The menopause society's consensus group concluded that the estrogen-only (ET) formulations (typically used for women without a uterus) can be used for seven years without increasing risk of breast cancer, while combination estrogen-progestin therapy (EPT) increases that risk after three to five years of use.

The recommendation for duration of therapy differs for EPT and ET. For EPT, duration is limited by the increased risk of breast cancer and breast cancer mortality associated with three to five years of use; for ET, a more favorable benefit/risk profile was observed during a mean of seven years of use and four years of follow-up, a finding that allows more flexibility in duration of use.

The Women's Health Initiative and Nurses' Health Study both pointed to a possible reduced risk if use didn't start immediately after menopause.   However, the evidence for this "gap theory" (also called the critical window hypothesis)  isn't very solid and menopausal symptoms are usually worse in the first two to five years, Warren said in an email to ABC News/MedPage Today.

The bigger clinical impact from the guidelines is likely to come from its conclusions on cardio- and cerebrovascular risks, she suggested.   With estrogen alone, women in their 50s in the Women's Health Initiative actually had a reduced risk of combined endpoints including coronary heart disease and total myocardial infarction.

With combined estrogen and progestin, that trial showed an absolute increase in heart disease by an estimated eight cases per 10,000 women per year, whereas observational studies had found a longer duration of use associated with a reduced risk.

The potentially reduced coronary heart disease risk among women who used hormone therapy for five or more years was "not conclusive and should be considered in light of other factors altered by duration of therapy, such as breast cancer," the statement warned.

There was a clear differentiation in risk by timing of hormone therapy after menopause, though, in the opposite direction than for breast cancer risk.  Both unopposed estrogen and estrogen with progestin were associated with elevated coronary heart disease risk when therapy started more than 10 years after menopause.

For stroke, hormone therapy had appeared to raise risk overall, with eight additional strokes per 10,000 women per year of combined hormone therapy and 11 extra with estrogen only.  But recent analyses of the two together found no significant stroke risk for women ages 50 to 59 at initiation, the statement noted.

"They have essentially rescinded the position concerning the heart data as long as you start within 10 years of menopause commencing," Warren summarized.

However, Marcia Stefanick, MD, of Stanford University, who had been involved with the Women's Health Initiative steering committee, took issue with that conclusion, calling it misleading.The analysis actually showed no interaction with age for stroke risk, which means all age groups are at elevated risk, she told ABC News/MedPage Today.Another problem was that the women on unopposed estrogen in the Women's Health Initiative only used the drug for an average of 3.5 years because so many discontinued.

"I don't think we have data suggesting that you can go beyond three to five years," she said. "It is misleading to say [estrogen is safe for] seven or more years."

The NAMS statement urged clinicians to consider a number of additional factors when considering hormone therapy for patients:

  • A woman's individual risk and history of venous thrombosis, heart disease, stroke, and breast cancer
  • Route of administration and dosing, as transdermal and low-dose oral estrogen are associated with lower venous thromboembolism and stroke risks than standard oral estrogen doses
  • Type of symptoms, with low-dose, local administration of estrogen when only vaginal symptoms are present

Further research is still needed, especially in interpreting individual risk and assessing long-term implications, the statement noted.

By Crystal Phend, Senior Staff Writer, MedPage Today

Primary source: Menopause: The Journal of The North American Menopause Society
Source reference:
"The 2012 hormone therapy position statement of the North American Menopause Society" Menopause 2012; 19: 257-271.

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