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.

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.

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.

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.

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.

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.