Perimenopause: Oral Micronized Progesterone May Reduce Hot Flashes, Night Sweats and Sleep Problems

MedicalResearch.com Interview with:

Jerilynn C. Prior, MD Professor in the Department of Medicine Division of Endocrinology and Metabolism University of British Columbia in Vancouver

Dr. Prior

Jerilynn C. Prior, MD
Professor in the Department of Medicine
Division of Endocrinology and Metabolism
University of British Columbia in Vancouver

Dr. Prior has written the second edition of the award-winning book, Estrogen’s Storm Season—Stories of Perimenopause this year as an ebook on Google Play.


MedicalResearch.com: What is the background for this study?

Response: There is an urgent need for an effective therapy for perimenopausal hot flushes/flashes and night sweats (vasomotor symptoms, VMS). Although often considered “estrogen deficiency symptoms” VMS are common and very problematic for women in the menopause transition and who have not yet been one year without flow. About 23% of North American women are now in the perimenopausal age range. Surprisingly VMS are more common in perimenopause than in menopause; 9% of perimenopausal women have severe VMS as classified by the FDA, meaning more than 50 VMS per week of moderate to intense severity.

The commonly used therapies for VMS in midlife women have not been proven more effective than placebo! That includes combined hormonal contraceptives (CHC) and menopausal-type hormone therapy (MHT) as well as the SSRI/SNRI anti-depressants and gabapentin.  Continue reading

Topical Estrogen No Better Than Moisturizer for Postmenopausal Vaginal Dryness

MedicalResearch.com Interview with:

Caroline Mitchell, MD, MPH Vincent Center for Reproductive Biology Assistant Professor, Obstetrics, Gynecology & Reproductive Biology

Dr. Caroline Mitchell

Caroline Mitchell, MD, MPH
Vincent Center for Reproductive Biology
Assistant Professor, Obstetrics, Gynecology & Reproductive Biology
http://massgeneral.link/MitchellLab

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In this study we compared two commonly recommended treatments for menopausal vaginal discomfort – low dose vaginal estradiol tablets and a vaginal moisturizer – to placebo, and found no difference in reduction of symptom severity; all three groups improved over 12 weeks of treatment.  This is great news for women, as it means that using any treatment regularly is likely to have benefit, whether it costs $20 or $200.

Symptoms of vaginal dryness, irritation and pain with sex, which occur in over half of postmenopausal women, cause a significant decrease in quality of life and negatively impact intimate relationships.  The significant impact of these symptoms is reflected in the fact that we enrolled all 302 participants in under a year, a faster enrollment than any of the four prior trials  conducted by the MsFlash research network that evaluated treatments for hot flashes.  Women were desperate for some kind of intervention for these symptoms. Continue reading

Menopausal Hormone Therapy Linked To Favorable Cardiac Profile

MedicalResearch.com Interview with:

Mihir Sanghvi Academic Junior Doctor Barts Health NHS Trust

Dr. Sanghvi

Mihir Sanghvi
Academic Junior Doctor
Barts Health NHS Trust

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The effect of menopausal hormone therapy (MHT), previously known as hormone replacement therapy, on cardiovascular health in post-menopausal women remains controversial and unclear. Extensive observational data had suggested MHT to be cardioprotective, leading to MHT being routinely prescribed for both primary and secondary prevention of coronary heart disease (CHD). However, subsequent data from the Women’s Health Initiative (WHI) and Heart and Estrogen/Progestin Replacement Study (HERS) studies cast doubt on the beneficial cardiovascular effects of MHT; this was reflected in learned societies’ clinical guidance concerning MHT’s role in CHD prevention. The most recent randomised trial data on the subject arose from the Danish Osteoporosis Prevention Study, which indicated that women taking menopausal hormone therapy had a reduced risk of the composite endpoint of mortality, heart failure and myocardial infarction but the study has been subject to criticism [10]. In more recent work, again from the WHI, there was no difference in cardiovascular mortality in MHT users compared to placebo, although the authors themselves state that cause-specific mortality data should be interpreted “cautiously”.

The UK Biobank is an ongoing, large-scale, population-based study designed to examine determinants of health in middle and old age. Besides extensive collection of health questionnaire data, biological samples and physical measurements, it has incorporated cardiovascular magnetic resonance (CMR) imaging – the gold standard for analysis of cardiac structure and function – to provide detailed imaging phenotypes. At present, there is a paucity of data on the effects of  menopausal hormone therapy on left ventricular (LV) and left atrial (LA) volumes and function, alterations in which are markers of subclinical cardiovascular disease and have prognostic implications.

We found that in a large, population-based cohort of post-menopausal women free of cardiovascular disease, use of menopausal hormone therapy is not associated with adverse, subclinical changes in cardiac structure and function.

Indeed, we demonstrate significantly smaller LV and LA chamber volumes which have been linked to favorable cardiovascular outcomes in other settings.

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Menopausal Hormone Replacement Should Not Be Used For Disease Prevention

MedicalResearch.com Interview with:

Dr-Suzanne Fenske.jpg

Dr. Fenske

Dr. Suzanne Fenske, MD
Assistant Professor of Obstetrics, Gynecology and Reproductive Science
Icahn School of Medicine at Mount Sinai

 MedicalResearch.com: What is the background for this study? What are the main findings?

Response: USPSTF recommendations are based off several studies, but is mainly based off of the Women’s Health Initiative.

The Women’s Health Initiative was a 15 year prevention study with a focus on death, disability and impaired quality of life in postmenopausal women. This study was originally performed in 1991.

The USPSTF reevaluated the data along with several other studies to assess the role of hormone replacement therapy in prevention of chronic diseases such as heart disease, stroke, blood clot, gallbladder disease, dementia.  The USPSTF has found that hormone replacement therapy has some benefit in reducing the risk of fractures, and, potentially, diabetes.  The USPSTF has found that hormone replacement therapy can increase the risk of coronary artery disease, stroke, blood clot, gall bladder disease, urinary incontinence and dementia.

With these risks, the USPSTF states that hormone replacement therapy should not be used as a preventative medicine, but, rather, used for treatment of symptomatic menopause and not prevention of osteoporosis or heart disease.

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Women With Severe Hot Flashes At Higher Risk of Obstructive Sleep Apnea

MedicalResearch.com Interview with:
Stephanie S. Faubion, MD, FACP, NCMP, IF
Director, Executive and International Medicine
Director, Office of Women’s Health
Associate Professor of Medicine
Division of General Internal Medicine 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Data Registry on Experiences of Aging, Menopause and Sexuality (DREAMS) was used for this study investigating the association between vasomotor symptoms (hot flashes and night sweats) and risk for obstructive sleep apnea, a common and underdiagnosed sleep disorder in women which is associated with increased cardiovascular risk.

We found that Women who had severe or very severe hot flashes or night sweats were more likely to be at increased risk for obstructive sleep apnea.  This association held even after adjusting for age, body mass index, smoking and hypertension, such that the odds of women having intermediate /high risk for obstructive sleep apnea were 1.87 times higher for those with severe/very severe hot flashes/night sweats compared to those with less severe symptoms.  We decided to analyze the group of women with normal body mass index, and indeed, this finding was still significant in the lean group of women.

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Hormones Affect Carotid Plaque Stability and Stroke Vulnerability

MedicalResearch.com Interview with:

Marija Glisic Epidemiology, Erasmus MC

Marija Glisic

Marija Glisic
Epidemiology, Erasmus MC 

MedicalResearch.com: What is the background for this study?

Response: Carotid atherosclerosis is one of most important risk factors for developing stroke. Carotid atherosclerotic plaques characterized by lipid core presence and intraplaque haemorrhage are considered to be unstable, and therefore more prone to rupture and lead to consequent stroke. Sex differences have been observed in carotid plaque composition as well as in stroke incidence. Sex hormones, particularly estrogen and testosterone actions are suggested to underlie the observed sex differences in atherosclerosis. Experimental evidence suggests a direct action of estradiol and testosterone on the vascular system, affecting various mechanisms that may impact plaque composition and subsequently stroke risk.

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Cataract Surgery Linked To Improved Health and Survival, As Well As Sight

MedicalResearch.com Interview with:

Anne L. Coleman, MD, PhD Center for Community Outreach and Policy, Stein Eye Institute David Geffen School of Medicine Director, UCLA Mobile Eye Clinic Department of Epidemiology, Fielding School of Public Health UCLA

Dr. Coleman

Anne L. Coleman, MD, PhD
Center for Community Outreach and Policy, Stein Eye Institute
David Geffen School of Medicine
Director, UCLA Mobile Eye Clinic
Department of Epidemiology, Fielding School of Public Health
UCLA

MedicalResearch.com: What is the background for this study?

Response: Cataracts are a leading cause of vision loss worldwide, and cataract surgery is an intervention that is known to be extremely effective to address the vision loss related to cataract. However, it is unclear if there are benefits of cataract surgery beyond vision improvement in people with cataracts. Previous studies have suggested that in addition to improving vision, cataract surgery may decrease the risk of fractures and accidents, improve mental health, and improve overall quality of life. The purpose of the present study was to further investigate the potential benefits of cataract surgery and to determine if cataract surgery was associated with increased survival in people with cataracts.

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Half of Menopausal Women Report Getting Insufficient Quality Sleep

MedicalResearch.com Interview with:
Dr. Anjel Vahratian PhD MPH Maternal and Child Health Epidemiologist Branch Chief at the National Center For Health Statistics   Centers for Disease Control and PreventionDr. Anjel Vahratian PhD MPH

Maternal and Child Health Epidemiologist
Branch Chief at the National Center For Health Statistics
Centers for Disease Control and Prevention

MedicalResearch.com: Why did you conduct this study?

Response: Our research focuses on the health of women as they age and transition from the childbearing period. During this time, women may be at increased risk for chronic health conditions such as diabetes and cardiovascular disease.

As insufficient sleep is a modifiable behavior that is associated with these chronic health conditions, we wanted to examine how sleep duration and quality varies by menopausal status.

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Study Finds 5-7 Years Post-Menopausal Hormone Therapy Not Associated with Increased Risk of Mortality

MedicalResearch.com Interview with:

JoAnn E. Manson, MD, DrPH Chief, Division of Preventive Medicine Brigham and Women's Hospital Professor of Medicine and the Michael and Lee Bell Professor of Women's Health Harvard Medical School Boston, Massachusetts  02215

Dr. Manson

JoAnn E. Manson, MD, DrPH
Chief, Division of Preventive Medicine
Brigham and Women’s Hospital
Professor of Medicine and the
Michael and Lee Bell Professor of Women’s Health
Harvard Medical School
Boston, Massachusetts  02215 

MedicalResearch.com: What is the background for this study?

Response: The current report provides new information on total mortality and the rates of death from specific causes (cardiovascular disease, cancer, other major illnesses) over 18 years of follow-up in the Women’s Health Initiative (WHI) randomized trials of hormone therapy (estrogen + progestin and estrogen alone). This is the first WHI report to focus on all-cause and cause-specific mortality. It includes all of the 27,347 women in the 2 hormone therapy trials with >98% follow-up over 18 years, during which time 7,489 deaths occurred. This is more than twice as many deaths as were included in earlier reports. The report also provides detailed information on differences in results by age group (ages 50-59, 60-69, 70-79) at time of study enrollment.

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Cardiovascular Fat in Women at Midlife Varies By Race and Body Shape

MedicalResearch.com Interview with:

Samar R. El Khoudary, PhD, MPH, BPharm, FAHA Associate Professor, Epidemiology PITT Public Health Epidemiology Data Center University of Pittsburgh Pittsburgh, PA 15260 

Dr. El Khoudary

Samar REl KhoudaryPhDMPH, BPharm, FAHA
Associate Professor, Epidemiology
PITT Public Health
Epidemiology Data Center
University of Pittsburgh
Pittsburgh, PA 15260  

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Heart fat is associated with greater coronary heart disease risk. Postmenopausal women have greater heart fat volumes than premenopausal women, and the association between specific heart fat depots and calcification in the coronary arteries is more pronounced after menopause. Race, central adiposity, and visceral adiposity are important factors that could impact heart fat volumes.

We evaluated whether racial differences in heart fat volumes and in their associations with central (abdominal visceral fat) and general adiposity (as measured by body mass index [BMI]) exist in midlife women. Our study included 524 women from the Study of Women’s Health Across the Nation (SWAN) (mean age: 51 years; 62% White and 38% Black) who had data on heart fat volumes, abdominal visceral fat and BMI.

After accounting for the potential health effects of lifestyle and socioeconomic factors we found that midlife Black women had less heart fat volumes than white women and not surprisingly, the more fat a women carries overall, the higher her risk for a fatty heart. However, white women with higher BMI had significantly more heart fat, as measured by a CT scan, than black women with the same BMI. For black women, the levels of heart fat were greater if they carried more fat in their midsection, as measured by a cross-sectional CT scan, compared with white women with the same volume of fat in their midsection. The results echo the findings we have reported previously in midlife men and published at the International Journal of Obesity (2015) 39, 488–494.
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