Articles about menopause information, drugs, treatment methods, research etc.

About menopause

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What exactly is menopause itself? To put it very simply, menopause is the stop (pause) of your periods (menses). Your periods stop because your ovaries have run out of eggs, are no longer responding to your body's hormonal signals, have been damaged or have been surgically removed.

Before your periods stop, you go through a transition period called perimenopause. This can last on average from two to six years, although some women have it for a shorter amount of time, and others longer. And once your periods have stopped for a year, you're considered as being in menopause.
http://www.earlymenopause.com/whatis.htm∞

FSH Blood Level Measurement
This is the key test to determine whether or not you are in menopause. A sample of your blood is taken to measure the levels of FSH -- follicle stimulating hormone -- in your blood. Because your FSH levels rise when your ovaries stop producing enough estrogen, high FSH levels can signal that your body is entering menopause.

http://www.earlymenopause.com/tests.htm∞

...because hormone levels can and do fluctuate, remember that the FSH is far from foolproof. Some women can test with a high FSH, then revert to normal levels the next month...and so on. Again, it's generally wise to get tested more than once.
http://www.earlymenopause.com/tests.htm∞

All women approaching the menopause need to make decisions about whether or not to take medication or taking herbal treatments to help with the symptoms. The treatments can carry a risk of cancer developing and the benefits need to be balanced by the risks.
But for those who have had cancer, the decision may be much more difficult.

Another difficulty may be faced by those with an ileostomy, or with short bowel syndrome - they need to make sure that any drugs they take are being absorbed.

About early menopause

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EARLY MENOPAUSE CAUSED BY SURGERY OR CANCER TREATMENTS


In the case of surgery:
In the case of cancer treatments, either chemo or radiation, the treatments have caused your ovaries to fail -- and, again, they're no longer producing the hormones they used to.
http://www.earlymenopause.com/whatis.htm∞

Early Menopause.com
A website and support community for women who are experiencing early menopause -- menopause years before they expected it....due to natural early menopause; premature ovarian failure; surgery -- hysterectomy and oophorectomy; cancer treatments, such as chemotherapy or radiation; autoimmune disorders, etc.
http://www.earlymenopause.com/∞

FAQs about Early Menopause
http://www.earlymenopause.com/faqs.htm∞

Symptoms of Early Menopause
http://www.earlymenopause.com/symptoms.htm∞

Information about HRT:
http://www.earlymenopause.com/hrt.htm∞
http://www.earlymenopause.com/ukhrt.htm∞

Diet and Bone Health
http://www.vegansociety.com/phpws/index.php?module=pagemaster&PAGE_user_op=view_page&PAGE_id=30&MMN_position=8:5∞

Message Board Questions

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http://www.ostomyland.com/cgi-bin/yabb/YaBB.pl?board=cancer;action=display;num=1131200047∞

http://www.ostomyland.com/cgi-bin/yabb/YaBB.pl?board=generalissues;action=display;num=1149408639∞

Latest Research

Remifemin(R) A Safe HRT Alternative, Major Study Finds

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02 Feb 2006
The controversy over Hormone Replacement Therapy (HRT) rages on. Over 40 million American women are within menopause age, and in five years the numbers will increase to over 60 million. In the search for safe ways to reduce menopausal symptoms and discomfort without HRT, many have embraced black cohosh -- used traditionally as a remedy by Native Americans, and by Europeans since the 19th century.

A recent study found that Remifemin black cohosh extract reduced menopausal symptoms by 70 percent in 12 weeks, including hot flashes, night sweats, mood swings, irritability, and related occasional sleeplessness. A randomized, placebo-controlled, double-blind, study published in Obstetrics and Gynecology (2005;105:1074-83) found that Remifemin significantly reduced menopausal symptoms. The results were similar to recent hormone replacement therapy study results showing Remifemin is a safe and effective alternative to HRT.

"Remifemin is clearly the world's most clinically tested black cohosh product, with over 15 clinical trials that demonstrate the safety and efficacy of the product," says Mark Blumenthal, Founder and Executive Director of the American Botanical Council. "Almost all of the scientific literature on black cohosh was conducted on Remifemin including recent clinical trials showing no estrogenic activity of the product." Remifemin is completely hormone-free, without plant-based estrogens that can affect breast and uterine cell growth. It is safe for women with a history of breast cancer who cannot take estrogen.

"Smart German chemists have been working on Remifemin for over 50 years," says Yale University School of Medicine Clinical Professor Mary Jane Minkin, MD, who recommends Remifemin as a standard alternative to HRT. "While its mechanism of action is unclear, black cohosh is one of the few products that seems to relieve hot flashes. Twenty percent of patients sail through menopause without problems, but eighty percent have varying degrees of symptoms, some severe," she explains. "I talk to everyone about Remifemin, along with lifestyle issues like healthy diet and exercise. I respect the personal preferences of my patients, many of whom do not want drug intervention." Dr. Minkin is author of A Woman's Guide to Menopause & Perimenopause (Yale University Press 2005).

Not all black cohosh is the same. Most products in the market lack the standardization and research that can ensure efficacy and safety, and multi- ingredient compounds can potentially create problems from drug interactions. "Remifemin, with over 90 scientific papers, is the most researched black cohosh product in the world," explains Matt Schueller, Senior VP Marketing for Enzymatic Therapy, Inc., exclusive distributors of Remifemin in North America and one of the first to introduce standardization to the U.S. supplement industry. "Comprising a proprietary, standardized extract (uniform dosage) of pure black cohosh root called RemiSure(TM), it is the #1 OB/GYN-recommended non-prescription menopause therapy."
http://www.medilexicon.com/medicalnews.php?newsid=36992∞

MPA Is Effective Treatment For Hot Flashes, Study Suggests

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03 Mar 2006

ROCHESTER, Minn. -- Mayo Clinic researchers working with other North Central Cancer Treatment Group (NCCTG) investigators have found that a single dose of depomedroxyprogesterone acetate (MPA) more effectively reduces hot flashes than does the antidepressant venlafaxine (Effexor®). Results of the study are available online in the Journal of Clinical Oncology.

Hot flashes are a major problem for many women as they approach menopause. Estrogen-based therapy had been the standard for many years, resulting in an 80 to 90 percent reduction in hot flashes. However, concerns about a link between estrogen and progesterone combined therapy and an increased risk of breast cancer, heart disease and/or cognitive dysfunction were reported in articles about the "Women's Health Initiative" published in JAMA in 2002 and 2004, and have led to a search for alternate therapies.

Some newer antidepressants such as venlafaxine (Effexor?) and some progestin-based drugs such as megestrol acetate (Megace®) or MPA (Depo-ProveraTM) are non-estrogen ways of treating hot flashes. No reports were published previously comparing the efficacy of the newer antidepressants to hormone therapy for treating hot flashes. Charles Loprinzi, M.D., Mayo Clinic oncologist and lead author of the study, and his fellow researchers conducted this study to make that comparison, hoping to identify the best available alternative.

Patients were randomly selected to receive either 75 milligrams of venlafaxine orally every day or one 400 milligram intramuscular shot of MPA, and then report on hot flashes, potential side effects and quality of life issues over a six-week period. The reduction in hot flashes was significantly greater in the group receiving MPA than the group receiving venlafaxine (79 percent versus 55 percent reduction). The effectiveness of the single dose of MPA was similar for cancer patients with or without tamoxifen therapy, and treatment effectiveness also appeared be the same for women with or without a history of breast cancer.

Although follow-up information is not available for all the patients after six weeks, the collected data indicated that the improved hot flash benefit appeared to last for at least six months in some women following the single MPA dose. Almost three times as many MPA patients still reported a 90 percent reduction in hot flashes after six months, compared to those receiving venlafaxine.

While both venlafaxine and MPA appear to be well tolerated, MPA shows a distinct advantage in the early part of treatment, with the patients receiving venlafaxine reporting more nausea, appetite loss, dizziness, constipation, mouth dryness and sleepiness. One shot of MPA also costs significantly less than a three-month supply of venlafaxine. The obvious benefits need to be weighed against the uncertainty that exists with regard to MPA safety, in terms of risk for breast cancer, says Dr. Loprinzi. "While there is some data to suggest that MPA might slightly increase breast cancer risk, other data suggest that MPA, when not given in combination with estrogen, might decrease risk," he says. "Given that, MPA does provide a treatment option that is reasonable for women to consider."
http://www.medilexicon.com/medicalnews.php?newsid=38637∞

Herb Tested To Stop Breast Cancer Patients' Hot Flushes And Night Sweats

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30 Apr 2006

Researchers at the University of Manchester, UK, are testing a secret herb in a bid to stop the severe hot flushes that besiege breast cancer patients on hormone treatment.

Professor Alex Molassiotis, of the School of Nursing, Midwifery and Social Work, says the herb - one of the mint family, found in any kitchen - is thought to stop the hot flushes and night sweats which can be so bad that some women have to change their clothes three or four times a night.

It is traditionally used by Mediterranean women undergoing the menopause, but Professor Molassiotis cannot name it as he and his team are carrying out a double blind trial (neither the patient nor the doctor is allowed to know whether they are in the group taking the herb or a placebo).

The women are taking hormone treatment to lower oestrogen and progesterone levels as these affect the growth of some breast cancer cells. This can lead to early or revisiting menopause with symptoms such as anxiety, dry skin, bone thinning and hot flushes, with some women having up to 30 flushes a day. It is too risky for them to take Hormone Replacement Therapy (HRT) as this will increase the hormone levels again. Instead they are advised to cut out tea, coffee and nicotine, try alternative remedies or a certain type of anti-depressant.

Professor Molassiotis said: "It is hoped that the herbal remedy will be simpler and cheaper to take, as well as more effective, thus improving the lives of women who need all their energy to fight the disease."

He and his team are now recruiting 170 volunteers for the randomized trial, half of whom will take the phytooestrogen herb in the form of a pill and half of whom will take a placebo, from Greater Manchester and Cheshire. Only breast cancer patients who have or are receiving hormone treatments for their cancer are allowed to take part, and only if they experience at least one hot flush a day of moderate and above severity for at least a month. The treatment will be for a total of three months, taking one pill a day. The team will assess the volunteers' hot flushes four times over six months from starting the trial with questionnaires and a blood sample.

To take part in the trial, find out more about the study or see if you are eligible to participate, please contact Research Associate Dr Barbara Potrata on 0161 446 8550 or email barbara.potrata@christie-tr.nwest.nhs.uk.

The University of Manchester's School of Nursing developed the first nursing degree in England. It achieved 23 of a maximum 24 possible points in the latest Subject Review inspection by the Quality Assurance Agency, a score unrivalled by any institution of similar scale. During the last Research Assessment Exercise (RAE) in 2001, it was awarded a rank of 5 on a scale 0-5* meaning all our academics are producing work of international or national excellence. Professor Alex Molassiotis leads the Cancer, Supportive and Palliative Care programme, which falls into two broad themes; symptom experience and symptom management, and palliative care service provision. Here he also leads the Academic Nursing Research Unit at the Christie Hospital and focuses on symptom experience and symptom management.

http://www.manchester.ac.uk/aboutus/news∞
http://www.medilexicon.com/medicalnews.php?newsid=42494∞

New Light Over The Role Of The Hormone Progesterone In Breast Cancer

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01 Jan 2007

Progesterone is a female sex hormone known to regulate the growth of normal breast tissue while also seeming to be involved in breast cancer. Its exact role in the carcinogenic process, however, is still unclear. But now, in work about to be published in the "Journal of Cellular Biochemistry", a team of Portuguese scientists shows that progesterone seems to sustain the formation of blood vessels, which, by supplying nutrients to the tumour cells, are vital for breast cancer progression. This finding has important implications not only for a better understanding of the disease, but also for present and future therapeutic approaches against it.

Breast cancer is the second most common cancer in the world with approximately 1 million of new cases every year, even if the disease tends to have a relatively favourable prognosis. One of the reasons for this is the fact that a majority of breast cancers are hormone-dependent, and treatments blocking these hormones (and consequently cancer progression) can be extremely effective, sometimes even more than chemotherapy.

In fact, ovarian hormones known to play an important role in the development of normal breast tissue - such as oestrogen and progesterone - also seem to be involved in breast cancer development, with 70 to 80% of primary breast tumours showing oestrogen and/or progesterone receptors in their cells. These receptors act as on-off switch; when the right molecule (in this case oestrogen or progesterone) binds to its specific receptor, the switch is turned on, leading, in the case of breast cancer, to disease progression. In result, anti-hormonal therapy (especially anti-oestrogen therapy), which blocks the hormones' action, is widely used against the disease with good results.

But if oestrogen has been clearly associated with cancer growth, the role of progesterone in breast cancer (and consequently the importance and the specific mechanism of progesterone-blocking therapy) is much less clear.

But now Raquel Soares, Susana Guerreiro and Mónica Botelho from the University of Porto in Portugal found that breast cancer cells that respond to progesterone, produce, when exposed to the hormone, Platelet-derived growth factor A (PDGF-A) a protein known to stimulate cell growth and division. Furhermore, PDGF-A did not seem to act directly on the tumour cells, but was instead released into the space outside of the cell suggesting an effect on neighbouring cells.

Interaction between tumour cells and their environment is crucial for cancer progression and in fact PDGF-A has been suggested to be involved in the formation of new blood vessels (also called angiogenesis). Angiogenesis is a process crucial for cancer sustainability since without new blood vessels around the tumour site to supply nutrients, cancerous cells will starve and die. To test if PDGF-A could be in fact involved in the formation of blood vessels around breast cancer tumour sites, Soares and colleagues decided to analyse smooth muscle cells, which are known to be involved in this process while also have been described as having receptors for PDGF-A. And in fact, PDGF-A (and so progesterone) was found to increase the growth and viability of smooth muscle cells confirming a role to both these molecules supporting angiogenesis.

What Soares and colleagues' work strongly suggest is that progesterone stimulates cancer development by helping the formation and stability of blood vessels formed adjacent to the tumour cells. These new blood vessels are, not only crucial to the supply of nutrients to cancer cells, but also important 'exits'? for these cells to spread throughout the body. These results show how current anti-progesterone therapies block cancer progression by targeting not only progesterone-dependent cancer cells but also the formation of new blood vessels, and emphasise the importance of continue to pursue anti-progesterone therapeutics.

Piece researched and written by:
Catarina Amorim
http://www.medilexicon.com/medicalnews.php?newsid=59703∞

Menopause And Insomnia -- New Findings Link Estrogen Decline, Sleeplessness And Mineral Deficiency

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15 May 2007

Women in the pre-menopause and menopause years are more and more finding themselves experiencing symptoms of chronic insomnia, hot flashes, night sweats, migraine headaches, anxiety, fatigue and depression. Uzzi Reiss, M.D., author of Natural Hormone Balance for Women, says: "Some of the above reactions occur nearly simultaneously whenever the level of estrogen falls."

Hormone drugs, nutritional remedies, and lifestyle changes are some of the options available to women. Consumer Affairs.com reports that while 70 percent of women entering menopause will have some symptoms, most symptoms can be managed with healthy lifestyle improvements. In their recent report, they do not recommend hormone drugs for women who have an elevated risk of heart disease, stroke or cancer - which is 35 to 50 percent of all women 50 and older.

As menopause approaches, another emerging link between estrogen decline and its symptoms is the aspect of mineral deficiency. Mildred Seeling, M.D. describes this in the Journal of the American College of Nutrition. She says "Estrogen enhances magnesium utilization and uptake by soft tissues and bone and may explain the resistance of young women to heart disease and osteoporosis -- as well as the increased prevalence of these diseases when estrogen production ceases."

Magnesium works best when it's balanced with calcium. The pioneering nutritionist Adelle Davis writes of mineral deficiency during menopause in her book Let's Get Well. Davis says: "Calcium is less well absorbed and the urinary losses are greater when the output of estrogen decreases. Such calcium-deficiency symptoms as nervousness, irritability, insomnia, and headaches are common."

Sleep in magnesium deficiency is restless, agitated and disturbed by frequent nighttime awakenings. However, all forms of magnesium are not equally effective. In a study of more than 200 patients, Dr. W. Davis used magnesium chloride as a possible means of combating insomnia. The researcher reported that sleep was induced rapidly, was uninterrupted, and that waking tiredness disappeared in ninety-nine percent of the patients. In addition, anxiety and tension diminished during the day. (W. Davis and F. Ziady, "The Role of Magnesium in Sleep," Montreal Symposium).

Magnesium chloride crystals are made from seawater. Separately, both magnesium and chloride have important functions in keeping us healthy. Chloride combines with hydrogen in the stomach to make hydrochloric acid, a powerful digestive aid that declines in the body as we grow older. Using other forms of magnesium is less beneficial as these have to be converted into chlorides before they can be digested. For example, when we take magnesium in the oxide or carbonate form, we then have to produce additional hydrochloric acid to absorb it.

Another benefit of magnesium chloride crystals is that they instantly dissolve in any temperature of water. In addition to it's relaxing effects, magnesium chloride has been shown to provide improved digestion, a stronger immune system, calmer nervous system, lower blood sugar levels, and stronger nails and hair. Natural remedies for sleep, such as Sleep Minerals from Nutrition Breakthroughs, have begun to include this highly digestible form of magnesium.

Jobee Knight, a nutritional researcher and founder of Nutrition Breakthroughs in Glendale, CA., is someone who fought her own battle against insomnia. She decided to put her background to use by searching out effective natural ingredients for relaxation and deeper sleep. The result was Sleep Minerals, a unique blend of magnesium chloride and calcium lactate gluconate.

Nancy Richardson of Burbank, CA. says: "The Sleep Minerals put me to sleep pretty fast and I slept like a rock for many hours. It was quite beneficial. And I've been having trouble getting to sleep and staying that way, but this was quite helpful."

Consumer Reports advises that hormone drugs can increase the risk of heart disease, breast cancer, blood clots and stroke. An increasing number of women are turning to non-pharmaceutical solutions for insomnia. Highly absorbable forms of natural minerals can be a soothing alternative.
http://www.medilexicon.com/medicalnews.php?newsid=70832∞

Postmenopausal Hormone Therapy: IMS Updated Recommendations

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22 May 2007

INTRODUCTION

The past decade has seen marked fluctuations in opinions concerning the merits and risks of postmenopausal hormone therapy. In July 2002, menopause management faced a major turning point when the first data from the Women's Health Initiative (WHI) trial were released. The study was categorized as a primary prevention trial for coronary heart disease, although the fact that mean age at recruitment was 63 years was not given enough importance at that time. WHI investigators concluded that hormone therapy (HT) was not cardioprotective, and, in fact, its risk-benefit ratio did not favor the use of postmenopausal hormones for prevention of chronic diseases. As a result, there was a dramatic change in prescription habits following recommendations to reserve HT for very symptomatic women, and to limit its use to the 'shortest duration needed' and 'to the lowest effective dosage'. This was the atmosphere in which the International Menopause Society (IMS) initiated the IMS Workshop held in Vienna (December 2003) and the IMS Position Paper that was based on the Workshop discussions. Looking at global perspectives, and being independent of local or regional constraints imposed by official health authorities, this IMS Statement called for a more balanced approach in the interpretation of the scientific data on hormone use that were available in 2003. Since then, additional information has been accumulated from both arms of the WHI study, observational trials and from other studies, allowing a more comprehensive review on all issues related to the use of hormones in the postmenopausal period. In view of the above, the IMS Board decided that it is time to update the 2004 Statement and to enlarge its scope to menopause management and adult women's health in general. More than 30 experts from the various fields of menopause medicine reviewed the latest information in a Workshop held in Budapest in February 2007.

The following Recommendations express the views of the IMS on the principles of hormone therapy in the peri- and postmenopausal periods. Throughout the Recommendations, the term HT will be used to cover all therapies including estrogens, progestogens, combined therapies and tibolone.

The previous IMS Statement in 2004 is still valid and serves as a basis for the current Updated Recommendations.

We are aware of the geographical variations related to different priorities of medical care, different prevalence of diseases, and country-specific attitudes of the public, the medical community and the health authorities toward menopause management, which may all impact on hormone therapy. The following recommendations, therefore, give a global and simple overview that serves as a common platform on issues related to the various aspects of hormone treatment. These Recommendations were reviewed and discussed by representatives of more than 60 National and Regional Menopause Societies from all continents. These Recommendations can be easily adapted and modified according to local needs.

GOVERNING PRINCIPLES

Hormone therapy should be part of an overall strategy including lifestyle recommendations regarding diet, exercise, smoking and alcohol for maintaining the health of postmenopausal women. HT must be individualized and tailored according to symptoms and the need for prevention, as well as personal and family history, results of relevant investigations, the woman's preferences and expectations. The risks and benefits of HT differ for women around the time of menopause compared to those for older women.

HT includes a wide range of hormonal products and routes of administration, with potentially different risks and benefits. Thus, the term 'class effect' is confusing and inappropriate.

Women experiencing a spontaneous or iatrogenic menopause before the age of 45 years and particularly before 40 are at higher risk for cardiovascular disease and osteoporosis. They will benefit from hormone replacement, which should be given at least until the normal age of menopause.

Counselling should convey the benefits and risks of HT in simple terms, e.g. absolute numbers rather than as percentage changes from baseline expressed as a relative risk. This allows a woman and her physician to make a well-informed decision about HT.

HT should not be recommended without a clear indication for its use.

Women taking HT should have at least an annual consultation to include a physical examination, update of medical history, relevant laboratory and imaging investigations and a discussion on lifestyle.

There are no reasons to place mandatory limitations on the length of treatment. Whether or not to continue therapy should be decided at the discretion of the well-informed hormone user and her health professional, dependent upon the specific goals and an objective estimation of benefits and risks.

Dosage should be titrated to the lowest effective dose. Lower doses of HT than have been used routinely can maintain quality of life in a large proportion of users. Long-term data on lower doses regarding fracture risk and cardiovascular implications are still lacking.

In general, progestogen should be added to systemic estrogen for all women with a uterus to prevent endometrial hyperplasia and cancer. However, natural progesterone and some progestogens have specific beneficial effects that could justify their use besides the expected actions on the endometrium. Low-dose vaginal estrogens administered for the relief of urogenital atrophy do not require progestogen co-medication. Direct delivery of progestogen to the endometrial cavity from the vagina or by an intrauterine system is logical and may minimize systemic effects.

Androgen replacement should be reserved for women with clinical signs and symptoms of androgen insufficiency. In women with bilateral oophorectomy or adrenal failure, androgen replacement has significant beneficial effects, in particular on health-related quality of life and sexual function.

BENEFITS OF HORMONE THERAPY

General

HT remains the most effective therapy for vasomotor and estrogen-deficient urogenital symptoms. Other menopause-related complaints, such as joint and muscle pains, mood swings, sleep disturbances and sexual dysfunction (including reduced libido) may improve during HT. Quality of life and sexuality are key factors to be considered in the management of the aging individual. The administration of individualized HT (including androgenic preparations when appropriate) improves both sexuality and overall quality of life.

Postmenopausal osteoporosis

HT is effective in preventing the bone loss associated with the menopause and decreases the incidence of all osteoporosis-related fractures, including vertebral and hip, even in patients at low risk. Although the magnitude of decline in bone turnover correlates with estrogen dosage, even lower than standard-dose preparations maintain a positive influence on bone indices in most women. Based on updated evidence on effectiveness, cost and safety, HT is an appropriate first-line therapy in postmenopausal women presenting with an increased risk for fracture, particularly under the age of 60 years and for the prevention of bone loss in women with premature menopause. The protective effect of HT on bone mineral density declines after cessation of therapy at an unpredictable rate, although some degree of fracture protection may remain after cessation of HT.

The initiation of standard-dose HT is not recommended for the sole purpose of the prevention of fractures after the age of 60 years. Continuation of HT after the age of 60 years for the sole purpose of the prevention of fractures should take into account the possible long-term effects of the specific dose and method of administration of HT, compared to other proven therapies.

Cardiovascular disease

Cardiovascular disease is the principal cause of morbidity and mortality in postmenopausal women. Major primary prevention measures (besides smoking cessation and diet control) are weight loss, blood pressure reduction, and diabetes and lipid control. There is evidence that HT may be cardioprotective if started around the time of menopause and continued long-term (often referred to as the 'window of opportunity' concept). HT markedly reduces the risk of diabetes and, through improved insulin resistance, it has positive effects on other related risk factors for cardiovascular disease such as the lipid profile and metabolic syndrome.

In women less than 60 years old, recently menopausal and without prevalent cardiovascular disease, the initiation of HT does not cause early harm and in fact reduces cardiovascular morbidity and mortality. Continuation of HT beyond the age of 60 should be decided as a part of the overall risk-benefit analysis.

Other benefits

HT has benefits for connective tissue, skin, joints and intervertebral disks. HT may reduce the risk of colon cancer. HT initiated around the time of menopause or by younger postmenopausal women is associated with a reduced risk of Alzheimer's disease.

POTENTIAL SERIOUS ADVERSE EFFECTS OF HORMONE THERAPY

Studies on the risks of postmenopausal hormone use have mainly focused on breast and endometrial cancer, venous thromboembolism (pulmonary embolism or deep vein thrombosis), stroke and coronary events.

Breast cancer

The incidence of breast cancer varies in different countries. Therefore, currently available data cannot necessarily be generalized. The degree of association between breast cancer and postmenopausal HT remains controversial.

Women should be reassured that the possible risk of breast cancer associated with HT is small (less than 0.1% per annum). For combined HT, observational data from the Million Women Study suggested that breast cancer risk was increased as early as the first year, raising serious reservations on possible methodologic flaws. On the contrary, randomized controlled data from the Women's Health Initiative (WHI) study indicate that no increased risk is observed in women initiating HT, for up to 7 years. It should be noted that the majority of subjects in the WHI study were overweight or obese.

Data from the WHI and Nurses' Health Study suggest that long-term estrogen-only administration for 7 and 15 years, respectively, does not increase the risk of breast cancer in American women. Recent European observational studies suggest that risk may increase after 5 years.

There are insufficient data to evaluate the possible differences in the incidence of breast cancer using different types and routes of estrogen, natural progesterone and progestogens, and androgen administration. Baseline mammographic density correlates with breast cancer risk. This does not necessarily apply to the increase in mammographic density induced by HT.

The combined estrogen-progestogen therapy-related increase in mammographic density may impede the diagnostic interpretation of mammograms.

Endometrial cancer

Unopposed estrogen administration induces a dose-related stimulation of the endometrium. Women with a uterus should have progestogen supplementation.

Continuous combined estrogen-progestogen regimens are associated with a lower incidence of endometrial hyperplasia and cancer than occurs in the normal population.

Direct intrauterine delivery systems may have advantages. Regimens containing low-/ultra-low-dose estrogen and progestogen cause less endometrial stimulation and less bleeding.

Thromboembolism and cardiovascular events

The HT-related risk for serious venous thromboembolic events increases with age (although .minimal until age 60), and is also positively associated with obesity and thrombophilia. By avoiding first-pass hepatic metabolism, transdermal estrogen may avert the risk associated with oral HT. The impact on the risk of a thromboembolic event may also be affected by progestogen, depending on the type. Late starters of standard-dose HT may have a transient slightly increased risk for coronary events. The risk of stroke is correlated with age. HT may increase the risk of stroke after the age of 60.

Safety data from studies of low-dose and ultra-low-dose regimens of estrogen and progestogen are encouraging.

ALTERNATIVE TREATMENTS

The efficacy and safety of complementary alternative medicines have not been demonstrated and further studies are required.

Selective serotonin reuptake inhibitors, selective noradrenaline reuptake inhibitors and gabapentin are effective in reducing vasomotor symptoms in short-term studies. Their long-term safety needs further evaluation.

There are no medical or scientific reasons to recommend unregistered 'bioidentical hormones'. The measurement of hormone levels in the saliva is not clinically useful. These 'customized' hormonal preparations have not been tested in studies and their purity and risks are unknown.

RESEARCH

There is urgent need for further research especially into the relative merits of lower doses, regimens and routes of administration.

CONCLUSION

The safety of HT largely depends on age. Women younger than 60 years old should not be concerned about the safety profile of HT. New data and re-analyses of older studies by women's age show that, for most women, the potential benefits of hormone therapy given for a clear indication are many and the risks are few when initiated within a few years of menopause. In view of the new data, Regulatory Authorities should review their current recommendations as a priority.
http://www.medilexicon.com/medicalnews.php?newsid=71270∞

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