Friday, December 15, 2006

Not forever, not for everybody

Hormones again in headline news, this time newsworthy by the the benefits of their absence.

Recent analysis of cancer incidence statistics for 2003 show a significant 7% drop in breast cancer cases for this particular year, the first full year of data following the abrupt termination of the Women's Health Initiative. Millions of women went off HRT as a result of the WHI data, and within a year, breast health improved.

While doctors acknowledge that cancers take years to form, they theorize that cancer cases may have decreased as itty bitty cancers that were forming in response to estrogenic stimulation shrank or disappeared. Indeed, the biggest decline was in tumors whose growth is fueled by estrogen--no estrogen, no support of tumor growth.

This news emphasizes the importance of individual decision-making in medical care. Any big decision--and to take hormones or not is a huge one--requires weighing many factors including personal and family health history, current symptoms, individual beliefs and worst fears, and future health goals.

Estrogen stimulates cell growth and repair. That is a good thing for neurons, muscle cells, osteocytes (bone), connective tissue, and healthy blood vessels. That is a bad thing for breast and uterine cells.

If a lack of estrogen makes a woman fuzzy-headed, sad, anxious, stiff, sleepless, or hot beyond belief, she may choose to use hormones for some indefinite period of time. If she has a family history of Alzheimer's disease, she may elect ongoing use. If she has a personal or family history of breast cancer, or if that is her worst fear, she may pass up HRT no matter how uncomfortable she is.

This is certainly dramatic news, and I will add this information into my discussions with menopausal women as they consider their plans for future care. I'm certainly taking it into consideration in my personal health care; for now, the pros continue to outweigh the cons in favor of ongoing HRT use. The patch stays attached into 2007!

I appreciate all of you who sent me e-mails regarding these statistics, and I look forward to talking to you about it as we adjust your therapies in the months to come.

Saturday, September 16, 2006

Youngish women should hang on to those ovaries!

The question usually arises when facing a hysterectomy about whether or not to remove the ovaries as well. Ovarian cancer is difficult to diagnose, so the removal rationale reasons that an ovary snatched is a deadly tumor ducked.

Scientists at the Mayo clinic compared a large group of women who underwent oopherectomy (removal of ovaries) at the time of hysterectomy with a group of women motoring into the future with ovaries intact. Those women under 45 who lost both ovaries to surgery had a 67% increased risk of dying from any cause in the years following surgery. More notably, most of the elevated mortality risk occurred in the group who both lost their ovaries and received no estrogen replacement. This sub-group had double the all-cause mortality risk!

One Mayo Clinic surgeon remarked, "For women with average risk for breast and ovarian cancer where we might have considered preventive ovariectomy, the discussion will have more of an emphasis on conserving the ovaries for protecting the health of the woman." Furthermore, study authors felt that women under 50 undergoing oopherectomy should receive estrogen if there are no specific health reasons why they should not.

In my experience in this post-WHI world, many women under 50 who've run out of estrogen due to surgical reasons are scared to use estrogen. Hopefully, this study will ease their fears about choosing hormonal therapy.

Tuesday, August 29, 2006

Holding up those aging joints

I certainly noticed that the onset of flagging estrogen levels correlated very strongly with the onset of crumbling knees. Now we have a study that confirms the association between low levels of serum estradiol and a rising incidence of osteoarthritis of the knees.

In other words, the lower your estrogen levels, the higher your risk of knee joint degeneration. Read more in the upcoming issue of vintagefemail.

Tuesday, August 22, 2006

ET and the risk of breast cancer

As many of you know, I spend a lot of time reading about menopausal therapy. I not only want to give you the best and the latest information on traveling these middle years in health and style, I have an immediate and PERSONAL need to know.

No surprise that the heart of the hormone controversy is the association between breast cancer and the ongoing use of hormones after menopause. The Women's Health Initiative results released in 2002 clearly demonstrated that a combination of Premarin and Provera was associated with a slight but significant and increasing risk of breast cancer after four years of use. But data from the estrogen-only arm of the trial suggested that up to five years of use may be associated with a slightly decreased risk of breast tumors.

Information is now available from twenty-plus years and more than 28,000 nurses who reported on their use of estrogen alone and their incidence of breast cancer as part of the Nurses' Health Study. While use of estrogen for up to 10 years was indeed associated with a very slight decrease in breast cancer risk, the incidence of hormone-receptor positive breast cancer--which generally carries a more favorable prognosis than hormone-receptor negative cases--was significantly increased after 15 years of use.

Thursday, August 10, 2006

Rooting for coolness?

Investigators from the Mayo Clinic set out to determine whether menopausal flashers were better off using black cohosh root to treat the heat compared with no herbs at all.

132 hot women were assigned to try the supplement for 4 weeks followed by a month on fake cohosh. They all kept daily diaries (covered in hot pink no doubt) in which they scored each flash from 1-4 for severity. Total points for the fourth treatment and placebo weeks were compared to a baseline week prior to the study's start.

The average decrease in hot flash score was 20% for the week on black cohosh vs. 27% for the week on fake cohosh. This extraordinary placebo response has been noted in many other menopausal symptom treatment trials. Investigators concluded that black cohosh does not beat the postmenopausal heat.

I had one patient develop hepatitis as a result of using black cohosh. This side effect is uncommon but has been previously reported.

Tuesday, August 08, 2006

Delayed cell death

Brain injuries, traumatic, toxic, or ischemic (lack of blood flow due to stroke or aneurysm) cause immediate cell death that is unavoidable. A secondary wave of death occurs, however, when cells adjacent to the damaged site basically commit molecular hari-kari. This secondary die-off is called apoptosis which means 'fading away,' an unfortunate event occurring in healthy neurons exposed to inflmmation.

Researchers have found in animal experiments that estrogen "dramatically" protects against this delayed cell death in brain injury. Neurobiologists at the University of Kentucky began the investigation by removing the ovaries of 100 rats, plummeting the unsuspecting rodents into menopause.

They then gave half the rats low doses of estrogen. After one week, the rats were subjected to an 'experimental stroke' as the researchers cut off blood flow through a cerebral artery. While estrogen did not protect against the initial cell death that occurred within hours of the stroke, it did markedly reduce the secondary damage.

The scientists have identified the mechanism by which the hormone protects the brain. They hope to develop designer estrogens in the future that have purely protective actions without any detrimental effects on body tissues such as the breasts.

Monday, August 07, 2006

An aging coed's hippocampus

Weird name for an important structure deep in our brain involved in memory. If yours shrinks with age, we know that your risk of Alzheimer's disease increases.

Dr. William Jagust of the University of California studied 59 women with MRIs to check out the size of their hippocampi. 46 were not on hormones and 13 were. He also scanned the brains of 38 men.

The women on HRT had significantly larger memory centers, roughly 10% bigger than those not on HRT and also larger than those of the male participants.

He continues to monitor the group to see if these mighty hippocampi protect against memory loss over time.

Saturday, August 05, 2006

Bad vagina days

When you're out of estrogen, you're bound to have some vaginal discomfort. Breast cancer chemotherapy as well as the long-term use of estrogen inhibitors to prevent recurrence can plunge survivors into an endless string of bad vagina days. While oncologists have used low-dose local estrogen therapy such as Vagifem tablets or the Estring to counteract these BVDs, a recent study suggests this may not be a wise strategy.

London researchers studied six women taking aromotase inhibitors (Femara, Aromasin, or Arimidex) as adjuvant therapy for breast cancer. The women had virtually undetectable levels of estrogen before initiating therapy with Vagifem for four months. All the participants experienced a prompt and significant rise in their estrogen levels. While hormone levels dropped to baseline levels in two of the women, the remaining subjects had sustained elevations that were notably elevated in two.

The investigators concluded that "Using this vaginal form of estrogen which, we found, increases systemic estradiol levels, will counteract aromatase inhibitor treatment." The efficacy of aromatase inhibitors depends on near total suppression of estrogen causing concern among the researchers that long-term use of vaginal estrogen would increase the risk for recurrent cancer.

Saturday, July 15, 2006

Reassuring news for the younger menopausal set

Investigators did a final sort through data from this trial that made headline news 4 years ago. They looked at risks of heart disease in younger women (ages 50-59) randomized to Premarin only or placebo. Women in this part of the WHI had undergone hysterectomies prior to entering the study so no progestogens were needed.

Women in this age group ordinarily do not have heart attacks no matter what they do, so the numbers of affected participants were small. Nevertheless, those in the treatment group were 40% less likely to have a heart attack or die from coronary heart disease compared with the group on no estrogen at all.

While experts still agree that HRT should NOT be used for heart attack prevention, these results are reassuring to women who choose to use estrogen for symptom control as they enter menopause.
Fuhgeddaboutit. There isn't one for us aging ladies.

Check out Dr. Stefanick's comments below, then look for information on Evista and the RUTH (Raloxifene Use for The Heart) trial in the upcoming edition of Vintagefemail.

For now, there is no magic bullet that can reduce the risks of major health problems related to estrogens and aging without introducing other potentially serious health concerns.
--Marcia Stefanick, PhD
Why another Blog?

I just picked up the "Overview of Satellite Symposia Presented at the 16th Annual Meeting of The North American Menopause Society." Just a little light summer reading in this appropriately hyper-heated Denver July. For those of you who did not receive your copy in the mail, I plan to post important information from these NAMS experts as well as from other researchers at the forefront of menopausal menopause.

Don't forget to also check out Denver Doc Online for more general up-to-date health information from the cutting edge and lunatic fringe of medical research.