Telephone Delivered Cognitive Behavioral Therapy Improved Insomnia and Hot Flashes in Menopausal Women

MedicalResearch.com Interview with:

Dr. Susan McCurry Principal Investigator Clinical psychologist and research professor School of Nursing University of Washington

Dr. Susan McCurry

Dr. Susan McCurry
Principal Investigator
Clinical psychologist and research professor
School of Nursing
University of Washington

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

Dr. McCurry: Every woman goes through menopause.  Most women experience nighttime hot flashes/sweats and problems sleeping at some point during the menopause transition.  Poor sleep leads to daytime fatigue, negative mood, and reduced daytime productivity.  When sleep problems become chronic – as they often do – there are also a host of negative physical consequences including increased risk for weight gain, diabetes, and cardiovascular disease.  Many women do not want to use sleeping medications or hormonal therapies to treat their sleep problems because of concerns about side effect risks.  For these reasons, having effective non-pharmacological options to offer them is important. Continue reading

Oophorectomy Linked To Increased Risk of Colon Cancer

MedicalResearch.com Interview with:

Josefin Segelman MD, PhD Senior consultant colorectal surgeon Department of Molecular Medicine and Surgery Karolinska Institutet Ersta Hospital Stockholm Sweden

Dr. Josefin Segelman

Josefin Segelman MD, PhD
Senior consultant colorectal surgeon
Department of Molecular Medicine and Surgery
Karolinska Institutet
Ersta Hospital
Stockholm Sweden

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

Dr. Segelman: Hormonal factors influence the development of colorectal cancer. Observational studies and clinical trials have reported a protective effect of hormone replacement therapy and oral contraceptives. Oophorectomy alters endogenous levels of sex hormones, but the effect on colorectal cancer risk is unclear. Removal of the ovaries alters levels of sex hormones in both pre- and postmenopausal women. In premenopausal women, bilateral oophorectomy is followed by surgical menopause as the endogenous estrogen levels drop. Both before and after natural menopause, bilateral oophorectomy promptly decreases endogenous androgen levels by half as the ovaries and adrenals are equally important for androgen production.

MedicalResearch.com:  What are the main findings?

Dr. SegelmanThe present nationwide cohort study explored the association between removal of the ovaries for benign indications and subsequent risk of colorectal cancer. Among 195 973 women who underwent the procedure from 1965 – 2011, there was a 30% increased risk of colorectal cancer compared with the general population. After adjustment for various factors, women who underwent bilateral oophorectomy had a higher risk of rectal cancer than those who had unilateral oophorectomy (HR 2.28, 95% CI 1.33-3.91).

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Mediterranean Diet in Post Menopausal Women Linked to Better Bone Health

MedicalResearch.com Interview with:
Bernhard Haring, MD MPH
Department of Medicine I
Comprehensive Heart Failure Center
University of Würzburg
Germany

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

Dr. Haring: The primary aim of this study was to examine the association between adherence to a diet quality index constructed on the basis of dietary recommendations or existing healthy dietary patterns and bone outcomes in a large population of postmenopausal women.

We found that higher diet quality based on a Mediterranean diet may play a role in maintaining bone health in postmenopausal women.
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For Many Women, Migraines Worsen During Menopause

Dr. Vincent Martin, MD Professor of Internal Medicine University of Cincinnati College of Medicine Cincinnati OH

Dr. Martin

MedicalResearch.com Interview with:
Dr. Vincent Martin, MD
Professor of Internal Medicine
University of Cincinnati College of Medicine
Cincinnati OH

Medical Research: What is the background for this study? What are the main findings?

Dr. Martin: Past studies have found that the perimenopause is associated with an increased prevalence of migraine headache, but there have been no studies to determine if the frequency of migraine attacks is increased during this time period.  In our study we reported that high frequency headache (≥10 days per month with headache) was increased by 62% during perimenopause (irregular menstrual cycles) as compared to premenopause (regular menstrual cycles).  We later divided the perimenopause into early and late stages.  During the early perimenopause women experience irregular menstrual bleeding while during the late perimenopause women begin skipping menstrual periods for 2-11 months.  Of the two stages the late perimenopause in particular had the greatest likelihood for high frequency headache increasing its risk by 86%.  This could suggest that low estrogen and progesterone levels, which occur when menstrual periods are skipped, might account for the increased probability of headache attacks in women with migraine.

The common belief in the medical field is that migraine attacks improve in women during menopause.  To the contrary we found that high frequency migraine increased by 76% during menopause compared to premenopause.  This indicates that a subgroup of women with frequent headaches tend to worsen with menopause.  The increased probability of high frequency headache appeared to be secondary to an increased intake of pain medications occurring during this time period, which could result in “rebound headaches”.  Rebound headaches occur from overuse of pain medications.

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Acupuncture No Better Than Placebo For Hot Flashes

Acupuncture-Wikipedia-Image

Acupuncture Presure

MedicalResearch.com Interview with:
Carolyn Ee
MBBS
Department of General Practice
University of Melbourne
Carlton, Victoria, Australia

Medical Research: What is the background for this study? What are the main findings?

Response: Hot flushes affect up to 90% of women during the menopause and beyond, and women are turning to complementary therapies. Our randomised sham-controlled trial found no difference between real and sham acupuncture (given with a blunt needle) for hot flushes, with both groups improving by around 40% at the end of treatment.

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Early Menopause Raises Risk of Postmenopausal Depression

MedicalResearch.com Interview with:
Eleni Petridou, MD, MPH, PhD
Marios K. Georgakis, MD
Department of Hygiene, Epidemiology and Medical Statistics
School of Medicine
National and Kapodistrian University of Athens
Athens, Greece

Medical Research: What is the background for this study?

Response: Previous epidemiologic studies have shown that women during their reproductive life are more vulnerable (by a factor of two) to depression than men; this has been particularly evident during peaks of intense fluctuations of ovarian hormones, like the premenstrual, perimenopausal and postpartum periods. Endogenous (natural) female sex hormones, however, have been shown in various experimental studies to possess neuroprotective and anti-depressive properties. Production of these hormones is diminished after menopause; therefore, age at menopause can be used as a proxy of the lifetime exposure to endogenous hormones. Our research hypothesis was whether longer exposure to endogenous sex hormones has a cumulative anti-depressive action, i.e., whether later age at menopause decreases the risk for postmenopausal depression.

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Menopausal Hormone Therapy May Raise Risk Of Basal Cell Carcinoma

MedicalResearch.com Interview with:
Elizabeth K. Cahoon, PhD
Radiation Epidemiology Branch
Division of Cancer Epidemiology and Genetics, National Cancer Institute
National Institutes of Health
Department of Health and Human Services
Bethesda, MD

Medical Research: What is the background for this study? What are the main findings?

Dr. Cahoon: Although basal cell carcinoma (BCC) is the most common cancer in the United States, there is relatively little research on risk factors since few population-based cancer registries do not capture information on this malignancy.

Sun exposure (in particular ultraviolet radiation) is the primary risk factor for basal cell carcinoma, but less is known about other factors that may affect this risk. A previous study found a relationship between menopausal hormone therapy (MHT) use and increased risk of BCC in a population of Danish women.

In our study we looked to see if factors related to estrogen exposure from multiple sources was associated with basal cell carcinoma risk in a large, nationwide, prospective study. These included use of oral contraceptives or menopausal hormone therapy, but also reproductive factors (like age at menarche and menopause).

We observed that women who experienced natural menopause later in life were more likely to develop basal cell carcinoma compared to women who had natural menopause at a younger age.

In addition, women who reported using menopausal hormone therapy for one year or longer were more likely to develop basal cell carcinoma compared to women who did not report MHT use.

Women who reported natural menopause and menopausal hormone therapy use for 10 or more years had the highest risk of basal cell carcinoma, compared to women with no menopausal hormone therapy use.
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Menopause Increases Asthma Risk

Kai Triebner, MSc Department of Clinical Science University of Bergen Bergen, Norway
MedicalResearch.com Interview with:

Kai Triebner, MSc
Department of Clinical Science
University of Bergen
Bergen, Norway


Medical Research: What is the background for this study?

Response: During the last decades female life expectancy has risen far beyond 50
years worldwide. This means that the quality of life after menopause is
highly relevant today. Menopause implies profound hormonal and metabolic
changes leading to higher risk of diabetes and cardiovascular diseases.
Although researchers are increasingly aware that hormonal status and
inflammation may also deteriorate respiratory health, our knowledge is
very scarce. So far, no prospective study had investigated whether
menopause increases the risk of asthma in the general population.

Medical Research:? What are the main findings?

Response: We studied the association between menopausal status and newly diagnosed  asthma, after the age of 44. We found that the odds of getting asthma
were more than twice as high for women going through the menopausal
transition or after menopause, compared to non-menopausal women. The
risk was particularly high for overweight and obese women. These results
were not due to general aging and were independent of smoking and
geographical location.

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Can Menopause Be Prevented In Young Women on Chemotherapy For Early Breast Cancer?

Rodrigo R. Munhoz, MD Hospital Sírio Libanês São Paulo, Brazil MedicalResearch.com Interview with:
Rodrigo R. Munhoz, MD
Hospital Sírio Libanês
São Paulo, Brazil 

Medical Research: What is the background for this study? What are the main findings?

Dr. Munhoz:  Chemotherapy-induced early menopause and its impact on quality of life is clinically relevant issue that often arises during the treatment with curative intent of premenopausal patients with early breast cancer. The use of neo-/adjuvant chemotherapy is associated with risks of ovarian dysfunction, permanent or transient amenorrhea, infertility and symptoms of menopause with a premature onset. In addition to osteoporosis, loss of libido, increased cardiovascular risk and atrophic vaginitis, early ovarian dysfunction may adversely impact quality of life and result in significant psychosocial burden.

Currently available guidelines addressing fertility preservation in young women undergoing treatment for early breast cancer recommend that patients at reproductive ages should be advised about the potential risks of fertility impairment and additional effects of adjuvant chemotherapy and that preservation techniques should be carefully considered. However, “evidence regarding the effectiveness of ovarian suppression” is quoted as “insufficient” and the use GnRH agonists as “experimental” .

The current meta-analysis includes a large number of patients and also the results of recently presented clinical trials, and suggest that the use of GnRH agonists is associated a higher rate of recovery of regular menses in patients with breast cancer undergoing chemotherapy.These results summarize the findings of different clinical trials and has immediate clinical implications – this was not clear in the literature, since negative results had been reported across different clinical trials.

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Vitamin D Did Not Improve Bone or Muscle Health in Post-Menopausal Women

MedicalResearch.com Interview with:
Karen E. Hansen, M.D., M.S.
Associate Professor of Medicine
University of Wisconsin School of Medicine and Public Health
Madison, WI 53705-2281

Medical Research: What is the background for this study?

Dr. Hansen: The USPTF says to older community dwelling adults, “don’t bother taking vitamin D”, the Endocrine Society says “take 2,000-4,000 IU daily” and the Institute of Medicine gave an RDA of 600-800 IU daily. The Endocrine Society argues that optimal vitamin D levels are 30 ng/mL and higher, while the Institute of Medicine concludes that 20 ng/mL and higher indicates optimal vitamin D status. The disagreement between experts prompted my study.

Medical Research: What are the main findings?

Dr. Hansen: Among postmenopausal women whose vitamin D level was ~21 ng/mL at baseline, there was no benefit of high-dose or low-dose vitamin D, compared to placebo, on spine/hip/total body bone mineral density, muscle fitness by 5 sit to stand test or Timed Up and Go, or falls. We did see a small 1% increase in calcium absorption in the high-dose vitamin arm, but this small increase did not translate into clinically meaningful changes in bone density or muscle tests.

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Menopausal Women Accumulate Fat…..Around Their Hearts

Samar R. El Khoudary, Ph.D., M.P.H. Assistant professor Graduate School of Public Health Department of Epidemiology University of Pittsburgh MedicalResearch.com Interview with:
Samar R. El Khoudary, Ph.D., M.P.H.

Assistant professor
Graduate School of Public Health Department of Epidemiology
University of Pittsburgh

Medical Research: What is the background for this study?

Dr. El Khoudary: Cardiovascular disease is the leading cause of death in women, and it increases after age 50 – the average age when a woman is going through menopause. Weight gain in women during and after menopause has long been attributed to aging, rather than menopause itself. However, recent research identified changes in body fat composition and distribution due to menopause-related hormonal fluctuations.

No previous study had evaluated whether those changes in fat distribution during menopause affect cardiovascular fat. Increased and excess fat around the heart and vasculature can be more detrimental than abdominal fat, causing local inflammation and leading to heart disease. Doubling certain types of cardiovascular fat can lead to a more than 50 percent increase in coronary events. My team and I investigated whether there may be a link between menopause and cardiovascular fat using data from 456 women from Pittsburgh and Chicago enrolled in the Study of Women’s Health Across the Nation (SWAN). The women averaged about 51 years of age and were not on hormone replacement therapy.

Medical Research: What are the main findings?

Dr. El Khoudary: Our study is the first to find that  late- and post-menopausal women have significantly greater volumes of fat around their hearts than their pre-menopausal counterparts. As concentrations of the sex hormone estradiol – the most potent estrogen – declined during menopause, greater volumes of cardiovascular fat were found. The finding held even after my colleagues and I took into account the effects of age, race, obesity, physical activity, smoking, alcohol consumption, medication use and chronic diseases. Continue reading

Endocrine Therapies for Young Breast Cancer Patients Can Cause Abrupt Menopause Symptoms

MedicalResearch.com Interview with:
Dr. Jürg Bernhard Ph.D.

International Breast Cancer Study Group Coordinating Center and Bern University Hospital, Inselspital, Bern, Switzerland

Medical Research: What is the background for this study? What are the main findings?

Response: In the combined analysis of the SOFT and TEXT trials, the aromatase inhibitor exemestane was more effective than tamoxifen in preventing breast cancer recurrence in young women (premenopausal) who also receive ovarian function suppression (OFS) as adjuvant (post-surgery) treatment for hormone-sensitive early breast cancer, providing a new treatment option for these women. These trials were conducted by the International Breast Cancer Study Group (IBCSG) and involved more than 4700 patients of over 500 centers in 27 countries. Now we present patient-reported quality of life outcomes from these trials.

In the TEXT and SOFT trials, patients assigned exemestane+OFS reported more detrimental effects of bone or joint pain, vaginal dryness, greater loss of sexual interest and difficulties becoming aroused, while patients assigned tamoxifen+OFS were more affected by hot flushes and sweats. Global quality of life domains (mood, ability to cope and physical well-being) were similar between the randomized treatment groups. Continue reading

Menopausal SSRIs Increases Risk of Bone Fractures

MedicalResearch.com Interview with:
Dr Matthew Miller
Department of Health Science Northeastern University
Department of Health Policy and Management,
Harvard T.H. Chan School of Public Health Harvard University
Boston, Massachusetts

and Yi-Han Sheu
Department of Epidemiology
Harvard T.H. Chan School of Public Health
Harvard University Boston, Massachusetts

Medical Research: What is the background for this study?

Response: Selective serotonin reuptake inhibitors (SSRIs) were recently approved by the FDA to treat vasomotor symptoms associated with menopause. No prior study has directly examined whether fracture risk is increased among perimenopausal women who initiate SSRIs or among a population of women without mental disorders more generally..

Medical Research: What are the main findings?

Response: We found that SSRIs treatment for non-psychiatric conditions at doses customarily used to treat depression is, all else equal, associated with higher rates of fractures — an effect that first became evident several months after beginning treatment and, importantly, persisted over the five year study period.

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Post Menopausal Hormones Improve Mood But Not Cognition

Dr.Carey Gleason Ph.D School of Medicine and Public Health, University of Wisconsin Geriatric Research, Education and Clinical Center William S. Middleton Memorial Veterans Hospital Wisconsin Alzheimer's Disease Research Center, Madison, WisconsinMedicalResearch.com Interview with:
Dr.Carey Gleason Ph.D

School of Medicine and Public Health, University of Wisconsin
Geriatric Research, Education and Clinical Center
William S. Middleton Memorial Veterans Hospital
Wisconsin Alzheimer’s Disease Research Center, Madison, Wisconsin

Dr. Gleason: In this response I refer to hormone therapy (HT), which was formally called hormone “replacement” therapy. In particular, we examined menopausal HT, i.e., the use of HT during the menopausal transition to address menopausal symptoms.

Medical Research: What is the background for this study? What are the main findings?

Dr. Gleason: The WHI Memory Study (WHIMS) suggested that HT was associated with cognitive harm for women age 65 and older. In contrast, we found that the cognitive performance of women randomized to receive menopausal hormone therapy did not differ from that of women randomized to receive the placebo. On a measure of mood states, women treated with conjugated equine estrogens showed improvements compared to those on placebo.

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Early Onset, Frequent Hot Flashes Linked To Increased Cardiovascular Disease Risk

Dr. Rebecca Clark Thurston Ph.D Associate Professor of Psychiatry, Epidemiology, Psychology, and Clinical and Translational Science University of PittsburghMedicalResearch.com Interview with:
Dr. Rebecca Clark Thurston Ph.D
Associate Professor of Psychiatry, Epidemiology, Psychology, and Clinical and Translational Science
University of Pittsburgh

 

MedicalResearch: What is the background for these studies? What are the main findings?

Dr. Clark Thurston: The understanding of women’s cardiovascular disease and the role that reproductive factors play in women’s cardiovascular health is evolving. There are some studies showing links between menopausal hot flashes and cardiovascular disease risk in women. These studies help further refine this understanding. We showed in two separate studies that women who have hot flashes, particularly frequent hot flashes early in midlife, have poorer vascular health on certain indices.

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Phytochemical May Prevent Liver Damage In Post Menopause Women

Colette Nicole Miller FDN Department of Foods and Nutrition Edgar L. Rhodes Center for Animal and Dairy Science University of Georgia, Athens, GeorgiaMedicalResearch.com Interview with:
Colette Nicole Miller FDN
Department of Foods and Nutrition
Edgar L. Rhodes Center for Animal and Dairy Science
University of Georgia, Athens, Georgia

Medical Research: What is the background for this study?

Response: Our laboratory has been interested for quite some time in the relationship that natural, plant-derived compounds have on various tissues in the body. Both bone and adipocytes are derived from the same progenitor cell, mesenchymal stem cells. Thus, if a drug or compound affects one type of cell, it may affect both. When women transition through menopause, and see a reduction in their female sex hormones like estrogen, they can see adverse changes in both how much fat they store and their bone density. Thus our lab is interested in compounds that can be used to prevent the bone loss and visceral adipogenesis that menopausal women often experience. Previous work both in vivo and in vitro has shown that phytochemicals have synergistic effects and thus can ultimately work together to reduce the dosages needed to promote overall health. Through this work we have identified a combination of genistein, resveratrol, quercetin and Vitamin D that improve bone density in addition to promoting apoptosis of adipocytes. However, the health of the liver had never been addressed with our phytochemical blend. We know that supplements are sometimes toxic to the liver for many different reasons. Thus, it was very important for us to address the toxicity and potential risk of non-alcoholic fatty liver disease with our phytochemical blend in a menopausal rat model.

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Hot Flashes Linked With Increased Risk of Hip Fracture

Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at University of California, Los Angeles UCLA Medicine/GIM Los Angeles, CA 90024MedicalResearch.com Interview with:
Carolyn J. Crandall, MD, MS
Professor of Medicine
David Geffen School of Medicine
UCLA Medicine/GIM
Los Angeles, California 90024

Medical Research: What is the background for this study? What are the main findings?

Dr. Crandall: In a large group of postmenopausal women aged 50-79, we found that women who reporting having hot flashes at baseline had increased risk of hip fracture during the subsequent 8 years of observation, nearly double the risk compared with women who did not have hot flashes at baseline.
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Recommended Osteoporosis Screening May Not Effectively Screen Younger Patients

Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at University of California, Los Angeles UCLA Medicine/GIM Los Angeles, CA 90024MedicalResearch.com Interview with:
Carolyn J. Crandall, MD, MS
Professor of Medicine
David Geffen School of Medicine at University of California
UCLA Medicine/GIM Los Angeles, CA 90024

Medical Research: What are the main findings of the study?

Dr. Crandall: Clinical guidelines recommend that women aged ≥ 65 years should be screened for osteoporosis.  However, for younger postmenopausal women aged between 50 and 64 years, the United States Preventive Services Task Force (USPSTF) recommends osteoporosis screening for women who have a 10-year predicted risk of osteoporosis fracture that is ≥9.3%.  We tested the ability the USPSTF strategy, and two other strategies (called OST and SCORE), to distinguish between women who did and did not experience a fracture in the subsequent 10 years.  We found that the USPSTF strategy did not identify the majority of who experienced osteoporotic fracture in the subsequent 10 years.  Especially in women aged 50-54 years, the USPSTF strategy identified fewer than 5% of women who experienced fracture over 10-year follow-up.

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CHEST 2014: Obstructive Sleep Apnea Linked To Cognitive Difficulties in Postmenopausal Women

Chitra Lal, MD. Assistant Professor Medical University of South CarolinaMedicalResearch.com Interview with:
Chitra Lal, MD. Assistant Professor
Medical University of South Carolina

 

 

Medical Research: What are the main findings of the study?

Dr. Lal: We studied the prevalence of cognitive problems in early postmenopausal women (age 45-60 years) with obstructive sleep apnea syndrome (OSAS+) and without obstructive sleep apnea syndrome (OSAS-) using a questionnaire called the Mail-In Cognitive Function Screening Instrument (MCFSI).

We found that the mean MCFSI scores after adjusting for depression were significantly higher in obstructive sleep apnea syndrome+ then the OSAS- group, indicating more self-reported cognitive difficulty in OSAS+ women

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Postmenopausal Effect of Estrogen on Cardiovascualar Events and Hot Flashes

S. Mitchell Harman, M.D., Ph.D. CAPT US Public Health Service, retired Professor, Clinical Medicine, U of AZ College of Medicine Interim Chief, Dept. of Internal Medicine Chair, IRB Subcommitee Phoenix VA Health Care System Phoenix, AZ 85012-1892MedicalResearch.com Interview with:
S. Mitchell Harman, M.D., Ph.D.
CAPT US Public Health Service, retired
Professor, Clinical Medicine, U of AZ College of Medicine
Interim Chief, Dept. of Internal Medicine
Chair, IRB Subcommitee
Phoenix VA Health Care System
Phoenix, AZ 85012-1892

Medical Research: What are the main findings of the study?

Dr. Harman: The major findings are:

1.       Neither transdermal nor oral estrogen treatment significantly accelerates or decelerates rate of change of carotid artery intimal medial thickness (CIMT) in healthy recently menopausal women.

2.       Both estrogen treatments have some potentially beneficial effects on markers of CVD risk, but these differ depending on the route of estrogen delivery with improvements in LDL and HDL cholesterol seen with oral, and reduced insulin resistance with transdermal.

3.       No significant effects were observed on rate of accumulation of coronary artery calcium.

4.       Women reported significant relief of vasomotor (hot flush) symptoms with both estrogen treatments

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Hot Flashes? Nightsweats? It May Be Your Caffeine….

Stephanie Faubion, M.D Director of the Women’s Health Clinic Mayo Clinic in RochesterMedicalResearch.com Interview with:
Stephanie Faubion, M.D
Director of the Women’s Health Clinic
Mayo Clinic in Rochester

 

Medical Research: What are the main findings of the study?

Dr. Faubion: In this study that included over 1800 women, we found that caffeine intake was associated with more bothersome hot flashes and night sweats in postmenopausal women.
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Prevention of Breast Cancer in High-Risk Postmenopausal Women

Jack Cuzick PhD Centre for Cancer Prevention Wolfson Institute of Preventive Medicine Queen Mary University of London, London UKMedicalResearch.com Interview with:
Jack Cuzick PhD
Centre for Cancer Prevention
Wolfson Institute of Preventive Medicine
Queen Mary University of London,
London UK

Dr. Cuzick offers the manuscript below to put the results of the Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial in focus for MedicalResearch.com.

The Prevention of Breast Cancer

The first human evidence that drug treatment might reduce the incidence of breast cancer was reported in 19851, where it was found that use of tamoxifen in a trial of women with breast cancer to reduce recurrence of existing tumours also had a major impact on new tumours in the opposite breast, reducing them from 10 to 3. That observation has subsequently been confirmed in several other adjuvant trials and an overview of all such trials indicates that after an average of about 8 years of follow up, 5 years of tamoxifen reduced new contralateral tumours by 39%, with similar effects in years 0-5 and 5-10 in women with oestrogen receptor positive or unknown primary tumours2. These observations and positive results from animal studies3, led to the evaluation of 5 years of tamoxifen in women without breast cancer, but at high risk in 4 large trials. A recent overview4 indicates a 33% reduction in all breast cancer after a 10 years follow up, with a larger reduction in years 0-5 (48%), when treatment was given, and a continuing (22%) effect in years 5-10. Reductions were seen for oestrogen receptor positive invasive cancer (44%) and DCIS (28%), but no effect was seen for both oestrogen receptor negative invasive cancer, where in fact a non-significant 13% (P=0.4) increase was observed. Somewhat larger effects were seen for these other selective estrogen receptor modulators (SERMs) – raloxifene, lasofoxifene and arzoxifene – in trials of osteoporotic women, where the primary endpoint was fracture reduction4. A subsequent head-to-head trial of raloxifene vs tamoxifen, showed tamoxifen to be about 20% more effective, but raloxifene had fewer side effects5. Lasofoxifene not only showed benefits for breast cancer reduction but also reduced fracture rates and heart disease6, and this multi-dimensional set of benefits makes it an attractive candidate for prevention.
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Moderate Physical Activity May Decrease Heart Disease Risk in Perimenopausal Women

Unab I. Khan, M.B.,B.S., M.S.            Assistant Professor of Pediatrics and Family & Social Medicine Division of Adolescent Medicine The Children’s Hospital at Montefiore The Pediatric Hospital for Albert Einstein College of Medicine Bronx, NY 10467MedicalResearch.com Interview with:
Unab I. Khan, M.B.,B.S., M.S.  
Assistant Professor of Pediatrics and Family & Social Medicine
Division of Adolescent Medicine
The Children’s Hospital at Montefiore
The Pediatric Hospital for Albert Einstein College of Medicine
Bronx, NY 10467


MedicalResearch: What are the main findings of the study?

Dr. Khan: We wanted to find factors that lead to either an increase or decrease in risk of developing cardiovascular disease. We found that in middle aged overweight and obese women, who may not have any medical problems like diabetes, high blood pressure, high cholesterol, an increase in weight over time and the development of any of the conditions stated above, increased the risk of cardiovascular disease significantly.

On the other hand, even moderate physical activity decreased the risk of heart disease, even in the presence of the above stated conditions.
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Obstructive Sleep Apnea Associated with Hypertension in Perimenopausal Women

MedicalResearch.com Interview with:
Rodrigo Pinto Pedrosa, MD, PhD
Sleep and Heart Laboratory,
Pronto Socorro Cardiológico de Pernambuco
Pernambuclo, Brazil

MedicalResearch.com: What are the main findings of the study?

Dr. Pedrosa: Perimenopause is associated with increased cardiovascular risk. This study evaluated the association between obstructive sleep apnea (OSA) and arterial stiffness and hypertension in perimenopausal women. OSA (apnea-hypopnea index: ≥5 events/hour) and moderate/severe OSA (apnea-hypopnea index: ≥15 events/h) were diagnosed in 111 (40.1%) and 31 (11.1%) of women, respectively.  Women with moderate/severe obstructive sleep apnea  had a higher prevalence of hypertension, were prescribed more medications for hypertension, had higher awake blood pressure,  nocturnal blood pressure,  diastolic blood pressure, as well as higher arterial stiffness (pulse wave velocity: 11.5 [10.1 to 12.3] vs 9.5 [8.6 to 10.8] m/s, p<0.001) than women without obstructive sleep apnea, respectively. Oxygen desaturation index during the night was independently associated with 24h arterial blood pressure and with arterial stiffness.
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Calcium-Vitamin D Supplementation: Effects on Vitamin D and Cholesterol Levels

Peter F. Schnatz, D.O. Associate Chair & Residency Program Director The Reading Hospital Department of OB/GYN Reading, PA  19612-6052MedicalResearch.com Interview with:
Peter F. Schnatz, D.O.
Associate Chair & Residency Program Director
The Reading Hospital
Department of OB/GYN
Reading, PA  19612-6052

MedicalResearch.com: What are the main findings of the study?

Dr. Schnatz: In a subsample of 576 women from the parent WHI CaD (calcium plus vitamin D supplementation)  trial* , there was a significant (38%) increase in mean serum 25OHD3 concentrations after two years (95% CI 1.29-1.47, p< 0.001) for women randomized to CaD (24.3ng/mL vs. 18.2 ng/mL).

Women randomized to CaD had a 4.5 mg/dL mean decrease in LDL-C which was statistically significant.  After accounting for serum 25OHD3 concentration, the effect of CaD was attenuated, suggesting that higher concentrations of 25OHD3, in response to CaD supplementation, are associated with improved LDL-C.

In observational analyses, higher concentrations of 25OHD3 were associated with significantly higher HDL-C along with significantly lower LDL-C and TG concentrations.

* 1,000 mg of elemental calcium plus 400 IU of vitamin D3 daily
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Post Menopause: Exercise Reduced Blood Pressure, Atherosclerosis Marker

MedicalResearch.com Interview with:
Michael Nyberg Ph.D.
Post-doc  Human Physiology and Exercise Physiology
Integrated Physiology Group
Department of Nutrition, Exercise and Sports,
Faculty of Science, University of Copenhagen and

Jens Bangsbo, Dr. Sci., Ph.D.
Professor of Human Physiology and Exercise Physiology
Head of Integrated Physiology Group, Section of Human Physiology
Head of Copenhagen Centre of Team Sports and Health
Deputy Head of Department, research
Copenhagen Denmark

MedicalResearch.com: What are the main findings of the study?

Answer: The main findings of the study were that despite being of similar age, the postmenopausal displayed higher blood pressure and higher blood levels of an early marker of atherosclerosis than women that had not reached menopause. Furthermore, just 12 weeks of floorball training twice a week for one hour improved the women’s conditions and reduced their blood pressure significantly. In addition, there was positive development in levels of substances vital to blood vessel function, including a decrease in the early marker of atherosclerosis.

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Menopause and Poor Sleep Quality

MedicalResearch.com Interview with:
Chih-Jen Chang, MD
Department of Family Medicine
National Cheng Kung University Hospital, Tainan, Taiwan

MedicalResearch.com: What are the main findings of the study?

Dr. Chang:  Postmenopausal women without vasomotor symptoms (hot flushes and night sweats) have poorer sleep quality than premenopausal women. In addition, menopause and snoring are associated with an increased risk of poor sleep quality independently of cardiometabolic factors and lifestyle.
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Sugar-Sweetened Beverages and Endometrial Cancer

Maki Inoue-Choi, PhD, MS, RD Division of Cancer Epidemiology and Genetics, National Cancer Institute National Institute on Minority Health and Health Disparities, NIH Rockville, MD 20850MedicalResearch.com Interview with:
Maki Inoue-Choi, PhD, MS, RD
Division of Cancer Epidemiology and Genetics, National Cancer Institute
National Institute on Minority Health and Health Disparities, NIH
Rockville, MD 20850

MedicalResearch.com: What are the main findings of the study?

Answer: In our study, postmenopausal women who reported higher consumption of sugar-sweetened beverages were more likely to develop estrogen-dependent type I endometrial cancer, the most common type of this cancer.
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Menopausal Hormone Therapy and Health Outcomes

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 900 Commonwealth Avenue , 3rd fl Boston , Massachusetts   02215 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

WHI investigators publish most comprehensive report to date on the two Hormone Therapy Trials and extend follow-up to 13 years: Results inform clinical decision making

Researchers from the Women’s Health Initiative (WHI) Hormone Therapy (HT) Trials provide new information from extended follow-up of postmenopausal women in the two HT trials (estrogen plus progestin and estrogen alone) and the most comprehensive look at the findings to date. The study, published October 2 in the Journal of the American Medical Association, presents information on a wide range of diseases and quality-of-life outcomes, comparisons of the two trials side-by-side, and a full breakdown of results by age and time since menopause onset. The WHI, which enrolled 27,347 women nation-wide in the two hormone therapy trials, is sponsored by the National Institutes of Health.

“Our main goal was to provide as much information as possible from the WHI hormone therapy trials to help women and their clinicians make the most informed decisions about hormone therapy use. The WHI findings, presented in detail by age group and time since menopause onset, help to guide clinical decision making,”, said JoAnn Manson, MD, DrPH, first author of the report and Chief of Preventive Medicine at Brigham and Women’s Hospital. Manson is one of the Principal Investigators of the WHI and the Michael and Lee Bell Professor of Women’s Health at Harvard Medical School .

 

Key findings of the report are that hormone therapy has a complex pattern of health risks and benefits and that younger women tend to have a more favorable risk-to-benefit profile than older women. The researchers also found that combination estrogen plus progestin (in women with an intact uterus) had more risks than estrogen alone (used in women with hysterectomy), primarily due to an increased risk of breast cancer with the former but not the latter. Both forms of hormone therapy increased the risk of stroke, blood clots in the legs, gallstones, and urinary incontinence, while benefits included decreased risk of hip fractures, other fractures, diabetes, and hot flashes/night sweats. Estrogen plus progestin increased dementia (in women >65 years), but neither treatment affected cognition in younger women. For estrogen alone, younger women (ages 50-59) had more favorable results for all-cause mortality, heart attacks, and colorectal cancer, and their overall risk-to-benefit profile on estrogen alone was more favorable than for older women.  Effects on quality-of-life outcomes with HT were mixed, with improvement in sleep and joint pain but increases in breast tendernes.

After stopping hormone therapy, most risks and benefits of hormone therapy dissipated. However, over the 13-yr cumulative follow-up period, breast cancer risk remained slightly elevated for estrogen plus progestin but became significantly reduced for estrogen alone. For estrogen plus progestin, a significant reduction in uterine (endometrial) cancer emerged during follow up and the risk of hip fracture remained significantly (but modestly) reduced. For both forms of hormone therapy, there was no significant increase or decrease in the rate of total cancer (all types combined), cancer mortality, cardiovascular mortality, or all-cause mortality in the overall study population.

 

The researchers conclude that the findings from the two WHI trials do not support use of hormone therapy for prevention of chronic disease, but treatment is appropriate for symptom management in some women. The absolute risks of adverse events in younger women are lower than in older women, menopausal symptoms are more common in younger age groups, and the quality-of-life benefits are likely to outweigh the risks for many women who seek treatment for symptoms during the menopause transition.  “Short-term use of hormone therapy to manage moderate-to-severe hot flashes or other symptoms in early menopause remains appropriate,  A clear distinction between the use of hormone therapy for symptom management in women with indications for treatment and its use for the purpose of chronic disease prevention is essential,” added Manson.  “Although studies of other hormone therapy formulations , doses, and routes of delivery are needed to find treatments with fewer risks, these medications are now among the best studied treatments in medical history. Clinicians can share information from the WHI trials with their patients and help them make more informed choices.”

Citation:

Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal Hormone Therapy and Health Outcomes During the Intervention and Extended Poststopping Phases of the Women’s Health Initiative Randomized Trials. JAMA. 2013;310(13):1353-1368. doi:10.1001/jama.2013.278040.

Yoga and Effect on Menopause Symptoms

MedicalResearch.com Interview with:
Katherine Newton, PhD
Senior Investigator at Group Health Research Institute in Seattle

MedicalResearch.com: What are the main findings of the study?

Answer: We found that when women took a 12-week yoga class and practiced yoga at home, they had significantly less insomnia than did women who did not. This was the only statistically significant finding in this MsFLASH (Menopause Strategies: Finding Lasting Answers for Symptoms and Health) Network randomized controlled trial. We also found that being in the yoga class did not decrease the number of hot flashes or night sweats. Yoga  was linked to better sleep quality and less depression—but  these effects were not statistically significant. In separate papers, published slightly earlier, our MsFLASH group reported that a non-yoga exercise program seemed linked to slightly improved sleep and less insomnia and depression—but these effects were not statistically significant. And an omega-3 (fish oil) supplement was not linked to any improvement in hot flashes, night sweats, sleep, or mood.

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