Tag: menopause

Categories : Obstetrics & GynaecologyTags :

Hot Flash Drug Shows Significant, Rapid Benefits

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The investigational drug elinzanetant significantly reduces the frequency and severity of hot flashes associated with menopause while improving women’s sleep and quality of life, new UVA Health research published in JAMA shows.

The nonhormonal drug, which contains no oestrogen, was tested in two phase 3 trials, Oasis 1 and 2, at dozens of locations in the United States, Europe and Israel, including UVA Health. Postmenopausal women ages 40–65 with moderate to severe hot flashes were randomised to receive either 120mg of elinzanetant daily for 26 weeks or a placebo for 12 weeks followed by 14 weeks on elinzanetant.

The women who received elinzanetant reported rapid improvements in their symptoms and quality of life. The trials revealed statistically significant reductions in hot flash frequency and severity within the first week in both trials. At the same time, sleep quality and overall quality of life improved in both trials by week 12.

“The effectiveness for relief of hot flashes in highly symptomatic women along with improvements in sleep and mood across multiple trials and favourable safety profile of elinzanetant suggests it has potential as a non-oestrogen treatment for women with bothersome menopausal symptoms,” said researcher JoAnn V. Pinkerton, MD, UVA Health’s director of midlife health. “Elinzanetant is a dual neurokinin receptor antagonist in testing, meaning it works on two receptors in the brain to improve hot flashes, night sweats, sleep and overall mood.” 

Hot Flash Treatment

Hot flashes are caused by decreased oestrogen levels during menopause and, for some women, for years after. While there are existing treatment options, such as hormone therapy, some women cannot tolerate them or do not wish to take them because of potential side effects or contraindications. Because of that, the researchers say, menopausal women need a new, effective and safe non-oestrogen alternative.

“There is a huge unmet need for new treatments for burdensome hot flashes and sweats, which have been shown to affect workplace productivity and relationships, both at work and home,” said Pinkerton, professor of obstetrics and gynaecology at the University of Virginia School of Medicine and executive director emeritus of The Menopause Society “Sleep disturbances are one of the most bothersome symptoms reported by menopausal women and can impact mood, fatigue, emotional lability, work productivity and their quality of life.”

Pinkerton and her colleagues tested elinzanetant in the double-blinded Oasis studies to see if it could safely and effectively offer a new alternative for women struggling with hot flashes.

In addition to evaluating the drug’s effect on hot flashes, sleep disruptions and quality of life, the researchers also looked for potential side effects. Headache and fatigue were the most common, and these were mild. Importantly, there were no severe side effects, which is reassuring for the drug’s safety.

“I am excited about the potential of elinzanetant to serve as a nonhormonal treatment option for women with highly bothersome menopausal symptoms who can’t or won’t take hormone therapy,” Pinkerton said. “I hope that it may become a safe and effective non-oestrogen option for menopausal women suffering from the triad of moderate to severe VMS, sleep disruption and decreased menopause-related quality of life.”

Source: University of Virginia Health System

Categories : Cardiovascular Disease Obstetrics & GynaecologyTags :

New Findings on Cardiovascular Risk, Menopause and Migraines Ease Concerns

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Research suggesting a link between migraines and menopause symptoms and cardiovascular disease has gotten a lot of attention. But a pair of new studies in the journal Menopause suggest that most women experiencing these symptoms can rest easier, especially if they don’t have both migraines and long-term hot flashes and night sweats.

Instead, they should focus on tackling the other factors that can raise their cardiovascular risk by getting more sleep, exercise and healthy foods, quitting tobacco, and minding their blood pressure, blood sugar, cholesterol and weight.

For women who have experienced both migraines and hot flashes or night sweats over many years, one of the new studies does suggest an extra level of cardiovascular risk.

That makes heart disease and stroke prevention even more important in this group, says study leader Catherine Kim, MD, MPH, of the University of Michigan.

And for women currently in their 20s and 30s who experience migraines, the new research suggests that they might be heading for a higher risk of long-term menopause-related symptoms when they get older.

Long-term study yields important insights

Kim and her colleagues at Michigan Medicine, U-M’s academic medical centre, published the new pair of studies based on an in-depth analysis of data from a long-term study of more than 1900 women who volunteered to have regular physical exams and blood tests, and to take yearly health surveys, when they were in their late teens to early 30s.

Those women, now in their 50s and 60s, have provided researchers with a priceless view of what factors shape health in the years leading up to menopause and beyond, through their continued participation in the CARDIA study.

“The anxiety and dread that women with migraines and menopausal symptoms feel about cardiovascular risk is real – but these findings suggest that focusing on prevention, and correcting unhealthy habits and risk factors, could help most women,” said Kim, who is an associate professor of internal medicine at U-M and a primary care physician.

“For the subgroup with both migraines and early persistent hot flashes and night sweats, and for those currently experiencing migraines in their early adulthood, these findings point to an added need to control risks, and address symptoms early,” she adds.

Just over 30% of the middle-aged women in the study reported they had persistent hot flashes and night sweats, which together are called vasomotor symptoms or VMS because they relate to changes in the diameter of blood vessels.

Of them, 23% had reported also having migraines. This was the only group for whom Kim and her colleagues found extra risk of stroke, heart attack or other cardiovascular events that couldn’t be explained by other risk factors that have long been known to be linked to cardiovascular problems.

In addition to those with persistent vasomotor symptoms starting in their 40s or before, 43% of the women in the study had minimal levels of such symptoms in their 50s, and 27% experienced an increase in VMS over time into their 50s and early 60s.

The latter two groups had no excess cardiovascular risk once their other risk factors were taken into account, whether or not they had migraines.

Use of hormone-based birth control and estrogen to address medical issues did not affect this risk.

Controlling destiny

In the study of data from the same women in their earlier stages of life, the researchers found that the biggest factors in predicting which ones would go on to have persistent hot flashes and night sweats were having migraines, having depression, and smoking cigarettes, as well as being Black or having less than a high school education.

“These two studies, taken together, underscore that not all women have the same experiences as they grow older, and that many can control the risk factors that might raise their chances of heart disease and stroke later in life,” said Kim.

“In other words, women can do a lot to control their destiny when it comes to both menopause symptoms and cardiovascular diseases.”

She notes that the American Heart Association calls these risk factors the “Essential 8” and offers guides for what women, men and even children and teens can do to address them.

Evolving knowledge and treatment

The long-term study that the two new findings come from was specifically designed to look at cardiovascular risks when it launched in the mid-1980s. CARDIA stands for Coronary Artery Risk Development in Young Adults.

Back in the 80s, knowledge about the biology of blood vessels, down to the cellular and molecular level, was nowhere near where it is today. Both vasomotor symptoms in menopause and migraines have to do with blood vessel contraction and dilation.

But decades of research has shown the microscopic impacts on blood vessels of years of smoking, poor sleep, poor eating habits and lack of activity, as well as a person’s genetic inheritance, life experiences and hormonal history.

Newer injectable migraine medications called calcitonin gene-related peptide (CGRP) antagonists have reached the market in recent years. Using monoclonal antibodies, they target a key receptor on the surface of blood vessel cells to prevent migraines and cluster headaches. But they are expensive and not covered by insurance for all people with migraines.

While the new study is based on data from years before these medications became available, Kim said she recommends them to her patients with persistent migraines, as well as working with them to understand what triggers their migraines and how to use other medications including pain relievers and antiseizure medications to prevent them.

She also notes that the paper on future risk of persistent hot flashes and night sweats echoes the recent trend of using antidepressant medications to try to ease these menopause effects.

Kim also says that evidence has grown about the importance of healthy sleep habits for reducing hot flashes, as well the short-term use of oestradiol-based hormone therapy patches, which have not been shown to have a link to cardiovascular risk. And, she notes that research has not shown any over-the-counter supplement or herbal remedy to be effective, and that these are far less regulated than medications.

Source: Michigan Medicine – University of Michigan

Categories : Exercise Obstetrics & GynaecologyTags :

Swimming in Cold Water Improves Menopause Symptoms

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Researchers have found that swimming in cold water results in a significant improvement in menopause symptoms for women. The research, published in Post Reproductive Health, surveyed 1114 women, 785 of which were going through the menopause, to examine the effects of cold water swimming on their health and wellbeing.

The findings showed that menopausal women experienced a significant improvement in anxiety (as reported by 46.9% of the women), mood swings (34.5%), low mood (31.1%) and hot flushes (30.3%) as a result of cold water swimming.

In addition, a majority of women (63.3%) swam specifically to relieve their symptoms.

Some of the women quoted in the study said that they found the cold water to be “an immediate stress/ anxiety reliever” and described the activity as “healing.”

One 57-year-old woman stated: “Cold water is phenomenal. It has saved my life. In the water, I can do anything. All symptoms (physical and mental) disappear and I feel like me at my best.”

Senior author, Professor Joyce Harper (UCL EGA Institute for Women’s Health), said: “Cold water has previously been found to improve mood and reduce stress in outdoor swimmers, and ice baths have long been used to aid athletes’ muscle repair and recovery.

“Our study supports these claims, meanwhile the anecdotal evidence also highlights how the activity can be used by women to alleviate physical symptoms, such as hot flushes, aches and pains.

“More research still needs to be done into the frequency, duration, temperature and exposure needed to elicit a reduction in symptoms. However, we hope our findings may provide an alternative solution for women struggling with the menopause and encourage more women to take part in sports.”

Most of the women involved in the study were likely to swim in both summer and winter and wear swimming costumes, rather than wet suits.

Alongside aiding menopausal symptoms, the women said their main motivations for cold water swimming were being outside, improving mental health and exercising.

Professor Harper said: “The majority of women swim to relieve symptoms such as anxiety, mood swings and hot flushes. They felt that their symptoms were helped by the physical and mental effects of the cold water, which was more pronounced when it was colder.

“How often they swam, how long for and what they wore were also important. Those that swam for longer had more pronounced effects. The great thing about cold water swimming is it gets people exercising in nature, and often with friends, which can build a great community.”

The researchers also wanted to investigate whether cold water swimming improved women’s menstrual symptoms.

Of the 711 women who experienced menstrual symptoms, nearly half said that cold water swimming improved their anxiety (46.7%), and over a third said that it helped their mood swings (37.7%) and irritability (37.6%).

Yet despite the benefits of cold water swimming, the researchers were also keen to highlight that the sport comes with certain risks.

Professor Harper explained: “Caution must be taken when cold water swimming, as participants could put themselves at risk of hypothermia, cold water shock, cardiac rhythm disturbances or even drowning.

“Depending on where they are swimming, water quality standards may also vary. Raw sewage pollution is an increasingly common concern in UK rivers and seas. And, sadly, this can increase the likelihood of gastroenteritis and other infections.”

Study limitations

The study may contain some bias due to the survey only being taken by women who already cold water swim. And, as the survey was conducted online, it is likely that women were more likely to complete the survey if they noticed an association between menopause symptoms and cold water swimming.

Source: University College London

Categories : Cardiovascular Disease Obstetrics & GynaecologyTags :

Study Links Hot Flashes to Cardiovascular Risk Factors

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It has long been known that hot flashes are linked to a number of adverse health effects. Emerging data suggests an association between them and cardiovascular disease. A new study is the first to link physiologically assessed hot flashes with heightened systemic inflammation – a risk factor for cardiac disease. Study results will be presented during the 2023 Annual Meeting of The Menopause Society in Philadelphia September 27-30.

Vasomotor symptoms, more often referred to as hot flashes, are one of the most common symptoms identified during the menopause transition, with roughly 70% of midlife women reporting them. Not only do they interfere with a woman’s quality of life, but they have also been related to physical health risks, such as cardiovascular disease.

Previous research linking hot flashes with heightened systemic inflammation has relied on self-reporting to document the frequency and severity of the hot flashes. These self-reports of hot flashes are limited as they ask women to recall hot flashes over weeks or longer and may be subject to memory or reporting biases. A new study that included 276 participants from the MsHeart study, however, utilised sternal skin conductance to physiologically assess hot flashes and tested whether more frequent physiologically assessed hot flashes are associated with heightened system inflammation.

While large increases in inflammatory markers indicate acute infection or clinical disease, small and sustained increases of markers of inflammation that are in the physiologically normal range are predictive of later disease risk. For example, small and/or sustained increases in inflammatory biomarkers (conceptualised as heightened levels of systemic inflammation) have been related to plaque development and atherosclerotic cardiovascular disease.

Based on the results, the researchers concluded that physiologically assessed hot flashes during wake were associated with higher levels of a high-sensitivity C-reactive protein, even after adjusting for potential explanatory factors such as age, education, race/ethnicity, body mass index, and oestradiol.

The results will be presented during the Annual Meeting of The Menopause Society as part of the presentation entitled “Physiologically measured vasomotor symptoms and systemic inflammation among midlife women.”

“This is the first study to examine physiologically measured hot flashes in relation to inflammation and adds evidence to a growing body of literature suggesting that hot flashes may signify underlying vascular risk and indicate women who warrant focused cardiovascular disease prevention efforts,” says Mary Carson, MS, lead author from the Department of Psychology at the University of Pittsburgh.

“Since heart disease is the leading cause of death for women in the US, studies like these are especially valuable,” adds Dr Stephanie Faubion, medical director of The Menopause Society. “Healthcare professionals need to ask their patients about their hot flash experiences as they not only interfere with their quality of life but may also indicate other risk factors.”

Source: EurekAlert!

Categories : Ageing Cardiovascular DiseaseTags :

Stressful Life Events Contribute to Atrial Fibrillation Risk in Postmenopausal Women

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An estimated 1 in 4 postmenopausal women may develop atrial fibrillation in their lifetime, with stressful life events and insomnia being major contributing factors, according to new research published in the Journal of the American Heart Association.

Atrial fibrillation may lead to blood clots, stroke, heart failure or other cardiovascular complications. It primarily affects older adults.

“In my general cardiology practice, I see many postmenopausal women with picture perfect physical health who struggle with poor sleep and negative psychological emotional feelings or experience, which we now know may put them at risk for developing atrial fibrillation,” said lead study author Susan X. Zhao, M.D., a cardiologist at Santa Clara Valley Medical Center in California. “I strongly believe that in addition to age, genetic and other heart-health related risk factors, psychosocial factors are the missing piece to the puzzle of the genesis of atrial fibrillation.“

Researchers reviewed data from more than 83 000 questionnaires by women ages 50-79 from the Women’s Health Initiative, a major US study. Participants were asked a series of questions in key categories: stressful life events, their sense of optimism, social support and insomnia. Questions about stressful life events addressed topics such as loss of a loved one; illness; divorce; financial pressure; and domestic, verbal, physical or sexual abuse. Questions about sleeping habits focused on if participants had trouble falling asleep, wake up several times during the night and  overall sleep quality, for example. Questions about participants’ outlook on life and social supports addressed having friends to talk with during and about difficult or stressful situations; a sense of optimism such as believing good things are on the horizon; and having help with daily chores.

During approximately a decade of follow-up, the study found:

  • About 25% or 23 954 women developed atrial fibrillation.
  • A two-cluster system (the stress cluster and the strain cluster).
  • For each additional point on the insomnia scale, there is a 4% higher likelihood of developing atrial fibrillation. Similarly, for each additional point on the stressful life event scale, there is a 2% higher likelihood of having atrial fibrillation.

“The heart and brain connection has been long established in many conditions,” Zhao said. “Atrial fibrillation is a disease of the electrical conduction system and is prone to hormonal changes stemming from stress and poor sleep. These common pathways likely underpin the association between stress and insomnia with atrial fibrillation.”

Researchers noted that stressful life events, poor sleep and feelings, such as depression, anxiety or feeling overwhelmed by one’s circumstances, are often interrelated. It’s difficult to know whether these factors accumulate gradually over the years to increase the risk of atrial fibrillation as women age.

Chronic stress has not been consistently associated with atrial fibrillation, and the researchers note that a limitation of their study is that it relied on patient questionnaires from the start of the study. Stressful life events, however, though significant and traumatic, may not be long lasting, Zhao notes. Further research is needed to confirm these associations and evaluate whether customised stress-relieving interventions may modify atrial fibrillation risk.

Source: EurekAlert!

Categories : Ageing Obstetrics & GynaecologyTags :

Rethink Needed for the Genetic Cause of Very Early Menopause

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A new study showed that it may be necessary to rethink the genetic cause previously held to be behind very early menopause. Until now, variants in any one of more than 100 genes were thought to cause premature ovarian insufficiency (POI), which results in menopause before age 40. This affects around 1% of women, making it a leading cause of infertility. Under current guidance, a variation in one of these genes is cause for clinicians to consider a genetic diagnosis of POI.

Now, in the largest study to date, published in Nature Medicine, researchers analysed genetic data from more than 104 733 women in UK Biobank, of whom 2231 reported experiencing menopause before the age of 40.

The study found evidence that 98% of women carrying variations in the genes that were previously considered to be causes of premature menopause in fact had menopause over 40, therefore ruling out a diagnosis of POI in these women.

Anna Murray, Professor of Human Genetics at the University of Exeter Medical School is a senior author on the study. She said: “Our research means rethinking what causes very early menopause. The presence of specific genetic variants in multiple women who experience premature menopause has led to the assumption that they are causing the condition – but we have shown that these gene variations are also found in women with a normal age of menopause and therefore in many cases the link could just be coincidence. It now seems likely that premature menopause is caused by a combination of variants in many genes, as well as non-genetic factors. As genomic medicine evolves, we need to apply this standard of evidence to other conditions, so we can tailor diagnosis, treatment and support.”

Dr Julia Prague, Consultant Endocrinologist and Clinical Academic at the University of Exeter, and an author on the paper, said: “Having a very early menopause is often extremely distressing because it means losing fertility and treatment with hormone replacement is required to prevent negative health consequences. Clinicians need to understand the reasons why premature menopause occurs so that they do not miss the true underlying cause and can counsel patients appropriately. Misinterpreting genetic tests could have negative implications for women, such as suggesting that their relatives may also be at risk of very early menopause due to their genes, when in fact they may not be.”

Stasa Stankovic, of the University of Cambridge’s MRC Epidemiology Unit, and co-lead analyst of the study, said: “Each woman’s unique genetic combination shifts menopause timing, either earlier or later. Although genetic variation in the studied genes were not sufficient to cause very early menopause, we did identify genetic drivers that had a much more subtle impact on reproductive longevity. For example, women carrying genetic variation in TWNK and SOHLH2 genes experienced menopause up to three years earlier than the general population. Our future studies will continue using the power of human genomics to better understand the underlying biology of reproductive ageing in women and key genetic drivers of its extreme forms, including very early menopause. With this knowledge, we are also paving the path towards development of next-generation treatments for reproductive disorders.”

Source: University of Exeter

Categories : Ageing Cardiovascular DiseaseTags :

Oestrogen Pills may Increase Hypertension Risk

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Women ages 45 years and older taking oral oestrogen pills were more likely to develop hypertension than those using transdermal or vaginal formulations, according to new research published in Hypertension.

Less oestrogen and progesterone is produced in a woman’s body after menopause, which may increase the risk for cardiovascular diseases including heart failure, according to the American Heart Association.

Hormone therapy may be prescribed to relieve symptoms of menopause, in gender-affirming care and in contraception. Previous studies have found that some hormone therapies may reduce cardiovascular disease risk in menopausal women under 60 years of age or for whom it has been fewer than 10 years since menopause. The authors of this study noted that while hypertension is a modifiable risk factor for cardiovascular disease, the potential effects of different types of hormone therapy on blood pressure in menopausal women remain uncertain. 

“We know oestrogens ingested orally are metabolised through the liver, and this is associated with an increase in factors that can lead to higher blood pressure,” said lead study author Cindy Kalenga, an MD/PhD-candidate at the University of Calgary. 

“We know that post-menopausal women have increased risk of high blood pressure when compared to pre-menopausal women, furthermore, previous studies have shown that specific types of hormone therapy have been associated with higher rates of heart disease,” Kalenga said. “We chose to dive deeper into factors associated with hormone therapy, such as the route of administration (oral vs non-oral) and type of oestrogen, and how they may affect blood pressure.”

This study involved a large group of over 112 000 women, ages 45 years and older, who filled at least two consecutive prescriptions (a six-month cycle) for oestrogen-only hormone therapy, as identified from health administrative data in Alberta, Canada between 2008 and 2019. The main outcome of high blood pressure (hypertension) was identified via health records.

First, researchers investigated the relationship between route of oestrogen-only hormone therapy administration and risk of developing high blood pressure at least one year after starting the treatment. The 3 different routes of hormone therapy administration were oral (by mouth), transdermal and vaginal application. Additionally, researchers evaluated the formulation of oestrogen used and the risk of developing high blood pressure. For this study, the researchers reviewed medical records of individuals taking oestrogen-only hormone therapy. The two most common forms of oestrogen used by study participants were oestradiol – a synthetic form of oestrogen closest to the naturally produced form – and conjugated equine oestrogen, an animal-derived form of oestrogen and the oldest type of oestrogen therapy.

The analysis found:

  • Women taking oral oestrogen therapy had a 14% higher risk of developing high blood pressure compared to those using transdermal oestrogen and a 19% higher risk of developing high blood pressure compared to those using vaginal oestrogen creams or suppositories. After accounting for age, a stronger association was seen among women younger than 70 years of age compared to women older than 70.
  • Compared to estradiol, conjugated equine estrogen was associated with an 8% increased risk of developing high blood pressure.

Taking oestrogen for a longer period of time or taking a higher dose was associated with greater risk of high blood pressure, the authors noted. According to Kalenga, the study’s findings suggest that if menopausal woman take hormone therapy, there are different types of oestrogen that may have lower cardiovascular risks.

“These may include low-dose, non-oral oestrogen – like oestradiol, in transdermal or vaginal forms – for the shortest possible time period, based on individual symptoms and the risk–benefit ratio, Kalenga said. “These may also be associated with the lowest risk of hypertension. Of course, this must be balanced with the important benefits of hormone therapy, which include treatment of common menopausal symptoms.”

The average age of natural menopause among women worldwide is about 50 years of age. Current evidence supports that initiating menopausal hormone therapy in the early stages may have cardiovascular benefits, though not in the late stages of menopause, according to the American Heart Association’s 2020 Statement on Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention. Previous studies have found that menopausal hormone therapy may help relieve symptoms of menopause, including hot flashes, night sweats, mood changes or sleep disturbances.

Limitations included being based only on medical records, not including women younger than the age of 45 and not collecting data about hysterectomies or menopausal status (which was inferred by taking oestrogen after 45).

The authors will be conducting more research investigating combined oestrogen and progestin, as well as progestin-only formulations of hormone therapy and their impact on heart and kidney diseases.

Source: American Heart Association

Categories : Gender NeurologyTags :

Lower Oestrogen Levels may Explain Migraine Increase During Menstruation

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New research published in Neurology may explain why migraine attacks are more common during menstruation. The researchers found that, as oestrogen levels fluctuate, for female migraine sufferers, levels of the protein calcitonin gene-related peptide (CGRP) that plays a key role in starting the migraine process also fluctuate.

“This elevated level of CGRP following hormonal fluctuations could help to explain why migraine attacks are more likely during menstruation and why migraine attacks gradually decline after menopause,” said study author Bianca Raffaelli, MD, of Charité – Universitätsmedizin Berlin. “These results need to be confirmed with larger studies, but we’re hopeful that they will help us better understand the migraine process.”

The matched cohort study involved three groups of female participants with episodic migraine, all with least three days with migraine in the month before the study. The groups were those with a regular menstrual cycle, those taking oral contraceptives, and those who had gone through menopause. Each group had 30 people, for a total of 180, and were age-matched to women without migraine history.

Researchers collected blood and tear fluid to determine CGRP levels. In those with regular menstrual cycles, the samples were taken during menstruation when oestrogen levels are low and around the time of ovulation, when levels are the highest. In those taking oral contraceptives, samples were taken during the hormone-free time and the hormone-intake time. Samples were taken once from postmenopausal participants at a random time.

The study found that female participants with migraine and a regular menstrual cycle had higher CGRP concentrations during menstruation than those without migraine. Those with migraine had blood levels of 5.95 picograms per millilitre (pg/ml) compared to 4.61pg/ml for those without migraine. For tear fluid, those with migraine had 1.20ng/ml compared to 0.4ng/ml for those without migraine.

In contrast, those taking oral contraceptives or were postmenopausal had similar CGRP levels in the migraine and non-migraine groups.

“The study also suggests that measuring CGRP levels through tear fluid is feasible and warrants further investigation, as accurate measurement in the blood is challenging due to its very short half-life,” Raffaelli said. “This method is still exploratory, but it is non-invasive.”

Raffaelli noted that while hormone levels were taken around the time of ovulation, they may not have been taken exactly on the day of ovulation, so the fluctuations in oestrogen levels may not be fully reflected.

Source: American Academy of Neurology

Categories : CancerTags :

Hormone Therapy does not Increase Breast Cancer Recurrence Risk in Survivors

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Research published in the Journal of the National Cancer Institute found that menopausal hormone therapy for breast cancer survivors is not associated with breast cancer reoccurrence, despite worries among some researchers and physicians.

Hot flashes and night sweats, as well as vaginal dryness and urinary tract infections, are common in breast cancer survivors, worsening quality of life and can lead patients to discontinue therapy. These symptoms may be alleviated by vaginal oestrogen therapy or menopausal hormone therapy (MHT). However, the safety of systemic and vaginal oestrogen use among breast cancer survivors, particularly those with oestrogen receptor-positive disease, has been unclear.

Many doctors caution breast cancer survivors against using MHT following the demonstration of an increased risk of breast cancer recurrence in two trials in the 1990s. Though later studies have not shown increased recurrence, they were seriously limited, with small sample sizes and short follow-up periods.

This study compared hormonal treatment with the risk of breast cancer recurrence and mortality in a large cohort of Danish postmenopausal women treated for early-stage oestrogen receptor-positive breast cancer.

Participants were diagnosed between 1997 and 2004 with early-stage breast cancer who received no treatment or five years of hormone therapy.

Among 8461 women, 1957 and 133 used vaginal oestrogen therapy or MHT, respectively, after diagnosis. No increase was seen in the risk of recurrence or mortality for those who received either vaginal oestrogen therapy or MHT.

“This large cohort study helps to inform the nuanced discussions between clinicians and breast cancer survivors about the safety of vaginal oestrogen therapy,” said Elizabeth Cathcart-Rake, writing in an accompanying editorial. “These results suggest that breast cancer survivors on tamoxifen with severe genitourinary symptoms can take vaginal estrogen therapy without experiencing an increase in their risk for breast cancer recurrence. However, caution is still advised when considering vaginal oestrogen for breast cancer survivors on aromatase inhibitors, or when considering menopausal hormonal therapy.”

Source: EurekAlert!

Categories : Obstetrics & GynaecologyTags :

Early Menopause and Oral Contraceptive Link

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Long-term use of oral contraceptives, as well as certain methods of tubal ligation (TL), were linked to lower levels of antimüllerian hormone, a biomarker for ovarian aging, suggesting an increased risk for early menopause, according to preliminary research.

Using data from the Nurses’ Health Study II, researchers at the UMass Amherst School of Public Health and Health Sciences examined the association of oral contraceptive use and tubal ligation with antimüllerian hormone (AMH).

Published in the journal Menopause, the results were “intriguing,” according to lead author Christine Langton, PhD candidate.

“We’re one of the larger studies to have looked at both of these contraceptive methods at the same time,” says Langton, now a post-doctoral researcher at the National Institute of Environmental Health Sciences. “We feel we’re contributing to the story, and to the literature, though nothing we did was definitive. This is a piece of the puzzle.”

Early menopause, which occurs before 45, puts women at greater risk for a range of health conditions including cardiovascular disease, osteoporosis and dementia. The researchers noted that oral contraceptives change hormone levels and prevent ovulation; tubal ligation may affect blood supply to the ovaries, and certain methods of the procedure may damage the ovary and surrounding neural tissue. 

“Recently, AMH has become an established marker for the timing of menopause and was found to be strongly associated with the risk of early menopause,” the authors wrote. “Yet, the association of reproductive and lifestyle factors with AMH levels remains unclear.”

The team focused on a subset of 1420 premenopausal women in the Nurses’ Health Study prospective cohort who had provided a blood sample between 1996 and 1999. A history of their oral contraceptive use and tubal ligation began in 1989 and was updated every two years until their blood was collected.

“Women who reported that their [tubal ligation] procedure included the use of a clip, ring or band had significantly lower AMH levels compared to women who never had a TL procedure,” the researchers wrote.

One limitation is the small number of women reporting the type of tubal ligation, Langton added.

When it came to oral contraceptives, “we saw a significant inverse association – the longer the use of oral contraceptives, the lower the AMH levels were,” Langton said. “That particular finding was a little surprising to us because it didn’t completely align with what we saw when we looked at oral contraceptives and early menopause in the larger cohort” of more than 115,000 women.

Even after adjusting for factors including BMI, smoking, alcohol, number of pregnancies and breastfeeding, the inverse association between oral contraceptive use and AMH levels remained significant.

“We think further research is warranted,” Langton said.

Source: University of Massachusetts