Estrogen helps brain keep weight in check
Posted by on November 3, 2011 - 2:44pm

A recent UT Southwestern Medical Center study found that estrogen regulates energy expenditure, appetite and body weight, while insufficient estrogen receptors in specific parts of the brain may lead to obesity.

“Estrogen has a profound effect on metabolism,” said Dr. Deborah Clegg, associate professor of internal medicine and senior author of the study published Oct. 5 in Cell Metabolism. “We hadn’t previously thought of sex hormones as being critical regulators of food intake and body weight.”

The mouse study is the first to show that estrogen, acting through two hypothalamic neural centers in the brain, keeps female body weight in check by regulating hunger and energy expenditure. Female mice lacking estrogen receptor alpha – a molecule that sends estrogen signals to neurons – in those parts of the brain became obese and developed related diseases, such as diabetes and heart disease.

Similar results were not seen in male mice, although researchers suspect other unknown estrogen receptor sites in the brain play a similar role in regulating metabolism for males as well. Estrogen receptors are located throughout the body, but researchers found two specific populations of estrogen receptors that appear to regulate energy balance for female mice.

The findings are potentially important for millions of postmenopausal women, many of whom have decided against hormonal replacement therapy. The study could lead to new hormonal replacement therapies in which estrogen is delivered to specific parts of the brain that regulate body weight, thereby avoiding the risks associated with full-body estrogen delivery, such as breast cancer and stroke.

Doctors stopped routinely recommending long-term estrogen therapy for menopausal women in 2002 when a Women’s Health Initiative study showed the hormone did not prevent heart disease in women who already were at increased risk.

“The role of estrogen in postmenopausal women continues to remain uncertain,” Dr. Clegg said. “Current research is focused on the timing and the type of estrogen supplementation that would be most beneficial to women. Our findings further support a role for estrogens in regulating body weight and energy expenditure, suggesting a benefit of estrogen supplementation in postmenopausal women.”

Source: UT Southwestern Medical Center

 

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.

Diabetes and menopause
Posted by on September 19, 2011 - 7:47am

Menopause has little to no impact on whether women become more susceptible to diabetes, according to a one-of-a-kind study.

Postmenopausal women had no higher risk for diabetes whether they experienced natural menopause or had their ovaries removed, according to the national clinical trial of 1,237 women at high risk for diabetes, ages 40 to 65.“In our study, menopause had no additional effect on risk for diabetes,” says study lead author Catherine Kim, M.D., M.P.H., an associate professor of internal medicine and obstetrics and gynecology at the University of Michigan Health System. “Menopause is one of many small steps in aging and it doesn’t mean women’s health will be worse after going through this transition.”

Kim and colleagues in the Diabetes Prevention Program Research Group will publish their results in the August issue of Menopause.  The findings also shed light on the impact of diet and exercise and hormone replacement therapy on the health of postmenopausal women.

Previous evidence has suggested that menopause would speed the progression to diabetes because postmenopausal women have relatively higher levels of the hormone testosterone, which is considered a risk factor for diabetes. But the recent study shows healthy outcomes for postmenopausal women.

The women in the study were enrolled in the Diabetes Prevention Program, a clinical trial of adults with glucose intolerance, meaning tests show their body’s struggle to process glucose, or blood sugar, into energy.

Glucose intolerance is often a pre-stage to diabetes, a condition common later in life and is diagnosed when the body has abnormally high levels of blood sugar. Age, weight, physical activity and family history can contribute to type 2 diabetes.

But Diabetes Prevention Program researchers have shown lifestyle intervention and the blood sugar-lowering drug metformin can prevent diabetes in those with glucose intolerance. The interventions work well in women who have gone through menopause.

Menopause is the end of monthly periods and chance for pregnancy and estrogen production by the ovaries stops. In the United States, menopause happens around age 51 or 52.

The research is considered the only menopause study that specifically analyzed the impact of diabetes on women who had natural menopause and those who had their ovaries removed. Most other studies mixed them together or excluded one group.

According to the new study, for every year 100 women were observed, 11.8 premenopausal women developed diabetes, compared to 10.5 among women in natural menopause and 12.9 cases among women who had their ovaries removed.

However for women whose estrogen production ended as a result of having their ovaries removed, and engaged in lifestyle changes, cases of diabetes were extremely low. For every year 100 of these women were observed, only 1.1 women developed diabetes.Lifestyle changes included losing 7 percent of their body weight and exercising for at least 150 minutes a week. For instance, a 180-pound postmenopausal woman would see benefits from losing 12.6 pounds.

The results among this group were surprising considering almost all of the women who had their ovaries removed were on hormone replacement therapy, a regime that women and doctors fear puts them at risk for a host of health issues. Study authors say more research is needed on the role of hormone therapy and diabetes risk.

“Physicians can be empowered to tell women that lifestyle changes can be very effective, and that menopause does not mean that they have a higher risk of diabetes,” Kim says.

Source: University of Michigan Health System

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

New research examines how estrogen could protect women from heart disease
Posted by on August 26, 2011 - 6:54am

The sex hormone estrogen could help protect women from cardiovascular disease by keeping the body's immune system in check, new research from Queen Mary, University of London has revealed.

The study has shown that the female sex hormone works on white blood cells to stop them from sticking to the insides of blood vessels, a process which can lead to dangerous blockages.

The results could help explain why cardiovascular disease rates tend to be higher in men and why they soar in women after the menopause.

The researchers compared white blood cells from men and pre-menopausal women blood donors. They found that cells from premenopausal women have much higher levels of protein called annexin-A1 on the surface of their white blood cells.

The scientists also found that annexin-A1 and estrogen levels were strongly linked throughout the menstrual cycle.

White blood cells play a vital role in protecting the body from infections. When they are activated they stick to the walls of blood vessels. This process normally helps the cells to tackle infection but if it happens too much, it can lead to blood vessel damage, which in turn can lead to cardiovascular disease. However, when annexin-A1 is on the surface of these white blood cells, it prevents them from sticking to the blood vessel wall.

The new research shows that estrogen can move annexin-A1 from inside the white blood cell, where it is normally stored, to the surface of the cells, thereby preventing the cells from sticking to blood vessel walls and causing vascular damage. This may have important implications in cardiovascular disease.

Dr Suchita Nadkarni from the William Harvey Research Institute, Queen Mary, University of London, who led the research, said: "We've known for a long time that estrogen protects pre-menopausal women from heart disease, but we don't know exactly why. This study brings us a step closer to understanding how natural estrogen might help protect our blood vessels.

"We've shown a clear relationship between estrogen levels and the behaviour of these white blood cells. Our results suggest that estrogen helps maintain the delicate balance between fighting infections, and protecting arteries from damage that can lead to cardiovascular disease.

"Understanding how the body fights heart disease naturally is vital for developing new treatments."

The study is published in American Heart Association journal Arteriosclerosis, Thrombosis and Vascular Biology. It was co-funded by the British Heart Foundation, the Wellcome Trust and the National Institutes of Health Research (NIHR).

15 Aug 2011

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.

Green Tea and Tai Chi--a Healthy Partnership
Posted by on May 16, 2011 - 12:13pm

Green tea has become an international mainstay beyond the Orient.   Many observational studies have shown that green tea is full of potent polyphenols (an antioxidant) that lower the risk of several chronic degenerative diseases such as heart disease and osteoporosis.  A recent study from Dr. Chwan-Li (Leslie)  Shen, an associate professor and a researcher at the Laura W. Bush Institute for Women's Health at Texas Tech University Health Sciences Center looked at the mechanism behind this correlation and believes it may have to do with lowering chronic levels of inflammation.

Dr. Shen has developed an animal model to study  green tea consumption and its protective effect on the breakdown of the bone's microarchitecture.  In humans, this can lead to osteoporosis, a condition common in postmenopausal women.  In her most recent study, she investigated the potential for green tea to work synergistically with tai chi, a moderately aerobic exercise popular among Chinese cultures.  Together, can these two interventions enhance bone strength?

Her randomized controlled study (the gold standard) included 171 postmenopausal women (average age was 57) who had weak bones but not full fledged osteoporosis.  They were divided into 4 groups:

  • Placebo (starch pill) and no tai chi
  • Green tea polyphenols (GTP)  and no tai chi (TC)
  • Placebo and tai chi
  • GTP plus TC

Blood and urine samples were collected on all women for 6 months and muscle strength assessed..

The GTP + TC group showed enhanced markers of bone health and muscle strength at 3 and 6 months.   Of greatest interest was the Dr. Shen's finding that both GTP and TC had on biological markers of oxidative stress, the precursor to inflammation.  Inflammation is not only a factor in osteoporosis but other chronic diseases as well.  Her findings were presented in a poster at the Experimental biology meetings in April.   Further studies are needed to confirm and better understand the mechanisms involved.

In the meantime, drinking green tea and trying tai chi sounds like a good idea, especially for premenopausal women!

Hot Flashes Associated with Lower Risk of Breast Cancer
Posted by on March 30, 2011 - 8:13am
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.

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

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