Dr. Teresa Woodruff and Dr. Melina Kibbe of the Women's Health Research Institute's Leadership Council were featured recently on WTTW Chicago Tonight. They discussed their activism for the inclusion of males and females in pre-clinical research studies. The recent shift by the NIH to include both genders in NIH-funded basic research, will help minimize gender biases in devises and medications once studies reach the clinical phase. Dr. Woodruff and Dr. Kibbe laud the NIH for this shift and also share their insights on this important issue. Watch the full WTTW interview today!
The average age of menopause in the United States is around 51 years old, but the onset can widely vary. Premature menopause refers to menopause of onset at or before 40 years of age. This can occur because of a variety of causes, including surgery (i.e. bilateral oophorectomy, removal of ovaries), chemotherapy or pelvic radiation treatments for cancer, chromosomal or genetic defects, and spontaneous premature ovarian failure.
A study based on a sample of 4868 women tested cognition at baseline, two, four, and seven years, and it also looked at the effects of the type of menopause, whether natural or surgical, could play a role.
Natural menopause was reported by 79% of the 4868 participants, 10% underwent menopause from surgical causes, and 11% reported menopause from other treatment causes including radiation or chemotherapy. Approximately 7.6% of the women in the study had a premature menopause, and the study further delineated 12.8% of the women had an early menopause (between 41 and 45 years of age).
Results showed that women who underwent premature menopause had a more than 40% increased risk of poor performance on verbal fluency and visual memory tasks, compared to those who experienced menopause at or after the age of 50. Women who underwent premature menopause also were associated with a 35% increased risk of decline in psychomotor speed. There was no significant association with the risk of dementia.
Both premature menopause secondary to surgery and premature ovarian failure, were associated with long-term negative effects on cognitive function, which cannot entirely be answered by hormone therapy. Researchers agree more studying needs to be done to better understand the potential benefits using hormone therapy.
Healthcare professionals should be aware of the potentially significant impact premature menopause can have on cognitive function in later life. Professionals should also consider these effects when aiding younger women in the decision-making process of undergoing oophorectomy. To learn more about how menopause can affect you long-term, visit Northwestern's menopause website here.
Source: J Ryan, J Scali, I Carrière, H Amieva, O Rouaud, C Berr, K Ritchie, M-L Ancelin.Impact of a premature menopause on cognitive function in later life. BJOG: An International Journal of Obstetrics & Gynaecology, 2014; DOI: 10.1111/1471-0528.12828
Loss of bladder control, or urinary incontinence, is a problem that millions of women face. The involuntary loss of urine can range in presentation; it can be minimal, from a few drops when you laugh, exercise, or cough. Or, it can be an accident when you suddenly urge to urinate and can't keep it in. Most episodes of urinary incontinence are the result of altered pressures or stress on the muscles and nerves that help you pass or hold urine in. Hormone changes can also affect muscle strength. Like your vaginal tissue, the muscle tissue in and surrounding the bladder and urethra (the short tube that passes urine from the bladder out the body) requires estrogen to remain supple and strong. When estrogen levels drop in menopause, the tissue around the bladder and urethra thin and weaken,which can lead to incontinence.
The most common types of urinary incontinence include stress incontinence and urge incontinence. Stress incontinence occurs when the pressures from activities such as laughing, coughing, and sneezing cause leakage. Urge incontinence occurs when you have the urge to urinate and your bladder squeezes at the wrong time. Often, these two types can create a mixed picture. Other bladder problems that can happen are nocturia, when you must wake up multiple times throughout the night to urinate, and dysuria, painful urination.
If you think you have incontinence, visit a professional to learn more about the variety of options you have for treatment. A professional can be your primary care physician, gynecologist, urologist, and even a urogynecologist. Your physician may recommend lifestyle changes such as limiting alcohol or caffeine intake, recording a voiding diary, or strengthening your pelvic floor muscles with Kegel exercises. Beyond this, therapies also include devices inserted into the vagina to hold up the bladder (pessaries), a variety of medications, and surgery if necessary. Your physician will also be the one to exclude other potential causes of bladder problems including infection and neurological damage.
To learn more about urinary issues or other symptomatology that arise during menopause, visit Northwestern's menopause website here.
New research proves yet another reason for women to quit smoking: smoking may cause earlier signs of menopause. Heavier smokers may enter menopause up to nine years earlier compared to nonsmokers.
In the United States, the average age for menopause is 51. Previous studies have already showed that smoking can hasten menopause by one to two years, regardless of race or genetic background. New research shows that menopause can happen much quicker specifically in white female smokers who are carriers of two different gene variants.
Over 400 women ages 35 to 47 from the Penn Ovarian Aging Study were compared. Heavy smokers, light smokers, and nonsmokers who were carriers of the CYP3A4*1B variation had an average time-to-menopause of 5.09 years, 11.36 years, and 13.91 years, respectively, after entering the study. This suggests that certain white females with a specific genetic make-up may enter menopause up to nine years earlier than nonsmoking females.
The average time-to-menopause for white carriers of the CYP1B1*3 variation, was 10.41 years, 10.42 years, and 11.08 years among heavy smokers, light smokers, and nonsmokers, respectively. The results were statistically significant but the discrepancies were obviously not as huge as the CYp3A4*1B variant.
Dr. Teresa Woodruff of the Women’s Health Research Institute has been a consistent voice advocating for sex-based research. Recently, Dr. Woodruff consulted with CBS on an upcoming feature to shed light on the importance of sex as a research variable—due to the imbalances between male and female research subjects resulting in inadequate health care for women. In a reaction to the FDA recalling the recommended dosage for women taking Ambien, CBS announced today that their 60 Minutes feature this Sunday will investigate drug dosage differences between men and women. Ambien, a popular sleep drug, was discovered to have adverse effects in women last year. Researchers found that women metabolize Ambien differently than men, which leads to a higher percentage of the drug in the female body. The FDA responded to this incident by halving the previously recommended dosage, just in women.
Last year’s Ambien debacle is merely the tip of the iceberg; it is just one example of the importance of sex differences in research! The truth is, little is actually known or studied about how drugs affect women differently than men. Despite ever-growing evidence of sex differences in health research and care, there are no official standards mandating the observation of sex as a variable in drug and device studies. A report on the incidence of adverse drug reactions published at Johns Hopkins Hospital in 1965 revealed “a striking correlation between incidence and the sex of the patient.” This 49-year-old study revealed that women accounted for 73% of the adverse drug reactions tested—and numbers have hardly improved in the half a century since this study was published. This is appalling. The knowledge of adverse drug reactions in women has been publically stated for nearly 50 years! We have this knowledge. We've known this for half a century. It is time to act on this knowledge.
Dr. Woodruff and the Women’s Health Research Institute as a whole are thrilled that 60 Minutes is broadcasting about the potentially catastrophic events that can occur if drugs are not moderated for use on female patients. Dr. Woodruff and colleague Dr. Melina Kibbe were honored to serve as crucial collaborators on this CBS feature. It’s critical that discussion sparks action on this issue. Addressing the differences between men and women at the research level will lead to more accurate science and better-tailored health care for women. Be sure to tune into CBS on Sunday, February 9th at 7:00pm ET to get the full story!
Watch a preview of the feature HERE.
New long-term research shows that hot flashes continue, on average, for five years after menopause. More than a third of women can experience hot flashes for up to ten or more years after menopause.
A recent study evaluated 255 women in the Penn Ovarian Aging Study who reached natural menopause over a 16-year period. The results indicate that 80 percent reported moderate to severe hot flashes, 17 percent had only mild hot flashes, and three percent reported no hot flashes.
Hot flashes are momentary episodes of heat that can occur with other symptoms including sweating and flushing. Changing hormone levels after cessation of menses are believed to cause hot flashes as well as other menopausal symptoms including insomnia, anxiety, joint and muscle pain, and memory problems. Hormone therapy repletes the hormones estrogen and progesterone the body stops making during menopause, and it has been proven an effective treatment for hot flashes.
Although hormone therapy is highly effective, it is not recommended for all women. In addition, concerns about health hazards linked to hormone therapy have made some physicians hesitant to prescribe it, or to adhere strictly to recommended duration guidelines; current guidelines suggest that exogenous hormones should not be taken for more than five years. This new research on the long-term persistence of hot flashes suggests that women should collaborate with their physicians to determine the risks and benefits of different hormonal and nonhormone therapies available for menopausal symptoms. Women should be able to individualize their treatment to appropriately minimize the the symptoms they may have, no matter how severe or how persistent. To learn more about the variety of treatments available for menopausal symptoms, visit Northwestern's Menopause website here
Source: Ellen W. Freeman, Mary D. Sammel, Richard J. Sanders. Risk of long-term hot flashes after natural menopause. Menopause, 2014; 1 DOI:10.1097/GME.0000000000000196
Men and Women are physiologically different, and it is essential to ensure adequate participation of both sexes in research studies in order to determine sex-based differences in disease presentation, prevalence, and treatment. A press release from Mary Ann Liebert, Inc. Publishers revealed a study that tested the participation rate of women in post-approval studies mandated by the Food and Drug Administration (FDA). Out of their sample size, researchers found that only 14% of studies “included a multivariate analysis that included sex as a covariate” and a meager 4% “included a subgroup analysis for female participants.” These shocking results mean that women are not getting adequate attention in clinical trials, which may result in harmful drug or device reactions in women.
Women vary from men in genetics, hormones, body size, sex-specific physiology, diet, sociocultural issues, and more—therefore, it is incorrect to assume that women and men will react the same way when tested for medical devices and drugs. Most researchers limit sex-based research to areas that are inherently sex-biased, for instance obstetrics and gynecology more often involves women, while urology more often involves men. However, men and women differ in nearly everything from their hearts to their knees—and research needs to keep these differences in mind. If researchers neglect to include sex as a variable in their research, devices and drugs can be approved for public use without fully understanding the reaction such drugs could have on women.
In response to this growing concern, the FDA has implemented new procedures to ensure participation by sex is evaluated in post-approval study reviews. This is certainly a step in the right direction towards recognizing and evaluating sex-specific health responses to new research.
Source: Journal of Women's Health
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.
New research shows that women with high blood pressure during pregnancy may be at higher risk of having troublesome menopausal symptoms in the future. A research study from the Netherlands examined the relationship between hypertensive diseases and hot flashes and night sweats.
Investigators looked at 853 women who regularly visited a cardiology clinic. Among these women, 274 had a history of high blood pressure during their pregnancy, such as preeclampsia. Participants were classified as having hypertension (high blood pressure) if her systolic blood pressure was 140 mmHg or higher, if her diastolic was 90 mmHg or higher, or if she took antihypertensive medication.
The study revealed that women with a history of hypertensive pregnancy disease were more likely to have vasomotor symptoms of hot flashes and night sweats during menopause. Hot flashes and night sweats are considered vasomotor because of sudden opening and closing of blood vessels near the skin. 82% women with history of hypertension during pregnancy had hot flashes and night sweats, compared to 75% women without. Moreover, women with hypertension during pregnancy reported experiencing hot flashes and night sweats for a longer time period.
Researchers concluded that the findings were modest but more research needs to be done to establish a definite association. One must also consider that every woman experiences menopause differently; you might have symptoms that are barely noticeable, while your friends could experience almost all of them. To learn more about the different types of symptoms during menopause, visit the Women's Health Research Institute's menopause website here.
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/